T Nation

21 y/o. Prescribed Test Cyp. Lab Results


#1

Scenario: I am 21 and recently had bloodwork done. After the results were returned my doctor prescribed me .2 iu hcg twice daily. 200 mgs of testosterone cypionate weekly (watson) to be injected once weekly (on monday mornings).

.25 mgs of progesterone (to be taken once every evening at bedtime). .9 mgs of Anastrozole (to be taken twice weekly). My doctor is an awesome anti-aging doctor and is extremely knowledgeable about androgens.

Personal History: I have been lifting and eating correctly for 2 years. When I was 19 I lost 30 pounds through correctly dieting and training. I went through puberty relatively earlier than most of my friends (I began to undergone the expected changes around the age of 11). Before I lost weight I was 5 '10 200 pounds.

I am now 5'11 170 pounds and had my bf percentage measured by skinfolds at 9%. I have never had any noticeable emotional problems. Throughout my life I have had what I consider to be normal levels of vitality, emotion and sex drive. Although recently (within the past 6 months) I have felt these fluctuate more than I remember them fluctuating in the past. (By this I mean I have felt more peaks and lows in my mood and sex drive).

My libido has decreased greatly since I was 16 or so. I also do not get erections very frequently and when I do I do not maintain them for very long. I also have a very hard time losing bodyfat. (I know that once you break into single digit bodyfat it becomes increasingly difficult to get leaner but I assure you my diet and training schedule are in check). I also have noticed that I wake up in the middle of the night to urinate every night.

Lab Results: (were taken fasted at 10 am in the morning on 6/30/2011)
Sodium: 140 mmol/L
Potassium: 5.2 mmol/L
Chloride: 105 mmol/L
Carbon Dioxide: 30.1 mEq/L
BUN: 24 mg/dl
Creatinine: 0.9 mg/dl
BUN/Creatinine Ratio: 26.7 ratio
Calcium Total: 9.8 mg/dl
Alkaline Phosphate:113 U/l
Protein Total:6.9 g/dl
Albumin:2.5 ratio
Globulin:2.0 g/dl
Albumin/Globulin Ratio: 2.5 ratio
Bilirubin Total: 1.5 mg/dl
AST: (SGOT): 55 U/L
ALT (SGPT): 44 U/L
Estimated GFR (eGFR): >60 mL/min
Iron: 63 ug/dl
Insulin 4.2 uU/ml
Magnesium: 2.0 mg/dl

Glucose: 88 mg/dl

Total Cholesterol: 131 mg/dl
Triglycerides: 56 mg/dl
HDL chol: 62 mg/dl
LDL Chol: 58 mg/dl
VLDL: 11 mg/dl
Cholesterol/HDL ratio 2.1 Ratio

Vitamin D 25 hydroxy: 46 ng/ml

Cortisol Total: 9.1 ug/dl
Ferritin: 153 ng/ml

T3 Free 2.82 pg/ml
T4 Free: .83 ng/dl
TSH (ultrasensitive): .86 uIU/ml

IGF-1 (somatomedin-c): 156 ng/ml
Testosterone Total: 498 ng/dl
SHGB: 80.4 nmol/L
Free Testosterone: 53 pg/ml
% Free Testosterone: 1.06 %
Bioavailable Testosterone: 140 ng/dl
Albumin: 4.9 g/dL
DHEA-S: 219.9
Estradiol: <20 pg/ml
LH: 3.9 mIU/mL

PSA (ultrasensitive) 0.51 ng/ml

Lp-Pla2: 152 ng/ml

Pregnenolone: 19 ng/dL
*Note: I know some of these test results are extraneous, but I was unsure as to exactly which ones to post on here, for this I apologize.

Questions:
*Should I take the compounds my doctor has prescribed? (I have read everything I can on this website for nearly two years and am greatly aware of the vast risks that someone of my age and health profile would undertake if deciding to undergo a TRT protocol such as the one my doctor prescribed)

*If not, what steps can I go through to increase my bodies free test?
*how can I increase my mood and sex drive naturally?
*are their any glaring problems with my labwork?
*If I do decide to undergo the aforementioned protocol should I make any changes to it? (ex: injecting 100mgs of test cyp E3D instead of 200 mgs once weekly)

*Do I risk completely shutting down my bodies natrual production of testosterone even with the use of hCg?
*What risks overall do I incur if I decide to undergo the aforementioned TRT protocol?

Thanks in Advance


#2

It will help a great deal if you include the lab ranges also next to your values. Looking at your results your testosterone is around the 500 mark, free testosterone is hard to judge since we have no lab ranges same with all the other figures.

200mg of test a week is quite a lot from what I have read, and you will be shut down no matter what. If you plan on doing the HRT multiple doses per week is the way to go rather than 1 big one all at once. But I would really stop and think what you are getting yourself into. What other tests have you had done? Sounds like your doctor likes HRT and not much is needed to convince him (usually the other way around).

I would really only start HRT as the last resort not the first option.
Could your low BF have an effect on your testosterone quite possibly yes.

Let others chime in and see what they have to say, there are some really knowledgeable guys on here.

At 21 there could be something else and HRT might not be needed.


#3

Thanks a lot for your response.

Here are the lab results with reference ranges:
Lab Results: (were taken fasted at 10 am in the morning on 6/30/2011)
Sodium: 140 mmol/L (134-146)
Potassium: 5.2 mmol/L 3.5-5.3)
Chloride: 105 mmol/L (98-110)
Carbon Dioxide: 30.1 mEq/L (21-31)
BUN: 24 mg/dl (7.0-25.0)
Creatinine: 0.9 mg/dl (0.7-1.2)
BUN/Creatinine Ratio: 26.7 ratio (10.0-20.0)
Calcium Total: 9.8 mg/dl (8.5-10.5)
Alkaline Phosphate:113 U/l (0-126)
Protein Total:6.9 g/dl (6.4-8.5)
Albumin:2.5 ratio (3.5-4.8)
Globulin:2.0 g/dl (2.0-3.9)
Albumin/Globulin Ratio: 2.5 ratio (1.0-2.2)
Bilirubin Total: 1.5 mg/dl (0.2-1.3)
AST: (SGOT): 55 U/L (0-40)
ALT (SGPT): 44 U/L (0-50)
Estimated GFR (eGFR): >60 mL/min (>=60)
Iron: 63 ug/dl (45-182)
Insulin 4.2 uU/ml (1.9-23)
Magnesium: 2.0 mg/dl (1.6-2.6)

Glucose: 88 mg/dl (60-99)

Total Cholesterol: 131 mg/dl (150-200)
Triglycerides: 56 mg/dl ((<150)
HDL chol: 62 mg/dl (>40)
LDL Chol: 58 mg/dl (<130)
VLDL: 11 mg/dl (<30)
Cholesterol/HDL ratio 2.1 Ratio

Vitamin D 25 hydroxy: 46 ng/ml (>30)

Cortisol Total: 9.1 ug/dl (n/a)
Ferritin: 153 ng/ml ((24-336)

T3 Free 2.82 pg/ml (2-3.9)
T4 Free: .83 ng/dl (.58-1.64)
TSH (ultrasensitive): .86 uIU/ml (.34-4.00)

IGF-1 (somatomedin-c): 156 ng/ml (116-358)
Testosterone Total: 498 ng/dl (170-780)
SHGB: 80.4 nmol/L (13-71)
Free Testosterone: 53 pg/m (47-224)l
% Free Testosterone: 1.06 % (1.5-3.2)
Bioavailable Testosterone: 140 ng/dl (128-430)
Albumin: 4.9 g/dL (3.5-4.8)
DHEA-S: 219.9 (N/A)
Estradiol: <20 pg/ml (<47)
LH: 3.9 mIU/mL (1.24-8.62)

PSA (ultrasensitive) 0.51 ng/ml (0-4)

Lp-Pla2: 152 ng/ml (<200)

Pregnenolone: 19 ng/dL (23-173)

*Note (the following were noted as being in abnormal ranges)
Albumin: High
Bilirubin Total: High
AST (SGOT): High
Albumin/Globulin Ratio: High
BUN/Creatinine Ratio: High

Total Cholesterol: Low

% Free Testosterone: Low
SHBG: High
Albumin: High

Pregnelone: Low


#4

Administering exogenous testosterone to a 21 year old male with a TT=500 is sketchy at best...

Your problem is not a T problem...from your bloodwork I note the following:

-Total T is good
-Free T is bad, because:
-SHBG is sky high...look into ways of controlling this, most likely:
-Need to increase your cholesterol, which leads to:
-Your pregnenolone is very low, which leads to:
-Cortisol is too low (which may tie into your high SHBG)

Are you on any meds currently? Ever taken cholesterol lowering drugs?

Your E2 test is the wrong test, but I can't imagine why your doc would prescribe you adex based on that since you are already below the arbitrary 20 range...get the right test (4021x from Quest, but I imagine your doc uses his own lab)...

The only sensical thing your doc seems to be doing for you is scripting you the progesterone (this is in the cortisol production line), but that doesn't make total sense since I'm sure he is charging you an arm and a leg for compounded progesterone from him when it is available over the counter for MUCH cheaper (Life-Flo brand). Never trust your drug dealer to always have your best interests in mind, cost wise.

Prog may increase your cortisol and essentially reboot your system once you taper off of it (don't stop it cold turkey!) so you can run normally...

If your DHEA-S is on the standard range (100-500 or so), then it is slightly low (which is unsurprising since your entire production line front end is low) so I would probably opt for a Pregnenolone + Progesterone combination....Life-Flo also makes this...


#5

Thank you so much for this, this is extremely helpful. Recently (within the past two weeks) I started using .2 iu's of hcg twice daily, pregnenlone once daily, the prescribed progesterone and 6k-8k IU's of Vitamin D3 2-3x weekly but have yet to feel anything significant.
To answer your question I have never taken any Cholesterol lowering Medication. I have a history of being prescribed adderall xr (I took this from the ages of 14-16 consistently and from 16-21 intermittently. (This is the only medication I have ever been prescribed for longer than a 1 week duration).
Further Questions:
*If I am correct, my low cortisol levels and high SHGB levels could be signs of adrenal fatigue? (Which could arise from chronic overtraining/lack of sleep/stress?)
*What are some options to control SHGB so more of my TT becomes FT?
*What are some options for increasing my Cholesterol? (I eat a diet that is moderate in fat: between 50-75 grams per day, but I obviously will look to increase this to 120 grams per day)?
*Is it worth anything to try to supplement with a daily DHEA vitamin?
*What is an acceptable protocol to use to taper off progesterone (I will likely run it for 6 weeks)?


#6

Keep in mind that some people are poor absorbers of transdermal medications, including pregnenolone and progesterone. I assume you are taking TD and not oral?

Your prior adderall usage is very significant. It can significantly effect the body's ability to produce adequate cortisol (resulting in "adrenal fatigue") due to over stimulation...if I had to point at anything, I would definitely look at this...

Once you get your cortisol production line humming again, your body may essentially "reboot" itself...this would be ideal...

I am not sure how to decrease SHBG, but I think it may involve improving cortisol...you should be able to google it and find some answers...Dr. Crisler's board probably has some good info...

I would maybe increase overall fat intake...make sure you are getting good blend of saturated, mono unsaturated, and polyunsaturted fat sources...

I think DHEA would be an ok choice, but probably wouldn't do a huge deal of good since it is independent of your cortisol production line which I think is where your problems probably lie....

For prog, I would probably decrease my dose by 25% or so per week until tapered off....


#7

How long have you been dieting? If this is a long term diet, I am not surprised at all you are having a hard time getting below 9%bf.... that is not uncommon. I would remove that as a symptom.

Also, you describe your doc as very knowledgeable... yet, he is prescribing once-weekly T shots? That goes against most of what I have read on this forum.

I would definitely look into eating more fat, as your CHOL is low and is the precursor to your adrenals/sex hormones. Without CHOL there is no cortisol, DHEA, Test, etc. I would definitely consider 50g fat to be "low" and not "moderate" fat intake.

x2 on VT's post as well. Good luck.


#8

Do you suppose that, since preg can go either way, if the body is preferentially trying to boost cortisol it can do so at the expense of DHEA, and that both pathways can wind up shorted if there aren't enough building blocks to complete both productions?

While you wouldn't expect the body's systems to always flow as logically as one might expect, I know that boosting my DHEA-S had a significant impact upon my extreme morning lethargy (which is a classic low cortisol symptom).

His DHEA isn't too low, but I know LEF has published their opinion of an optimal range of 400 to 560 (Dr. Dzugan goes even higher with 500 - 640).


#9

Thanks everyone for the input it is much appreciated.

  1. I am not taking transdermal progesterone, I am taking it orally (It is compounded by a pharmacy near me)
  2. No I have not been on an ongoing Diet. I am well aware of the detrimental effects of being in a long term calorie/nutrient deficit. (Just to be clear, I compete in Brazilian Jiu Jitsu and consequently I like to block out my training yearly into phases, i.e. I diet strictly but smartly during competition season to make weight and focus primarily on sport specific training. In my offseason time I usually like to do 3 8-12 week phases, (1. explosive training. 2. hypertrophy. 3. strength).
  3. I will research how to bring my normal DHEA-S and cortisol levels up but would appreciate any more input.
  4. My doctor mentioned that if I did not want to go through with the testosterone protocol I could simply use .4 mgs of hcg split up into two doses (one in the evening and one in the morning) and .9 mgs of anastrozole (twice weekly).
    4.A. What would the detrimental effects of using the above protocol be?
    4.B. What would the benefits of using the above protocol be?
    *Note: I would argue that simply because my doctor is not prescribing testosterone injection protocols in the same manner that some advocate for on this website is hardly enough information to classify him as not knowledgable.

Thanks again Guys. Everything is much appreciated


#10

How much are you paying out of pocket for your prog? I only ask because it is a fairly inexpensive hormone to purchase OTC if you do not require a particularly high dose.

Note that if you supplement with pregnenolone it is best to start small with DHEA and prog and use lab work to taper your dosage upwards according to where your preg goes and to what extent. When not under the supervision of a knowledgeable doctor, many decide to start with just the preg and work from there. Improving DHEA levels has been shown to work well for boosting mood (LEF has multiple articles on this).

A gent by the name of Dr. Lam has some interesting articles published at his site:
http://www.drlam.com/. He likes to use vitamins and minerals as a means of treating cases of adrenal fatigue.

Vitamin C (2 - 4/day) and a B complex (high potency) are said to help with "fatigued" adrenals. I didn't notice anything from high intake of both. I'm not sure how efficacious vitamins and mineral supps are for those who aren't deficient (but with your diet, you never know), particularly when compared to direct hormone interventions. I feel similarly about herbal products as anything more than the icing on the cake, but YMMV. The cost to cover your bases when considering all the options can add up quickly, as well.

I noticed improvement in libido and erection performance (nocturnal, morning and in the heat of the moment) after supplementing with a trace mineral complex, which are typically quite inexpensive.

I agree that jumping on T replacement at your age should be a last resort option. And yes, you will shut down your body's natural T production even with the hCG, though the hCG will keep your boys from shrinking.

Go to Dr. Crisler's website and read the hormone primer articles posted by 'chilln' (not sure if I can link to other forums but you can find what I'm talking about easily enough with key words from the preceding sentence)- they are quite insightful. While the methodology he advocates is fairly new compared to the 'standard' treatments - and I'm not aware of the success rate of people implementing his protocols vs. standard treatment - the background information on hormone modulation is a great resource.

Good luck.