28 Year Old - Please Evaluate My Labwork

Pharma / TRT Testosterone Replacement
1

Hello,

Can anyone give me some input on my labs? I have had some of the symptoms of low t, but the Dr. says I’m fine.

Age: 28
Height: 5’9"
Waist: 32
Weight: 164-170
Describe body and facial hair: Hairy legs, not much chest hair, light arm hair, facial hair is patchy, shave about once a week

Describe where you carry fat and how changed: Some on stomach, maybe legs? They are pretty strong though

Health conditions, symptoms: no health conditions. Symptoms: Not much energy, want to nap during lunch and when I get home from work. Not much motivation to do things, slightly depressed, some fatigue. Erections are not very strong.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever?: Vyvanse 70mg 1x per day, costco vitamin packs, costco fish oil pills 2 per day.

I generally try to eat somewhat healthy, I do not eat fast food very often and do crossfit a few times per week and hiking/yardwork on weekends.

Lab results with ranges: will post below

Describe diet: Breakfast: scrambled eggs with some turkey sausage, about 3 eggs. Lunch: Usually lean cuisine or healthy choice, banana, fruit cup (in juice) carrots, salad. Dinner: Usually chicken, broccoli, rice some days

Describe training: Usually do crossfit 2-3x per week, typically do squats, deadlifts, pushups and cardio. Weekends I try to hike and do some yard work. I have had trouble getting bigger muscles with chest and arms, I run out of steam pretty quickly.

Testes ache, ever, with a fever?: Sometimes, no fever. Left side has Varicocele, Dr said it was small, but it is larger than my testicle.

How have morning wood and nocturnal erections changed: I have been trying ‘nofap’ and have not had an orgasm in almost 2 months. This has brought back morning wood to a few times per week, when before I never had it. I started having night sweats recently.

First lab:

TEST RESULTS REFERENCE RANGES UNITS PL

HEMATOLOGY

CBC w/ Differential, w/ Platelet

WBC 4.4 - Range: 4.0 -­ 11.0 k/mm3

RBC 5.02 - Range: 4.30 ­- 6.00 m/mm3

Hemoglobin 15.7 - Range: 13.0 ­ - 18.0 g/dL

Hematocrit 46.8 - Range: 40.0 ­- 53.0 %

MCV 93 - Range: 78 ­ - 100 fL

MCH 31.3 - Range: 27.0 ­- 34.0 pg

MCHC 33.5 - Range: 31.0 ­- 37.0 g/dL

Platelet Count 155 - Range: 130 ­- 450 k/mm3

RDW(sd) 39.9 - Range: 38.0 -­ 49.0 fL

RDW(cv) 11.7 - Range: 11.0 ­ - 15.0 %

MPV 11.1 - Range: 7.5 ­- 14.0 fL

Segmented Neutrophils 56* - Range: 40 ­- 85 %

Lymphocytes 36 - Range: 10 - ­ 45 %

Monocytes 6 - Range: 3 ­ - 15 %

Eosinophils 2 - Range: 0 ­- 7 %

Basophils 1 - Range: 0 -­ 2 %

Absolute Neutrophil 2.5 - Range: 1.6 -­ 9.3 k/uL

Absolute Lymphocyte 1.6 - Range: 0.6 -­ 5.5 k/uL

Absolute Monocyte 0.3 - Range: 0.1 -­ 1.6 k/uL

Absolute Eosinophil 0.1 - Range: 0.0 -­ 0.7 k/uL

Absolute Basophil 0.0 - Range: 0.0 - ­ 0.2 k/uL

Immature Granulocytes 0 - Range: 0 ­ - 1 %

Absolute Immature Granulocytes 0.0 - Range: 0.0 ­- 0.1 k/uL

*Segmented

Neutrophils:

Automated Diff

CHEMISTRY

TSH with Reflex Free T4

TSH, High Sensitivity 1.19 - Range: 0.45 - ­ 4.50 mU/L

Testosterone, Total 372 - Range: 280 ­- 800 ng/dL

Comprehensive Metabolic Panel

Glucose 109 H * - Range: 65 ­- 99 mg/dL

Urea Nitrogen (BUN) 11 - Range: 8 ­- 25 mg/dL

Creatinine 0.93 - Range: 0.60 ­- 1.50 mg/dL

GFR Estimated (Non­African American) 111 ≥61 mL/min/1.73m2

GFR Estimated (African American) 129 ≥61 mL/min/1.73m2

BUN/Creatinine Ratio 11.8 - Range: 10.0 ­- 28.0

Sodium 144 - Range: 135 ­- 145 mmol/L

Potassium 4.0 - Range: 3.5 -­ 5.2 mmol/L

Chloride 102 - Range: 96 ­ -110 mmol/L

Carbon Dioxide (CO2) 26 - Range: 19 -­ 31 mmol/L

Anion Gap 16 - Range: 4 ­- 18

Protein, Total 7.0 - Range: 6.0 -­ 8.0 g/dL

Albumin 5.2 H - Range: 3.3 ­- 4.9 g/dL

Globulin 1.8 L - Range: 2.0 -­ 3.7 g/dL

Albumin/Globulin Ratio 2.9 H - Range: 1.0 ­- 2.0

Calcium 9.4 - Range: 8.7 ­- 10.5 mg/dL

Alkaline Phosphatase 58 - Range: 40 ­ 129 IU/L

Alanine Aminotransferase 14 - Range: 5 ­ - 60 IU/L

Aspartate Aminotransferase 17 - Range: 10 -­ 50 IU/L

Bilirubin, Total 0.4 - Range: 0.2 ­- 1.3 mg/dL

*Glucose: Glucose reference range reflects fasting state.

I thought the Testosterone was kind of low, so the Dr. had another blood test done two days later. The results are below, they called and said everything is fine. LH seems high, not sure if this is bad or not.

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Prolactin 7.9 - Range - 2.5 ­ - 22.5 ng/mL

FSH and LH

FSH 8.3 - Range - 1.5 -­ 12.4 mIU/mL

Luteinizing Hormone 11.4 H** * - Range - 1.7 ­ 8.6 mIU/mL**

*Luteinizing Hormone: Luteinizing Hormone Reference Ranges:

Overnight fasting is preferred. Nonfasting samples may have elevated results.

Male Reference Ranges:

Prepubertal: <1.1 mIU/mL

Pubertal: 0.4­ - 7.0 mIU/mL

Adult (18 years and older): 1.7­ - 8.6 mIU/mL

Testosterone, Free and Total

Testosterone, Free 58.8* - Range - 35.0­ - 155.0 pg/mL SL

Testosterone, Total, LC/MS/MS 394* - Range - 250­ - 1100 ng/dL SL

*All Tests Adult Reference Ranges:

*Testosterone, Free: Testosterone, Free

*All Tests Age Males Females

*All Tests Pediatric Reference Ranges:

*Testosterone, Total,

LC/MS/MS:

                   (pg/mL)           (pg/mL)

 18-­69 years       35.0­ - 155.0        0.1 - ­6.4

 70-­89 years       30.0 - 135.0        0.2 - ­3.7

 Testosterone, Free

                   (pg/mL)           (pg/mL)

 5­9.9 years       5.3 or less       0.2­ - 5.0

 10­ - 13.9 years     0.7­5 - 2.0          0.1 - ­7.4

 14­- 17.9 years     18.0­ - 111.0        0.5­ - 3.9

 Testosterone, Total

 Males:

 > or = 18 years    250- ­1100 ng/dL

 <img src="//cdck-file-uploads-global.s3.dualstack.us-west-2.amazonaws.com/tnation/uploads/default/original/3X/9/6/9676a7bb1d6d7d5ff4b23c56a32001e977bb4f51.jpg" width="386" height="500">
2

When did you start Vyvanse and why?
When do you feel that those reasons started?
“Not much motivation to do things, slightly depressed” ?

TSH looks good, but may not be telling the whole story.
Please see the 2nd post in the first thread in this forum and follow these links:

  • advice for new guys’
  • things that damage your hormones
  • thyroid basics explained ← check oral body temperatures as suggested and post

With your low motivation I suspect that your cross fit work may be fueled by adrenalin. That can lead to adrenal fatigue and rT3 blocking fT3. And stimulants make things worse [Vyvanse]. Your physical activity with low T levels is another stress problem I see in some young guys who compensate with shear will power. See the thyroid basics sticky for [rT3, Wilson’s book, adrenal fatigue]

Do you eat healthy fats?
Use iodized salt or iodine+selenium in vitamins?

Your LH/FSH is high because of your Varicocele. That can be surgically corrected.

Your T levels are low and you are not fully virilized and you have strong symptoms of hypogonadism. Something needs to be done. You have to take control of your medical care and you cannot be passive.

Labs are nicely done. But you also need:
E2 estradiol
AST/ALT
A1C
AM cortisol, please do at 8AM
TSH, fT3, fT3 rT3 if body temperatures are low.

"TSH with Reflex Free T4 TSH, High Sensitivity 1.19 - Range: 0.45 - ­ 4.50 mU/L "
Where is Free T4?

Glucose is high.
Where you fasting for that result?
Also, you seem to be dehydrated for first labs. Drink water.
A1C lab will provide a good measure of average glucose levels.

3

Thanks KSman!

To answer your questions:

When did you start Vyvanse and why? Ive been on Vyvanse for about a year I think, before that I was on Adderall IR 20mg up to 3x a day for 4 years.

I take it for ADD. I get distracted easily and it helps me focus and get things done.

When do you feel that those reasons started? I’ve always had ADD like symptoms, even when I was a kid and still do. I tend to wait until the last minute to do things, start things and never finish.

“Not much motivation to do things, slightly depressed” ? I’ve felt this way for a few years I guess. About four or five years ago, the Dr. gave me paxil which I took for less than a year. That was for social anxiety which I still have.

Do you eat healthy fats? I usually use olive oil when oil is needed. I eat Cashews and nuts when I want to snack at work.

Use iodized salt or iodine+selenium in vitamins? I read the sticky and wonder if I’m lacking in Iodine. I didn’t know how important Iodine was and have been using sea salt for years instead of iodized.

Where is Free T4? I’m not sure, I copy and pasted the lab results and also uploaded a picture.

Glucose is high.
Where you fasting for that result? I was not fasting, both tests were taken in the morning around 10-11am. I get up at 430 am and eat eggs, coffee and then take my medicine. I had eaten cinnamon and apple oatmeal 1.5 hours before the test.

I drink a lot of water everyday. Usually a cup or two before work in addition to coffee, and then at work I drink 50-60 more ounces of water. I drink more when I get home and then usually another 32 or more at the gym. I’m always thirsty and have dry mouth, I believe its from the vyvanse. I also have dry skin and hair, but figured that was because I usually shower 2x a day.

I am usually hot when other people aren’t but I think that may be from vyvanse as well? I switched to the vyvanse because on Adderall I started to sweat more. Lately I feel like I get cold easily, like if its 70 out I may feel cold, when normally I would love it.

I used to go to the gym 5x a week, but now I don’t go as much, I figured I was burned out of it, plus I didn’t seem to get much stronger (plateau maybe?) I feel like I don’t have much adrenaline, I only get adrenaline rushes when I almost hit another car or vice versa. When I am at the gym, it’s hard to get started, but I figured I was just lazy. Once I start working out, it’s not as bad and easier to continue, but I guess the motivation to even go to the gym is what I have been struggling with.

I will take my temperature tomorrow morning when I wake up and see what it is.

As far as the missing labs, not sure why my Dr. didn’t test those, I will look into getting another one done with everything. On a side note, I haven’t really noticed many benefits of ‘nofap’ and will probably start masturbating again, do you think if I was doing it daily like I used to, my T levels would be lower? The tests were done with no ejaculation for over a month.

4

Labs are nicely done. But you also need:
TT
FT
E2 estradiol
AST/ALT
LH/FSH
prolactin
A1C
AM cortisol, please do at 8AM
TSH, fT3, fT3 rT3 if body temperatures are low.

Social avoidance is common with low T guys.