T Nation

34 Male / Help with Lab Results


#1

34 Year Old Male
Height: 5’7"
Weight: 175
BF%: ~20

I’ve been on antidepressants of one form or another for 10 years. Also been on Propecia for about the same. I stopped taking the Propecia two years ago because I was getting a breast lump. I went to my GP recently and told him I thought there was something else affecting my mood then mental health. I have anxiety but I’m not depressed. Lately I have no energy, mood is blah and so is motivation. I’ve been a gym goer for 16 years and not beach work. I squat, deadlift, press and even do some local minor competitions. Lately in addition to the mood and energy my body composition has turned mediocre at best despite good diet. My GP recommended testing my T (results below). I went to an Endo who said to stop taking protein shakes and stop taking creatine. I have no faith in him.

Libido / Sex
Fairly normal. Erections are not as hard as before.

Body & Scalp Hair:
My mid section has expanded. I look fit to most people but for me my waist is not athletic. Recently started thinning hair up front.

Stress & Lifestyle:
I’m a construction manager and have two young kids so my life is stressful.

Fat Storage:
I store fat mostly in my lower abdomen. Legs arms, and chest are pretty solid.

Initial Blood Work 4/08
TT: 459 (348 - 1197)
Free T: 4.5 (8.7-25.1)
PSA: .7 (0-4.0)
LH: 4.8 (1.7-8.6)
TSH: 2.290 (1.7-8.6)
FSH: 4.5 (1.5-12.4)
T4: 1.19 (.82-1.77)

Second Blood Work 4/14
TT: 524 (348 - 1197)
Free T: 8.3 (8.7-25.1)
PSA: .7 (0-4.0)
LH: 2.6 (1.7-8.6)
TSH: 1.96 (1.7-8.6)
FSH: 4.3 (1.5-12.4)
T4: 1.18 (.82-1.77)
BUN/Creatine 20 (8-19)
Cholesterol 215 (100-199)
LDL 137 (0-99)
HDL 58
Dihydrotestosterone 14 (30-85)
DHEA 378 (138-475)
Estradiol 14.9 (7.6-42.6)
IFG-1 126 (88-246)
Reverse T3 14.3 (9.2-24.1)
Vitamin D 42.8 (30-100)
B12 694 (211-946)
Esterone Serum 79 (12-72)
SHBG 54.8 (16.5-55.9)

The second bloodwork was done by a local T clinic to evaluate me further. Aside from the cholesterol issues, my T appears fine but the free T is low again. Also my Esterone is high, DHT is low, and my SHBG is high. So I can’t figure out if low T is a cause of my issues or its in my head. I eat healthy and exercise a ton.

Any insight from the gurus? Thanks!


#2

fT is definitely on the low side! Your cholesterol suggests that some lifestyle and diet changes need to be made causing certain symptoms.

SHBG is a very messy topic to discuss, i also have high SHBG and low fT. What i have been seeing though is that fT is fairly consistent in people with high SHBG even when SHBG is down some time later. E2 is not the cause for higher SHBG. SHBG inflates some of TT that we see in the labs, as the clearance rates of testosterone are slower with more SHBG.

Thyroid indicates subclinical problems. TSH is a bit high, T4 seems on the lower side suggesting this subclinical hypothyroidism. DHT is low due to low fT which is common. You are producing enough LH/FSH(like me) but not adequate fT levels which suggests a incapability of testes/combination of both testes and hypothalamus to produce optimal T levels. LH is on the low side definitely but it is usually released in pulses so you may have caught a low reading. You also need prolactin labs to rule out a prolactin secreting adenoma which lowers T production.

Please read the thyroid sticky and take body temperatures and read about the importance of iodine for optimal thyroid function.

I am no expert and still learning from my own problems and others here. Having said that i have similar fT numbers and i don’t feel very well so i can understand to a good measure how you feel. My advice would be may be look into some thyroid issues and your diet and see how you feel first and then look deeper into it. You also need to be very very wary of finding a doctor who is knowledgable on TRT and is willing to work with you in a way you require. For better understanding you can read the TRT protocol for injections thread in the stickies.

Best of luck and hope we come out better.


#3

Well I went to the T Clinic to follow up on the blood work. The doctor recommended 140mg/wk of T replacement along with progesterone and HCG. She said that should lower my estrogen levels and boost my free T. My wife thinks that I should see another Endo and that I’m too young to need any of this. I’m kind of lost. She’s right, the T Clinics push hormone replacement and I can’t find an Endo that knows anything. Lost…


#4

While i agree that your local T clinic will be pushing hormone replacement, i do not think at all that your problems are only in your head. You have multiple issue that you need to address to regain quality of life. I also think you should not think that you’re too young for these problems. Like i said, i have similar hormonal labs and i am 25. I discovered my problems 3 years late due to this thinking that i am too young to be having T problems, being young only enforces the need for potential treatment as you know that the decline is definitely not age related and no one young wants to have the QOL of an older person, i’m sure i don’t.

I suggested that may be you could make some lifestyle changes that are apparent with your cholesterol levels and try to reduce some of the stress.

The bottom line is that it’s apparent that your T levels are low. Now the course of action depends on your lifestyle and needs. Making some lifestyle changes can often result in better hormonal status, although not significant. Whether these changes are adequate for you is personal. Any treatment is dependent on your wants, if you want to feel a certain way, like a young healthy guy, you should consider T replacement. This is just my thoughts and advice as a guy with similar problems so take it as advice and nothing else. If you do decide on going for it, please read the stickies especially the TRT injections protocol. You need certain ancillaries to get the most out of your treatment.


#5

Well more confusing updates. I had my prolactin levels tested to ensure my pituitary was normal before starting t therapy. Levels came back at 27 ng/dl. The normal range is 4-15ng/dl. They did a pituitary MRI and it came back normal. Any insight on how this affects my path for t treatment? I don’t want to start it if it will worsen things or mask something. They want me to see another endo now and the endos are booked out for months. Sigh…


#6

Have you found a knowledgable doctor to help you with this? Elevated prolactin levels are associated with low dopamine secretion taking the pleasure out of life and lowering LH/FSH and by that mechanism lowering T. Your values are not very very high and could be a lab issue. Did you engage in sexual activity prior to your labs or hugged puppies or babies, these can cause some elevations in prolactin labs.

You should do labs for this once more after abstinence for 24-48 hours. If high, very low dose caber is usually prescribed to lower prolactin and that itself may improve T levels.


#7

Well I got my 6 week labs back and boy am I surprised at the results. My cholesterol took a dump and so did my E but I wasn’t fasting for cholesterol. Thoughts? I eat extremely health and even supp fish oil. My DHT is really high. What could that affect? I think I am definitely backing off the anti-E

C Total 233 / 100-199
Triglycerides 207 / 0-149
HDL 35 / >39
VLDL 41 / 5-40
LDL 157 / 0-99
Test Serum 1399 / 348-1197
Test Free 24.1 / 8.7-25.1
DHT 154 / 30-85
T4 1.12 / .82-1.77
TSH 2.32 / .450-4.5
Estradiol 5.0 / 7.6-42.6
IGF-1 121 / 88-246
T3 15.1 / 9.2-24.1
Triiodothryronine 3.3 / 2.0-4.4