T Nation

34 Years Old. High Blood Pressure, Low FSH and Test

About me:
34 year old male
6’0" 195lbs
Strength training with barbells 3x per week
Walking/running 3-4x per week
High protein / high fat / low carb nutrition plan
Not on any medications
Only supplements are creatine monohydrate, pre-workout (cut down on this recently), fish oil, probiotic, and multivitamin

Symptoms are loss of strength, loss of motivation, loss of sex drive, ED, stubborn belly fat, and inability to gain any more muscle mass

At my recent physical, blood pressure was 160/90 (!!!) but I test around 135-150/75-80 at home.

Labs:
CBC With Differential/Platelet
WBC 8.2 3.4-10.8 x10E3/uL 01
RBC 5.83 HIGH 4.14-5.80 x10E6/uL 01
Hemoglobin 16.9 13.0-17.7 g/dL 01
Hematocrit 50.0 37.5-51.0 % 01
MCV 86 79-97 fL 01
MCH 29.0 26.6-33.0 pg 01
MCHC 33.8 31.5-35.7 g/dL 01
RDW 14.3 12.3-15.4 % 01
Platelets 306 150-379 x10E3/uL 01
Neutrophils 42 Not Estab. % 01
Lymphs 44 Not Estab. % 01
Monocytes 7 Not Estab. % 01
Eos 6 Not Estab. % 01
Basos 1 Not Estab. % 01
Neutrophils (Absolute) 3.5 1.4-7.0 x10E3/uL 01
Lymphs (Absolute) 3.6 HIGH 0.7-3.1 x10E3/uL 01
Monocytes(Absolute) 0.6 0.1-0.9 x10E3/uL 01
Eos (Absolute) 0.5 HIGH 0.0-0.4 x10E3/uL 01
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL 01
Immature Granulocytes 0 Not Estab. % 01
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL 01

Comp. Metabolic Panel (14)
Glucose 99 65-99 mg/dL 01
BUN 23 HIGH 6-20 mg/dL 01
Creatinine 1.20 0.76-1.27 mg/dL 01
eGFR If NonAfricn Am 78 >59 mL/min/1.73 01
eGFR If Africn Am 91 >59 mL/min/1.73 01
BUN/Creatinine Ratio 19 9-20 01
Sodium 143 134-144 mmol/L 01
Potassium 4.7 3.5-5.2 mmol/L 01
Chloride 103 96-106 mmol/L 01
Carbon Dioxide, Total 23 20-29 mmol/L 01
Calcium 9.7 8.7-10.2 mg/dL 01
Protein, Total 7.4 6.0-8.5 g/dL 01
Albumin 5.0 3.5-5.5 g/dL 01
Globulin, Total 2.4 1.5-4.5 g/dL 01
A/G Ratio 2.1 1.2-2.2 01
Bilirubin, Total 0.5 0.0-1.2 mg/dL 01
Alkaline Phosphatase 79 39-117 IU/L 01
AST (SGOT) 31 0-40 IU/L 01
ALT (SGPT) 28 0-44 IU/L 01

Testosterone, Serum 318 264-916 ng/dL 01
LH 3.4 1.7-8.6 mIU/mL 01
FSH 1.0 LOW 1.5-12.4 mIU/mL 01
Estradiol 17.5 7.6-42.6 pg/mL 01

Lipid Panel
Cholesterol, Total 174 mg/dL 100 - 199 01
Triglycerides 104 mg/dL 0 - 149 01
HDL Cholesterol 46 mg/dL >39 01
VLDL Cholesterol Cal 21 mg/dL 5 - 40
LDL Cholesterol Calc 107 High mg/dL 0 - 99

Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 1.2 ng/mL 0.0 - 4.0 01

DHEA-Sulfate 559.0 High ug/dL 138.5 - 475.2
TSH 1.000 uIU/mL 0.450 - 4.500
IGF-1 208 ng/mL 88 - 246
Free Testosterone, Direct 11.4 pg/mL 8.7 - 25.1
SHBG, Serum 22.4 nmol/L 16.5 - 55.9

I have consultation scheduled with Defy Medical one week from Thursday (8/23/18). Anyone have any idea what I could be looking at here?

You CBC results are high across the board for someone with low testosterone, hemoglobin hematocrit and RBC are all high. Adrenals gland are pumping out too much DHEA contributing to your symptoms of low testosterone. High DHEA could be from adrenocortical tumor, cushing disease, adrenal cancer, or adrenal hyperplasia.

TRT will be difficult with your CBC results, normally men on TRT showing similar CBC results would lower the dosage of testosterone and you’re not on TRT. I also had high blood pressure when testosterone was low, TRT can fix it provided testosterone and estrogen are in a range good for you.

Strength training while testosterone is low can be hard on the adrenals glands, your body is already under enough stress from being having low testosterone and you may be making your situation worse be lifting weights.

FSH is already very low, TRT may make you infertile. HCG and adding FSH to your TRT protocol can help when it’s time for kids.

Doctor say anything about your hematocrit level? Thick blood.

Edit: Looks like elevated hematrocrit (viscosity) may add to high BP and hypertension: https://academic.oup.com/ajh/article/12/7/739/112746

I don’t want kids, so infertility isn’t an issue for me.

Haven’t spoken to the doctor about my blood results yet. I have a consultation scheduled with Defy Medical on 8/23/18.

If you want to get dialed in to your TRT protocol and not waste time, I would recommend smaller injections EOD. SHBG will decrease after a few months after starting TRT which is normal, which will make frequent injections even more important for controlling your estrogen levels.

As SHBG lowers Free T and Free E2 rises, your estrogen levels will make or break TRT for those that are sensitive to estrogen. Some who have insulin resistance and fatty liver may see an increase in SHBG one diet and weight loss has occurred, but this doesn’t appear to be a problem for you.

Frequent blood donations may be needed, careful though as you lose ferritin after donating and thyroid hormone require ferritin.

Is there a chance that Defy Medical will not put me on TRT due to my CBC results or high blood pressure?

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I don’t know, if they do it will be on a lower dosage until they can figure out why CBC levels are high.

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Phone consultation with Dr. Calkins at Defy Medical is in a couple hours. Based on my labs, any questions I should have prepared ahead of time to ask the doctor?

Update
Here’s the regimen Defy recommended for me:

Begin T Cyp 200 mg/ml – 0.25 ml IM/SQ three times a week(25G, 5/8” needle/ (1cc syringe Luer only)

Begin HCG 30iu SQ three times a week to reverse/prevent testicular atrophy

Begin Anastrozole 0.125mg three times a week – h/o elevated E2, titrate on follow-up

Begin Vitamin D3 5000 iu daily

Begin Fish oil 3-4 g by mouth daily for HDL support

If that was me too, i would definitely do a BIG blood donation before doing any T.R.T infact i might not do actual T.R.T at all with your Whooping 50% Hematocrit Dude. I would just do H.C.G MONOtherapy and hope it helps your already low Testosterone levels, there is a select group of Lucky guys who do very well on HCG monotherapy you might be one of those. and it shouldn’t raise Red blood cells too much, however i ain’t Expert maybe it still has same affect on Red blood cells. definitely get a Big Blood donation before any decisions though. all the best to your Health Montgomery.

Probably unlikely DefyMedical will, you might even have Polycythemia dude and might Not even know about it. Honestly need a doctor to investigate Further into why you have that blood count result.

What did they say about high blood pressure.
High RBC and hct?

Defy prescribed the regimen above yesterday. I don’t have any symptoms of Polycythemia other than fatigue and Dr. Calkins didn’t think my high RBC count or hematocrit wasn’t anything to worry about at this point. Just said to donate blood every 3 months or so and we’ll keep an eye on it when we do my 3 month follow-up labs.

Dr. Calkins said that high DHEA doesn’t really cause high blood pressure. He said that my blood pressure is probably a little high because of anxiety, which will subside a bit once my testosterone is in a healthy range.

At home, I’m getting BP readings around 125-135/70-75 now. The only changes I’ve made to lower it are a little less sea salt in my diet and 10 minutes of meditation every night.

I don’t like this. You want to donate for the rest of your life?? And why would they start you at 200 mg a week???

I would start trt do CBC after 6 weeks.

It’s 200mg/mL in the vial. Each injection is 50 mg, so it’s actually 150mg per week.

What’s wrong with donating? Biolife runs a CBC every time you donate blood, so I’ll be getting that for free every time I go, plus I get paid. Seems like a win/win to me.

*** Update ***
New labs drawn after 9 weeks on TRT:

Diagnostic Test / Results Results Out of Range Flag Units Range Site Stat
CBC With Differential/Platelet [Final]
Notes Fasting - Yes
WBC x10E3/u 3.4-10.8
7.3 01 F

RBC x10E6/u 4.14-5.80
6.00 H 01 F

Hemoglobin 17.8 H g/dL 13.0-17.7 01 F
Hematocrit 54.0 H % 37.5-51.0 01 F
MCV 90 fL 79-97 01 F
MCH 29.7 pg 26.6-33.0 01 F
MCHC 33.0 g/dL 31.5-35.7 01 F
RDW 14.5 % 12.3-15.4 01 F
Platelets x10E3/u 150-379
282 01 F

Neutrophils 37 % Not Estab. 01 F
Lymphs 45 % Not Estab. 01 F
Monocytes 10 % Not Estab. 01 F
Eos 7 % Not Estab. 01 F
Basos 1 % Not Estab. 01 F
Immature Cells NP 01 X
Neutrophils (Absolute) x10E3/u 1.4-7.0
L
2.7 01 F
Lymphs (Absolute) x10E3/u 0.7-3.1
3.3 H 01 F

Monocytes(Absolute) x10E3/u 0.1-0.9
0.7 01 F

Eos (Absolute) x10E3/u 0.0-0.4
0.5 H 01 F

Baso (Absolute) x10E3/u 0.0-0.2
0.1 01 F

Immature Granulocytes 0 % Not Estab. 01 F
Immature Grans (Abs) x10E3/u 0.0-0.1
0.0 01 F

NRBC NP 01 X
Hematology Comments: NP 01 X
Comp. Metabolic Panel (14) [Final]
Glucose 100 H mg/dL 65-99 01 F
BUN 21 H mg/dL 6-20 01 F
Creatinine 1.24 mg/dL 0.76-1.27 01 F
eGFR If NonAfricn Am mL/min/1 >59
.73
75 01 F
eGFR If Africn Am mL/min/1 >59
.73
87 01 F
BUN/Creatinine Ratio 17 9-20 01 F
Sodium 140 mmol/L 134-144 01 F
Potassium 4.6 mmol/L 3.5-5.2 01 F
Chloride 100 mmol/L 96-106 01 F
Carbon Dioxide, Total 23 mmol/L 20-29 01 F
Calcium 9.5 mg/dL 8.7-10.2 01 F
Protein, Total 7.2 g/dL 6.0-8.5 01 F
Albumin 4.8 g/dL 3.5-5.5 01 F
Globulin, Total 2.4 g/dL 1.5-4.5 01 F
A/G Ratio 2.0 1.2-2.2 01 F
Bilirubin, Total 0.7 mg/dL 0.0-1.2 01 F

Comp. Metabolic Panel (14) [Final]
Alkaline Phosphatase 74 IU/L 39-117 01 F
AST (SGOT) 37 IU/L 0-40 01 F
ALT (SGPT) 28 IU/L 0-44 01 F
Lipid Panel w/ Chol/HDL Ratio [Final]
Cholesterol, Total 188 mg/dL 100-199 01 F
Triglycerides 74 mg/dL 0-149 01 F
HDL Cholesterol 48 mg/dL >39 01 F
VLDL Cholesterol Cal 15 mg/dL 5-40 01 F
LDL Cholesterol Calc 125 H mg/dL 0-99 01 F
Comment: NP 01 X
T. Chol/HDL Ratio 3.9 ratio 0.0-5.0 01 F
T. Chol/HDL Ratio
Men Women
1/2 Avg.Risk 3.4 3.3
Avg.Risk 5.0 4.4
2X Avg.Risk 9.6 7.1
3X Avg.Risk 23.4 11.0
Notes
Testosterone,Free and Total [Final]
Testosterone, Serum 1055 H ng/dL 264-916 01 F
Adult male reference interval is based on a population of
healthy nonobese males (BMI <30) between 19 and 39 years old.
Travison, et.al. JCEM 2017,102;1161-1173. PMID: 28324103.
Notes
Free Testosterone(Direct) 32.2 H pg/mL 8.7-25.1 02 F
DHEA-Sulfate [Final]
DHEA-Sulfate 505.3 H ug/dL 138.5-475.2 01 F
TSH [Final]
TSH 0.855 uIU/mL 0.450-4.500 01 F
Prostate-Specific Ag, Serum [Final]
Prostate Specific Ag, Serum 1.2 ng/mL 0.0-4.0 01 F
Roche ECLIA methodology.
.
According to the American Urological Association, Serum PSA should
decrease and remain at undetectable levels after radical
prostatectomy. The AUA defines biochemical recurrence as an initial
PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory
PSA value 0.2 ng/mL or greater.
Values obtained with different assay methods or kits cannot be used
interchangeably. Results cannot be interpreted as absolute evidence
of the presence or absence of malignant disease.
Notes
Estradiol, Sensitive [Final]
Estradiol, Sensitive 33.5 pg/mL 8.0-35.0 02 F
This test was developed and its performance characteristics
determined by LabCorp. It has not been cleared by the Food and
Drug Administration.
Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)
Notes
Sex Horm Binding Glob, Serum [Final]
Sex Horm Binding Glob, Serum 25.2 nmol/L 16.5-55.9 01 F

Follow-up consultation with Defy is at 3:30 today.

After about 2 weeks on TRT, I noticed a definite improvement in mood and a dramatic reduction in anxiety. About 3 weeks in, morning erections came back on a regular basis for the first time since I was 20. Getting and maintaining erections is easier as well, but still not where I’d like them to be. Blood pressure has dropped. I’m averaging around 130/72 most of the time now. After 4 weeks, I was setting new PR’s in both bench and overhead press. I hadn’t set a new PR in either lift in over a year.

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Your RBC , HCG and hemoglobin are high.

You have room to lower your dose since free t is high.

This was discussed during my follow-up consultation with Defy. They recommended getting a blood draw soon and having a sleep study done. Sleep apnea may be the cause of my high hematocrit/RBC.

Everything else looked good, so they kept all my dosages the same.