T Nation

40 Y/O Man, Review my Test Results and History


#1

I am a 40 year old male in southeast Texas. I was not feeling myself. I had a reputation as a hustle kind of guy. Non-stop worker and just busy getting stuff done. It just went away about 6-7 years ago. I was avoiding tasks, couldn’t stay awake. Gaining weight fast. I got up to 265.

Started treatment at a franchise TRT clinic in September 2015. The symptoms described on the radio commercial sounded like my sympoms. (I don’t have any of the labs from my times there)

First Free T result came back a “119” in September 2015. They checked it again, still the same. Low enough that the PA refused to treat me. He ordered a pituitary MRI. Diagnosed with Rathke Cleft cyst. Treatment was started shortly after at 200mg Test Cyp every week for a month. Then dosage was reduced to 150mg per week.

Arimidex was prescribed at .5mg - 48 hours after shot in February 2016. In response to a really bad mood and increasing fatigue.

Had shots every week from October 2015 to August 2017 with increasing dosages. Not sure of when dosages were raised. The increases were in response to my symptoms. Finished at 240mg per week when I stopped and searched out an Endo. Weight was up to 285 and I had no control. Dieting did nothing. BF % was 24% according to a float test done at the gym I used.

Endo shut down all Test and arimidex first week of Sep 2017. I haven’t had anything since. Labs were ordered and as follows:

Cortisol - AM / 4.3 ug/dL / 6.2-19.4 / Below low normal

Hematocrit / 46.1 % / 37.5-51.0

Vitamin D, 25-Hydroxy / 27.4 ng/mL / 30.0-100.0 / Below low normal

Testosterone, Total, LC/MS / 761 ng/dL

ACTH, Plasma / 9.2 pg/mL / 7.2-63.3

Hemoglobin A1c / 5.8 % / 4.8-5.6 / Above high normal

IGF-1(BL) / 155 ng/mL

Prostate Specific Ag, Serum / 0.8 ng/mL / 0.0-4.0

TSH-ICMA / 1.2 uU/mL

Free T4 by Dialysis/Mass Spec / 0.85 ng/dL

Cholesterol, Total / 230 mg/dL / 100-199 / Above high normal
Triglycerides / 527 mg/dL / 0-149 Above high normal
HDL Cholesterol / 27 mg/dL / >39 / Below low normal

Glucose, Serum / 101 mg/dL / 65-99 Above high normal
BUN / 15 mg/dL / 6-24
Creatinine, Serum / 1.06 mg/dL / 0.76-1.27
BUN/Creatinine Ratio / 14 / 9-20
Sodium, Serum / 139 mmol/L /134-144
Potassium, Serum / 4.5 mmol/L / 3.5-5.2
Chloride, Serum / 100 mmol/L / 96-106
Calcium, Serum / 9.6 mg/dL / 8.7-10.2
Protein, Total, Serum / 6.8 g/dL / 6.0-8.5
Albumin, Serum / 4.6 g/dL / 3.5-5.5
Globulin, Total / 2.2 g/dL / 1.5-4.5
A/G Ratio / 2.1 / 1.2-2.2
Bilirubin, Total / 0.2 mg/dL / 0.0-1.2
Alkaline Phosphatase, S / 59 IU/L / 39-117
AST (SGOT) / 23 IU/L /0-40
ALT (SGPT) / 47 IU/L / 0-44 Above high normal

The next step was to take a different Cortisol test. I was given a ACTH Stim test. Pulled blood, gave me a shot, Waited an hour (I went and fell asleep in the truck, felt ill the rest of the day), Pulled blood again. Awaiting results.

I am just exhausted. Not motivated to do anything. If I sit down for any length of time, I am falling asleep. I am taking some modafinil too just to keep up with family stuff but if I lay down to sleep, I am out like a light. I have lost 20 pounds since stopping the shots but a lot of that is water weight and some intermittent fasting may be dropping some. I am at my wits end on this. I am not tied to this doctor. I am listening.


#2

What is range for Free Testosterone? Total T of 761 is not bad unless SHBG is high. I don’t
see that or Estradiol sensitive on your labs.

Your lipids profile, weight gain, and blood glucose numbers suggest insulin resistance/pre-diabetes and metabolic syndrome. The forums at diabetesdaily will help you a lot with that.

You may need to address diet and exercise and start testing your blood sugar after meals. There could be more to your symptoms than just low testosterone.


#3

Also, your very high triglycerides level of 527 mg/dL could have been artificially elevated by alcohol consumption the day before your blood draw.


#4

The total T before treatment was 119. Not sure of free T other than the labs provided. The 761 was 10 days after a 300mg injection. Because of the holidays fell in September, they dosed me up because I was going to miss my normal shot.

Addressing diet and exercise now. Haven’t thought of testing blood sugar after meals. That should be fairly easy with over-the-counter testers. Let me head over to the threads you suggested.


#5

Yes, the finger stick tests are very easy and they provide the information you need to keep glucose levels in check. I use the AccuCheck TrueMetrix meter from Walgreen and order (way cheaper) knock-off test strips via Amazon.

Reduced insulin resistance is often mentioned as a benefit of TRT. I will be testing that claim myself. I will be getting fasting blood tests at 6-wks and 3-months after starting Test Enan 100ml/2x weekly+HCG+AI on 04 October.


#6

I wanted to throw out some lab results and get some opinions since the last time I posted. I stopped all treatment last September. I started treatment back this June. I have a consult with the TRT doc that is ordering the tests and prescriptions on this upcoming Friday. I am going to list my labs from the bloods in May and the bloods I just took in the last two weeks.
Blood Work on May 15, 2018:

TEST RESULT RANGE FLAG
Comp. Metabolic Panel
Glucose 100mg/dL 65 - 99 High
BUN 18mg/dL 0.76 - 1.27
Creatinine 1.06 mg/dL 0.76 - 1.27
Lipid Panel w/ Chol/HDL Ratio
Cholesterol 226 mg/dl 100-199 High
Triglycerides 238 mg/dl 0-149 High
HDL Chol 35 mg/dl >39 Low
VLDL Chol Cal 48 mg/dl 5-40 High
LDL Chol 143 mg/dl 0-99 High
T. Chol/HDL Ratio 6.5 ratio 0.0-5.0 High
Testosterone, Free and Total
Test, Serum 203 ng/dl 264-916 Low
Free Test (Direct) 9.9 pg/ml 6.8-21.5
Hormone Panel
Thyroxine (T4) Direct .92 ng/dl 0.82-1.77
DHEA – sulfate 260.9 ug/dl 102.6-416.3
TSH 2.070 uIU/ml 0.450-4.500
Luteinizing Hormone 5.1 mIU/mL 1.7 – 8.6
PSA 0.7 ng/mL 0.0-4.0
IGF-1 107 ng/mL 83-233
Estradiol, Sensitive(LC/MS/MS) 7.9 pg/Ml 8.0-35.0 Low
Triiodothyronine, Free, Serum 3.4 pg/mL 2.0-4.4
SHBG 21.2 nmol/L 16.5-55.9

Consulted with Doctor after these labs came back. Was prescribed following:

BEGIN T Cyp 200 mg/ml – 0.20 ml IM/SQ EOD (every other day)
BEGIN HCG 500 iu SQ BIW to reverse/prevent testicular atrophy (Twice a week)
BEGIN Anastrozole 0.125 mg BIW as needed per E2 symptoms (reviewed with Pt.) Patient will hold for 3-4 weeks or until high E2 symptoms occur (twice a week)
BEGIN DHEA 25 mg one PO qhs (one at bedtime)
BEGIN Fish Oil 2-3 grams QD for HDL support (Once a day)
BEGIN Niacin 500mg ER One a day for Triglyceride and LDL control. Patient instructed to decrease fried food, egg yolk intake. Replace with oatmeal and polyunsaturated fats.
BEGIN Metformin 500mg One PO BID (twice a day)
BEGIN Ibutamoren 25mg PO qhs (one at bedtime)

I followed this protocol since mid June. I put on 15 pounds of (what felt like) water weight in 2 weeks when i started the shots. I never started the Anastrozole because I never saw any other symptoms. When scheduling the next round of bloods, I told the Nurse Practitioner that My hands were tingling and I had some swelling in my feet. She told me to start the AI. The Ibutamoren causes hand and feet swelling too. But I started like she said.

The only thing I did different was I started back at the crossfit gym. My energy tanked fast and it is just impossible to get through a workout. I thought maybe it was the Metformin. I stopped the Metformin on August 1st. Energy didn’t come back but I did not start taking it again.

These are my results as of August 30th:

TEST RESULT RANGE FLAG
Comp. Metabolic Panel
Glucose 118mg/dL 65 - 99 High
BUN 11mg/dL 0.76 - 1.27
Creatinine 1.16 mg/dL 0.76 - 1.27
Lipid Panel w/ Chol/HDL Ratio
Cholesterol 241 mg/dl 100-199 High
Triglycerides 461 mg/dl 0-149 High
HDL Chol 27 mg/dl >39 Low
VLDL Chol Cal N/A(wouldn’t run) 5-40 High
LDL Chol Triglyceride too high 0-99 High
T. Chol/HDL Ratio 8.9 ratio 0.0-5.0 High
Testosterone, Free and Total
Test, Serum 363 ng/dl 264-916 Low
Free Test (Direct) 16.1 pg/ml 6.8-21.5
Hormone Panel
A1C 6.7 4.8-5.6 High
Thyroxine (T4) Direct Did not test 0.82-1.77
DHEA – sulfate 552.7 ug/dl 102.6-416.3
TSH 2.050 uIU/ml 0.450-4.500
Luteinizing Hormone Did not test 1.7 – 8.6
PSA 0.7 ng/mL 0.0-4.0
IGF-1 Did not test 83-233
Estradiol, Sensitive(LC/MS/MS) <2.5 pg/Ml(verified by retest) 8.0-35.0 Low
Triiodothyronine, Free, Serum Did not test 2.0-4.4
SHBG 17.5 nmol/L 16.5-55.9

Energy is better than May but not even close to normal. Still feel some brain fog. Very frustrating.


#7

Your e2 is way low. Stop ai. Low e2 symptoms are horrible.

You need to check insulin. Your glucose and a1c high. Pre diabetic? Very low shbg goes with diabetics. And high triglycerides.

You ever check liver enzymes AST and ALT?
Also how did the acth stimulation go.

Imo If you stop ai stop dhea . Dhea usually cause e2 to climb.

You should probably start metformin again.


#8

I just got these results today so the AI is out until further tests tell me something different. I don’t have ED but Libido is pretty low. Guessing the Low E2.
I think the pre-diabetic is a good call. I have to get some weight off. Its tough when you don’t feel like doing much of anything though.

Results for Liver Enzymes from 8/30:
AST - 26
ALT - 28 (was a 44 in May)

ACTH Stim test results (October 2017):
Cortisol Baseline - 9.9
Cortisol Stimulated - 20.0

Looking at the A1C and the Glucose, I will be starting the metformin for sure.


#9

People without diabetes take metformin for anti aging. It’s a great drug.