T Nation

42 Y/O. Aussie Blood Test. Low T High PSA Help

Hi T-Nation

Australian so some of my labs might be in different units/ranges…

Main concerns/queries, started Testogel before being diagnosed primary/secondary. KSman do you know anything about T4 helper cells? T Biliruben?
Did I miss my chance a HPTA restart, or too old?

Also since this started a have developed Tinnitus and low alcohol tolerance, I haven’t seen any topics with regard to these symptoms.

Hopefully @KSman or other pro can offer some insights.

-33 waist
-80kg usually around 75kg
-Small amount of hair over belly and tuft on chest. Facial hair normal. I have fine hair, MPB, eyebrows thin. No hair on lower shins(front and back), I just thought that was from crossing over lower legs!
-Carry fat on belly, hips. Mainly torso. Skinny legs.
-Fit prior to 2014, surfing 2 x week. Paddling kayak regularly up to 15km open ocean. Have had 2 significant blows to head when younger. Back of head in bike flip 14yo, large lump behind ear. Knocked out from front of head blow.fell backwards on hard(dirt ground) 12yo, large heamatoma on forehead/concussion. Mumps around 10yo, bad dose but didn’t go to testes as far as I know only neck and armpits.
-No drugs prior to feeling crap. Been taking some Acetyl L-cartenine, D-ribose, B3 Vit plus extra B3, magnesium for a last . Have tried a Mens multi, upset my stomach bad so will try this again with another brand. maybe this iherb.com/pr/Optimum-Nutrition-Opti-Men-150-Tablets/57069
-Around Aug 2014 started the 5:2 diet. 2 poached eggs morning, 2 bowls of vege soup, home made dinner. 350 calories I estimate. Ate normally rest of the time. Red meat 1-2 week max. Chicken and fish lots of vegetables. I think I eat well. Cook 5-6 nights a week, plain yoghurt, olive oil. I have eaten iodized salt through my life but that may have dropped off recently due to what was in the cupboard.
-I did do exercise on fast days, brisk 3km walk(hills)and some quick intense training, planks, elliptical 2 mins max effort , 50 push ups, 30 burpees. I did this training 4 days a week. Plus surfing and kayak paddling. Otherwise work in office sitting on my bottom.
-Testes have never ached.
-Sex drive dropped to just about zero in 2016, no morning wood no noctunal erections. Never had a wet dream ever in my life.
-Body Temps good. Can reach 98.6 if I leave thermometre in mouth long enough. Morning temps were bang on as well. Done over a week, 4 days checked.
-If I do anything aerobic exercise, I hit the wall in a couple mins. Feel like I’m running on adrenaline, As my heart beats out of my just and my head feels like its going to explode. Then feel awful, lots of lactic acid.

August 2014 started 5:2 Got down to 71.8kg Dec, down from about 76kg, stopped as it was Xmas. Dec 2014 during Xmas break was surfing alot in the mornings. The afternoons I’d just hit the wall, very tired and nearly slept, I never sleep during the day. Went on for 5-6 weeks and blood tests, come back with high Ferritne.
Doctor and lab said it may have been my body fighting something. I seemed to come good end of January and everything seemed normalish.

October 2015 started 5:2 diet again. November started to feel off. Lethargic, lots of headaches, fatigue and poor alcolol tolerance. Was up and down some days pretty good other could hardly get out of bed.

Feb 2016 I was really low constantly and back to the doctor, high Ferritine still. Gene tested Heamacromatosis, viruses all OK. Gave blood and that knocked it back. Got worse, had tinnitus , headaches, fatigue, poor alcohol tolerance. Very poor recovery from simple things. Low sex drive no wood.

Labs done found out I had Low T. Had MRI to check that headaches were’t anything in the brain. So they didn’t really look at putuitary gland specifically.

Went to Endo and she was leaning to start me on t so she checked my PSA 2.4, off the urologist. Ended up getting TRUS biopsy, I don’t recommend, but all clear.
As I got my results he said no need to go back to see endo(his wife). Just go back to GP and get some testogel. Big error on my part, I really needed to go back and ask if my LH/FSH was high enough to support a good t level. Didn’t have this resource at that stage.

So started on Testogel November 2016. Only thing I notice ball shrinkage, don’t hang. Sex drive up, morning/night wood, not all the time.

Labs as at 26th August 2016 7:52am
TSH 1.9 [0.3-3.5] mIU/L
Free T3 4.4 [2.6-6.0] pmol/L
Free T4 14 [9.0-19] pmol/L
FSH 2 [<10] mIU/L
LH 3 [<9] mIU/L
Haemoglobin 148 [135-175] g/L
Haematocrit 0.44 [0.4-0.54]
Testosterone 8.4 [11-40] nmol/L
Cortisol 431 [100-535] nmol/L
PSA 2.4 H [0.25-2.2] ug/L
IGF-1 30 [13-35] nmol/L
AST 17 [10-40] U/L
ALT 24 [5-40] U/L
Prolactin 269 [<500] mIU/L
25-OH Vit D 69 [50-150] nmol/L
T-Helper CD4 0.48 L [0.5-1.9]
T-Cells CD3 0.91 [0.75-2.5]
White Blood 5.1 [3.5-10]
Lymphocytes 1.29 [1.0-4.0]
CRP 1 [<5] mg/L
U-Creatine Exc 16.4 [7-17] nmol/L

Labs as at 13th Feb 2016 7:32am After TRT
TSH 2.8 [0.3-3.5] mIU/L
Haematocrit 0.5 [0.4-0.54]
Haemoglobin 164 [135-175] g/L
Testosterone 38 [11-40] nmol/L
SHBG 22 [10-70] nmol/L
Cal FT 1125 H [260-740] pmol/L
PSA 3.8 H [0.25-2.2] ug/L
Oestradiol 140 [55-165] pmol/L
AST 20 [10-40] U/L
ALT 27 [5-40] U/L
T Biliruben 23 H [4-20] umol/L

Iron History
12/01/15 28/01/15 21/03/16
Iron 21 16 19 [5-30]umol/L
Transferrin 2.7 2.5 [1.9-3.1] g/L
TIBC 65 68 62 [45-72] umol/L
Trans Sat 32 24 31 [20-45] %
Ferritin 337H 319H 254 [30-300] ug/L

T Total History
9/05/16 7/06/16 26/8/16 7/02/17 (after testogel)
Testosterone 6.0 L 8.3 L 8.4L 38 [11-40] nmol/L

Serum iron tests vary wildly, do not make changes based on that alone.

Avoid iron fortified foods [pasta, bread, cereals etc] and select vitamin products that do not list iron. Men normally do not need any extra iron.


AST/ALT do not indicate any liver issues.
Low alcohol tolerance does suggest a change in liver function.
Eyebrows suggest low thyroid function, but body temps are in conflict with this.

TT is good
SHBG is low VS TT=38 and E2=140
E2=140 is high, would be better nearer to 80 pmol/L
Can you post any labs for fasting serum glucose or A1C?
Low SHBG can be indicative of insulin resistance or diabetes.
Docs will think that SHBG is normal.

Elevated E2 is a risk for the prostate. Estrogens are much worse than T or DHT. Do not do PSA labs soon after sex or a digital rectal prostate exam as PSA is then exaggerated. Do not test TSH etc soon after doc palpates thyroid.

FT=1125 can be quite high at times with transdermal T. You cannot utilize FT levels as indications that T dose is too high with transdermals applied before lab work.

Hematocrit=50 is a concern. Keep watching that number.

TSH=1.9, 2.8 is showing some thyroid issues. Could be from a lack of iodine.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • thyroid basics

Your T levels are good, E2 is too high. An aromatase inhibitor, anastrozole, can be used to lower E2. Suggest 1/2mg twice a week. However, getting that there is a bleak prospect, mostly because of the docs and the medical system.

TRT turns off LH and FSH and your testes shrink. Injecting 250iu hCG SC EOD will take care of that. Costly there and mostly not available. 10mg Nolvadex EOD might work, but availability an issue there.

Note that transdermal T delivery has the highest T–>E2 potential, injected T is lowest. Self injections probably not available there.

Keep tracking low T helper cells.

Vit-D25 is great? Supplements or all sunshine?

Thanks KSman, I appreciate the time you took to go through my lab work. I’m seeing my endo Wednesday, hopefully she has more for me this time. I’m beginning to think she is hopeless. In your opinion was my LH /FSH high enough for good T,sperm production?

I think my iron is OK now, just not sure why it climbed, docs/lab said my body may have been my body fighting something off. I don’t believe them as it was like that for over 12 months. [quote=“KSman, post:2, topic:226245”]
Eyebrows suggest low thyroid function, but body temps are in conflict with this.

I’ll put up a pic of my brows, I just think its my fine hair. Loss of lower leg hair no issue?[quote=“KSman, post:2, topic:226245”]
FT=1125 can be quite high at times with transdermal T. You cannot utilize FT levels as indications that T dose is too high with transdermals applied before lab work.

It had been 24 hours since I last applied. I am cutting the dose as TT=38 was pretty high. I think you have suggest around 24 is optimal.

Will do…

I thought my E2 may have been high, I have had lower leg swelling. Ankles and top of feet. My partner noticed it as well. Will post my glucose, labs. I think they are good.

[quote=“KSman, post:2, topic:226245”]
TSH=1.9, 2.8 is showing some thyroid issues. Could be from a lack of iodine.
[/quote] My TSH has been up and down. I eat lots of fish, but getting some idorol to try.

Not sure of the status of getting self injections, AI, HCG yet. I have seen guys chasing it on some bodybuilding forums here in Sydney. Will let yo know the outcome.

Vit D is good, middle of summer here and the sun is scorching, been 46-47 degrees close to me, I’m on the coast so only 35 degrees. Big heatwaves!

What about cortisol bit high?

Also still feel weak and fatigued at this high T level. I gather that’s the higher E2?

These are from most recent test. Been same since May 2016.
HbA1c (NGSP) 4.8 % (<6.5) %
HbA1c (IFCC) 29 mmol/m (<48)

Cholestrol 4.5 mmol/L (3.9-5.5)
Triglyceride 2 mmol/L (0.6-2.0)
HDL 0.97 mmol/L (0.9-1.5)
LDL 2.6 mmol/L (0.0-4.0)
Chol/LDL 4.6 H (0.4.5)

Other borderline results
Phosphate 0.9 mmol/L (0.8-1.5)
Anon Gap 6 mmol/L (5-15)

Not a happy camper, saw the endo this morning. I showed her some stuff from here and pretty much shot it all down. She said there is no data for HCG or serms working, She did agree that I was secondary. TSH is normal. All she cared about was my PSA at 3.8. Which I can understand from her point of view, but she just doesn’t get my point of view. Everyday is a struggle from start to finish.

Take half a sachet of testogel and come back in 3 months,:rage:

It is really bad there, docs work for the government, not you.

Loss of hair below the knees is classic effect of low-T + time.

If any guys are out there with Low T and high PSA that have started the injection protocol started here I’d love to hear how its effected your PSA level. Thanks.

We do not have many cases like that here. Probably because docs to not let the low-T conversation get started. We have a few guys who once had prostate cancer on TRT. 1 or 2

This is still my best guidance: Elevated E2 is a risk for the prostate. Estrogens are much worse than T or DHT. Do not do PSA labs soon after sex or a digital rectal prostate exam as PSA is then exaggerated.

Thanks KSman I’ll keep putting my details here for reference. From my readings I’m hoping there is initial spike in PSA then will settle down to normal levels. Higher PSA could have been caused by my prolonged low T. Forgot to add my uncle died from prostate cancer, he was in his mid eighties. This makes me high risk apparently as I have had relative with cancer. We don’t know what caused it so seems like shit medicine to me.

Keep in mind that you need to avoid estrogen dominance and with TRT, you need to keep E2 down near 80 pmol/L. “In range” will simply be wrong.

I will, I don’t think I can wait 3 months for next appointment, I’m going to keep an eye on feet. If they look like they have fluid I’ll be getting some Arimidex and just taking a low dose as you suggested. I can get it on black market but very expensive. $129 AUD for 30 x 1mg tablets, $19.99 on doctors prescription, I gather for women only. I can get HCG as well but buy the sounds of it it arrives as a powder and you have to mix it, possibly with bacteriostatic water from what I read this morning. I’m on steroid and body building forums.

HCG Pregny by Organon 5000iu x 3 amps + solvent $99

@flash74 I’d suggest looking up Dr Z. He’s based out of Perth, but does monthly clinics in Melbourne and Sydney. He was over your way today, so you’ll have to wait a few weeks.

He’s OK with prescribing injectables and Arimidex, and possibly HCG.

@Graemsay thanks mate. Found Dr Adrian Zentner online plus some youtube vids etc. Seems like he knows what he talking about. Got an appointment in Sydney in April. Bit of wait hopefully worth it. They did say its only a 10 minute appointment!

@flash74 glad to help.

Dr Zentner diagnosed me as hypogonadal based on my LH and FSH numbers. One was at the top of the range, and the other was above it, and he said that indicated my pituitary was screaming for more testosterone, but it wasn’t being produced.

This is a different approach to other doctors, and I got the impression that he knows a lot more than your average GP.

Good luck!

That sounds like primary hypogonadism, where the testes do not work. Were your testes examined?

hCG needs bacteriostatic water, 0.9% benzyl alcohol, which prevents bacterial growth. That is needed because the vial will last 40 days at 250iu SC EOD. These products are primarily intended for IVF fertility work where 5,000iu are injected all at once where stability in the vial is not an issue and sterile water or saline would be used. Try to find out what you would be getting.

That hCG price looks quite good. $99 AUD

@flash74 did you catch up with Dr Zentner this week? If so, how did it go?

Yes it went well. All I could have hoped for. He’s very knowledgeable and explained things with drawings and why its such a complex area. 10 min appointment went for 30 mins, so I got my moneys worth. I got prescriptions for T injections and an AI, seeing how that goes and might add HCG later. Will put up some more blood tests when I get a copy and keep this post updated with results.

Good to hear that!

Dr Z started me off on 250 mg as a single shot per fortnight. He suggested on my last appointment that I could inject half on a weekly basis. (Inject half one day, cap the syringe, inject the rest with a new needle the following week.) That might be a better protocol.