T Nation

48 YO Male First Blood Work


#1

Newbie here.
After a few (several) years of:
Weight gain
Low libido, ED
Decrease in focus, attention (highly cognitive job)
Fatigue
Decrease in persistent motivation
Hair loss on legs - esp calves and outsides

I decided to do a bit of research and found a local doc specializing in men’s health.

He sent me for blood work. Results attached. I’ll do a 2nd testosterone blood test this week but I’m interested in knowledgeable feedback. Lab range first then my results before units.

I did take Propecia in the late 90s but quit after a year or so.

Thanks in advance.
HEMOGLOBIN
110 - 169 141 g/L NORMAL
HEMATOCRIT
0.31 - 0.51 0.41 L/L NORMAL
RED BLOOD CELL COUNT
3.7 - 6 4.5 x 1012/L NORMAL
MEAN CELL VOLUME (MCV)
75 - 103 90 fL NORMAL
MEAN CELL HEMOGLOBIN (MCH)
23 - 33 31 pg NORMAL
MEAN CELL HEMOGLOBIN CONCENTRATION
308 - 340 348 g/L HIGH
RBC DISTRIBUTION WIDTH
12.4 - 18.8 12.4 % NORMAL
WHITE BLOOD CELL COUNT
3.5 - 11.8 4.7 x 10
9/L NORMAL
PLATELET COUNT
136 - 400 238 x 109/L NORMAL
MEAN PLATELET VOLUME
7.5 - 11.7 8.8 fL NORMAL
PANEL OF 5 TESTS
1.7 - 8.3
2.2 x
10
9/L
NORMAL 5/5
WBC NEUTROPHILS 1.7 - 8.3 2.2 x 109/L NORMAL
WBC LYMPHOCYTES 0.8 - 3.4 1.7 x 10
9/L NORMAL
WBC MONOCYTES 0.2 - 1 0.5 x 109/L NORMAL
WBC EOSINOPHILS 0 - 0.6 0.1 x 10
9/L NORMAL
WBC BASOPHILS 0 - 0.11 0.05 x 10*9/L NORMAL
SMEAR: Please see details UNAVAILABLE
GLUCOSE, FASTING
3.6 - 6 5.3 mmol/L NORMAL
CREATININE
60 - 110 70 umol/L NORMALALBUMIN
35 - 52 46 g/L NORMAL
BILIRUBIN, TOTAL
< 23 10 umol/L NORMAL
HOURS FASTING
Please see details 11 hrs UNINTERPRETED
CHOLESTEROL, TOTAL
< 5.2 5.66 mmol/L HIGH
TRIGLYCERIDES
< 1.7 0.72 mmol/L NORMAL
HDL CHOLESTEROL

= 1 1.50 mmol/L NORMAL
LDL CHOLESTEROL Please see details 3.83 mmol/L UNINTERPRETED
NON-HDL-CHOLESTEROL(CALC)
0 - 4.29 4.16 mmol/L NORMAL
TOTAL CHOLESTEROL/HDL RATIO
Please see details 3.8 UNINTERPRETED
VITAMIN B12
220 246 pmol/L NORMAL
FERRITIN
22 - 537 498 ug/L NORMAL
SODIUM 136 - 146 142 mmol/L NORMAL
POTASSIUM 3.7 - 5.4 4.5 mmol/L NORMAL
ALKALINE PHOSPHATASE (ALP)
40 - 129 69 U/L NORMAL
CREATINE KINASE
< 225 915 U/L HIGH
ALANINE AMINOTRANSFERASE (ALT)
< 46 74 U/L HIGH
THYROID STIMULATING HORMONE (TSH)
0.35 - 5 1.25 mIU/L NORMAL
FREE T4
12 - 22 15 pmol/L NORMAL
FREE T3
2.6 - 5.7 4.7 pmol/L NORMAL
LUTEINIZING HORMONE (LH)
2 - 9 6 IU/L NORMAL
FOLLICLE STIMULATING HORMONE (FSH)
2 - 12 5 IU/L NORMALSEX HORMONE BINDING GLOBULIN
12 - 60
28 nmol/L
NORMAL
PROSTATE SPECIFIC ANTIGEN (PSA)
0 - 2.5 0.33 ug/L NORMAL
TESTOSTERONE, TOTAL
7.6 - 31.4 5.8 nmol/L LOW
PROLACTIN
< 18 8 ug/L NORMAL
ESTRADIOL
< 224 <60 pmol/L NORMAL
TESTOSTERONE, FREE
196 - 636 120 pmol/L LOW
25 HYDROXY VITAMIN D
76 - 250 41 nmol/L LOW


#2

Find tiny oil based gel caps, 5000iu Vit-D3

Try to get a bit more iodine.
Using iodized salt?
Multi-vit listing iodine+selenium?

Thyroid labs not looking to bad. But there can still be something lurking in there. Please eval overall thyroid function by checking oral body temperatures as per the thyroid basics sticky.

You have some degree of secondary hypogonadism.

Did you notice a decline in libido then?

Blood is thinner but consistent with low-T.

ALT: High from sore muscles?

E2 is low because FT is low.
You need a different E2 lab as it does not resolve below 60 pmol/L and is thus not much guidance. With T+AI, we may need to calculate a new AI dose and <60 does not work.
SHBG is lower because E2 is lower.

48 is a reasonable age to start TRT

Suggest:

  • 50mg T eth/cyp self injected SC/SQ twice a week with #29 0.5ml 1/2" insulin syringes
  • 0.25mg anastrozole at time of injections - might need more after labs
  • 250iu hCG SC/SQ EOD to preserve testes
  • Always do labs half-way between injections to eliminate lab timing artifacts

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

Labs on TRT:
TT
FT
E2
PSA
DRE at 6 months then annual
CBC
hematocrit
AM cortisol - at 8AM please
fasting cholesterol - TRT often reduces
fasting glucose


#3

So I’m 3 months in now.

Started at 100 mg T cyp once per week.
Increased to 110 mg after one month.

Doc just moved me to 60 mg twice per week based on attached blood work.

The doc did not prescribe the “0.25mg anastrozole at time of injections - might need more after labs
250iu hCG SC/SQ EOD to preserve testes” as suggested by KSman
Appreciate any feedback.

Testosterone 13.6 7.6 - 31.40 nmol/L
Estradiol 223 (H) <=158.99 pmol/L
Please note new reference range effective February 22, 2017.
Hb 152 110 - 169.000 g/L
Hct 0.47 0.31 - 0.510 L/L
RBC 5.1 3.7 - 6.000 x 1012/L
MCV 92 75 - 103.000 fL
MCH 30 23 - 33.000 pg
MCHC 324 308 - 340.000 g/L
Random Distribution Width 14.4 12.4 - 18.800
WBC 6.3 3.5 - 11.800 x 10
9/L
Platelets 263 136 - 400.000 x 109/L
MPV 9.0 7.5 - 11.700 fL
DIFFERENTIAL WBC’S
Neutrophils (A) 2.8 1.7 - 8.3 x 10
9/L
Lymphocytes (A) 1.8 0.8 - 3.4 x 109/L
Monocytes (A) 0.9 0.2 - 1.0 x 10
9/L
Eosinophils (A) 0.6 0.0 - 0.6 x 109/L
Basophils (A) 0.06 0.00 - 0.11 x 10
9/L
Free Testosterone 372 196 - 636.00 pmol/L (Note: doc says 400 - 650 is target range)


#4

120 mg test cyp would probably put you at a perfect level if you can convince him to give you an AI to lower that E


#5

“Estradiol 223 (H) <=158.99 pmol/L”

"The doc did not prescribe the “0.25mg anastrozole at time of injections - might need more after labs”

You probably are not going to get that done passively. You need to fight for it and get into his face, or find a new doc.

Injecting once a week, levels change so much that lab timing cab be the biggest factor in lab results. Always do labs halfway between injections, doing labs at time of office visit can be wrong. Get lab order and control lab timing yourself.

Ask for labs in 4 weeks for TT, FT and E2 to get T dose tuned. Ask for anastrozole now so next labs reflect that and then the next labs can be used to calculate anastrozole dose to get near E22=22pg/ml - 80 pmol/L

Tell doc that you insist on getting E2 under control and that you want a therapeutic target if E2=22pg/ml - 80 pmol/L

You have ignored my points and questions in my prior post. Non of which is trivial.


#6

Thanks TJ


#7

KSman,

I certainly appreciate your inputs and fast feedback. Regarding your initial questions and suggestions:

Propecia decline in libido ((200-2003 timeframe) - I didn’t notice then but had young kids etc.
ALT: High from sore muscles? YES
Switched back to iodized salt
Taking D3 and B12
Selenium - no supplements. I eat a healthy diet - lots of veggies - amount and variety.

The doc asks me to take the labs right before the next dose so the values are not mid-week as you suggest.

Tricky part is that I just started with this doc 3 months ago. He has now informed his patients that he’s getting out of the TRT business. But he wants to get his patients stable before passing on the files to family docs. That’s my plan too. Hopefully my family doc will take on this piece.

I will ask for the anastrozole and see what he comes back with. To be honest, I felt a better boost about 3 weeks ago and have felt a decline since. Could be in my head or unrelated since I’ve travelled 5 of the last 7 weeks internationally and jet lag kicks my ass.

Once again, thanks very much for the feedback and recommendations.

Cheers!


#8

My doc replied that almost no physicians will prescribe anastrozole and that guidelines do not advise monitoring estradiol. We’re in Canada.

Since he’s passing this on to my family doc in the next few months, my take is that he wants to keep it as basic as possible.