T Nation

*5/28 update Referred to Endo Due to Lab Results - Advice Appreciated


#1

Hello,

I was referred to an Endo due to low test. Is there anything that jumps out to the experts here in terms of the lab numbers? Any advice on my first visit is appreciated.

In your case/thread opening post:
-age: 32
-height: 5'11''
-waist: 33
-weight: 173
-describe body and facial hair: have been shaving less (every 3-4 days) not allot of body hair
-describe where you carry fat and how changed: love handles and it seems like always had fatty chest
-health conditions, symptoms [history]: just lost that zest for life lately; don't feel like training, not focused at work
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever : none
-lab results with ranges:
total = 330
bioavailable = 90
SHBG = 32
Test Free = 44

All other labs normal including thyroid. Very, very good Cholesterol and lipids.

-describe diet [some create substantial damage with starvation diets]: 2800 calories good mix of fats, cabs, protein
-describe training [some ruin there hormones by over training]
-testes ache, ever, with a fever? : no
-how have morning wood and nocturnal erections changed : very infrequent

Thanks guys.


#2

I'll chime in before the veterans...you'll be advised to post all your labs, with ranges, instead of simply saying they're normal. Total T of 330 is "normal" per lab ranges too, but that doesn't mean it's healthy or ideal for you. "Normal" just means it's within the values that this lab has collected.

Good luck with the Endo, surprisingly they are some of the worst offenders when it comes to being educated and in favor of TRT. Anti-aging docs or an open-minded GP are your best bets, but I understand you're probably working within the constraints of insurance (as am I.) Read up as much as possible before your meeting.


#3

ditto reidnez.


#4

Yes I spent many years trying to use a dr/endo so I could use my insurance with no luck and some of the worst results you could imagine. I finally chose an HRT clinic and no they don't accept insurance but a months worth of meds and supplies is less than $200. The cost is well worth the results.


#5

Thanks guys. Are there other relevant labs that I need to post? Haven't done LH,FSH,E2 or Prolactin yet but called PCP and told him wanted these done prior to seeing Endo.

-age: 32
-height: 5'11''
-waist: 33
-weight: 173
-describe body and facial hair: have been shaving less (every 3-4 days) not allot of body hair
-describe where you carry fat and how changed: love handles and it seems like always had fatty chest
-health conditions, symptoms [history]: just lost that zest for life lately; don't feel like training, not focused at work
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever : none
-lab results with ranges:

Total Test = 330 (250-1100)
bioavailable = 90 (110-575)
SHBG = 32 (8-48)
Test Free = 44 (46-224)
Albumin = 4.5 (3.6-5.1)
L T4 FREE NON-DIALYSIS = 1.08 (.80-1.80)

-describe diet [some create substantial damage with starvation diets]: 2800 calories good mix of fats, cabs, protein
-describe training [some ruin there hormones by over training]
-testes ache, ever, with a fever? : no
-how have morning wood and nocturnal erections changed : very infrequent


#6

what does "all other labs" include? what was your TSH level? free T4 by itself is meaningless most of the time.


#7

Hi PureChance. My TSH = 2.96 (.40-4.50)
Don't have T3 or E2 or LH, FSH and prolactin yet.
Just called my endo office to see what I could have done prior to the visit and the nurse wasn't sure except that all HRT patients need to have digital rectal exam. So, I called my PCP and asked him to run FSH,LH,E2,Prolactin prior to the Endo visit.


#8

Must be LH and FSH! This must be tested before starting TRT.

Your FT and bio-T indicate that you qualify for TRT. TT does not, but in this case, looks like a large amount of your TT must be SHBG bound T [SHBG-T]; which is inert as that T cannot activate T receptors or get released from SHBG. You can read to the contrary, but such statements are completely wrong [and often repeated]. Yes, docs are mislead as well.

Hypothyroidism. Most docs will ignore because they think that the statistical "normal" means healthy. You need optimal.

Check waking body temp and check a few times during the day to see how close to 98.6 you get.

Describe your historic use of iodized salt and vitamins that contain iodine.

Any thyroid problems in your gene pool?

High dose vitamin D and EFA's such as fish oil will be helpful.

Be forceful for the need of E2, many docs are idiots about that.

Many symptoms of hypothyroidism are common to hypothyroidism. Often TRT will make a guy who has thyroid problems hit the wall as the thyroid levels will not support the metabolic demands restored by TRT. Ditto for adrenal fatigue. Note that low thyroid levels can lower T levels. And some find that fixing the thyroid problem restores T levels to some extent.

Post fasting cholesterol and glucose. Also need 'liver markers'. When doing that, important that you not have sore or bruised muscles.

There are many issues beyond T levels. We need the larger picture.

Head aches, reduced peripheral vision?

Read posts of others to see what goes on.
Feel cold easily?
Dry skin, brittle nails or hair?


#9

Wow thanks for the thoughfull response man!

Describe your historic use of iodized salt and vitamins that contain iodine.
- I am unsure on this. I never directly supplement this.
Any thyroid problems in your gene pool?
- My sister has hypothyroidism and is on Synthroid.

Post fasting cholesterol and glucose:
Total Choleterol: 150 <200
HDL: 61 (>39)
LDL: 88 (<100)
Triglyceride: 45 (<150)
Fasted Glucose: 85 (65-99) this was up a little bit more than normal

Head aches, reduced peripheral vision?
- never get headaches or have vision issues

Read posts of others to see what goes on.
Feel cold easily?
- no I am usually pretty warm
Dry skin, brittle nails or hair?[/quote]
- nothing noticeable to report

I have been supplmenting Vitamin D for the past 3-4 months.


#10

and........ this would be a prime example of why we keep insisting on seeing actual test results and won't accept "everything came back normal" as a valid answer.

please please please go read stopthethyroidmadness.com/things-we-have-learned/
and please have your sister read stopthethyroidmadness.com/t4-only-meds-dont-work/

TSH:

1 is a possible problem
2 is a problem
3 is a serious problem

feel free to repeat "yes, doctors are for the most part idiots."

please log your body temps immediately upon waking for the rest of the week and post the result. Body temps under 97.3-97.6 is a major symptom of hypothyroidism. avg daily temps of under 98.6 is also a symptom.


#11

I am going to read that now and will be taking morning temps startingt tomorrow. Thank you very much for the info. any other advice on next steps is greatly, greatly appreciated. I don't see my endo for another few weeks.


#12

PureChance: 96.8 (not a typo) this morning brother. I am going to get a better thermometer and keep checking all week.


#13

that is very typical result (<97) for people who are hypothyroid.

thyroid controls metabolism. metabolism has a major influence on body temps.
low body temps = low metabolism = significantly decreased ability to lose weight even with diet and exercise.


#14

Having been on TRT for a year now but only on an estrogen blocker for about a month 1/2 YOU NEED TO HAVE YOUR E2 CHECKED! When I finally started to get TRT treatment the symptoms went away for a couple months but then they came back and I couldn't figure out why. Increased the Test Cyp doesage and that didn't do anything but push my hemoglobin levels and resulted in 3 phlebotomies.. yay. I finally found a clinic that seems to understand TRT and they tested my E2 and prescribed an estrogen blocker, it's 100% changed the way I feel and I have not had any symptoms creep back in, yet at least. Listen to Ksman and what he says and get your E2 checked! :slight_smile:


#15

5/28 Update:

FSH = 4.2 (1.6-8.0)
LH = 3.8 (1.5-9.3)
Prolactin = 3.1 (2.0-18.0)
Estradiol = 33 (14-54)

Still a month before I see the endo. KS,Purechance Hardasnails, other vets anything jump out at you?


#16

The TSH at 2.96 popped out at me. Yeah, 2.96 is 'normal range', but it is not ideal. And it is far higher than one would expect to see in someone with a good diet and good training, as TSH is an exercise-responsive. I like to see the number closer to 2 in a sedentary person, and closer to 1 in someone who trains.


#17

thanks man for the input. That is definitly soemthing I will be discussing with the endo. I am curious if estradiol = 33 seems high for a test of 330 and bioavailable of 90? Also I would think LH would be higher due to my body trying to make more test? Could this point to an issue at the pituitary? Thansk to all for their help.