T Nation

Appointment Tomorrow! Help with Questions, etc.?

T Replacement
#1

Hey all,

I’ve been diagnosed with Low T and I’m going to the endocrinologist tomorrow to discuss options. What should I be asking about / asking for / etc.? Here are the test results I have access to:

VITAMIN D (25 OH) 73.2 ng/mL 30.0 - 100.0 ng/mL
SEX HORMONE BINDING GLOBULIN 13.2 nmol/L Male 20-50 years 13.3-89.5 nmol/L
TESTOSTERONE,TOT SRM 192.71 ng/dL 241.00 - 827.00 ng/dL
FERRITIN 146 ng/mL 24 - 336 ng/mL
TOTAL IRON 78 ug/dL 45 - 182 ug/dL
TOTAL IRON BINDING CAPACITY 346 ug/dL 252 - 460 ug/dL
LH,SERUM 2.3 mIU/mL 1.2 - 8.6 mIU/mL
FSH,SERUM 5.12 mIU/mL 1.00 - 19.00 mIU/mL
PROLACTIN 5.0 ng/mL 2.6 - 13.1 ng/mL
TSH 3.390 uIU/mL 0.340 - 5.600 uIU/mL
THYROXINE,FREE 0.83 ng/dL 0.57 - 1.25 ng/dL

He mentioned he calculates free testosterone based on SHGB and total - he said it was 55.9.

Let me know your thoughts - thanks!

#2

Time is short, start reading.

#3

Thanks! Will do. Let me know if you (or anyone!) has any input regarding my specific lab result numbers.

#4

Other than yes you are low T. These tests seem to be lacking. there are other people here who are much better at reading these than I am.

#5

FT ranges vary from lab to lab. So do not know what to make of calculated FT. Better to get a lab for direct measurement.

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

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

TIBC is high, indicating lower iron status. Total iron is not good because it swings based on last meal. But ferritin seems good.

TSH is too high, should be nearer to 1.0, published range is useless and too wide.
Are you not using iodized salt to support thyroid hormone production?
Check overall thyroid function by checking oral body temperatures as per the thyroid basics sticky.
Get cold easily?
Outer eyebrows sparse?
Generalized hair thinning?
fT4=0.83 is good, but the active hormone is fT3 and not tested.

You do need TRT, or if younger, need to find and fix the cause.

Your ?age? is important to diagnostics and treatment goals.

Where are you located? Affects options etc.

#6

Ah, yes - sorry, I’m newly 32, 6’6, 215lbs, in relatively decent shape. Normal diet, on anti-depressants and cholesterol meds.

I don’t get cold easily - much the opposite - I’m always warm/hot. No hair thinning of any kind. I can grow a full beard. I’m in Seattle, WA.

#7

At age 32 you should be looking for a cause, low T is the symptom.
You did not get E2 tested!

What was your cholesterol before statin meds?

Waist size?

What are your energy levels and how has that changes with statin med?
TRT can lower cholesterol.

Please check those oral body temps, this is often better than labs.

Labs:
E2
fT3
FT direct, not calculated
fasting cholesterol - can be too low, 180 ideal

TSH=3.39 really is a concern.

Many guys with low T feel like shit and doctors push SSRI’s when the cause is hormones.

Nice job on the Vit-D25! How much Vit-D3 to get you there in sunny seattle?

#8

The doc didn’t order E2 - I’ll ask about it tomorrow at the appointment. My cholesterol pre-statins was 220-230ish, now down to 170-180ish.

Waist size is a 34.

My energy levels have been low for a long time (no change with statin). They got much worse in the past year, which led me to look at causes. I’ve been diagnosed with sleep apnea and have been treating that (the hope was that it would raise the low T due to increased pituitary function with CPAP therapy, but no dice). I’ve had depression for many years as well, though hoping TRT might help with mood.

Do you think I should start taking iron supplements?

What makes the TSH a concern when it is within range? Should I press the doc about it?

I had low Vit D levels last year and now I take a lot of D3, haha. ~8,000 IUs / day.

#9

Docs do not understand the problems of subclincal hypothyroidism. They can’t see past the ranges which are idiotic. Everyone with a 11:1 range is perfectly optimal? Within range does not mean healthy!!! Insert lecture re statistical normal ranges and idiots thinking that that “normal” means normal or optimal state of health.

Check your oral body temperatures, that will settle the issue and its cheap/fast to do.
Do not waste time discussing TSH with doc until you get temperatures.
We also do not see docs asking about iodine, they have totally forgotten the basics and the state of things almost 100 years ago when iodine deficiency was horribly normal.

Do not think that your endo, or other docs are gods, most are idiots when it comes to TRT.
Doctors are mostly into disease management, not health optimization. It is hard to find the exceptional.

DO YOU USE IODIZED SALT?

Thyroid can rob your energy, mood and libido.

I have not seen a healthy guy yet with TSH near where you are.

Any low level chronic cough? That would be the statin drug.

Total cholesterol=220 is fine if your HDL is strong.
With TRT you may not need a statin drug as low T increases cholesterol.
Low thyroid function also increases cholesterol by slowing your metabolism.
If statin lowers CoQ10, that also increases cholesterol by slowing your metabolism.

#10

We don’t get a lot natural Vit D around here do we?

I found going on statin drugs dropped my T levers quit a bit. But my cholesterol levels were low before they put me on it for other reasons. SO it may not happen with you. I had to up my Testosterone dose a little bit over it.

You do not seem to need too much iron you are only a little low and you ferritin levels look good. Meaning you have plenty of stored iron. Excessive iron is not really good, especially with going on testosterone and having sleep apnea. SO ease into an increase in iron intake, you do not want to speed up the increase in your hematocrit levels.

#11

If you get option on what replacement, always go with shots, have the nurse show you how to do them, so you can do at home.
The gels are way more expensive and not as effective. 100mg shot of testosterone cypionate weekly more effective than 90mg topical *XIRON daily. The topical are around 500 bucks a months supply, the shots are 50 or so.