T Nation

Availability of Blood Tests and Meds in SE Asia?


#1

I'm British and have lived in the USA but now I live in Saigon, Vietnam. I'm considering starting TRT soon as I'm 51 and have started to experience symptoms of low T. The positives of living in SE Asia is that some meds are available OTC rather cheap (Sustanon 250, Arimidex) but others are unheard of. Also hormone testing might be tricky. The only test I was able to get was TT of 3.94 ng/mL and that was in a Korean hospital in Mongolia. I don't want to start TRT until I can found a reliable source fort tests and hCG.

Anybody else had experience getting tests and meds in SE Asia ?


#2

http://www.expatarrivals.com/vietnam/ho-chi-minh-city/healthcare-in-ho-chi-minh-city

Start asking around and read the finding a TRT doc sticky.

Read the advice for new guys sticky.

We need the lab ranges for lab values.

If hCG is not possible, you can use low dose Nolvadex.
hCG need refrigeration after adding BA water. Not good for travel in tropical heat.


#3

Thanks KSman. I’ve read the stickies. Now I’m trying to apply it to the situation in Saigon.

I’ve been quoted $120 for the following lab tests:

TT, FT, E2, LH/FSH

And another $25-32 to see a doctor for a consultation and DRE.

I’m a cash patient and I think it’s important. Do the prices seem reasonable? It’s at a private Vietnamese hospital, FWIW.


#4

At 51, a DRE is important.

That price for labs is decent and you can afford it.

See if you can find out more about the E2 test. If it is female centric, the ranges might be inappropriate.

Any concerns about general health?
CBC
fasting cholesterol
fasting glucose
TSH - you can read the thyroid basics sticky to see the issues, iodine, body temps, other labs

Are you feeling healthy?
Thyroid symptoms are largely the same as low T
Any exposure to tropical diseases?


#5

[quote]KSman wrote:
At 51, a DRE is important.

That price for labs is decent and you can afford it.

See if you can find out more about the E2 test. If it is female centric, the ranges might be inappropriate.

Any concerns about general health?
CBC
fasting cholesterol
fasting glucose
TSH - you can read the thyroid basics sticky to see the issues, iodine, body temps, other labs

Are you feeling healthy?
Thyroid symptoms are largely the same as low T
Any exposure to tropical diseases?[/quote]

I got the lab tests done today. TT, E2, fasting glucose, LDL/HDL, PSA, free-PSA, LH, FSH. Results should be Monday evening. Unfortunately they can’t do FT only TT. So I added PSA and Free-PSA at the urologists suggestion. I mentioned FT and the urologist didn’t understand the need even after I explained - bad sign maybe? E2 is calibrated to male, the nurse claimed. I’ll get the DRE at the follow up on Monday. BP was 90/138 pulse 70.

Generally, I feel healthy and fit. I’m 6’1.5", 203 pounds, 46" chest, 35" waist, maybe 15% body fat. I’d like to lose belly fat and get leaner and more energized. I’ve just started to feel a general lack of energy and motivation in the last 2 years.

I do weight training 3 times a week and walk a couple of miles a day. I’ve been a vegetarian for 21 years and I believe I’ve been eating healthy most of that time. I took my temperature with a digital thermometer (97.0 on waking, 98.1 in the afternoon). No tropical diseases.

I used transdermal DHEA gel for 4 weeks and finished it about 2 weeks ago. It’s unavailable here so I doubt I can get more. I got a little better motivated and an increase in libido at the end of that treatment. I met a new girl and spent an evening enjoying my new libido. My erection just wouldn’t go away for long after sex.

My refractory period seemed to be back to my teens - 5-10 minutes. Or maybe it was just her. But with my previous girlfriend my refractory period was about 2 hours. I must add I’ve been using ED drugs for 8 years. No problem getting erections but maintaining them for longer than 10 minutes is almost impossible with cialis or Viagra (half dose 50mg). I also tried some tongkat Ali. I’ve been off transdermal 2 weeks and tongkat Ali for 1 week.

When should I start the sustanon and Arimidex? I’m keen to start soon now I’ve had the labs.


#6

Your body temperatures suggest functional hypothyroidism. You are not talking, exercising, eating or drinking for a while before taking your oral body temperature?

Do you feel cold easily? Dry skin? Brittle nails?

Have you been using iodized salt continuously for years? Note that you might not be getting iodine with food prepared by others.

Thyroid symptoms are largely the same as low T

Do you take vitamins? Some are hard to get with a vege diet.
No eggs or fish? Locals may be getting some iodine in salt water fish. You?
How do you get essential fatty acids?

Politics and geography controls your iodine intake:

Bulletin of the World Health Organization

The International Council for the Control of Iodine Deficiency Disorders (ICCIDD) recommends universal salt iodization as the most effective strategy for eliminating IDD globally. In 1994 the prime minister of Viet Nam issued Decision 481, which urged the whole population to buy and use iodized salt.6 In 1999, the Government?s Decree 19 on the production and supply of iodized salt for human consumption stipulated that all salt for human consumption had to be iodized.7 Between 1995 and 2005 the Government, with support from the United Nations Children?s Fund (UNICEF) and the ICCIDD, implemented the National IDD Control (NIDDC) programme and established a well organized and efficient system to prevent and monitor IDDs in the country. Under this programme, KIO3 (Kali iodate) was provided to salt producers and the retail costs of producing iodized salt were subsidized. With these strategies, Viet Nam made remarkable progress in reducing IDDs in 1995 to 2005. The proportion of households using iodized salt increased from 25% in 1993 to 94% in 2005 and the national median urinary iodine concentration (UIC) increased from 32 µg/l to122 µg/l.8 However, in 2005 the Government declared that iodine deficiency in Viet Nam had been eliminated and promptly replaced Decree 19 with Decree 163, which removed the requirement that all salt for human consumption be iodized.9 The NIDDC programme was terminated and the budget for IDD control activities was reallocated.10

The World Health Organization (WHO), UNICEF and the ICCIDD have reiterated that strategies to sustain iodized salt use are essential to prevent the recurrence of IDDs in Viet Nam.11 In 2008, the National Survey of Iodine Deficiency Disorders reported a marked decline in household iodized salt coverage to 70%, nationally and less than 30% in urban areas, including Hanoi and Ho Chi Minh cities.10 Evidence of a drop in median UIC emerged.10,12


#7

[quote]KSman wrote:
Your body temperatures suggest functional hypothyroidism. You are not talking, exercising, eating or drinking for a while before taking your oral body temperature?

Do you feel cold easily? Dry skin? Brittle nails?

Have you been using iodized salt continuously for years? Note that you might not be getting iodine with food prepared by others.

Thyroid symptoms are largely the same as low T

Do you take vitamins? Some are hard to get with a vege diet.
No eggs or fish? Locals may be getting some iodine in salt water fish. You?
How do you get essential fatty acids?

[/quote]

I took the temperature immediately on waking. So, no to all.

No to cold, dry skin, brittle nails.

I haven’t been using salt at all in my own cooking but I eat out a lot. It seems like I took the warnings on sodium too seriously. I don’t take any kind of supplements. I just try to eat a wide variety of veggies, fruit and some nuts. I’m adding more nuts and paying more attention to the type because some have higher omega 3 than others. I don’t eat fish at all but I eat a lot of eggs and dairy products for protein. Plus legumes.

I’ll try to get some iodine, EFA supplements and possibly multi-vitamins. Or the food rich in them.


#8

Lets assume that you have an iodine deficiency. Try to find some high potency iodine supplements. You know the rest from the sticky.

It is really strange how we see most guys who land here have thyroid issues and many have low iodine intake. Something is going on. I seem to spend as much time dealing with thyroid issues as anything else. Some have accused my of wearing iodine colored glasses, but the data speaks for itself. In case; correcting iodine stores and maintenance levels is the least offensive of any medical interventions.


#9

I got some lab results and got the DRE. The urologist said they are all normal and doesn’t think I have hypothyroidism. But we ordered some more tests for tomorrow (CBC, Lipid, LDL/HDL,T3,T4). Here are what I have so far:

Fasting Glucose 94 mg/dl
FSH 4.5 mIU/ml
LH 3.0 mIU/ml
E2 32.5 pg/mL
TT 6.20 ng/ml at 9:30am 1.5hrs after waking (was 3.94 ng/ml a year ago tested at 2pm - 7hrs after waking)
PSA 2.54 ng/ml
Free PSA 0.38 ng/ml

I’m going to get iodized salt or a supplement tomorrow. I’m working with a pharmacy run by an American to see if I can get hCG or, if not, nolvadex.

Any thoughts on my results?


#10

fT3, fT4 - not T3, T4 if possible.

Add TSH

PSA range?
Any urine flow issues?

Iodized salt is good for maintenance but will not dig you out of the deficiency hole.


#11

[quote]KSman wrote:
fT3, fT4 - not T3, T4 if possible.

Add TSH

PSA range?
Any urine flow issues?

Iodized salt is good for maintenance but will not dig you out of the deficiency hole.
[/quote]

I asked them to change it to fT3, fT4, and TSH. Results for those plus CBC and lipid tomorrow.

I don’t know about PSA range. I’ve only ever had it tested once.

No, problems with urination flow or frequency. Same as it ever has been. No need to go at night.

I started sustanon 250 2 days ago. I’ll inject 100ml IM Every week and take 1/4mg Arimidex tablet ED. I’ll add hCG or nolvadex when I can source one of them. I also started on an EFA and a multi-vitamin/multi-mineral supplement today.


#12

The higher your T levels, the more T–>E2 you will get. Seems like a lot of T!

Some guys cannot get balanced on that much T. You could use less with the option of more later if needed.

If you are a normal anastrozole responder, that dose may not be enough. With T cyp and eth, one typically needs 1mg/week anastrozole for every 100mg T. Sustanon is less potent. So lets assume that your 250 = 200 of the others. You can see that your anastrozole dose might be too low for 250mg Sustanon.


#13

[quote]KSman wrote:
The higher your T levels, the more T–>E2 you will get. Seems like a lot of T!

Some guys cannot get balanced on that much T. You could use less with the option of more later if needed.

If you are a normal anastrozole responder, that dose may not be enough. With T cyp and eth, one typically needs 1mg/week anastrozole for every 100mg T. Sustanon is less potent. So lets assume that your 250 = 200 of the others. You can see that your anastrozole dose might be too low for 250mg Sustanon. [/quote]

I’ll try just injecting 250mg every 2 weeks. It’s supposed to be injected every 3 weeks, according to the info I’ve read but I heard patients say they feel bad if they wait 3 weeks. My dosage of Arimidex is actually quite high .25mg ED = 1.75mg per week.

I’ll get my TT and E2 levels checked at 5 weeks.


#14

I received the rest of my bloodwork results today. It’s not in digital format. They printed it on a report for me. I’ll get the other CBC’s added later but just wanted to do keep it simple for now:

CBC, all within except MCHC 36.6gm/dL “normal range” <32-36> HIGH

Cholesterol 245mg/dL HIGH “normal range” <130-200> HIGH
Triglycerides 160mg/dL “normal range” <70-200>
HDL 55mg/dl “normal range” <35-98>
LDL 158mg/dl “normal range” <0-160>

TSH 2.75uIU/L “normal range” <0.31 - 5.0>
fT3 2.79pg/mL “normal range” <1.8 - 4.6>
fT4 15.79pmol/l “normal range” <12 - 22>

I did some checking and the cholesterol and MCHC should be helped by supplementation with “Centrum” multi-vitamins/multi-mineral (includes B12 6mcg and iodine 150 mcg) and “Nature Made” flaxseed oil caps (omega 3-6-9). Also, revising my diet with more oatmeal and nuts.

Any problems with the Thyroid? It looks within the middle of the range.


#15

TSH should be near 1.0, it is having to flog the thyroid to make more T3, T4
fT3 midrange is 1.8+4.6/2 = 3.1m you are significantly below that.
fT3 should be near 17 and you are below that.

“Your body temperatures suggest functional hypothyroidism” and your labs suggest the same

You need to find your own sources of iodine. See the thyroid basics sticky re iodine replenishment.

TRT often lowers cholesterol, so we can wait to see what happens there. [There is always red rice yeast which has some lovastatin or low dose lovastatin as a drug every other day.]


#16

Thanks for all your tips, KSman.

I’m continuing with all my supplements. I’ve been tracking my daily temperatures, on waking and afternoon/evening. It seems to have stabilized at 97.3 on waking and 98.6 to 99 later in the day.

I can’t find an iodine replenishment supplement so I just continue with the ones that have 100% of the recommended daily intake and then add iodized salt to my food. I know it could take time but I am feeling better overall.

I’ve noticed subtle improvements in my libido, mood, mental acuity. Nothing radical but also no wild mood swings. I’m only about 2.5 weeks into TRT (injections) and supplementation. On Sunday, I self-injected 1ml 250mg of Sustanon and I felt my testicles tingling and ache a little. It was rather odd but not alarming. I didn’t feel that on the first injection.

I’ll get some blood tests at the 5 week mark. See how my levels are. I’m still struggling to source Nolvadex. That’s the downside of living in a developing country. I may have to fly to Thailand to get it. Apparently you can get anything there.


#17

I get some lab tests for the 5.5 week point. I increased my Sustanon 250 injections to 1ml per week for the last 3 pins. Looks like I need to cut down on Arimidex to half the dose. I have been taking Arimidex 0.25mg ED and Nolovadex 10mg ED. Sustanon 250 1ml weekly for 2.5 weeks (on Sundays) labs were done Thursday.

LAB 9/20/14 11/6/14 Normal Range
TT 620 1354 <280-1100>
E2 32.5 10.9 <7.63-42.6>
Cholstrl 245mg/dL 181 <130-200>
Trigly 160mg/dL 166 <70-200>
HDL-Chol 55 mg/dl 46 <35-98>
LDL-Chol 158 mg/dl 102 <0-160>

The strange thing is my mood hasn’t changed that much but my TT is off the chart and E2 is too low. Any recommendations?


#18

I’m having the same problem. It doesn’t seem very common. On my last blood test my tt was 586 but my e2 was <5.1 (7.6-42.56).

I was taking the recommended AI dose for over-responders .25mg per week. I stopped that all together but wont know if how it changed until my next round of tests.

If it’s still low I’ll see about increasing my test cyp dose and hope that I get more t–>e2 conversion.


#19

You should be trying to get near E2=22pg/ml. To get there your dose of Arimidex/anastrozole need to increased to .25mg x 10.9/22 = 0.125 [1/8th]mg

You could take 0.25 mg Arimidex EOD and get good results.

Given your T levels and dose, you are an anastrozole over-responder.

Total cholesterol 245–>181. That is fantastic. “TRT often lowers cholesterol, so we can wait to see what happens there.”

Watch for PSA change on next labs.
Check hematocrit, a potential problem with your T dose and levels!!!

Your labs were done “soon”, your levels are probably not final.


#20

I would be injecting more frequently than weekly. Every two or three days would be better especially since one of the esters in Sustanon is so fast acting. You’re getting a spike in the first half a day followed by decline. Many side effects could be associated with spikes in testosterone.