T Nation

Blood Work Came Back! Need Advice!


#1

Hello everyone,
I will begin by saying that I am 27 years old and I just got back my blood work results. I am not happy with the results but I was expecting it since I was not feeling my best for a while. Actually, this was the reason to have my blood tested in a first place.

-27
-5'7"
-35 in
-185 lbs
-thick hair on the legs, normal hair on arms and chest, no hair on back; no thick facial hair but I still need to shave every 3-4 days.
-I carry most of my fat on my belly. It has always been this way but in the last few months it increased even more.
-no health conditions besides allergies
-I have never taken any hair loss or prostate drugs
-I do not count calories and always eat as much as I want; I have intermediate fasted for the last 3 months.
-My strength training is usually 3 to 5 compound exercise (usually one push, one pull, and one lower body), 3 to 5 reps with heavy weight (I autoregulate). I lift weights 2-5 times a week, also training conditioning 1-2 times a week (either interval training or aerobic running). Additionally, I training MMA/Muay Thai 2-4 times a week. I train once a day, so if I do strength training I don't do MMA or conditioning...or if I do train MMA I don't do strength training or conditioning.
-testes ache, ever, with a fever? My testes sometimes ache but not too often, maybe once in a few months.
-how have morning wood and nocturnal erections changed: here is a bit confusing because some morning I have morning wood and others I don't.

Blood work results:
Glucose, Serum - 102 mg/dL (65-99)
Uric Acid, Serum - 4.8 mg/dL (3.7-8.6)
BUN - 15 mg/dL (6-20)
Creatinine, Serum - 1.14 mg/dL (0.76-1.27)
eGFR - >59 mL/min/1.73 (>59)
eGFR AfricanAmerican - >59 mL/min/1.73 (>59)
BUN/Creatinine Ratio - 13 (8-19)
Sodium, Serum - 139 mmol/L (135-145)
Potassium, Serum - 4.1 mmol/L (3.5-5.2)
Chloride, Serum - 101 mmol/L (97-108)
Calcium, Serum - 10.2 mg/dL (8.7-10.2)
Phosphorus, Serum - 4.2 mg/dL (2.5-4.5)
Protein, Total, Serum - 7.3 g/dL (6.0-8.5)
Albumin, Serum - 4.9 g/dL (3.5-5.5)
Globulin, Total - 2.4 g/dL (1.5-4.5)
A/G Ratio - 2.0 (1.1-2.5)
Bilirubin, Total - 0.4 mg/dL (0.0-1.2)
Alkaline Phosphatase, S - 57 IU/L (25-150)
LDH - 142 IU/L (100-250)
AST (SGOT) - 25 IU/L (0-40)
ALT (SGPT) - 34 IU/L (0-55)
GGT - 14 IU/L (0-65)
Iron, Serum - 124 ug/dL (40-155)
Cholesterol, Total - 237 mg/dL (100-199)
Triglycerides - 135 mg/dL (0-149)
HDL Cholesterol - 45 mg/dL (>39)
LDL Cholesterol Calc - 165 mg/dL (0-99)
T. Chol/HDL Ratio - 5.3 ratio units (0.0-5.0)
Estimated CHD Risk - 1.0 times avg. (0.0-1.0)
Homocyst(e)ine, Plasma - 9.0 umol/L (0.0-15.0)
C-Reactive Protein, Cardiac - 0.16 mg/L (0.00-3.00)
WBC - 6.8 x10E3/uL (4.0-10.5)
RBC - 5.14 x10E6/uL (4.10-5.60)
Hemoglobin - 16.2 g/dL (12.5-17.0)
Hematocrit - 46.7 % (36.0-50.0)
MCV - 91 fL (80-98)
MCH - 31.5 pg (27.0-34.0)
MCHC - 34.7 g/dL (32.0-36.0)
RDW - 13.6 % (11.7-15.0)
Platelets - 217 x10E3/uL (140-415)
Neutrophils - 31 % (40-74)
Lymphs - 48 % (14-46)
Monocytes - 8 % (4-13)
Eos - 12 % (0-7)
Basos - 1 % (0-3)
Immature Cells
Neutrophils (Absolute) - 2.1 x10E3/uL (1.8-7.8)
Lymphs (Absolute) - 3.3 x10E3/uL (0.7-4.5)
Monocytes(Absolute) - 0.5 x10E3/uL (0.1-1.0)
Eos (Absolute) - 0.8 x10E3/uL (0.0-0.4)
Baso (Absolute) - 0.0 x10E3/uL (0.0-0.2)
Immature Granulocytes - 0 % (0-1)
Immature Grans (Abs) - 0.0 x10E3/uL (0.0-0.1)

Testosterone, Serum - 339 ng/dL (249-836)
Free Testosterone(Direct) - 9.7 pg/mL (9.3-26.5)
Estradiol - 23.6 pg/mL (7.6-42.6)
Prolactin - 16.9 ng/mL (4.0-15.2)
DHEA-Sulfate - 239.5 ug/dL (160.0-449.0)
TSH - 3.920 uIU/mL (0.450-4.500)
T4,Free(Direct) - 1.07 ng/dL (0.82-1.77)
Triiodothyronine,Free,Serum - 3.4 pg/mL (2.0-4.4)
Prostate Specific Ag, Serum - 0.5 ng/mL (0.0-4.0)

Additional tests:
Vitamin B12 - 913 pg/mL (211-946)
Folate (Folic Acid), Serum - 16.0 ng/mL (>3.0)
LH - 5.4 mIU/mL (1.7-8.6)
FSH - 2.9 mIU/mL (1.5-12.4)
Dihydrotestosterone - 30 ng/dL
AM Cortisol - 21.0 ug/dL (2.3-19.4)
Vitamin D, 25-Hydroxy - 71.5 ng/mL (32.0-100.0)
Reverse T3 - 217 pg/mL (90-350)
Ferritin, Serum - 112 ng/mL (30-400)
Thyroid Peroxidase (TPO) Ab <6 IU/mL (0-34)
Antithyroglobulin Ab <20 IU/mL (0-40)

Body temps:

As you can see my TT and FT are low normal, which I read is not good. E2 seems okay but Prolactin is high. I really do not understand the rest of the hormones.

I need advice what should I do. Should I consider TRT? Or do you think that if I lower the prolactin level to 7-9 ng/mL my TT and FT would go up? Any advice is much appreciated.

Let me know if you need more information.

Thank you!


#2

your thyroid results are concerning. Your Free T4 is almost ideal and Free T3 looks ideal - which doesn't correlate with your TSH. You need additional tests (Reverse T3, 8am Cortisol, ferritin, and the two thyroid antibody tests).

man this is the third time today I have posted this, but have you read stopthethyroidmadness.com/things-we-have-learned ? It is a great site with a great deal of good information.

I would recommend looking into the prolactin and thyroid situation and getting your cortisol levels checked out (sorry, but I don't have any knowledge on prolactin related issues or solutions).

I would not recommend starting on any form of TRT until you get those other issues under control as resolving those may correct your hormone issues.


#3

Thanks! It is indeed a great site.

So I should check Reverse T3, Ferritin, Thyroid Antibody (ATA), Thyroid Peroxidase Antibody (TPO), and AM Cortisol? Wouldn't it be better to check AM/PM Cortisol or 24 hour Saliva Test (as mentioned in the web site) instead of just AM Cortisol?


#4

yes... but good luck in finding a doctor who will agree to order to saliva test or two cortisol tests. You can ask for the moon if you like and you might have a great doctor who will work with you... unfortunately if your doctor is like most, it will be a major fight just to get the basic tests you need - that is why I recommended the single 8am cortisol test.

Almost everyone who tests seems to come back below ideal levels (15-20 is ideal for an 8am blood draw).


#5

Did you masturbate or have sex within 24 hours of your blood test? This can increase prolactin...

I don't want to alarm you mate, but I had high prolactin and occasional achy testes, with similar Free and Total T values as you, and it ended up being testicular cancer...

Be sure to do a self-exam on yourself once a month...early detection is the key:

http://www.acor.org/tcrc/tcexam.html

I would definitely look into the other thyroid tests you mentioned as well-something there is amiss...Cortisol is also important...

May want to consider Vit D and Vit B-12 tests as well--especially the former...good to be in upper range...


#6

Yes, unfortunately all doctors are like that. Actually that is the reason why I am using online labs. And since I am paying anyway, I thought it would be better to get a more accurate results.

Do you know if anyone ordered those tests http://www.vrp.com/test-kits/cortisol-panel-4-tests ? Is the web site legit?


#7

Ahhh, testicular cancer is not good... It freaked me out! Just examined myself and didn't find lumps or felt any pain there but I will make sure to self-exam at least once a month.

What happened in your case? Did you take care of it?

You know what, I actually did have sex before the blood test but it was more like 36 hours before it. Soon after the test I found out that I shouldn't have had it 48 hours before the blood draw. I didn't really think that it will make a big difference.

I will add Vitamin D and Vitamin B12 test too. Thanks.


#8

What Rx and OTC drugs.

What supplements?

Iodized salt?
Iodine in your supplements.

Major problem with thyroid levels. Need to know if might be in part from an iodine deficiency.

Increase HDL with fish oil, high potency B-complex multi-vit - should have iodine too.

Take 4000-5000iu vit-D3 in oil based capsules.

Do labs after taking above for a while... no rush.

Check out lab work at lef.com - products|blood testing. Should be on-sale April-May.

For your FT level, your E2=32.6 still makes you estrogen dominant.

You need LH and FSH to know what is going on. Must do before TRT is started.

DHEA is low for your age, pregnenolone is probably low too, which is sort of expected if LH/FSH are low. You can try 25mg/day then adjust later after next labs.

How long ago did all of this start?
Any reduction in width of peripheral vision?
Testes smaller/softer?
Testes hanging normal or pulled up?
Lost some hair on lower legs?
Hair thinning all over scalp?
Dry skin?
Brittle nails?

Check your temperature when you wake then later during the day a few times, make notes and report back here after a few days. This is quite definitive for a functional state of hypothyroidism.

Note that hypothyroidism and hypogonadism have may symptoms in common. Having both is a double hit.

Please do not skip any of the above.


#9

What Rx and OTC drugs.
For headaches or joint/muscle pains I usually take:
Advil, Tylenol, Aspirin, Analgin (metamizole sodium)

For allergy:
Loratadine

Not too often but I have also taken:
Antibiotics (amoxycillin, azithromycin)
Paracetamol

What supplements?
Everyday:
Biotest's Curcumin, Biotest's Power Drive, Multivitamin/Multimineral supplement, Biotest's Mineral Support, GLC 2000 (glucosamine), Ashwagandha, Fish oil, Vit-C, Vit-D3, Lecithine

Occasionally (usually if I am going to have an exam or very intensive traning):
Vinpocetine, DMAE, Biotest's Alpha GPC

I have also taken Boitest's HOT-ROX but not currently.

Iodized salt?
- Yes, I use iodized salt.

Iodine in your supplements.
- The multivitamin/multimineral supplement has 150 mcg iodine. Is that enough or I need more?

Major problem with thyroid levels. Need to know if might be in part from an iodine deficiency.
- Do I need a test for iodine levels?

Increase HDL with fish oil, high potency B-complex multi-vit - should have iodine too.
- I will get more fish oil since I know I don't take enough. I will get a high potency B-complex too. So it should have iodine in it?

Take 4000-5000iu vit-D3 in oil based capsules.
- I already take 5000-10000iu of these.

Do labs after taking above for a while... no rush.

Check out lab work at lef.com - products|blood testing. Should be on-sale April-May.

For your FT level, your E2=32.6 still makes you estrogen dominant.
- My E2 levels are 23.6, not 32.6 but I think you just misquote it. What should I do about it? Should I consider any Anti-Estrogen?

You need LH and FSH to know what is going on. Must do before TRT is started.
- I will check these too.

DHEA is low for your age, pregnenolone is probably low too, which is sort of expected if LH/FSH are low. You can try 25mg/day then adjust later after next labs.
- Should I take a DHEA supplement too or just prognenolone? So I should check prognenolone levels too next time?

How long ago did all of this start?
- I would say that about a year ago I started to feel low on energy and motivation. Started to feel depressed more often. I haven't experienced any loss of erections but I just get horny less often now and not enjoy sex as I used to. Also I noticed that it was really hard for me to lose any body fat no matter how strict my diet and training were. I don't know if that matters too but I started to get more pain in my joints and got injured more frequently.

Any reduction in width of peripheral vision?
- No.

Testes smaller/softer?
- Occasionally smaller but not softer.

Testes hanging normal or pulled up?
- Most of the time hanging normal but sometimes pulled up.

Lost some hair on lower legs?
- I haven't noticed any loss of hair on my legs.

Hair thinning all over scalp?
- No.

Dry skin?
- The skin on my face and hands has always been dry but I haven't noticed it getting dryer.

Brittle nails?
- No.

Check your temperature when you wake then later during the day a few times, make notes and report back here after a few days. This is quite definitive for a functional state of hypothyroidism.
- Okay, I will report that after a few days.

Note that hypothyroidism and hypogonadism have may symptoms in common. Having both is a double hit.

Please do not skip any of the above.


#10

Yes I typo'd the E2 level, but the point of estrogen dominance still stands.

Dry skin can indicate thyroid problems.

Your b-complex multi-vit will displace your current multi-vit, so in the long run you will not have both for iodine.

Sounds like your iodine should not be really low. We have some who have very poor intake. There are not any readily available iodine tests. What is needed is a urine iodine test, followed by 50mg iodine, then another urine test, might be 24 hours, to see how much was excreted to determine how much the uptake was. If iodine stores/reserves are high, not much will be absorbed.... Sounds expensive, one can try loading up iodine if body temps are low, then watch for those to normalize, then see if TSH levels are normal or still bad. This is not a conventional approach.


#11

KSMan, what's your take on the risk of developing auto-immune diseases (e.g Hashimoto's) when supplementing with high doses of iodine?


#12

I got the additional tests back (the blood was drawn at 8:30am):

Vitamin B12 - 913 pg/mL (211-946)
Folate (Folic Acid), Serum - 16.0 ng/mL (>3.0)
LH - 5.4 mIU/mL (1.7-8.6)
FSH - 2.9 mIU/mL (1.5-12.4)
Dihydrotestosterone - 30 ng/dL
AM Cortisol - 21.0 ug/dL (2.3-19.4)
Vitamin D, 25-Hydroxy - 71.5 ng/mL (32.0-100.0)
Reverse T3 - 217 pg/mL (90-350)
Ferritin, Serum - 112 ng/mL (30-400)
Thyroid Peroxidase (TPO) Ab <6 IU/mL (0-34)
Antithyroglobulin Ab <20 IU/mL (0-40)

And here is a chart with my body temps. I used the axillary method (under the armpit).


#13

can't see the body temps, blocked at work.

ferritin, D3, Cortisol, B12 - all look great.
RT3 is a middle of the road reading. 120 or less is ideal I believe and over 300 is a problem.

there is still nothing here that can explain why you have a high TSH reading.

if body temps are not ideal, then maybe try loading up on Iodine like 12.5mg daily - and maybe consider supplementing or researching Selenium.


#14

Thanks for the fast input!

I will just rewrite the temps here:
Day 1 - 97.3, xx.x, 98.5, 98.3, 98.7
Day 2 - 96.8, 97.8, 98.3, 98.4, 98.3
Day 3 - 97.3, 97.8, 98.1, 98.3, xx.x
Day 4 - 97.3, 97.6, 98.2, 98.4, 97.9
Day 5 - 97.5, xx.x, 97.8, xx.x, 98.3

I backordered iodoral but I won't get it until the end of May. Since then I am taking 5000-6000 mcg sea-iodine. It's been almost a week but I still haven't seen a rise in day body temp.

I will also research Selenium as you suggested. Thanks.


#15


Trying to post body temp image.


#16

body temps look good I think given auxillary reading. still very odd about your high TSH.

fluctuating temps if temperature was taken at the same time each day could point to cortisol fluctuations which a 4-times daily saliva test would reveal.

what are your continuing symptoms? what is impacting your quality of life?


#17

I also think that there is something wrong with my cortisol levels because usually I have a hard time falling asleep and I also feel much more energized during the night. I actually thought that my AM cortisol levels would be very low since I have a hard time waking up.

Symptoms are no motivation, low energy, moodiness, emotionality, irritability, reduced sexual desire, reduced interest in surroundings, really hard time losing body fat, not improving in the gym (strength, muscle mass), really slow time of recovery. I think that all these are connected to testosterone deficiency.


#18

Iodine: How long have you used the vits with 150mcg iodine. Prior to that nothing?


#19

I'm not sure you recognize the importance of PureChance's first line. Your high TSH is indicative of subclinical hypothyroidism. From personal experience, I know that hypothyroidism is responsible for no motivation, low energy, moodiness, etc....

TSH > 3 is indicative of subclinical hypothyroidism, many people feel best between 1 - 2.

<-------------- Not an MD


#20

I have been using it for years since I was a little kid. Same goes for iodinezed salt.
Right now I am taking 5000-6000 mcg until I get the iodoral supplement.