T Nation

Blood Work Came Back Today

First a little background. I’m 31. I know this is the over 35 lifter forum, but I have HRT issues, so I’m posting here. Today my weight is at 179, down from 236 Jan 11th, and down from my all time high of 266 2.5 years ago. I’ve done it the right way, basically following Bartl’s exact diet and exercise regimen for the last 4 months. I’m pretty lean now, with a 6 pack and everything. Some lose skin around the waist, but I hope that tightens up over the next year or so.

I was a very good athlete all the way up to age 19. Varsity sports in high school, varsity rowing my freshman and soph year in college. I had a knee problem I thought was fixed before my freshman year in college, but it got worse my soph. year, so I quit rowing and joined a fraternity. In the frat, I’d spend 4-6 months getting fat eating crappy food and excessively drinking, with no exercise except walking to class. Then I’d spend a month “getting back into shape” which basically was just running/biking and starving trying to lose weight.

Then when I got my 1st job, and internship in Phoenix. Not wanting to go to a warm weather climate being fat, I searched for a good weightlifting routine, and I found T-Nation. This was back in 2000 or so. I started following the coaches here, and spent a good 9 months lifting and eating right, and got back into shape. When I came back to Ohio, I was in great shape, and felt pretty good.

Then for the next 6 years I basically ate fast food 2-3 times a day, pizza 2-3 times a week, and drank 5-6 beers a weeknight, and 12-18 during the weekend. Add in no lifting, too much stress from working on my MS, then my PhD, and then starting my own company. A good formula for fat gain. That’s how I ballooned up to 266.

But for the last 2.5 years I’ve been on and off training and dieting, going up and down 20-30 pounds. This year I decided to make it permanent, and quit drinking all together, and follow a strict diet and exercise plan. And it’s working, dropping 56 pounds this year and looking freaking great right now.

The problem I have, and why I’m here, has to do with my libido. Ever since I quit rowing, I’ve had basically zero libido. Freshman year in college was great, I never had any performance issues, and could chase women all night long, sleep 4 hours, go to class, go workout and row, and repeat.

But since then, I’ve had no sex drive. So I stopped asking girls out. And in the few cases where women were agressive and asked me out, I end up having “performance issues.” It’s gotten to the point where I actually avoid any situations that could end up with me flirting with any women. Just to avoid that embarrassment. A situation I want to clear up asap. So last week I went to the doctor, and after reading posts here from guys like KSman, I asked for and received several tests.

So I just got back from the office and here are the results:

Lipid Panel:
Cholesterol: 148, 100-199 mg/dL
Trigycerides: 42, 30-150 mg/dL
HDL: 50, 40-59 mg/dL
LDL Chol Cacl: 90 mg/dL
Chol/HDL Ratio: 3.0

So the clean diet for the last 4 months has completely cleared up my lipids. This looks super healthy to me.

Test tests:
Estradiol: 22, 0-56 pg/mL
Prolactin: 4.1, 1.6-18.8 ng/mL
Test, Free: 7.9, 8-7-55.0 pg/mL
Test, Total: 255, 280-1000 ng/dL
TSH: 2.95, 0.32-5.00 mclU/mL

Here is the real problem. I have the testosterone of a girl!

There was one other test that was off. It’s a liver enzyme test:
ALT(SGPT): 74, 0-40 U/L

But I was wondering if beta-alanine would cause this to test high, since SPGT is alanine aminotransferase. I’m currently in the 3rd week of taking Beta7.

For the test, the doc agrees the test is too low, and is scheduling an appointment for me with a Urologist.

So my task is now to research the hell out of TRT. KSman, or any other of you in-the-know guys, anything you can point me to on the web to get me started? I’ve read several of KSmans posts about TRT shutting down the tests, and needed HCg to keep them going, and an ai to keep the e2 in check. But I’d like to know more before going to the Urologist so I don’t get screwed up any worse.

Hey brother-be carefull of the low cholesterol score-newer research seems to indicate that levels below 150 could lead to heart and stroke problems-I can’t wait to see a response to your ALT situation-I’m having the same prob on my recent tests-good luck.

…courtesy of happydog. That should keep you busy reading over the weekend…hebs

http://www.happydog.net/hrtlinks.html

[quote]LeRONIN wrote:
Hey brother-be carefull of the low cholesterol score-newer research seems to indicate that levels below 150 could lead to heart and stroke problems-I can’t wait to see a response to your ALT situation-I’m having the same prob on my recent tests-good luck.[/quote]

The doc didn’t mention it to me, but both liver tests were higher than normal:

AST(SGOT): 52, 0-45 U/L
ALT(SGPT): 74, 0-40 U/L

So there might be some liver damage. She is running more tests checking for Hepatitis A and C. She couldn’t feel any liver swelling, so she was stumped.

I’ll keep this thread updated with any news as I work all this out.

[quote]hebsie wrote:
…courtesy of happydog. That should keep you busy reading over the weekend…hebs

http://www.happydog.net/hrtlinks.html

[/quote]

Thanks hebs. Just got a call from the doc, and my urologist visit is Monday morning, so I’ll have to get to reading asap.

Altered liver metabolism can reduce the liver’s ability to remove E2 from the body. Might be a connection to the “excessive drinking” which is thought to increase T, thus lowering E in some cases. Review your meds for liver impact.

Your E2 is not high, but your T is low. The E2 that you have may be making you estrogen dominant. You are might be too young for the effects of that on the prostate to be noticed.

Once E2 is dominant, it can probably down reg the PHTA and add to testosterone loss.

Elevated or dominant E can kill libido, on top of the libido issues from low T.

I don’t know how you manage the training and results in your hormone state.

Your TSH is a bit high… warranting labs for free T3 and free T4. TRT can recover some [lesser] thyroid problems.

Note that cholesterol is the substrate for pregnenolone leading to DHEA and neural steroids important for brain health [and mood]. Other important hormones are based on cholesterol. Low cholesterol can cause hormone problems. Get tested for DHEA-s. If that is crashed, you need to supplement with DHEA and pregnenolone [do not confuse with progesterone].

Vitamin D is based in cholesterol via a complicated chain of processed. The body stores this for months from sun exposure. I in the winter you can run out. Vitamin D is converted into vitamin D hormone and all of the cells of the body have receptors for this hormone. Lack of vitamin D weakens the immune system and is a factor in TB infections and recovery. Other adverse effects are higher rates of heart attacks and MS in colder climates where one does not get enough sun exposure [in the winter]. Most need 2000iu per day. It is not toxic. One can take 100,000 units 3 times per year… works, but might not absorb well in such high amounts. With your low cholesterol, this may further deepen the vitamin deficiency that almost everyone has. Get some 1000mg tabs and take 5000 a day for 1 week then down to 2000 and see if you notice anything. Those with dark skin in colder climates are at severe risk.

Some people can have severe problems with statin drugs and low cholesterol, depression, dry skin, loss of libido, weak immune system, hair falling out. These things are not just theory. Happened to some one close to me. Stopped the statin drug and was better in 2 weeks and normal in 4. This was caused by total cholesterol of 160. Your body needs fats and cholesterol. The drug companies tell you that low cholesterol will make you live longer… but at what cost to QOL and perhaps you die from the effects of low cholesterol instead of a heart attack. That is totally consistent with the goal of statin drugs. And low CoQ10 can lead to congestive heart failure… a terrible way to die… but still not a heart attack.

E dominance can kill mood and lead to apathy, social withdrawal and depression.

[quote]KSman wrote:
Altered liver metabolism can reduce the liver’s ability to remove E2 from the body. Might be a connection to the “excessive drinking” which is thought to increase T, thus lowering E in some cases. Review your meds for liver impact.
[/quote]

I’m not taking any prescription meds. The only supps I use are ZMA, Flameout, BETA-7 and lots of Metabolic Drive. And I’ve only had 2 glases of wine since Jan 11th. So I’m not sure why my liver enzymes are high.

I noticed that both E2 and Free T are in pg/mL. Is this the ratio of T/E that’s important? Since my E2 is 22, and my Free T is 7.9, there is about 3x more estrogen available in my blood than testosterone, correct?

I guess it’s kinda like being depressed. If you are always depressed, you get used to it, and can function mostly when you force yourself.

For years I’ve been sedentary and had no motivation to train. But I made a commitment to stick to it this time, and I have a strong will. Just judging from pictures I’ve taken along the way, I’ve not gained any muscle mass over the last 4 months of training, but I thought that was just from the low-carb, lower-cal diet I’ve been following. Now I wish I’d known about the low T a long time ago. I can’t imagine the progress I could have made with even normal T levels. The weight loss results are from being strict, I’ve had one cheat mean in 4 months. Every other meal has been exactly as planned.

I’ll make a not of this to discuss with the urologist Monday.

[quote]
Note that cholesterol is the substrate for pregnenolone leading to DHEA and neural steroids important for brain health [and mood]. Other important hormones are based on cholesterol. Low cholesterol can cause hormone problems. Get tested for DHEA-s. If that is crashed, you need to supplement with DHEA and pregnenolone [do not confuse with progesterone].

Vitamin D is based in cholesterol via a complicated chain of processed. The body stores this for months from sun exposure. I in the winter you can run out. Vitamin D is converted into vitamin D hormone and all of the cells of the body have receptors for this hormone. Lack of vitamin D weakens the immune system and is a factor in TB infections and recovery. Other adverse effects are higher rates of heart attacks and MS in colder climates where one does not get enough sun exposure [in the winter]. Most need 2000iu per day. It is not toxic. One can take 100,000 units 3 times per year… works, but might not absorb well in such high amounts. With your low cholesterol, this may further deepen the vitamin deficiency that almost everyone has. Get some 1000mg tabs and take 5000 a day for 1 week then down to 2000 and see if you notice anything. Those with dark skin in colder climates are at severe risk.

Some people can have severe problems with statin drugs and low cholesterol, depression, dry skin, loss of libido, weak immune system, hair falling out. These things are not just theory. Happened to some one close to me. Stopped the statin drug and was better in 2 weeks and normal in 4. This was caused by total cholesterol of 160. Your body needs fats and cholesterol. The drug companies tell you that low cholesterol will make you live longer… but at what cost to QOL and perhaps you die from the effects of low cholesterol instead of a heart attack. That is totally consistent with the goal of statin drugs. And low CoQ10 can lead to congestive heart failure… a terrible way to die… but still not a heart attack.

E dominance can kill mood and lead to apathy, social withdrawal and depression.[/quote]

I didn’t think 148 was all that low for the cholesterol, since it was almost exactly in the middle of the range in the lab report. I’m not taking any statins to lower it. It’s just dropped to here naturally since I cleaned up my diet. I have been eating a dozen eggs per week, 0.5 pounds of chicken a day, and 1 pound of fish per day. That’s all the sources of cholesterol I have in my diet.

Maybe I need to add in some gamey red meat?

And I probably am vitamin D deficient, since it’s been an awful winter here in Ohio. The good news is I’m moving to San Diego in a month and will be getting plenty of sun. :slight_smile:

Thanks for all the info KSman! I’m taking notes and printing out some of the articles linked to from happydog to take with me to the urologist Monday.

Wilsonj,

Not that I’m a doc, but I have the same history as you. The liver thing will probably be fatty liver or Nonalcoholic steatohepatitis (NASH). It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. The doc will have to biopsy your liver to make sure.

Your weight loss will probably correct the liver enzyme thing. Keep up the good work and good luck with the T stuff

[quote]j_willy3 wrote:
Wilsonj,

Not that I’m a doc, but I have the same history as you. The liver thing will probably be fatty liver or Nonalcoholic steatohepatitis (NASH). It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. The doc will have to biopsy your liver to make sure.

Your weight loss will probably correct the liver enzyme thing. Keep up the good work and good luck with the T stuff [/quote]

Thanks for info j_willy3. Looking into fatty liver, I see the causes include rapid weight loss as well as obesity. Well, I’ve lost 56 pounds in 15 weeks, so that’s pretty rapid. And I was obese just 4 months ago :wink: I’ll have to wait until the new blood work from my primary care doc comes back to make sure there isn’t a major disease causing the problem. But I’m starting to think that I can wait another 6 months before worrying about the elevated liver enzymes. Unless of course the urologist thinks it’s related to the low T.

Wilson,

I was diagnosed with fatty liver at 37 (now I’m 47)I wasn’t as diligent as you and didn’t get the weight off. My SGPT was 114, SGOT was 83 when diagnosed. My liver was a train wreck! Had biopsies 5 years apart,and no relative change in scaring even though my weight went up. Docs put me on Avandia to make me more sensitive to insulin. Also gave me Actigal until my gall bladder went bad.

Started taking L-Arginine, Betanine, and Taurine, also E and lots of fish oil. All have been studied to help aid liver function according to info given to me by my liver doc. Somewhere I have some info from a doc that specializes in environmental medicine that promotes an additional supplement. I will try to find it.

Now the docs are saying fatty liver is a component of metabolic syndrome.

Anyway let your body settle out and take the tests for hepatitis. I would bet if you keep your weight in line and stay on a low carb diet the liver function will be happy again. IF it is in fact fatty liver.

[quote]j_willy3 wrote:
Wilson,

I was diagnosed with fatty liver at 37 (now I’m 47)I wasn’t as diligent as you and didn’t get the weight off. My SGPT was 114, SGOT was 83 when diagnosed. My liver was a train wreck! Had biopsies 5 years apart,and no relative change in scaring even though my weight went up. Docs put me on Avandia to make me more sensitive to insulin. Also gave me Actigal until my gall bladder went bad.

Started taking L-Arginine, Betanine, and Taurine, also E and lots of fish oil. All have been studied to help aid liver function according to info given to me by my liver doc. Somewhere I have some info from a doc that specializes in environmental medicine that promotes an additional supplement. I will try to find it.

Now the docs are saying fatty liver is a component of metabolic syndrome.

Anyway let your body settle out and take the tests for hepatitis. I would bet if you keep your weight in line and stay on a low carb diet the liver function will be happy again. IF it is in fact fatty liver.[/quote]

The primary care doc just called and said all the hepatitis tests came back negative. Whew! She also said that the ggt test came back normal, so she doesn’t think the liver is damaged from the drinking I used to do. She suggested we wait 4-6 weeks, keep my weight down during that time, and retest. I’m prone to agree with this diagnoses.

On the other hand the Urologist doesn’t think my test levels were all that low. At that point almost laughed. But he did agree that testosterone supplementation was a viable option, and wrote me a prescription for Androgel. Unfortunately when I went to fill the script, Anthem didn’t want to cover it. So I’ll have to wait 3-5 days while the pharmacy faxes some paper work to the urologist, who will have to send it to the insurance company, to approve the drug.

He gave me another prescription to get my Free and total T, as well as E2, taken again one month after starting the gel. So at least that will be covered and I can see the results of the gel for myself. I’m worried about the E2 wihtout using an AI, and he seemed to just dismiss it without much thought. We’ll see.

Okay, my doc finally, after 2 months, returned my phone call. I had blood work done 2 months ago, and he is just getting back to me. The 5mg Androgel that I’ve been taking for 4 months now has had the following effect:

total T: from 255 to 413
free T: from 7.9 to 13.1
E2: from 22 to 47

Well, the ratio of free T to E2 has actually gotten worse. For the 1st 2-3 weeks I was using the gel, I felt awesome. Libido was sky high, well at least for me. But after that it fall off drastically. And the last couple months have been just enough to get by, but not what it should be, certainly not what I was experiencing at the start.

But the doc seems to think that the new numbers are good enough. I can’t convince him to switch to test injections, or an AI. I have a feeling that he thinks, after seeing me in the office at 9% bodyfat, that I’m just trying score legal test.

So now that I’m in a new city, I’m giving up on him. Anyone know a good doc to conact about HRT/hypogonadism in San Diego? I’ll try calling around for the docs that are in my network out here, but I’d sure like some leads. Please do not post the doctor information here in the forums. After hearing how doctors who prescribe T injections are treated, I’d rather not see any heat brought upon these physicians who are doing their best.

Please PM me the information instead. I’m desperate here and don’t want to resort to heading to Mexico for my medical needs.

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Slightly offtopic: Wait, is it possible to have low BF% and be quite muscular and strong and yet have LOW T levels?

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[quote]acidhell wrote:
Slightly offtopic: Wait, is it possible to have low BF% and be quite muscular and strong and yet have LOW T levels?[/quote]

The Urologist, after I explained my symptoms, didn’t even believe I had low T. He basically said by looking at me I was fine.

It wasn’t until I showed him the lab work that primary care doctor had ordered until he agreed on HRT.

As for my physique, it’s all from the diet. I’ve never eaten as clean as I have for the last 8 months. I can count on my two hands the number of cheat meals I have had this year. Of course I put in my time in the gym, but I’ve done that before. It wasn’t until I fixed my diet that I’ve been able to get to my current state.

From a general standpoint, I’d ask you how do natural females athletes get shredded and muscular? Same way we all do, hard work under iron and strict diets.