T Nation

"Blood Work Perfect" Need 2nd Opinion

I’m new to TRT and have been reading trying to get as much info as I can but have ran into a few things I would like a second opinion on. I’m 35 years old, 6’5" 288 lbs. I’ve been using TRT for about 3 months now with a starting T of 225 Endo Dr started me on .3 ml Cyprionate twice a week. Within 3 weeks of being on TRT I gained 15 lbs without changing any diet. After reading around online it seems like that’s not abnormal to gain weight at first so I didn’t worry to much.

Around 6 weeks after starting I really didn’t feel much better and actually starting getting short of breath for no apparent reason. I scheduled an appointment with Endo Dr and did blood work and my T level was a 440 and he bumped me up to .4 ml and said the shortness of breath wasn’t from the Cyprionate.

For the past 6 weeks I have been trying to eat much better cutting out almost all fried food eating tons of fruit and vegetables and only a couple of beers a week with 0 weight loss. I don’t go to the gym but own a lawncare company where I get plenty of walking in normally 7-10 miles a day. I had blood work done a couple weeks ago that I’ll attach at the bottom of this post. My T level is now 877 but can’t honestly say I feel much better than when it was 225.
My main concerns are the shortness of breath, my cholesterol has been on the higher side but the last blood test on 6/2/17 looked horrible and GP wants me to get back on statin. I’m hoping with the eating better and fish oil I can get cholesterol in check without statins. I know exercise will help this, but with shortness of breath without exercising it concerns me. I appreciate your help. The knowledge y’all have on this is amazing! Please let me know if I left anything out or if there are anymore questions. Thank you!

I am not a doctor so please do not take this as medically sound commentary or advice.

Shortness of breath is a serious thing for sure. Can you say more about it? What is your blood pressure? Oxygen saturation (typically given by a sensor on the little finger)?

There are several general categories of things that could do this besides the obvious (COPD, arterial blockage, etc). Off the top of my head the biggest 3 are:

1 is pneumonia, which is unlikely because you don’t have any other symptoms of it or infection (fever, cough, etc)
2 is some type of lung cancer (not likely, but you want to get checked out)
3 is some type of interstitial lung disease

There are most likely others. It is possible that you are having an allergic reaction of some kind to one of the ingredients in the TRT preparation (not the testosterone itself, but some other item). An allergic reaction will most likely stop with a change in medication type or cessation of the test cypionate.

I’d really recommend a chest X-ray and heart stress work-up to eliminate the really bad options of heart problems or cancer. Chest X-ray could also shed light into pneumonia or interstitial lung disease.

Has the shortness of breath gotten noticeably worse in the past 6 weeks vs the 1st 6 weeks you were noticing the shortness of breath?

I’m going to say that even if you are 100% good to go on heart and lung via the work up, you need to lose weight. Carrying significant amounts of extra fat can cause shortness of breath even in the absence of COPD or heart/lung disease.

Of course you need to make sure those are not factors before getting a doctor to sign off on you working out. But it’s also possible the shortness of breath is due to the extra 15 lb you just put on. You need to get down in weight.

Also, your vitamin D is very low for a guy who spends all his time out on site in the sun. It’s not technically deficient but it certainly gives me pause. Deficiency in vitamin D is linked to a number of health issues including heart disease. Medically obese people also see low vitamin D levels because fat cells draw it out of the blood stream and can sequester it. Another reason to lose weight.

It took me 10 weeks to “start” feeling a little better, slow improvements over time for a lot of guys. Some people respond in a few weeks while other’s take MONTHS. Don’t get discouraged.

Do not ignore the last paragraph in this post.

It is torture trying to read those lab shots. Try it!

You should not be showing your name in these. You can directly edit the above post, find the pencil icon below it.

Did you have LH/FSH tested before starting TRT? Cannot test LH/FSH after starting TRT. But a one time FSH can screen for a FSH secreting testicular cancer, if FSH not near zero, there is a problem.

Are you OK loosing fertility? Did doctor discuss this with you?

You need these labs:
TT <-- often does not tell the whole story
FT <-- the active hormone
fT4 - please not T3, T4 watch what doctor writes on lab ticket.
AM cortisol, do this at 8AM or one hour after waking up.

Is this a seasonal problem? Exposure to pollen, dust, mold and law chemicals?

Take 5000iu Vit-D3, find tiny 5000iu oil filled gel capsules. Take 25,000iu first 5 days, 5000iu thereafter.

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

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I went to the urgent care yesterday b/c I woke up feeling short of breath that seemed to get worse throughout the day. They did an EKG, chest Xray and some blood work which all came back perfectly normal. I feel like my anxiety is probably causing a bunch of these symptoms since I’m feeling worse I’m thinking something else is wrong with me. I understand the weightloss and I was hoping the TRT was going to be the stepping stone to help that, but it seemed to go the complete opposite way and instead of this positive effects TRT was supposed to bring it seemed like I got none of those.

KSMAN I’m sorry about posting my labwork like that I wasn’t sure how everyone else was posting their numbers. I’m assuming they are typing everything in? I will delete them now. I didn’t have LH/FSH tested before starting TRT. I had a vacectomy done 6 months ago so I’m not worried about that anymore. I am taking 5000 IU of Vitamin D ( I didn’t take 25000 for the first 5 days) now but I’m unsure why I would be low in D since I spend most of my time outside. I feel like the shortness of breath is linked to anxiety worrying about why I feel the way I do. They did some more blood work yesterday at urgent care but only a few things of what you asked for.

ALT 50 range 10-47
AST 37 range 11-38
E2 27.2 range less than 60.7
TSH 1.84 range .34 -5.60 (from year ago)

As far as ordering these other test would you recommend going though my PCP? The Endo Dr I am seeing doesn’t seem to feel like any of these issues are caused from the TRT and doesn’t seem as open to help me get on the right path since my “numbers are perfect”

I will check my temperature mid day today and the next couple of mornings but first thing this morning my temperature was 97.1. I’ve always had low temps but noone has ever mentioned it could be a problem.

I have checked my temperature several days before getting out of bed and my temperature has been 96.8-97.1. My mid day temp has average in the 97.9-98.2 range. My Dr had me do a 24 hour Urine sample to test for Cortisol but I saw that you recommendation was to have AM blood work instead. He tested my TSH T3 and FT4 last week and I’ll post those results at the bottom of this post. My GP feels like I should come off the TRT for the fact I haven’t seen any improvements other than a little better sex drive. I have gained 20 lbs in 3 months and with eating good and light exercise I haven’t lost any weight. I am planning on having the rest of the blood work done you asked for August 1 when our new insurance goes into effect but was hoping you could get some insight from the work that I had done last week? Thank you for your help

TSH 1.45 range .34-5.60
Thyroxine 7.39 range 5.1- 14.1
T3 119 range 80-200
ALT 51 range 17-63
AST 27 range 15-41

With the fish oil and better diet all my lipids are almost back at the pre testosterone numbers which weren’t great but much lower than when we tested them a month after starting TRT.

I got my 24 Hour Urine Cortisol test results back.

CORTISOL-RATIO TO CRT 11.06 ug/g Less than 32 ug/g
CORTISOL,URINE FREE UG/D 24.2 Reference range: <=60.
CREAT,URINE MG/DAY 2192 Reference range: 1000 to 2500

My GP suggested that I came off the TRT for a few months since it doesn’t seem like it has done any positive for me. I still feel like I am Iodine deficient but am unsure how much I should take? Does anyone have any suggestions for me?

Three and a half months is not enough time to reach maximum benefits of TRT, I see a lot of guys give up TRT because they expect immediate results. The longer you’re on it the more benefits you get out of it. It sounds like you’re just starting to see results and are ready to stop it, everything you mention about weight gain and little better sex drive is very common in the early stages. Longer you’re on it…

I understand that 14 weeks isn’t enough time to see maximum benefits from the TRT but I thought I would have seen some improvements. Only thing I have really seen is the 20 lbs in weight gain and a slightly harder erection. I feel like there is something else going on that is making me feel the way I do that’s why I started researching Iodine deficiency. I’m just confused if all my thyroid blood work looks good and my morning temps are less than 97 degrees does that mean I’m lacking Iodine?

You say no improvement, but then you say your erections are slightly harder, is that not an improvement? Some of that extra weight is likely muscle even though you may not see it and the rest water retention which goes away after some time. I see a lot of guys quit to early because they want relief right now and TRT doesn’t workout like that.