T Nation

Blood Work Scheduled for This Friday


#1

I'm muscular, 32 years old, 6 foot, 220 lbs, more than likely 20% bodyfat with a 35 inch waist. For the past 3 years, the following symptoms have gotten worse and worse until they're truly affecting the quality of my life:

-Fatigue, lethargy, no motivation or interest
-sadness
-mild depression
-anxiety
-insomnia
-low libido
-irritable/aggressive
-Regardless of diet and training, seem to store fat around waist/hips
-General weakness and dizziness

I'm going in on Friday for lab work to be done. Money is an issue and I have read the stickies. Below is what I was planning to get tested. Should anything be added or removed for my test on Friday? Any help is greatly appreciated! Thank you.

TT
FT
E2
prolactin
LH/FSH
TSH
fT3
fT4
CBC
ALT/AST
AM Cortisol


Thyroid Basics Explained
TRT Doctors in Chicago
Testosterone Cypionate
KSman is Here
KSman is Here
#2

Also, it looks as though KSman is unavailable currently. I would love any feedback/help from Bill Roberts and any other knowledgable/experienced posters. Thank you again for any help.


#3

You can check your body temperatures as per the thyroid basics sticky and if excellent, skip the thyroid labs. In any case, you need to make sure that your iodine and selenium intake is good and probably need larger amounts if you have not been using iodized salt for a long time.

Your symptoms can be from low T and/or low thyroid function.

You did not address OTC and Rx meds which can cause low T for some.

Stress is not something to ignore.

You list of labs is a good start to cover your symptoms.

With a constrained budget; self injected T is very effective and least cost. If you have thyroid problems, you may not be able to absorb transdermal T.

I was on the road for 11 days.


#4

[quote]KSman wrote:
You can check your body temperatures as per the thyroid basics sticky and if excellent, skip the thyroid labs. In any case, you need to make sure that your iodine and selenium intake is good and probably need larger amounts if you have not been using iodized salt for a long time.

Your symptoms can be from low T and/or low thyroid function.

You did not address OTC and Rx meds which can cause low T for some.

Stress is not something to ignore.

You list of labs is a good start to cover your symptoms.

With a constrained budget; self injected T is very effective and least cost. If you have thyroid problems, you may not be able to absorb transdermal T.

I was on the road for 11 days.[/quote]

Thank you for your response! I did follow 50 mg of iodine replacement for 2 weeks along with 200% recommended daily dose of selenium. My temperature slightly increased, but it stayed in the low 97 range and at times I awoke with temps in the low 96’s.

I always used iodized salt and believe that I have since birth (morton salt).

The only real RX meds I take on occasion are xanax for the anxiety.

Is it a stupid question to ask where in the world I would get “self injected T”? This is something that needs to be prescribed via a Dr, correct? I’d also prefer to avoid trans dermal as I have young kids and my wife is pregnant.


#5

Below is the lab work I’ve received back. . Any thoughts on the below lab work?

TESTOSTERONE TOTAL
240 to 950 Unit: ng/dL
394

TESTOSTERONE FREE
9 to 30 Unit: ng/dL
13

DEHYDROEPIANDROSTERONE SULFATE
65 to 334 Unit: mcg/dL
507 Note: Dr had me supplement with oral DHEA which I assume is why this number is so high

CORTISOL - AM
3.7 - 19.4 mcg/dL
15.2

CORTISOL - PM
2.9 - 17.3 mcg/dL
5.8

PROLACTIN
3.5 - 19.4 ng/mL
5.9

LUTENIZING HORMONE
0.57 - 12.07 mIU/ml
4.0

FOLLICLE STIMULATING HORMONE
0.95 - 11.95 mIU/mL
2.8

ESTRADIOL
11 - 44 pg/mL
26

T3 FREE
1.71 - 3.71 pg/mL
3.42

Free T4
0.7 - 1.5 ng/dL
1.2

THYROID STIMULATING HORMONE
0.35 - 4.94 uIU/mL
0.73

CALCIUM, SERUM
9.1 - 10.6 mg/dL
9.9

GLUCOSE
70 - 99 mg/dL
77

BUN BLOOD
8 - 25 mg/dL
15

PROTEIN TOTAL
6.5 - 8.0 g/dL
7.7

ALBUMIN
3.5 - 4.6 g/dL
4.3

BILIRUBIN TOTAL
0.1 - 1.2 mg/dL
0.6

ALKALINE PHOSPHATASE
29 - 128 U/L
78

AST/SGOT
10 - 34 U/L
24

SODIUM
135 - 145 mmol/L
141

POTASSIUM
3.4 - 4.9 mmol/L
4.2

CHLORIDE
99 - 110 mmol/L
106

CARBON DIOXIDE, VENOUS BLOOD
21 - 30 mmol/L
26

ALT/SGPT
10 - 44 U/L
50

CREATININE
0.7 - 1.5 mg/dL
1.1

EGFR, NON-AFRICAN AMERICAN

59.9 mL/min/1.73sq.m
88

EGFR, AFRICAN AMERICAN

59.9 mL/min/1.73sq.m
102

ANION GAP
6.00 - 12.00 MMOL
9

WHITE BLOOD CELL COUNT
4.0 - 10.8 K/uL
9.82

RED BLOOD CELL COUNT
4.5 - 6.1 M/uL
5.59

HEMOGLOBIN
14.0 - 17.0 gm/dL
15.3

HEMATOCRIT, POC
42.0 - 52.0 %
46.0

MEAN CORPUSCULAR VOLUME
81 - 99 fL
82.3

MEAN CORPUSCULAR HEMOGLOBIN
27 - 33 pG
27.4

MEAN CORPUSCULAR HEMOGLOBIN CONC
32 - 36 g/dL
33.3

PLATELET COUNT
130 - 400 K/uL
271

RDWSD
35 - 46 fL
38.8

MEAN PLATELET VOLUME
9.4 - 12.4 fL
11.3


#6

Bump


#7

Other than low-T, this stands out:
ALT/SGPT
10 - 44 U/L
50

Any muscle soreness or injuries at time if lab work?

Thyroid looks good, but with low body temperatures and IR completed, I have to wonder if rT3 is blocking fT3. If that were so, I would expect some higher TSH levels which you do not have.

Have you looked at stress and adrenal fatigue issues in thyroid basics.

DHEA–>DHT is very unusual. Cannot explain, but DHT is HPTA repressive and might be a factor, but I don’t think that it would be the primary cause of low-T. But if so, the solution is TRT to get T levels up. One could try a low dose 5-alpha reductase inhibitor [5AR] and watch interplay of lower DHT on LH/FSH and T; but that does entail some significant risks for the few who are vulnerable.

I have read claims that progesterone reduces 5AR activity. If this was a factor for you, this might imply that progesterone levels are low. Unfortunately, many?most progesterone labs do not resolve the low levels of males very well.

So you can see that I am looking at some odd possibilities and none may be valid. The only sure solution is TRT. With more T, there will be more FT–[5aR]–>DHT and DHT levels will increase. You may have more 5AR or an altered 5AR that is more effective.


#8

[quote]KSman wrote:
Other than low-T, this stands out:
ALT/SGPT
10 - 44 U/L
50

Any muscle soreness or injuries at time if lab work?

Thyroid looks good, but with low body temperatures and IR completed, I have to wonder if rT3 is blocking fT3. If that were so, I would expect some higher TSH levels which you do not have.

Have you looked at stress and adrenal fatigue issues in thyroid basics.

DHEA–>DHT is very unusual. Cannot explain, but DHT is HPTA repressive and might be a factor, but I don’t think that it would be the primary cause of low-T. But if so, the solution is TRT to get T levels up. One could try a low dose 5-alpha reductase inhibitor [5AR] and watch interplay of lower DHT on LH/FSH and T; but that does entail some significant risks for the few who are vulnerable.

I have read claims that progesterone reduces 5AR activity. If this was a factor for you, this might imply that progesterone levels are low. Unfortunately, many?most progesterone labs do not resolve the low levels of males very well.

So you can see that I am looking at some odd possibilities and none may be valid. The only sure solution is TRT. With more T, there will be more FT–[5aR]–>DHT and DHT levels will increase. You may have more 5AR or an altered 5AR that is more effective.

[/quote]

Thanks for your response! I didn’t have any major soreness or injuries. My Dr was slightly concerned about that marker as well and indicated that my blood was slightly acidic, more than likely due to food choices + stress which he indicated could also turn the body acidic.

I’m going to attempt to reduce stress and increase alkaline foods in my diet. I picked up Wilson’s book on adrenal fatigue and am about half way through it. My Dr also indicated he thought I did have some signs of adrenal fatigue indicated by my PM cortisol level, which he said he typically liked to see at half my AM levels. Mine was lower than that.

I was able to convince him to start TRT with me. He initially wanted to go to a sublingual bio-identical T replacement but because I wasn’t sure about insurance, I asked him if we could start with injection, which he agreed to. Any opinions on the sublingual bio identical T?

The first injection was 100 mg test cypionate. He indicated that most of his patients only need one injection per month, some every two weeks. My follow up appointment is 2 weeks from the day of my first injection (Thursday 2nd) , where he wants to talk about how I feel and assess from there.

The more research I do, I’m concerned about the valleys and peaks associated with TRT. I’m confident I can get him administer an every two week injection, but obviously I’d prefer at least once per week and ideally, self administered, to save time going in once per week, potentially injecting twice per week.

My Dr is open minded and reasonable, so I believe once I gain his trust over time, I’ll be able to get him to accommodate me, however is there anything anyone else has done to help speed the process? I know he wants to be cautious and conservative, but I’m tired of suffering and the idea of feeling even worse than before (via the “valleys”) is a bit daunting. This is one article I’ve found that supports at least once per week injection:

https://www.jstage.jst.go.jp/article/endocrj/53/3/53_3_305/_pdf

It’s also worth mentioning that perhaps it was placebo, but I felt substantially better the same day of the injection. Fatigue decreased, mental clarity increased, sex drive increased, anxiety decreased. I’m hopeful that this has been the missing link these past few years. Thank you again for any help and insight!


#9

Normal virile males produce around 10mg T per day, 70mg/week.

When you inject 100mg T cypionate, you get around 70mg after the cypionate ester group is removed.

So you should inject 100mg T cypionate per week, best as 50mg twice a week.

When you inject T esters in oil, the T ester is released slowly, a time release delivery and the ester groups get removed and you get testosterone and it is bio-identical. Many are very confused and mislead about this.

Sublingual is not going to work well for males. Perhaps to deliver small amounts for females.

See these stickies:

  • advice for new guys
  • thyroid basics

Please review my comments above re rT3, low body temperature etc.


#10

[quote]KSman wrote:
Normal virile males product around 10mg T per day, 70mg/week.

When you inject 100mg T cypionate, you get around 70mg after the cypionate ester group is removed.

So you should inject 100mg T cypionate per week, best as 50mg twice a week.

When you inject T esters in oil, the T ester is released slowly, a time release delivery and the ester groups get removed and you get testosterone and it is bio-identical. Many are very confused and mislead about this.

Sublingual is not going to work well for males. Perhaps to deliver small amounts for females.

See these stickies:

  • advice for new guys
  • thyroid basics

Please review my comments above re rT3, low body temperature etc.[/quote]

Thanks for your response and the info! I re-reviewed your comments on fT3 but thought you indicated that if rT3 was blocking fT3, you’d expect some higher TSH levels which I do not have?

So far my plan of attack is to get him comfortable with me and trust me. I don’t want to start all over and I know that it’s difficult to get a Dr to administer TRT in the first place. My Dr seems to want to be of service to me, is willing to dialogue and is reasonable. My only concern currently is he’s operating under the assumption that TRT only needs to be administered once per month or every two weeks.

I believe I can get him to inject every two weeks and possibly down the road once per week. I am however concerned about convincing him to allow me to self inject at home.

Do you agree to be patient for now and let him be cautious initially and grow to trust me and then ask for more, little by little down the road?

Worst case scenario, if he doesn’t operate in a way that’s conducive to my health, I suppose I’ll have to call around to the Dr’s in my network, explain that I’m on TRT and would like to self inject due to time constraints etc.

Does this seem like sound logic?


#11

If you are OK with the time it takes.


#12

Otherwise the best thing to do would be to call around and find other drs willing to let me self inject, hopefully find one, approach my Dr and if he disagree say good bye? Seems like the most time effective approach.


#13

Update:

It’s been about 6 weeks since my first injection. I’ve now convinced my Dr to allow me to self inject 100 mg test cyp, split twice per week.

I began to talk about holding water, being bloated and being concerned about aromatization of T to e2 and also hCG preventing the atrophy of my testes. This prompted him to want to find someone a little more well versed, another GP, but one that’s certified in the american institute of anti-aging medicine.

After speaking with the receptionist of new said Dr, she indicated that he often prescribes AI’s with his TRT patients.

Some things that I’m noticing that I believe I could have avoided with an AI and also hCG:

  • Water retention, specifically around my chest
  • Atrophy of the testes
  • A new type of fatigue that I’m unfamiliar with: My mind feels slow, sluggish and I have a difficult time working through complicated problems that were previously not an issue.
  • I have a difficult time getting out of bed in the morning and feel like I always nee coffee. I wonder if the TRT prompted a new stage of adrenal fatigue that the hCG could have helped me avoid?

#14

Not reviewing your case; TRT can make symptoms of untreated [iodine deficiency, hypothyroidism] worse.


#15

Yo, you check out the Kal progesterone cream for adrenal fatigue? I’m having amazing results with that + vit C.

PS: Fight for that HCG it definitely makes a difference. I went a couple weeks on bunk HCG and felt a lot worse. There’s always the indian pharmacy + prego test for checking if it’s real.

As for doctors I’ve gone to two naturopaths and simply through channeling KSMan I’ve convinced them in one visit to prescribe his protocol. I used the “call compounding pharmacies and ask who prescribes HCG” technique to find one of them. I also got my insurance to pay for all of this shit. Just gotta fight, this is a legitimate medical issue.


#16

Also, get your E2 checked again. You were at 26, which is good, but if it is high from the test it can make you lethargic, and if you are low form an AI, it can make you lethargic…libido is also affected from high or low E2.


#17

[quote]K_ wrote:
Yo, you check out the Kal progesterone cream for adrenal fatigue? I’m having amazing results with that + vit C.

PS: Fight for that HCG it definitely makes a difference. I went a couple weeks on bunk HCG and felt a lot worse. There’s always the indian pharmacy + prego test for checking if it’s real.

As for doctors I’ve gone to two naturopaths and simply through channeling KSMan I’ve convinced them in one visit to prescribe his protocol. I used the “call compounding pharmacies and ask who prescribes HCG” technique to find one of them. I also got my insurance to pay for all of this shit. Just gotta fight, this is a legitimate medical issue. [/quote]

Thanks for your response K. I did try progesterone cream in various ways. Initially I tried it at night at a dose of 5-20 mg. both doses induced a dream like thought racing vivid insomnia that made me feel very strange and badly the next day. I also tried it in the mornings but didn’t feel “better” or have more energy.

I’m very lucky that my initial GP who prescribed try and self admittedly didn’t know enough found another dr within my insurance network who has an anti aging clinic. I met with him last week and he was immediately concerned about my adrenals/cortisol, estradiol and lack of hCG in my current treatment. That day he ran blood tests and my follow up appointment is next week, so I’m hopeful I’ve found someone knowledgable who will finally work with me.


#18

[quote]The Myth wrote:
Also, get your E2 checked again. You were at 26, which is good, but if it is high from the test it can make you lethargic, and if you are low form an AI, it can make you lethargic…libido is also affected from high or low E2.
[/quote]

Thanks for your response myth. I’m in total agreement. I’d bet that my e2 is elevated. My e2 was 26 with a TT of 390. If my TT comes back doubled, it’s realistic that my e2 could now be around 50. I’m definitely experiencing problems that I believe are related to high estrogen and non existent LH.

I say this because I’ll tear up and get emotional if I watch a sad movie with my wife and have similar responses when I wouldn’t have otherwise. On top of testicular atrophy, a few days ago I added in a relatively high dose of pregnenolone (200 mg) and DHEA (100 mg) and within 1 hour the blurry vision lifted, my energy and balance returned and my mood improved. I’ve lifted the past 3 days in a row where I haven’t had the energy or desire for the past 3 weeks. It’s my understanding that my testes have more than likely stopped producing pregnenolone because LH is at or approaching zero and had hCG been in my protocol this wouldn’t have happened as it’s an analogue to LH.

Any other thoughts, ideas or tips are always welcomed.


#19

Just received half of my blood tests back:

9/1/15 after approximately 2 months on only test cyp 50 mg twice per week

Cortisol: taken around 11 am - 13.1
Cortisol Reference Ranges
AM Level: 6.7 - 22.6 ug/dL
PM Level: Less than or equal to 10 ug/dL

Estradiol 34
Estradiol Reference Ranges
Adult Males: <20 - 47 pg/mL

T4, Free 0.8
Reference Range 0.6 - 1.4 ng/dL

T3, Free 3.8
Reference range 2.5 - 3.9 pg/mL

TSH (Thyroid Stimulating Hormone) 3.04
Reference Range. 0.34 - 5.60 uIU/mL

Vit D, 25-Hydroxy, Total. 91.6
Reference range 30.0 - 100.0 ng/mL


#20

At first glance it appears that my e2 is slightly elevated, my cortisol is a bit low and my TSH skyrocketed since pre trt. Is this cause for concern?