T Nation

Bloodwork, Low T

I’m 30, 5’9 and about 160 pounds. My waist is about 33 inches and I have no idea about bodyfat levels. I’ve been lifting consistently for the past 2.5 years and have made some slow gains doing a variety of programs, starting strength, doggcrapp (way too early, but they had so many cool articles on it!) and for about the past 9 months or so, the 5/3/1, which I really enjoy. I’ve stuck pretty strictly to a carb cycling diet and have added in sled dragging twice a week. I’ve also been reading the over 35 forum for a while and have seen a lot of the effects of low testosterone in myself. So I finally went and had some bloodwork done to see what the hell was wrong. Here are the results.

Estradiol: 32, range 13-54.

Testosterone total: 279, range 250-1100
% Free Testosterone: 2.58%, range 1.50-2.20
Testosterone Free: 72, range 35-155

Cortisol: 0.19, range .07-0.93
Vitamin D: 46, range 20-100

Thyroid Panel
Throxin-T4: 9.4, range 4.5-12.5
T3-Uptake: 34%, range 27.8-40.7
CFT4: 3.3, range 1.6-3.7
TSH: 1.73, range .4-4.50

Lipids
Trig: 56
Chol: 175
HDL: 39
LDL: 125, range 0-100
Cholesterol/HDL Ratio: 4.5, ratio 0-5

The followup appointment was a bit of a disappointment. The Dr seemed interested in prescribing the Androgel and I guess I made the mistake of asking about the other components that I had read about on here, arimidex and HCG. That seemed to scare him away and he gave me a referral to an endocrinologist. I ended up making an appointment with a local anti-aging doctor instead that the compounding pharmacies said prescribed the HCG. I may see the endocrinologist as well, since apparently you have to do a lot of fishing to get what you actually want from a doctor. I won’t be seeing the anti-aging specialist for several weeks and am wondering if there is anything that I should be doing in the meantime, or should I just wait it out? It bothers the hell out of me that I’ve probably had the low testosterone all my life and am just now finding out about it.

Oh and as for the iodized salt, I’ve been using Kosher salt for a while now (thanks stupid Foodnetwork), but have just bought a tub of regular Morton’s iodized salt. Also no head trauma that I can think of.

Free T is released in surges and the exact value is not too important. If one is injecting T frequently, then a measure of FT is very representative. In your situation, TT is more indicative.

E2=32 is not bad, but you would feel better if it was lower.

Is that FT4 or CFT4?

B vitamins can increase HDL

Cortisol really needs to be uninterpreted in the context of time-of-day.

Write down your symptoms for the docs/

Thanks for weighing in KSman, much appreciated.

The sheet says CFT4.

I’m taking multivitamins now with the B in them, which I hadn’t been doing for a while. Hope that helps the cholesterol. It was funny, the wife had her cholesterol results at the same time as mine - she had a HDL of 80 and a LDL of about 40. We eat the same foods and her levels were so much better!!

Let me see if I can explain the cortisol slightly better. The cortisol number was 0.19 mcg/dl. The range from 8:00-10:00 am was 0.07-0.93 mcg/dl. My blood was drawn at 11:30 am, if that makes a difference.

The anti-aging doc charges around $450 for the initial visit, plus any extra labs. Supposedly insurance may reimburse some of that (50-80% they said). Not sure if this is the right way to go rather than taking my chances with an endocrinologist and only having to pay the $35 co-pay. All I really want, after reading the stickies on here, is to get a doctor to prescribe the HCG so my poor balls don’t rot off.

[quote]Groats wrote:
Thanks for weighing in KSman, much appreciated.

The sheet says CFT4.

I’m taking multivitamins now with the B in them, which I hadn’t been doing for a while. Hope that helps the cholesterol. It was funny, the wife had her cholesterol results at the same time as mine - she had a HDL of 80 and a LDL of about 40. We eat the same foods and her levels were so much better!!

Let me see if I can explain the cortisol slightly better. The cortisol number was 0.19 mcg/dl. The range from 8:00-10:00 am was 0.07-0.93 mcg/dl. My blood was drawn at 11:30 am, if that makes a difference.

The anti-aging doc charges around $450 for the initial visit, plus any extra labs. Supposedly insurance may reimburse some of that (50-80% they said). Not sure if this is the right way to go rather than taking my chances with an endocrinologist and only having to pay the $35 co-pay. All I really want, after reading the stickies on here, is to get a doctor to prescribe the HCG so my poor balls don’t rot off.[/quote]

I feel for you as many people do not get the proper help they need. I know of a good dr that may take your insurance and is excellent in adrneal and thyroid issue as well as getting down to the main cause of the problem. He is not hesitant to prescribe the necessary drugs to get you functioning properly again. He also looks into several other factors that other dr’s totally forget about such as nutrition, lifestlye, and looks at you from a holistic stand point but is not afraid to order adex, hcg, T, or cortef in needed. Anti aging places are a rip off and they do not do indivudlized programs like this dr does. Pm me for details.

Thanks Hardasnails, I sent you a pm.

Got a call from the anti-aging doctor regarding the labs and questionnaire I sent in. She was concerned about the low testosterone at my age (30) and seemed to think that it was likely caused by adrenal fatigue. At our appointment next tuesday she said that she would consider having me run a few tests including the all day pee in a jar one and some saliva tests (I think to check overall T levels and thyroid/cortisol). I hope that I can bring my pee jar to work and show it off. That’s going to be fun!!

Did some research on my own about adrenal fatigue and didn’t find a whole lot in terms of treatments. Most of what I’ve seen involves taking vitamins and supplements. I also read that adrenal fatigue was invented by supplement companies to sell more of their products. But you read a lot of crazy stuff on the internet, so it’s tough to know what’s true.

What she did say that made a lot of sense was the idea of fixing whatever is causing the low testosterone rather than just treating the symptoms.

[quote]Groats wrote:
Thanks Hardasnails, I sent you a pm.

Got a call from the anti-aging doctor regarding the labs and questionnaire I sent in. She was concerned about the low testosterone at my age (30) and seemed to think that it was likely caused by adrenal fatigue. At our appointment next tuesday she said that she would consider having me run a few tests including the all day pee in a jar one and some saliva tests (I think to check overall T levels and thyroid/cortisol). I hope that I can bring my pee jar to work and show it off. That’s going to be fun!!

Did some research on my own about adrenal fatigue and didn’t find a whole lot in terms of treatments. Most of what I’ve seen involves taking vitamins and supplements. I also read that adrenal fatigue was invented by supplement companies to sell more of their products. But you read a lot of crazy stuff on the internet, so it’s tough to know what’s true.

What she did say that made a lot of sense was the idea of fixing whatever is causing the low testosterone rather than just treating the symptoms. [/quote]

i be cautious about the term antiaging dr’s because they are some times out for one thing your wallet and loading you up on supplements making you psychologically dependent upon them.

If you were you I would do 24 hour adrenal saliva cortisol test with comprehensive thyroid panel which I have already mention as well as a list of test that I have suggested in many threads then collect the data and let who ever come up with a came plan. I always look at adrenal and thyroid first then sex hormones. Some times taking care and identifying the stress which could be numberous things can resolve adrenal and other issues. Also you need to look to see what nutrients you could be low in. Actually alot of stress I see is from unresolved gi issue and hidden food allergies that can cause a huge mess load of intestinal inflammation that may not show up on a GI endoscopy. I these people I suggest a gluten free diet and with in days they will feel better if that is the issue and they are following it religiously. As health consultant it my job to find out where the problem lies then go after the root cause while supporting other proper systems.

I feel you dude, my initial blood test results showed my t-level at 265 (I think, 260’ish) and they said that it was close enough and weren’t going to do anything. I told the nurse that I feel like crap and I have all of the symptoms of T-Deficiency and wanted something to be done. It sucks, we pay all this money for insurance and still have ridiculous co-pays and stuff, we should have to fight liek this to get what we need.

[quote]Jaynick77 wrote:
I feel you dude, my initial blood test results showed my t-level at 265 (I think, 260’ish) and they said that it was close enough and weren’t going to do anything. I told the nurse that I feel like crap and I have all of the symptoms of T-Deficiency and wanted something to be done. It sucks, we pay all this money for insurance and still have ridiculous co-pays and stuff, we should have to fight liek this to get what we need.[/quote]

What Dr’s do is to look for the cause and treat that then rather try to use TRT as a temporary bandaid for something else. Dr’s just need to take time to dig, but inorder to find a good one it is very difficult. They just want to push you in and out of the offie really quick and run just a few tests. The results come back “normal” and you vicitim of the system like many others. TEll you truth if you have a HMO you will get treated much less then a person that has a PPO because in dr’s eyes it is not worth time and effort why they keep visits to HMO. For what we do we do not accept HMO for the fact that the complexity of the cases require not the average 15 miniutrs by much much more time.

[quote]Hardasnails wrote:

[quote]Jaynick77 wrote:
I feel you dude, my initial blood test results showed my t-level at 265 (I think, 260’ish) and they said that it was close enough and weren’t going to do anything. I told the nurse that I feel like crap and I have all of the symptoms of T-Deficiency and wanted something to be done. It sucks, we pay all this money for insurance and still have ridiculous co-pays and stuff, we should have to fight liek this to get what we need.[/quote]

What Dr’s do is to look for the cause and treat that then rather try to use TRT as a temporary bandaid for something else. Dr’s just need to take time to dig, but inorder to find a good one it is very difficult. They just want to push you in and out of the offie really quick and run just a few tests. The results come back “normal” and you vicitim of the system like many others. TEll you truth if you have a HMO you will get treated much less then a person that has a PPO because in dr’s eyes it is not worth time and effort why they keep visits to HMO. For what we do we do not accept HMO for the fact that the complexity of the cases require not the average 15 miniutrs by much much more time. [/quote]

I agree, but I had gone through six-months of testing at that point; I even did a sleep study.

[quote]Jaynick77 wrote:

[quote]Hardasnails wrote:

[quote]Jaynick77 wrote:
I feel you dude, my initial blood test results showed my t-level at 265 (I think, 260’ish) and they said that it was close enough and weren’t going to do anything. I told the nurse that I feel like crap and I have all of the symptoms of T-Deficiency and wanted something to be done. It sucks, we pay all this money for insurance and still have ridiculous co-pays and stuff, we should have to fight liek this to get what we need.[/quote]

What Dr’s do is to look for the cause and treat that then rather try to use TRT as a temporary bandaid for something else. Dr’s just need to take time to dig, but inorder to find a good one it is very difficult. They just want to push you in and out of the offie really quick and run just a few tests. The results come back “normal” and you vicitim of the system like many others. TEll you truth if you have a HMO you will get treated much less then a person that has a PPO because in dr’s eyes it is not worth time and effort why they keep visits to HMO. For what we do we do not accept HMO for the fact that the complexity of the cases require not the average 15 miniutrs by much much more time. [/quote]

I agree, but I had gone through six-months of testing at that point; I even did a sleep study. [/quote]

I have several guys on antidepressants that once we got hormones balanced with help of their psyhchiatrist they were able to lean off them over a month or so. One guy was on 4 different kinds after proper hormone an thyroid manipulation and open mind shrink he is now fine. Again some people do need them not saying no all do not need them. It is just found that people can reduce them or even stop them when thyroid, adrenals, and sex hormones.

Well as it turns out my health insurance won’t reimburse anything from an out of service provider, which is unfortunately what my appointment tomorrow is for. There’s no way I’m eating the whole cost for who knows what. I ended up making an appointment with an endocrinologist at Georgetown at the end of next month. In the meantime I will probably keep looking for alternatives. It’s going to be a long month if I will have to feel like crap for all of it.

I’m curious about the treatments for adrenal fatigue, because I haven’t seen a whole lot in terms of actual medication. Most of what I’ve seen are crazy things like licorice and ginger or ginseng. Maybe that works, but I guess I’ll wait on experimenting until I can talk to a medical professional.

[quote]Jaynick77 wrote:
I feel you dude, my initial blood test results showed my t-level at 265 (I think, 260’ish) and they said that it was close enough and weren’t going to do anything. I told the nurse that I feel like crap and I have all of the symptoms of T-Deficiency and wanted something to be done. It sucks, we pay all this money for insurance and still have ridiculous co-pays and stuff, we should have to fight liek this to get what we need.[/quote]

That sucks man, it looks like we’re both stuck playing doctor roulette and jumping through hoops until we find somebody worthwhile. Good luck in your search!

[quote]Groats wrote:

[quote]Jaynick77 wrote:
I feel you dude, my initial blood test results showed my t-level at 265 (I think, 260’ish) and they said that it was close enough and weren’t going to do anything. I told the nurse that I feel like crap and I have all of the symptoms of T-Deficiency and wanted something to be done. It sucks, we pay all this money for insurance and still have ridiculous co-pays and stuff, we should have to fight liek this to get what we need.[/quote]

That sucks man, it looks like we’re both stuck playing doctor roulette and jumping through hoops until we find somebody worthwhile. Good luck in your search![/quote]

I’m just glad my insurance allows me to go to a specialist without referral. She started to treat me but wanted to change my dosage to 400mg once a month! 200mg every two weeks wasn’t enough and 400mg every two weeks wasn’t enough… I was like FUCK THAT and found myself a specialist in a hurry.

[quote]Groats wrote:

[quote]Jaynick77 wrote:
I feel you dude, my initial blood test results showed my t-level at 265 (I think, 260’ish) and they said that it was close enough and weren’t going to do anything. I told the nurse that I feel like crap and I have all of the symptoms of T-Deficiency and wanted something to be done. It sucks, we pay all this money for insurance and still have ridiculous co-pays and stuff, we should have to fight liek this to get what we need.[/quote]

That sucks man, it looks like we’re both stuck playing doctor roulette and jumping through hoops until we find somebody worthwhile. Good luck in your search![/quote]

Dealing with adrenal fatigue is not that difficult.
The first thing one needs to do is to intentify where those stressors are coming from (past or present emotional or mental distress, nutritiional imbalances, thyroid issues, sleep patterns, hiddden infection, heavy metals, enviromnemntal toxins, ect) The first thing I would look at in a big guy like you would be insulin resistance and sleep apnea which can be caused by low thyroid and or adrenal issues.
To idenitify the adrenal issues I would recommend getting a ZRT lab adrenal cortisol saliva done for your own reference and then from there you will have a better idea of what you are dealin with . Sleep apnea test would also be advisable from your dr as I am seeing more and more guys showing up with this disorder early in life (mid 30’s even) !!

Get this book:

The subject and issues are too large to manage in a post. You need to read the book. There are no medications to fix this. Do not expect to find a doctor who will understand this or manage this for you.

DHEA can be helpful. DHEA-S lab results will indicate a deficiency or adequacy of dosing.

[quote]KSman wrote:
Get this book:

The subject and issues are too large to manage in a post. You need to read the book. There are no medications to fix this. Do not expect to find a doctor who will understand this or manage this for you.

DHEA can be helpful. DHEA-S lab results will indicate a deficiency or adequacy of dosing. [/quote]

Got the book and read through it. You’re right, there’s no quick fix and no doctors to help. It’s interesting how a lot of what’s in there doesn’t apply to me. According to the survey I only have low to moderate adrenal fatigue. I get 8 hours of sleep a night, don’t have any respiratory issues, no traumatic events (knock on wood), eat well, don’t drink coffee (mostly water and green tea). I do have a nightmare of a boss and upper management, 3 hours of commuting and a fairly toxic work environment - all things that are difficult to fix.

The Elisa food allergy test looks promising, but my diet is pretty plain. Basically the AD with post workout carbs. I’ll give the gluten free a try and see how that goes, that’s a great idea.

What I’m left wondering is how much can low adrenal or thyroid or food allergies be responsible for the low testosterone numbers? Would having all of those in order cause the T numbers to rise to something more acceptable, say 800+? I’m just thinking that it could be possible to have everything fixed, but still need to do the TRT anyway.

Thanks again for everyone’s input and thanks for the patience with putting up with my questions.

I think that the issue is co-morbidities. Some guys have low T and also have a low adrenal hormones [and/or thyroid]. I think that you have a T problem, not just T lowered by adrenal issues. It is well known that weak adrenals cannot support the increased metabolic demands created by TRT.

[quote]KSman wrote:
I think that the issue is co-morbidities. Some guys have low T and also have a low adrenal hormones [and/or thyroid]. I think that you have a T problem, not just T lowered by adrenal issues. It is well known that weak adrenals cannot support the increased metabolic demands created by TRT.[/quote]

thank you Ksman i have trying to tell many people that but i have been getting met with resistance and ridicul from people on another forum. If your adrenals are weak and you are older then going on TRT and supporting the adrenals and or thyroid is the proper protocol to follow. With younger guys I start them on clomid if they are able to produce and before doing this adrenals and thyroid are check as well supported at same time clomid restart is begun. The back bone nutritionally is also put into place to provide the building blocks for hormone production. If you kick start and have no foundation to keep you going you chances of success will drop trememndously as I have seen in the past with people that have tried restarts from other dr’s. Once the other components where put in place success rate went up.

Just got back the partial results from lab work done about a month ago. I’m still missing a few things like SHBG and IGF levels. Who knows when or if those will come.

Here is what I have so far:

Ferritin: 233 ng/ml, range 20-345
Cortisol: 14.2 mcg/dl, range 3.0-17, this was taken in the PM

Pregnenolone: 34 ng/dl, range 13-208
Prolactin, serum: 7.2 ng/ml, range 2-18

LH: 1.8 mIU/ml, range 1.5-9.3
FSH: 2.4 mIU/ml, range 1.6-8

Estradiol: 42, range 13-54

DHEA, LC-MS-MS: 132 ng/dl, range 61-1636. Not sure if this is DHEA-S, it doesn’t look like it.

17-OH- Progesterone: 33 ng/dl, range 32-307

Androstenedione, 59 ng/dl, range 50-220

Total T: 218 ng/dl, range 250-110
Free T %: 1.97%, range 1.5-2.2
Free T: 42.9 pg/ml, range 35-155 (these were taken in the afternoon so are understandably low)

Gliadin AB IGA: <3 U/ml, <11 is negative for Coeliac

Lyme test was negative

Pituitary and brain MRI were negative. Well there was a brain in there, really. But apparently nothing was wrong with any of it. My wife would probably argue with you on that though.

Vitamin D in my last test was fairly high, around 50 or so I think, since then I have increased my vitamin D dose and felt somewhat better. Have switched to iodized salt, nightly ZMA and NOW Adam multivitamins.

I’ve got an appointment next week with an endocrinologist.

Would appreciate your insight on this.

Thanks!

Ft and DHEA are release in surges and the lab can catch highs or lows. TT and DHEA-S are less variable and are thus better measures of what is going on.

Your high E2 may be strongly HPTA repressive. Lowering E2 could improve your T levels and allow your T to work better. You need anastrozole to do this. With T so low, you can start with 1/4mg week - but I don’t know how you will do divided doses. You can try going to 1/2mg week later. If your body responds with more LH and T, the increased T should support the higher anastrozole dose. With all of your other problems, you do not want to suffer from low E2 levels.

Low DHEA indicates adrenal insufficiency. You need to take DHEA. Low DHEA can rate limit T production in some cases, but your low LH is already the controlling factor.

Low pregnenolone leads to low DHEA. Pregnenolone is made in the testes and low LH reduces that. Pregnenolone is otherwise made by the mitochondria in your cells. You can try acetyl-l-carnitine and r-lipoic acid to improve mitochondrial function. If that works, you will also have more energy. Fish oil will help cell wall permeability. You also need lots of anti-oxidants and b-vitamins.

These things might help and perhaps your HPTA can be restarted. Such an attempt can also use hCG or a SERM.

What is driving up E2? OTC or Rx drugs? Liver problems?

Any labs with “liver function markers”?