T Nation

Bloodwork & TRT Cheatsheet


#1

I updated this OP on 28 April 2011 since things have grown possibly beyond the scope of this forum. What started out as concern about low hormones turned into me having testicular cancer...that diagnosis and follow-up treatment information starts on the bottom of Page 4 if anyone can benefit from it.

OP:

Cheatsheet

KSMAN has recently put together a good cheatsheet here:

http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/prototype_advice_for_new_guys?pageNo=0#4350862

The following information may be included, but is supplementary if not.


#2

I would go with the FT and perhaps add bio-T, just because most are not familiar with bio-T numbers. Note that bio-T and FT do track each other. Maybe your doc works with bio-T.

If Vit-D25 is low, you will take vit-D3. The level of vit-D3 might not be needed.

Doc may want to know what problems others in your family have such as diabetes and thyroid.

PSA detects prostate cancer and young men do not get that. PSA is neither an antigen or cancer specific. But useful just the same. Good to have a pre-TRT base line.

You would have been better off taking vit-D3 then have the test tell you something on top of the supplementation that almost all are needing.

Do you snore... tell the doc.

Sugar cravings, salt cravings, nails brittle

Adrenal and stress: the question was more of a concern about stress leaving you feeling beat-up or weak.

When did these problems start and did you have any blows to the head preceding that?

Do not get a DRE [digital rectal exam] before lab work [releases PSA]. No sex or masturbation prior to lab work as that can release prolactin.


#3

KSman, thanks for the input. Much appreciated.

My mother had diabetes temporarily while pregnant with my brother (he was a BIG baby) but it went away after she lost the baby weight. My dad's family has a few cases of it (his mother, uncle, and some cousins) but they all eat like shit and don't ever exercise. No thyroid problems that I know of.

Thanks for advice on PSA, I will add it. I just read in the Testosterone Toolbox article that it wasnt necessary for younger folks, but I agree on having a baseline.

I was supplementing with D3 throughout the winter, but stopped in early April cause I ran out and didn't start feeling crappy without it. Thought it might be a good idea to get my baseline without the supplement.

Snoring is real bad. My girlfriend wears earplugs and friends avoid having to share hotel rooms with me. What does this indicate?

I don't really crave sugar or salt, some candies but easily controllable. Nails seem fine.

Stress doesn't seem to leave me beat up or weak. I'm thinking adrenals are pretty decent.

I had a pretty bad concussion in high school from football (couldn't remember friends last names and didn't know exactly where I was, lined up on wrong side of the ball a couple time afterward), and have had at least one since then (don't remember how it happened, just that it did). Erection problems have occurred since I was young, but have gotten dramatically worse over the years. Other problems seem to have manifested after I quit playing sports in college and started drinking heavily (especially the disproportionate fat storage). Testicle pain has been about a year and a half now on and off (more off than on, until recently).

Roger that on putting the kebash on fingers in the ass! No problems there.

Thanks for all your help KS.


#4

So I had my first appointment this morning and it didn't go exactly as expected. I knew from the get-go that this doc wasn't the TRT-friendly type that the pharmacist had made him out to be. He nearly scoffed when I told him I thought my Total Testosterone of 479 (taken one year ago) was too low--the usual "in range" response.

He asked me questions about my snoring and depression (and family history of depression) and decided that I may have sleep apnea (entirely possible, admittedly) and that I may be depressed (possibly triggered by sleep apnea). He stated that he treats a lot of patients with depression (unsurprisingly).

So I have a night in a sleep tent coming up in my near future. Awesome.

The good news is that he agreed to give me MOST of the bloodwork that I wanted done and wrote a script for:
-Free T
-Total T
-Estradiol
-TSH
-fT4
-fT3
-CBC
-CMP
-ESR (something to do with clotting?)
-DHEA-S
-Urinary Analysis

After examining me, he decided that there was no need to do LH or FSH since my boys were in order (don't agree there), refused SHBG since it is redundant if Free T is known (don't agree, but ok), stated that PSA wasn't necessary for someone my age and doesn't give it, didn't think my adrenals were a problem so didn't do cortisol, and said that most people are Vitamin D deficient so doing that level was not needed (wrong!) and recommended I start taking only 1,000iu/day of Vit D and stated that my previous dosing of 4,000iu/day wasn't needed and possibly harmful.

So yeah, not a perfect blood script, but I think it will at least put some of my questions to bed when it comes back. Is there any reason to go off and get the LH and FSH from LEF.org or somewhere now (probably)? should I wait till these bloodworks come back to do so (probably)?


#5

That is a good start. I do not see the point of SHBG and agree with the doc.

TRT increases snoring... not good news for you. Loosing weight seems to be a good thing for that.


#6

Just got some of my bloodwork back.

E2 was 48 pg/mL [Range <52]

They had to send off for Free T and Total T. I should have that by the end of the week.

And I think they fucked up and didn't take my thyroid panel since its not mentioned on the printout, but its possible they just forgot to print it and give it to me.

So the high estrogen isn't going to be high enough to set off the flag with my doctor, which sucks. Any advice is much appreciated.


#7

You could do like I did and jump on the arimidex yourself.

It's weird they got your E2 back so quick. My T results came back in ~3 days but E2 took 8+


#8

Yeah that's what I think I'm going to do. I ordered some Rez-V from the site and was going to give it a go once I got my numbers back, but from a cost perspective, it is actually cheaper to go with research anastrazole (and you get PROVEN estrogen lowering results to boot).

Is there any reason not to start the AI before I know the rest of my blood work (thyroid, and maybe LH/FSH & cortisol)? I intend to get the full panel done at lef.org and if there's no reason to wait to start the AI, I will go ahead and start and then get the full panel from LEF about a month later to gauge progress (don't think my doctor is going to be willing to give me too many blood workups).

Not sure why the E2 came back faster than the test--even the nurse wasn't sure they even did E2 in house but thought they did Free & Total T. Looks like she had it backwards. Either way, I should have everything done in less than a week (I verified that they did do thyroid and had to send it off as well).


#9

I ordered liquid anastrozole from an online research chem lab. Should be here Friday. The buying experience was quick and painless, and follow up from their customer care was immediate. Shipped the next day. I would highly recommend them.

I intend to start dosing at 1 mg/week as my starting point. I will frontload at 0.5 mg on Day 1, and take .285 mg EOD ongoing (not sure yet how this corresponds to the dropper volume).

Should have my other labs back by the end of the day or tomorrow.

I have a few questions that I hope someone may help answer:
-Should I just round down to .25 mg EOD if this is easier based on dropper volume?
-Is front loading 0.5 mg (the steady state level) a bad idea?
-Should I wait to start my AI until I have my LH/FSH levels checked (I don't see why this would matter, just making sure I'm not missing something)?


#10

Lowering E2 should increase LH/FSH. So if you want to know how things were you will wait.

Do not front load adex as you could crash if an adex over-responder.

Lets review adex dose later when you will also have TT and FT data.

Your adex dose without TRT would start at 0.5mg/week. You need EOD dosing. So think in drops, not 1/4th mgs.


#11

Just got the thyroid panel:

TSH: 1.79 uU/mL [0.35-5.5]
T3: 116 ng/dL [76-181]
fT4:1.0 ng/dL [0.9-1.8]

Everything looking good here?

Still no FT/TT/DHEA-S.


#12

fT3 would be better, that is what gets the job done.

fT4 seems low, should be mid range and you are at the low end.

iodine might be an issue


#13

Yeah my script was for fT3, not sure why they only returned my T3. I haven't gotten all the paperwork back and this was just given to me over the phone, so its possible they did both (maybe?).

I was concerned about the fT4 being so close to the bottom of the range, but don't know enough about thyroid to really interpret it.

I usually salt my food liberally (not sure if it is iodized salt or not though) and eat seafood about once a week and supplment with 4 caps of Flameout and FA-3 per day.

I really with they would hurry up and get me the freakin T numbers already!


#14

Numbers are in

TT: 372 ng/dL [250-1100]
FT: 2.67% [1.5-2.2]
99.3 pg/mL [35.0-155.0]

Tests performed by Quest Endocrinology. The TT test I got last year showed ~470 and was from Quest as well (though had different ref ranges). I'm concerned about both the low TT number and its 100 point drop in less than a year.

Advice at this point is definitely appreciated.


#15

Total T: 372 ng/dL [250-1100]
Free T: 2.67% [1.5-2.2] & 99.3 pg/mL [35.0-155.0]
E2: 48 pg/mL [<52]
TSH: 1.79 uU/mL [0.35-5.5]
T3: 116 ng/dL [76-181]
fT4:1.0 ng/dL [0.9-1.8]
DHEA-S: TBD

Don't have the DHEA-S back yet, but I will come back and edit this post when I do. I just wanted to consolidate my bloodwork.

I began taking the liquid anastrozole today. I found dosing to be very difficult as the product I bought is dispensed via a squirt mechanism instead of a medicine dropper. I was a little miffed by this as I was expecting something easier. The product did not indicate how much was dispensed with each pump either, but I assume its highly anyway.

I went to CVS and got a small plastic syringe that has .10 mg accuracy, so I was able to dose 0.14mg from that (calculated dosing is 0.143 EOD @ 0.5 mg/week). I tried converting this to number of drops but the syringe is sort of a piece of crap and I couldn't put the right amount of constant pressure on it to get continuous drops.


#16

Again many times dr have right church and wrong pew. The test he order was the wrong one you want 4021 13-54 from quest. ultra sensitive and rapid are invalid for a male and can give miss leading inforamation. If you are going to use adex I would get it from alldaychemist. I have seem patients use liquid a from all different sources and e2 goes all over the place and rarely gets stabilized. That is why just taking adex .25 is so much easier then worry about the purity of the liquid and so forth. A guy your size I would look into potential sleep apnea and also hypothyroid because that can actually cause sleep apnea directly.


#17

So I have my first appointment with the doctor up in Philly tomorrow. I will write up a trip report when I get back. From the convos I've had with the doctor's assistant, I feel very confident that these guys will be able to help me sort things out. Thanks guys.

On a side note, I've been supplementing with gummy Vitamin D3 I picked up at Walmart for the past few weeks. Feeling a lot more energetic and focused, but I am admittedly a very high placebo responder so who knows what is actually going on.

Is gummy D3 ok? This is the link (not sure if Tmuscle will remove it or not, though I hope they wont since I would gladly buy my Vit D3 from Biotest if they made it...HINT HINT GUYS!)

This ok?


#18

I am not a vitamin expert, but I have learned quite a bit over the last three or four years while researching treatment options.

This is just me personally, but I would not be comfortable taking any vitamins from Wal-Mart. Wal-Mart's main objective is to provide the cheapest products possible to the most people possible. In my experience, their focus on quality comes second or third to their focus on price, and when it comes to putting supplements in my body, I would prefer to spend a little more to increase my odds of getting a higher quality product.

Do you have a general health food store or vitamin store nearby?


#19

Candy.


#20

Ok, so what do I need to be looking for when it comes to this? There are GNCs nearby, so availability isn't an issue. I just picked these up because they were convenient and I was in Walmart one day.