T Nation

Chasing Down an Unknown?


#1

Posting up my results as this seems to be a very helpful place to garner feedback and support for what I have been dealing with for basicly 11 months now with not much improvement.

Feb 28th 2011 (8:07am) as part of routine check-up I had labs of:

Total T 533ng/dl
Free T 77pg/ml
3 Gen TSH 1.62munit/ml
Prolactin 23ng/ml
SHBG 52nmol/L
HDL 110mg/dl
LDL 112mg/dl
Trig 86mg/dl
25 Hydroxy VD 25 ng/ml
Estrogen and E2 were never measured.....being I have an HDL of 110 makes me think it "may" be higher then normal since both hormones are responsible for sustaining HDL levels in men and women.

My doc said my prolactin was high and so he gave me parlodel to handle that. It sucked ass! After 3 months I was super run down and lethargic as hell all the time. I said it was not going to happen so we swapped it for bromocryptine. 2 more months pass. It kinda worked! My numbers by late June were close to within range for normal prolactin levels. Sadly my total t and free t had dropped some! Not quite what was expected.

REFERENCE LABS_ (06/28/2011 8:05 AM CDT)

SHBG 67 nmol/L
Testosterone 517 ng/dL
Testost Free 62 pg/mL
Prolactin 17ng/ml

At this point he had me stay with bromo for 3 more months to assure the levels stayed down and that my t came up more. September comes and even I am noticing I am losing weight without dieting or adding more cardio?? 4-5lbs actually. Side effect of Bromo I start to think right....

Next labs has me at...

REFERENCE LABS_ (09/16/2011 8:20 AM CDT)

SHBG 62 nmol/L
Testosterone 492 ng/dL
Testost Free 62 pg/mL
Prolactin 3ng/ml

Ok great we have the prolactin well under control but now my T is lower then ever....shit! Not cool! Doc takes me off of bromo at this point since the prolactin is doing fine at this point. Doc has me take 1000IU of Vitamin D3 a day for the next 6 weeks and make sure I get at least 7 hours of sleep a night or as close to that as I can. Most nights I would get 7 hours(some nights each week I was getting 5-6 because of work shifts) so those nights I would take a nap the next day after work to get the 7 hours average every night. I also cut back to just 2 short 30 minute cardio sessions a week on days I did not lift.

Then comes November labs, weight loss has stopped but weight gain seems impossible yet. New labs show...

REFERENCE LABS_ (11/22/2011 8:03 AM CST)

SHBG 60 nmol/L
Testosterone 260 ng/dL
Testost Free 32 pg/mL
25 Hydroxy VD 36ng/ml

Still dropping! VD has climbed so it was not that. I am sleeping more then before and training a little less/recovery more. Now I am getting really pissed off and frustrated that despite treatment and meds I am dropping lower yet and faster then ever! But thats not all. At this point my doc has me set (after discussion with me and weighing my options) to go on TRT. 300mg of t enathate every 2 weeks and then every 3rd week after that. After 2 injections of 300mg and 5 weeks of being on the drug, we test again to see whats happening.....

REFERENCE LABS_ (01/06/2012 8:35 AM CST)

SHBG 63 nmol/L
Testosterone 204 ng/dL
Testost Free 24 pg/mL

Still dropping! And even faster then any other 2 labs have shown to date! In 6 weeks my total and free have dropped and my SHBG is back up some! WTF is all I can think now???

My doc in the mean time having gotten the labs ups my dose to 400mg for the 3rd injection I just got on the 10th of this month. My next one is set for the 31st at the same dose.

I also have taken it upon myself to see a specialist. I have an appointment on Friday next week to go see an endocrinologist who deals specifically with male endocrine disorders.

I hope to god I can get some answers as to why my T levels continue to drop despite sleeping well, avoiding stress, eating very well (accounting for fat intake, eating lean red meats, good cholesterol intake from omega eggs, taking fish oils, no flour or sugars, ample calories etc....) not over training....4 days a week split, dropped out almost all cardio to be sure it was not OTS......VD supplementation....I cant see anything else that would cause this?

At 27 years old, non smoker, rarely drink, never used pro hormones or AAS of any kind I am really kinda lost on this one folks.

Friday I pray brings some answers to the table so I can pin point the issue at hand once and for all.


#2

My post is only stating the obvious, but where is the T going? Some if it is aromatizing, that's to be expected (although without E2 we don't know how much), but what the heck?


#3

So you are injecting every 3rd week when this lab was taken? How long after your last shot were the labs taken? Im guessing quite a ways? You are on a stupid injection protocol. Look through the stickeys to find out why and what you need to do to rectify it.

Your T levels were not dropping too badly before you were on TRT, except for the November test--no idea there. I definitely wouldn't have agreed to go on TRT if I were you--you clearly had other issues going on that you should have gotten to the bottom of.


#4

la crosse - please read through the threads at the top of this forum.

They will answer 90% of your questions... and probably give you 20 more questions to ask or confirm.

did you doctor stop testing your TSH? You really should keep testing that given that it is slightly elevated.


#5

I have recently just now read the vast majority of the stickies here and thats helped me reference the phys and metabolism of these drugs, there pharmakinetics and pharmadynamics much better. The does and donts and the why and how of fundamental TRT. I only wish most medical doctors would also read this vs abstract after abstract of how to help men in their 70 and 80s come back to normal ranges for their age.

Going into my endo appointment Friday armed with this knowledge will help me better justify and structure my concerns and needs when I speak to the endo specialist vs just letting the "expert" run the show as I have been doing with my primary for the past 11 months.

I am not asking for any aggressive cycle of any kind mind you. I am just looking to get back in the high 500 or low 600's where I was back in Jan 2011 and a happy 208lbs and 11% bodyfat. Is that so much to want?


#6

no, not too much to want... but go off symptoms and issues rather than chasing numbers.

you also really need to test your thyroid/adrenals, and have low expectations when you meet with your endo. I have never read a single success story from anyone who saw an endo... but then again easy to fix males don't search out forums such as this....


#7

Saw the endo on Friday and the take home is this...

They have me going 6 weeks (from my last shot Jan 10th) to let the T clear my system 100% before running another blood test. This time they are doing a 3 sample test every 20 minutes over 1 hour to gain a true average of my values. The endo (I saw a fellowship endo student first who I respect but honestly knew nothing more then I already did when I came in.) I did end up seeing a formal endo specialist at the end of the appointment. She was equally impressed with the fact that I was not some 40 year old person with no freaking clue about anything physiological as I am sure 99% of her patients are like.

They are taking a retrospective approach in this whole matter which I agree with. Going back to the root cause of why the T is dropping and so fast and why after the prolactin came down did T drop vs go up as expected? The specialist in fact does not think my prolactin was ever that high at all to start (23ng/ml vs 3ng/ml or less) which she said can be acutely stimulated (up to 30ng/ml) by stress, hot showers, tactile stimulation, and other daily factors. She thinks we may have caught it at a random peak and then treated an item with no real justification.

So on Feb 21st I go in at 8am for this full blood test to look at:

total t
free t
TSH
T4
LH/FSH
SHBG
Prolactin
CBC
Liver Enzymes

Within 24 hours of the labs I am to get the results sent to me online for review. The specialist is going to call me to explain and suggest treatment from then on based on findings.

Right now she just wants to know if this is primary (testicular matter) or secondary (pituitary matter) which then of course dictates treatment options.

So no more TRT until this is completed and evaluated which I am fine with because at 27 I do not like the fact that I am already needing therapeutic T when every other lifestyle factor is being controlled for bypass anything at all that would lead to low T levels. For the time being I am going to do everything in my power to naturally bolster my T levels back up. The plan is:

-Sleep 7 hours a night every night, 8 if possible
-Eat ample calories in the correct macros every day (no less then 3300kcals a day)
-Eat 6 whole egglands best eggs per day
-Take 6g Barleans omega 3 fish oils
-Take 200 mg DIM per day
-Take 2000IU vitamin D3 per day
-Consume 8oz sirloin steak at least once per week (Texas Roadhouse!!)
-Continue to avoid all processed foods, dairy and flour
-Drop all sports supplements accept MTS Whey and Xtend
-Train 4 days a week for no more then 75 minutes a shot
-Cardio only 2 days a week LISS for 30 minutes a shot

I hope the next labs are simple and the numbers pop back up to the high 500's or low 600's which I am just fine with! Time will tell.


#8

It is very likely your HPTA will still be suppressed in 6 weeks since you have been on exogenous T. Be aware of this (it will show up with low LH/FSH if this is the case).

I don't see the benefit of taking 3 samples in an hour. I don't think your T is going to fluctuate that much within 60 minutes. But if thats what they want to do and you're ok, then give it a shot I guess. I'd at least be curious to see how it changes for my own knowledge.

Agree that your prolactin treatment may have been premature as it was just based on one bloodtest.


#9

Addressing e2 levels via proper lifeestyles, lossing excessive fat , proper eating as well as appropriate detoxfication of the GI, and liver will help you reduce e2 levels significantly lower your SHBG freeing up your free testosterone levels.

With a testosterone of 492 I would not have had the Dr adminster HRT right off the bat, but rather explored why your SHBG was elevating. Find the source do not treat the symptoms. This is the problem with modern medicine.


#10

testing for Total T4 only is basically useless. The standard is TSH plus Free T4 compared to Free T3 (plus RT3 if your TSH is high, but your FT3 looks normal).


#11

Thats why I like where my endo specialist is going. The root cause. Not right to treatment. I have gotten 3 injections between 11-22-11 and 1-10-12 of 300-400mg T Enathate and thats all. Nothing since and nothing again till this blood work comes back after 2-21-12.

This will then allow my endo doc to make a more informed decision for what treatment is needed and what is not needed. With all lifestyle factors being tightly controlled (as they have been) it should allow us to pinpoint if this really is a truly physiological abnormality thats just not quite on key with my system vs anything extraneous.


#12

Continue on that pathways and you will eventually reach your goal. 40 years you qualify for HRT, just proper adminstration of it will help allow body to possible lower e2 conversion. Smart change one variable at time. Fish oils are way too high..1/3 of that will be fine..


#13

Jose Antonio, Alwayn Cossgrove as well as Doug Kalman, all prominent nutritional scientist and practitioners, recommend that adult men involved in regular physical activity or sport take 4-6g of fish oils per day. However the grams per tab matters less then the actual EFA content does so they recommend getting 1,600mg/EPA and 800mg/DHA daily. My Barlean's Organic Cold Pressed fish oils require 6 tabs to get just a smidgen over that dose.


#14

They are mistaken, being in the medical field with over 1000 cases I can tell you personally they are doing more damage then good. Been there done that and paid the price for it. Vballa will back me up with this 100% about how mis informed people even the experts are. You are putting you body into a potential pre diabetic and highly oxidative stressful state.


#15

I don't see anything wrong with 4-6 g of fish oils per day. I take around that.


#16

Why no prolactin test after going off bromo? what if it went back up? not sure how far over reference ranges indicate Hyperprolactinaemia, but that can really screw things up.


#17

I would be very interested in seeing your citations saying 4 -6 grams of fish oil a day causes prediabetes.

I would also point out that salmon averages 1.5 grams of omega 3 fatty acids per 3 oz serving. And that both the inhabitants of Arctic Greenland as well as Okinawa, Japan have some of the highest marine animal consumption and lowest rates of heart disease and that heart disease is positively correlated with diabetes.


#18

I mean, we are talking about ESSENTIAL FATS here...its not like fish oil is some mysterious space debris from krypton we are putting into our body haphazardly.


#19

OK buys here we have it. Results from the Endo and my blood work taken on Tuesday morning fasted are finally in! I had a laundry list of blood panels taken but I will only post those that are of significance to the Testosterone matter. If you look back up in earlier post my last reading while on TRT was 204ng/dl. My last injection was on Jan 6th and that was a dose of 400mg T enathate. I have not had anything since then.

3rd Generation TSH 1.83 mcunit/mL
Free Thyroxine 1.17 ng/dL 0.93 - 1.70
Prolactin 10.2 ng/mL 4.0 - 15.0
FSH 3.0 munit/mL 1.5 - 12.4
LH 2.4 munit/mL 1.7 - 8.6
TT 411ng/dl
FT 55pg/ml
SHBG 56nmol/L

All of these values above were within range of the labs reference ranges so nothing was really putting up red flags with the endo specialist. My T did coe back up and my SHBG did come down so some progress is good progress I suppose. However I am still pissed off in that last year at this time I was at 537ng/dl total T without taking a damn thing.

The only other value not directly related to T was that my WBC was low. Lower enough for him to ask if this had been an issue in prior tests. I had never had my WBC taken before so I really have no reference to base off of. My values were 3000/mcl when a normal range is 4500 to 10000/mcl. I am curious to know why my WBC count would be so low despite not having any illness since last September which was a mear ear infection for a few days.


#20

The new found news my endo was concerned with more then anything was my WBC which was part of this round of tests. My WBC was 3000 and normal is 45000-10000 according to this lab. He asked me if my WBC had ever been low before and to my knowledge it has not. It had not been a part of my past 4 blood tests in the part year either.

None of the likely causes for Leukopenia are items I have any exposure or history to. I take none of the drugs that can lower WBC either. In my studies I have found that in very rare cases in 3rd world countries some women can develop the condition to clinical levels if they go months without adequate copper, zinc or folate intake. But lets face it, I eat well, I am not a women and I am not in a 3rd world country so thats not the case here.

I have not been ill either outside a acute ear infection that was mild and last only a few days. Not so much as a cold since....WTF?