Discussion of Lab Results Prior to Defy Medical Consult

Pharma / TRT Testosterone Replacement
1

Hey guys. 31 year old male here. I have my consult with Defy tomorrow, but wanted to post my results here so I could get your advice on things to ask about while talking to them, since I am admittedly a newbie to all this.

Long story short - my free T is very low (outside of range) while my SHBG is very high (outside of range), but my Estradiol seems normal. Is that a common set of circumstances? Is there anything you recommend I ask them or bring up to them (outside of symptoms) tomorrow? Thanks a lot, I appreciate all of your input!

Diagnostic Test / Results Results Out of Range Flag Units Range Site Stat

CBC With Differential/Platelet [Final]

Notes Fasting - Yes

WBC x10E3/u 3.4-10.8

L

6.1 01 F

RBC x10E6/u 4.14-5.80

L

4.86 01 F

Hemoglobin 14.4 g/dL 13.0-17.7 01 F

Hematocrit 43.2 % 37.5-51.0 01 F

MCV 89 fL 79-97 01 F

MCH 29.6 pg 26.6-33.0 01 F

MCHC 33.3 g/dL 31.5-35.7 01 F

RDW 12.8 % 12.3-15.4 01 F

Platelets x10E3/u 150-379

L

190 01 F

Neutrophils 52 % Not Estab. 01 F

Lymphs 40 % Not Estab. 01 F

Monocytes 6 % Not Estab. 01 F

Eos 2 % Not Estab. 01 F

Basos 0 % Not Estab. 01 F

Immature Cells NP 01 X

Neutrophils (Absolute) x10E3/u 1.4-7.0

L

3.1 01 F

Lymphs (Absolute) x10E3/u 0.7-3.1

L

2.4 01 F

Monocytes(Absolute) x10E3/u 0.1-0.9

L

0.4 01 F

Eos (Absolute) x10E3/u 0.0-0.4

L

0.1 01 F

Baso (Absolute) x10E3/u 0.0-0.2

L

0.0 01 F

Immature Granulocytes 0 % Not Estab. 01 F

Immature Grans (Abs) x10E3/u 0.0-0.1

L

0.0 01 F

NRBC NP 01 X

Hematology Comments: NP 01 X

Comp. Metabolic Panel (14) [Final]

Glucose 89 mg/dL 65-99 01 F

BUN 23 H mg/dL 6-20 01 F

Creatinine 1.07 mg/dL 0.76-1.27 01 F

eGFR If NonAfricn Am mL/min/1 >59

.73

92 01 F

eGFR If Africn Am mL/min/1 >59

.73

106 01 F

BUN/Creatinine Ratio 21 H 9-20 01 F

Sodium 142 mmol/L 134-144 01 F

Potassium 4.6 mmol/L 3.5-5.2 01 F

Chloride 101 mmol/L 96-106 01 F

Carbon Dioxide, Total 24 mmol/L 20-29 01 F

Calcium 9.8 mg/dL 8.7-10.2 01 F

Protein, Total 7.5 g/dL 6.0-8.5 01 F

Albumin 5.0 g/dL 3.5-5.5 01 F

Globulin, Total 2.5 g/dL 1.5-4.5 01 F

A/G Ratio 2.0 1.2-2.2 01 F

Bilirubin, Total 0.7 mg/dL 0.0-1.2 01 F

Comp. Metabolic Panel (14) [Final]

Alkaline Phosphatase 54 IU/L 39-117 01 F

AST (SGOT) 49 H IU/L 0-40 01 F

ALT (SGPT) 35 IU/L 0-44 01 F

Lipid Panel w/ Chol/HDL Ratio [Final]

Cholesterol, Total 165 mg/dL 100-199 01 F

Triglycerides 47 mg/dL 0-149 01 F

HDL Cholesterol 65 mg/dL >39 01 F

Effective October 22, 2018, HDL Cholesterol

reference interval will be changing to:

Male Female

40 - 999999 50 - 999999

Notes

VLDL Cholesterol Cal 9 mg/dL 5-40 01 F

LDL Cholesterol Calc 91 mg/dL 0-99 01 F

Comment: NP 01 X

T. Chol/HDL Ratio 2.5 ratio 0.0-5.0 01 F

T. Chol/HDL Ratio

Men Women

1/2 Avg.Risk 3.4 3.3

Avg.Risk 5.0 4.4

2X Avg.Risk 9.6 7.1

3X Avg.Risk 23.4 11.0

Notes

Testosterone,Free and Total [Final]

Testosterone, Serum 515 ng/dL 264-916 01 F

Adult male reference interval is based on a population of

healthy nonobese males (BMI <30) between 19 and 39 years old.

Travison, et.al. JCEM 2017,102;1161-1173. PMID: 28324103.

Notes

Free Testosterone(Direct) 6.1 L pg/mL 8.7-25.1 01 F

DHEA-Sulfate [Final]

DHEA-Sulfate 273.2 ug/dL 138.5-475.2 01 F

TSH [Final]

TSH 2.370 uIU/mL 0.450-4.500 01 F

Luteinizing Hormone(LH), S [Final]

LH 7.0 mIU/mL 1.7-8.6 01 F

Prostate-Specific Ag, Serum [Final]

Prostate Specific Ag, Serum 0.4 ng/mL 0.0-4.0 01 F

Roche ECLIA methodology.

.

According to the American Urological Association, Serum PSA should

decrease and remain at undetectable levels after radical

prostatectomy. The AUA defines biochemical recurrence as an initial

PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory

PSA value 0.2 ng/mL or greater.

Values obtained with different assay methods or kits cannot be used

interchangeably. Results cannot be interpreted as absolute evidence

of the presence or absence of malignant disease.

Notes

IGF-1 [Final]

Insulin-Like Growth Factor I 267 H ng/mL 88-246 02 F

Estradiol, Sensitive [Final]

Estradiol, Sensitive 19.5 pg/mL 8.0-35.0 02 F

Estradiol, Sensitive [Final]

This test was developed and its performance characteristics

determined by LabCorp. It has not been cleared by the Food and

Drug Administration.

Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)

Notes

Sex Horm Binding Glob, Serum [Final]

Sex Horm Binding Glob, Serum 64.9 H nmol/L 16.5-55.9 01 F

Cardiovascular Report [Final]

Interpretation Note 03 F

Notes Supplemental report is available.

2

As to your question about high shbg and low free test with normal e, yes I believe that would be normal. Because your SHBG is high it binds your testosterone so that your have less free testosterone, leaving little to be aromatized into estrogen.

3

I mean why can’t we just lower shbg then? I know it easier said then done.

Liver enzyme slightly elevated. Why not figure out why shbg is high? Defy will obviously jump on trt.

LH is at a great level. Not secondary most likely. Primary? If not primary what’s the dx - high shbg. Not sure if that’s a dx.

4

Do you workout? Just asking because if you are that could be cause of the slightly elevated liver enzymes, also with the BUN if I remember right. I had similar enzyme and bun readings about 7 years ago but I was doing a pretty intense workout program. When your sore and have been breaking muscle tissues down it will release those same enzymes into the blood stream giving you higher readings. They had a article about it in Men’s Health or Fitness (not sure which exact magazine) a few months ago about readings in your routine blood work that could cause health scares that could be in fact just due to exercise and not necessarily cause for concern.

If those can raise your SHBG I am not sure. It would be interesting to know.

5

Thanks for weighing in. I train 6 days a week. 5 days very intense strength program (about 50 minutes per workout, never more than 45 seconds between sets), 1 day focused on lighter, rehabilitation type movements.

6

The problem definitely isn’t the pituitary gland, it’s cranking out plenty of LH to produce enough testosterone, unfortunately your liver is ruining everything by creating too much SHBG which is binding up a good potion of free testosterone.

Defy Medical is a smart move and Dr. Saya is an excellent hormone doctor, he’s my doctor as well. He will probably put you on 60-70mg twice weekly and if fertility is a concern HCG and even FSH added to your TRT protocol if by some chance HCG isn’t enough to get the job done.

Normally I consider a TSH of 2.5> to be a problem in the making, checking Free T4, Free T3, Reverse T3 and antibodies would be a good move if you fail to respond properly to TRT.

7

Can’t guarantee that is why your enzymes and BUN are high but I would guess that is why with the way you workout. I looked up my numbers and I was actually almost double on one of them. Doctor ended up checking me for hepatitis and had me go in for ultrasound and they could find nothing wrong. No inflammation, fatty liver or anything. Last bloods I got back there was nothing wrong with my AST, ALT or BUN.

8

That’s exactly what his Dr needs to do and other Drs for these guys. Rule out other disease that can cause his symptoms and labs numbers to be off.

My Dr actually tested me in addition to other stuff - for carcinoid syndrome. Cause of the hot cool flashes I was having.

9

I would agree to that if he tested high again after taking a few days off working out before testing. I dont believe ultrasounds are cheap and personally I’m not going to fling money to test other things when it has been shown to be exercise induced without further testing to verify there truly is a problem.