Doctor No Help

Pharma / TRT Testosterone Replacement
1

I have been struggling with health issues for quite some time. My symptoms are fatigue, frequent urination, memory loss, confusion, lack of focus, low libido, no morning or night erections, inflammation, tinnitus, depression, tingling in my hands feet.

I am a 46 yo male and in good health until symptoms started about 4 years ago. In fact never was sick ever and did not go to Dr. I have been tested for lots of stuff including MS and everything they test to rule that out which is lots of stuff.

Finally thought to ask my Doc to test my T. Wow, it was so hard to get them to even be willing to do that. Blah. They would only test TT so I got a cheap test from life extensions. Results are

T serum is 398 hg/dl
Free T is 12 pg/ml
Dhea-S is 243.6 ug/dl
E2 is 27.4 pg/ml
PSA is 2.7 ng/ml

Dr says it is all normal and won’t do anything.

I also have lots of other labs but am not sure what is important yet. I did have a brain MRI and all was normal. Had an ultrasound of thyroid and that was normal.

TSH was 1.88 uiu/ml. CBC all in normal range per lab.

Interested in your thoughts please.

2

Please read these stickies:

  • advice for new guys ---------- supply more info
  • protocol for injections
  • finding a TRT doc

Need lab results with ranges.

Labs:
TT
FT
E2
LH/FSH
CBC
hematocrit
DHEA-S
TSH
fT3
fT4

TSH should be closer to 1.0
TSH=1.88 is too high, the lab ranges are useless
What is your history of [not] using iodized salt.

You are estrogen dominant and that is helping to inflame your prostate.

Tell us where you are located.

3

Thanks for the quick reply. I had labs drawn this morning and expect to get them back next week. I will back when I get them, with ranges.

I do not believe I am iodine deficient as I supplement with Lugols on a fairly regular basis. I also take 10,000 of vit D and a B complex daily. When I take my iodine I always take selenium as well. I also take zinc and magnesium a couple times a week.

My diet is good. Very little sugar. When I buy a 5 lbs bag of sugar it lasts about 6 months and my kids use most of it. I am gluten free as well. I drink alcohol on the weekends. Maybe 2 or 3 drinks when I go out.

I am 46 years old, 6 feet tall and 180 lbs. over last 5 years I’ve gained about 15 lbs. normality I am very lean. I have looked at the stickies you mentioned and will probably read them several more times to make sure I understand.

I have made an appointment with an age management Doc as my go and local Docs are not well informed. I am in Portland Maine.

4

Check your overall thyroid function by oral body temperatures:

  • when you first wake up, should be 97.7-97.8, higher is OK, 97.3 is a problem
  • also check for 98.6 mid-afternoon
    see the thyroid basics sticky
5

My morning body temp was 98. I will check again on a different day as I felt very hot when I woke up this morning. I have days when I feel hot and days when I feel cold. Mostly it is hot.

Labs back next week so will post when I get them. I have done an iodine detox regime about six months ago with high doses of iodine selenium magnesium vit C and Celtic sea salt. Had lots of detox symptoms but they passed. Probably time to do it again as there are lots of bromides and fluorides in our daily lives.

6

Bromine accumulation is very slow unless exposure is acute.

7

Okay, I got my labs back today and they are:

TESTOSTERONE, TOTAL 458 ng/dl F 280-1100
TESTOSTERONE, FREE 9.82 ng/dl F 1.9-27
DHEA-SULFATE 263.9 ug/dl F 44.3-331.0
ESTRADIOL 17.9 pg/ml F 7.6-42.6
LH 4.0 mIU/ml F 1.7-8.6
Sex Hormone Bind Globulin 29 nmol/L F 10-80
IGF-1 181.0 ng/ml F 119-166
CORTISOL 26.8 ug/dl F (no reference range provided)
T3, FREE 3.3 pg/ml F 1.8-4.6
T4, FREE 1.37 ng/dl F 0.9-1.7
TSH 2.080 uIU/ml F 0.27-4.2
GGT 80 U/L F 11-51
ALT / GPT 55 U/L F <42
AST / GOT 45 U/L F <39
Vitamin D,25-OH,Total 44 ng/ml F >30
VITAMIN B12 894 pg/ml F 243-894
RBC 4.98 M/ul F 4.2-6.0
PLATELET COUNT 317 k/ul F 140-400
PSA, TOTAL 1.250 ng/ml F 0.0-4.0

You also asked for CBC and Hemotocrit (is that RBC?). I am not sure what these are on the tests. Most recent morning body temp was 97.9 this morning.

8

My labs. Sorry if this is posted twice. Was not sure the last post was successful.

GLUCOSE 75 mg/dl F 65-100
BUN 15 mg/dl F 6-20
Creatinine 1.1 mg/dl F 0.5-1.2
BUN/CREAT RATIO 13.6 F 7.3-21.7
GFR, estimated 77 ml/min
URIC ACID 5.5 mg/dl F 3.4-7.0
Na 142 mmol/L F 133-145
K 5.4 mmol/L F 3.3-5.1
Cl 100 mmol/L F 96-108
CO2 19 mmol/L F 22-32
Ca 9.7 mg/dl F 8.5-10.5
TOTAL PROTEIN 7.2 g/dl F 6.4-8.3
ALBUMIN 4.6 g/dl F 3.2-4.8
GLOBULIN 2.6 g/dl F 2.1-3.6
Albumin/Globulin Ratio 1.8 F 0.8-2.0
BILIRUBIN, TOTAL 0.4 mg/dl F 0.0-1.0
GGT 80 U/L F 11-51
ALT / GPT 55 U/L F <42
AST / GOT 45 U/L F <39
A1C 5.5 % F < 5.7
LH 4.0 mIU/ml F 1.7-8.6
ESTRADIOL 17.9 pg/ml F 7.6-42.6
DHEA-SULFATE 263.9 ug/dl F 44.3-331.0
TESTOSTERONE, TOTAL 458 ng/dl F 280-1100
TESTOSTERONE, FREE 9.82 ng/dl F 1.9-27
Sex Hormone Bind Globulin 29 nmol/L F 10-80
IGF-1 181.0 ng/ml F 119-166
CORTISOL 26.8 ug/dl
DHT 21.0 ng/dl F 11.2-95.5
T3, FREE 3.3 pg/ml F 1.8-4.6
T4, FREE 1.37 ng/dl F 0.9-1.7
TSH 2.080 uIU/ml F 0.27-4.2
Vitamin D,25-OH,Total 44 ng/ml F >30
VITAMIN B12 894 pg/ml F 243-894
PSA, TOTAL 1.250 ng/ml F 0.0-4.0
ALKALINE PHOSPHATASE 84 U/L F 35-129
CHOLESTEROL, TOTAL 204 mg/dl F <200
TRIGLYCERIDES 137 mg/dl F <150
HDL CHOLESTEROL 46 mg/dl F >40
LDL CHOLESTEROL, calc. 131 mg/dl F <100
CHOL/HDL RATIO 4.4 F <5.0
WBC 6.6 K/ul F 3.9-11.1
RBC 4.98 M/ul F 4.2-6.0
HGB 14.9 g/dl F 13.2-18.0
HCT 46.9 % F 38.5-54.0
MCV 94 fl F 80.0-100.0
MCH 29.9 pg F 26.0-34.0
MCHC 31.7 g/dl F 31.0-37.0
RDW 14.0 % F 11.0-15.5
PLATELET COUNT 317 k/ul F 140-400
MPV 9.2 fl F 7.5-11.6

9

I am not sure if it matters but my testicles ache after sex. This is something that is very new for me. I have not had the feeling before, except when I was younger and ejaculated multiple times in a day.

Now it is after one ejaculation, even when I go several days between having sex. Blah, my sex drive is totally in the dumps. Most of the time I do not even want it. Thank god my woman still wants it and initiates otherwise I probably wouldn’t have sex at all.

10

T3, FREE 3.3 pg/ml F 1.8-4.6
T4, FREE 1.37 ng/dl F 0.9-1.7
TSH 2.080 uIU/ml F 0.27-4.2

TSH seems high, but so far, body temps look good. Should check waking AND mid-afternoon
fT3 is good, and also fT3. fT3 should support good body temps and if so, rT3 is not creating a problem.
TSH can be elevated during large doses of iodine.
Once you have done an iodine replenishment, you should drop to a maintenance dose. You could do 6.25mg once a week,

HTC is hematocrit and that looks good relative to your T levels and thus no suggestion of a low level GI bleed from digestive problems.

Cortisol seems high. What time of day was this done?

Cholesterol is fine.

Because LH levels vary a lot in time, any singe sample has limited use. That is why FSH is also requested because its levels are steadier and FSH is a better indicator of your LH status than LH itself. So we are a bit in the dark.

ALT / GPT 55 U/L F <42
AST / GOT 45 U/L F <39
I am concerned about the above.
What meds are you taking, Rx or OTC?
High alcohol consumption?
Exposure to heavy metals, chemicals or fumes?

Sugar metabolism is good!

Whatever the cause of your frequent urination, its not from diabetes.
Are you urinating more and thirsty, or just needing to empty your bladder more often.
If the later, that can be from not emptying properly. PSA does not indicate a prostate problem, but perhaps a prostate inflammation.
Have you had a urinalysis. Sample from morning when urine is more concentrated might be better.
Urologist might have best expertise in these things, but see what your other docs suggest.

Your TT and FT levels are not adequate and you do not seem to have secondary hypogonadism. Have your testes been examined. That can be simple physical exam or ultrasonic. Your observations of aching are very important. Hard to know more without FSH lab data.

Your T production is not rate limited by low DHEA.
IFG-1 is normal for your age.

Have you been expose to tick bites?
Your fatigue is not explained by low thyroid or low cortisol.
If anything, your cortisol seems a bit high.
Low T can cause brain fog and some lethargy, but perhaps not fatigue.

You should increase your vit-D3 intake. 5,000iu often suggested.

What multi-vit do you take?

11

The blood draw was at 8 am.

I have been tested for Lyme and do not have it.

I am not taking any medication at all.

I regularly take a B complex and 10,000 of D3. A multi from twin labs two to three times a week and a probiotic.

I do drink but not excessively. However I had high liver scores about 4 years ago and stopped all drinking. Levels returned to normal afterward. This has been my first liver test in a while. I drink probs 3 drinks between Monday and Thursday and probs 5 or 6 on the weekend usually all on Friday or Saturday night. I am an accountant in an office job so no chemicals or fumes. I do have a cousin with autoimmune hepatitis. I was tested for all forms of Hep 4 years ago and do not have it. Both my grandfathers died of liver failure and were excessive drinkers. I am worried about my liver too and will be discussing with Dr and not drinking, well no more than one when in a social context.

I do believe my TT and FT are low. I have not had testes examined yet. Have an exam next week. Self exam makes me think I have a varicocele on my right side. I do not remember this feeling until after my vasectomy. Left side seems fine. Testes are def smaller and softer than a few years ago.

I have wondered about enlarged prostate relative to the urination issue. I am going to ask for a DRE at next visit.

Oh yeah, my body temp this morning was 96.8 which seems low but other days have been good. This may be because I have been sick with a cold last couple of days so I am going to retake over next week for consistency.

Many thanks for your observations.

12

repeat:
If the later, that can be from not emptying properly. PSA does not indicate a prostate problem, but perhaps a prostate inflammation.
Have you had a urinalysis. Sample from morning when urine is more concentrated might be better.
Urologist might have best expertise in these things, but see what your other docs suggest.