T Nation

Dr Recommends Testralin by Metagenics


#1

age: 40
height: 6'4
weight: 205
waist: 32
describe body and facial hair: Moderate/thick body and facial hair
did to grow fast or slow and steady as a teen: Grew fast - about a foot in a year - prior to the growth spurt i had a stage where i got overweight and began to develop breasts
testes ache or hurt? ever?: No
mood: poor mood sometimes/ low energy / mental focus issues
depression: not constant, but i have good days and bad.
libido: no desire issues, but erection problems
get cold easily? a change?: No
dry skin, brittle nails?: Skin beginning to dry and thin
use iodized salt?: Yes
eat much sea food? Yes
exposure to chemicals? No
ever used hair loss drugs? No
Rx and OTC drugs: Cialis as needed

Lab results: taken at 7:00 AM (fasting)
Total Testosterone: 609 (250-1100 ng/dL)
Free Testosterone: 74.9 (46-224 pg/mL)
Bioavailable Testosterone: 157.2 (110-575 ng/dL)
SHBG: 38 (10-50 nmol/L)
Albumin, Serum: 4.6 (3.6-5.1 g/dL)
IGF I, LC/MS: 154 (52-328 ng/mL)
Z score: .2 (-2 - +2 SD)
DHEA Sulfate: 272 (45-345 mcg/dL)
FSH: 1.9 (1.6-8.0 mIU/mL)
LH: 4.3 (1.5-9.3 mIU/mL)
Progesterone: 0.8 (<1.4 ng/mL)
Estradiol: 40 (H) (< or = 39 pg/mL)
Cortisol: 13.9 (4-22 mcg/dL)

Cholesterol, Total: 148 (125-200 mg/dL)
HDL: 42 (> or = 40 mg/dL)
Triglycerides: 126 (<150 mg/dL)
LDL: 81 (<130 mg/dL)
Chol/HDLC ratio: 3.5 (< or = 5)
NON HDL Chol: 106 (Target: 30 mg/dL higher than LDL)
Homocysteine, Cardio: 14.3 (H) (<11.4 umol/L)
Hemoglobin A1c: 5.2 (<5.7 = Decreased risk of diabetes)

Vitamin D, 25-OH, Total: 47 (30-100 ng/mL)
Vitamin D, 25-OH, D3: 47 (no range established)
Vitamin D, 25-OH, D2: <4 (no range established)

TSH: .52 (.4-4.5 mIU/L)
T4, Free: 1.2 (.8-1.8 ng/dL)
T3, Free: 3.4 (2.3-4.2 pg/mL)

Lab Results: taken 2 weeks prior at Urologist 11:00AM (non-fasting)

Glucose: 96 (65-99 mg/dL (going off a picture of results and cut off some unit description)
Urea Nitrogen: 12 (7-25 mg/dL)
Creatinine: .94 (.6-1.35 mg/??)
eGFR Non-Afr American: 100 (> or = 60ml/??)
eGFR African American: 116 (> or = 60ml/??)
Sodium: 142 (135-146 nmol/??)
Potassium: 4.3 (3.5-5.3 nmol/??)
Chloride: 104 (98-110 nmol/L)
Carbon Dioxide: 22 (19-30 nmol/L)
Calcium: 9.8 (8.6-10.3 mg/??)

CBC
White Blood Cell Count: 8.9 (3.8-10.8 Thou)
Red Blood Cell Count: 5.41 (4.2-5.8 Mil)
Hemoglobin: 16.4 (13.2-17.1 g/d?)
Hematocrit 48.8 (38.5-50%)
MCV: 90.3 (80-100 ??)
MCH: 30.3 (27-33 pg/??)
MCHC: 33.6 (32-36 g/??)
RDW: 13.4 (11-15?)
Platelet Count: 227 (140-400 thou)
Absolute Neutrophils: 6586 (1500-7800 cells)
Absolute Lymphocytes: 1878 (850-3900 cells)
Absolute Monocytes: 365 (200-950 cells)
Absolute Eosinophils: 45 (15-500 cells)
Absolute Basophils: 27 (0-200 cells)
Neutrophils: 74%
Lymphocytes: 21.1%
Monocytes: 4.1%
Eosinophils: .5%
Basophils: .3%

LH: 5.6 (1.5-9.3 mIU??)
Prolactin: 4.2 (2-18 n??)
Testosterone, Total: 485 (241-827 ng/??)
PSA, Total: .2 (< or = 4)

Basically, i have been feeling low energy and lack of focus, i'm somewhat moody and get depressed sometimes. Having ED symptoms, urologist says its a blood flow issue. Very weak at the gym with very little improvement. I cut alcohol out of my diet 4 years ago. I eat very well for a non-health nut type diet. A lot of fruits and vegetables, very little junk food. I smoke cigarettes, planning to quit (again), but the mental focus issue is killing me, seems the only way i can keep focus is to smoke cigarettes.

I went to the Urologist for testing for low T, number came back in the 400's, i don't plan on growing old gracefully, i will go kicking and screaming. I wanted to look into T replacement, but the urologist was a brick wall. I went to a HRT specialist (actually an anesthesiologist who runs a Hormone clinic once a week) and did further testing (top results) he says i have plenty of T, but my E2 is high. He wants me to take a supplement (he sells) called Testralin by Metagenics. Says it will lower my E2 without taking "dangerous" prescription drugs. He does say that he is open to prescribing me Anastrozole if this doesnt work and possibly Testosterone if i don't see any improvement.

I was hoping to get some advice from somebody knowledgeable in broscience, My sister is a Doctor of Pharmacy, and she is on my side, but conservative. She wants me to try the supplement.

My train of thought up to this point (when i had only the results reflecting the 400's number) was why be a 400's when i can be a 900's and feel great. (About 5 years ago i did a Test/Deca cycle and felt like a million bucks) Now my number comes in a 600 and looks like i don't need it, but all my numbers are at the low range (test/free test/bioavailable), my SHBG seems high, and my E2 is high.

I know this is a ton to read, and i thank you in advance for taking the time to help me.


#2

Your high E2 is reducing T production via HPTA negative feedback. Reducing E2 is the goal for you.

Your high E2 may be from compromised clearance rates by the liver. We need to have liver maker labs: ALT/AST
When you do these labs, refrain from muscle training for 5-6 days as this can create misleading results. Muscle injury or bruising also an problem for the labs.

Homocysteine: This indicates that you have inflammation [endothelial dysfunction] in your arteries that is damaging the endothelial cells [endothelium] . That is the mechanism of "heart" disease. You can combat this with:

  • lower E2, E2 is toxic to the endothelium, E2 needs to be lower and balanced by DHEA plus T in men and progesterone in women
  • high quality fish oil caps
  • other EFA's: nuts, flax seed oil or meal
  • good DHEA levels, yours is good
  • high potency B-complex multi-vits with trace elements
  • 50 or 100mg Ubiquinol form of CoQ10
  • vit-C
  • natural source vit-E
  • other anti-oxidants
  • olive oil and other healthy fats
    -- this problem is not caused by cholesterol. However, [google that] allows cholesterol to enter the arterial wall which leads to inflammation, scarring etc
    -- ibuprofen can increase homocysteine with higher and constant use

Body temperatures good as per the thyroid basics sticky?

Your cholesterol is a bit low. Better near 180. Are you doing anything diet wise to reduce cholesterol?

Broscience is a term for misleading and erroneous info about steroids/hormones, you can drop that terminology. This is a broscience free zone.

Anastrozole is preferred for these reasons:
- is rarely not sage in the recommended doses with target E2 lab range.
- the side effects in the literature are from the effects of E2-->zero, not the drug it self
- anastrozole dose/response is well understood here in a TRT context
- anastrozole might always be cheaper than "naturals"
- dose/response of naturals can be poor and at best, not predictable
- liquid anastrozole can be dosed in one drop increments for fine dose tritation

Were you ever not using iodized salt for a period of time?
Thyroid in any way enlarged, asymmetrical or lumpy?
Your labs do look good. TSH=0.52 is making me curious.

Skin beginning to dry and thin: This can in general be from low FT and/or reduced thyroid function [check body temps]


#3

Didn't mean to offend with the "Broscience" term. I thought it meant only knowledge gained by research and self experience, not medical school. Thank you for your input. I plan on managing the Homocysteine levels with the vitamin regimen you are talking about, and also quitting the cigarettes as soon as i can get back enough focus to allow it, i deal with highly technical information daily and can't afford to drop the ball and screw something up. I haven't monitored my temperature, but always seems very close to normal when at the doctors, always in the 98.something range. but will check in the future. I believe i have always used iodized salt, but will look into supplementation as well. I dont think my thyroid is asymmetrical or lumpy. Everyone always states that my cholesterol is great, so not sure what i am trying to do with that or what to eat to make it better. why is the TSH at .52 making you curious? Again, my thanks for your input.


#4

and btw, great advice. i copy and pasted onto notepad for a checklist. I'll check into the liver test.


#5

Doctors got sold lies by the drug companies who make statin drugs. Cholesterol is essential for your body. Some with very high cholesterol do not have arterial disease and some with low do. Total cholesterol levels at and below 160 are associate with increased all-cause mortality. 180 is considered ideal. All of your "steroid" hormones are based on cholesterol. The critical issue is endothelial function.

See this: http://en.wikipedia.org/wiki/Steroid_hormone
and explore the links in the above

How is your blood pressure?

When you get your temperature checked at the doctors:
- they are looking for a fever
- they are not looking for or concerned with low temperatures
- by being outside, taking, perhaps eating or drinking recently, your temperature can be pushed lower
- we are looking for
-- waking oral body temps below 97.7, 97.3 is a call to action
-- or not been able to get to 98.6 in the middle of the afternoon

Thyroid is tricky. TSH can be up from low iodine, the high TSH can lead to enlargement and nodules that produce hormones outside of the control loop and TSH signal, then TSH can start to get low or go to zero. So hyper can progress to hypo. A period of iodine deficiency in ones past can create issues that persist after one has switched to iodized salt for years. So you can see that the situations are sometimes tricky. Your TSH=0.52 might be perfectly good. Body temperatures are the bottom line.