T Nation

Great Labs - Bad Symptoms


#1

I’ve been on a cream for a couple of months and here is one set of my labs. The other set taken a month ago was nearly identical:

Total T: 762 ng/dL (348 - 1197)
Free T: 22.8ng/dL (9.2 - 26.5)
Estradiol: 22.1pg/mL 22.1 (7.6 - 42.6)

Hematocrit: 47.5g/dL (37.5 - 51.0)

I do have high iron, maybe from supplementing which I stopped about a month ago, maybe not:

Iron, Serum: 235 ug/dL (38 -169)
Iron Saturation 72% (15 - 55)

From another set of labs I also got done, I had nearly 0 pregnenalone, which I’ve been supplementing 30mg for the past few days. I also had low vitamin B12 ~300 on a scale of 211-946. My vitamin D was 41.4 on a scale of 30.0 - 100.0.

Anyways, I don’t have a sex drive at all and I feel very fatigued. Is this because I’m on the cream instead of injectable, if not is it because of these other things which are off?


#2

FT is actually quite low. With transdermals, there is a surge of T entering your system then its mostly over. FT has a short half life, so FT can peak and fall. The bio identical zealots like to day that is a natural pattern, I think not. In any case, because FT is changing, a lab can catch a peak or a trough and the result is major uncertainty.

Frequently self-injected T is the most cost effective T delivery and provides the most cost effective, steadiest and most consistent T levels. When T esters are injected in oil, the injections are slowly absorbed and as T ester molecules become mobile in your system, the ester groups are removed and you have a bio-identical T time release system, but the bio identical zealots can’t quite grasp that.

Your TRT may be inadequate. We do know that transdermal T absorption is poor with low thyroid function, which you should evaluate via last paragraph in this post. Low thyroid function can present almost all of the symptoms of low-T, even when TRT T levels are high.

So what was your lab timing?

If SHBG is elevated, there is more non bioavailable SHBG+T that inflates TT and then TT is misleading.

Men do not need added iron unless there is a pathology such as a GI bleed.

Humans hoard iron, men retain, fertile women do not. Try to avoid iron fortified vitamins, flour, rice, breads, breakfast cereals. Serum iron is quite variable depending on recent meals; I do not trust serum iron as a guide for change. Iron saturation does perhaps present a problem. In any case, HTC=47.5 does not indicate a problem. RBC, hemoglobin and ferritin might be useful.

Please post CBC.

Low thyroid function will absolutely rob your energy.
Also do lab: AM cortisol blood work and do 1 hour after waking.
And test SHBG which can add clarity in a case like this.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

Thanks for the response @KSman, lab timing was at 8AM for those labs. I woke up about an hour and a half earlier and applied my cream.

I MISTYPED! My free-t was 22.8!

Here is a picture of my labs:

Additionally, here is another set of labs I did on 5/12:

FT: 159.6 pg/ml (0 - 260)
TT: 587 ng/Dl (0 - 1460)
SHBG: 15.2 nmol/L (0 - 84)
Albumin 5 g/dL (0 - 8.5)
DHEA-S 194.0ug/dL (0 - 650)
PSA, Total 0.89ng/ml (0 - 8)
Estrodiol 26.90 (0 - 90)
Progesterone 0 (0 - 18) (undetected)
Pregnenalone 0 (0 - 196) (undetected)
TSH 1.73 (0 - 2.9)
FT4 1.1ng/dL (0 - 2.6)
FT3 342 pg/dL (0 - 600)
Triglycerides 152 mg/dL (0 - 190)
Total Cholesterol 177 (0 - 320)
HDL 47 (0 - 150)
LDL Calc 100mg/dL (0 - 170)
Cholesterol/HDL ratio 3.8 (0 - 8)
Homocystine 8.3 (0 - 17)
CRP 2.0mg (0 - 6)
Hemoglobin A1c 5.2% (0 - 10)
GL Glucose 136 (0 - 235)
GL Insulin 131 (0 - 90)
Comprehensive Metabolic Panel
BUN 14mg/dL (0 - 29)
eGFR >60 (0 - 205)
Creatinine 0.9 mg/dL (0 - 2.3)
Albumin 5.0g/dL (0 - 8.5)
Globulin 2.9g/dL (0 - 6.4))
A/G Ratio 1.72 (0 - 3.1)
Total Bilirubin 0.60 mg/dL (0 - 1.5)
Red Blood Cell Count 5.58 x 10E6 (0 - 10)
Hematocrit 50.2% (0 - 69)
Hemoglobin 117.2 (0 - 31)
Vitamin B12 325.0 (0 - 1175)
Vitamin D 35.1 (0 - 133)
IGF-1 166.0ng/mL (0 - 330)

I got a good deal on the above labs at an antiaging clinic so I figured why not.

I have tried the AM temperatures thing and my AM temperatures are typically >97.3.


#4

Soon after waking up you want to be 97.7F or better.
TSH should be closer to 1.0

Your T levels are decent. Thyroid may be cause of low energy.
Need AM and afternoon temperatures as requested.

Please describe your use and history of iodized salt.

DHEA is marginal.

How old are you?
Need the info suggested in the 1st sticky.

Low pregnenolone probably cascading through other steroid hormones, but DHEA-S is not severe. HPTA shutdown can reduce pregnenolone as testes shrink.

In the adrenals, pregnenolone–>progesterone–>cortisol
Please do lab ‘AM cortisol’ and do that 1 hour after waking up.
Cortisol is very important for energy levels.

Read the stickies please.


#5

@KSman

I had a bad thermometer. With a new, more expensive, thermometer my temps are always above 98 degrees. I get to 98.6 and sometimes slightly higher in the mid-afternoon.

New labs:

RT3: 18.9 (9.2 - 24.1)
TSH 1.7
Ferritan 122 (30 - 400)
Saturation 25%
UIBC 254 (111 - 343)
Serum iron 85 (38 - 169)

AM cortisol 19 (13 - 24) *this was a while back

I’m 26.

I switched to injections and I see the “time-release” results, which are nice.

Do you have any other tips for adrenal fatigue than “read wilson’s book”? Adrenal fatigue is very nebulous and there is an equal amount of articles talking about how to treat it as well as saying that it’s BS. I’ve had high chronic stress so I’m sure that is the best fitting diagnosis. I’ve tried quitting caffeine and then there are days which I feel so terrible that I relapse. I work a very difficult job and am trapped in it due to high amounts of student loans. It allows me to put a couple thousand into them every months, but I am definitely exhausted. If I could cope better in my job/life, if I had the energy, then I could live a healthier life, but it’s almost chicken and the egg. I need energy to do healthier habits.

Also, I’ve used iodized salt for years as well as have tried your iodine replenishment protocol.


#6

rT3 is elevated. I need to point out that some labs have range upper limits lower than you lab value.

You do have a lot of stress. AM cortisol was good.

Good body temps indicate that rT3 is not creating too much or a problem. TSH is upping the game and so far, compensation is working.

HTC is getting interesting. HTC–>69 probably certain death.
This is wrong too: Hemoglobin 117.2 (0 - 31)
GL Glucose ???136 (0 - 235)???
Please audit your data.

Vit-D25=35 is too low. Take 5000iu Vit-D3

Blood proteins are good, effect of T.


#7

I took modafinil for 2 weeks and felt completely free of symptoms, I felt anew! I started running daily and lifting weights, I was doing super well at work. Then I crashed - felt like a 3 day hangover, felt anxious/stressed/and no longer “cured”. It sucked, I had a couple days of feeling normal then back to feeling like crap. What gives? Do you know what explains the crash?