T Nation

Help Evaluate My Labs

Hey Guys i have been suffering from symptoms of low T for a while now and finally decided to do something about it. Just got my blood-work done (results below). i want to start with TRT but i am sacred to death about the side effects. For now can you please look at my results and tell me if i need TRT or can i clean this up with my diet. I am 6’1 and weigh 218 lbs? I am leaning towards injectibles as whatever research i have done they are the most cost effective option:

  • Thyroxine (T4)	6.6  normal 	                Reference Range: 4.5-12.0 ug/dL
    
  • Triiodothyronine (T3)	122  normal 	Reference Range: 71-180 ng/dL
    
  • Testosterone, Serum	346  normal 	Reference Range: 264-916 ng/dL
    
  • TSH	1.930  normal 	                                Reference Range: 0.450-4.500 uIU/mL
    
  • Prolactin	14.5  normal 	                         Reference Range: 4.0-15.2 ng/mL
    
  • Estradiol	28.9  normal 	                         Reference Range: 7.6-42.6 pg/mL
    
  • Prostate-Specific Ag, Serum	0.4  normal 	Reference Range: 0.0-4.0 ng/mL
    
  • FSH and LH		
    
  • LH	7.2  normal 	Reference Range: 1.7-8.6 mIU/mL
    
  • FSH	3.1  normal 	Reference Range: 1.5-12.4 mIU/mL
    
  • Sex Horm Binding Glob, Serum	25.9  normal 	Reference Range: 16.5-55.9 nmol/L
    
  • **Free Testosterone(Direct)	6.5low 	                Reference Range: 8.7-25.1 pg/mL**
    
  • Comp. Metabolic Panel (14)		
    
  • Calcium	9.8  normal 	                        Reference Range: 8.7-10.2 mg/dL
    
  • Glucose	86  normal 	                        Reference Range: 65-99 mg/dL
    
  • BUN	10  normal 	                                Reference Range: 6-20 mg/dL
    
  • Protein, Total	7.1  normal 	                Reference Range: 6.0-8.5 g/dL
    
  • Albumin	4.5  normal 	                        Reference Range: 3.5-5.5 g/dL
    
  • Bilirubin, Total	0.5  normal  	                Reference Range: 0.0-1.2 mg/dL
    
  • Alkaline Phosphatase	110  normal 	Reference Range: 39-117 IU/L
    
  • AST (SGOT)	18  normal 	                Reference Range: 0-40 IU/L
    
  • Potassium	4.7  normal 	                        Reference Range: 3.5-5.2 mmol/L
    
  • Sodium	141  normal 	                        Reference Range: 134-144 mmol/L
    
  • Chloride	101  normal 	                        Reference Range: 96-106 mmol/L
    
  • Creatinine	1.06  normal 	                        Reference Range: 0.76-1.27 mg/dL
    
  • ALT (SGPT)	22  normal 	                Reference Range: 0-44 IU/L
    
  • Carbon Dioxide, Total	26  normal 	Reference Range: 20-29 mmol/L
    
  • BUN/Creatinine Ratio	9  normal 	Reference Range: 9-20 
    
  • Globulin, Total	2.6  normal 	                Reference Range: 1.5-4.5 g/dL
    
  • A/G Ratio	1.7  normal 	                        Reference Range: 1.2-2.2 
    
  • eGFR If NonAfricn Am	90  normal 	Reference Range: >59 mL/min/1.73
    
  • eGFR If Africn Am	104  normal 	        Reference Range: >59 mL/min/1.73
    
  • Testosterone, Total	342  normal 	
    
  • Bioavailable Testosterone, S	175  normal 	
    
  • Bioavailable Testosterone, %	51.1  normal 	CBC/Diff Ambiguous Default
    
  • WBC	6.1  normal 	                                 Reference Range: 3.4-10.8 x10E3/uL
    
  • RBC	4.96  normal 	                                 Reference Range: 4.14-5.80 x10E6/uL
    
  • Hemoglobin	14.2  normal 	                 Reference Range: 13.0-17.7 g/dL
    
  • Hematocrit	43.2  normal 	                 Reference Range: 37.5-51.0 %
    
  • MCV	87  normal 	                                 Reference Range: 79-97 fL
    
  • MCH	28.6  normal 	                                 Reference Range: 26.6-33.0 pg
    
  • MCHC	32.9  normal 	                         Reference Range: 31.5-35.7 g/dL
    
  • Neutrophils	53  normal 	                 Reference Range: Not Estab. %
    
  • Immature Granulocytes	0  normal 	 Reference Range: Not Estab. %
    
  • Lymphs	37  normal 	                         Reference Range: Not Estab. %
    
  • Monocytes	7  normal 	                 Reference Range: Not Estab. %
    
  • Eos	3  normal 	                                Reference Range: Not Estab. %
    
  • Basos	0  normal 	                        Reference Range: Not Estab. %
    
  • Platelets	314  normal 	                        Reference Range: 150-450 x10E3/uL
    
  • Neutrophils (Absolute)	3.2  normal 	Reference Range: 1.4-7.0 x10E3/uL
    
  • Immature Grans (Abs)	0.0  normal 	Reference Range: 0.0-0.1 x10E3/uL
    
  • Lymphs (Absolute)	2.3  normal 	        Reference Range: 0.7-3.1 x10E3/uL
    
  • Monocytes(Absolute)	0.4  normal 	Reference Range: 0.1-0.9 x10E3/uL
    
  • Eos (Absolute)	0.2  normal   	               Reference Range: 0.0-0.4 x10E3/uL
    
  • Baso (Absolute)	0.0  normal 	       Reference Range: 0.0-0.2 x10E3/uL
    
  • RDW	13.6  normal 	                                Reference Range: 12.3-15.4 %
    

I am working with Dr. Michael Rotman in NY. Incase anyone here is a patient pls feel free to msg me directly.

What is it that you think will happen?

The side effects will be more frequent erections, more sex, more libido, more muscle mass, more fat loss.

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T4 is low and should be midrange, but you seem to have plenty of T3, but you should be testing fT3 which tells you how much thyroid hormone is making it into the cells, T3 is obsolete and best for diagnosing hyperthyroidism, T3 is not a biologically active hormone.

I doubt rT3 would be a problem with TSH <2.5, but you never know.

Your testosterone is low no argument and to the point, you may in fact be primary meaning testicular failure with high LH with TT and FT levels low, so your question about fixing this naturally is a negative.

You will struggle on TRT if you inject infrequently, you need very frequent injections every day or EOD or you’ll struggle with symptoms of high estrogen once you double or triple TT and FT levels (FT–>E2). Your FT is very low and estrogen healthy which will change once TT and FT levels are higher.

Your thyroid and prolactin levels cannot explain low TT and FT levels, the testicles are either on there way out or got damaged somehow, maybe a blow to the groin or even varicocele which could cause low T, high LH and infertility. In this latter case I think we would see FSH high as well.

As @studhammer mentioned, exactly WHAT side effects are you terrified of? Let us dispel some rumors for you.

Your lab results certainly would correlate to low testosterone symptoms. A good place to start is 150mg injection once weekly. I expect you’ll do fine with that, maybe need to increase it slightly. About 85-90% of the guys on TRT use once weekly injections with dosing ranging between 150-200mg.

Ok so getting some conflicting answers from your and systemlord. I am just trying to figure out which was is best in terms of injecting as in do it more frequently or just once a week. Once a week sounds a lot better :slight_smile: but is that the right approach?

Developing Prostate cancer due to prolonged use my main worry. Acne breakout, Water retention being other things along with the biggest one which my wife worries about which is my temperament she thinks i will turn into some sort of monster and blow of fuse at every small thing

T-cypionate spikes T and E2 more than any other form of TRT, these unnatural spikes will produce an unnatural surge in hormones. Once weekly will also have levels high in the first few days and lower by day 6, a lot of men notice these functions and are sensitive to them which can cause symptoms.

You need to go through other members treads and see what other are doing, then decide for yourself. When you double or triple your TT and FT levels, what do you think will happen to your estrogen levels knowing that FT is converted to E2 and that your E2 is already normal?

The estrogen towards the top of the ranges while FT is low suggests you aromatise a good portion of Free T–> E2, however if E2 was low alongside your low FT, then perhaps once weekly injections would work.

Do the math and then decide.

This was proven to be false. High test does not cause cancer. Otherwise, every 17 year old would have it. If anything its a low Test/high E2 ratio.

Now this is real. Test increases your sebaceous glands which can lead to breakouts but they arent too bad.

Again, these are old false beliefs, roid rage is bullshit. Test makes you more confident which can lead to more confrontations but its certainly not rage. Proper hormone levels make you feel great. Why would anybody have rage like this. We are talking about test, not things like Tren which can affect moods.

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Yeah, sorry about that. First off, there is no one size fits all approach. This is what I can tell you. I knew hundreds of guys who used PEDs back in the 70s and 80s when I was competing. I was one of them. Typical dose for test was 200-800mg a week. Injections were once weekly unless taking over 400mg a week then they were divided only so you didn’t have to put 3cc in your ass at once, 600mg would scare no one.

Very few guys had any troubles such as reported here. Some did, bodybuilders seemed to have more issues than powerlifters with weightlifters having the least, but it was unusual. We used lower amounts (relatively) probably because our results were more dependent on skill than strength. Nothing was used for estrogen until the mid 80s and then by the bodybuilders because fluid retention was their mortal enemy.

Guys here with protocol difficulties, needing up to a year, or more, to “dial in”, are outliers. Those overly sensitive to fluctuations, a “massive” dose of testosterone, E2 or needing to be level or “stable” at all hours of the day are outliers. I guess those needing small dosing and multiple injections a week never would have made it in our PED sport.

I know several hundred guys on TRT currently, some under the care of doctors or TRT clinics, some underground self-medicating. Around 85-90% of them are taking 150-200mg once weekly. The other 10% inject twice. I suspect some of them are taking a larger dose and that is why. Most underground do not use an aromatase inhibitor. AIs are about 50-50 on those under professional care. They all are very happy with their protocol.

So, what about you? Do what you are doing. Soak it all in. You know yourself and your history best. Plus, you do have a doctor and presumably, he has experience with TRT and you can benefit from that. Multiple injections won’t hurt you. My position is try once a week. You can always increase it if you need to. Very few have the trouble reported here and I think that some, in large part because of what they read, find these problems. The meathead in the gym taking 200mg once a week doing great is not on the internet discussing tender nipples, fluid retention or being emotional. There are a lot of them. If you have side effects, and it is very doubtful that you will, you can always go with the more exotic programs. I am not saying that it cannot happen, I do believe some are overly sensitive to hormones, just that it is not the norm and I would not begin this assuming you are one of them unless there is a reason to think so.

Good luck. It sure looks are though you would benefit from TRT.

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You might check this guy out:

Perfectly said. I have a ton of friends on TRT and all are on 200mg once a week, have no idea what an AI is or E2 for that matter and don’t have any issues besides wanting to pound every chick that isn’t their wife.

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Thanks for the advise. I am going to speak to my doctor and decide accordingly.

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High levels of exogenous T (TRT) was believed to cause prostate cancer, notice how I said believed, there was never any clinic studies that showed TRT causes prostate cancer. Newer studies are showing men with low FT have more aggressive prostate cancer than those with high FT.

When men age their TT to FT ratios change and was as the T->E2 ratios, T is lower in relation to E2. If prostate cancer runs in your family, than there is nothing you can do about it, you’ll either get it or you won’t, but TRT will have nothing to do with it, your genes do.

There are no increases in prostate cancer with men on TRT, this tells you we got it wrong.

Testosterone Replacement Therapy and Prostate Cancer Incidence

Several trials on men on TRT found no higher risk of prostate cancer than the general population.

Testosterone Therapy in Men With Prostate Cancer

The use of testosterone therapy in men with prostate cancer was previously contraindicated, although recent data challenge this axiom. Over the past 2 decades, there has been a dramatic paradigm shift in beliefs, attitude, and treatment of testosterone deficiency in men with prostate cancer.

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ok so my doc suggested weekly shot of T-cypionate 100mg. You think thats adequate based on my labs? Also should i break it down into multiple weekly shorts? or say bi-weekly 50mg shots?

TRT will decrease your SHBG <20 quickly making you a low SHBG guy, it will probably end up around 15 or possibly lower, very frequent dosing is recommended or I expect to see you back in a short while with estrogen side effects.

Your estrogen is already close to the top of the ranges, daily injections, minimum EOD, but the latter may very well degrade the way you feel. I’ve been doing this for 3 years almost every day on my spare time and I’m pretty darn good at seeing problems before they arise if an inappropriate protocol is chosen.

You are what’s known as a high converter, converting a hefty portion of FT–>E2 considering FT is damn low. I consider myself a moderate converter, 50mg twice weekly (689 ng/dL at trough) got my estrogen to 70 pg/mL (<35), double the reference ranges.

You want more sides, inject EOD, you want less, inject daily. It’s all about the math and a little unpredictable biology dosing not being linear.

Most of the low SHBG guys do have all the problems on infrequent dosing beyond EOD unless they are blessed with low amounts of aromatase enzymes. The fact you are considering multiple shots per week, your odds of not quitting TRT within 6 months just went up considerably.

I recommend 12-14 mg daily since I have no idea how sensitive your HPTA is to testosterone. It’s neither a low or high dosage. Most can see levels at least midrange on 100mg weekly injecting infrequently, daily you need less.

Remember as T-cypionate decreases SHBG, this means FT increase and since SHBG will be lower, I’m not recommending a high starting dosage.

No, I still think 150mg is a good starting place. Is the doctor a TRT doc? If not, he is likely treating a deficiency rather than an insufficiency. However, you can start with 100mg, see how you respond, and hope he’ll consider moving up if needed.

You can, but as I reported above, that is usually not necessary. Many fans of multiple dosing here will tell you otherwise. My position is start with once until proven otherwise. You can take two, or even more, won’t hurt you.

Good luck, at least you have options that include testosterone.