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Help Interpreting Initial Lab Results

Please help me interpret my initial labs.

38 year old male.
5’10 225lb. ~27-30% bodyfat.
Never been over 200lb until 2020. Weight stayed between 180-190 for years.
Fat is mostly in stomach and love handles.

-Loss of hair on lower legs, skin below the knees is smooth and shiny.

Additional symptoms
Borderline gyno symptoms the last few months. Part of it is the weight but had clear sensitivity / pain in pecs behind nipples.

Long time body temperature regulation issues. Borderline hot flashes. I have been on prescription opiates for years and always assumed the thermoregulation issues were a side effect of RX opiates but I understand hormones can play a factor. I’m frequently hot when others are cold. Occasional hot flashes where I’ll actually break into light sweat but temperature doesn’t increase.

libido comes and goes. It is definitely lower than it should be.

Decent bone structure. Never broken a bone outside of knuckles and toes from martial arts in my youth. Have been getting cavities easier the last 5-10 years.
No issues growing facial hair.
Male pattern baldness runs in the maternal side of my family. I shave my head but there’s a solid quarter + sized bald spot on my crown.

History of prescription stimulant use due to ADD diagnosis.
History of depression on and off since late 20’s. It’s not debilitating depression by any means but the biggest symptom is always social withdrawal.

Current complaints at the top of my list (outside of weight gain) are lethargy / fatigue and really poor physical recovery… if I do a weekend of heavy physical labor I’m eating nsaids like m&ms and walking like an 80 year old. I’m sure the extra weight isn’t helping but this last year sore muscles take twice as long to recover and hurt twice as bad.

Overall my energy is extremely inconsistent. I feel like I have 3 good days a week where I can really kick ass. Other days I struggle to get up the drive and motivation to get up and do work. I’ll lazily work from bed instead of home office on these days and maybe clear 50% of my workload if I’m lucky.

Sleep is pretty bad. I get 7 hours on average but I frequently wake up throughout the night. Half of the time even if I do seem to sleep ok I don’t wake up refreshed.

If I missed anything let me know. I appreciate any insight.

I’m going back in to see the doc that rx’d these labs for me tomorrow. She’s open to TRT via one of the clinics, she doesn’t RX it herself. She’s also willing to request more labs.

Do I need FSH/LH, more thorough thyroid testing? Estrogen / prolactin? Or is what I’ve got here enough to go ahead and reach out about starting a TRT protocol?

Feel like maybe you don’t know what depression is, friend.

Look man, you’re overweight, on opiates (which means you have a shit-for-brains PCP), you sleep poorly, your diet is bad…no offense, but what makes you think you shouldn’t feel like hammered shit? You’ve basically designed a lifestyle whose sole purpose is to run you down and eventually kill you.

And maybe trt is the answer, but your low testosterone could be caused by (and at the very least exacerbated by) your lifestyle. Getting on trt isn’t going to help you eat better or exercise or get off the pain pills or or or. You have a shitload of work to do if you want to get better. Trt can be one small piece of the puzzle, but if you want to live a better life then you’re going to need to make some serious changes.

As of right now what’s the one thing you’d fix if there was a magic solution? Like if a pill existed to fix one ailment, which one would you choose? (There are no wrong answers here)

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This is usually related to low estradiol and isn’t uncommon to see in guys with low testosterone or more to the point low Free T which is converted to estradiol. The joint ache is likely from low estradiol.

I wouldn’t be surprised if some of these symptoms are related to your low testosterone values. TRT can have an antidepressant affect, so if anything it should improve the depressive symptoms and possibly eliminate them altogether.

If you think TRT is a magic potion that is going to solve all your problems, then you will be disappointed. TRT is a tool to achieve a healthy state and you must be willing to change your lifestyle to reap the full benefits.

The recurring problems I see guys having are the treatment protocols because the guidelines are dated and mostly lead to treatment failure. Test should be injected at a minimum 1-2 weekly at least 100mg with the majority needing more.

There are some guys that need to inject more often to alleviate side effects. When you’re on TRT, the values are less important, how you feel should ultimately guide your protocol direction.

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Sorry man. The comment you quoted was from a format that I copied and pasted to try and put the correct information in so you guys could offer insight. Those were symptoms as listed out by KS man and I forgot to delete them before making my post.

I’m currently Dictating this message blind because there’s a half page T nation banner that is covering up half of the page regardless of what browser I choose.

I’ll try to logon later when I can get figure out a way to reply without this banner. Currently tried every browser on my iPad and desktop mode and it’s popping up on all of them? Sorry for the technical difficulties. Appreciate the insights

Dude. Happens to me every time I log in using my iPad. Very annoying typing blind.

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[[quote=“systemlord, post:3, topic:271726”]
This is usually related to low estradiol and isn’t uncommon to see in guys with low testosterone or more to the point low Free T which is converted to estradiol. The joint ache is likely from low estradiol.
[/quote]

I will request labs for estradiol levels. My lab has a test called “Estradiol fractionated, serum” This seems like the closest thing to the highly sensitive assays that are usually recommend it for estradiol/estrogen testing.

[[quote=“systemlord, post:3, topic:271726”] I wouldn’t be surprised if some of these symptoms are related to your low testosterone values. TRT can have an antidepressant affect, so if anything it should improve the depressive symptoms and possibly eliminate them altogether.

If you think TRT is a magic potion that is going to solve all your problems, then you will be disappointed. TRT is a tool to achieve a healthy state and you must be willing to change your lifestyle to reap the full benefits.

The recurring problems I see guys having are the treatment protocols because the guidelines are dated and mostly lead to treatment failure. Test should be injected at a minimum 1-2 weekly at least 100mg with the majority needing more.

There are some guys that need to inject more often to alleviate side effects. When you’re on TRT, the values are less important, how you feel should ultimately guide your protocol direction.
[/quote]

The doc I spoke to who would be most likely handling the TRT protocol was fine with starting off with something like 75mg every 3.5 days and then going from there. Also fortunately he definitely takes the approach to treat symptoms more than numbers.

I completely agree with both you and iron that it will not be a magic pill. I am optimistic and hopeful that it will help me implement larger overall lifestyle changes that I do need to make.

Re testing:
Outside of the estradiol testing would it be of benefit for me to try and get other labs like LH, FSH, prolactin? PSA?
I know very little about TSH and thyroid but with my TSH number showing up at 2.21 Should I try to get any of those other thyroid tests ran?

This much testosterone may not be ideal, your SHBG is very low and large to moderate doses will hammer it down.

Low SHBG men tend to do better on more frequent injections, but 75mg injections are going to knock your SHBG way down and thats not what you want.

I recommend daily or EOD injections, 15 daily or 20-30mg EOD using 29 gauge insulin syringes.

I doubt a doc would allow you to start TRT without PSA, LH and FSH since the latter two would hint at a primary or secondary hypogonadism diagnosis which is what insurance companies require in order to cover treatment.

The PSA is mandatory yearly for men on TRT. The prolactin if high enough can cause low-T, so another important lab test.

Your TSH doesn’t hint at a problem, but if you want more testing for thyroid hormones, fT4, fT3 and rT3 are what you want.

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[quote=“systemlord, post:7, topic:271726”]
This much testosterone may not be ideal, your SHBG is very low and large to moderate doses will hammer it down.

Low SHBG men tend to do better on more frequent injections, but 75mg injections are going to knock your SHBG way down and thats not what you want.

I recommend daily or EOD injections, 15 daily or 20-30mg EOD using 29 gauge insulin syringes.[/quote]

Great advice. I worry slightly about the potential damage from long term daily injections but I’ll get over that as I learn proper injection techniques. Plus I understand that guage needle is very small. I was not aware of the shbg / test interaction. I have several friends who much prefer daily / EOD for other reasons so I will definitely discuss this when we start my therapy.

[quote=“systemlord, post:7, topic:271726”] I doubt a doc would allow you to start TRT without PSA, LH and FSH since the latter two would hint at a primary or secondary hypogonadism diagnosis which is what insurance companies require in order to cover treatment.

The PSA is mandatory yearly for men on TRT. The prolactin if high enough can cause low-T, so another important lab test.[/quote]

After speaking to is nurse yesterday he is requiring me to get a PSA for the reasons you stated and a sensitive estradiol test due to several of my symptoms. Actually the same symptoms you referenced as being related to estradiol, being hot all the time and history of joint pain.

To properly quote, right click and highlight what you want to quote and click “Quote” tab that is displayed right above the highlighted section of text.

Thank you man. So got my PSA and estradiol results in and they were as follows:

This seems lower than the range most guys seem to feel comfortable at. When I looked up the common symptoms for low estrogen they definitely fit right along with the common symptoms for low T.

I’m finally having my consult tomorrow morning, possibly even later today. I’m going to ask about EOD injections recommended above. Anything else I should make a point to inquire about?

An E2 of 7 is very low, 20 is the minimum and anything lower is probably going to start affecting bone density.

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I’d go ahead with FSH, LH, prolactin, DHEA-S and IGF-1. VitD while you’re at it. Thyroid? Yes, free T3 and free T4.

I did see your E2 and PSA. E2 needs to be higher.

I’d start with whatever frequency is comfortable. Unfortunately, there is very little, if any, evidence indicating SHBG levels should affect dosing. I just do not see it either. Sometimes SHBG drops on TRT, sometimes no, it increases, usually, no significant change.

Good luck.

1 Like