T Nation

Help Read Blood Test Results Before I Talk to Dr


#1

Not on any TRT replacement therapy.

I decided to get some blood tests done on my own since it cost a fortune to get at my Dr. to order them. I did have a previous test done with them that checked my Test levels and they were low but got the normal analysis of they are okay because they are in range, which was on the low end of the range. They did not check the Prolactin or any other hormone levels that I have below. So, by reading on here and doing some more research, I decide to take my own health in my hands and got Blood results.

One concern is my High Prolactin, which could be the direct results of my lower Testosterone, and Estradiol levels?
EDIT I did find this study that would suggest the Trazodone I am on could be the culprit on why my Prolactin is high. I have been on a dose of 75mg for over 2 years.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2376090/

Could my Bilirubin, Total High level be from red wine? They are on the borderline of being high. I do drink a glass or 2 a night. I do not have nay yellowish tent on skin or around eyes.

Iron levels are borderline, is that a concern?

-age
40
-height
67"
-waist
31"
-weight
162lbs
-describe body and facial hair
Normal
-describe where you carry fat and how changed
Have some around mid section and lower back. Exercise regularly for the past 5years; been trying to put on muscle, therefore body fat has been a little high to bulk up. BF =14%
-health conditions, symptoms [history]
Can’t sleep through the night (on 75mg of Trazodone). High stress levels at times, Been through a recent divorce. headaches, blurred vision, orgasm not the best, decreased sex drive, and not being able to get, or keep an erection sometimes.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
75mg Trazodone
-lab results with ranges
see below
-describe diet [some create substantial damage with starvation diets]
Clean Diet: with Daily Mulitviatamins that have 200mcg and Iodine 150mcg. I use salt with Iodine regularly.
Meal 1:
6 egg whites
30g oatmeal
1 slice ezekiel bread( red or orange package)

Meal 2:
1.5 scoops whey in water
40g berries
1/2 banana
26g ( scale weight) pb or almond butter

Meal 3:
6oz chicken or turkey
5oz red potato

Meal 4: Pre:
5oz beef
160g jasmine rice
30g natural pb

During training:
1 scoop Karboyln mix (Carbohydrate powder)
5g taurine
5g beta alanine
5g glycerol monosterate
5g citrulline malate

Meal 5: Post:
1.5 scoops whey
3oz pineapple
21g ( scale weight) honey on leg and back days

Meal 6:
6oz chicken or turkey
3oz green veg.
26g pb

Non training day meals.
1:
8 egg whites
3oz green veg

2:
1.5 scoops whey
30g berries
20g scale weight/ pb

3:
6oz chicken or turkey
3oz green veg.

4:
6oz chicken or turkey
3oz green veg.
5g ( scale weight coconut oil)

5:
6oz steak( sirloin, flank, top round )
6oz red potato

6:
1.5 scoops whey
40g berries
32g pb

-describe training [some ruin their hormones by over training]
Train for about 90-120 minutes 5 days a week. This includes free weights ,and cardio sessions.
-testes ache, ever, with a fever?
no pain or aches
-how have morning wood and nocturnal erections changed
Only when I have to wake up and have to urinate sometimes, otherwise nonexistent.

LabResults:

LabCorp
SPECIMEN INFORMATION
COLLECTED: 2016/10/24 08:47
RECEIVED: 2016/10/24 11:08
REPORTED: 2016/10/28 12:10
PATIENT INFORMATION
AGE: 40
GENDER: Male
FASTING: Yes
Test Name Result Flag Reference Range Lab
CBC With Differential/Platelet
WBC 4.6 3.4-10.8 x10E3/uL 01
RBC 5.11 4.14-5.80 x10E6/uL 01
Hemoglobin 16.3 12.6-17.7 g/dL 01
Hematocrit 46.5 37.5-51.0 % 01
MCV 91 79-97 fL 01
MCH 31.9 26.6-33.0 pg 01
MCHC 35.1 31.5-35.7 g/dL 01
RDW 13.2 12.3-15.4 % 01
Platelets 185 150-379 x10E3/uL 01
Neutrophils 46 % 01
Lymphs 38 % 01
Monocytes 12 % 01
Eos 4 % 01
Basos 0 % 01
Neutrophils (Absolute) 2.2 1.4-7.0 x10E3/uL 01
Lymphs (Absolute) 1.7 0.7-3.1 x10E3/uL 01
Monocytes(Absolute) 0.5 0.1-0.9 x10E3/uL 01
Eos (Absolute) 0.2 0.0-0.4 x10E3/uL 01
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL 01
Immature Granulocytes 0 % 01
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL 01
Comp. Metabolic Panel (14)
Glucose, Serum 84 65-99 mg/dL 01
BUN 15 6-24 mg/dL 01
Creatinine, Serum 0.94 0.76-1.27 mg/dL 01
eGFR If NonAfricn Am 101 >59 mL/min/1.73 01
eGFR If Africn Am 117 >59 mL/min/1.73 01
BUN/Creatinine Ratio 16 9-20 01
Sodium, Serum 142 136-144 mmol/L 01
Please note reference interval change
Potassium, Serum 4.4 3.5-5.2 mmol/L 01
Please note reference interval change
Chloride, Serum 102 97-106 mmol/L 01
Please note reference interval change
Carbon Dioxide, Total 25 18-29 mmol/L 01
Calcium, Serum 9.2 8.7-10.2 mg/dL 01
Protein, Total, Serum 6.7 6.0-8.5 g/dL 01
Albumin, Serum 4.6 3.5-5.5 g/dL 01
Globulin, Total 2.1 1.5-4.5 g/dL 01
A/G Ratio 2.2 1.1-2.5 01
Bilirubin, Total 1.3 HIGH 0.0-1.2 mg/dL 01
Alkaline Phosphatase, S 66 39-117 IU/L 01
AST (SGOT) 22 0-40 IU/L 01
ALT (SGPT) 15 0-44 IU/L 01
Urinalysis, Routine
Specific Gravity 1.023 1.005-1.030 01
pH 7.5 5.0-7.5 01
Urine-Color Yellow Yellow 01
Appearance Clear Clear 01
WBC Esterase Negative Negative 01
1 of 3
Protein Negative Negative/Trace 01
Glucose Negative Negative 01
Ketones Negative Negative 01
Occult Blood Negative Negative 01
Bilirubin Negative Negative 01
Urobilinogen,Semi-Qn 1.0 0.2-1.0 mg/dL 01
Nitrite, Urine Negative Negative 01
Microscopic Examination Comment 01
Microscopic follows if indicated.
Lipid Panel
Cholesterol, Total 155 100-199 mg/dL 01
Triglycerides 51 0-149 mg/dL 01
HDL Cholesterol 58 >39 mg/dL 01
According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
negative risk factor for CHD.
VLDL Cholesterol Cal 10 5-40 mg/dL 01
LDL Cholesterol Calc 87 0-99 mg/dL 01
Iron and TIBC
Iron Bind.Cap.(TIBC) 249 LOW 250-450 ug/dL 01
UIBC 134 111-343 ug/dL 01
Iron, Serum 115 38-169 ug/dL 01
Iron Saturation 46 15-55 % 01
Testosterone,Free and Total
Testosterone, Serum 137 LOW 348-1197 ng/dL 01
Comment: Comment 01
Adult male reference interval is based on a population of lean males
up to 40 years old.
Free Testosterone(Direct) 4.4 LOW 6.8-21.5 pg/mL 02
Hemoglobin A1c
Hemoglobin A1c 5.1 4.8-5.6 % 01
.
Pre-diabetes: 5.7 - 6.4
Diabetes: >6.4
Glycemic control for adults with diabetes: <7.0
Thyroxine (T4) Free, Direct, S
T4,Free(Direct) 1.56 0.82-1.77 ng/dL 01
DHEA-Sulfate
DHEA-Sulfate 223.5 102.6-416.3 ug/dL 01
TSH
TSH 1.500 0.450-4.500 uIU/mL 01
Luteinizing Hormone(LH), S
LH 4.0 1.7-8.6 mIU/mL 01
FSH, Serum
FSH 2.2 1.5-12.4 mIU/mL 01
Prolactin
Prolactin 73.8 HIGH 4.0-15.2 ng/mL 01
Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 0.7 0.0-4.0 ng/mL 01
Roche ECLIA methodology.
.
According to the American Urological Association, Serum PSA should
decrease and remain at undetectable levels after radical
prostatectomy. The AUA defines biochemical recurrence as an initial
PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory
PSA value 0.2 ng/mL or greater.
Values obtained with different assay methods or kits cannot be used
interchangeably. Results cannot be interpreted as absolute evidence
of the presence or absence of malignant disease.
C-Reactive Protein, Cardiac
C-Reactive Protein, Cardiac 0.19 0.00-3.00 mg/L 01
Relative Risk for Future Cardiovascular Event
Low <1.00
Average 1.00 - 3.00
High >3.00
Estradiol, Sensitive
2 of 3
Estradiol, Sensitive 9.4 8.0-35.0 pg/mL 02
This test was developed and its performance characteristics
determined by LabCorp. It has not been cleared by the Food and
Drug Administration.
Methodology: Liquid chromatography tandem mass spectrometry(LC/MS/MS)
GGT
GGT 23 0-65 IU/L 01
Magnesium, Serum
Magnesium, Serum 2.0 1.6-2.3 mg/dL 01
Insulin
Insulin 3.7 2.6-24.9 uIU/mL 01
Ferritin, Serum
Ferritin, Serum 390 30-400 ng/mL 01
Triiodothyronine,Free,Serum
Triiodothyronine,Free,Serum 3.1 2.0-4.4 pg/mL 01
Sex Horm Binding Glob, Serum
Sex Horm Binding Glob, Serum 29.4 16.5-55.9 nmol/L 01
Performing Laboratory Information:
01: LabCorp San Diego, 13112 Evening Creek Dr So Ste 200, San Diego CA, phone: 858-
668-3700
Medical Director: MD Jenny R Galloway
02: LabCorp Burlington, 1447 York Court, Burlington NC, phone: 800-762-4344
Medical Director: MD William F Hancock
3 of 3


#2

I believe that alcohol the night before a test could cause bilirubin to rise. Tests say not to drink 24-48 hours before.

I looked at that study too and agree. Perhaps you can find an alternative to trazodone. Other causes could be kidney issues (creatinine looked ok), a benign pituitary tumor, or hypothyroidism. An MRI of the pituitary could potentially show a tumor (although it may not catch very small ones). I’d personally maybe look into trazodone first.

Prolactin itself can eff up your testosterone. Can easily be treated with the drug cabergoline. From what I’ve read, testosterone doesn’t always recover from fixing prolactin, but it isn’t uncommon for it to recover. Would be a good place to start.

Did you have these symptoms 2 years ago before you started taking trazodone?

I’m far from an expert but am just giving you my .02 from what I’ve learned so far.


#3

After a quick look. Cholesterol is too low. Needs to be 180-200. Cholesterol is needed for all sex hormones. E2 is too low. Needs to be in the low to mid 20’s. TT and FT way too low. You are a candidate for TRT. If you opt for TRT, be sure to get on a good protocol. As your T levels go up, so will your E2.


#4

While I do not know why you are take Trazodone, there are other medications that may not raise prolactin. While you may hear serotonin reuptake inhibition plays some role in prolactin level increase it is not exactly the case. An antagonist of the D2 receptor (Dopamine) will prevent prolactin secretion inhibition creating a 2 to 10 times increase from baseline levels. A medication that agonizes or even has a null effect would be preferred. As someone who has to concern themselves with that I would try a medication change prior to TRT. Depending on your reason for taking that medication I can post a list of medications that would not raise prolactin levels if you are interested. High prolactin will interfere with GnRH from the hyperthalamus, thus lowering T levels.


#5

Thanks for the info. I take Trazodone for sleep only purposes. I am thinking of tapering off and completely eliminating it, retest in a couple of months to see if my prolactin levels improve. I will definitely talk with my Dr and see what she thinks about the Trazodone having that affect on my levels, but am very skepitcal on her in the first place of not testing for these blood tests.


#6

Probably not a bad plan on tapering off. Just find a balance between taper speed and symptom relief. If you taper to fast you will likely find insomnia. In addition even after the taper it will be a delayed response in any raising of testerone. In addition the 12 hour half life implies the drug may have a hard rebound in tapering. As for the doctor, we are all critical often of doctors here it seems. However, in this case a psychologist or internist not understanding the process bt which the medication perscribed may effect the endocrine system and how to identify correlating symptoms is understandable. They are not taught those things. It is research doctors that look for those things and stay read up. If you take the information from the NIH and your lab results and the doctor is still not getting it or does not care to read it then you definitely have a doctor problem.


#7

@grungephreak
Thanks again for the info. I will see what what the doctor says. I have a feeling she is just going to send me to and Endo for scans. I have tapered off the Trazodone before for about 3 months, but decided to go back on due to my insomnia. I don’t have a problem falling asleep, it is the staying asleep and trying to get back to sleep after I wake up I have had issues with, so, I went back on. With me not having any blood work of my prolactin before I ever started, it is hard to guess whether this is the culprit, but, it is a start to see if by going off my levels improve. I am still not ruling out and TRT, but will definitely stop the Trazodone first .


#8

Trazodone administration was found to increase significantly prolactin concentrations, when measured at baseline and after 12 hours, 1 week and 2 weeks treatment, the means ± S.D. of plasma prolactin concentrations increasing from 9.1 ± 5.6 ng/ml to a maximum of 15.3 +/− 8.5 ng/ml at one week (Otani et al 1995). These recent results are at variance with those of older studies that documented a decrease in prolactin concentration in ten healthy patients treated with trazodone (Rolandi et al 1981).

Too much doubt!


#9

TIBC border line low: This means that you have good iron saturation. Ferritin may be a better indicator. I do not see any iron issues. You could avoid iron fortified foods! Men do not need iron if they do not have a blood loss or GI bleed. Your Daily Mulitviatamins should be iron free and most male specific vitamins are deliberately iron free.

Total cholesterol getting too low. 180 is ideal, <160 is associated with increased all-cause mortality. Cholesterol supports steroid hormone production, including Vit-D3 and cortisol. Egg yokes?

CRP is good.
CRP is not cardio-specific, this lab report is going on discredited info
Lab work, homocysteine is cardio specific to endothelial dysfunction and inflammation.

Thyroid appears OK, fT4 noted a bit high re mid-range.
Please check oral body temperatures as per the thyroid basics sticky to complete the picture. If low, we suspect elevated rT3 blocking your good fT3. Stress increases rT3, not stress in your life? Divorce is hard!

Prolactin can also be from a prolactin secreting pituitary adinoma. If the adinoma is large, it can press on the optic nerves and one can note that width of peripheral vision is reduced, should be near 180 degrees.

Blurred vision: Many need to get glasses at age=40

Sleep: I use trazodone and time release 5-6mg melatonin. Must be time release.

I do not see any source of essential fatting acids in your diet.

Do you supplement Vit-D3? 5000iu suggested unless you get a lot of sun exposure.


#10

Hormones: You TT, FT labs suggest testicular failure, type 1 hypergonadism. But then LH/FSH expected high and these are lowish. So combined type I and type II. Low LH/FSH could be from whatever is elevating prolactin or prolactin itself. A MRI can be done to image the pituitary.

A SERM challenge and testing TT, FT, LH/FSH and E2 would be useful to clarify type I suspicion above.

DHEA is OK, so testicular output is not limited by low DHEA.

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

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

#11

@KSman

Thanks for the information KSman. If I understand you correctly, do you think I should try the protocol below now, or should I stop my Trazodone,test blood again in 4-6 weeks, then come up with a plan based on labs? Should I bother with any Caborgoline?

"First stage:
1a) Inject 250iu hCG SC EOD then do labs for TT, FT, E2 after 4-6 weeks. If things have not improved, stop and go to TRT.

1b) Now if T levels acceptable, now do Nolvadex below to get hypothalamus and pituitary in the game.

Now hypothalamus and pituitary are active.

—or

1a) 20 mg Nolvadex EOD [Clomid if only option]. Then do labs for LH/FSH, TT, FT, E2 after 4-6 weeks. If LH/FSH low, stop and go to TRT. If LH/FSH good and T levels still low, stop and go to TRT. "


#12

Both lead to the same target.


#13

Has anyone seen Gynocamastia form due to low E and elevated prolactin?


#14

It would seem to be possible.
We do not have any expectations from a female model as that never has low E2.
In males, this situation is quite rare.
I have noted that low SHBG is not a factor.
T opposes some of the gene expression from E2 and/or prolactin and you did have very low T, leaving E2 and/or progesterone effects unopposed.


#15

Well I finally went in to discuss my results with my current Dr. But,my current Dr wasn’t available for a couple of months so I saw another one…Mistake. He pretty much looked at my labs and said these are not bad to not let this discourage me…that he has seen worse. I asked him if he thought my Prolactin was an issue and he pretty much stuck an alcohol swab in my face and asked me if I smell acetone or alcohol. I said alcohol and huh?? WTF!! He told me that he didn’t think my pituitary gland was an issue. I then asked him about my test and estrogen levels and he said they are low but should give it 4 -6 weeks and test again. He then wrote me a script for cialis…lol. I told him that I wanted a referral to another Dr (who didn’t get their credentials from a cracker jack box, I didn’t really say this, but was thinking it), I had done some research on and he granted me the referral. So, I have an appointment with him next week. Hopefully, this one didn’t go to the same school as the one I just saw.


#16

Quick update. The referral Dr. ended up being another quack, but I did manage to get my family practitioner to get an MRI ordered. I got the results back and it showed negative for tumor. I have since went of the Trazodone and got my blood levels checked again. My test and prolactin are still close to the previous results 6 weeks ago. I reached out to Defy and and have an appointment with Dr Saya in a few weeks. They are already talking about Cabergoline as a possibility for treatment. But my question is does trt usually go with that start, or do they normally do the Caber first, check levels again in 4-6 weeks then decide on if trt is needed. Any other on here with similar experiences?

thanks


#17

Good luck with Defy, and waiting “a few weeks” for your appointments. I left Defy after being told that he wasn’t available for an appointment for 5 weeks. Found another FL clinic that has a flat monthly fee and I’m happy enough with them so far - only had to wait a day or so for an appointment.