Help w/ Lab Results and Follow Up Qs

Oh one more thing to add. the Endo said if we dont get any answers from this blood work she will be sending me to get an MRI of my pitulitary gland. Which i had been expecting. Any info you guys could give to help me with my follow up would be greatly appreciated.

run away from this doc (after the MRI and after you get a copy of your results). Make her office fax you the test results BEFORE your appointment so that you can review them and go in with a game plan (not that it will help with this particular doc). post your results and go in armed with suggestions.

those thyroid tests are useless. You already knew you had a possible issue, and needed the Free T4, Free T3, Reverse T3 to show you exactly what was wrong. Total T4 is useless. TSH is mostly useless.

testing for Cortisol is good, but why is she running estradiol without checking your Total T at the same time. The tests she picked seem completely random. I can’t see how they will help much.

I have gone through three years of this with eight different doctors and having a missmash of random tests that don’t give you the full picture which just prolongs your suffering and treatment plan. If I had the right tests two years ago and a good doctor who knew how to read test results (btw, most docs truly don’t know how to read test results), I would have gotten to the point I am at now a whole lot quicker.

the way I see it you will wait 3 weeks to get the results and then find out that you don’t have enough data to point to any particular cause. then the doc more than likely will say ‘well these tests are inconclusive (or normal or "in range), we don’t need to do anything more or run more tests because that would just be a waste of time. it must just be in your head. you just need to get more sleep, or more exercise, or go on these antidepressants.’ or he/she will put you on some sort of treatment plan that basically is just a random guess, because you can’t create a comprehensive treatment when you don’t know what is wrong.

Based on her refusal to run any of the legitimate tests you asked form, I strongly advise that you find a new doc.

Purechance,
Thx for the feedback. I called the DR office about getting my results faxed to me as soon as they get them before my appointment and they refused. They said they cannot release the results until the Dr. has had a chance to review them and follow up with me. They said they would give me a copy at my appointment. It appears they are going to squeeze another co-pay out of me to get these results from them.

My only other option I can try is when I go to Quest next week to do the blood work ask them if I can have a copy of the results mailed to me or something like that. At this point I think I will start to look for another Dr. just in case.
Depending upon what she says at this so called â??followâ?? up I might skip the MRI and go right to the next Dr. I donâ??t want to have to pay ANOTHER co-pay after this appointment to get these darn MRI results considering they wont release them to me unless I have the follow up.

For those who want to do out-of-pocket lab work with LEF.com, they will email the PDF of the labs to you and you will also receive a hard copy via the mail.

This is probably a shot in the dark, but does anyone know any good Doctors in FL?

Did you read this sticky?

sounds like a pretty bad office/doctor.

the only reason not to share the test results before hand is to keep the patient in the dark and not allow the patient to partner with the doctor on the patients treatment plan. sounds like the typical control freak doctor.

Quest won’t give you the results. you are at the mercy of the doctor.

I have been told no in the past, but I pushed back and argued that I need the results before the exam so that I can do my own research in order to have an intellegent conversation with the doctor about MY options and to avoid wasting the doctor’s valuable time. It hasn’t always worked, and I have had to leave some bad doctors who wouldn’t work with me.

Ksman:
Thx for the info. I have got numbers to 2 local compounding pharmacies. I will be calling them later to get referrals. Thx for the help.

Purechance:
Thx as well. I will call the Dr. office next week after i have the tests done and try to argue that point.

Update.
Had all blood work done today. Also dropped off my 24 hour urine collection… That was a pain. I stopped taking Iodine 5 days before these tests. My waking body temp has been around 96.8 during that time. I will resume iodine intake starting tomorrow. I will be calling my Dr. office probably Tuesday next week to verify the results are in. If so i will demand to have a copy of them before my follow up.
If this Dr. orders my MRI of the Pituitary gland this visit i will be satisfied. After i get those results i will go to my new Endo that i found through my local compounding pharmacist… thx to Ksman.

Symptoms update.
Since I stopped taking iodine I noticed a decrease in energy towards the afternoons. Not sure if the iodine is related to my decrease in energy lately.
I drank a full throttle energy drink over the weekend and it perked me right up. I felt great… energy wise. This was odd because usually energy drinks and coffee never have any effect on me.

Energy drink: Do you feel a slump in energy at a particular time of day?

[quote]KSman wrote:
Energy drink: Do you feel a slump in energy at a particular time of day?[/quote]

I would have to say late afternoons. anywhere from 3-6pm. At these times i feel my lowest energy levels. Mornings i am usually great. Once i wake up i feel good. I usually cannot go back to sleep once i wake up. I start my day every morning at 6AM. Never feel to tired to get up.

To say that waking body temp is always an indicator of pure thyroid malfunctioning is absurd. You clearly need testosterone and should get some from your doctor in injection form. You should also monitor your E2 and SHBG and make sure the SHBG is low. Let’s just cut to the chase boys. Guys have kids on TRT still. Your kids would probably be healthier for it knowing that the DNA being encoded is no longer from a sluggish dude like we all are with 200 testosterone. Young guys left and right including myself have to get on T because the metabolism is basically genetically screwed…that is one reason…so insulin rises - opposes T etc… I wouldn’t worry about other hormones until you fix testosterone and then assess how you feel in a month on say 100mg/week without HCG. All HCG is going to do is produce more estrogen in your body. I apologize for my last derogatory post - my doctor has been screwing with my prescription and so I turn into a grumpy old man when I can’t get any. Luckily I have a new doctor who actually understands TRT. Be very cautious of putting your life in the hands of a doctor who has no idea what taking away testosterone or putting in too much of the wrong kind does to you.

It might be informative to get a cortisol lab done during an afternoon when you feel particularly dumpy.

I learned a lot today:

Insulin rises and opposes T, here I though that low T contributed to insulin resistance which then causes insulin levels to increase.

TRT alters ones DNA in their sperm, leading to genetically superior children, the TRT master race.

One can make sure that SHBG is low by monitoring it

hCG does nothing but produce estrogen, no other benefits

Waking body temp has nothing to do with thyroid status, when every other respected source states the opposite.

What is “pure thyroid malfunctioning”? How many kinds of thyroid malfunctions are are not pure?

CJ continues to be a cesspool of misinformation.

KSman,
Thx for the help. Is there a way i can test cortisol OTC?

You can order lots of blood labs [including cortisol] via LEF.com which uses labcorp. You can’t do 4 sample saliva tests from them [that I am aware of], but many sell that on the WWW. If doing a single test, you could do that at a time of the day when you typically feel run down. That might provide some good insight. Do testing on a typical stressful day, not a relaxed day off.

Good morning!
I will post my lab results before ym follow up summary.

TSH 3rd Generation 1.51 ( .40-4.50 )MIU/L
FSH 1.8 ( 1.6-8.0 )
LH 1.7 (1.5-9.3)
Prolactin 3.5 ( 2.0-18.0) ng/ml
Total Testosterone 211 (250-1100)
Free T 33.3 (35.0-155.0) pg/ml

Complete metobolic panel w/eGFR
Glucose 84 (65-99) mg/dL
Urea Nitrogen Bun 17 (7-25) mg/dL
Creatinine 0.88 (0.80-1.30) mg/dL
eGFR Non-AFR. American >60 (> or = 60) mL/min/1.73m2 ( Not sure what this was for?)
eGFR African American >60 (> or = 60) mL/min/1.73m2 ( Not sure what this was for?)
Sodium 139 (135-146) mmol/L
Potassium 4.0 (3.5-5.3) mmol/L
Chloride 99 (98-110) mmol/L
Carbon Dioxide 28 (21-33) mmol/L
Calcium 10.0 (8.6-10.2) mg/dL
Protein, total 8.1 (6.2-8.3) g/dL
Albumin 5.0 (3.6-5.1) g/dL
Globulin 3.1 (2.1-3.7) g/dL (Calc)
Albumin/Globulin ration 1.6 (1.0-2.1) (Calc)
Bilirubin, total 1.2 (.2-1.2) mg/dL
Alkaline Phosphatse 107 (-40-115) U/L
AST 32 (10-40) U/L
ALT 50 (9-60) U/L
Magnesium 2.1 (1.5-2.5) mg/dL
TSH, 3RD Generation 1.89 (.40-4.50) mIU/L
T4 (throxine), total 11.5 (4.5-12.5) mcg/dL
Free T4 index (T7) 3.5 (1.4-3.8)
T3 Uptake 30 (22-35%)
ACTH, plasma 20 (7-50) pg/mL

24 HR urine collection LC/MS/MS
Cortisol, Free, Urine 22.0 (4.0-50.0)mcg/24 H
Creatinine, Urine 1.73 (0.63-2.50) g/24 h
IFG I, ECL 340 (88-374) ng/mL

Iron and total iron
Binding capacity
iron total 70 (45-175) mcg/dL
iron binding capacity 411 (250-425) mcg/dL
% SATURATION 17% (20-50%)(calc) I asked the Dr. About this and she told me i need to talk to my PCP about this. which was werid… not sure why she even did the test
Estradiol 34 (13-54) pg/mL
Cortisol AM 15.3 reference range 8AM (7-9AM) Speciment: (4.0-22.0)

Ok now with that out of the way let me go over what the Endo told me. She told me that pretty much everything is normal…(Purechance you are a genius for predicting this LOL). She is now sending me for an MRI of the pituitary and sperm count (Per my request YAY she actually ALMOST listened to me HAH) The endo told me that my T levels could be MY Norm… i kept pressing her about the symptoms at this point and how is that suppose to be NORMAL… She ended up prescribing me AndroGel and to take four pumps and day and apply to the shoulders. When i asked her about HCG to maintain my fertility she said she didnt know anything about that and i should see a Fertility Specialist for that…(which i might actually do if i think they will give me the HCG). My next question to her was… When T levels rise dosnt E levels rise also? … Her simple answer… That is not your concern and that i shouldnt need to worry about that…
Anyway to make a LONG story short I took the scrip ( I dont think i will be using it )
I will be getting the MRI and sperm count. Once those are done i have found ANOTHER Endo through my local compounding pharmacy (Thanks to KSman) and i will be taking ALL my results there after i finish with all these tests…
Sorry for the long post, any feedback, help or suggestions would be GREATLY appreciated. Also i am sure i have left something out here but i cant figure out what… *(must be the brain fog)

sorry for the experience. 99% of us have been there and done that multiple times.

Don’t try to find an Endo - they are too much “in the box” thinkers. You need a good HRT doc one who knows about compounding pharmacies, T shots, estrogen control, thyroid regulation, cortisol-thyroid interaction, etc.

your cortisol looks good.
Thyroid seems a bit stressed - still need to get tested for Free T4 and Free T3 (not RT3 for now since your Cortisol level looks pretty decent).
Magnesium looks low. may want to start a supplement for that.
T is completely shut down with such low LH FSH numbers.
Estradiol is extremely high for such low T levels - very estrogen dominate. a short course of Arimidex might help keep you T around longer.
not sure what the iron test shows - need ferritin levels (male ideal around 150 I think).

Don’t wait for the tests to find a new doc. start now. It might take awhile to find one.

Yes, VERY estrogen dominant. Something is depressing LH, but it is not prolactin. So there will not be a prolactin producing adinoma

PureChance, did you misread something? “Magnesium 2.1 (1.5-2.5) mg/dL”

A hCG or SERM challenge followed by a TT/FT test would indicate if the testes are OK. With LH low for a long time, the challenge phase should be extended to allow for physical recovery of the testes before checking T levels. If that works, hCG could be used instead of T+hCG. Note standard warnings that high dose hCG or high LH levels from, by definition, too much of a SERM, can be harmful.

This might be an intractable case of secondary hypogonadism.

KSman thx for the suggestions. I definitly want to try the HCG combo with Armidex. Do you know anywhere i could get HCg or armidex from a good quality source?

My next thing i am going to do. I am scheduling an appointment with my pcp to check the iron issue and have him test Ferritin levels and possibly free t3 and t4 and E2 levels. Hopefully i can persuade him to do so.

My next step was. If i cannot find the HCG online or anywhere else i am going to schedule an appointment with the fertility Dr and show him my sperm count (havent taken yet). At that point i will try to get him to perscribe me HCG… however this would still leave me short of armidex…

if none of that works I have another Endo lined up who was recommened by my compounding pharmasist, i will schedule to see him and bring ALL my results.

Another thing… let me see if i am grasping this right. I apparently am very estrogen dominant. So for some reason my Estrogen is not getting converted to T and this is what i am trying to correct? So with HCG to help boost my Testes and Armidex to reduce Estrogen levels i might be able to restart normal production of T? if this is the case then this is very good news for me. I really appreciate the help guys.

We do not post sources here, for some good reasons.

E2 converts to T, not the other way around!!! hCG will do what your LH should be doing, everything after that is business as usual in most cases.

HPTA restart does not happen routinely. You can do the right things, then see what happens. A SERM challenge will indicate if there is any hope with the pituitary. If that works, then there are specific things to try.