T Nation

Help With Bloodwork For Low Libido & ED

Hi Guys,

26 year old male here with a past history of steroid use. I havent recovered from last cycle 2 1/2 years ago and I’ve been searching for the root cause every since.

My main symptoms are brain fog, fatigue, low libido & ED.

I’ve moved to functional medicine and I’m currently working with a doctor whom i hope is finally the one that helps cure my ailments.

I’ve done a sleep study for sleep apnea (i know i dont have it though) currently doing a saliva & urine cortisol test. I’ll also be getting a brain MRI and i took a boatload of blood work as well.

I dont think I’ve gotten all my bloodwork back yet but I have gotten quite a bit over the last 2 weeks.

I’ve been dealing with Euthyroid Sick Syndrome and I’ve been trying to find the cause so i can move on with my life.

Currently on 8 weeks of TRT. 100mg per week with 1000iu hcg split twice weekly along with 25mg of aromasin per week. i dont know if this is my optimal dosage yet. I was on 125mg weekly but my test came back high, this is my readjustment.

I’d appreciate the help in interpreting my latest blood work and helping me see things that I may not have been able to see myself.

06/06/2019 blood work:
TOTAL GLUTATHIONE 752 (544-1228 uM)
OMEGA 3 (EPA+DHA) 2.1 (2.2-3.2)
OMEGA 6/OMEGA 3 RATIO 12.3 (5.7-21.3)
EPA/ARACHIDONIC ACID RATIO <0.1 (0.2 OR LESS)
ARACHIDONIC ACID 11.3 (5.2-12.9 %)
EPA 0.3 (0.2-1.5 %)
DHA 1.8 (1.2-3.9 %)
OSMOLALITY,SERUM 290 (275-295 mOsm/kg H2O)
MAGNESIUM 2.0 (1.5-2.5 mg/dL)
FIBRINOGEN ACTIV,CLAUSS FIBRINOGEN 237 (175-425 mg/dL)
FSH <0.7 L (1.6-8.0 mIU/mL)
LH <0.2 L (1.5-9.3 mIU/mL)
THYROID PEROXIDASE AB <1 <9 IU/mL
THYROGLOBULIN ANTIBODIES <1 < OR = 1 IU/mL
CERULOPLASMIN 31 (18-36 mg/dL)
VITAMIN C 0.7 (0.2-2.1 mg/dL)
TNF-ALPHA,HIGHLY SENSITIVE 0.54 L (0.56-1.40 pg/mL)
ESTRADIOL, ULTRASEN,LC/MS 51 H
DIHYDROTESTOSTERON,LCMSMS 64 (16-79 ng/dL)
TESTOSTERONE,TOTAL, MS 1387 H (250-1100 ng/dL)
TESTOSTERONE,FREE 274.6 H (35.0-155.0 pg/mL)
17-HYDROXYPROGESTERONE 40 (32-307 ng/dL)
VITAMIN A (RETINOL) 46 (38-98 mcg/dL)
IMMUNOGLOBULIN A 150 (81-463 mg/dL)
SEX HORMONE BINDING GLOB 41 (10-50 nmol/L)
WBC 2.9 L (3.8-10.8 Thousand/uL)
RBC 5.95 H (4.20-5.80 Million/uL)
HEMOGLOBIN 16.3 (13.2-17.1 g/dL)
HEMATOCRIT 49.5 (38.5-50.0 %)
MCV 83.2 (80.0-100.0 fL)
MCH 27.4 (27.0-33.0 pg)
MCHC 32.9 (32.0-36.0 g/dL)
RDW 15.3 H (11.0-15.0 %)
PLATELET COUNT 231 (140-400 Thousand/uL)
MPV 9.9 (7.5-12.5 fL)
TOTAL NEUTROPHILS,% 46.8 (38-80 %)
TOTAL LYMPHOCYTES,% 42.3 (15-49 %)
MONOCYTES,% 6.8 (0-13 %)
EOSINOPHILS,% 3.4 (0-8 %)
BASOPHILS,% 0.7 (0-2 %)
NEUTROPHILS,ABSOLUTE 1357 L (1500-7800 cells/uL)
LYMPHOCYTES,ABSOLUTE 1227 (850-3900 cells/uL)
MONOCYTES,ABSOLUTE 197 L (200-950 cells/uL)
EOSINOPHILS,ABSOLUTE 99 (15-500 cells/uL)
BASOPHILS,ABSOLUTE 20 (0-200 cells/uL)
ACTH,PLASMA 33 (6-50 pg/mL)
HEMOGLOBIN A1C 5.3 (<5.7 % of total Hgb)
COPPER 124 (70-175 mcg/dL)
MAGNESIUM,RBC 4.5 (4.0-6.4 mg/dL)
SELENIUM 142 (63-160 mcg/L)
ZINC 63 (60-130 mcg/dL)
VITAMIN B6, PLASMA 38.0 H (2.1-21.7 ng/mL)
VEGF,ELISA QNI VASCULAR ENDOTHELIAL GF <31 L (31-86 pg/mL)
HUMAN TGF BETA 1 (TGF-B1) 15460 H (344-2382 pg/mL)
VITAMIN B1 (THIAMINE), B 76 L (78-185 nmol/L)
VITAMIN E (TOCOPHEROL) AMD ALPHA-TOCOPHEROL 12.9 (5.7-19.9 mg/L)

Comp Metab Panel
GLUCOSE,FASTING 91 (65-99 mg/dL)
SODIUM 139 (135-146 mmol/L)
POTASSIUM 4.3 (3.5-5.3 mmol/L)
CHLORIDE 105 (98-110 mmol/L)
CARBON DIOXIDE 30 (20-32 mmol/L)
UREA NITROGEN 17 (7-25 mg/dL)
CREATININE 1.33 (0.60-1.35 mg/dL)
CALCIUM 9.4 (8.6-10.3 mg/dL)
PROTEIN, TOTAL 6.9 (6.1-8.1 g/dL)
ALBUMIN 4.4 (3.6-5.1 g/dL)
GLOBULIN 2.5 (1.9-3.7 g/dL) (calc)
ALBUMIN/GLOBULIN RATIO 1.8 (1.0-2.5) (calc)
BILIRUBIN,TOTAL 0.6 (0.2-1.2 mg/dL)
ALKALINE PHOSPHATASE 109 (40-115 U/L)
AST 37 (10-40 U/L)
ALT 28 (9-46 U/L)
EGFR NON AFR AMERICAN 73 >=60 mL/min/1.73m2
EGFR AFRICAN AMERICAN 85 >=60 mL/min/1.73m2

LIPID PANEL
CHOLESTEROL,TOTAL 175 (<200 mg/dL)
HDL CHOLESTEROL 62 (>40 mg/dL)
CHOLESTEROL/HDL RATIO 2.8 (<5.0 calc)
LDL-CHOLESTEROL 101 H (<100 mg/dL) (calc)
TRIGLYCERIDES 41 (<150 mg/dL)
NON HDL CHOLESTEROL 113 (<130 mg/dL) (calc)
GGT 10 (3-70 U/L)
IRON,TOTAL 75 (50-195 mcg/dL)
IRON BINDING CAPACITY 298 (250-425 mcg/dL) (calc)
IRON % SATURATION 25 (15-60 %)

TSH 1.34 (0.40-4.50 mIU/L)
T4,FREE 1.1 (0.8-1.8 ng/dL)
T3,FREE 3.0 (2.3-4.2 pg/mL)
LIPASE 46 (7-60 U/L)
FERRITIN 59 SUB OPTIMAL (20-345 ng/mL)
PROGESTERONE 0.5 (<1.4 ng/mL)
VITAMIN B12 510 (200-1100 pg/mL)
FOLATE,SERUM 13.4 (> 5.4 ng/mL)
CORTISOL (AM) 11.8 (4.0-22.0 mcg/dL)
INSULIN 3.0 (2.0-19.6 uIU/mL)
DHEA SULFATE 392 (85-690 mcg/dL)
HS CRP 0.8 mg/L
HOMOCYSTEINE 7.6 (<11.4 umol/L)
VITAMIN D,25-OH,TOTAL,IA 52 (30-100 ng/mL)
INTERLEUKIN-6(IL-6),SERUM <1.40 (<5.00 pg/mL)
PREGNENOLONE,LC/MS/MS 62 (22-237 ng/dL)
T3 REVERSE, LC/MS/MS 14 (8-25 ng/dL)
VIP <50 (<75 pg/mL)

This is my latest bloodwork to date.
i swear this is a nightmare. Out of all the test and blood work done, there has been NOTHING definitive about my situation. My total t3 and free t3 have been definitive in terms of being low, but now my free t3 has bumped up a bit for whatever reason. My total t3 has always fluctuated between 60-80 without thyroid medication and i know thats far too low.

I also feel like a aromatize a lot more than i should. During past AAS cycles i NEVER needed an AI, now it feels like my estrogen is always privy to being higher. I dont know if thats a clue for my dilemma or not.

My pregnenolone levels look lowish & ferritin seems to be below optimal, any clues there?

I’m at a loss guys. I’ve either yet to find the main source of the problem or the issues in my body are quite subtle and don’t jump out right away. If theres any ideas in terms of direction i can look in, ill heavily appreciate it.

I would drop the HCG for a month and see how you feel. That’s if I understand you are still having these symptoms after 8 weeks on trt. And drop any ai at the same time you drop the HCG.

Also hard to find root cause when you already started trt. At least you’re doing MRI. Try to do a testicular ultrasound too. At least you can rule out some diseases causing low t.

Your thyroid is not optimal but not bad either.

Any other meds ? Or supplements?

I didn’t want to do trt until i found the problem, but i absolutely had to.

I can barely function without trt. My intellectual capacity is far reduced and i feel timid as fuck! I can barely work my job and go to the gym, i was about to lose my job unless i chose to hop back on trt 2 months back.

I did drop the hcg when i was on my last stint a few months back, however i do fear ruining my fertility being off for a long period of time so maybe i didn’t stay off long enough. I might choose to do 250iu EOD and try to find that right balance of T -> E.

I do think there’s something legitimately wrong in my body. I don’t think it would be as simple as stopping hcg or tinkering with dosages per say.

Everytime i start testosterone back up, i get the boost for 1-2 weeks, feel a rise in libido and energy, then it stops. I’m wondering what could be holding my body, and most likely my thyroid back.

The last time i had an extended peroid of feeling good was when i came off trt for 2-3 weeks and started HGH. From weeks 2-3 of HGH, i was about 50-60% of where i needed to be and i was doing very well until i plateaued again. Wondering if i could find any correlation between this all.

Thanks for your response!

This is way high. Look into this.
Also your wbc count low.
Retake CBC.
Did you get igf-1 lab? If not ask for that too. And prolactin

I’ve def looked into TGF-B1. Still an esoteric topic and something ill have to bring up with the functional medicine doctor. Things that have stood out to me are the fact it can increase during HRT so maybe there’s a direct correlation between that and my testosterone supplementation, and could be indicative of inflammatory conditions.

There are a few pieces of blood work that have indicated some type of inflammation in the body. However bloodwork wasn’t consistent in terms of being high/low one second and normal range the next.

Through this all, i do suspect there is inflammation, but not enough information to be definitive.

WBC has been low over the years, not sure what it correlates to in the end as research hasn’t been entirely clear.

IGF-I,LC/MS 362 (63-373 ng/mL) this was taken 12/27/2018. However some blood values would consider this too high so I’m not sure if this needs to be looked into more.

Prolactin may still be coming in the next week or so, but its always been towards the bottom quarter of the range in recent years.

If your are able to.
I would see a rheumatologist and an endocrinologist. And a urologist. This is complex stuff.

This should cover all diseases. Different specialist analyze things differently and have a unique point of view.

You’re HPTA is very sensitive to testosterone, the HCG is doing some heavy lifting as well. A course correction is needed, lowering your dosage or increasing injection frequencies and injecting smaller more frequent doses will lower estrogen.

You can do one of two things, lower your T dosage and/or HCG dosage to lower estrogen. Maybe you will not even need an AI if you dose smartly.

TRT can deplete core minerals and vitamins, months or years down the road, so when you feel TRT isn’t quite working anymore, you’ll know where to look.

Would like to see an iron panel, these test could indicate an iron deficiency. I started TRT with an iron deficiency and broke me.

No good, thyroid needs >70 to support optimal thyroid function. Maybe not iron deficiency just yet, but you may be well on your way because TRT accelerate the process.

HCG increases intramuscular testosterone and estrogen, the latter is unaffected by the use of AI’s, so then the HCG dosage must be reduced.

This is an easy fix.

Unfortunately I’ve seen a dozen urologist, endos and seen a rheumatologist.

rheumatologist said everything was clear, but i bet it couldn’t hurt to see another one.

Ive seen plenty of urologist and my current one is managing my trt.

Endos have been kinda useless as they would only test for so many things, thats what led me to functional medicine. Getting bloodwork for pregnenolone from an endo alone was like pulling teeth.

although now that i have more evidence, maybe they can help make sense of it.

Pretty much the consensus, they do not specialize in TRT, these doctors are into thyroid and diabetes. The same can be said for urologists who treat the prostate and reproductive system, there is no standard of care for TRT since there are no doctors that specialize in this field of medicine.

There are those who make it their life’s mission to be excellent at TRT, most of these doctors are into anti-aging and sports medicine.

Got it Systemlord!

I’ll cop some omega 3s no problem.

Def going to correct my T dosage as well. I’ll drop down to 100mg divided into twice weekly dosages, along with hcg at 250iu 3x per week. that should be enough to preserve testes and fertility.

MCH & MCHC are interesting. I’ve never looked at them since they were within range, didn’t even notice that they were so close to be too low.

How did you feel during the iron deficiency during trt. Were you still dealing with limp penis & low libido during that time?

I felt exhausted and fatigued the higher the Total T (500 ng/dL), you would expect to get more for your mileage pushing higher levels. MCH and MCV were midrange at the start of TRT, but declined and after two years were below range which is microcytic anemia. Then it appeared I had kidney and heart failure, edema over my entire body. All tests came back healthy and doctors could find nothing to explain these symptoms.

They appeared to miss the iron and potassium connection. Found potassium below range, looked back at older labs and days of injections, potassium and iron are both below range, then rebound a bit until the next injection and over two years I was running on fumes. This caused vasoconstriction of all arteries and explained why every new injection murdered erectile strength ~ low potassium = vasoconstriction.

There are a lot of men on TRT struggling to achieve an erection, some have poor potassium to sodium ratios or other combinations of other core minerals, electrolyte imbalances which can be detected in the hair follicle during testing.

Only three weeks after stopping TRT I started supplementing iron and then potassium and when the vasoconstriction reverted, erections started and natural production fired up.

My low T was caused by low iron and low potassium, so see what cause the testosterone decline forced me off TRT and to discover the bombshell why testosterone was low in the first place. The question is will it hold.

hmmm interesting.

My potassium and iron look fine, however the ferritin is puzzling.

I was considering iron supplementation but that seems too simple.

Any ideas of where i should delve further into?

I’ll most likely schedule an appointment with an endo soon. Functional medicine is out of pocket every visit and this particular doctor charges $150 for every 15 minutes. I just had to pay $100 the other day for bloodwork analysis over the phone and they told me nothing i didn’t already know so im being weary for now.

There are telemedicine options available, experienced doctors are a telephone call away. It averages $1200-$2000 per year including medicine, labs and consultants and no more working with clueless doctors.

I’m signed on with Defy Medical for advice only consultants, TRT is prescribe through insurance doctors who more or less are uninvolved in balancing all my levels.