T Nation

Help with Initial Lab Results Please

Age:46
Weight: 96kg, was 110kg 2 years ago. I’m a pretty thickset guy, I was at peak fitness while in the army about 18 years ago, and weighed 88kg very lean even then. less worried about weight than body composition really.
Body fat: about 20% (was 28% by Dexa scan 2 years ago). Limbs are very lean, and have lost a lot of weight while building muscle over the last 2 years, but the last residual is around the middle and seems impossible to shift.
Diet: clean eating last 2.5 years, mostly paleo but some dairy. very infrequent alcohol.
Exercise: lifting 2xwk, cardio about 1-2/wk. Doing Tough Mudder in Oct, so I am happy with both strength and conditioning (except the love handles!)
Other health: diagnoses sleep apnea a few years ago via sleep study, but no treatment at the moment = snoring.

Symptoms: Loss of libido, fat in “woman places”, no morning wood for years. Getting moody.

So in the UK, its hard to get the health system to even look at this issue, so i privately tested and the following results came back today. If anyone could recommend further test required it would be great, as well as any feedback and advice on what these numbers might be saying. Initially I was concerned that I might have lowT and high Estradiol, given the fat deposit locations, and worried that the fat deposits were creating more E2 in a cycle hard to break - 2 years of clean eating and solid exercise have helped but I seem to be plateauing.

My initial reading is that T is not so bad, but E2 is quite low, probably because of quite high SHBG.

Results are as follows:

FSH 7.8 IU/L Range 1.5-12.4
LH 4.9 IU/L range 1.7-8.6
Test 21.7 nmol/L (equal to 625 ng/dL) range 7.6-31.4 (219-904) so this seems OK for a 46yo.
SHBG 81 nmol/L range 16-55 so this seems very high
DHEA Sulphante 6.6 umil/L range 0.44-13.4
17Beta Estradiol 54 pmolL range 44-156. I think this converts to 14.7 pg/ml which seem low.

My reading would suggest that high SHBG is more a baromoter of what is going on elswher and is hard to adjust directly. WHat would you guys recommend?

Many thanks

With high SHBG E2 can be expected to be higher, but is not. With higher SHBG we can expect that FT will be low relative to TT.

So that is strange.

See: https://en.wikipedia.org/wiki/Sex_hormone-binding_globulin#Conditions_associated_with_high_or_low_levels

Please read the thyroid basics sticky and check your body temperatures and evaluate your long term sources of iodine.

FSH 7.8 IU/L Range 1.5-12.4
LH 4.9 IU/L range 1.7-8.6
FSH is a better indicator of LH status than LH itself as LH has a short half life and is release in pulses. FSH suggests primary hypogonadism. There is enough DHEA-S, so the problem is not a lack of DHEA.

Any pain in your testes or side changes?

Please read the advice for new guys sticky and post more lab data if you have it. Interested in fasting glucose, cholesterol, hematocrit and liver markers AST/ALT

Fat torso and skinny legs. Does this fit at all? https://en.wikipedia.org/wiki/Cushing's_syndrome#Signs_and_symptoms

Thanks for your reply KSman

The thyroid sticky was very interesting especially the interactions with hypogonadism. To be honest, I don’t think I have ANY sources of Iodine, as I do not add salt to food, nor cook with it. Given i have been pretty paleo (plus diary) for 2 years, I dont eat much pre-prepared food at all. I am buying a thermometer today to check am and pm temps and will report back. If i went for IR (50 mg iodine per day and get .75 grams in two weeks) is there a maintenance level i should be looking at after the initial IR?

None of the Cushings stuff seems applicable. When I say skinny legs, they are actually quite muscular (years as an infantryman hauling stuff up hills), just low body fat.

Both the FSH and LH seem “in range” but do my results achieve “optimum” rather than “in range”?

Initially I was thinking I would have elevated E2 given the low-T symptoms and locations of hard to shift adipose, but the E2 is very low. Could it be the case that the high SHBG is causing very low free T, thus less to aromatise to E2 as well? Should I rerun the E2 test to be sure as it does seem weird. Should I order a bioavailable T test as well?

No pain in testes of sides. I did have a vasectomy about 3 years ago, not sure if that impacts.

I am ordering liver, lipid and thyroid tests today so should have these results in about a week.

not sure if it helps but I had a blood panel 2 years ago, before i lost weight, fixed diet and increased exercise. I am confident my lipids have improved, but the new test will tell shortly. The results are below (first numbers are lab ranges, second numbers are my results). As I said, not sure how applicable given it was 2 years ago, but thought i would put it out there in case it helps.

Haematology Profile
Red Blood Cells
Haemoglobin g/dL 13.0 - 17.0 13.8
HCT 0.37 - 0.50 0.418
Red Cell Count x10^12/L 4.40 - 5.80 4.61
MCV fL 80-99 90.7
MCH pg 26.0-33.5 29.9
MCHC g/dL 30-35 33
RDW 11.5-15.0 13.4
White Blood Cells
White Cell Count x10^9/L 3.0-10.0 5.32
Neutrophilis x10^9/L 2.0-7.5 3.03
Lymphocytes x10^9/L 1.2-3.65 1.76
Monocytes x10^9/L 0.2-1.0 0.38
Eosinophilis x10^9/L 0.0-0.4 0.13
Basophilis x10^9/L 11.5-15.0 0.02
Clotting Cells
Platelet Count x10^9/L 150-400 195
PMPV fL 7-13 12.1
Inflamation Marker
ESR mm/hr 1-20 18
Biochemistry Profile
Kidney Function
Sodium mmol/L 135-145 143
Potassium mmol/L 3.5-5.1 3.4
Chloride mmol/L 98-107 97
Bicarbonate mmol/L 22-29 21
Urea mmol/L 1.7-8.3 6.2
Creatinine umol/L 66-112 99
Liver Function
Bilirubin umol/L 0-20 14
Alkaline Phosphatese IU/L 40-129 50
Aspartate Transferase IU/L 0-37 21
Alanine Transferase IU/L 10-50 22
CK IU/L 38-204 136
Gamma GT IU/L 10-71 17
Proteins
Total Protein g/L 63-83 67
Albumin g/L 34-50 46
Globulin g/L 19-35 21
Minerals
Calcium mmol/L 2.15-2.55 2.34
Corrected Calcium mmol/L 2.15-2.55 2.3
Phosphate mmol/L 0.87-1.45 1.58
Gout Test
Uric Acid umol/L 266-474 440
Diabetes Test
Random Blood Glucose (FL) mmol/L 3.5-7.9 7.3
Fasting Blood Glucose (FL) mmol/L 3.5-5.8 7.3
Iron Profile
Iron umol/L 10.6-28.3 21.3
T.I.B.C. umol/L 41-77 43
Transferrin Saturation % 20-55 50
Lipid Profile
Triglycerides mmol/L <2.3 1.1
Cholesterol mmol/L Optimum <5.0 5.8
HDL Cholesterol mmol/L 0.9-1.5 1.1
LDL Cholesterol mmol/L Up to 3.0 4.2
Heart Disease Risk
HDL % of total % 20 and over 19
Endocrinology
Thyroid Test
Free Thyroxine pmol/L 12.0-22.0 18.2

Thanks for your reply KSman

The thyroid sticky was very interesting especially the interactions with hypogonadism. To be honest, I don’t think I have ANY sources of Iodine, as I do not add salt to food, nor cook with it. Given i have been pretty paleo (plus diary) for 2 years, I dont eat much pre-prepared food at all. I am buying a thermometer today to check am and pm temps and will report back. If i went for IR (50 mg iodine per day and get .75 grams in two weeks) is there a maintenance level i should be looking at after the initial IR?

None of the Cushings stuff seems applicable. When I say skinny legs, they are actually quite muscular (years as an infantryman hauling stuff up hills), just low body fat.

Both the FSH and LH seem “in range” but do my results achieve “optimum” rather than “in range”?

Initially I was thinking I would have elevated E2 given the low-T symptoms and locations of hard to shift adipose, but the E2 is very low. Could it be the case that the high SHBG is causing very low free T, thus less to aromatise to E2 as well? Should I rerun the E2 test to be sure as it does seem weird. Should I order a bioavailable T test as well?

No pain in testes of sides. I did have a vasectomy about 3 years ago, not sure if that impacts.

I am ordering liver, lipid and thyroid tests today so should have these results in about a week.

Potassium was low. Check dietary sources of potassium.

I am often asked about post IR maintenance doses. For those with 12.5 mg/tablets, I suggest 6.25 ever weeks or every two weeks.

HDL was low:

  • high potency B-complex multi-vit with trace elements and iodine
  • EFA’s: fish oil, flax seed oil/meal, nuts
  • health fats
  • DHEA [if needed]
  • ubiquinol form of CoQ10 if blood pressure elevated
  • 5,000 iu vit-D3 per day. Take 25,000 per day for first 5 days
  • natural source vit-E

You were fasting or not?
Random Blood Glucose (FL) mmol/L 3.5-7.9 7.3
Fasting Blood Glucose (FL) mmol/L 3.5-5.8 7.3

Did not see magnesium in your labs. If you get leg or foot cramps your magnesium is low.

[quote]KSman wrote:
Potassium was low. Check dietary sources of potassium.

I am often asked about post IR maintenance doses. For those with 12.5 mg/tablets, I suggest 6.25 ever weeks or every two weeks.

HDL was low:

  • high potency B-complex multi-vit with trace elements and iodine
  • EFA’s: fish oil, flax seed oil/meal, nuts
  • health fats
  • DHEA [if needed]
  • ubiquinol form of CoQ10 if blood pressure elevated
  • 5,000 iu vit-D3 per day. Take 25,000 per day for first 5 days

You were fasting or not?
Random Blood Glucose (FL) mmol/L 3.5-7.9 7.3
Fasting Blood Glucose (FL) mmol/L 3.5-5.8 7.3

Did not see magnesium in your labs. If you get leg or foot cramps your magnesium is low.
[/quote]

Yeah, I think the fasting was not right. Magnesium only ever had two cramps in legs over the last 2 years, so think magnesium is ok. Will focus on potassium intake via food - how does this play into the thyroid problem/ low T?

Starting vit D and fish oil. For the iodine, is Lugols liquid ok, or nascent iodine tabs?

Waking temp was 34.9C =94.8F

Also, are you saying earlier that a FSH of 7.8 by itself would indicate hypogonadism?

Source of iodine is not a major issue.

Maintenance dose can be 6.25mg every week or two.

Potassium is a general health concern, not significant to your hormones

Higher FSH/LH can be indicate a degree of primary hypogonadism. So one can look at problems with the testes. Could be a vascular issue. And note that high FSH can occur with some testicular cancers. When a guy goes on TRT and FSH does not go to zero, that is a strong symptom for cancer. A physical exam might resolve that too and an ultrasonic method might be utilized.

So Lipid and Thyroid test results came back. Liver test needs to be redone as the sample was not good.

Lipid test:
TRIGLYCERIDES 1.4 mmol/L Recommended< 2.3
CHOLESTEROL * 6.0 mmol/L Recommended <5.0
HDL CHOLESTEROL 1.2 mmol/L Recommended 0.9 - 1.5
LDL CHOLESTEROL * 4.2 mmol/L Recommended Up to 3.0

Thyroid test:
Thyroid Function
THYROID STIMULATING HORMONE 0.91 mIU/L Range 0.27 - 4.2
FREE THYROXINE 20.9 pmol/l Range 12.0 - 22.0
TOTAL THYROXINE(T4) 104 nmol/L Range 59 - 154
FREE T3 5.4 pmol/L Range 3.1 - 6.8
Thyroid Antibodies
Thyroglobulin Antibody 10.6 IU/mL Range 0-115(Negative)
Thyroid Peroxidase Antibodies 13.5 IU/mL Range 0 - 34

Do any of these cause concern? The Free Thyroxine is quite high and Free T3 is upper end. Any of these that might be causing the very high SHBG. I calculated that the SHBG is 4.667 standard deviations above the mean, or top 0.0002% - that is freaking me out!

From the link: " SHBG levels increase with estrogenic states (oral contraceptives), pregnancy, hyperthyroidism, cirrhosis, anorexia nervosa, and certain drugs. "

Thyroid might be the problem. Your body temperatures are still low? Low temperatures and high fT3 suggests rT3 blocking fT3.

Good fT3 would be near 4.95. Good fT4 would be near 17.0

Your fT3, fT4 suggest some kind of hyper that might lead to higher SHBG.

Total T4 is high.

TSH should be near 1.0 - you are TSH=9,1. Seems odd.

Have thyroid checked for size, lumps and asymmetry.

This is a complicated situation.

Please repeat waking and mid afternoon body temperatures ********************

Thyroid hormones act on the mitochondrial bodies in your cells to regulate body temperatures. Mitochondria burn fats, cholesterol and convert some cholesterol to pregnenolone. So your lower body temperatures can also be seen as reduced mitochondrial activity, contributing to low steroid hormones and fat gain as part of a slower metabolism.

Suggest that you focus on thyroid issues. You can test rT3. If rT3 is high, read about Wilson’s book, rT3 and stress in the advice for new guys sticky and thyroid basics sticky.

So I went to my GP and showed him all these results. He was pretty useless really. We did a digital prostate exam, and he says it all seems normal. I am due a colonoscopy anyway (every 5 years due to family history) so that is now booked. He wants to rerun the Testosterone panels as I don’t think he believed my SHBG level (even though it was from a reputable lab the NHS itself uses).

He was not really interested in talking thyroid. He had a quick feel and said “it all feels normal”

I have now had 2 weeks of iodine replen and my temps remain low. am temps remain in the range 35.4 to 35.8. Lunch and afternoon temps get up to around 36.9 but I have only cracked 37 once in 2 weeks. Regarding TSH in the test results above, I am confused where you say it is 9,1 but should be 1. The results were 0.91 m IU/L which seems close to 1 - am I getting units wrong?

I am also confused where you say HYPER thyroid can cause high SHBG, but my low temps would suggest HYPO thyroid, and Total Th, T3 and T4 look “within range”