T Nation

Help With Lab Results - 39 Yr Old With Fatigue


#1

Hi. It’s great to stumble upon this site with so much knowledge available. After years of trying to heal from HPTA dysfunction(see conditions/symptoms below) I am seeing a new MD and am very optimistic as he treats the symptoms not necessarily the lab results. These are more extensive labs that I have ever had. I would love any help with interpreting these results as a second opinion. Never any steroid use. My goal is to get back to full energy/cognition levels and lead an active life. If I could get back to semi-serious weight training it would be a cherry on top. I tried to post as much information as I could. Let me know if anything else is needed.

Questions

  1. Any help interpreting the labs below would be great. Please note that I was still on my hpta supplents listed below(adrenal cortex, thyroid glandular, dhea and pregnenolone) that would show up on these tests.
  2. Not sure why I have low iron. I eat plenty of red meat. Any ideas?
  3. Not sure why lipids and glucose have slid backwards for me(In Nov 2016 glucose was 97 and HDL- 65, Triglycerides-62). Is this due to high E2 or borderline low Thyroid?
  4. Any labs that I should request next appt? Already have LH and FSH on my list just in case we try TRT.

Age/Height/Waist/Weight:
39 - 6’2 - 43" -260lb

-lab results with ranges
Cholesterol, Total 205 (125-200 mg/dL)
HDL 50 (> OR = 40 mg/dL)
Triglycerides 76 (<150 mg/dL)
LDL 140 (<130 mg/dL)

GLUCOSE - 104 (65- 99 mg/dL)

TSH - 1.27 (.40- 4. 50 mi U/ L)
T4, Free - 1.3 (0 . 8- 1.8 ng/ dL)
T3, Free - 3.7 (2.3-4.2 pg/mL)
T3, Reverse - 13.0 (8- 25 ng/dL)

IGF 1 , LC/MS - 202 (53-331 ng/mL)
Z SCORE (MALE) - .8 (-2 .0- +2 .0 SD)

CORTISOL, TOTAL, LC/MS/MS - 15.0 mcg/dL (8-10 AM - 4 .6- 20.6 mcg/dL)
CORTISOL, FREE, LC/MS/MS - 0.51 (8 -10 AM - 0.07-0.93 mcg/dL)

IRON, TOTAL - 74 (50- 180 mcg/dL)
IRON BINDING CAPACITY - 378 (250- 425 mcg/dL)
% SATURATION - 20% (15-60 %)

ESTRADIOL - 37 (< OR = 39 pg/mL)

TESTOSTERONE , TOTAL - 677 (250-1100 ng/dL)
FREE TESTOSTERONE - 86.0 (35 . 0-155 . 0 pg/mL)

PSA, TOTAL 0.5 (< OR = 4.0 ng/mL)

VITAMIN D, 25-OH, TOTAL - 66 (30-100 ng/mL)

C. ALB I CANS IGG - 1.4 ( <1 . 0 Antibody not detected - > or = 1 .0 Antibody detected)
C.ALBICANS IGA - 1.8
C .ALBICANS IGM - 1.0

CBC -
WHITE BLOOD CELL COUNT- 4.9 (3 .8 - 10.8 Thousand/uL
RED BLOOD CELL COUNT- 5.56 (4.20 - 5.80 Million/uL)
HEMOGLOBIN - 15.9 (13.2 - 17.1 g/dL)
HEMATOCRIT - 50.3 High (38 .5-50 .0 %)
MCV - 90.5 (80.0 - 100.0 fL)
MCH - 18.6 (27.0 - 33.0 pg)
MCHC - 31.6 Low (32 .0 - 36.0 g/dL)
RDW - 14.0 (11. 0-15 .0%)
PLATELET COUNT -163 (140 - 400 Thousand/uL)
MPV - 8.4 (7.5 - 12 .5 fL)
ABSOLUTE NEUTROPHILS - 3278 (1500-7800 cells/uL)
ABSOLUTE LYMPHOCYTES - 1269 (850-3900 cells/uL)
ABSOLUTE MONOCYTES - 225 (200-950 cells/uL)
ABSOLUTE EOSINOPHILS - 113 (15- 500 cells/uL)
ABSOLUTE BASOPHILS -15 (0-200 cel ls/uL)
NEUTROPHILS - 66.9%
LYMPHOCYTES - 25.9%
MONOCYTES - 4.6%
EOSINOPHILS - 2.3%
BASOPHILS - .3%

-describe body and facial hair
Lots of coarse body and facial hair. Hair is coarse(i’m half asian) but not too dense. Covers full torso(including back) and full beard including neck and cheeks.

-describe where you carry fat and how changed
Carry fat all over. More subcutaneous fat around midsection. Very broad/thick frame. Huge legs and calves. Classic endomorph. Weigh about 20lbs more than you think I would.

-health conditions, symptoms
Have been dealing with adrenal fatigue/hpta dysfunction for about 4 -5 years. I believe was the result of stimulant overuse and lifestyle(partying, over training, lack of sleep) Symptoms of hpta dysfunction: brain fog, fatigue/lethargy, concentration problems, panic attacks, lack of sex drive, crash with stress/overexertion. Extremely bad recovery - takes about a week to recover from workout. Have some injuries from 4 years ago that just won’t full heal. Weight gain (approx 40lbs) - maintained at 210 - 220 for years - now gain very easliy and very hard to lose.

Most of these have gotten significantly better over the past 2.5 years with treatments below. I would say that I am at about 75% energy wise. At the lowest point I was at about 40% energy wise. Saliva tests showed low cortisol all day and Estrogen dominance.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
For adrenal fatigue/hpta under Naturopath’s care(All taken regularly for the tests above - except the morning of) Licorice, Adrenal Cortex, Thyroid Glandular, Vit C, Glutiathione, B 12 (Methly, Hydroxy and Adenyl), B5, Folate, DHEA(50mg), Pregnenolone(20mg), Berberine, D3(15000iu per day), Lugols’s Iodine, Selenium, Magnesium, Zinc, Copper

New MD ordered tests shown above. Prescribed HCG shots(with very low calorie diet - 20 days worth to kick start weight loss - 10 days in have dropped 9lbs), Arimidex (1mg 3x per week), Iron Supplement, Probiotic, Glucose control(chromium). Considered for next visit: Sermorelin Injections for GH (Wondering if I should just use MK 677?) - Possible TRT once my weight is back down.

Was on Propecia for about a year in my mid 20’s. Suffered ED so discontinued.

-describe diet
Generally low carb/paleo. Organic/grass fed meats and veggies. I eat the healthiest diet out of anyone I know.

-describe training
Currently since trying to recover - 1 full body weight session a week… Lots of walking. Yoga 2x per week.

-testes ache, ever, with a fever?
No

-how have morning wood and nocturnal erections changed
Morning wood rarely. Nocturnal erection seems to have increased from HCG shots.


#2

Really need to have labs for your hCG and Arimidex!
How is hCG dosed and injected?

Iron may be low from GI blood loss.
Get occult blood test to detect any blood in your poop, might be related to candida.
Need CBC lab results.

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

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#3

DHEA: Some guys freely convert oral DHEA–>E2 in their adrenals. 50mg is a large dose. Do you have DHEA-S lab results on 50mg/day?


#4

Thanks for the quick reply!

I believe that I am on 200iu a day of HCG(not entirely sure as they prefilled the syringes for me.) Injected into belly fat just to the right and below belly button. This is just temporary along with a low calorie diet for weight loss.

I added my CBC results to the original post.

I will start tracking body temperature and update the post once I have some data.

I don not have DHEA-S results. I will ask for this next time along with occult blood test, LH and FSH.

Any ideas about the low IFG-1?

Thanks again! Much appreciated.


#5

Looking at CBC:
I see no evidence of low iron in your CBC or any reason to do the occult blood test. But at your age, the occult blood test might be good screening.

Serum iron is quite volatile, depending on recent meals. I have had low readings and very high readings. Test again in the future.

There is the question of iron in supplements, breads, flour, rice and breakfast cereals etc. Normally men do not need iron. Men bodies horde iron because we share the female blueprint and women need to hold onto what iron they have because of their blood loss.

So back to your case, your CBC says that you should maybe avoid iron. With HTC=50.3, you may have issues if you were to get T near upper range. But note that dehydration increases HTC. Be sure to drink water while fasting for labs.

IGF-1=200 is not really low for your age. In any case, your option of injecting Rx hGH is $6000 per year.
Test serum iron again later. Note what recent meals were.

Back to thyroid: What is your history of using iodized salt?
Looks like you have been using it for a while at least.


#6

Thanks for the recs re: iron. I’ll discuss this with him the next visit. The weird thing is that I eat plenty of red meat so unless there is blood loss somewhere, I wouldn’t think that I would be considered low.

For the low IGF he was considering Sermorelin injection at about $70 per month.

RE: Iodine. I switched to sea salt a few years ago but I have taken Lugol’s Iodine for about the past 2 years. I started out with larger doses but now I get approx 3mg 3x per week. So I guess that I can drop to the maintenance dose you recommend(6.25mg EOW)? How could you tell from my labs that I had sufficient Iodine?