T Nation

Help with Lab Work, Feeling Bad


#1

I'm 30 y/o, been on TRT for about 8 years. I've had a bilateral orchiectomy for medical reasons (not cancer) so I make no testosterone or other things that come from testicles. I'm 5' 11" and weight 202 lb. I work out 4 times a week and can do 15 pull-up, 44 push-ups, and am generally pretty athletic. I carry around too much body fat and have always had prominent love handles.

I can still see my abs but my scale says I'm about 20% BF (not sure how accurate that is). I used to be pretty good at running (4 minute mile at my peak) but it hurts me to much now (probably my weight).

Anyway, the reason I'm posting is because I feel pretty lousy. My chief complaint is libido. I can get erections to have sex pretty easy but having an orgasm takes forever (it always has for me) and I rarely get morning wood unless I haven't had sex for about a week. As it is, it's almost impossible for me to have an orgasm more than about every other day. Through sex or masturbation. Other complaints include, difficulty losing weight, brain fog sometimes, possible visual reduction, fatigue, sleepy a lot, and slow healing/scaring.

I've been on testosterone propionate 50 mg inj EOD for about a year and arimidex 1/2 mg EOD. Prior to that I've been on cyp up to 200mg/wk. I switched to prop from cyp to see if it made any difference and it hasn't. I'm from Southwestern Pennsylvania USA. I have an appointment with my wonderful Dr in less than 2 weeks and I would like some input from you guys to see your thoughts.

My Dr is awesome and has been really good to me and will consider just about anything I talk to him about. I also take a GNC multi vitamin, fish oil, flax seed oil, 100 mg pregnenolone, and 1000 mg of MSM daily. I'm going to quit the preg and msm unless someone can give me a good reason not to because I've noticed no improvement. Also, I've been using about 50 grams of soy protein isolate from non gmo sources for about a month now to help with recovery from exercise. My diet has been pretty good with not much junk food and miminal sugar leading up to my test for about a month.

Most recent labs 10/5/10 from Quest Diagnostics (12 hr fast and 8 am test):

Cholesterol 283 mg/dl 125-200
HDL 46 mg/dl >40
Ratio 6.2 <5
LDL 191 mg/dl <130
Triglycerides 232 mg/dl <150
WBC 4.0 thous/mcl 3.8-10.8
rbc 5.43 mil/mc. 4.2-5.8
hemoglobin 16.1 g/dl 13.2-17.1
hematocrit 46.6% 18.5-50
platelet count 217 thous/mcl 140-400
other things in cbc all in range
t4 total 6.1 ug/dl 4.5-12.5
tsh 3rd gen 3.49 miu/l .4-4.5
t4 free 1.1 ng/dl .8-1.8
t3 free 3.6 pg/ml 2.3-4.2
prolactin 7.7 ng/ml 2.0-18.0
estradiol 33 pg/ml 13-54
t3 total 99 ng/dl 76-181
t3 reverse 19 ng/dl 11-32
testosterone total 435 ng/dl 250-1100
testosterone free % 3.27% 1.5-2.2
testosterone free 142.2 pg/ml 35.0-155.0

I took this test just before my next shot of prop so my T levels are usually higher. I thought for sure my prolactin would come back high because when I squeeze a nipple I get a clear/yellowish fluid out pretty easliy. Now I'm scratching my head a little about what would make me feel better.

My current thinking is thyroid. I know my estradiol was a little high but I've had it below 14 before and did not feel much better. My WBC has been as low as 3.6 before. Should I be concerned about that?

Tests from more than a year ago:
Cortisol Total 18.6 mcg/dl 4.0-22.0
DHEA Sulfate 481 ug/dl 110 - 510
Dihydrotestosterone 32 ng/dl 25-75
pregnenolone 16 ng/dl 13-208
IGF -I 305 ng/ml 126-382

Any thoughts you guys have would be much appreciated.


#2

hey there, welcome onboard.

check out the sticky threads - they have some great information.

Pregnenolone is critical, and you have none. Your 100mg oral Pregnenolone appears as though it is not being absorbed - this is not uncommon. Some people have had better luck with 100-300mg Lipid Matrix Micronized Pregnenolone.

Cholesterol is high - wonder if your system is trying to feed more raw material to make more pregnenolone (not sure what % of pregnenolone is from testicular production).

have you ever tested for Vitamin D25OH? most people are low. I would recommend everyone be on 6,000iu D3 daily.

Cortisol looks good - which is weird with low pregnenolone. I wonder what your progesterone levels look like?

TSH is high - which is weird since your free T3 and RT3 look ok. RT3 is a tad high, but not aweful. It makes me wonder what your ferritin levels look like?

isn't chronically low WBC an indicator of hidden infections - your system is so run down that it slows down the production on WBC?? not sure. Hardasnails usually speaks to this.

I have no knowledge about MSM.


#3

Tim,

I would be concerned that your T levels are that low if you are indeed injecting 50 mg EOD. Even if the test was done just before your next injection, at that frequency the difference should be minimal.

Sounds like your body is metabolizing the stuff at a faster rate than normal. That could point to something else being out of balance. Perhaps someone else would have some insight as to why this would happen?

And BTW ditch the soy protein - whey is a much better alternative.


#4

Thank you for the responses.

PureChance - The pregnenolone test results were from before I was supplementing but from the same time the cortisol was tested. It was the reason I started supplementing. I'm pretty sure msm is snake oil. I got it because I thought it would help with my joints. It's supposed to get sulfer into you. I've never tested D25OH or ferritin but I'll ask my dr about it at my next appt. I had a very bad infection which is what started all of this in the first place (not an STD). Maybe I'm still having some problems with that but I think I would know if I had an active infection in me for the past couple of years wouldn't I? <- serious question

pcdude - I was concerned that my t levels would test really high so I tested about 60 hours after my last shot and did my next one right after. Prop has a short half life so it drops off pretty quick. I'm going to go back to the cyp to even things out a little more with the same dosing schedule. I was hoping the soy would help my cholesterol but it didn't. I've had it down to 230 with fish oil and niacin before but that's the best it's ever been. I'm very opposed to statins.


#5

One question I have.

Should Thyroid levels be low after a 12 hour test or do reference ranges take that into account usually?


#6

I received a note yesterday from my doctor and his comments were "sluggish" in reference to my thyroid and too high in reference to my cholesterol. I go to see him in just over a week.

I definitely want to try and treat something to see if I feel better. I'll probably go back to niacin because it was helping my cholesterol and it seems that something for thyroid would make sense because that should help cholesterol also. Does anyone have any thoughts on what to treat with T4, T3, Armour? Dosage? Should this have a rapid effect on my libido if this is what was depressing it? My main complaint is a very long refractory time of about 48 hrs.

I have been interested in trying a dopamine agonist (cabergoline or pramipexole). Is there any chance one of these would help my thyroid? It should help my libido.


#7

I would suspect that something is still going on because of your lowish WBC. Your system is too run down to keep fighting it. Not sure how to test for hidden infections though. I think (maybe?) my doctor did it by running a number of Immunoglobulin A, G, and M tests.

your highish cortisol ad high TSH may be due to that possible infection as well (or some other cause).

with your CHOL#, I would ask for a detailed VAP Cholesterol test to get more specifics.

you also need to run more Thyroid tests
Thyroid Peroxidase and Thyroglobulin Antibodies
Thyroglobulin
Thyroxine binding globulin
maybe Iodine (blood test) as well as ferritin and total Iron capacity
recent cortisol tests (a four times daily saliva test would be best) and new pregnenolone, progesterone, etc. would be helpful as well.

have you read through the stickies? There is one on recommended blood tests along with some reasoning behind the requests.

I wouldn't make any major changes or start anything brand new until you get a better baseline.


#8

dup


#9

Are you using iodized salt? Eating sea food? Make sure you have some iodine intake before testing iodine levels. Any thickening of your thyroid gland? Doc checks that?

Check your waking body temp when you first wake, before feet on the floor and record. Pattern near 97F is a problem, near 97.8 would be ideal. Indicative of thyroid function.

High potency V-vits can lower LDL and increase HDL. Optimal T levels can lower LDL.

Test homocysteine to eval endothelial dysfunction.

You might feel better near serum E2=22pg/ml. To get there, new dose of Arimidex would be 0.5mg * (33/22) = 0.75mg

With EOD injections, the ester type of T does not matter, however, some T esters have more T than others. In any case, one would change the dose of any T ester to achieve target T numbers. Your FT is not bad, TT is too low.

Increase your own production of pregnenolone by improving mitochondrial function with fish oil, C0Q10, anti-oxidants, acetyl-l-carnitine, lipoic acid.

Consider 10mg lovastatin, very cheap at Walmart. Get 20mg tabs and split. This is equivalent to the active ingredient in better red rice yeast extracts, but much less expense.


#10

I had my appt yesterday. The Dr. thinks I'll eventually have to replace thyroid (he prescribes Armour) but feels that something else is causing my issues. I am not starting any new meds right now.

He is going to have me do an overnight pulse ox to test for sleep apnea. He says my airway is slightly narrow and I know I have a deviated septum. My wife says I snore too much too. His initial evaluation of me over a year ago was that I was a candidate for sleep apnea. If that turns out to be true we will try to treat that and see if there is improvement.

If I turn out to not have sleep apnea we are going to do some more involved testing of hormones, adrenals, pituitary, and thyroid. I'll probably also see if he can add some of Purechance's recommendations about looking for an underlying infection.


#11

thanks for the update. best of luck.

let us know how things go or what you (and your doctor) ultimately decide for a treatment plan.


#12

TRT has a reputation for making snoring worse.

Your thyroid med is not effective, TSH should come down and T4 is low. FT3 is good, and T4 lowish, so you appear to be a good T4-->T3 converter. Switch to a T4 med. Watch your waking and daily body temps as an indicator of T3 status. If you get TSH down, T4 up and T3 mid-range, if waking body temp is low, then you may have a problem with rT3. You should not have unresolved symptoms. You may need T3 meds as some are not good T4-->T3 converters in peripheral tissue. T4 only meds can be a disaster for some. If rT3 is a problem, then cortisol may be low. You iron status appears to be good, so that is probably not a player in the thyroid game.

With your thyroid problem, we expect that you would not respond to transdermal T products and would have to inject? That also means that transdermal DHEA or pregnenolone would not be expected to work.

Are you taking oral DHEA? Otherwise, low pregnenolone and high DHEA does not make sense.

You need to supplement more pregnenolone, as an oral. Pregnenolone is important for mental functioning. As you now take 100mg, you are not absorbing well. Take with a meal that has oils or fats. Never take this with a high fiber meal or oatmeal etc. Ditto for DHEA, vit-D3, CoQ10 etc.

The other recommendations that I suggested will still be needed as your mitochondrial function is probably low. [Increase your own production of pregnenolone by improving mitochondrial function with fish oil, C0Q10, anti-oxidants, acetyl-l-carnitine, lipoic acid. ]

You can get 5000iu vit-D oil based caps at Walmart.

Increase anastrozole as I suggested earlier.


#13

Add deca, remove fish oil, flax oil, and soy estrogenic BS. the polyunsaturated fatty acids just wreak havoc with infalmmation.


#14

Deca? -idiot; could easily make sexual issues worse.

Fish oil and other EFA's are anti-inflammatory. What are you saying? If you are going to be contrarian, you need to support post with facts. Otherwise you are a distraction.

OP: Are you trying to get closer to E2=22pg/ml? This can have a big effect.


#15

Just got the results of the sleep apnea test, it was normal. Now I'm waiting to hear what doc wants to do next.
I'm thinking he is going to want to run some very thorough tests.

KSman - I am trying to get closer to 22 pg/ml. I've upped the anastrozole (from pharmacy) slightly in that I take a whole pill twice a week for a total dosage of 4.5 mg/wk. Has anyone else gone from brand name Arimidex to the generic (from pharmacy)? Has it caused issues for anyone?

Thanks for calling cjackson out. I read that yesterday and laughed. I assumed he replied to the wrong topic or was making a joke or something because it seems very contrary with exception of the soy. If only deca cured all ills that would be awesome for all of us. Fix thyroid, adrenals, cholesterol, and libido with deca and you'll be a billionaire.


#16

From looking at the thyroid i would like to see ferritin levels because it appears the ft3 is pooling either due to low ferritin or low cortisol. ADrenal saliva test would defintely be a huge key here. If rt3 are elevated then the source of the stress needs to be identified and dealt with. Insulin resistace staring you right in the eye one needs to know what type of eatin patterns you have. Deca is no TRT and can issue worse so any one that is recommending deca for HRT as MD should have licensce revoked. Using test prop will cause a huge surge in e2 making it almost impossible to keep stable. It appears to me that thyroid deficeincy at the tissue is the most logical explanation for the lipids being out of wack. Your issue is not thyroid directly but making it more functional at the tissue level by factors which i noted above needing further investigation. People with low pregenolone are mostly hypoadrenal and low thyroid to begin with.


#17

Finally, more lab results. These are all blood from Quest taken at 1:00 PM with no fasting.

Progesterone 3.6 ng/ml <1.4 High
TSH 2.15 mIU/L .4-4.5
T4 Free 1.1 NG/DL .8-1.8
T3 Free 3.5 PG/ML 2.3-4.2
DHEA Sulfate 921 UG/DL 110-370 High
Prolactin 22.7 NG/ML 2.0-18.0 High
Estradiol 24 PG/ML 13-54
Vitamin D, 25-OH Total 36 NG/ML 30-100
D3 36 NG/ML
D2 <4 NG/ML
IGF-I 366 NG/ML 64-334 High
Cortisol 17.0 MCG/DL 3.0-17

I requested Ferritin but it was not performed. I think they subed IGF-I in for it because I had not requested it.

Current meds/supplements
the Dr has me on 30 mg of Armour thyroid / day and I have been doing it for about a month now. I think there was a slight improvement when I started it but that went away.

Symptoms are still the same as my original post.

Any thoughts from this?


#18

Cortisol might seems high for 1pm. What time did you wake up that day?

Also Low Vit D. That can be an issue.

Usually my cortisol drops pretty significantly 2-4 hours after waking based on Salivary tests from the past.


#19

I woke up at 6:30 am that day.

I need to take you guy's advice and pick up some D3.


#20

TSH says that your system still needs more thyroid.
high prolactin could be causing problems.
very high 1pm Cortisol could also be causing problems.

most people start with 4,000-6,000 D3 daily.

are you breaking the 30mg and dosing twice a day? Armour contains some T3 which has a very short half life, and is best if you can dose at least twice daily.