I have been reading these forums for some time but this is my first post. My stats:
Lift 3 - 4 times a week for approximately 4 years
Diet is low carb-high protein and fat.
Okay, so I have been struggling with ever lower energy levels, mental acuity, attention span, libido etc for the last 10 years or so. Along the way I have been diagnosed with the following:
Sleep Apnea Ã¢?? Treated with CPAP Insomnia Ã¢?? Treated with Lunesta 2mg per night ADHD Ã¢?? Treated with Concerta 54mg per day plus 20mg Ritalin in the evenings as needed Depression Ã¢?? Treated with Lexapro 20mg per day Osteoarthritis in the neck/shoulder Ã¢?? treated with NSAID and Tramadol 25mg as needed High Cholesteral Ã¢??Treated with Lovastatin 20mg, Lovasa 4 gr per day and Slo Niacin 1500 mg per day.
With all of this, I still am exhausted, depressed, anxious and generally feel crappy. This led me to these forums and the pursuit of effective TRT in the hope that this is the core issue.
In September 2010, I met with my primary care Doc to discuss this. He agreed to have me tested for Low-T. The test results showed total T of ~400 which was at the very low end of the range. Nevertheless, he deemed me normal and said I was getting older and the best thing would be just to accept it. Not liking this answer and having read these forums, I understood that A, total T on its own is relatively worthless and B being in range does not mean things are well. So with the help of a local compounding pharmacy, I found a Dr. who is a little more open minded and knowledgeable about HRT.
In October 2010, he sent me for the a series of tests te results of which are here:
CARDIO CRP(R) 0.5 mg/L KS
HOMOCYSTEINE,CARDIOVASCULAR 8.5 <11.4 umoLL
GLUCOSE 123 H 65-99 mg/dL
UREA NITROGEN (BUN) 17 7-25 mg'dL
CREATININE 1.02 0.78-1.34 mg/dL
eGFR NON-AFR. AMERICAN >60 > OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN >60 > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO NOT APPLICABLE 6-22 (calc)
SODIUM 133 L 135-146 mmol/L
POTASSIUM 4.9 3.5-5.3 mmoL/L
CHLORIDE 99 98-110 mmol/L
CARBON DIOXIDE 26 21-33 mmol/L
CALCIUM 9.8 8.6-10.2 mg/dL
PROTEIN, TOTAL 7.6 6.2-8.3 g/dL
ALBUMIN 4.7 3.6-5.1 g/dL
GLOBULIN 2.9 2.1-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.6 1.0-2.1 (calc)
BILIRUBIN, TOTAL 0.5 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 82 40-115 U/L
AST 25 10-40 U/L
ALT 47 9-60 U/L
VITAMIN D, 25-HYDROXY, LC/MS/MS
VITAMIN D, 25 OH TOTAL 38 30-100 ng/mL
VITAMIN D, 25 OH, D2 <4 ng/mL
VITAMIN D, 25 OH, D3 38 ng/mL
TSH, 3RD GENERATION 1.36 0.40-4.50 mIU/L KS
T4, FREE 1.3 0.8-1.8 nq/dL KS
T3, FREE 2.9 2.3-4.2 pg/mL KS
* DIHYDROTESTOSTERONE 16 L 25-75 ng/dL AMD
SEX HORMONE BINDING GLOBULIN SHBG 15 9-45 nmol/L
ESTRADIOL,ULTRASENSITIVE ELC/MS/MS 5 pg/mL Reference Range: < OR = 29
IGF I, ECL 247 ng/mL Reference Range: 50-303
ESTRONE, LC/MS/MS 15pg/mL Reference Range: < OR = 68
DHEA SULFATE 186 45-345 mcg/dL KS
FSH 4.3 1.6-8.0 mIU/mL KS
INSULIN 7 <17 uIU/mL KS
LH 4.0 1.5-9.3 mI11/mL KS
PROLACTIN 2.9 2.0-18.0 ng/mL KS
PSA, TOTAL 0.8 < OR = 4.0 ng/mL KS
IGF BINDING PROTEIN 3 (IGFBP 3) 4.6 3.3-6.7 mg/L
TESTOSTERONE, FREE AND TOTAL, LC/MS/MS
TOTAL TESTOSTERONE, 374 250-1100 ng/dL
FREE PERCENT 2.50 H 1.50-2.20
FREE TESTOSTERONE 93.5 35.0-155.0 pgÃ¢?Â¢mL
HDL-2 (LARGE,BUOYANT) 8 L >10 mg/dL
HDL-3 (SMALL, DENSE) 39 >30 mq/dL
VLDL-3 (REMNANT LIPO) 16 H <10 mg/dL
At this point my doc put me on 25mg of Chlomid every day, 4 gr of Lovasa per day and the cholesterol lowering meds. Lovastatin 20 and Slo Niacin 1500.
Six weeks later he re-ran some tests with the following results:
Test Name In Range Out Of Range Reference Range Lab
* DIHYDROTESTOSTERONE 21 L 25-75 ng/dL
SEX HORMONE BINDING
SHBG 20 9-45 nmol/L
IGF I, ECL 141 ng/mL ref range 50-303
ESTRONE, LC/MS/MS 42 pg/mL Ref < OR = 68
DHEA SULFATE 335 ref 45-345 mcg/dL
ESTRADIOL 51 13-54 pg/mL
CORTISOL, P.M. 2.5 L mcg/dL Reference Range 4 p.m. (3-5 p.m.) Specimen: 3.0-17.0
CORTISOL, A.M. 14.2 Reference Range 8 a.m. (7-9 a.m.) Specimen: 4.0-22.0
PSA, TOTAL 0.8 < OR = 4.0 ng/mL
TESTOSTERONE, FREE AND
TESTOSTERONE TOTAL 696 250-1100 ng/dL
FREE TESTOSTERONE 166.3 H 35.0-155.0 pg/mL
Based on this, he says all is well except for PM Cortisol which he is ordering a Cortrosyn Stimulation Test to rule out adrenal insufficiency.
So my questions other than a general sanity check about my DrÃ¢??s approach are as follows.
What other test might I request?
Is Clomid a long term answer?
What about Thyroid, Pituitary or sub-clinical adrenal problems? Dr. says due to TSH that Thyroid is okay but since that is low and free T3 are low, isnÃ¢??t that problematic?
AM body temps usually between 95 and 96
Body hair is generally on the light side
Male pattern baldness since late 20Ã¢??s
Putting on abdominal fat but not elsewhere.
Not losing fat on ketogenic diet as in the past.
Have had head impacts.
Mood swings and low frustration threshold.
Lack of general motivation etc.
Anyhow, any general, or specific suggestions or comments welcome. I want to direct my Doc to look more closely at the Thyroid, Adrenals, Pituitary as from I understand, if these are out of whack, TRT will be ineffective. So if anyone can assist, it would be greatly appreciated.