T Nation

Help with Labs Before I See Doc


#1

Hi, this is my first post, I have been reading for sometime, but I did not sign up until like a week ago, I have read the stickies a few times. I would really like your help before I go to the doctor, I want to be prepared. My symptoms are weaker erections since years ago, libido is fine, morning wood a couple of times a week, but my main concern is that I have not been able to add muscle, only a little, and getting stronger is going very very slow, I am very slim, I have been reading T-nation articles for about 7 years, I have learned a lot, so, my diet, workout routine, and sleeping are dialed in, and I have tried different methods, and end up gaining fat instead of muscle. I do have a small bone structure, shoe size is 8, pant size 30x30. I would be happy at around 140lbs 12% bf. So I decided to get some labs. These are my numbers:
Gender: Male
Age: 44
Height: 5’ 8”
Weight: 129lbs. Max 155lbs (mostly fat) Min 122lbs (losing fat and muscle)
Body fat: 14%
Vasectomy in 2006, I have three children. LH, FSH LOW?
Hernia surgery in groin area in 2014.
I suffer from respiratory allergies, I take loratadine for that from time to time. Mostly seasonal allergies.
My fat is mostly in belly, love handles. When I was heavier most of my fat was in my torso, neck and face, my limbs remained skinny, just a little more fat there.
Body hair: Forearm a little and thin, legs more than forearms and less thin, torso only a little in middle chest and around nipples, also thin. I can grow a full beard but not high on the cheeks, not thick, a little sparse, it takes almost two months to look full. Thick eyebrows. Full head hair.
No history of using iodized salt, since junior high school trying to avoid it, (father=hypertension) only the salt that already comes in food, when eating out, never add salt to anything. Did not know about iodine.
Supplements: Multivitamin daily (150mcg iodine, 75mcg selenium, No Iron), 2000mg vitamin C daily, 5000 iu Vitamin D3 daily, 3grams fish oil daily, ZMA (magnesium aspartate 450mg, zinc 30mg, vitamin b6 15mg) daily. Whey protein.
Never used AAS.
I train four days a week, 45-60minutes, Back and chest twice a week, Shoulders, arms and abs once a week, lower body once a week, walk for 30 minutes three to five days a week, I do not run, I walk at a moderate pace and sometimes just a breeze walk.
Diet: 2550Cal, 19.7XBW, 166gr Protein 26%, 1.3gr per pound of BW, 299gr Carbs 47%, 77gr Fat 27% Close to 30/40/30. Main carb sources are white rice, boiled sweet potatoes and potatoes, bananas, apples, pineapple, unlimited veggies. Main fat sources are Olive oil, fish oil, avocado, almonds, and what comes with meat and fish. Protein sources are red meat, white and whole eggs, fish, chicken, shrimp, whey protein and casein. No sugar (only from fruit) No alcohol, No bread, limited saturated fats from meat and eggs.
May/5/2018 8am
TT 334 ng/dL 132 – 813
FT 4.4 pg/mL 4 – 30
SHBG 43 nmol/L 11.2 – 78.1
E2 14.335 pg/mL 5.37 – 65.9 Asked sensitive and got ECLIA
DHT 370 pg/mL 135 – 1365
FSH 1.38 mUI/mL 1.55 – 9.74 LOW
LH 3.41 mUI/mL 4 – 28 LOW
PSA 0.664 ng/mL 0 – 4
Cholesterol:
Total 173 mg/dl 50 – 200
HDL 52 mg/dl
LDL 95 mg/dl
Triglycerides 63 mg/dl 50 – 150
Fasting Glucose 93 mg/dl 60 – 110
RBC 4.97 Mu/L 4.7 – 6.1
Hemoglobin 16.42 g/dL 13.8 – 17.2
Hematocrit 47.99 %. 41 – 50
MCV 96.63 ft 80 – 100
MCH 33.07 pg/cell 27 – 31 HIGH
MCHC 34.22 g/L 32 – 36
RDW 10.03 % 11.5 – 14.5 LOW
Leukocytes 6.3 K/uL 4.5 – 10.5
Neutrophils 50.2 % 40 - 60
LYMPHOCYTES 41.2 % 20 – 40 HIGH
Monocytes 4.8 % 2 – 10
Eosinophils 3 % 0 – 4
Basophils 0.8 % 0 - 1
PLATELETS 136 K/uL 150 – 400 LOW
MPV 9.34 fl 6 – 10

Body temperatures
(All my life I have to wear socks to sleep all year round, my feet get very cold, my hands and my body according to my wife and kids are always too warm, I like warm weather better than cold weather, I cannot tolerate cold weather that much)
May-15 5am 96.6 2pm 98.4
May-16 5am 96.8 2pm 98.6
May-17 5am 96.8 2pm 98.6
May-18 5am 96.8 2pm 98.6
May-19 6am 97.1 2pm 98.8
May-20 5am 96.8 2pm 98.4
May-21. 5am. 96.7 2pm 98.4
Thyroid Labs:
TSH 1.96 uUI/ml 0.465 – 4.68
T3 111 ng/dL 97 – 169
T4 8.55 ug/dL 5.53 – 11
FT4 1.01 ng/dL 0.78 – 2.19
FT3 3.0 pg/mL 1.9 – 5.4
PBI 6.39 mg/dl 4 – 8.5 Protein bound Iodine
T4I 5.55 mg-dl 3 – 7.5 Serum thyroxine Iodine

I will see the doctor on Monday may-25. I would really appreciate your help. Thank you.


#2

According to your Total T and SHBG, Free T is 5.64 ng/dL = 1.69 %, 2-3 percent is considered normal. Elevated SHBG is choking your Free T and Total T is being overstated by high SHBG, so T production is worse than it looks.

Hematocrit and hemoglobin are at the higher end of normal, if given TRT be prepared to donate blood regularly and possible phlebotomy to keep hemoglobin in ranges. You will need two injection 50-60mg twice weekly given your SHBG levels and possibly an AI to help control estrogen.

You should run from any doctor who doesn’t believe in estrogen management, estrogen management is critical to a man’s success on TRT. Thyroid results indicated iodine deficiency, low Free T4 and slightly low body temperatures is an indication of iodine deficiency. Also you want Free T3 midrange of better, yours is below midrange. You may be able to improve Free T3 and Free T4 by supplementing iodine and selenium.

Circulation problem that keeps blood from flowing to your extremities might be to blame. Cardiovascular disease can be one cause; it’s a sign that your heart is not pumping blood effectively, prevents blood from getting to your fingers and toes. This happens to those who have low testosterone.

I was always cold before I was diagnosed with low T, generally I was colder, but my feet were by far colder to the point of feeling frostbite. TRT solved all feelings of coldness and now feel warm throughout my body.


#3

When we see guys training with low T and low thyroid function we often see adrenal stress with elevated rT3 interfering with what fT3 you have.

How long have you been using that vitamin with 150mcg iodine and 75mcg selenium? 200mcg selenium would be better.

Salt does not cause heart disease or high blood pressure. When there is high blood pressure, less sodium means less blood volume and pressure can be reduced, at the cost of reduced blood circulation. Because of this a brain dead medical community, they decided that salt was a cause and that simply is not true. I have seen where doctor directed low sodium diets have created iodine deficiency and associated problems and the rather useless wide thyroid lab ranges means that they think that this result is great. The press swallowed this hook, line and sinker.

“TT 334 ng/dL 132 – 813”
132? -really? Who is the lab company? Where are you located?

With low FT, FT–>E2 is low and serum E2 is thus as seen.

fT3=3.0 is a bit low. The range looks odd or not so typical. Normally mid-range is ~3.2

Can you get rT3 tested?

TSH should be ~1.0

Is your whole family iodine deficient?

There are some odd things in your CBC.
not having enough vitamin B12 or folic acid in the body?
Do you have heart burn and take meds for that?


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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#4

Thank you very much @systemlord, @ksman for your quick responses, this will be very helpful when I see the doctor.
My high hematocrit and hemoglobin, could it be I eat boiled spinach five times a week? I did it to get more greens. Boiled they become so small you don’t get full, raw I could eat a lot less.
I have been using multivitamins fot the last four years, always iron free, the last one I had was 100mcg iodine, 150mcg selenium, on this one I’ve been about three weeks. I got this one because it has more iodine but less selenium.
This test was done in Mexico, I was shocked to see this TT lab ranges.
rt3 was not available but they told me if I need it, they can get a lab to do it.
I don’t think my parents are iodine deficient, they got married over forty and started to worry about salt when they were over fifty. My wife has thyroid problems, I am going to see her doctor. She likes using fancy salt.
What I saw about my CBC is that my high MCH, low RDW, high lymphocytes, and low platelets, they have in common vitamin b-12 and folic acid deficiency, so I injected 10,000mcg vitamin b-12, 100mg b-1 and 50mg b-6 last Monday. Wonder what the doctor will say.
No heartburn or meds for that.
I will do iodine supplement, lodoral and selenium too. I think I will do 12.5mg a day and see.
I am worried about my LH and FSH being low, pituitary problem? Too old for a restart?
Thank you again.


#5

Successful restarts are rare and usually a much better chance in young men in their 20’s, chances are slim to known as hormonal problems are to be expected at our age. Low LH and FSH is a pituitary failure, secondary hypogonadism. Welcome to the club.

You should get a sleep study done as this can increase hematocrit and can decrease life expectancy, TRT can worsen or cause sleep apnea.


#7

It does not take long to become iodine deficient.

Fancy Salt is most always without any iodine.


#8

Hello, I am about to start my TRT journey, I am going with the advice from here and start with 50mg test enth E3.5D, no HCG, no AI for now and see how I do, and after about six weeks labs and see.
The testosterone I can get in my country is PrimoTeston Depot 250mg/ml, it comes in prefilled syringes of 1ml, I do not know the gauge of the needle but its for intramuscular use so it’s kind of thick.
I would like to know if it’s safe to inject 4 of this prefilled syringes (4ml/1000mg) in to a empty sterile vial and dose from there 50mg into insulin syringes, and it would last 10 weeks. Risky? Bacteria? I would really appreciate some help please.
@ksman