T Nation

Hormone Optimization Needed

Age 46 5’ 11" 37" waist 205 pounds
Average body hair, facial hair grows well, scalp hair does not grow much
I carry fat around the waist primarily - no real change
generally feel good. I could have more energy and dropping fat is hard. Morning temp is typically low from 96 to 96.5 About 6 years ago did some cortisol testing the nutrition guy thought I might be border line stage 2/3 adrenal fatigue. I tried some progesterone and then DHEA. The DHEA seemed to help.

While using DHEA I had a blood test and my ldl came out a bit higher at 194 and the doc did not like I was taking DHEA. At the time my HDL was 64 and triglycerides were 28. As a result of his urging I stopped the DHEA. It was right about that time I had my best powerlifting total in a meet and this was at age 42 in the same weight class (198) since I was 24.

No drugs have been taken, prescription or otherwise.

Lab Results from sample taken 8/21 10am
wbc 3.4 ref 3.4 - 10.8
rbc 4.32 ref 4.14 - 5.8
hgb 14.2 ref 12.6 - 17.7
hct 41.5% ref 37.5 - 51.0
Platelet Ct 169 ref 150 - 379
Sodium 142 ref 134 - 144
Potassium 4.3 ref 3.5 - 5.2
Chloride 102 ref 97 - 108
CO2 28 ref 18 - 29
BUN 21 ref 6 - 24
Creatinine .97 ref .76 - 1.27
Calcium 9.2 ref 8.7-10.2
Phosphorus 3.4 ref 2.5 - 4.5
Uric Acid 4.8 ref 3.7 - 8.6
Protein, total 6.6 ref 6.0 - 8.5
Albumin 4.4 ref 3.5 - 5.5
Globulin 2.2 1.5 - 4.5
A/G ratio 2.0 ref 1.1 - 2.5
Glucose 97 ref 65 - 99
Cholesterol total 223 ref 100 - 199
Triglyceride 46 ref 0 - 149
HDL 57 ref > 39
LDL 157 ref 0 - 99
Chol/hdl ratio 3.9 ref < 4.0

Cholesterol Particle Size Lab
LDL-P 1983 ref high = 1600 - 2000
LDL-C 150 ref < 100
HDL-C 55 ref > 39
Triglycerides 72 ref < 150
Chol, Total 219 ref < 200
LDL and HDL Particles
HDL-P (total) 29.9 ref > 30.5
small LDL-P 718 ref < 527
LDL size 20.8 ref > 20.5
LDL Size Large Pattern A = 23.0 to 20.6 Small Pattern B = 20.5 to 19.0

T3 Uptake 37% ref 24 - 39
T4 5.7 ref 4.5 - 12
T4-T Uptake Index 2.1 ref 1.2 - 4.9
T3 82 ref 83 - 200
TSH 1.390 ref .450 - 4.500
Thyroxine, Free 1.24 ref .82 - 1.77
Free T3 2.8 ref 2.0 - 4.4
Vit D 52.9 ref 30 - 100
PSA .4 ref 4 - 10
Sex Horm Bnd Glb 62.8 ref 14.5 - 48.4
Test Total 708.8 ref 348 - 1197
DHEA SO4, Serum 65.1 ref 71.6 - 375

Additional test on 8/29 5pm
HGB ALC 5.5% ref 4.8 - 5.6
Homocysteine 11.0 ref 0.0 - 15.0
Testosterone 455 ref 348 - 1197
Free Test 36 ref 52 - 280
% Free Test .8% ref 1.5 - 3.2
Estradiol 7.6 ref 7.6 to 42.6

Diet - whole foods lots of animal product, grass fed beef, chicken thighs eggs, cheese, butter lots of fresh veggies, nuts, small amounts of fruit, some sprouted grain wheat and flax bread - not a lot of processed food eat restaurant food about once per week - during training usually have Plazma

Training 4-6 weight training sessions a week training for powerlifting occasional hiking throughout the year

morning wood is occasional

I don’t think I need HRT but I do think my hormones could be optimized.

I was surprised on this last blood test. Cholesterol was about normal for me and I figured with my hdl and low triglycerides my particle test would look better. I’ve never had this test before and my interpretation is this should be better.

Possibly the cholesterol is a bit off due to the hormonal factors that appear to be out of range.

I would appreciate any insights and recommendations.

p.s. I used a new login name some my results aren’t tied to my regular user name. I’ve been on T-Nation since the start.

Get back on DHEA!
Very low: DHEA SO4, Serum 65.1 ref 71.6 - 375

  • suspect adrenal function
  • need adrenal followup

Testosterone 455 ref 348 - 1197
Free Test 36 ref 52 - 280 *** LOW ***
% Free Test .8% ref 1.5 - 3.2
Estradiol 7.6 ref 7.6 to 42.6
Sex Horm Bnd Glb 62.8 ref 14.5 - 48.4 *** HIGH ***

Your SHBG is high and FT is thus very low.
In this case TT does not matter as most of it is T+SHBG that is not bio-available

SHBG is made in the liver. I don’t see ALT/AST above.

E2 is to low, affect brain and nerve function, joints and tendons might ache

T3 Uptake 37% ref 24 - 39
T4 5.7 ref 4.5 - 12
T4-T Uptake Index 2.1 ref 1.2 - 4.9
T3 82 ref 83 - 200
TSH 1.390 ref .450 - 4.500
Thyroxine, Free 1.24 ref .82 - 1.77
Free T3 2.8 ref 2.0 - 4.4

TSH is a bit high.
T4=5.7, should be near mid range 8.25
T3-82, should be near mid range 140
fT4=1.24, sbn 1.30 so that is good
ft3=2.8, sbn 3.2 - low

Please read the thyroid basics sticky and AGAIN check your waking AND mid afternoon body temperatures. Also evaluate your long term intake/sources of iodine; iodized salt and vitamins that list iodine.

Your labs and low body temperature history suggests long term functional hypothyroidism. The insane ranges for thyroid labs means that your doctor may not do anything. You might benefit from iodine replenishment if your intake suggests that this is possible. Otherwise you will need Rx thyroid hormones.

You have hypogonadism and we do not know if primary or secondary

  • get LH/FSH lab work AFTER resuming DHEA for two weeks
  • get prolactin lab work IF LH/FSH are low

Your low DHEA may be rate limiting DHEA–>T production inside your testes. If that is so LH/FSH may be elevated. But at your age, things are never that clear and many men can be a combination of primary and secondary and you are at an age where age related hypogonadism is the norm and TRT is typically commenced without any reason to do deep diagnostics.

Summary: FT indicates hypogonadism, your thyroid has problems and your adrenals are not producing DHEA.

Refer to these stickies:

  • advice for new guys
  • thyroid basics
  • note references to adrenal fatigue and rT3

If you get T levels normalized, optimize thyroid and cortisol; your metabolic rate will recover and fat loss should be relatively easy.

TRT will probably lower your cholesterol levels [HDL will not change].
Thyroid improvements will allow for more fat burning in the mitochondria.

Based on your FT lab results, you should be thinking seriously about starting TRT. But do the suggested labs first.

Thank you so much fro the very detailed reply KSman. I really appreciate it.

I’ll read through those stickies again and start on the iodine and DHEA. I’ll also post some morning and afternoon temps.

I did find ALT/AST results
ALT (GPT) 24 ref < 45
AST (GOT) 24 ref 0 - 50

After a couple weeks of DHEA I’ll get some lab tests again. You want me to get LH/FSH run should I also get all the other items done too?

I will consider TRT. I’m really hoping with some other changes I could get things to turn around. Do you think that is a long shot without taking TRT?

Also, once I start TRT then I would need to continue that for life right?

Thanks again.

If you get on TRT, you will probably never want to consider stopping! So it is for life.

No obvious liver issues.

When testosterone and thyroid are low. TRT can make some feel worse as the increased metabolic rate created by the T over-runs your body’s capacity to deliver. Similar considerations with adrenal/cortisol. So you do have some work and labs to do.

Body temps will clarify things.

I was just wondering with E2 that low if your Achilles’ tendons or other tendons or joints ache?
My E2 was driven to low with the medication “Femara” and it caused me to have severe pain in my Achilles’ tendons, knees and elbows.
And in my opinion you could benefit from TRT. Just do it like KSman has written in the “Protocall for injections” sticky.

mbalmr, thanks for the post. I haven’t had any Achillies issues. I do have plenty of musculoskeletal issues. My hamstrings seem to get gummed up quite a bit. I can work out the tissue but it doesn’t last long. I feel it has more to do with poor glute firing though. I’ve been working on coming back from a hip injury in a Powerlifting meet over 4 years ago. The last 10 months have shown pretty good progress. I attribute much of that to following Kelly Starrett from Mobility WOD.

I took morning and afternoon temps but am now wondering about the accuracy of the digital thermometer.

For three days here are the measurements
Morning afternoon
96.8 97.1
92.2 97.3
97.3 97.3

Then tonight I tried comparing to a second thermometer and had my wife try both too at 9pm
Original 2nd Thermometer
me 97.8 98.1
wife 97.3 96.8

I’m wondering if would be worthwhile to buy something else? On amazon I see a couple Braun ear thermometers that get very high ratings and reviews.

I got and Ear Thermometer from Braun and it seems to be more consistent and I expect more accurate although I’d still like to see more consistency. My digital seems to read about 1 to 1.5 degrees lower.

Day Morn Afternoon
Fri 98.0 97.7
Sat 97.8 98.3
Sun 98.0 98.4

I started taking 12.5 mg of Iodoral for about 12 days ago. All though I started to feel like maybe it was making me feel a little anxious. So I stopped for a couple days. Might be better to take 1/2 a pill each day.

I’m going to meet with my Naturopath soon and I’m sure she will agree with adding DHEA. I’ll suggest to her that I have a blood test again after 15-30 days of using DHEA.

Do I need to have everything that I ran before run again?

Also, is there anything else you suggest I do now beside adding the DHEA?