T Nation

In Search of Optimal: Lab Results

Looking for help from the forum to get back to optimal health and well-being. Here is the requested info –

Age: 46
Height: 6’2
Waist: 34
Weight: 210#
Describe body and facial hair: Normal, no recent changes
Describe where you carry fat and how changed: mostly belly fat, still not carrying much, but it has been more of a challenge to keep it at bay.
Health conditions, symptoms [history]:

  • Difficulty gaining muscle
  • Strength plateau or decreased
  • Achy joints
  • Difficulty recovering from exercise
  • Most recently have been carrying more fat in abdomen
  • Libido is significantly reducedâ?¨
  • Sometime difficult getting erections, requires lots of stimulation
  • Moderate difficulty maintaining erections
  • Erections are not as stiff as they used to be
  • Lack of sensitivity in penis
  • Often feel anxious and nervous (this is not normal for me)
  • Bouts of irritability
  • Stressful situations leave me feeling exhausted, wear me down, make me feel weak

Rx and OTC drugs, any hair loss drugs or prostate drugs ever : No Rx, allergy shots, multivitamin, Vitamin D, omega 3, glucosamine, chondroitin, no hair loss or prostate drugs ever.
Diet: Good. Lost of protein, veggies. Bit of a sweet tooth. Drink only milk and water. No fast food, no junk food, no soda. No alcohol, no smoking, no drugs.
Describe training: Train 4-6 days per week. Use hard day/easy day approach. Lifting, sprinting, tempo. Recovery has been increasingly difficult. Lots of soreness, achy joints
Testes ache, ever, with a fever? No, no
How have morning wood and nocturnal erections changed? Happens only once in a while, used to be all the time.

Lab Results (27 Feb 2013, Quest Diagnostics)

Cholesterol, total 192 125-200
HDL cholesterol 55 >= 40 mg/dL
Triglycerides 81 < 150 mg/dL
LDL cholesterol 121 < 130 mg/dL
Chol/HDLC ratio 3.5 <= 5.0
Non HDL cholesterol 137
Cardio CRP (R ) 0.9 < 1.0 = low cardiovascular risk

Glucose 80 65-99 mg/dL
Urea nitrogen 18 7-25 mg/dL
Creatinine 1.34 0.6-1.35 mg/dL
eGFR 63 >= 60 mL/min/1.73m2
Sodium 139 135-146 mmol/L
Potassium 4.5 3.5-5.3 mmol/L
Chloride 104 98-110 mmol/L
Carbon dioxide 22 19-30 mmol/L
Calcium 9.4 8.6-10.3 mg/dL
Protein, total 6.7 6.1-8.1 g/dL
Albumin 4.6 3.6-5.1 g/dL
Globulin 2.1 1.9-3.7 g/dL
Albumin/Globulin ratio 2.2 1.0-2.5

Bilirubin, total 1.2 0.2-1.2 mg/dL
Alkaline phosphatase 63 40-115 U/L
AST 31 10-40 U/L
ALT 25 9-60 U/L
Hemoglobin A1c 5 <5.7 = decreased risk of diabetes

Vitamin D, 25 OH, total 46 30-100 ng/mL
Vitamin D, 25 OH, D3 46 ng/mL
Vitamin D, 25 OH, D2 <4 ng/mL

TSH 6.26 0.40-4.50 mIU/L
T4, free 1 0.8-1.8 ng/dL
T3, free 2.9 2.3-4.2 pg/mL

Testosterone, total 360 250-1100 ng/dL
Testosterone, free 50.2 46.0-224.0 pg/mL
Testosterone, bioavailable 103.3 110.0-575.0 ng/dL

Sex hormone binding globulin 30 10-50 nmol/L
Albumin, serum 4.5 3.6-5.1 g/dL
Dihydrotestosterone (DHT) 25 16-79 ng/dL

CBC
White blood cell count 4.8 3.8-10.8 k/uL
Red blood cell count 5.15 4.20-5.80 M/uL
Hemoglobin 16.2 13.2-17.1 g/dL
Hematocrit 48.7 38.5-50%
MCV 94.5 80.0-100.0 fL
MCH 31.5 27.0-33.0 pg
MCHC 33.3 32.0-36.0 g/dL
RDW 13.5 11.0-15.0%
Platelet count 186 140-400 k/uL
Absolute neutrophils 3163 1500-7800 cells/uL
Absolute lymphocytes 1152 850-3900 cells/uL
Absolute monocytes 398 200-950 cells/uL
Absolute eosinophils 67 15-500 cell/uL
Absolute basophils 19 0-200 cell/uL
Neutrophils 65.9 %
Lymphocytes 24 %
Monocytes 8.3 %
Eosinophils 1.4 %
Basophils 0.4 %
DHEA sulfate 67 45-345 mcg/dL
Insulin 3 <23 uIU/mL
LH 1.2 1.5-9.3 mIU/mL
Prolactin 7.3 2.0-18.0 ng/mL
PSA, total 0.5 <= 4.0 ng/mL
Estradiol, ultrasensitive 45 <= 29 pg/mL

Also did a saliva cortisol test
Morning: 5.4 ng/mL 3.7-9.5
Noon: 2.4 ng/mL 1.2-3.0
Evening: 1 ng/mL 0.6-1.9
Night: 0.6 ng/mL 0.4-1.0

Doctor diagnosis:
Low T levels caused by low levels of LH
High estradiol
Slightly below optimal Vitamin D and would like to see DHEA higher
Concern about thyroid as well.

Plan:
hCG injections 1000 2x/week
Arimidex 0.5mg 2x/week
Increase Vit-D supplements 4000/day
Re-test in mid-May, see if T replacement is necessary depending on how I respond to hCG

Does this sound like a reasonable plan of attack? Anything that the Dr missed or I should keep an eye on? I’m trying to get the hCG right now. There don’t seem to be any local pharmacies that stock it.

Thanks for your help!

Please read the thyroid basics sticky!!!

  • provide history of use for iodized salt and any vitamins listing iodine
  • post oral body temperatures, when you wake up and mid afternoon
  • dry skin, brittle nails or hair?
  • feel like you get cold/chilled more than you should
  • if you are iodine deficient, others in your household probably are too, check their temps

Doc palpates your thyroid and ?
Your neck appears thick where your thyroid is?
Looks or feels asymmetric or lump?
Thyroid area ever sore?

LH varies minute to minute, FSH is a better indication, typical labs are LH & FSH

You need a full thyroid panel!!!

With hCG half life, better to inject SC EOD. Suggest that you start with 250-300iu EOD. Larger amounts might lead to high T–>E2 inside the testes and Arimidex/anastrozole does not work there.

CRP is not cardio specific. Homocysteine is cardio specific. No need to do this now, for the future.

Joints: Any possible exposure to tick bites? [Lyme disease]

  • fish oil and vitamins might be helpful

Are you exposed to toxins or fumes?
Anyone else in your household having any joint issues.

Thanks, KSman! Yes, I have read the thyroid basics sticky.

I moved to sea salt a couple years ago.
My morning and afternoon temperatures have been consistently low. Below 97.0 in the mornings and only slightly above 97.5 in the afternoon.

I started iodine supplementation on Feb 18, a little over a week before my blood test.
I found a potassium iodide supplement with 130 mg of potassium and 3.75 mg Iodine per capsule. There were 60 capsules in the bottle and I just finished the bottle this morning.

It doesn’t seem to be making much of a difference. This morning, my temp was 97.4 and afternoon temps was 97.6.

Should I continue supplementing at that level?

Nails are fine, skin and hair are a bit dry. Not particularly sensitive to cold, but more than I used to be.

The doc did not palpitate thyroid. Neck appears normal and there is no lump as far as I can tell. It is not and has not ever been sore.

I will ask doc for full thyroid panel and make sure to include FSH next time, but if I’m injecting hCG I understand that LH will go to zero. Will FSH also be effected?

I’ll make sure to inject EOD.

As far as joints, yes I’m in the northeast, so ticks are a possibility, but I haven’t seen any other symptoms of Lyme disease and I’ve been pretty careful about checking. I do a pretty good job with fish oil and vitamins. Doc said low T can cause achy joints too?

No toxins or fume as far as I know. No other family members having joint issues.

Thanks so much for your help!

You have taken 210 mg iodine and a total of 750mg [.75 gram] is suggested. If you have a thyroid disease condition, IR will not solve the problem. The big problem is a doc prescribing thyroid meds that you have to take for the rest of your life when the problem is only iodine deficiency.

Your morning temps appear to be better, keep up the program and note changes. Often a change to mental clarity is reported as an early sign. One is more able to notice and define improvements when the changes occur more rapidly. That would be one advantage to taking large amounts over a shorter time span, such as 50mg/day for two weeks.

Diagnosis of late-stage Lyme disease is often complicated by a multifaceted appearance and nonspecific symptoms, prompting one reviewer to call Lyme the new “great imitator.”[87] Lyme disease may be misdiagnosed as multiple sclerosis, rheumatoid arthritis, fibromyalgia, chronic fatigue syndrome, lupus, Crohn’s disease, HIV or other autoimmune and neurodegenerative diseases.

TSH 6.26 0.40-4.50 mIU/L - should be closer to 1.0, 6.26 is a major concern
T4, free 1 0.8-1.8 ng/dL - should be near mid range 1.3, you are only at 77% of that goal
T3, free 2.9 2.3-4.2 pg/mL - mid range is 3.25, you are only at 89% of that goal

We see iodine deficiency and good recovery with IR for guys who have much better labs than yours. Your lab results are quite extreme for what we see reported here. So your report of joint pain, while not self reported here very often, would seem to simply be a degree of the same problem.

Note, that recovery of your T levels may make you feel worse if you do not first have your thyroid and iodine issues resolved first. So I would delay the TRT and focus on this issue and then you might also see improvement in your LH/FSH/T levels.

Your E2 is really high. You need to focus on liver issues and possible external factors. We do not know functional hyperthyroidism affects liver and E2. We do know that hyperthyroidism can lead to hypergonadism and vise versa. Suggest low dose anastrozole now in a pre TRT or non-TRT situation.

Yes, if you start hCG, LH/FSH–>0

NOTE: I just reviewed hyperthyroid symptoms on the WWW. These include joint pain/aches, muscle pain/aches carpal tunnel syndrome etc. So Lyme may not be a factor. However, the implications of untreated Lyme is so severe; it makes sense to do labs to hopefully rule it out.

Makes sense! I’ll continue with IR at higher daily doses and keep monitoring my temperature.

Re: Lyme disease, I will work on getting the blood test, but it looks like that test is not considered authoritative either. As far as the achy joints, it is generally in response to heavy lifting and confined to my knees. I know that I have had cartilage damage in the past and doctors told me it was just part of getting older.

It sounds like I need to get through the whole 750 mg of IR and then do a complete thyroid panel to see what’s going on. Are you thinking that HYPER- (as opposed to HYPO-) thyroidism is a potential issue? Wouldn’t T4 and T3 reflect that?

I just started anastrozole yesterday (0.5mg, 2x/week) to control E2. Will be getting hCG later this week and was planning on starting it immediately. Does that seem reasonable? No TRT planned until after we get labs back and see how the AI and hGC effect me.

Thanks again for all your help!

Your TSH says hypothyroidism, your fT4 says hypo, fT3 says hyper, body temps clearly indicate a functional state of hypo, your iodine intake was low for a couple of years.

Do you have stress issues? Some high stress events can leave you feeling physically unwell? rT3 resulting from adrenal fatigue can block effects of fT3.

hCG, do not do high dose

Low T and low LH suggest secondary hypothyroidism. So the hCG may work. No need to check LH/FSH then, should go to zero if T levels recover.

Got the hCG from the pharmacy today. 10,000 U of powder was in the vial, I had the pharmacist dilute it with 10 mL of biostatic water and will inject 300 U (0.3 ml) every other day as you recommended. Looks like it expires after 30 days, so there will be lots left over.

Yes, good call on the stress issues. I have been going through some challenging personal / relationship issues over the last year or so. However the physical symptoms I listed in the initial post started a couple years ago, before the stress really hit me. They have just gotten worse over the last year. Trying to get things back to normal to reduce the stress component. I bought the Wilson book on adrenal fatigue so I’ve started going through that too.

How does one reverse the effects of rT3? Is that in the Wilson book?

I’ll keep you updated on my (hopefully!) progress.

hCG expiration?

KSman, in a different thread, you posted the following in reference to hCG:

"Many use 10,000 vials that last 80 days with no problems. The manufactures have to have an expiry date and they do not do anything science based, they just make something up and different products have different dates? "

Are you talking about hCG that has been reconstituted? Or not? Once it is mixed with bateriostatic water, it needs to be refrigerated and I have been told it needs to be used within 30 days or it loses potency. Is this true? With my protocol, I will have nearly half of it still left after 30 days, so it would save me a bunch of $ if I could use the rest of it.

I’ve been tracking morning temperatures. They are better than when I started but still not optimal. Last Tuesday was 97.4, this morning was 97.6. I just got a bottle of Iodoral and yesterday I started taking 50mg/day. I’ll do this until I hit the .75g recommendation.

I’ve also been on anastrozole and hCG since last Monday (Just over a week.) I’m taking 0.5 mg of anastrozole E3D and 300 IU Novarel EOD. Plus started 50mg of DHEA every day for the last four days.

My question is, when should I start to notice a difference? I haven’t really noticed any changes in my physical or emotional state. Am I just being to impatient or is there something I am missing?

OK, finished the loading phase for the iodine. Was doing 50 mg of iodine per day. No noticeable side effects. The thing is, it doesn’t seem like it has done much for my waking temperatures. They used to be in the high 96 to low 97 range. Now they seem to be in the low 97 to mid 97 range. This seems like an indication that there is something going on with the thyroid.

Should I continue to supplement iodine at that dose? Or drop it back to 12.5 mg/day?

I read through Wilson’s book on Adrenal Fatigue and I can’t say that what it describes fits my symptoms very well. So while I’m not ready to rule it out, I’m not convinced that is a big player in my case.

I started with 0.5 mg of anastrozole E3D back on March 25. Also, I’ve been supplementing with 50mg/day of DHEA along with the hCG. I haven’t really felt any difference. Maybe some very subtle improvements, but nothing that is beyond the power of my imagination. I started at 300 IU of hCG EOD. I went up to 400 IU EOD and am thinking of pushing to 500 IU EOD. I know that high doses of hCG are not good and I read somewhere that about 500 IU was about the max to use without frying the Leydig cells. So is bumping up to 500 IU EOD a good idea or a bad idea?

I have a phone consult with my Dr on Friday. They want to schedule my next bloodwork. I am getting at least the full male panel (T, Free T, E2, etc) Is there anything else I should look at?

If you are not feeling well because of a thyroid issue, you are not in any condition to eval effects of hCG. Too much hCG may drive up E2 as well.

What changes to mid afternoon temps?

Need labs to see TT, FT and E2. Enough time for hCG to get the job done? Hard to tell. Any changes in your testes?

Take iodine to 6.25 once or twice a week for a maintenance dose.

Thanks for the reply!

I haven’t been as regular at taking my mid afternoon temperatures, but they don’t seem to have changed much. Hovering around the low 98s. No noticeable changes in my testes – maybe a bit lower.

Should I push the Dr to get a complete thyroid panel done?

Yes, a thyroid panel makes sense. Make sure that you get the ones that you want. Doc may just pick a panel that is not suitable.

rT3 as well

Spoke with Dr today. I told him I haven’t noticed much of a difference on the current regiment. For my next blood work in the middle of May, I’m going to get the normal male hormone panel as well as the complete thyroid panel including rT3.

I’ve been doing 500 IU EOD of hCG and 0.5 mg aramidex E3D. Doc wants me to bump that up to 1000 IU 2x/week or even go as high as 1000 IU EOD to see how I feel. I think he’s trying to determine if I have secondary hypogonadism and seeing if the testes will respond at all.

Thoughts on these higher doses? Is it worth trying it for a couple of weeks? I’m worried that higher doses will increase estradiol too much (and mine is already high!)

OK, got new bloodwork back last week. As a refresher, I prior to the test, my protocol was 700 IU hCG EOD and 0.5 mg anastozole E3D.

Here are the results:

Lab Results (9 May 2013, Quest Diagnostics)

TSH 4.86 0.40-4.50 mIU/L
T4, free 0.9 0.8-1.8 ng/dL
T3, free 2.9 2.3-4.2 pg/mL
T3, reverse 11 8-25 ng/dL
Thyroid Peroxidase (TPO) Antibodies 112 <35 IU/ml

Testosterone, total 751 250-1100 ng/dL
Testosterone, free 140.9 46.0-224.0 pg/mL
Testosterone, bioavailable 277.6 110.0-575.0 ng/dL
Estradiol, ultrasensitive 72 <= 29 pg/mL
Sex hormone binding globulin 25 10-50 nmol/L
Albumin, serum 4.3 3.6-5.1 g/dL
Dihydrotestosterone (DHT) 62 16-79 ng/dL
PSA, total 0.6 <= 4.0 ng/mL

I have also been taking careful track of my temperature and it never gets above 97.7 during the day.

I clearly have a problem with my thyroid. I believe the high TPO antibodies indicate Hashimoto’d disease. I’m seeing a couple of thyroid specialists in the next few weeks to get opinions on how to manage that. If anyone on the board has experience or ideas, please let me know.

Also, while my T came up pretty nicely on the hCG, my Estradiol went through the roof! Probably explains why I have not been feeling very good even with the higher T levels. Dr wants me to continue on 700 IU hCG EOD but bump up to 1 mg anastozole E3D. I told him I was concerned that much of the aromatization was happening in the testes because of the high doses of hCG but he thought we could control it with the anastozole. I’m not so sure.

I have dropped the hCG down to 500 IU EOD and but am increasing to 1 mg of anastozole E3D. What do the experts on the board think of this? KSman?

BTW, for those of you who have a script for anastozole, Costco has the cheapest prices I can find on it. I got a 3 month supply for just over $15!

Thanks for your help!

Cool prices on anastrozole!

If your hCG is driving T–>E2 inside the testes, anastrozole cannot stop that and it cannot reduce E2 that then is releases into serum. Anastrozole is a competitive drug to T and T levels are very high inside the testes and serum anastrozole levels cannot work there. You can drive down T–>E2 in peripheral tissues, but if that is very low, serum E2 can still be too high. T–>E2 inside the brain is not something that one should vastly eliminate. We have seen insane anastrozole doses that are ineffective. Same happens with too much of a SERM.

Your DHEA was extremely low. You need more for DHEA–>T inside your testes.

Did I make other nutritional suggestions?

Sorry to hear the TPO news.

Your fT4 is way low. fT3=2.9 is not great. Your body temp problems seem explained. You and your testes might respond better with some thyroid meds. I am not familiar with what your meds will need to be. You should end up feeling a lot better, metabolism will increase and weight loss should be facilitated.

DHT should be good for libido. But E2 and thyroid messing with that.

I do feel that your doc does not understand the hCG—E2—anastrozole issue. But that is hardly a surprise. Drug reps do not detail these things. And there is the risk of LH receptor desensitization.

Thanks for the review! I forgot that I had reverse T3 tested as you recommended. I updated the previous post. It was 11 (range 8-25).

I have been supplementing with 50 mg/day of DHEA since the first lab test. We didn’t test DHEA blood levels this time. Is that something I should add for the next test?

I also loaded iodine and have been supplementing at maintenance doses since then, but the literature on iodine with Hashimoto’s is mixed. So I’m not sure if I should continue or not. I’m hoping the thyroid specialists can shed some light on that. I’ve heard Synthroid (straight T4) works well for some, but others need a combo drug like Armour (T4 and T3). I’m getting that taken care of as soon as I can.

However, in the mean time, does 500 IU EOD of hCG seem reasonable? I’m trying to find a dose that will keep T levels high without desensitizing LH receptors and reducing aromatization in the testes.

I have more labs scheduled for later this month.

Given your fT4, fT3 labs, you may do well on T4 meds alone. But some simply do better on something like armour thyroid.

Doc will probably not be intelligent re iodine and Hashi. But you would not want to be iodine deficient either.

You can try less hCG, but may not get E2 relief. I would cut hCG by 50% vs prior dose and then do labs later. We have seen 1 or 2 guys here who are hCG over-reacting as far as E2 goes. You need to experiment.

I cut my hCG to 400 IU EOD and increased my anastozole to 1 mg E3D. Here are the lab results:

T total (250-1100): 902
T free (46-224): 184.1
T bioavailable (110-575): 362.6
Estradiol (<29): 64
SHBG (10-50): 24
Albium (3.6-5.1): 4.3

So you can see that things are trending in the right direction and everything is looking good except my E2 is still way too high. Had a phone consult with the Dr and he recommended that I keep the hCG at the same dose and take 1 mg anastozole 4x per week (4mg/week total). I decided to do this, but drop the hCG to 350 IU EOD. I will get retested again in about four weeks. Physically, I have been better, but still not 100% right. Hoping I can get this dialed in.

Has anyone experimented with doing hCG every day? My thinking is that I could go down to <200IU every day and that would reduce the bumps in hCG concentration which might help reduce E2 creation in the testes. Worthwhile idea or not?

I also chatted with a thyroid specialist about my Hashimoto’s. Just yesterday, I started 1/4 grain (16.25 mg) Nature-Throid 2x per day. Nature-throid is similar to Armour in that it contains desiccated pig thyroid. Dr likes it better than Armour – said it works better since Armour was reformulated. In any case, 1/2 grain/day seems like a very low dose. From what I have read, the usual starting does is 1 grain per day and quickly works up with 2-4 grains/day. I’m going to continue to monitor my daytime temperatures and increase the dose as necessary.

Lyme can attack every endocrine system and the symptoms are of great numbers and never the same for anyone. with the auto immune thyroid problem I wouldn’t be ruling it out and I believe ksman has made a very good suggestion to check it out.

Igenex in California is the gold standard for the western blot test. They are a lab dedicated to only Lyme testing

Also the fry test is the next step for co infections

Both tests are paid out of pocket but do not ever ignor this nasty critter…

The regular Lyme tests have a big failure rate for being accurate they leave many people undiagnosed. A 14 year old girl I know was told it was all in her head after government testing failed to find it. 50 k later she is walking again. Test it bro