T Nation

Initial Dr. O & HAN Consultation

So… I made the trip to see these guys recently. The ladies up front were very nice & actually called HAN into the office as I arrived a few hours early for my appointment(nice touch). We sat down and talked for about an hour about what brought me to them. HAN clearly is really into this stuff & wants to get to the root cause of the issues. He was way above my head with some of the technical terms & science though. No big deal. I consider myself to be a fairly intelligent guy, but was lost with some of the technical stuff. That’s fine though. In my opinion, it showed that he is really passionate about what he does. It excites him. That benefits us both!

I met with Dr. O afterwards. He is a really nice guy. He took the time to listen to what I had to say & comment on it. A physical examination ensued. All the typical stuff. After the exam, HAN came back in, and we all talked. These guys are a perfect team. They work well together and appear to strive for the answers to the issues.

Overall, this was a worthwhile visit. I didn’t feel rushed at all & left with a plan on how we are going to initially proceed. These guys are extremely thorough and knowledgeable. The front office staff is great as well. The ladies were super nice & even gave great lunch recommendations.

I’ve got about a gallon of blood to give Labcorb soon to test for EVERYTHING. It should give a great picture of how my body is working. Also going in for a pituitary MRI. I’ll keep everyone posted on my progress…

So what was the reason you went to them?

I’ll post bloodwork once I get results. After first draw, I’m going on clomid challenge.

height: 6’3
weight: 270 (high teens bf, I imagine)
Body hair/facial hair: never had a beard. Goatee only in past few years with androgel. Not very hairy otherwise
testes ache or hurt? ever? Sometimes, rarely there is a dull ache.
depression: no however I ran out of gel for like 10 days & felt like shit until I got my order in
libido : lower than usual
get cold easily? a change? All through life it seems. Nothing extreme like having to wear a coat indoors tho. Extremities freeze in the snow, cold rain, etc
dry skin, brittle nails? no
use iodized salt? No more than anyone else
eat much sea food? Maybe 2-3 times a month
exposure to chemicals? not much. Work in industrial type area sometimes & shoot a fair amount
ever used hair loss drugs? No, but if I could to grow a beard, that’d be great :slight_smile:
Rx and OTC drugs: androgel, multivitamin, protein & Pre-workout stuff
general energy levels: fairly decent. Only when I went off gel did I feel horrible
difficulty gaining muscle / recent muscle loss: muscle gain seems to be fairly decent, but nothing stellar. I’m a fairly strong guy, but I imagine that I could be stronger if my levels were right.
weight gain (difficulty losing weight): around belly & face. Need to drop some lbs
general diet: not the best. Never eat breakfast, portions have always been too large
concentration/focus/drive/memory: fluctuate, but not as good as they should be
confidence level/anxiety level: fairly good confidence, mild anxiety from time to time. High stress makes adrenal area hurt/throb. Never knew what this was before reading this board

chest size/gyno?/chest sensitivity: large, barrel-type chest. nipples have been kinda puffy whole life.
morning erections/ability to maintain erections : no more morning wood. Not as firm as teen/early 20s. Sad…
supplement history: creatine, protein, vitamins, C4 Pre-workout. Ephedra caffeine aspirin stack way back in the day. Never any AAS
headaches: almost never

PS: thanks to VTBalla for the referral to these guys!

So, I just got the first set of labs back. This was a baseline before a Clomid Challenge. It looks like there are some things WAAAY ot of whack. What do you guys think?

 Tests                        	Results    	 Units 	Reference Interval	 	 

     VAP Cholesterol Profile	 
 LDL Cholesterol 		137	 H 	 mg/dL 	  <130 	 	
 HDL Cholesterol 		56		 mg/dL 	  >=40 	 	 
 VLDL Cholesterol 		17		 mg/dL 	  <30 	 	 
 Cholesterol, Total 		210	 H 	 mg/dL 	  <200 	 	
 Triglycerides 			88		 mg/dL 	  <150 	 	 
 Non HDL Chol. (LDL+VLDL) 	154		 mg/dL 	  <160 	 	 
 apoB100-calc 			1		 mg/dL 	  <109 	 	 
 LDL-R (Real)-C 		114	 H 	 mg/dL 	  <100 	 	
 Lp(a) Cholesterol 		9.0		 mg/dL 	  <10 	 	 
 IDL Cholesterol 		13		 mg/dL 	  <20 	 	 
 Remnant Lipo. (IDL+VLDL3) 	23		 mg/dL 	  <30 	 	 
 Clinical Consideration 			   	   	 	 
 Probable Metabolic Syndrome 	No		   	  No 	 	 
 Sub-Class Information 			   	   	 	 
 HDL-2 (Most Protective) 	15		 mg/dL 	  >10 	 	 
 HDL-3 (Less Protective) 	41		 mg/dL 	  >30 	 	 
 VLDL-3 (Small Remnant) 	10	 H 	 mg/dL 	  <10 	 	
 LDL1 Pattern A 		17.4		 mg/dL 	   	 	 
 LDL2 Pattern A 		35.9		 mg/dL 	   	 	 
 LDL3 Pattern B 		57.5		 mg/dL 	   	 	 
 LDL4 Pattern B 		3.4		 mg/dL 	   	 	 
 LDL Density Pattern 		A		   	  A 	 	 

     CBC With Differential/Platelet	 
 WBC 				2.9	 L 	 x10E3/uL 	  4.0-10.5 	 	
 RBC 				5.92	 H 	 x10E6/uL 	  4.10-5.60 	 	
 Hemoglobin 			17.9	 H 	 g/dL 	  12.5-17.0 	 	
 Hematocrit 			51.3	 H 	 % 	  36.0-50.0 	 	
 MCV 				87		 fL 	  80-98 	 	 
 MCH 				30.2		 pg 	  27.0-34.0 	 	 
 MCHC 				34.9		 g/dL 	  32.0-36.0 	 	 
 RDW 				13.0		 % 	  11.7-15.0 	 	 
 Platelets 			244		 x10E3/uL 	  140-415 	 	 
 Neutrophils 			28	 L 	 % 	  40-74 	 	
 Lymphs 			62	 H 	 % 	  14-46 	 	
   Lymphocytes appear reactive.	 
 Monocytes 			9		 % 	  4-13 	 	 
 Eos 				1		 % 	  0-7 	 	 
 Basos 				0		 % 	  0-3 	 	 
 Neutrophils (Absolute) 	0.8	 L 	 x10E3/uL 	  1.8-7.8 	 	
 Lymphs (Absolute) 		1.8		 x10E3/uL 	  0.7-4.5 	 	 
 Monocytes(Absolute) 		0.3		 x10E3/uL 	  0.1-1.0 	 	 
 Eos (Absolute) 		0.0		 x10E3/uL 	  0.0-0.4 	 	 
 Baso (Absolute) 		0.0		 x10E3/uL 	  0.0-0.2 	 	 
 Immature Granulocytes 		0		 % 	  0-2 	 	 
 Immature Grans (Abs) 		0.0		 x10E3/uL 	  0.0-0.1 	 	 
 Hematology Comments: 	Note:		   	   	 	 
   Verified by microscopic examination.	 

Comp. Metabolic Panel (14)	 
 Glucose, Serum 		111	 H 	 mg/dL 	  65-99 	 	
 BUN 				16		 mg/dL 	  6-20 	 	 
 Creatinine, Serum 		1.15		 mg/dL 	  0.76-1.27 	 	 
 eGFR If NonAfricn Am 		84		 mL/min/1.73 	  >59 	 	 
 eGFR If Africn Am 		97		 mL/min/1.73 	  >59 	 	 
   Note: A persistent eGFR <60 mL/min/1.73 m2 (3 months or more) may	 
   indicate chronic kidney disease. An eGFR >59 mL/min/1.73 m2 with an	 
   elevated urine protein also may indicate chronic kidney disease.	 
   Calculated using CKD-EPI formula.	 
 BUN/Creatinine Ratio 		14		   	  8-19 	 	 
 Sodium, Serum 			138		 mmol/L 	  134-144 	 	 
 Potassium, Serum 		4.4		 mmol/L 	  3.5-5.2 	 	 
 Chloride, Serum 		105		 mmol/L 	  97-108 	 	 
 Carbon Dioxide, Total 		22		 mmol/L 	  20-32 	 	 
 Calcium, Serum 		9.6		 mg/dL 	  8.7-10.2 	 	 
 Protein, Total, Serum 		8.1		 g/dL 	  6.0-8.5 	 	 
 Albumin, Serum 		4.6		 g/dL 	  3.5-5.5 	 	 
 Globulin, Total 		3.5		 g/dL 	  1.5-4.5 	 	 
 A/G Ratio 			1.3		   	  1.1-2.5 	 	 
 Bilirubin, Total 		1.4	 H 	 mg/dL 	  0.0-1.2 	 	
 Alkaline Phosphatase, S 	1		 IU/L 	  25-150 	 	 
 AST (SGOT) 			48	 H 	 IU/L 	  0-40 	 	
 ALT (SGPT) 			38		 IU/L 	  0-55 	 	 

Allergen Profile, Basic Food	 
 Class Description 			   	   	 	 
       Levels of Specific IgE       Class  Description of Class	 
       ---------------------------  -----  --------------------	 
                       <0.08         0         Negative	 
              0.08 -    0.15         I	 
              0.16 -    0.50         II        Increasing	 
              0.51 -    2.50         III         levels	 
              2.51 -   12.50         IV            of	 
             12.51 -   62.50         V        Specific IgE	 
             62.51 - >100.00         VI         Antibody	 
 F0-IgE Milk (Cow) 		<0.08		 kU/L 	  Class 0 	 	 
 F004-IgE Wheat 		0.29		 kU/L 	  Class II 	 	
 F008-IgE Corn 			0.19		 kU/L 	  Class II 	 	
 F3-IgE Peanut 			0.16		 kU/L 	  Class II 	 	
 F4-IgE Soybean 		<0.08		 kU/L 	  Class 0 	 	 
 F6-IgE Pork 			<0.08		 kU/L 	  Class 0 	 	 
 *F7-IgE Beef 			<0.08		 kU/L 	  Class 0 	 	 
 *FX-IgE Fish/Shell Mix 	<0.08		 kU/L 	  Class 0 	 	 
 *F245-IgE Egg, Whole 		<0.08		 kU/L 	  Class 0 	 	 
 *F052-IgE Chocolate/Cocoa 	<0.08		 kU/L 	  Class 0 	 	 

Catecholamines, Plasma	 
 Catecholamine Frac,P 			   	   	 	 
 Norepinephrine, Pl 		810		 pg/mL 	  0-874 	 	 
 Epinephrine, Pl 		59		 pg/mL 	  0-62 	 	 
 Dopamine, Pl 			32		 pg/mL 	  0-48 	 	 
Testosterone,Free+Weakly Bound	 
 Testosterone, Serum 		565		 ng/dL 	  348-1197 	 	 
 Testost., % Free+Weakly Bound 	20.4		 % 	  9.0-46.0 	 	 
 Testost., F+W Bound 		115.3		 

Vitamin B12 and Folate	 
 Vitamin B12 			588		 pg/mL 	  211-946 	 	 
 Folate (Folic Acid), Serum 	8.6		 ng/mL 	  >3.0 	 	 

				              Indeterminate:  2.2 - 3.0	 
                                              Deficient:           <2.2	 
Insulin, Free and Total, Serum	 
 Insulin, Free 			4.9		 uIU/mL 	  0.0-22.0 	 	 
 Insulin, Total 		9.2		 uIU/mL 	  0.0-22.0 	 	 

Luteinizing Hormone(LH), S	 
 LH 				16.8	 H 	 mIU/mL 	  1.7-8.6 	 	
Testosterone, Free, Direct	 
 Free Testosterone(Direct) 	4.6	 L 	 pg/mL 	  8.7-25.1 	 	
 Estradiol 			34.0		 pg/mL 	  7.6-42.6 	 	 
   Roche ECLIA methodology	 
 DHEA-Sulfate 			219.4		 ug/dL 	  160.0-449.0 	 	 
 Insulin-Like Growth Factor I 	238		 ng/mL 	  115-307 	 	 
Thyroxine (T4) Free, Direct, S	 
 T4,Free(Direct) 		1.51		 ng/dL 	  0.82-1.77 	 	 
 TSH 				1.470		 uIU/mL 	  0.450-4.500 	 	 
ACTH, Plasma	 
 ACTH, Plasma 			56.1		 pg/mL 	  7.2-63.3 	 	 
   ACTH reference interval for samples collected between 7 and 10 AM.	 
Homocyst(e)ine, Plasma	 
 Homocyst(e)ine, Plasma 	7.5		 umol/L 	  0.0-15.0 	 	 
Vitamin D, 25-Hydroxy	 
 Vitamin D, 25-Hydroxy 		23.9	 L 	 ng/mL 	  30.0-100.0 	 	

Hemoglobin A1c	 
 Hemoglobin A1c 		6.1	 H 	 % 	  4.8-5.6 	 	
            Increased risk for diabetes: 5.7 - 6.4	 
            Diabetes: >6.4	 
            Glycemic control for adults with diabetes: <7.0	 

Thyroxine (T4) 			6.7		 ug/dL 	  4.5-12.0 	 	 
T3 Uptake	 
 T3 Uptake 			43	 H 	 % 	  24-39 	 	
 Free Thyroxine Index 		2.9		   	  1.2-4.9 	 	 
Triiodothyronine (T3) 		99		 ng/dL 	  71-180 	 	 
Progesterone 			0.7		 ng/mL 	  0.2-1.4 	 	 
Sex Horm Binding Glob, Serum 	88.7	 H 	 nmol/L 	  16.5-55.9 	 	
Triiodothyronine,Free,Serum 	3.3		 pg/mL 	  2.0-4.4 	 	 
Thyroid Peroxidase (TPO) Ab 	10		 IU/mL 	  0-34 	 	 
Antithyroglobulin Ab 		<20		 IU/mL 	  0-40 	 	 
   Siemens (DPC) ICMA Methodology	 
Prealbumin 			27		 mg/dL 	  20-40 	 	 
Cortisol - AM 			9.6		 ug/dL 	  6.2-19.4 	 	 
Ceruloplasmin 			22.9		 mg/dL 	  15.0-30.0 	 	 
Ferritin, Serum 		321		 ng/mL 	  30-400 	 	 
C-Reactive Protein, Quant 	1.2		 mg/L 	  0.0-4.9 	 	 

Cholesterol is slightly out of range, but fine IMO. I do not trust CHOL lab ranges since it has been heavily influenced by big pharma. Personal preference.

WBC is scary low. Look at causes for this. Disease states related to blood and bone can cause this. Investigate this further.

Couple liver markers are high (AST) but if you work out, this is to be expected.

LH is very high. Do not have a corresponding increase in T. Your body is asking for more T but not getting it. Indicates either degree of testicular damage (have you self-examined for testicular cancer?) or possible pituitary issues (ask for pituitary MRI).

T4 is on the high side, T3 is on the low side. Coupled with your low cortisol, this indicates that you could likely have RT3 issues. I don’t see RT3 on here, which is surprising.

E2 could be improved, but may be related to liver clearance as your high SHBG would also indicate. Note that high SHBG seems to be correlated with low cortisol.

Vitamin D3 is abysmall. 15k iu/day for a couple weeks to start then cruise with 6-8k iu/day. Get a good brand (Dr. O and HAN have a brand they recommend taht I use and I really like it).

Progesterone and morning cortisol low. I would try MLM pregnenolone 150 mg 2 x a day.

You are getting close to diabetic level on Ha1c. Glucose level also indicates this.