T Nation

Input on Labs, Docs Recommendation


#1

I dont post very often but I respect the opinions of the guys that post here and I am looking for some input on my lab work and my docs ideas. A little background..38 years old past history of testiclular cancer at age of 10, 1 remaining. 3 yeas of chemo. workout 3-4 times a week. My diet is clean. Have used TRIBEX and alphamale over the years cycling as directed with positive results.

Never had libido or ED problems until going through a bad marriage and divorce over this last year and a half. Had mental fogginess, memory wasnt as sharp as I usually am, horrible sleeping patterns, hard time dropping weight, and general fatigue, lack of morning wood. In January , it clicked that I was probably having low test and or adrenal fatigue.

I was able to procure 2 month supply of clomid and started with 25 mg of clomid EOD, within 4 days or so, I was feeling great, almost all symptoms dissapeared, good libido, no ED, morning wood every morning. Went to see a doctor ( first ime in 13 years I had seen a doc) in order to have labs run. These were the results:

lab performing test Quest
1/13/2010
DHEA- 29 mcg/dl (110-370)
Total Test- 1233 ng/dl (250-1100)
Free test- 84 pg/ml ( 46-224)
Bioavailable test- 165 (110-575)
SHBG- 82 ( 8-48)
Estradiol 89 ( < or =29 )

with these results, I started DHEA at 200mg per day and cut the clomid to 12.5 mg EOD, and DIM 400 mg per day

Follow up labs on 3/30
DHEA- 384
Total test- 1243
Free test- 108
Bioavailable Test- 203
SHBG- 66
Estradiol-60

By May , was still feeling good and opted to wean off Clomid and to back off the DHEA to 150 mg/day... so by mid June , not feeling horrible but not feeling as good as I was on the 25 mg of clomid or hte 200 of DHEA. Morning wood not nearly as often , maybe 2-3 times/week.

So finally, Just had last batch of tests ran, and here are the results:

7/29
DHEA-115
Total test- 681
Free Test- 35.6
Bioavilable test- 66.9
SHBG- 97
Estradiol-6

So my doc wants to start on Androderm 5 mg/day and keep the DHEA at 150 mg/ day ( he thinks maybe lab error). I have concerns that I am totally going to kill my HPTA since I am producing some test at this time. Should I recommend HCG to preserve natural production?

Also , should I be checking FSH and LH levels before starting the TRT ( he has not ordered these labs as of yet), Anyone with good results with androderm? Any other suggestions would be greatly apprectiated..Thanks in advance


#2

I am glad that clomid did not have severe sides for you.

Clomid must have been pushing LH/FSH high, as your TT and FT would not have jumped otherwise. LH may have been too high, acting like too high of a hCG dose, leading to high E2.

Third test: E2=6 really sounds like a lab error.

So your pituitary can produce lots of LH and your one teste can make lots of T. But your hypothalamus is not telling your pituitary to make LH unless it is subjected to a SERM.

Your current fT is low because SHBG is high. Most of your TT is SHBG bound T [SHBG-T], which is functionally inert. With you low T levels now, your LH is low. You do not have primary hypogonadism. Testing LH/FSH will not change that conclusion.

You might be able to run on hCG instead of TRT, but you are still injecting EOD. And you would need to use anastrozole to control E2. But if the amount of hCG needed to get your one teste to do the job is high, then E2 levels could easily be beyond management with anastrozole.

Normally high SHBG is the result of high E2 or hyperthyroidism. Are you heat intolerant and have lost weight? Do you have any thyroid labs? Thyroid gland is thick or has lumps? Hard to swallow?

Your low FT and low bio-T confirm that SHBG is high and that the result is not a lab error.

How do you react to major stress? -feel physically drained or unwell?


#3

Thanks for the response KSman. Had an initial thyroid panel drawn as well in january…I am usually cold probably renauds secondary to 3 years of chemo…very common after effect. But I thought I would check the thyroid function out as well since I typically had dryer skin, cold intolerance, and inability to lean out even when doing keto diets in the past and slightly thining hair with very fine texture all post chemo. I used to have really course thick hair before it regrew after my last bout of cancer at 18yo…

Here are those labs:

TSH- 1.08 (.5-4.5)
Free T4- 1.16 ( .8 - 2.2)
Free T3- 281 ( 230-420)

To ansewr your question about stress, I usually handle it well, I am nurse, work nights in an ICU, so stress is normal and dealing with it was never an issue. But during my marriage and the divorce, hormonally , things just fell apart…I had truely never had these types of symptoms before, not while dating my exwife , not on the honeymoon, ( it was a short marriage, only a year and a half) it was about 3-4 months into the marriage that I realized that I had probably made a big mistake in marrying her…Too much to go into but there were a hell of a lot of promises made before the marriage that all were forgotten 4 months into the marriage. On top of that I was working a lot of overtime getting about 5 hours of sleep a day.

So I picked up the androderm this morning. Should I begin to use it or speak to the doc about HCG thearapy in conjungtion with the TRT? I am realy concerned about killing my own T production and atrophying the remaining teste.
Also, do you have any ideas why I am requiring so much DHEA and do you think that getting up the DHEA level might help with boosting total T and Free T.

Thanks again


#4

I personally would not start HRT at this point due to the concerns you listed plus it sounds like a possible cortisol problem that Androderm won’t fix - working nights, ICU nurse, personal turmoil, etc.

have you read the blood test sticky? did your doctor run any of those tests? can you get your doctor to run any of those tests?


#5

I will check the blood test sticky out…thanks
The only other tests that were run were a cbc and chem panel…both with no significant findings


#6

[quote]PureChance wrote:
I personally would not start HRT at this point due to the concerns you listed plus it sounds like a possible cortisol problem that Androderm won’t fix - working nights, ICU nurse, personal turmoil, etc.

[/quote]

I agree. OP: you should check out Dr. Wilson’s excellent book entitled Adrenal Fatigue. You can get it for like $8 off of Amazon as an e-book. Your story almost parallels several of the patients the doctor has worked with.

I would suggest getting a 4 times/day saliva test for cortisol that will track your production throughout the day. Discuss with your doctor. This is how my low cortisol production was identified.

You should also look into managing your E2. I agree with KSMan that the last lab could be in error. Get it rechecked and pursue anastrozole (either through your doc or as a research chemical online).


#7

Thanks VT…Has anyone used the website testmyhormones.com for the salivary test and does insurance cover it if ordered by my doc?

Thanks again


#8

Yes, please buy my book! Lame joke :slight_smile:

I agree with Pure, don’t go on HRT until you have exhausted every other option available. Pure has gone through the gauntlet himself and he can provide you some great advice. However, use your logic and don’t get bogged down in the details. Try to see the forest for the trees.

A lot of people out there will try to capitalize on your misfortune so be wary of these people. Don’t be afraid to ask the board if something seems like a scam. It usually is.

[quote]VTBalla34 wrote:

[quote]PureChance wrote:
I personally would not start HRT at this point due to the concerns you listed plus it sounds like a possible cortisol problem that Androderm won’t fix - working nights, ICU nurse, personal turmoil, etc.

[/quote]

I agree. OP: you should check out Dr. Wilson’s excellent book entitled Adrenal Fatigue. You can get it for like $8 off of Amazon as an e-book. Your story almost parallels several of the patients the doctor has worked with.

I would suggest getting a 4 times/day saliva test for cortisol that will track your production throughout the day. Discuss with your doctor. This is how my low cortisol production was identified.

You should also look into managing your E2. I agree with KSMan that the last lab could be in error. Get it rechecked and pursue anastrozole (either through your doc or as a research chemical online).
[/quote]


#9

P.S. Androderm is crap. I think almost EVERYONE who takes it has an adverse reaction to the adhesive and I’ve yet to hear of someone who has been on it long-term. Most end up switching to gels or injections.


#10

Thats what i understand bout androderm as well from various reviews and forums…BTW JL, what is your opinion on testmyhormones.com and their cortisol tests? Worth the 165 dollars?


#11

On another note, if my doc doesn’t feel the need to add in HCG and arimidex if I do end up on HRT could anyone give me some direction in how to procure it in a personal email. I have never ordered anything previously and would rather work with a compnay that has been trusted by my fellow T-Nation members.


#12

[quote]gman72 wrote:
Thats what i understand bout androderm as well from various reviews and forums…BTW JL, what is your opinion on testmyhormones.com and their cortisol tests? Worth the 165 dollars?[/quote]

Definitely not worth $165. I’ve never used LEF but I’m sure everyone here likes them; everyone knows I pimp out Private MD Labs. (www.privatemdlabs.com) Found a 24 hour urinary test for $79.99, which may be more accurate than saliva. You can probably get cheaper since they provide a coupon at check-out. The only stipulation is that it has to be a LabCorp. Quick turn around (usually 24-48 hours) and they e-mail you the results in a .pdf form.

That’s my preferred MO IF you can’t get your doctor to write you the blood work order, you don’t have insurance, or you want a quick turn around.


#13

[quote]gman72 wrote:
Thats what i understand bout androderm as well from various reviews and forums…BTW JL, what is your opinion on testmyhormones.com and their cortisol tests? Worth the 165 dollars?[/quote]

The saliva test I took was from Genova Diagnostics. You pay a $75 fee up front that will cover everything entirely if your insurance doesn’t pay. If your insurance pays (which mine does) they reimburse you appropriately, up to the full amount.


#14

thanks to all for the replies …I am going to check out both of these sites


#15

Urine test results vary by how much water you drink and how much you sweat.

Both fT3 and fT4 are below mid range and you are symptomatic.
Do you have waking body temps near or below 97F?
Do you use iodized salt? You do not want to treat an iodine deficiency with thyroid meds.

But TSH looks good. I would be tempted to do a trial of low dose T4 or a T4/T3 combo product to see how your body responds. Chemo may have altered many systems in your body and a perfect TSH=1.0 may be misleading.


#16

Ksman, that what I was thinking when I first spoke with my doc about those levels. I tried to get a scrip for low dose armour but he wasn’t going for it. I have been using organic sea salt for the last year and a half, maybe I should switch over to regular iodized salt, though my symtoms have been going on for years well before switching salt types.


#17

[quote]gman72 wrote:
Thanks for the response KSman. Had an initial thyroid panel drawn as well in january…I am usually cold probably renauds secondary to 3 years of chemo…very common after effect. But I thought I would check the thyroid function out as well since I typically had dryer skin, cold intolerance, and inability to lean out even when doing keto diets in the past and slightly thining hair with very fine texture all post chemo. I used to have really course thick hair before it regrew after my last bout of cancer at 18yo…

Here are those labs:

TSH- 1.08 (.5-4.5)
Free T4- 1.16 ( .8 - 2.2)
Free T3- 281 ( 230-420)

To ansewr your question about stress, I usually handle it well, I am nurse, work nights in an ICU, so stress is normal and dealing with it was never an issue. But during my marriage and the divorce, hormonally , things just fell apart…I had truely never had these types of symptoms before, not while dating my exwife , not on the honeymoon, ( it was a short marriage, only a year and a half) it was about 3-4 months into the marriage that I realized that I had probably made a big mistake in marrying her…Too much to go into but there were a hell of a lot of promises made before the marriage that all were forgotten 4 months into the marriage. On top of that I was working a lot of overtime getting about 5 hours of sleep a day.

So I picked up the androderm this morning. Should I begin to use it or speak to the doc about HCG thearapy in conjungtion with the TRT? I am realy concerned about killing my own T production and atrophying the remaining teste.
Also, do you have any ideas why I am requiring so much DHEA and do you think that getting up the DHEA level might help with boosting total T and Free T.

Thanks again[/quote]

Your thyroid levelsa are really low and you need the totals to see exactly what is really going on. You need to first get levels checked with out HCG so you know what the testoserone patches are doing. Did he put you on the patches? If he did you need run as fast as you can away from him because that is ancient. Go with compunded gel or testim over androgel. Apply the gel wait 2 hours then get tested optimal levels should be about 700-900 with e2 of 20-25 providing SHBG is not sky high. I see more issues with thyroid and gels may not absorbed properly and shots may be the way to go. You are on why too much dhea which is going straight to estrodial. I would switch to the trans dermal DHEA 50 mgs then test urinary out put 24 hour in one month. Once on TD you can not go by serum any more and have to go by urine.


#18

hardasnails,
I was concerned about the thyroid panel as well, but since they were low normal, he wasn’t going for any treatment options. I did have another appointment today with him, I broght all of the studies that were mentioned in another previous post as well as John Crisler’s protocol and Shippen’s protocol. He actually was open to look them over and was pretty attentive to what my concerns were. Also, I mentioned that since my last labs showed a total test of 600ng/ dl but the free and bioavailable were low secondary to elevated shbg, so he was going to look into a way to drive down the shbg and free up more bound T.

I am going tomorrow to have lh, fsh, prolactin, estradiol, and DHEA ran again. Hopefully he gets back to me this week with some ideas after reading all of the paperwork that I have given him. He did prescribe the patches and I did reccomend the testim or compounded cream that Crisler reccomends as well as the injection options that KSman has recommended with insulin needles etc… At this time I dont really feel bad, just a slight decrease in libido, but nothing like it was a year ago. I will definalty look into the dermal dhea choice. Thanks for the info and input.