T Nation

Interpreting Labs (All Labs Added 8/29/16)


#1

For basic info about myself I am 34 years old and went to my family doctor in early June for testicular pain which at that point had been going on for four months accompanied in the last month with delayed finishing with the wife (an hour to 1.5 hours) which was causing problems for us. Doctor ordered tests for STD's which of course came back negative so he scheduled an ultra sound for the pain and two anti-anxiety meds for the delay issue (never did take the Xanax because after reading about one of the side effects was delay in finishing).

Also asked if I could get my T level checked again because of the delay as some internet forum said its possible. Ultrasound came back with cysts on veins what ever that means but no cancer or infection so no worry. First result (posted below was) was 245 ng/dl . So my doctor ordered an expanded test and referred me to a urologist. The urologist said I do not have cancer or infection and testosterone should come up have a good day nothing he can do if I do not have cancer or an infection no followup needed. I asked him what the hell the pain was that had been going on for five months and he said take Advil. I could go on but whats the point?

Yes I check off a lot of the symptoms on the for signs for low test but my GP seems to think its related to my OCD and I need Zoloft (which I have refused so far). Last I checked untreated OCD does not prevent morning wood or random erections but what do I know. Oh and I eat relatively healthy and go to the gym 3 days a week if that makes a difference.

6/22/2016
Test Name Results Reference Range Lab
TESTOSTERONE, TOTAL, MALES (ADULT), IA 245 L 250-827 ng/dL MX2

06/30/2016
Test Name Results Reference Range Lab
TESTOSTERONE, FREE,BIO AND TOTAL, LC/MS/MS SLI
TESTOSTERONE, TOTAL, LC/MS/MS 386 250-1100 ng/dL
TESTOSTERONE, FREE 82.0 46.0-224.0 pg/mL
TESTOSTERONE,BIOAVAILABLE 168.7 110.0-575.0 ng/dL
SEX HORMONE BINDING GLOBULIN 17 10-50 nmol/L
ALBUMIN,SERUM 4.5 3.6-5.1 g/dL

edit will fill this out

-age 34
-height 5'10"
-waist 32
-weight 143
-describe body and facial hair legs hairy face not so much
-describe where you carry fat and how changed - gut - in the last two years I went from 115 to 160. Changed diet and dropped to 150 hitting gym 3x a week now at 141 to 143
-health conditions, symptoms [history] - semi-related OCD (anxiety disorder that causes stress). As far as energy I have little, I have until reading here attributed that to working full time and going to school full time while trying to maintain a healthly relashionship with my wife and kids. Libedo has dropped off to almost nothing and my wife says I have been depressed, moody and more axinous (GP says OCD related shrink says test related but neiter are experts in the area they each blame) over the last few months.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
-- real dangers! see this http://propeciahelp.com/overview22
-lab results with ranges posted above
-describe diet [some create substantial damage with starvation diets] Ensure for breakfast, no lunch, dinner is 1 serving of meat, starch and a veggie
-describe training [some ruin there hormones by over training] 1 mile walk, 30-45 mins arc trainer, 3reps each 80-100 leg press, Chest Press 40-50lbs, lat pulldown 70-80lbs, I recently stopped doing the tricep extensions and bicep curl due to time
-testes ache, ever, with a fever? nearly all of the damn time, no fever I have noticed
-how have morning wood and nocturnal erections changed no morning wood (once a week if I am lucky and its not how it used to be. No nocturnal or daytime erections, until 4 or 5 months ago it was no issue.


#2

You have both low T symptoms and low T test results. Being in the range is useless. Those ranges encompass 80 year olds. You need Estradiol checked and thyroid panel done. Check the stickies. They will tell you exactly which tests to run. You also need to find a new doc. Yours is a moron.


#3

Thank you for the quick reply. After reading it last night I decided to look for a different doctor. A guy at work has mentioned he is on trt so I asked him about and he recommended his doctor so I see her late next month. While not happy with that long of a wait, whats another 30 days? Again thank you for the quick reply and your thoughts and onion. I will read more on the stickies.


#4

See these stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman
* advice for new guys
* things that damage your hormones
* protocol for injections
* finding a TRT doc

Labs, post with ranges:
TT
FT
E2
prolactin
LH/FSH
CBC
hematocrit
fasting cholesterol
fasting glucose
TSH
fT3
fT4 [please not T3, T4]


#5

Get the tests done that KSman posted. If your GP won't order the labs, get them done yourself as a cash pay. We can't tell if you are primary or secondary hypo without the labs. You appear to be normal case of low T as your total numbers are very low and your free to is low as well. Need your LH/FSH and E levels. Read the stickies on standard protocol for starting TRT.

You were on propecia? Me too. Stopped due to risks. I think it was a cause of part of my problems. Anti depressants also cause ED as a side effect. I am on Lexapro with no issues but my father has issues so stopped. Xanax will also likely affect your delayed orgasm issues.

As far as your total stats you are underweight. I'm not saying puny or out of shape, so don't take offense. But at 5'10 and 34 you are probably in the bottom 5%. Your diet stinks. Missing lunch is bad. Keep your ensure but add some more calories for breakfast. Have a mid morning snack... hard boiled egg, yogurt, something. Eat lunch! Consider this fuel not necessarily fun or hunger. Have a mid afternoon preworkout snack. Eat a full dinner. I eat the same thing every day. I am only 5'7" but I am a very solid 185 and even before TRT I could squat 405, pull 405, and bench 275 at that weight (after 16 years of training mind you).

My diet:
1: 7am - Breakfast of protein shake, almond milk, fish oil, and powdered greens
2: 9-10am - Mixed nuts or hard boiled egg
3: Noon - Chicked and swiss sandwich, apple, carrots or other vege
4: 2-3pm - Yogurt or mixed nuts
5: 5pm - Dinner, whatever wife cooks
6: 9pm - Protein shake with almond butter added for more healthy saturated fats


#6

Thank you all. I am have been working on eating and have been adding in lunch and some reasonable snacks. Still though weight is now down to 136 when ibwe8ghed myself yesterday at the gym.

I did see the new pcp on Thursday and she just said we need to know if this is primary or secondary and ordered a ton of blood work which I got done Friday morning and will post results as soon as I have them. As for the xanax I quit taking that two months ago and the buspar (supposed to help with anxiety related to ocd and delayed orgaism did little on the first and nothing on the second) a month that ago. Now the shrink wants me ssri's still but she said she would wait to go that route until the hormones are in normal range so we can see how that may effect things. Will keep you guys posted. Thanks! Need the help.


#7

Cool, post the labs. SSRIs are not evil, I take Lexapro. You may want to get your hormones sorted out first. You may not need an SSRI if your hormones get corrected, assuming they are no bueno.


#8

I know SSRI's do very well for some people, they scare the hell out of me for personal reasons. Hopefully this is part of a larger treatment picture that will prevent the need for xanax and an SSRI/Tricyclant.


#9

Labs, post with ranges:
TT 245 ng/dl (06/22/2016) 386 ng/dl (06/30/2016)
FT 82 pg/ml (06/30/2016)
E2 20.5 pg/ml (08/26/2016)
prolactin does not seem I have this lab
LH/FSH (LH) 1.0 mIU/mL (standard range 1.3 - 7.2 MIU/mL) (FSH) 1.7mIU/mL (standard range mIU/mL)
CBC: Component Your Value Standard Range
WBC 7.9 bil/L 3.5 - 10.1 bil/L
RBC 4.65 tril/L 4.31 - 5.48 tril/L
Hemoglobin 15.0 g/dL 13.5 - 17.0 g/dL
Hematocrit 44.8 % 40.1 - 50.1 %
MCV 96 fL 80 - 100 fL
MCH 32 pg 28 - 33 pg
MCHC 34 g/dL 32 - 35 g/dL
RDW SD 45 fL 37 - 47 fL
RDW CV 13 % 12 - 15 %
Platelets 184 bil/L 150 - 400 bil/L
Neutrophils 4.5 bil/L 1.6 - 7.2 bil/L
Lymphocytes 2.5 bil/L 1.1 - 4.0 bil/L
Monocytes 0.5 bil/L 0.0 - 0.9 bil/L
Eosinophils 0.3 bil/L 0.0 - 0.4 bil/L
Basophils 0.1 bil/L 0.0 - 0.1 bil/L
Immature Granulocytes 0.01 bil/L 0.00 - 0.04 bil/L

hematocrit 44.8% (standard range 40.1 - 50.1%)
*fasting cholesterol do not see that one so I am adding the full lipid panel to the bottom
fasting glucose 88 mg/dL (standard range 60-99 mg/dL)
TSH 0.89 mcIU/mL (standard range 0.50 - 5.0 mcIU/mL)
fT3 (free FT3) 3.7 pg/mL (standard range 2.3 - 4.2 pg/mL)
fT4 [please not T3, T4] Do not see this one, I have "TSH with reflex to FT4" (which is posted above as TSH)

*Component Your Value Standard Range
Cholesterol 126 mg/dL 70 - 199 mg/dL
200-239 mg/dL Borderline high

240 mg/dL High
Triglycerides 90 mg/dL 30 - 149 mg/dL
150-199 mg/dL Borderline high
200-499 mg/dL High
=500 mg/dL Very high
HDL Cholesterol 37 mg/dL 40 - 90 mg/dL
<40 mg/dL Increased risk of CHD
LDL Cholesterol, Calculated 71 mg/dL 50 - 129 mg/dL
<70 mg/dL Optimal for a very high risk person
<100 mg/dL Optimal for a high risk person
100-129 mg/dL Near or above optimal
130-159 mg/dL Borderline high
160-190 mg/dL High
190 mg/dL Very high
Non-HDL Cholesterol, Calculated 89 mg/dL 70 - 159 mg/dL
Cholesterol/HDL Ratio 3.4 1.8 - 4.9
<5.0 Desirable
5.0-6.0 Borderline high
6.0 High


Well that is quite a few of the 22 labs ran for this issue by my doctor. If you need anything else let me know. Thanks again in advance for all of the help


#10

Prolactin just posted on my online chart! Sorry about that

3.7ng / mL range of 2.0 - 18.0 ng/mL


#11

I know every one is busy. Please when someone whom understands all of this is able please respond. I'm an atmospheric chemist, not a bio chemist so that may make me more of a danger when attempting to understand what it is I am seeing in the lab results. :slight_smile:

Thank you


#12

anyone have any thoughts here? I see the second urologist Tuesday the 6th.

@KSman , @blshaw and @Nashtide you guys seems to have a great handle on this stuff, are you guys around by chance?


#13

You are a good candidate for TRT. If at all possible you'll want to inject T cyp 100mg/week in two divided doses. Also be sure you have an AI like adex at 1mg/week in two divided doses. You'll also want to inject 250iu of hcg EOD. Your E2 is great at the moment, so some will suggest holding off on the AI until you get labs in 6 weeks. I'm more in the camp of starting the AI from the jump. The important thing is to choose a protocol then stick with and adjust after labs. Also try to test halfway between injections.


#14

thanks! I will see if the urologist agrees Tuesday, if not I will be using one of those expensive online doctors in Florida :confused:


#15

Yes as Nash said you are a good candidate from the labs. You appear to be secondary hypo based on your LH/FSH levels. The protocol Nash listed is proper for starting. You can consult remotely with Defy if you want to use a third party clinic. AIs react strongly for me so I wish I had waited to start them but you can start and AI right away too. Your call, either wait 6 weeks or start with 1mg adex split up twice a week.


#16

Urologist said "245 is bad but you have this one test at 350 so you are fine so this can not cause your symptoms" So ordering from the expensive online doctor today. Not sure what they said on the dosages for AI and HCG but it was 200/mg test. Which the test seems like a lot to me to start at, but what do I know. Thank you all for the help and I am sure I will have more questions to come. Only one I have for now is, if after 3 months I do not find the cost benefit to be there can I safely discontinue usage as I will have been using HCG and an AI during the course of treatment?


#17

Do not start at 200mg/week. Follow the protocol listed. You can always up your dose depending on how you respond. Working it in reverse is bad as you chase problems. Start at 100mg/week and take labs after 6 weeks. If you don't like the treatment, you can try an HPTA restart.


#18

Right on will do. I'm sure I will have some questions when I get the medications tomorrow. Thank you for quick reply!


#19

What was range for FT?

FT3 very strong.
What are your oral body temperatures as per the thyroid basics sticky?

Total cholesterol=126 is horribly low.
<160 is associated with increased all-cause mortality, also reduces hormone production as steroid hormones, Vit-D and corticosteroids are all based on cholesterol.

MCV is interestingly elevated
ever tested AST/ALT?

TRT:
You will need anastrozole as your are near E2 target with low T and E2 can only go up.


#20

Range was .5 to 5.2

Body temperature ranges from 97.8 to 98.4F

Did not know total cholesterol could be to low but after reading I see it is associated with anxiety and depression...interesting

Not sure what AST or ALT is but I will check lab corps site.

I have Anastrozole .5mg that I am told to take 1 the day after injection and another two days later. First T injection is tomorrow (hcg yesterday and today) and I am interested to see how that goes.