Lab Results and Intro- Please Advise

Pharma / TRT Testosterone Replacement
1

I have been experiencing symptoms of low testosterone for years now, and finally complained to my doctor of my symptoms during a physical. These are textbook low T symptoms of low energy/fatigue, low libido, erection difficulties, etc. The results from a few Dr. visits are below. Any input would be greatly appreciated on anything that doesn’t look right…

I am 31 yrs old, 240lbs, about 17-18% bf. Been training for roughly 10yrs, focusing mostly on strongman/powerlifting style routines. Definitely feel difficulties gaining/maintaining muscle mass. I’ve done one cycle of a PH in the early years of training, and have never used any other anabolics/steroids.

FROM ROUTINE PHYSICAL APPT ON 7/8/10:
CHOLESTEROL 152 (<200)
HDL 35 (>35)
LDL 96 (<100)
TSH 1.27 (0.358-5.04)
TESTOSTERONE 380 (280-800)
CORTISOL 21 (4-22)
*no units were given on results sheet, and my Dr. gave me the ‘testosterone is in range, and is normal’ reply. I asked about the high-normal cortisol and he claimed that high is good?

After this appt, I made an appt with a urologist mentioned on this board:

FROM UROLOGIST APPT ON 10/1/10:

TESTOSTERONE 365 ng/dL (241-827)
SEX HORMONE BINDING GLOBULIN 14 nmol/L (8-48)
PROLACTIN 5.5 ng/mL (2.1-17.7)
*He only tested these few things and was helpful with some information, but also didn’t think my testosterone levels were low enough to be causing any of the symptoms that I was experiencing.

I ordered a ‘male ultimate anti aging panel’ from private md labs to get more results to work with:
FROM 11/2/10 8:30AM:

CBC WITH DIFFERENTIAL/PLATELET

WBC 5.5 x10E3/uL (4.0-10.5)
RBC 5.48 x10E6/uL (4.10-5.60)
HEMOGLOBIN 16.5 g/dL (12.5-17.0)
HEMATOCRIT 48.5 % (36.0-50.0)
MCV 89 fL (80-98)
MCH 30.1 pg (27.0-34.0)
MCHC 34.0 g/dL (32.0-36.0)
RDW 13.5 % (11.7-15)
PLATELETS 205 x10E3/uL (140-415)
NEUTROPHILS 52 % (40-74)
LYMPHS 37 % (14-46)
MONOCYTES 9 % (4-13)
EOS 2 % (0-7)
BASOS 0 % (0-3)
NEUTROPHILS (ABSOLUTE) 2.8 x10E3/uL (1.8-7.8)
LYMPHS (ABSOLUTE) 2.0 x10E3/uL (0.7-4.5)
MONOCYTES (ABSOLUTE) 0.5 x10E3/uL (0.1-1.0)
EOS (ABSOLUTE) 0.1 x10E3/uL (0.0-0.4)
BASO (ABSOLUTE) 0.0 x10E3/uL (0.0-0.2)
IMMATURE GRANULOCYTES 0 % (0-1)
IMMATURE GRANS (ABS) 0.0 x10E3/uL (0.0-0.1)

COMP. METABOLIC PANEL

GLUCOSE, SERUM 97 mg/dl (65-99)
BUN 22 mg/dl (5-26)
CREATININE , SERUM 1.23 mg/dl (0.76-1.27)
eGFR >59 mL/min/1.73 (>59)
BUN/CREATININE RATIO 18 (8-27)
SODIUM, SERUM 141 mmol/L (135-145)
POTASSIUM, SERUM 4.0 mmol/L (3.5-5.2)
CHLORIDE, SERUM 102 mmol/L (97-108)
CARBON DIOXIDE, TOTAL 25 mmol/L (20-32)
CALCIUM, SERUM 9.2 mg/dL (8.7-10.2)
PROTEIN, TOTAL, SERUM 6.9 g/dL (6.0-8.5)
ALBUMIN, SERUM 4.5 g/dL (3.5-5.5)
GLOBULIN, TOTAL 2.4 g/dL (1.5-4.5)
A/G RATIO 1.9 (1.1-2.5)
BILIRUBIN, TOTAL 0.8 mg/dL (0.0-1.2)
ALKALINE PHOSPHATASE, S 67 IU/L (25-150)
AST (SGOT) 35 IU/L (0-40)
ALT (SGPT) 43 IU/L (0-55)

URINALYSIS, ROUTINE

  • I left out these results thinking they weren’t necessary, and to save some typing. If they would be helpful, I can add them.

LIPID PANEL

CHOLESTEROL, TOTAL 160 mg/dL (100-199)
TRIGLYCERIDES 84 mg/dL (0-149)
HDL CHOLESTEROL 45 mg/dL (>39)
VLDL CHOLESTEROL CAL 17 mg/dL (5-40)
LDL CHOLESTEROL CALC 98 mg/dL (0-99)

IRON AND TIBC

IRON BIND. CAP. (TIBC) 350 ug/dL (250-450)
UIBC 243 ug/dL (150-375)
IRON, SERUM 107 ug/dL (40-155)
IRON SATURATION 31 % (15-55)

TESTOSTERONE, FREE/TOT EQUILIB

TESTOSTERONE, SERUM 353 ng/dL (280-800)
TESTOSTERONE, FREE 13.48 ng/dL (5.00-21.00)
% FREE TESTOSTERONE 3.82 % (1.50-4.20)

HEMOGLOBIN ALC 5.4 % (4.8-5.6)
DHEA- SULFATE 362.8 ug/dL (160.0-449.0)
LH 2.8 mIU/mL (1.7-8.6)
ESTRADIOL 21.7 pg/mL (7.6-42.6)
C-REACTIVE PROTEIN, CARDIAC 0.81 mg/L (0.00-3.00)
VITAMIN D, 25-HYDROXY 59.4 ng/mL (32.0-100.0)
T4, FREE (DIRECT) 1.22 ng/dL (0.82-1.77)
PROSTATE SPECIFIC AG, SERUM 0.4 ng/mL (0.0-4.0)
IGF-1 246 ng/mL (115-307)
TSH 2.300 uIU/mL (0.450-4.500)
FSH, SERUM 5.8 mIU/mL (1.5-12.4)
GGT 21 IU/L (0-65)
INSULIN 9.5 uIU/mL (0.0-24.9)
MAGNESIUM, SERUM 2.3 mg/dL (1.6-2.6)
FERRITIN, SERUM 164 ng/mL (30-400)
SEX HORM BINDING GLOB, SERUM 15.6 nmol/L (14.5-48.4)

Feel free to ask for any other information, and thanks again…

2

You are not normal for 31YO

Your LH/FSH are consistent with your TT, FT, E2, SHBG levels.

TSH-2.1 is getting to be a problem. Low thyroid levels are sometimes a contributor to low T. Do you have iodine in your vitamins? Use iodized salt?

If you are a hairy beast and otherwise highly virilized, then these levels would create major problems. The same levels for someone who had always been a lower T type would not suffer so much at these levels.

Your FSH is not bad and is a better measure of your gonadotrophin output as LH is highly variable.

DHEA is really good. Do you supplement.

Some drugs will cause hormone problems, but more often increasing E2 which is not evident here.

How do you maintain 18% BF? Any extreme of diet?

What is your waist size and height?

What is your resting pulse and BP.

A SERM trail dose as a challenge would indicate what your HPTA is capable of.

What supplements?

Good docs will treat primarily based on symptoms, realizing that T needs vary. Such docs are hard to find. There are clinics that will prey on your situation and rip you off.

3

Thanks for the reply. There is 150 mcg of iodine in the multi vitamin that i currently take, and i do use iodized salt. Should i get further testing done for possible thyroid issues? I do not supplement at all for DHEA. I’m not on any real extreme of a diet, although i do eat very clean just out of personal preference- hardly any sugars/sweets, don’t eat out a lot, no fast food, etc. I cook most of what I eat which is basic chicken, steak, turkey, rice, and other boring things.

I am 6’2", and waist is approximately 38". I definitely store most of my BF around my mid section. This rang a bell in a recent T-Nation article saying that low T/high cortisol will cause this. My resting pulse sitting at my desk right now is 72. Blood pressure has always been normal- not sure of the exact current numbers. Supplements include protein shakes/bars, creatine, jack3d pre workout sometimes, and recently been adding fish oil caps. If i missed any answers or you have more questions, please just ask. Thanks again for the time.

4

You can take your waking body temp before feet on the floor. 97.8 would be ideal, 97 definitely a flag for thyroid issues. I do not see anything really obvious. Most are vit-D deficient who are not taking large amounts. You could add 4000-6000iu per day. This will not fix your T.

NYC or where. Perhaps some here could recommend a doc.

Your E2 is ideal for someone with high T levels. Given your current levels, E2 is becoming dominant. Your %BF sounds good, but for a trim guy. 18% of 240 pounds [43 pounds] may be the problem and will certainly be a large factor in your E2:T balance. If you start reading about the health implications of MBI, you will see that the implicit risks are now recognized to be relative to waist size. If you can make progress there, there may be multiple benefits. Given your age, where does 38" go from there as you get older? The big problem is often that fat lowers T and lower T and higher E2:T ratios make one fatter and make weight difficult or worse. I think that you need to lower your calorie load and/or increase your metabolic rate. With your lower T levels, you are becoming catabolic and will be loosing muscle mass. So you have less muscle that should be burning calories 24x7. You could try something like Alpha Male that might help you make some changes and feel better too.

5

Thank you once again for taking the time to reply. I’ll look into everything you suggested. I was set on thinking something must be complicated and wrong, but the answer or at least some help might come from very simple changes.

6

Being in NYC the biggest thing I run into clients from that area is toxicity from excessive exhaust fumes which can potentially act as iodine blockers (goitergenic). Your T levels are alittle bit low, but it really depends on how you feel. If you feel good then I would not screw with it other words there needs to be further evaluation of thyroid. My main concern is the potential from excessive cortisol produced from dealing with the toxic environment.

I feel that xenoestrogens are very over looked by medical community and now research is starting to be shown just how little it takes to cause hormonal imbalances. I am finding people in over polluted city are the ones that are suffering from these issues. I have several young guys from cali area that once you get them detoxed their hormones and symptoms tend to get better over time.

7

Hardasnails- I am actually not in NYC, but in the suburbs so I’m not sure if toxicity would still be a factor. I do appreciate your thoughts though.

Waking body temp yesterday was 97.1, and 97.0 today. TSH, T4, and ferritin didn’t seem horrible, but I suppose there could be a thyroid issue. I’ve been reading over at stopthethyroidmadness and it does seem like a good possibility. I’ll continue to monitor the waking temps. Any thoughts?

8

You just have to look at the whole scenerio and start from proper testing, when it occured, what happened around that time 3-6 months prior before not feeling well, your nutritional habits, lifestyle, sleep patterns, ect ect. Bring in NY your vitamin D levels are probably not in optimal range which can really affect your whole endocrine system and thyroid. We live in a toxic world peroid. The food we eat,water we drink , air we breath , thought we have are all toxic to our health one way or another

9

Speaking of possible low cortisol as a factor… how much stress in your life, any changes in how stress affects you, how do you react to major stress, feel physically harmed by major stress, or just another challenge? Accidents, infections, surgeries, rapid weight loss or starvation, crisis can have long term effects on your adrenals. Stimulants and weight loss agents are a real problem. Stressful situations that you once easily managed can become toxic.

I would not want to see your total cholesterol go any lower.

Any blows to the head or whiplash prior to the onset of these problems? When T is low with younger guys, it makes sense to look for pituitary damage or an adinoma as a cause. If you have lost some peripheral vision, that can indicate the latter.

Try more iodine so see how your waking body temp responds.
Test TSH, fT3, fT4, rT3 - do not be dehydrated for lab work
If rT3 is a problem, do a 4 sample saliva cortisol test and read about “adrenal fatigue” Wilson’s book.
While these may not solve your T issues, still need to addressed.

I still feel that your body fat is a factor with your low T.