T Nation

Lab Results, Looking for Advice


#1

Thanks for your suggestions about what to get tested (I posted a while back but can't find the thread). My results are below. Any advice would be greatly appreciated:

27 Male

Symptoms: chronic (terrible) insomnia, fatigue, brain fog, muscle loss, poor body fat distribution (skinny-fat), ejaculatory anhedonia (everything "works", but feel no pleasure), intermittent bleeding gums

Drug history: no steriods, took adderall (for the "brain fog" mentioned above) for 2 years (stopped 1 year ago). currently on nothing but melatonin (every once in a while), ambien maybe 1-2 times a month. Used marijuana 4-5 times (all more than a year ago). Alcohol socially (2-3 times a month)

Complete Blood Count
- All within range (around the middle) except for
Neutrophils 38 (low) (40-74)
Eosinophils 10 (high) (0-7)

Metabolic Panel
- All well within ranges

Lipid Profile (yikes!)
- Cholesterol, Total 250 (high) (100-199)
- Triglycerides 222 (high) (0-149)
- HDL 50 (>39)
- VLDL Cholesterol Cal 44 (high) (5-40)
- LDL Cholesterol Calc 156 (high) (0-99)

Thyroid Panel
- TSH 1.900 (0.45 - 4.500)
- T4 5.8 (4.5-12.0)
- T3 Uptake 39 (24-39)
- Free Thyroxine Index 2.3 (1.2-4.9)

Hormone Levels
- LH 6.0 (1.7-8.6)
- FSH 1.3 (low) (1.5-12.4)
- Prolactin 8.6 (4.0-15.2)
- Testosterone, Serum 416 (249-836)
- Testosterone, Free 10.48 (5.0-21.00)
- % Free Testosterone 2.52 (1.5-4.20)
- PSA 0.2 (0.0-4.0)
- IGF-1 99 (LOW) (117-329)
- Estradiol, sensitive 17 (3-70)


#2

How's your total bodyfat level? Your lipids say you're overweight but I would have suspected higher E2 if that was the case.

Your test should be higher but shouldn't be low enough for horrid side effects.

How is your fatigue? What all was tested in the metabolic panel?

TSH is OK but not optimal... other thyroid labs are useless, need Free T3 and Free T4 (instead of total/uptake).

Really suggest 8am cortisol draw.


#3

I'm 5'11'' 166 lbs, so not overweight. My body fat is around 17% the last time I checked (6 months ago). Most of this seems to be around my midsection (love handles). I'm decently athletic, played tennis in hs/college and basketball in hs. But my athleticism has dropped last 2-3 years due to the fatigue, etc.

Fatigue is terrible. Very hard to focus on getting tasks done. Its even hard to read, get tired every paragraph or so. Have to re-read things multiple times.

I'm really concerned about the low IGF-1, low FSH and low-normal Test. Being only 27, these should be a lot higher, no? 6 Months ago I had a sleep study for apnea (mild and corrected with a dental mouthpiece) and some bloodwork. I don't have those results, but my remember my doctor mentioning low IGF-1 levels. He believed it would be corrected by fixing the apnea, and getting better sleep. But doesn't seem to have done so.

Here's the full metabolic workup:
Glucose 72 (65-99)
BUN 10 (6-20)
Creatinine, serum 0.97 (0.76-1.27)
eGFR 107 (>59)
Bun/Creatinine 10 (8-19)
Potassium, serum 5.1 (3.5-5.2)
Chloride, Serum 99 (97-108)
Carbon Dioxide, total 27 (20-32)
Calcium, Serum 10.1 (8.7-10.2)
Protein, Total 7.3 (6.0-8.5)
Albumin 4.7 (3.5-5.5)
Globulin 2.6 (1.5-4.5)
A/G 1.8 (1.1-2.5)
Bilirubin 0.5 (0.0-1.2)
Alkaline Phosphatase, S 56 (25-150)
AST 22 (0-40)
ALT 15 (0-55)

My 8 AM cortisol was tested (salivary) one month ago at 16.83 (5.1-40)


#4

That is not good. 8am should be at the top of the range. I'm going to take a guess here that since you have very high cholesterol, and low T/cortisol, that your body is having a hard time breaking down cholesterol into pregnenolone (the precursor to the cortisol chain and the testosterone chain). I would suggest testing pregnenolone and if it's low, start supplementing that.

Additionally, it looks like you are hypothyroid (though it MAY just be your adrenals being too weak to support thyroid production, and not a thyroid problem in and of itself). I would get a full thyroid lab - TSH, Free T3, Free T4, Reverse T3.

Personally, what I would do is supplement pregnenolone for a few weeks, and see if I'm still fatigued, then get another round of labs (cortisol, thyroid labs and sex hormone labs, along with lipid panel).

I am not a doctor, but that is what I'm guessing because you have more then enough cholesterol to make T and cortisol. Read the "advice for new guys" and "lab work, blood tests and symptoms" threads and write down the chain of production of cholesterol, see if my suggestions make sense to you. Or google the production line or whatever... don't blindly take my word for it, you do need to decide for yourself.


#5

Cool, thanks again. I had an earlier lab (salivary), though it seems that there is debate over whether this type of test is meaningful. In that test (2 months ago), DHEA was high 381 (137-336). DHEA is made by the adrenals correct?

I had a couple doctors both clear the cortisol level as acceptable, maybe I should press them on that a bit. To give you some more info, the 8AM cortisol was part of a set of 4 (8AM, 12PM,6PM,12AM)

8AM: 16.83
12PM: 7.72
6PM: 9.43
12AM; 27.22 (!!)

My doctor said that this was likely caused by the fact that I didn't sleep well the night before the test, causing a temporary dysregulation. Since the 12AM value was so high, he said it looks like the adrenals were at least capable of working properly. I'm going to have them retested in a month.


#6

Useless without ranges...though i suspect 12am is still high

Would probably explain the low values all through the day, but doesn't really explain the sudden spike at night.

Have you recently worked night shifts or anything like that?


#7

Sorry about that..

8AM: 16.83 (5.1-40.2)
12PM: 7.72 (2.1-15.7)
6PM: 9.43 (1.8-12)
12AM; 27.22 (0.9-9.2)

I've never worked night shift. I have trouble sleeping 3-4 days of the week at least. I "go to bed" at 11PM-12PM each night. Again, doc said not to worry unless another test shows the same pattern. I will be taking this in another month.


#8

Those are weird reference ranges...but... wow I don't know how to explain that midnight value. I have heard of people with adrenal fatigue who feel tired, but get a "second wind" at 11:30pm-ish, as per a recent John Meadows article (love that dude). But that is extreme.

Your adrenals are capable of working. I would still test pregnenolone. You have a lot of CHOL that is going nowhere.


#9

Yeah I was shocked by that 12AM value. I will mention pregnenolone to my doc, but I took the opportunity to review the relevant wikipedia page. Pregnenolone turns into DHEA right. My DHEA was high. Is there any other pathway that produces DHEA?

If not, this is rather strange. Its as if there is a problem affecting the pathway on multiple points rather than a single step (Pregnenolone -> DHEA or Cholesterol -> Pregnenolone).


#10

DHEA saliva test is useless... you want DHEA-Sulfate (DHEA-S) serum test.

Pregnenolone turns to DHEA and also turns to progesterone (precursor to cortisol)


#11

I disagree about DHEA saliva. It appears to track pretty closely to DHEA-S.


#12

Might want to PM someone to change the lab work sticky then