T Nation

Lab Results - Now What?


#1

Hi- I'm 28- 5'10" and weigh 165lbs.
I appear thin but shirtless reveals another story.

I had tests done by an endo and my total T was 276 and my Estradiol was 47.
He sent me paperwork to get prolactin and another T test- free and total and bio it said on the lab.
The nurse said since everything is in range it's unlikely the doctor will treat me but he wanted these other tests done first.

I went to an endo about gynecomastia. I have other symptoms that may or may not be caused by low T.
Anxiety, mid section fat, gyne, low energy, decreasing libido (still good erection tho), and small muscle mass.

I'm new to this whole topic, and overwhelmed by it all. Not sure what to think, who to see, what to do. Etc.

Also I'd like to add I circled estadiol on my labs myself on the second test. Dr didn't think it was abnormal, but I found it unsettling to be 47 in a range of 13-54.

Any tips, suggestions, feedback very much appreciated.

Thnx.


#2

You should read some of the threads here. Others may comment on additional testing and diagnostics.

I was pretty close to where you are. Slightly less T and a bit less E2. You can check out my thread to see what work relatively well for me so far. Summary:

Make sure your diet is decent.

Make sure you are getting good sleep.

Get E2 down.

I suppliment good fats, vit D, Magnesium/Zinc, and superfood. Magnesium Oil worked really well getting my DHEA-s up. My T has been better since supplimenting with it. Not sure there's any direct effect other than generally getting Mag and Zinc.

Once you get E2 down and have the basics covered, get tested again and try some T boosters if you think you still need them.


#3

Thanks. A lot of that is gibberish to me, but I'm sure with time I'll learn since this is likely something I'll need to address the rest of my life.
My diet isn't great, but I don't eat horribly either. I'm at a decent BMI so I'm not "overweight" but like I said my torso is fatty where the rest of my body has little fat.
I really don't want to lose too much more weight (have lost about 20-25 pounds over the past year or so from cutting alcohol, sodas, and sweets back and drinking a lot more water.

I suppose it's early to decide what to do- not until I get my second set of results back should I decide...

Also- it's kind of hard to find information about TRT or anything T related without it being tied in with building muscle, etc.
While I'd love to have more muscle, I'd really like to have my energy back, and not have a reoccurrence of gyne if I opt in for surgical removal...

What are some other good resources to information on hormones etc?


#4

Those numbers aren't good. I'd call you a definite candidate.

All the info you really need is on this board. Read all of the stickies, they're great. I've bought two books on TRT and didn't find them to be superior to what I could have gotten here, as far as practical knowledge. You don't need a deep understanding of endocrinology in order to do this, but you do need to know enough to be your own advocate and recognize when your doc doesn't know what he's doing. That said, as you can see from the boards, a lot of us are totally fascinated by this stuff and strive to learn all we can. TRT is a novel and evolving protocol, most docs are either not on board or are open-minded but not yet informed.


#5

Make sure you test TSH and cortisol (8am blood draw) at the bare minimum before you go on TRT. TRT won't work if the thyroid or adrenals aren't functioning well enough to support increased T. Low energy is a symptom of low thyroid and/or poor adrenal function.

E2 is definitely way high, and at 5'10" 165 I can safely it's not because of obesity.

edited.


#6

When did you get gyno? It's very common in pubescent boys but for 90% it goes away (along these lines).

God blessed me w/a decent rack - I'd describe my mammaries as moderate (at least). I'd seriously consider surgery if I were more financially healthy.

The way I see it, your estrogen (or E2 as it is called according to my fellow T-Nation) is way too high. I didn't have my E2 tested until well after I started TRT as my endo never ordered it, but when I stopped my TRT for a few weeks, pursuant to a new docs request, tested hormones, everything was shutdown, including my E2.

I would definitely be addressing the E2. You may want to see a few docs before going w/one, as it's a major decision. There's going to be docs out there that are more open-minded than others. The T is unacceptable also, pragmatically speaking IMO.


#7

You may get your doctor to test your thyroid and adrenals. Can cause stubborn fat and mental issues.

TSH, FREE T3, FREE T4, CORTISOL

Did your doctor test you for LH and FSH yet to see if you have secondary or a primary problem? My guess is secondary but still.


#8

UPDATE

I got my second set of tests back and they are as follows:

Test // Level // Range
Testosterone, Total, LC/MS/MS // 361 // 250-1100ng/dL
Testosteron Free // 59.4 // 46-224 pg/mL
Testosterone Bioavailable // 124.7 // 110-575 ng/dL
Sex Hormone Binding Globulin // 24 // 10-50 nmol/L
Albumin, Serum // 6.4 // 2-18 ng/mL
Estradiol // 22 // 13-54 pg/mL

Some good news the Estradiol is in a better level than before (47) but the T levels in my opinion are pretty damn low...
Could this be causing fatigue, slight depression, anxiety etc? Also the body fat low muscle tone and pathetic ability to grow a decent full beard?

To who asked about gyne- I first felt self conscious about it at a young age. Maybe 12 or 13. As I grew and thinned out the self consciousness went away to a degree but I was always a bit self conscious, not only about that but my thin body and out of proportion mid section. (not huge but not in proportion) In my 20's when I gained some weight (was around 130 my teen years, then jumped up to 190 over the course of a couple years when my wife got pregnant and after turning 21 etc etc. Now I'm back down to 165.

So about these levels- some I don't know what they mean, others I can assume. But the T levels don't look too good- am I alone on that or does everyone agree? This totally blows. The nurse said since I'm in "normal range" she doesn't think the doctor will likely think I need treatment. But it's been on his desk apparently a couple days and hasn't gotten to it. Either too busy or debating on if I'll benefit.

Additionally- I'm concerned since I have gyne that T treatment will cause more growth, which still boggled my mind as to why it would... is it because "E follows T"?

Thanks for any and all feedback!


#9

^^^ if you have T treatment, you can manage E2 levels with Aromatose Inhibitors (AIs) such as arimidex.

Before you begin though, you need to make sure your adrenals and thyroid are strong enough to support the demands that increased T will put on your body. If they are weak, fixing them might take care of T without direct TRT.

You need 8am cortisol and TSH, I would also recommend Free T3, Free T4, DHEA-S, and cholesterol.

Simply put, we need more info to know which link in your body's biofeedback chain is broken.


#10

My first test had more than just T and E tested. It had other things I don't know what they are- but I can get the report and post them up to see if this helps shed light on anything else.

Shouldn't my doctor know all of these things? (Endocrinologist)


#11

They know, they just don't care...doctors are in the business of keeping people alive (in the short term), not optimizing their health


#12

Posting lab values with reference ranges would be a big help. As VT said, endo's (and all docs) are not as invested in fixing your problems as you are.


#13

Thanks. Regardless of what the doctor says I won't start any treatment without much research and at least 1 other doctors second opinion.

I'll get the first lab and post all of the data so you guys can tell me what you think. To me, since I'm new to it all, it's a bunch of jibberish. :frowning:

Also- I've read some people see a urologist about their hormones. Is there a better doc to see? Endo or Uro? If Uro that'd be great- my wife's best friend is in med school to be a urologist. However it may be awkward to discuss with her at first. lol

Thanks guys- wish me luck in my journey to recovery and I'll post back whenever I have updates!


#14

It's much more dependent on the personality of the doctor than what his specialty is. A lot of people here have good success with open-minded, enthusiastic GPs who aren't specialists at all.

Read the lab work and advice for newbie stickies like 10x each...that's what I did... makes a little more sense each time you go through them. Additionally it helps to read through a bunch of people's posts and responses to get an idea of what we typically look at first.


#15

Here are the first results from the first test. I don't know what most of this is, but maybe someone will see something that stands out or could tell me if things look good for treatment, or if I even need treatment. Still waiting for follow up from doc. =\

TEST // LEVEL // RANGE

UREA NITROGEN // 10 // 7-25 mg/dL
CREATININE // .79 // .80-1.30 mg/dL
eGFR NON-AFR AMERICAN // 122 // > OR = 60mL/min/1.73m2
eGFR AFRICAN AMERICAN // 142 // > OR = 60mL/min/1.73m2
BUN/CREATININE RATIO // 13 // 6-22 (calc)
SODIUM // 143 // 135-146 mmol/L
CHLORIDE // 106 // 98-110 mmol/L
CARBON DIOXIDE // 25 // 21-33 mmol/L
CALCIUM // 9.9 // 8.6-10.2 mg/dL
PROTEIN, TOTAL // 7.8 // 6.2-8.3 g/dL
ALBUMIN // 5.0 // 3.6-5.1 g/dL
GLOBULIN // 2.8 // 2.1-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO // 1.8 // 1.0-2.1 (calc)
BILIRUBIN, TOTAL // 0.5 // 0.2-1.2 mg/dL
ALKALINE PHOSPHATESE // 74 // 40-115 U/L
AST // 20 // 9-60 U/L
ALT // 17 // 9-60 U/L
TSH, 3RD GENERATION // 2.17 // 0.40-4.50 mIU/L
T4, FREE 1.1 // 0.8-1.8 ng/dL
TESTOSTERONE, TOTAL, MALES // 276 // 241-827 ng/dL
ESTRADIOL // 47 // 13-54 pg/mL


#16

TSH is high, possible subclinical hypothyroidism, but it's crucial we get a cortisol lab. E2 is way too high but we already knew that. I think optimal for E2 is in the 20s?

Need Free T3 and a cortisol (8am blood draw). Generally it's useless to start thyroid meds or TRT without knowing the state of adrenal health.


#17

I will no longer be answering any bloodwork posts that do not have an accompanying list of symptoms


#18

It's in the original post.......


#19

Low, you may or may not benefit from thyroid help...however a doctor will be very reluctant to prescribe it to you with your numbers since your TSH is good and your T4 is midrange. I would really like to see a t3 test, because you may have a bad conversion from t4 to t3 and it may be due to excess cortisol. My t4 was normal like yours yet my t3 (total) was almost too low and I had slightly high cortisol...I have no idea if that caused anything, but I do know high cortisol does interfere with conversion (however it usually has to be pretty high).

Did you get an FSH and LH test? I am sure you have a secondary problem but it is still worth getting. Also prolactin (gynecomastia).

With regards to your testosterone we really need an fsh and lh and prolactin test just to rule out things. I know it is annoying to keep getting labs.


#20

The lab results are out of order. I posted my second lab results first, and then a couple days later posted the first ones.
Prolactin was in range, on the low end, which is good.

I don't know anything about these tests yet- so if I posted it that lab has been done.

Maybe good news is that my doctor hasn't sent in the plans on what to do next, which could mean he's looking into it further and analyzing everything I've told him and everything the labs tell him.

I'll update this as I get updated from doc- but before I do any type of treatment if applicable I'll be getting a 2nd and 3rd opinion and I'll see what you guys have to say too.

Thnx.