T Nation

Lab Results, Symptoms - Would Love Some Advice/Opinions


#1

Hey all. This is a bit of a longer thread, so I will say thank you in advance to anyone that takes the time to read the full thing and is willing to offer up any thoughts, opinions, advice, recommendations. It’s greatly appreciated.

I’ve been checking out the threads here for awhile, thinking something was wrong with my system and I’m going to do my best to lay it all out and explain it. I’m sorry if I repeat information as I go through this.

I’ve suspected that something was quite right for about 2 years now and I might be on to something. Here’s the finer points.

Age: 36 (just turned 5 days ago)
Height: 6’2"
Waist: 32" (was 34 2 months ago)
Weight: 195 (I was up to 210, started a cut recently)
Hair: Body hair is finer, thinner. None on my back really, never been a hairy guy. Facial hair is patchy, always has been. Grows relatively slowly, I don’t even try to grow a beard.
Fat: Any fat I carry would be around my waist, but I’m currently quite lean at 195. Since I was 17, I’ve been between 10-15% bodyfat roughly and kept it that way with relative ease.
Health: I’m typically healthy. I very rarely, if ever, get sick. When I do, it’s usually stomach based and only lasts about 12 hours. I haven’t had a head cold in probably 2+ years. Last issue I had was a sinus infection in 2014. I have dust allergies, but even those have become pretty dormant (started using breathe strips while sleeping, fixed that issue and I’m not taking any allergy meds at all anymore).
Drugs: I’m not taking anything OTC or prescription currently. I don’t take painkillers for anything, I don’t take anti-inflammatory drugs at all. Only supplements. I’ll list those later.
Diet: My diet is about as good as it gets. My friends and co-workers are astounded at how well I keep that up. Chicken, beef, turkey, fish, veggies(at every meal usually), fruits(1-2 pieces a day), nuts, healthy oils, protein shakes. I supplement with BCAAs, creatine, plazma, EliteMineral Pro. Not a lot of sugar. I cut out wheat and dairy of my own accord.
Training: I was guilty of overtraining, big time. I was worn down, not recovering, but kept pushing. I remedied this, after reading stuff in the forums here about adrenal fatigue and such. I took 2 months and dropped weights to next to nothing, worked on mobility and bodyweight stuff. Slowly brought training back up. Currently doing 4 days a week of lifting (style change to more bodybuilding based, stopped chasing heavy stuff for the most part), 2 days of lighter lifting or conditioning. I don’t really do total ‘off’ days, I will walk or do sleds to help promote recovery.
Testes: Occasional aches seem to come to mind, but very, very few and far between. None in recent memory at all, but over the course of the years, I recall a couple of times.
Morning wood/nocturnal erections: Occasionally, yes. But not very often. No ‘random’ springing up during the day either.
Blows to the head: When I was 17, I was in a car accident (passenger). Dodge RAM hit the right front tire area of my buddy’s car, hard. I was in the passenger seat, 4 feet from impact. My head swung right, hit the window. Had a baseball sized lump for a couple days, but I had ZERO symptoms of anything. No headache, no dizziness, it didn’t even really hurt that bad at all, but slightly sore neck.
I play ice hockey too, so there’s been some hard hitting in the past, some TMJ issues from that, all of which is cleared up. I took a shoulder pad to the chin (glancing blow, from left side, that spun my head to the right), thought nothing of it, but it knocked my jaw a little out, went right back in. Two days later I had concussion symptoms. Passed in about 2 more days, I was perfectly fine a week later with activity cut out for that time frame. Have had no issues since.
Stress/Anxiety: I have very little stress going on(some monetary, but I don’t bother worrying about it. I don’t suffer from any anxiety. Overall, I’m happy, I’m cheerful. I rarely get pissed off (other than at people who can’t drive). I’m calm, my BP and pulse are always stable and normal (latest 122/76, pulse 60).

I’ve also, always, never been able to get ‘hard’ (not related to my penis this time). I’ve got a good amount of muscle mass, but my chest I’ve never been able to bring up and fill out, and the skin is always ‘loose’ (not droopy though, just easy to pinch, the muscle there isn’t as defined, even when I flex it and I’ve always carried extra around my midsection, that’s been impossible to cut down or eliminate.

Supplements:

Curcumin
Flameout
Vitamin D
Univeral Nutrition’s Packs
-Animal PAK (basically a hefty multi-vitamin, I take it spaced through the day)
-Nitro (BCAAs)
-Cuts (currently trying to cut down to 10% again for a live stage show which requires me to be basically bodybuilder lean, playing Rocky in Rocky Horror Show)
-PM (essentially the same as Biotests Z-12, which is my usual go to, but I wanted to try something new)
Plazma

Symptoms/Thoughts:

Over the course of the last 2-3, maybe 4 years, I was fighting the following:

Brain fog
Low libido
Hair thinning/falling out, hairline receded on both sides at widows peak, though only slightly
Low body temps
Dry skin
Feeling cold easily(especially in my hands. Feet, occasionally. Weird part of this is, I tend to ‘run warm’, where my body temp is low to check it, but my outward feel is that of a furnace. Ex girlfriends liked me, to steal my warmth)
Sparse eyebrows
Erectile dysfunction (issues with acheiving, then maintaining when I did, and with them being ‘weak’, rather than rock hard)
Constant fatigue
Trouble sleeping (waking up 3-4 times a night to piss)
Trouble putting on muscle/gaining weight (if I stop lifting, or don’t eat as much for a few days, I can shed pounds like crazy)
Concentration issues
Lack of motivation with work (lifting though, there is no lack of motivation). I like my job, I have fun there. I just can’t keep my focus.

After reading through the wealth of information on this site (after getting bloodwork in 2014, which I will post those results, as well as current results), I knew something wasn’t right and adding up. It was just the beginning of this year though, that I really started paying attention to it (when I took the time off). I started to suspect low iodine levels based on the symptoms, so I did a round of IR with Iodoral.

The IR cleared up a good number of issues (coupled with the discovery by me that my sinuses were jacked up and not letting me sleep properly. I was waking up pissing 3-4 times, never dreaming and always tired. Previously mentioned breathe strips have helped that immensely, I now wake up either no times or 1 time a night and I’m dreaming. I wake up feeling rested and rarely have energy issues through the day, but I am using caffeine a bit). I don’t use iodized salt, so I was supplementing for that reason. The above noted Animal PAK multi has iodine/selenium in it, but only RDA for them. Brain fog, hair thinning/falling out/receding fixed itself, dry skin went away, eyebrows are better, fatigue better, sleep better, morning wood better, but still only like 2 days a week on average, but up from basically never.

Body temp issue remained, though I would have a few random days of checking it orally where it would start at 97 and get up to 98.6. Most days though, it’s between 95.8 and 96.6 to start. I also decided to check it the rectal way, as a comparison, and it was usually around 96.9 that way. This has been consistent over the last month of checking it, after IR for almost a month. I was worried about taking too much iodine and causing problems (I was getting selenium via EliteMineral Pro, so that was covered), so I backed off on the Iodoral. Interestingly, on nights I take 25mg of that before bed, I seem to wake up the next morning with wood, but not always.

My libido issue remains as well, on top of the ED stuff. And my hands are almost always cold, anything under about 68 degrees (unless I’ve been doing something to warrant more blood flow) and they’re chilly (they’re cold right now typing this up). I like girls, I find them attractive still, I still want them. But when faced with the opportunity to do stuff with them of a physical nature, I find the performance portion an issue, which is frustrating as hell.

Lab results:

Results 2/17/2014 - as stated, this was before I started really paying attention to this stuff, I got the blood work done as I was just starting to exhibit some ED issues and feeling ‘off’. The doctor at the time told me everything looked ‘fine’, plus my T levels were high, so the ED could simply be ‘in my head’. Yeah. Since I didn’t know what all I needed then, a few results are lacking.

TSH 2.35 uIU/mL 0.27 - 4.2 uIU/mL
FREE T4 REFLEXIVE NOT APPLICABLE 0.7 - 1.7

ALBUMIN 4.9 g/dL 3.8 - 5.0 g/dL
SHBG 65 nmol/L 12 - 91 nmol/L
TESTOSTERONE,TOTAL 990.3 ng/dL 249 - 836 ng/dL H
FREE TESTO, CALC 141.0 pg/mL 35.1 - 130.4 pg/mL H
BIOAVAIL TESTO, CALC 374.5 ng/dL 78.9 - 334.8 ng/dL H

LDL (CALCULATED) 80 mg/dL 0 - 129 mg/dL
HDL-CHOLESTEROL 61 mg/dL >39 mg/dL
TRIGLYCERIDES 37 mg/dL <200 mg/dL
CHOLESTEROL 148 mg/dL <200 mg/dL

25OH VITAMIN D TOTAL 42.4 ng/mL 30.0 - 100.0 ng/mL

BUN 17 mg/dL 6 - 20 mg/dL
CREATININE 1.0 mg/dL 0.6 - 1.2 mg/dL
GFR ESTIMATED >60.0 mL/min >60 mL/min
SODIUM 139 mmol/L 135 - 146 mmol/L
POTASSIUM 4.3 mmol/L 3.5 - 5.1 mmol/L
CHLORIDE 104 mmol/L 98 - 111 mmol/L
CO2 28 mmol/L 22 - 32 mmol/L
ANION GAP 7 mmol/L 7 - 15 mmol/L
GLUCOSE 93 mg/dL 70 - 120 mg/dL
CALCIUM 9.5 mg/dL 8.3 - 10.5 mg/dL

WBC 3.83 K/uL 4.00 - 10.80 K/uL L
RBC 4.97 M/uL 4.50 - 5.25 M/uL
HGB 15.1 g/dL 14.0 - 16.5 g/dL
HCT 43.0 % 40.0 - 47.0 %
MCV 86.5 fL 82.0 - 99.5 fL
MCH 30.4 pg 27.0 - 34.0 pg
MCHC 35.1 g/dL 32.0 - 36.0 g/dL
RDW 12.6 % 11.5 - 15.5 %
PLATELET COUNT 318 K/uL 140 - 400 K/uL
MPV 9.0 fL 6.6 - 11.1 fL

Results - 9/28/2016 - I had these done 3 days ago, 2 days after I turned 36.

TSH 4.75 uIU/mL 0.27 - 4.2 uIU/mL H
T3, FREE 3.3 pg/mL 2.5 - 4.3 pg/mL
T4, FREE 1.43 ng/dL 0.9 - 1.7 ng/dL

PROLACTIN 10.8 ng/mL 4.0 - 15.2 ng/mL

LH 2.62 mIU/mL 1.7 - 8.6 mIU/mL
FSH 4.1 mIU/mL 1.5 - 12.4 mIU/mL

ESTRADIOL 12.5 pg/mL 5.0 - 42.5 pg/mL

ALBUMIN 5.0 g/dL 3.8 - 5.0 g/dL
SHBG 58 nmol/L 12 - 91 nmol/L
TESTOSTERONE,TOTAL 681.1 ng/dL 249 - 836 ng/dL
FREE TESTO, CALC 96.5 pg/mL 35 - 130 pg/mL
BIOAVAIL TESTO, CALC 261.4 ng/dL 79 - 335 ng/dL

TRIGLYCERIDES 36 mg/dL <200 mg/dL
HDL-CHOLESTEROL 63 mg/dL >39 mg/dL
LDL (CALCULATED) 71 mg/dL 0 - 129 mg/dL
CHOLESTEROL 141 mg/dL <200 mg/dL
CHOL/HDL RATIO 2.2

BUN 24 mg/dL 6 - 20 mg/dL H
CREATININE 1.1 mg/dL 0.6 - 1.2 mg/dL
SODIUM 142 mmol/L 135 - 146 mmol/L
POTASSIUM 4.3 mmol/L 3.5 - 5.1 mmol/L
CHLORIDE 101 mmol/L 98 - 107 mmol/L
CO2 29 mmol/L 22 - 32 mmol/L
ANION GAP 12 mmol/L 7 - 15 mmol/L
GLUCOSE 91 mg/dL 70 - 120 mg/dL
ALBUMIN 5.1 g/dL 3.8 - 5.0 g/dL H
AST 35 U/L 10 - 50 U/L
ALKALINE PHOSPHATASE 50 U/L 0 - 153 U/L
BILIRUBIN 0.6 mg/dL 0 - 1.2 mg/dL
CALCIUM 9.7 mg/dL 8.4 - 10.2 mg/dL
PROTEIN 7.6 g/dL 6.0 - 8.3 g/dL
ALT 47 U/L 10 - 50 U/L
E GLOM FILT RATE >60.0 >60

WBC 3.54 K/uL 4.00 - 10.80 K/uL L
RBC 4.59 M/uL 4.50 - 5.25 M/uL
HGB 14.2 g/dL 14.0 - 16.8 g/dL
HCT 41.0 % 40.0 - 48.4 %
MCV 89.3 fL 82.0 - 99.5 fL
MCH 30.9 pg 27.0 - 34.0 pg
MCHC 34.6 g/dL 32.0 - 36.0 g/dL
RDW 12.5 % 11.5 - 15.5 %
PLATELET COUNT 261 K/uL 140 - 400 K/uL
MPV 9.0 fL 6.6 - 11.1 fL

So, as I’m a bit of an amatuer with this stuff, I’m hoping that you all can help me shed some light on this.

TSH has doubled basically. My T levels have gone down quite a bit (seems normal). My estradiol level is, based on everything I’ve read on here, about 10 pg/mL low to where ‘ideal’ seems to fall.

WBC count is low, was in 2014. Unsure what that’s all about, honestly. BUN and Albumin slightly elevated, but I’ve read that those numbers can jack up a bit when you eat a high protein diet (which I do, so I’m not worried there much). Cholesterol levels are basically the same 2 years later, though it seems they may actually be a bit low overall, should probably try to bring that up some?

As for the LH/FSH and prolactin numbers, I’ll admit my knowledge there is lacking a bit, so this is where I’m hoping to get some thoughts from everyone else. My TSH is worrisome to me, as it has gone up a good bit. And my E2 being low is as well. The doctor I went to was very good for ordering tests as requested by me, but their lab requests didn’t have an rT3 to even order, so that one is lacking, sadly. If I get blood work done again, I’m going to use an online (found one called Chekd that will come to you and do the draw, seems pretty slick, but I need to investigate it more) testing facility next time to recheck my levels.

Thoughts from me:

Pituitary issue causing the thyroid issue?
Thyroid issue - seems hypo to me, though I could be off?
E2 being low is likely making me feel like I am, coupled with the high TSH.

I’m going to open this up to you all and see what you think. KSMan, I’m rather hoping you’re willing to toss some insight my way as well. I’m hoping to figure out which direction to push on this, so I don’t spin my wheels and waste any time in getting things sorted out.

Please let me know if there are any questions, or anything I’ve left out of this description, as it’s a lot of information and I’m sure (even though I’ve read the stickies multiple times) that I’ve missed something somewhere along the line with this.

Edit: Got this number back too, it was a little behind the others.
DIHYDROTESTOSTERONE 30 ng/dL 16 - 79 ng/dL


#2

Your T numbers are pretty good. A lot of docs won’t even consider TRT with those levels. Your E2’is too low. That will make you feel crappy and is not great for long term health. Your cholesterol is also too low.


#3

Thanks for the reply, Nashtide.

I thought the same thing. My T numbers prior and this time, even with the slight drop, are still pretty good. I don’t think I necessarily need TRT for anything.

The E2 number is a definite concern for me, as is the cholesterol number. I also realized I forgot to get Vitamin D and cortisol on the test.

However, I just got off the phone with the doctors office, with the following transpiring(It was not the doctor though, it was the desk girl relaying a message for him):

Your TSH is a little elevated, but just barely out of range, so that’s ok. Your white blood cell count is a little low too, so the doctor would like to re-run the blood work to check that again, it’s possible you were fighting some infection or something, he just wants to see if it’s gone up.

So, I’m going to go get the blood draw again. I’ll reference last weeks numbers back in against this weeks numbers, once I have them (probably by Friday) and see if anything changes for any of them.

I know I’m not sick, I know I’m not fighting any infections (though I know when I get cuts and stuff, it does seem to take a bit longer to heal than I feel should be necessary, but it’s always been like that as long as I can remember).

There’s definitely some stuff amiss, and it seems like this PCP doctor will not be the one to lead me to a resolution, unless I can convince him after blood work round 2, that there is indeed an issue with my numbers that needs to be addressed.

Thanks again for looking at this stuff.


#4

You are on 25mg iodine? That would explain TSH and until you are stable on a reasonable maintenance dose, TSH labs are quite meaningless.

fT3 should be maintaining good body temps. If your body temps are low, rT3 is suspected. See the thyroid basics sticky for explanations and causes.

E2 is too low and can cause a lot of problems.
Cholesterol is too low, ideal is 180, <160 associated with increased all-cause mortality.

TT and FT are good for lowish LH/FSH. There is room for improvement, but no leverage with prolactin or E2.

I would like to see some adrenal data:
AM cortisol - at 8AM please
DHEA-S - not DHEA

HTC=41 seems low VS T levels. Albumin and total proteins vote against any GI blood loss.

AST/ALT may be elevated by training.

Have you seem all of the stickies linked here: About the T Replacement Category


#5

Thanks, KSMan, for taking the time to look over my info, I greatly appreciate it.

I’ll go maintenance on iodine this week, I’ll do half a tablet of Iodoral every week or two for that, then.

I’ve read through the stickies multiple times, but I have to admit that my full understanding of it all is a bit lacking.

As for cortisol and DHEA-S, those were oversights by me. My doctor wants me to redraw this week, so I’ve just contacted them to add those tests to the re-testing we’ll do on Wednesday, so I ought to have those results to post by Monday at the latest, I’ll update then.

What all can I do around the cholesterol and the E2 to try to bring those numbers up? I’m open to suggestion and happy to pursue things, I just want to get working on resolving whatever the issues are.


#6

Cholesterol needs more unhealthy fats.
Triglycerides are also low, suggesting too much cardio?

Vit-D25=60-80 would be a good target.

I am on a fishing expedition for adrenals doing something odd.

Low body fat can make one AB normal.

Girls freaked out by cold hands?


#7

I would say, in the past, you’re on point for the cardio thing. I used to do a lot of conditioning. And I play baseball and hockey. I’ve backed off a lot on that, since I had worn myself into the ground back around March of this year. I’m rarely doing any conditioning at this point. I do have a pretty low body fat at present though, probably hovering around 10-12%.

Perhaps I’ll dial back the amount of work I’m doing still (it’s already been dialed back a bit) and see if that helps me out any, and I’ll add in some extra fats through the week.

I’ll update when I get the second round of blood work and we’ll see how the fishing trip looks.

As for the cold hands, not one single female has complained. I just get sick of my hands constantly being cold after awhile.


#8

Do read up on rT3 and see if anything concerning adrenal fatigue sticks.


#9

New blood work results are coming in from Friday draw. I’ll post them all as soon as they are all available to me.

KSMan, starting to wonder about the adrenal fatigue aspect myself. I’ll have a few more thoughts I’ll add in once I post the blood work numbers, regarding the AF.


#10

Here’s what I’ve gotten of the new results so far. Reverse T3 and DHEA-S, plus cortisol came through already and CBC numbers, updated. I don’t have time to review the sticky notes, unfortunately, to try to rehash through my brain how the rT3 numbers line up and such, so any help is greatly appreciated.

Edit: I’ll post the rest in here as an edit update as soon as I get them. Thanks, all!

Edit 2: That’s all that they’re testing/retesting. The doctor’s assistant called me and let me know that everything is ‘normal’, that my cortisol is slightly elevated, but it’s nothing to really worry about, but all the other blood work looks ok as well. Recommended I continue my vitamin D supplementing.

So, needless to say, I’m done with that doctor, but I thank him for his time in getting me my lab results. Now, I need to find a good TRT or endocrine doctor in the State College, PA area. Anyone on the site from around there, have any ideas or recommendations?

And I need to try to get to the bottom of it all, while I’m searching for a doctor. I definitely still think something is amiss, regardless of what the doctor has to say.

rT3 SERUM 14 ng/dL 8 - 25 ng/dL

DHEAS-SULFATE 173 mcg/dL 106 - 464 mcg/dL

CORTISOL 23.1 ug/dL 2.3 - 19.4 ug/dL H
AM REFERENCE RANGE 6.2-19.4 ug/dL

25OH VITAMIN D TOTAL >60 ng/mL >19 ng/mL

WBC 3.14 K/uL 4.00 - 10.80 K/uL L
RBC 4.48 M/uL 4.50 - 5.25 M/uL L
HGB 13.8 g/dL 14.0 - 16.8 g/dL L
HCT 40.0 % 40.0 - 48.4 %
MCV 89.3 fL 82.0 - 99.5 fL
MCH 30.8 pg 27.0 - 34.0 pg
MCHC 34.5 g/dL 32.0 - 36.0 g/dL
RDW 12.6 % 11.5 - 15.5 %
PLATELET COUNT 276 K/uL 140 - 400 K/uL
MPV 9.2 fL 6.6 - 11.1 fL
NEUTS 44.5 % 40 - 75 %
LYMPHS 37.9 % 18 - 42 %
MONOS 13.4 % 1 - 11 % H
EOS 3.2 % 0 - 6 %
BASOS 1.0 % 0 - 2 %
ABS. NEUTS 1.40 K/uL 1.8 - 7.7 K/uL L
ABS. LYMPHS 1.19 K/uL 1.0 - 4.8 K/uL
ABS. MONOS 0.42 K/uL 0.0 - 1.1 K/uL
ABS. EOS 0.10 K/uL 0.0 - 0.7 K/uL
ABS. BASOS 0.03 K/uL 0.0 - 0.2 K/uL


#11

What time of day and hours after waking up?

Take 25mg DHEA with your Vit-D3 avoid taking with high fiber foods. Ditto any fish oil.

DHEA supplements some times drive DHEA–>E2 inside the adrenals [not common] which you could use.

RBC is low
HTC is low
Persistent. As T levels are solid, I think that GI blood loss needs consideration and an occult blood test would be good to rule this in/out.

rT3 is good
fT3 is good, body temperatures are low
TSH is elevated, perhaps by low body temperatures and your body is not responding to fT3
Please try 50mg Ubiquinol form of CoQ10, not ubiquinone, and see if temperature and energy levels improve. If so, your antimitochondria were not responding to fT3 because there was not enough C0Q10 to support mitochondrial metabolism. This is a trial.

Many of your issues could be expected results of low body fat.

Any change in your needing to pee frequently at night?
Are you drinking excessive amounts of water? Thirst driven?


#12

Hey KSMan,

Thanks for getting back to me on my updated numbers, much appreciated.

For the cortisol, that blood was drawn at 8:45am, I woke up at 7:30 that day.

I’ll look into the DHEA supplements, do you have any specific DHEA supps you recommend? If you do, I’ll pick one up as soon as I hear back from you. in the meantime, I’ll do some research on them today and see if any of them seem better than others.

I was also wondering about the GI blood loss, after doing some reading on that recently. My stomach/digestion had been a bit of a mess until just recently, I started paying it more attention and things have become much more regular in that area, I think that my gut health was causing a decent amount of my issues overall. Probiotics (kefir) and psyllium husk have made a huge difference in my digestive health in the last 3-6 weeks now.

I can’t say that I’ve ever really supplemented CoQ10, so in that case I’m happy to give that a try and see if anything improves with it.

As for the peeing frequently, that is down to once a night, occasionally no times. The use of breathe right strips has helped keep my nasal passages open, so I don’t snore anymore, which then allows me to sleep much deeper and actually dream and such, so I’m getting better sleep overall (and more, I’m focusing on 7-8+ hours a night).
I do drink a decent amount of water, not always thirst driven when I do. I can’t give an exact amount, but last time I actually monitored it, I was around 2 liters a day, but not always.

Thanks again for the time/replies, it’s greatly appreciated.