T Nation

Lab work, Testosterone, B-12, D

First of all, I haven’t been on this website in a long time so I apologize for not posting this in the correct place.

I just had a huge amount of lab work done. I don’t have the test in hand, I will tomorrow so I can post all of my blood work if necessary.

All I know right now is what I was told on the phone.

My B-12 level should a value of 206 (211-946)
My Vitamin D level showed a value of 20.4 (32-100)

Those were the only two blood works that were not in the normal range.

Another test that caught my eye was my testosterone level. It is 339 on a scale of 300-800. I am a 21 year old male, 5 foot 9 and 245 pounds. I was wondering if this is a concern since it is on the lower end of the normal range? From what I have heard, 339 is within the normal range, however someone my age should have a significantly higher t-level than 339, since the test wasn’t based on age differential. I heard it doesn’t get to this level until the older years. I’m not sure if this is true, however.

Again, I have a bunch of other tests that were run and its about 7 pages long (I was suspected to have a brain tumor, which is why all these tests were done).

Thanks for all of the help. I appreciate it.

Are your hands and feet cold often? How is digestion?

I can’t say that I really noticed cold hands and feet.

I often have stomach aches and acid reflux but this has been attributed to a severe anxiety disorder which I have been hospitalized over several times. I also have treatment refractory depression (which is why I’m interested in the testosterone level since it has been said that lower levels have an impact on depression).

I also have intractable headaches that won’t go away with traditional headache prescription medication (Imitrex, Maxalt, Topamax, Inderal, or Migranal). My neurologist is the one who ordered all of these tests because of the brain issues.

I have also constantly complained about severe fatigue and extreme back and neck pain (I can’t walk for more than ten minutes because of this). This was also attributed to me somatizing the pain due to the depression. I also got knee tendinitis for no real reason and had to go to physical therapy for a number of months for it.

I gained 80 pounds over the course of 4-6 months because I was on heavy-duty psychiatric medications as well (2 anti-depressant combinations at the max possible dosages, Max Zyprexa which is infamous for the weight issues, etc)

Not sure if this is relevant or not but at the beginning of the year I contracted pneumonia and was unable to fight it off. I was on progressively stronger antibiotics for a total of 3.5 months until my x-ray was finally clear. The emergency room doctors didn’t know why it wasn’t going away.


It would be interesting to see the rest of your lab results. Did you check for prolactin? If so, im surprised they were “in range” mostly due to the heavy antidepressant medication. Which antidepressants were you on? Most cause an extreme raise in prolactin, which causes a huge drop in dopamin that leads to more depression yea its a huge clusterfuck.

Is it a pituitary gland tumor? Those can screw up hormones real bad, even though yours are “in range” doesnt necessarily mean they are in a healthy level


don’t take your doctors word on your tests. get your results in your hands and post them here. or upload them to www.2shared.com - just give us the link and the password.

I would suspect that along with critically low B12 and Vitamin D (and your low testosterone) that you also have problems with cortisol and your thyroid (along with extremely high Reverse T3 - which I will guess was never tested or discussed) along with others things like ferritin - and major digestion/absorption problems.

You probably will need more tests, but let’s see what you have to start with.

as a side note, knee pain can signal an Aldosterone problem (salt/electrolyte balance).
check out these sites for info on adrenals and how to test for a salt imbalance.


Can I assume that you are on antiacids or something similar? if so, you may want to check out this thread about acid issues - people found that LOW stomach acid can cause the same problems as too much stomach acid - and they were able to cure a lot of their problems by simply boosting their stomach acid with Betaine HCL.

[quote]Nidhogg wrote:
Did you check for prolactin? [/quote]
Not sure, I’ll check when I get my results in hand tomorrow.

I was on these anti-depressants over the course of 2 years. I started at low dosage for each and eventually bumped them up to the max dosage over the course of a few months. These are the order in which I was on them. I was weened off of my last medication (wellbutrin/effexor) just about 2 months ago.

Zoloft (to max dosage)
Prozac (to max dosage)
Cymbalta (to mid level dosage)
Wellbutrin (to max dosage)
Celexa (to max dosage)
Combination Wellbutrin and Celexa (both to max dosage)
Combination Wellbutrin and Effexor (both to max dosage)

I had a brain and neck mri done as well, he said he found nothing.

Don’t worry. The only reason I don’t have them in hand now is because I’m not at my permanent address. I’ll have them in hand tomorrow though and will be sure to post them.

On a side note, I collapsed this morning. I was suffering from a cold and I took cold medicine earlier that night. I woke up at 5 am this morning (my girlfriend got me up) and I was walking to the bed and the next thing I know I’m face down on the ground. I have a huge amount of rug burn on the left side of my face. So basically I collapsed and was completely out to the point where I didn’t even try to prevent the fall. I don’t remember any of it. My girlfriend said I was mumbling something on the ground too. Not sure if this is useful at all.


Ok, I have the results in hand. Here it is…

Testosterone Serum- 339 (280-800)
Testosterone Free- 10 (9.3-26.5)

Methylmalonic Acid Serum- 112 (73-376)

Globulin- 2.1 (1.5-4.5)
A/G Ratio- 2.0 (1.1-2.5)
Bilirubin- 0.4 (0.0-1.2)
Alkaline Phosphatase, S- 65 (25-150)
AST (SGOT)- 18 (0-40)
ALT (SGPT)- 30 (0-55)

BUN/Creatinine Ratio- 17 (8-27)
Sodium, Serum- 141 (135-145)
Potassium- 3.9 (3.5-4.2)
Chloride- 105 (97-108)
Carbon Dioxide, total- 21 (20-32)
Calcium, Serum- 8.9 (8.7-10.2)
Protein, Total, Serum- 6.3 (6.0-8.5)
Albumin, Serum- 4.2 (3.5-5.5)

Baso (Absolute)- 0 (0.0-0.2)
Immature Granulocytes- 0 (0-1)

Glucose- 81 (65-99)
BUN- 19 (5-26)
Creatinine, Serum- 1.10 (0.76-1.27)
eGFR- >59 (>59)
Neutrophils- 51 (40-74)
Lymphs- 36 (14-46)
Monocytes- 10 (4-13)
Eos- 3 (0-7)
Basos- 0 (0-3)
Neutrophils Absolute- 3.2 (1.8-7.8)
Lymphs Absolute- 2.3 (0.7-4.5)
Monocytes Absolute- 0.7 (0.1-1.0)
Eos Absolute- 0.2 (0.0-0.4)

WBC- 6.4 (4.0-10.5)
RBC- 4.84 (4.10-5.60)
Hemoglobin (14.8 (12.5-17.0)
Hematocrit- 43.9 (36.0-50.0)
MCV- 91 (80-98)
MCH- 30.6 (27.0-34.0)
MCHC- 33.7 (32.0-36.0)
RDW- 12.4 (11.7-15.0)
Platelets- 248 (140-415)

Vitamin B12- 206 (211-956)
T pallidium- Not Reactive
C-Reactive Protein Quant- 0.8 (0.0-4.9)
Lyme IgG/IgM Ab- <0.91 (0.00-0.90)
Homocyst(e)ine, Plasma- 11.4 (0.0-15.0)
TSH- 2.380 (0.450-4.500)
Antinuclear Antibodies- Negative (Negative)
Vitamin D, 25-Hydroxy- 20.6 (32.0-100.0)
Sedmentation Rate-Westergren- 1 (0-15)

Hope this helps, thanks.

Have you started vit-D3 yet? Suggest 5000iu everyday, Walmart has those as tiny oil caps.

Get a high potency vit-B complex with trace elements and other vits. If your vit-D25 does not respond, you have an absorption problem. That can occur with age, typical, as well as from use of antacids and proton pump inhibitors. If that is the case, get B-12 sublingual lozenges.

The high dose SSRI’s can be expected to reduce E2 clearance, thus increasing E2 and lowering TT, increasing SHBG, lowering FT % fraction of the lowered TT. You need to review the effects of all of your drugs on hormones via loading the liver’s enzyme pathways. Cimetidine is perhaps the worst drug for this and it is an OTC stomach acid product.

You did not explain how all of this started and what might have initiated the problem.

Your TSH is worrying. You need to test fT4, fT3, rT3. Check your waking body temp when you first wake, before feet on the floor. Record the numbers for a few days. Ideal is 97.8F. A patter near 97F is indicative of subclinical hypothyroidism.

Homocysteine is worrying, should be lower. The higher end of the range is from people who have heart/aterial disease who are included in the sample population. This is an expected result with low B-vits, low vit-D and low T. So why were cholesterol levels not checked?

“Lyme IgG/IgM Ab- <0.91 (0.00-0.90)” does not make any sense, they cannot report a results in their own range?

Thanks for your reply KSman. I have indeed started 5,000 Vit-D a day. I have also started 2,500 Sublingual Vit-B12 a day. I am also scheduled to get Vit-B12 shots as well.

[quote]KSman wrote:
You did not explain how all of this started and what might have initiated the problem.

I have treatment resistant headaches, severe back pain (cannot walk for more than 10 minutes), and neck pain. These tests were ordered by my neurologist (with a brain/neck mri), to findout what could be a secondary cause for my treatment resistant headaches/migraines.

I don’t think the neurologist required them to be tested for what he was looking for. I got them from my cardiologist a few months ago. It was above the normal range, but it wasn’t high enough for him to be concerned. I wish I had the exact result so I can report it here.

That was weird as well. I forgot to mention that, along with B12 and D, was the only other test that was bolded on the 7 pages. I’m not sure why it was bolded.

Get some answers re the Lyme disease lab issue. Do your own research. The course of antibiotics is cheap and might just be done anyways instead of more diagnostics which are costly and might be inconclusive.

Do you have muscles that are in spasm with the pain, or is this more a case of nerve pain? Can you stretch your back or does it feel tight? If tight, then you could try some muscle relaxants. These can be sedating and you may have to use only in the evenings.

Fish oil and lecithin will support maintenance/healing of the protective covering of the nerves.

[quote]KSman wrote:
Get some answers re the Lyme disease lab issue. Do your own research. The course of antibiotics is cheap and might just be done anyways instead of more diagnostics which are costly and might be inconclusive.

Do you have muscles that are in spasm with the pain, or is this more a case of nerve pain? Can you stretch your back or does it feel tight? If tight, then you could try some muscle relaxants. These can be sedating and you may have to use only in the evenings.

Fish oil and lecithin will support maintenance/healing of the protective covering of the nerves.

Thanks for the reply. We determined that it is most likely a nerve issue. I don’t have tightness or spasms. I have been on muscle relaxants before for quite a while, as I was having the pain. It didn’t really help. Only made me really tired.

Try Fish oil and lecithin, these are natural products that may be helpful.

You still need to understand the implications of the Lyme lab report. Do not be passive about that, you need manage your own health care.

Ok, I have an update question.

So after my neurologist tested my t-levels, my cardiologist wanted to do his own test on me. I’m waiting for the results of the test to be mailed to me (I’m not at my house currently). He did give me a call and said that they are a little lower than the previous test by the neurologist.

Neither my neurologist or cardiologist was comfortable treating my testosterone and my cardiologist said that he would rather I see either an endocrinologist or a urologist.

My question is which specialty would be the best type of doctor to show my results to and get treatment?

The best doctor for this is one who is not a idiot or a drug-rep puppy. It is all rather easy. Specialists are so busy with other stuff that they do not want to take the time to learn what to do or the TRT work really does not fit into what his practice is. Have you read the finding a TRT doc sticky?

Urologists really have no special skills or inclinations for this either. A GP with his head screwed on right can do a better job.

Ok, a little update.

My second testosterone test came back with a result of 260 (280-800).

So after showing this to my new urologist he put me on Testim and I received a 3 month prescription with 3 refills.

I have a few questions if you don’t mind…

  1. Why does it say to put the Testim on your upper arm and shoulders and NOT your abdomen? Wouldn’t it be better to put it in a place that is more permeable. I heard some people put it on their scrotum, is this ok to do with Testim specifically, since other types of gels say you can put it in other places (androgel)? Is there something bad that happens if you put it on your scrotum or abdomen?

  2. I heard that people don’t even get any noticeable benefit from one tube a day and they use two tubes instead. Is this ok to do or are they going overboard? Will I notice anything bad if I were to do this?

  3. After I finish applying my gel, I notice there is still residue on my hands and the directions say to wash this off. Isn’t this a waste of testosterone and doesn’t this mean that I am not getting the full dose? Or is this nothing to worry about?

Your elevated TSH may block your response to transdermal T.

T gels have alcohol and will probably sting on your scrotum?

The areas of application reflect where applied during drug trials, the claims and results are in the context of where applied. Apply to inner arms, not just upper arms.

How much are you applying?

You can test TT, FT and E2 in 2-3 weeks.

If you apply more than prescribed, what you will notice is that you will run out and have none.

T gel on hands could transfer to others, that is the hand washing concern. Otherwise you can absorb that.

Read the stickies to better understand what you are doing.

This is an update of my current situation. I still have low testosterone despite being on 4 mg Androderm patch daily. My last lab work showed my free testosterone in the 255 region, despite being in my early-mid 20s. My vitamin D and vitamin B-12 levels have increased dramatically though.

However, I have noticed some new things that are quite embarrassing for me.

  1. This is perhaps the most important. I have been trying to find research that shows that lower testosterone can have an affect on penis size, but I’m not quite sure if it does or not. However, I personally have noticed that this has indeed happened. The most significant revelation came about 2-3 months ago. It seems like everything is screwed up in regards to my sex-drive, libido, and even physical appearance “down there”. It got so bad that my girlfriend of nearly 4 years left because of this reason which basically destroyed my psyche (which as I explained previously I already suffered from severe depression and anxiety).

Despite this, I have not been on any antidepressants for well over 8 months in hope of it improving the situation. In fact, despite androderm patch treatment, both my neurologist and my general practitioner have found that my T levels have decreased and not increased.

My neurologist wants me to see an endocrinologist as soon as possible and I agree with this, but I would like some guidance as to what I should be asking for or looking for test wise. I have been reading the stickies and other material and if at all possible, it would honestly be a great help to me if someone could just “lay down” a list of things I should either do/ask the doctor directly to examine through blood work/other means, or what to read. I’m really confused and this is starting to affect my life greatly. I have read the lab work sticky but it I just don’t understand what to do with it. Do I just simply tell the doctor I want these tests done and that’s it?

I would also like to point out an additional bit of information I left out. I have been on opioid pain killers for quite some time due a massive surgery I had to have in my abdomen area. I had been off/on for over a year previously for back issues and just recently had to be put back on oxycodone for this surgery that had me laying around 3 months. My neurologist made a point that these medications are known to lower testosterone and that while my test results were taken before I was given the surgery (and put on the meds), the meds are certainly not helping the testosterone situation. He said that it could act as a buffer against the patches to some degree.

So in summation, I apologize for such a long post, but I hope someone here would be able to help me because I would like to be able to get back on my feet and get into this research position/graduate program that is lined up for me in the late summer.

  1. Would low t for a person my age account for sudden penile shrinkage (embarrassing).
  2. What resources should I use when speaking with an endocrinologist who can basically review all my hormones and other things associated with this. My neurologist from John’s Hopkins basically said this is my best bet for answers, But I would like to be prepared as to what tests to ask for and questions I should answer myself or be prepared to answer on such a visit.

I would like to thank any one who can help me in advance. I greatly appreciate it.

Have a great day.

Hey, I know this was last touched on 2 years ago, but I have some potentially valuable advice. My story is LOW T and Infertility that reared it’s head at 30 y/o. I’ve been through way too many doctors. I also had a bad reaction to TRT (anxiety/high blood pressure) so had to stop.

My goal was/is to find the reason why all this is happening, not bandaid it. In the process of trying to bandaid temporarily (supplement T), I had a bad reaction, and that increased my drive to get to the bottom of my problems.

I am now doing genetic testing from 23andme.com and testing via Genova which is called NutraEval. Also, look at Spectracell.com for micronutrient testing. Genova NutrEval tests heavy metals, amino acids, fatty acids and more. Genetic and nutritional testing is the future of medicine. What I see in your instance is potentially similar to mine:

You have low B Vitamins in your first test, and you have high homocysteine. 11 is still high. From what I hear, ideal is around 7 for homocysteine. What that tells me could be that you have methylation pathway issues as I do (and many people do), and you need to get 23andme.com done (gene snps) and get with an integrative doctor to help address your methylation pathway, if your genetic results deem that an issue.

My methylation pathways are all messed up due to my genetic faults. Most people are much different, and have less severity. Methylation has to do with assimilating b vitamins and passing those on to be used in the rest of the methylation cycle (biochemical reactions) which produces energy, antioxidants, and more for cell health and function. Even if your b vitamin levels are up, you may not have the ability to absorb them, hence they are free floating in the blood. People with methylation issues need to be supplementing with bio-available forms of b vitamins, like 5-mthf or methylfolate (Folate) and methylcobalamin (B12). But, you need to do the genetic test and work with an integrative doctor in order to manage this healing process. You can’t just jump right in and supplement, trust me.

This is my best guess for many with Low T, all dependent on bloodwork and other markers, of course. For me, I am in the middle of it right now. I’ve always been a very healthy guy, and there is no reason for what is happening, except for our toxic world, and many of us don’t have the genetics to battle it as best we can. Best of luck, and I hope you find some sort of path to recovery.

The penis is elastic and needs nocturnal erections to sustain size, otherwise is it mostly connective tissue that can contract. TRT should be delivering high range TT and FT.

When you post lab results, we need lab ranges. Are we doing pg’s or pmol’s?

On TRT, results have nothing to do with your age. There is a well known pattern that thyroid problems can limit transdermal T absorption. So you might have thyroid issues.

You really needed to create your own thread/topic here for your case and not drop into someone else’s case.

Please see below and make your own thread.

I have no idea why this old thread floated up in my window today. ???

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.