T Nation

Labwork- Not Getting Answers from Doc

34 yr old male, 6’1, 205lbs, 25% BF.
Shoulder surgery 2 years, took a long time to recover, pulled hamstring not healing after 1 year. Felt like my body just wasn’t healing properly. Also showed other signs of low T so went to Dr. Had initial basic lab work done by GP, then referred to endo. More tests as below.

First Endo prescribed 200 mg IM/EOW Test cyp, nothing else.
Saw urologist for 2nd opinion (suggested Clomid 25 mg/day), not sure if thats the way to go or not, so am scheduled with other endo that is more known in the TRT/HRT community.

I am looking to just be healthy and fit again, able to train and recover, and of course lose a few lbs. I would like to get back into triathlons if possible. I have 2 kids, so fertility is not a primary concern, but teste health and looks are. In an ideal world i would lose a few lbs fat and gain some muscle, but more important is healing and general well being at this stage.

ACTH, PLASMA: 21.3 pg/mL (7.2-63.3)
CORTISOL AM: 13.1 ug/dL (6.2-19.4)
FSH :1.7 mIU/mL (1.5-12.4)
LH: 1.8 mIU/mL (1.7-8.6)
TSH : 1.55 uIU/mL (.45-4.5)
Growth Hormone Serum: .1ng/mL (0-2.9)
IGF-1: 164 ng/mL (132-333) 31-40yrs
Prolactin: 2.8 ng/mL (4.0-15.2)
Test Free: 7.9 pg/mL (8.7-25.1)
Test Serum: 263 (348-11**)
Estradiol was 16.5 (7.6-42.6)
Urinalysis-
Protein: negative (neg)
Glucose: negative (neg)
Ketones: negative (neg)
CBC-
WBC: 6.8 (4-10.5)
RBC: 4.93 (4.14-5.8)
Hemoglobin:14.5 (12.6-17.7)
Hematocrit:43.1 (37.5-51)
Platelets:282 (140-415)
Lymphs:37 (14-46)
Lipid Panel-
Cholesterol:161 (100-199)
Tri:62 (0-149)
HDL:41 (>39)
VLDL:12 (5-40)
LDL: 108 (0-99)
Metabolic Panel-
Glucose:95 (65-99)
Bun:18 (6-20)
Creatinine:.97 (.76-1.27)
Sodium:143 (134-144)
K:4.3 (3.5-5.2)
Chloride:104 (97-108)
CO2:25 (20-32)
Calcium:9.6 (8.7-10.2)
Protein:7.4 (6.0-8.5)
Albumin:5.1 (3.5-5.5)
Globulin:2.3 (1.5-4.5)
A/G:2.2 (1.1-2.5)
Bilirubin:.2 (0.0-1.2)
Alkaline Phos:69 (25-150)

So low test and low prolactic. FSH and LH at the bottom of “normal”. TSH and Estradiol fine.
Is this primary or secondary hypogonadism?
Do you think its safe to start Test cyp or should i have more work done?

Thanks

You have secondary hypogonadism.
Lowish cortisol.
Low growth hormone (which is also important in recovery)

Post all your other labs.
Read the thyroid sticky.

Your prolactin indicates you don’t have an adenoma. Same with GH and ACTH. In rare cases there can be some that don’t secrete anything at all.

For some reason you HPTA is repressed.

TRT is up to you, but in your case a restart can be attempted.

Assuming things like cholesterol, thyroid, adrenals are in order you can attempt to jump start your HPTA.

At your age and already having kids you could try TRT, but it has to be done right.

add in other blood work. hows the liver? hows glucose>? get thyroid labs!! read the stickies :slight_smile:

Your labs would indicate an issue in the pituitary gland. Primary hypogonadism would be signified by elevated LH and FSH, and as tunapancake said, you have secondary, so the testes are receiving the signal and are working properly. This is good, as primary is generally an uncorrectable issue.

Clomid would stimulate LH production from the pituitary and therefore increase testosterone, so this might not be such a bad route. I’ve never been on clomid treatment for TRT, but it has been proven to work in those with secondary. This would be utilizing your bodies’ own production as opposed to replacement therapy.

Agree with tunapancake on almost all accounts. Your HPTA is suppressed and you really need to find out why. TRT is long road and not a fix-all. You have other issues going on that need to be addressed first.

If you have access to an endo (which is terrible for TRT, but should have a grasp on the HPTA), ask why your prolactin is subnormal (which isn’t necessarily a bad thing), your IGF-1 is so low, and why he thinks you are secondary.

like iw84aces said, get a thyroid panel done. Post it here. Also look into a 4-point cortisol test.

TSH is OK? You cannot go by the ranges in this case. Read the thyroid basics sticky, post your history of use of iodized salt or vitamins that list iodine, and post waking and mid afternoon oral body temperatures.

What is your waist size, that is really the critical indicator.

GH lab is useless, IGF-1 is the indicator of GH status.

Cholesterol is getting lowish, try for 180. Are you avoiding fats? Are you getting EFA’s from salmon, fish oil caps, flax seed meal/oil or nuts?

Need DHEA status via DHEA-S lab.

Most endo’s are useless at this stuff, there is a sticky for fining a TRT doc.

Read the advice for new guys sticky, you are missing other issues like Rx and OTC drugs, supplements etc other complaints etc. Note other concerns that might fit.

Are you getting a lot of sun exposure or taking vit-D3? Suggest 5000iu in small oil based caps, Walmart has these. Start by taking 25,000iu/day for one week then at 5000iu thereafter.

Please note all of the items above.

This should have been done at 8AM: CORTISOL AM: 13.1 ug/dL (6.2-19.4)

There is a broad but useless term for your condition, pituitary insufficiency. Also can be called pan hypopituitarism. One has to be concerned that a adinoma is at work. Not all of these are hormone secreting.

Start TRT: Get iodine and body temp info first. Try clomid, but ask if you can get Nolvadex instead. If LH, FSH and T increase, that is important to know, top end of HPTA is then working and hCG monotherapy may be a good option if your testes are good. If a SERM does not increase LH/FSH; another sign that your hypothalamus-pituitary are not working.

After reading the stickies and other sites like drrinds.com, there seems to be an element of adrenal fatigue along with the thyroid issues.

How should I approach this along with an HPTA restart such as Clomid or Nolvadex?
Simultaneously or a month of adrenal repair (with iodine, maybe some vit B), then move on to the SERM?

Are SERM drugs lifelong like Test cyp, or is it to restart then come off the meds but continue to monitor blood work?

I posted additional info, but its not up yet for some reason.

Follow my suggestions. The best outcome would be a restart and the SERM is a stepping stone, not a destination.

What is the difference between Clomid and Nolvadex? how often should BW be taken?

When starting TRT, labs are often done at 6 weeks, but can be done earlier. Once one has dosing and labs dialed in, labs can be done every 6 month.

Clomid and Nolvadex are both SERMs

as per the the stickies…

Clomid has nasty estrogenic side effects for some, not rare. Nolvadex does not have that aspect. Both get the same job done. Clomid was the first born and was investigated extensively. When Nolvadex came along, it was soon apparent that it had similar actions and there was no need to repeat all of the studies. So the net effect is that the medical community can’t seem to make the leap because they can’t find all of the un-needed studies of the effects on males.

BW?

Adrenal fatigue: I direct guys to Wilson’s book on Adrenal Fatigue - amazon.com

[quote]KSman wrote:
TSH is OK? You cannot go by the ranges in this case. Read the thyroid basics sticky, post your history of use of iodized salt or vitamins that list iodine, and post waking and mid afternoon oral body temperatures.

What is your waist size, that is really the critical indicator.
34-35in
GH lab is useless, IGF-1 is the indicator of GH status.

Cholesterol is getting lowish, try for 180. Are you avoiding fats? Are you getting EFA’s from salmon, fish oil caps, flax seed meal/oil or nuts?
Not avoiding at all. Eat “paleo” due to gluten headaches, eats lots of fatty meat, fish, veggies. Have seen that a low total can be adrenal/thyroid fatigue related.
Need DHEA status via DHEA-S lab.

Most endo’s are useless at this stuff, there is a sticky for fining a TRT doc.

Read the advice for new guys sticky, you are missing other issues like Rx and OTC drugs, supplements etc other complaints etc. Note other concerns that might fit.
Take 3g fish oil, 2-4g glutamine, 5,000 iu Vitam D3, 200mg? magnesium, potassium
Are you getting a lot of sun exposure or taking vit-D3? Suggest 5000iu in small oil based caps, Walmart has these. Start by taking 25,000iu/day for one week then at 5000iu thereafter.
avoid sun as much as possible, really fare/susceptible to skin cancer
Please note all of the items above.

This should have been done at 8AM: CORTISOL AM: 13.1 ug/dL (6.2-19.4)
tests were @ 7:52 fasted
There is a broad but useless term for your condition, pituitary insufficiency. Also can be called pan hypopituitarism. One has to be concerned that a adinoma is at work. Not all of these are hormone secreting.
How do I test? What can be done?
Start TRT: Get iodine and body temp info first. Try clomid, but ask if you can get Nolvadex instead. If LH, FSH and T increase, that is important to know, top end of HPTA is then working and hCG monotherapy may be a good option if your testes are good. If a SERM does not increase LH/FSH; another sign that your hypothalamus-pituitary are not working. [/quote]

Thanks KSman. After reading more on Clomid/Nol, it seems that Nolvadex is better if only for the decreased affect on optic neuropathy. It also acts as a stronger estrogen in the liver than clomid.

If the restart is successful, is there an ideal test range to shoot for? studies have shown up to a 150% increase in total test using SERM’s.

Is there anything else I can do or take to increase my natural healing if the IGF-1 is low?

Sometimes improving T levels will help GH/IGF-1

It is difficult to increase GH status.