T Nation

Latest Bloodwork, Trying to Get Dialed In. Thoughts?


#1

Hi all,

Long time lurker (3.5yrs) but new member. I apologize in advance for another “here’s my bloodwork” post, but after having to change doctors because we had more knowledge than him, I trust your mentoring more than a 30 year degree. I have since found a doctor with more knowledge in hormone replacement, but I still believe the knowledge on here is a step ahead. Brief history; I got diagnosed with primary hypogandism a few years ago when my wife and I were trying to conceive. Tried the natural route of eating better, losing weight, hitting the gym and cutting back on drinking (I still drink but not near what I used to). I started having anxiety and panic attacks daily for about a year. And when you manage a restaurant and have to be in a room with 250 people, that doesn’t make for a good time. So I bit the bullet and got prescribed androgen by my endocrinologist at the time, and after the 5week check up I knew it was time to find another doctor when he only wanted to test for T, free T and hemocrit. On to IM injections 1ml weekly (recently convinced the doctor to let me split them into two a week). In the past month I’m feeling great. No more anxiety, but my libido has gone down. I still perform to keep my wife happy, but the desire isn’t what it was even before I started treatment. So thank you for reading my short novel, and ANY INSIGHT WOULD BE GREATLY APPRECIATED! And also thank you for sharing your wealth of knowledge that has made my transition into treatment more comforting.

Age-33
Weight-178
Height-5’12" :wink:
Waist- 37"
Body hair-decent beard, hairy legs patches on chest
Fat- carry it in the mid section
Rx and otc- just supplements; multivitamin, chelated copper, magnesium, zinc, fish oil, D3
Health conditions-none
Diet- fairly healthy
Training- strength 3-4 times a week
Testes ache- sometimes, no fever
Morning wood- yes
T free and total- 554 (348-1197)ng/dl
Free T direct- 12.2 (8.7- 25.1) ng/dl
Bio T w/o shbg
T total-503 (348-1197) ng/dl
Bioavailabile- 250 (128-430), %49.7
Fsh- .6 (1.5-12.4) mIU/ml
Lh- .2 (1.7-8.6) mIU/ml
Dht- 45 (30-85) ng/dl
T3- 115 (71-180)ng/dl
T4- 1.54 (.82- 1.77) ng/dl
Progesterone- .7 (.2-1.4) ng/ml
Insulin- 1.3 (2.6-24.9) LOW uIU/ml
SHBG serum- 26.9 (16.5-55.9) nmol/L
DHEA sulfate- 329.4 (138.5-475.2) ug/dl
Cortisol- 9.8 (6.2-19.4) ug/dl
TSH- 1.62 (.45-4.500) uIU/ml
Estradiol- 23.3 (7.6-42.6) pg/ml
IGF-1- 183 (88-246) ng/ml
Vit D- 31 (30-100)ng/ml

CBC looked good except for a flagged LOW of alkaline phosphatase of 38 (39-117).

The doctor wants an mri on my pituitary due to the decreased fsh and lh, but doesn’t this happen when you start injecting exogenous testosterone due to the negative feedback loop?


#2

Doc may be looking for a cause. Really need to have LH/FSH before any TRT was done.
Prolactin can be tested and if elevated, MRI is medically justified. He may be stupid, or wisely retrospectively looking at what caused T to drop; because diagnostics were bungled by others.

TSH should be closer to 1.0
fT3 is below mid range.
Do you use iodized salt?
If you eat your restaurant food and do not use iodized salt, there is your problem.
Would other family members be in the same boat?

Please follow these links to old stickies, 2nd posts of 1st forum topic:

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics explained — Check oral body temperatures as suggested

Labs:
AM cortisol [ at 8AM please ] if above was not at 8AM, please indicate
cortisol
fasting glucose
fasting cholesterol
hematocrit [you may have this]

Following assumes that you are injecting twice a week for the lab work, otherwise, ignore.
If injecting 200mg/ml T, you are injecting 100mg twice a week and T levels are mid range.
In any case, you should double your T dose.
Some guys are hypermetabolizers of T.
Do all lab work 1/2 way between injections - aways, so lab changes are not lab timing artifacts.
When you double T dose, E2 may need anastrozole management.

Stress:
Your stress is a freight train coming done the track at the restaurant. Add other life stresses and business stress and stir. If body temps are low, can be low iodine and also elevated rT3 that blocks fT3. Driving through these impediments with will power can make this problem worse. See the thyroid link and find references to stress, iodine, rT3, adrenal fatigue. Your cortisol may be low and that also lowers energy levels.

Your low insulin merits further investigation:


#3

@KSman, thank you for responding. I had labs in December and lh was 5.7 (1.7-8.6), and fsh was high do to testosterone not being produced adaquatly in the testes @ 22.7 (1.5-12.4). No doctor has an answer to why they just went down hill. They suggested mumps, but I was vaccinated as a child. And for the restaurant food, a rarely indulge in what’s on the menu. I cook myself lean protein, beans and vegetables 99% of the time. My cholesterol in December was 185 total (100-199), Triglycerdides 145 (0-149 and HDL 89 (>39). They didn’t pull cholesterol on the recent test. Test was done at 9am. Glucose 89 mg/dl (65-99) and hemocrit 44.7 %(37.5-51). I will reread the stickies. I read them years ago when I got diagnosed. Me switching two two shots a week started after the blood test and I am currently splitting a 100mg/ml test c at a1ml dose, so .5 Monday and .5 Thursday. As for the insulin it was at 3.9 before I started injecting. I will start looking into the salt. Thank you.


#4

So your lab results were heavily affected by lab timing, injecting once a week.

And your intake of iodized salt is?

You had primary hypogonadism. So his looking for a problem in the pituitary really does not look very good.

So you do not know time of day for labs? Please see all issues in my prior post.


#5

Labs where done at 9am on Wednesday as per the doctor. I used to only inject on Thursdays. Probably none to little iodinized salt intake. At work we prep with kosher salt, do not know if that is the right one I will have to investigate,and I season sparingly. I am currently in the middle of reading your post on salt and the thyroid. As for the doctor, my wife had a pituitary tumor, so we are fairly well versed in prolactin m, which struck me as odd that they did not order a less expensive blood test first.


#6

You could switch to iodized salt and that would be good for you and your customers.

Cortisol should be tested at 8AM. Perhaps 9AM is your 8AM if the business shifts your clock.

Strongly suggest 5,000iu Vit-D3. Find tiny oil based caps. Take with a meal that is more oils/fats and less fiber.
Take 25,000/day for first 5 days, 5,000 thereafter.
Who else is sharing your diet?

Should have stated T3 is below midrange.
Preferred labs are:
TSH
fT3
fT4
fT3 is what gets the job done. More concerned with free hormones and less that are bound to thyroid binding globulin [total T3, T4].

Others in family getting same lack of iodine as you?

You can eval the impact of your iodine status by getting those oral body temps. And others in family that may be affected.


#7

Thank you. I will check those temps starting tomorrow. I’ll get back to you in a week. As for the diet, pretty sure the wife isn’t getting a lot either. Will discuss with her. Take care and thank you