T Nation

Lifelong Symptoms: Lab Results

T Replacement
#1

I have had the following symptoms my entire life. None of my symptoms are new, I am 32. My erectile performance has been virtually the same my entire life with huge fluctuations between excellent and suboptimal, easily affected by any stress like anxiety.

  1. Slightly more vulnerable to cold than average, and slightly lower body temp
  2. Easier to get cold extremeties than average in slightly suboptimal temperatures
  3. Deal with anxiety on and off
  4. Erectile function is normal, but occasionally sub-optimal, and easily affected by anxiety

None of the above symptoms are new and I have been the same my whole life, but the severity fluctuates. I took the following blood test at noon about a week ago.

Stats at time of blood test:
Age: 32
Sex: Male
Height: 6’ 3"
Weight: 195
Bodyfat: 14% or less depending on how good shape I’m in, I often get it down under 10% when in great shape.
Drug Use: Nothing, not even alcohol except on rare occassions, and low dose cialis with new girls to help try to counter my sexual performance anxiety which causes ED.

I am tall, healthy, lean, and have no known medical issues except for possible self suspected dysautonomia mitral valve prolapse syndrome (self diagnosis) which I match a lot of the criteria for.

Test Score Reference Range

CBC with differential/platelet

WBC 5.1 4 - 10.5

RBC 5.36 4.14 â?? 5.8

Hemoglobin 15.4 12.6-17.7

Hematocrit 45.3 37.5 - 51

MCV 85 79 - 97

MCH 28.7 26.6 - 33

MCHC 34 31.5 â?? 35.7

RDW 13.5 12.3 â?? 15.4

Platelets 217 140 - 415

Neutrophils 46 40-74

Lymphs 43 14-46

Monocytes 8 4 - 13

EOS 2 0 - 7

Basos 1 0 - 3

Neutrophils (absolute) 2.4 1.8 - 7.8

Lymphs (absolute) 2.2 .7 â?? 4.5

Monocytes (absolute) .4 .1 â?? 1.0

EOS (absolute) .1 0 - .4

Basos (absolute) 0 0 - .2

Immature Granulocytes 0 0 - 2

Immature Granulocytes (absolute) 0 0 - .1

Complete Metabolic Panel

Glucose, Serum 83 65 - 99

BUN 14 6 - 20

Creatinine, Serum 1.23 .76 â?? 1.27

eGFR if Nonafrican 77 >59

eGFR if African 89 >59

BUN / Creatinine Ratio 11 8 - 19

Sodium, Serum 138 134 - 144

Potassium, Serum 4.3 3.5 â?? 5.2

Chloride, Serum 100 97 - 108

Carbon Dioxide, Total 26 20 - 32

Calcium, Serum 9.7 8.7 â?? 10.2

Protein, Total, Serum 6.9 6.0 â?? 8.5

Albumin, Serum 4.9 3.5 â?? 5.5

Globulin, Total 2.0 1.5 â?? 4.5

A/G Ratio 2.5 1.1 â?? 2.5

Bilirubin, Total .7 0.0 â?? 1.2

Alkaline Phosphatase, Serum 58 25 - 150

AST (SGOT) 33 0 - 40

ALT (SGPT) 38 0 - 44

Urinalysis, Routine

Specific Gravity 1.01 1.005 â?? 1.030

ph 7.0 5.0 â?? 7.5

Urine-Color Yellow Yellow

Appearance Clear Clear

WBC Esterase Negative Negative

Protein Negative Negative / Trace

Glucose Negative Negative

Ketones Negative Negative

Occult Blood Negative Negative

Bilirubin Negative Negative

Urobilinogen, Semi -QN .2 0.0 â?? 1.9

Nitrite, Urine Negative Negative

Lipid Panel

Cholesterol, Total High 206 100 â?? 199

Triglycerides 66 0 - 149

HDL Cholesterol 51 >39

VLDL Cholesterol Cal 13 5 - 40

LDL Cholesterol Calc High 142 0 - 99

Iron and TIBC

Iron Bind.Cap. (TIBC) 268 250 - 450

UIBC Low 142 150-375

Iron, Serum 126 40 - 155

Iron Saturation 47 15 - 55

Testosterone, Free and Total

Testosterone, Serum 513 348 -1197

Free Testosterone (Direct) 9.8 8.7 â?? 25.1

Hemoglobin A1c

Hemoglobin A1c 5.1 4.8 â?? 5.6

Thyroxine (T4) Free, Direct, S

T4, Free (Direct) 1.33 .82 â?? 1.77

DHEA-Sulfate

DHEA-Sulfate 342.7 160 - 449

TSH

TSH 2.63 .45 â?? 4.5

Luteinizing Hormone (LH) , S

LH 5.8 1.7 â?? 8.6

FSH, Serum

FSH 3.6 1.5 â?? 12.4

Prolactin

Prolactin 11.1 4.0 â?? 15.2

Prostate-Specific Ag, Serum

Prostate-Specific Ag, Serum 1.0 0.0 â?? 4.0

C-Reactive Protein, Cardiac

C-Reactive Protein, Cardiac .67 0 - 3

Estradiol, Sensitive

Estradiol, Sensitive 11 3 - 70

GGT

GGT 21 0 - 65

Magnesium, Serum

Magnesium, Serum 2.1 1.6 â?? 2.6

Insulin

Insulin 4.5 2.6 â?? 24.9

Ferritin, Serum

Ferritin, Serum 160 30 - 400

Triiodothyronine, Free, Serum

Triiodothyronine, Free, Serum 2.8 2.0 â?? 4.4

Sex Horm Binding Glob, Serum

Sex Horm Binding Glob, Serum 46.9 16.5 â?? 55.9

Thanks for any advice.

#2

TSH is up, fT4 looks good. ft3 is below optimal.
Reports of feeling cold indicates a thyroid system functional problem.

  • skin, nails or hair dry/brittle?
  • read the thyroid basics sticky and come back with body temp and iodine info *

E2 is low, but the range of the lab makes me wonder and the accuracy at the bottom of the range may be wanting. With low E2 it does not make sense that SHBG is so high. Your mid range TT and low FT is consistent with your SHBG levels. SHBG is made in the liver in response to estrogen levels. So it seems odd that your SHBG is this high with low E2. That suggests that your liver may be an issue. However, AST/ALT does not suggest a problem there. Technically, there could be other estrogens at work. Do you use a probiotic? Any gut issues/concerns?

Your iron markers look good. Low levels can suggest a gut problem and chronic GI bleed.

Liver function can be affected by meds, Rx or OTC and some dietary extremes. Need info. See the advice for new guys sticky.

Stress: You need an AM serum cortisol test. Do the lab at 8AM, get up a normal hour, do not go the gym first!

Your cholesterol levels are great. Low cholesterol can limit steroid hormone synthesis. Your DHEA is good, not rate limiting DHEA–>T inside your testes.

Use [edit] in your post above and add waist size in the above post.

#3

My TSH is in the center of the reference range, is that bad? I do not have most hypothyroid symptoms. The only ones I really have are related to cold vulnerability, and maybe a few others such as dry skin after showers but it goes away with some lotion and is not excessive. Nails are not brittle, and my hair is normal although I shave it off due to thinning hair on top from MPB which is in my genes on both sides. I also burn fat easily and have thick eyebrows. I’ve been this way my whole life (cold vulnerable and cold extremeties). My testosterone might be lower since I took the test at noon and high shbg is correlated in people with mpb.

I am not sure what my waist is exactly but if I don’t wear a belt with my size 34 pants they fall off. My waist is probably 32 or less, I have a very healthy and aesthetic physique except for chest assymetry (not easily noticeable) which is congruent with skeletal findings on people with mvps dysautonomia. The strange thing is that my magnesium levels are very good, while low levels are found in people with dysautonomia but this may due to me having a good diet and eating things such as cacao and occasionally taking ZMA.

As for my liver, it would make no sense for it to be bad since I dont drink or do any drugs or take any medication. I have maybe 3 times on my life taken a cialis and drank excessive alcohol on it, and had the worst hangovers of my life, but that was years ago and I doubt it did permanent damage to my liver. Also we must keep in mind that my symptoms are how I have been my whole life, so unless my liver has been bad my entire life it is extremely unlikely that anything is wrong with my liver. I do not use any probiotics although on occassion I take a ZMA and some testosterone boosting herbs like longjack, trubulas, and maca, but I take supplements irregularly.

Your thoughts on other estrogens does concern me because my body deposits fat dissimilar from most other guys. I get mostly subcutaneous fat deposit, and the skin in my butt and above love handles shows signs of extremely minor cellulite if my fat% goes over 14% which is rare. Is it possible to have low E2 but have high other estrogens?

Dysautonomia is a condition where your body over-reacts to stress, and I believe this stress can create erratic hormonal profiles. I believe mitral valve prolapse dysautonomia is causing all of my symptoms, since ive been the same my whole life, what do you think?

#4

I also wanted to throw in something interesting. I seem to have impaired sexual function at specific intervals in a day or after specific events. Most notably, my erections are weaker between hours 0-2 of waking up (which is when testosterone is highest, but also cortisol is highest) and they are strongest when I am sleepy (afternoon, evening, or late at night) or if I am being lazy and relaxing in a chair or bed for several hours.

Circadian rythms or cortisol/adrenaline seem to have intense effects on my erectile performance, my erections are noticeably weaker after any sort of event which causes high levels of anxiety or adrenaline. My erections are noticeably stronger the more relaxed I am, when I feel little to no anxiety and particularly from being seated or lying down for long periods or while sleepy. I have outstanding sexual performance throughout my long term relationships except in the beginning, but commonly have ED with new women or in new relationships.

Low body temp, cold hands and feet, postural changes over-effecting my heart rate and blood pressure, erratic sexual function ranging from normal to weak, stress hormones seem to cause accentuated negative sexual function within me. All factors seem to point to something haywire in my bodies stress response, ie: an overactive sympathetic nervous system. Any suggestions?

#5

-age 32

-height 6’ 3.5"

-waist 32"

-weight 195 lbs

-describe body and facial hair “normal facial and body hair, full beard”

-describe where you carry fat and how changed “fat deposits subcutaneous evenly all over body with extremely minor cellulite on butt or above love handles when above 14% bodyfat” Very rare for me to be over 14% bodyfat

-health conditions, symptoms [history] “No health conditions, besides anxiety and suspected dysautonomia”

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever “No drugs. Only pharms ever used are cialis and viagra to allow me to perform better sexually.”

– real dangers! see this http://propeciahelp.com/overvi… "Never used "

-lab results with ranges “Posted”

-describe diet [some create substantial damage with starvation diets] “Healthy balanced diet, sometimes a bit more paleo, sometimes more american. Occassionally do an unhealthy fast food diet for a week but Ive cut that out”

-describe training [some ruin there hormones by over training] “I used to train hard 5 days a week, but starting noticing that I had diminished sexual response during intense exercise, than experimented with various level of exercise and being sedentary. I found that I had improved sexual response by not exercising at all, but the effect would only last for two weeks before it would reverse and id be worse than when exercising. It appears my sexual performance is heavily influenced by circulating stress hormones, which can be raised by intense exercise. I found that balanced exercise (moderate training 5 days a week, intense 3 days per week helps me feel best) I now take plenty of full rest days and do not overtrain”

-testes ache, ever, with a fever? “No”

-how have morning wood and nocturnal erections changed “I found that once I reduced my orgasm frequency to under 4 per week I started getting regular night and morning wood which I did not have or notice through my twenties, but morning wood dissappates extremely rapidly upon awakening as it has my entire life. Spikes in my stress levels also greatly effect my night and morning wood and can shut it off for several days. Bouts of depression has this effect as well.”

#6

When I get ED, it is almost always caused due to one or a combination of 3 factors.

  1. Extreme performance anxiety (especially with new relationships)

  2. Not losing virginity until 25 (brain adapted to porn since age 12) and not trying no PMO until about 31

  3. Normal but possibly sub-optimal hormone profile and or sub-optimal venous constriction (making erections easy to get but harder to maintain and easier to lose under suboptimal conditions).

Factor 1 is basically the cause of all my ED, factors 2 and 3 just make me more vulnerable to getting it more easily. My ED was completely resolved when I was in a long term relationship in the absence of anxiety. The problem is that it is hard to find long term relationships with hot women, and so I have to somehow train myself to not have anxiety in random hookups.

#7

Sexual performance is from low FT. TT is FT, T+albumin and T+SHBG. T+SHBG is not bio-available. So TT can be misleading. Your results are consistent with LH/FSH.

As E2 is unusually low, we will take liver and SHBG off of the game board. Low E2 does not explain your HPTA repression. Prolactin is not high, might contribute but not a primary factor.

So a life long issue and not evidence of a new cause or worsening. So lets call it idiopathic secondary hypogonadism effects.

Based on your history of symptoms, you may be able to find a doc who will do TRT. You can explore hCG monotherapy as an option, you are still injecting, so you are not avoiding that burden. As for fertility, you can switch to nolvadex from time to time to keep things tuned up.

I still think that you have thyroid issues, but you are fighting that concept. You have symptoms.

repeat:

  • read the thyroid basics sticky and come back with body temp and iodine info *

TSH around 1.0 is good. The range, 0.5 to 5.5 [or .45 - 4.5] does not indicate or imply health or optimal. Generally we do not see TSH near 2.5 as any state of good health. The lab range means that 95% of the population falls in that range. That includes a lot of cases of subclinical and frank untreated hypothyroidism. You can never accept a 10:0 range of a lab result as healthy. You do want to see fT3, fT4 near mid range.

TRT will improve cholesterol numbers and insulin sensitivity.

You need to provide your iodine data and body temps!!!