T Nation

Making Sure I Get Right Labs Done. Long Time TRT, Libido Issues


#1

Hi,
I have been on TRT for pushing a decade. It helped pull my health out of the gutter. For many years my quality of life was amazing. No side effects and no complaints. Now only the past few years, my libido has crashed. Nothing else really, my energy is fine, my fitness is fine, bodyfat still low, etc. Just libido is next to nothing, and even if I do get it up it is not high performance anymore, and orgasms are lame if I can even get that far. It seems so bizarre. On an older thread here we discussed dopamine issues, which I brought up to my doctor, and they did not think so based on whatever labs they did with me. But I suspect it might be something still to do with dopamine, as my estrogen, FT, and TT levels seem to be pretty consistent for many years. I have gotten confused as of late reading on other forums, Dr Crisler testing more than just E2, and doing multiple other estrogen labs I do not think I have seen mentioned here. Reviews of Dr Mariano say he looks at hormones and neurotransmitters, copper and a bunch of other atypical stuff compared to other TRT docs.

I ask my doc to do extensive labs and make suggestions based on what I read here from KSman, but as some of you know even cooperative doctors probably go through the routine of whatever their typical labs are for male TRT even if you mention additional labs. I do not know if I have a thyroid issue, a dopamine desensitization issue, who knows. But I just got new insurance and they said once a year they pay in full for whatever extensive labs my doc wants to do, so i want to take advantage of it. Then perhaps I will finally have more complete info to come back here and get some advice. I also do not know what KSman thinks of Dr Mariano or Dr Crisler, as I have seen people either love or hate either of them…but if I cannot figure out my issue was considering doing a consult with one of them if they are held in high esteem here. I tend to read more positive stuff about Mariano. KSman I am all ears.

I tried to compile a list of labs to do based off the stickies here, plus a few from posts saying what Dr Mariano looks for, plus Inside Tracker, a company that does labs for athletes that generates feedback for nutrition and supplement suggestions. Who knows if Quest will actually have the ability to test all of these things, but if I get labs paid for once a year in full, I want to hit on everything possible I can (assuming Quest has it, or I think I can use LabCorp too).

So KSman if you had time to skim this and make any suggestions or corrections let me know, I sincerely appreciate it. I realize there may be some repeats, as I am trying to combine from different lists including the stickies here. This time I want to print it up and literally hand it to my doctor while he fills out the lab sheet so I know we get as much info as possible:
Glucose
Total Cholesterol
High-density Lipoprotein (HDL)
Low-density Lipoprotein (LDL)
Triglycerides
Creatine Kinase
Cortisol
Albumin
Calcium
Magnesium
Folate
Magnesium serum
Magnesium, RBC
Potassium, RBC
Selenium, whole blood
Copper, serum
Zinc
Vitamin B12
Vitamin A
Vitamin E
Vitamin B3
Hemoglobin
Ferritin
Total Iron Binding Capacity
Iron
Transferrin Saturation
White Blood Cell Count
High Sensitivity C-Reactive Protein
Fibrinogen
Potassium Sodium
Alanine Aminotransferase (ALT)
Aspartate Aminotransferase (AST)
Gamma-glutamyl Transpeptidase (GGT)
CompleteBloodCount(CBC)
Red Blood Cell Count
Hematocrit
Mean Cell Volume
Mean Cell Hemoglobin Concentration
Red Cell Distribution Width
Platelets
Mean Platelet Volume
Monocytes
Neutrophils
Lymphocytes
Eosinophils
Basophils

Free Testosterone
Total Testosterone
Total Estrogens
Estradiol (or Ultrasensitive Estradiol #30289 that Dr. John Crisler says to do??? stickies here KSman says NOT to do as I understand)
DHEA-S
Progesterone
Pregnenolone
Prolactin
Androstenedione
DHT
FSH
LH
TSH
Free T3
Free T4
Total T3
Total T4
Reverse T3
T3 Uptake
Thyroid Peroxidase and Thyroglobulin Antibodies
Thyroglobulin
Thyroxine binding globuline
Prealbumin/Transthyretin
Insulin, serum
IGF binding protein3
Aldosterone
Renin Activity, plasma
ACTH, plasma
Cortisol binding globulin (Transcortin)
Free and Total PSA
MTHFR
IGF-1
SHBG
HbA1c
Vitamin D
Hs-CRP, ferritin
Homocysteine
Hemoglobin A1C
Cortisol
Neurotranmitter Basic Panel (Does Quest have this?)
-Serotonin, Dopamine, Ephinephrine, Norephinephrine, GABA, glutamate.