T Nation

MRI Needed? Opinions Please


#1

urologist suggesting a pituary MRI based on results below. Opinions please?

Prolactin
Value - 5.8
Ref Range: 4.0 - 15.2

FSH
Value - 2.5
Ref Range: 1.5 - 12.4

LH
Value - 3.3
Ref Range: 1.7 - 8.6


#2

There is nothing in that lab data to suggest that unless he thinks that LH/FSH is low because of a non prolactin secreting adinoma. Can also be damage from blows to the head.

Last year you posted:
Estradiol: 11, range (8-43ng/l)
TSH: 2.15, range (0.27-4.20 MCU/ML)
T4: 5.7, range (4.5-10.9mcg/dl)
T3 Free, 2.3, range (2.3-4.2pg/ml)
SHBG: 27.3, range (16.5-55.9nmol/L)
Cortisol: 18.4, range (6.2-19.4mcg/dl)
FSH: 2.8, range (1.5-12.4 MIU/ML)
LH: 3.5, range (1.7-8.6 MIU/ML)
Prolactin: 10.4, range (4.0-15.2 NG/ML)

You have low thyroid function and sometimes that affects T levels.
Do you use iodized salt and/or vitamins that list iodine?

  • or are you iodine deficient?

Please see the thyroid basics sticky.

Most urologists are not very good at TRT and most are idiots.
Maybe you need to read the finding a TRT doc

Are you taking any Rx meds now?
Done anything about cholesterol and glucose.
You seem to have syndrome X aka metabolic disorder


#3

Your LH/FSH inhibition is not explained by E2 or prolactin. But your HPTA might be stuck.

Could try a restart:
https://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/hpta_restart_for_trt_guys_with_application_to_gear_and_pct


#4

Started an iodine supplement 4 months ago. Not on any rx meds. Havent taken any drugs for the high cholesterol. I keep going back and forth on that.

Anyway, urologist put me on clomid last year. Labs below after 6 months on 25mg daily dose.
Total T
Range: 250 - 1000
Value: 668
Sex hormone binding
Range: 11 - 78
Value: 34
Free androgen index
Range: 19.2 - 123.2
Value: 68.1
Free testosterone
Range: 47.0 - 244.0
Value: 145
FSH
Range: .9 - 15.0
Value: 3.7
LH
Range: 1.5 -9.3
Value: 3.1
Estradiol
Range: 11 - 41
Value: 15
Cholesterol: 262 range (<200)
Triglycerides: 129 range(55-320)
HDL: 47 range (30-65)
LDL: 194 (<130)

After 6 months the doc wanted me off of clomid and you can see the results of this. T totally tanked. I was feeling def better while on clomid but it didn’t seem to improve sexual function. I asked for other options and he doesn’t want to explore other options. Keeps bringing up risks and stating an MRI of the pituarity would be best. Also wants to refer me to an endo.


#5

You have low thyroid function and sometimes that affects T levels.
Do you use iodized salt and/or vitamins that list iodine?

  • or are you iodine deficient?

You seem to have syndrome X aka metabolic disorder
You need to be tracking glucose.

Most urologists are not very good at TRT and most are idiots.
Maybe you need to read the finding a TRT doc
You should become proactive and find someone who is able to provide decent medical care. Passive is not working.
see the finding a TRT doc sticky


#6

Even if you had an adinoma that did not create prolactin, you would still need TRT.


#7

I’ve reached out to Defy medical for help. They’ve ordered thyroid panels. When taking my temps a year ago they seemed to indicate nothing out of ordinary with thyroid. I need to track down those values.

In terms of iodine deficiency, I have been taking a weekly does of iodoral iodine supplement 25mg weekly.

Glucose level was fine last yearly physical but I’m up for that again. Last year I was in range. The high cholesterol does bother me. I consider myself very active in the gym. I train 4x5 weekly doing cardio and strength training. I’m 41 and everything seemed to hit me right when i turned 40. I’m 6’1 240. I really dont want to go on statins. I’ve heard horror stories.


#8

25mg iodine/week is too much for maintenance
6.25 should be adequate
your TSH levels may be exaggerated at this time

Were you taking iodine for these or later because of these?
TSH: 2.15, range (0.27-4.20 MCU/ML)
T4: 5.7, range (4.5-10.9mcg/dl)
T3 Free, 2.3, range (2.3-4.2pg/ml)

TRT sometimes improves total cholesterol while HDL stays the same.


#9

Will adjust iodine dose to suggested amount.

Those labs were prior to iodine dosing that I had my GP order. Just started iodine 3 months ago. I believe those numbers were when i first started having symptoms related to low T. I think those were back in 03/2014. I then went to urologist who put me on Clomid. T went up (def felt better but did not improve sexual function) and then got off of it(per doc orders) and T went down (symptoms returned)

Just got blood work done for TSH, DHEA and other panels ordered by Defy. Will post when i get the results back.

Thanks for your help. Based on the below LH was suppressed prior to initiating clomid treatment if that means anything

Labs ordered by UNC urologist when i came in w/ low T (Put me on Clomid 25mg daily and anastrozole 1mg weekly)
TESTOSTERONE - Final result (05/27/2014 10:26 AM EDT)
Testosterone 288 (179-756 ng/dL)
TESTOSTERONE, FREE - Final result (05/27/2014 10:26 AM EDT)
Free 9.7 (9-30 ng/dL)
Testosterone(Mayo) 347 (240-950 ng/dL)
LUTEINIZING HORMONE - Final result (05/27/2014 10:26 AM EDT)
LH 1.6 (3.0 - 10.0)
FSH 2.3 (1.6 - 9.7)
Prolactin 12 (4 - 18)
ESTRADIOL <20 (5 - 66)
PSA .4 (.0 - 4.0)
WBC 5.0 4.5-11.0 109/L
RBC 4.98 4.50-5.90 10
12/L
Hemoglobin 15.5 13.5-17.5 g/dL
Hematocrit 45.5 41.0-53.0 %
MCV 92 80-100 fL
MCH 31 26-34 pg
MCHC 34 31-37 g/dL
RDW 13.0 12.0-15.0 %
MPV 7.3 7.0-10.0 fL
Platelet Count 259 150-440 10*9/L

Labs below are after being on clomid for 5 months
UNC urologist referred me to a UVA urologist since it was closer for me.

TESTOSTERONE, BIOAVAILABLE (M) (TESTOSTERONE, BIOAVAILABLE)
Final result (09/16/2014 2:36 PM EDT)
Testosterone 668 (250-1000 ng/dL)
Sex Hormone Binding 34 (11-78 nmol/L
Free Androgen Index 68.1 (19.2-123.2)
Testosterone, Free 145.0 (47.0-244.0) pg/mL
Estradiol 15 (11 - 44)
LH 3.1 (1.5 - 9.3)
FSH 3.7 (.9 - 15.0)
Cholesterol 262 <200 mg/dL
Triglycerides 129 55-320 mg/dL
HDL Cholesterol 47 30-65 mg/dL
LDL Cholesterol 194 <130 mg/dL
LDL/HDL Ratio 4.1 <2.8 RATIO
Cholesterol/HDL Ratio 5.6 <4.4 RATIO
WBC 5.70 4.0-11.0 k/uL
RBC 5.32 4.60-6.20 M/uL
Hemoglobin 16.2 14.0-18.0 g/dL
Hematocrit 48.3 40.0-52.0 %
MCV 90.8 83.0-95.0 fL
MCH 30.5 28.0-32.0 pg
MCHC 33.5 32.0-36.0 g/dL
RDW 13.0 11.0-14.0 %
Platelets 243 150-450 k/uL


#10

What supplements do you take?

I do not see that you have tested fasting glucose.
Insulin resistance is part of metabolic disorder.
Could also test A1C

Suggest:
5,000iu Vit-D3
DHEA 25mg if DHEA-S below mid-range
Vit-C, natural source Vit-E
High potency B-complex multi-vit, listing iodine, selenium and other trace elements WITH NO IRON
Fish oil

You could take a weak cholesterol drug and if you also take CoQ10, the bad things should be prevented.
You can get this natural statin in red yeast rice, but Rx at $40 per year is cheaper.


#11

Had glucose tested last year but it was within range. Trying to find paperwork with value and ranges.

Supplements:
Flameout (fish oil) 6 capsules per day
D3 7000iu - just started this a month ago
Protein supplement
ZMA - nightly
superfood
idoine - 25mg weekly

Just had blood work done today and glucose test was part of panel.


#12

KSman, do u think i have metabolic disorder? if so, does that cause low T or did the low T bring on the metabolic disorder. Hoping my glucose level comes back ok.


#13

Metabolic disorder is characterized by weight gain, abdominal fat gain [more aromatase], insulin resistance, lower TT, higher E2, lower SHBG, lower FT, insulin resistance, increased cholesterol and processes of endothelial dysfunction [arterial damage]. Diabetes can follow. All that varies in degree and by time of development. High blood pressure can follow.

You can see how thyroid problems would add a new dimension.

Do not know if this truly applies to you. But if you take actions commensurate with that your health prospects would improve.


#14

Just got these results back

Comp. Metabolic Panel (14)
Glucose, Serum: 102 High mg/dL (65 - 99)
BUN: 33 High mg/dL (6 - 24)
Creatinine, Serum: 1.34 High mg/dL (0.76 - 1.27)
BUN/Creatinine Ratio: 25 High (9 - 20)
Sodium, Serum: 140 mmol/L (134 - 144)
Potassium, Serum: 5.1mmol/L (3.5 - 5.2)
Chloride, Serum: 104mmol/L (97 - 108 01)
Carbon Dioxide, Total: 22mmol/L (18 - 29)
Calcium, Serum: 9.8mg/dL (8.7 - 10.2)
Protein, Total, Serum: 7.3g/dL (6.0 - 8.5)
Albumin, Serum: 4.5g/dL (3.5 - 5.5)
Globulin, Total: 2.8g/dL (1.5 - 4.5)
A/G Ratio: 1.6 (1.1 - 2.5)
Bilirubin, Total: 0.2mg/dL (0.0 - 1.2)
Alkaline Phosphatase, S: 54IU/L (39 - 117)
AST (SGOT): 31IU/L (0 - 40)
ALT (SGPT): 36IU/L (0 - 44)

DHEA-Sulfate: 308.3 ug/dL (102.6 - 416.3)
TSH: 1.360 uIU/mL (0.450 - 4.500)
Estradiol, Sensitive: 11.5 pg/mL (8.0 - 35.0)


#15

forgot these values

eGFR If NonAfricn Am: 65 mL/min/1.73 >59
eGFR If Africn Am: 76 mL/min/1.73 >59


#16

TSH is not bad. How are body temps now?
DHEA-S is good.

Glucose seems better.
E2 is too low.

When does TRT start?


#17

I will need to retest body temps. Will do that this week.

TRT meds have just shipped. Consult was very informative and the doc answered all my questions. Protocol that i will be following is as follows:

140mg test cypionate twice a week
250iu hCG twice a week

No Arimidex/anastrozole was prescribed due to my low E2. He said it would def rise but he would be surprised if i needed to add that. Basically follow-up labs in 3 months will see how im progressing and how i feel. I’ll def be posting follow-up labs

I have started red yeast rice for high cholesterol and im really focusing on my diet. I’ve also added a fiber supplement, CoQ10 and PQQ. Thanks for all your help KSman.


#18

Do not take Vit-D3, iodine, CoQ10, DHEA, fish oil with “fiber supplement” or high fiber foods.


#19

Why cant u take those supplements together?


#20

You can take them together.

Do not take these supplements with high fiber foods as that would reduce absorption.