Multiple Bloodwork Results, Suggestions Welcome

Pharma / TRT Testosterone Replacement
1

32 yo, 5’11", 220lbs. Weight training 4 x week.

Been feeling really down and out for about six months. Moody, fatigued, no motivation, extremely tired, recently started having sexual symptoms. No loss of strength or muscle yet. No change in hair loss/growth.

RX: Omeprazole 40mg daily, Hydrochlorotiazide 6.25 daily

Had sleep study done, came back negative for sleep apnea.

All following test were conducted between 8am-10am on various days except as noted.

4/13 (PCP)
WBC 5.4 (4.1-10.9)
LYM 2.1 (0.6-4.1)
MID 0.5 (0.0-1.8)
GRA 2.7 (2.0-7.8)
LYM% 39.5 (10.0-58.5)
MID% 9.9 (0.1-24.0)
GRA% 50.6 (37.0-92.0)
RBC 5.06 (4.20-6.30)
HGB 15.5 (12.0-18.0)
HCT 46.1 (37.0-51.0)
MCV 91.1 (80.0-97.0)
MCH 30.6 (26.0-32.0)
MCHC 33.6 (31.0-36.0)
RDW 12.8 (11.5-14.5)
PLT 221 (140-440)
MPV 8.3 (0.0-49.9)

5/13 (PCP)
Glucose 107 (74-106) HI
Blood Urea Nitrogen 13 (7-18)
Sodium 144 (136-145)
Potassium 4.4 (3.5-5.1)
Chloride 104 (98-107)
Enzymatic Carbonate 32.4 (21.0-32.0) HI
Calcium 9.8 (8.5-10.1)
Creatinine 1.28 (.55-1.30)
TSH 0.29 (0.34-4.82) LO

5/15 (PCP)
Free T3 3.4 (2.0-4.4)
Free T4 1.25 (0.8-1.8)

5/23 (PCP) *Mid-afternoon
TT 217 (300-1080) LO

6/7 (Urologist)
TT 3.04 (3.00-10.00)

6/16 (Urologist)
Estradiol 8 (<61)
LH 5.4 (1.7-8.6)
Prolactin 12.5 (4.0-15.2)

6/23 (Anti-aging clinic)
TT 227 (348-1197) LO
Estradiol 5.1 (7.6-42.6) LO
PSA 0.4 (0.0-4.0)
Hemoglobin 15.1 (12.6-17.7)

6/27 (Anti-aging clinic)
TT 185 (348-1197) LO

The last two sets of tests were conducted at anti-aging clinic that was suggested by friend after urologist said i was okay (which i clearly am not). Anti-aging clinic says i am cleared for TRT.

Any insight or additional test suggestions would be greatly appreciated.

In my opinion, the thryoid needs to be investigated further.

I plan to add iodized salt and D3 supplements to my diet. I am going to start taking temp readings in the morning as well.

*Additional Tests i plan to ask for are FSH, rT3, FT, and possibly Cortisol. Any other i should request?

Please help me understand all this guys, I don’t want to start TRT if there is something else that could be done.

2

Clearly you have low T and low E as a consequence. Without running all the proper bloodwork at the same time you can’t diagnose the cause. You need TT, Free T, FSH, LH, E2, SHBG, and prolactin. It would be a good idea to run a thyroid panel too. Before starting a TRT regimen, get the proper bloodwork done so you can diagnose yourself. Once you start TRT you can no longer diagnose from labs.

3

Should test LH and FSH together. — cannot be tested after you start TRT.
I see that you are onto the need for FSH, good reading skills.
You might have primary hypogonadism.
Any aches or pains in your testes?
Doc examined testes?

How important is fertility?

Omeprazole long term can lead to multiple mineral deficiencies and B-12 deficiency.

Many are magnesium deficient and your two drugs create two risk factors. If you get leg/foot cramps or can contract a muscle and have it lock up, you are magnesium deficient. This site’s Biotest store sells ZMA.

Not using iodized salt for years can make one hypo and the effects of high TSH lead to thyroid nodules that start to make thyroid hormones independent of TSH providing permission. That can progress to hyperthyroidism and your lab are consistent with been part way through that transition. You really need to be getting selenium as you are at risk of thyroid autoimmune disease. Get a 200mcg selenium supplement and take for 2-3 weeks before introducing iodized salt or other iodine supplements. Need some caution.

Thyroid labs:
fT3
thyroid immune panel
get thyroid palpated for size, nodules etc
never do thyroid labs after palpation, do labs first or at another time

Cortisol should be “AM Cortisol” done at 8AM or 1 hour after waking up.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

4

Wow, that sounds pretty grim. Thank you the information though.

I will make appt with PCP to have all levels pulled at one time and full thyroid panel as well. Also will ask for referral to endo , if he does not suggest it.

No pain or ache in testes.

Yes, Urologist did examine testes. Found nothing out of place.

Fertility is important. Have a 4 month old, but Wife and I would like to try for another in a year or so.

Was not aware of that with Omeprazole. I was just switched to it from name brand Nexium. Have been taking these medications for about 15 years. Is there a safer alternative?

Magnesium- i do not get leg/foot cramps often, but i have had biceps/triceps lock up when contracted hard.

By auto-immune i’m guessing you mean Hashimotos?

I will start taking selenium as advised. I’m not sure of selenium content but i do eat a small handful of Brazil nuts almost every night.

Noted* Wait 2-3 weeks on Iodized salt.