T Nation

My Story and Some Help is Needed. (Labs Included)


#1

5'10" 168lbs. Age 35

So January 2015 I was sick for a week and the Dr. did a bunch of blood tests that were all normal except T was low ~ 270 from what I recall. Got better didn't follow up. At least the last 3 years I have had most symptoms of low T except ED. Fast forward to Jan this year and I wasn't feeling good. Bunch of blood tests all normal (liver, thyroid, etc). So in Feb I decided to go to a Dr and bring up the low T thing because I am dead tired and have zero energy. I wake in the morning and yawn all day and by the end of work my head hurts and I feel stick to my stomach. This is constant everyday. So this new Dr. runs tests and here are the results:

LH 2.1 1.70-11.20 (mIU/mL)
FSH 2.2 1.00-42.50 (mIU/mL)
Free Testosterone 13.4 4.3-30.4 (pg/mL)
Testosterone, Total 261 L 332-896 (ng/dL)

So he immediately wants me to go on Androgel. So I decide first to start researching and reading everything. I have read this forum and the stickies multiple times, other forums, the Testosterone for Life book, etc. With this knowledge I have gained (I think I know more than the Dr.'s at this point) I decided to go to a urologist for a second opinion. Didn't think the first Dr. knew enough. So I wait a little over a month and go. He talks about primary, secondary, clomid, all the other stuff. Knows his stuff. Want's more labs. This time the labs show:
Estradiol by TMS 28.8 pg/mL 10.0 - 42.0 pg/mL

Thyroxine Free 1.2 ng/dL 0.8 - 1.7 ng/dL
Sex Hormone Binding globulin 20 nmol/L 11 - 80 nmol/L
Albumin, S/P 4.8 g/dL 3.5 - 5.0 g/dL
LH 3.6 IU/L 1.7 - 8.6 IU/L
FSH 1.7 IU/L 1.5 - 12.4 IU/L
Testosterone, Adult Male 378 ng/dL 300 - 1080 ng/dL
TSH 2.12 mU/L 0.30 - 4.00 mU/L
Prolactin 6.6 ng/mL 2.1 - 17.7 ng/mL

So now my LH and Total T have gone up but FSH is down on this lab test. Which seems odd. So I always think a 3rd opinion would be goog before making a decision so I go to my Internist and talk to him. He wants to check a few other non T related tests like Cortisol, etc. Which is all perfect. He was trying to look for inflammation or something else thinking low T may be a by product of something else going on. Can't find anything.

So it appears I am Secondary. Which means a clomid therapy may work? Internist suggest to maybe try T for 1 month just to see if it helps and doesn't think my natural production would suffer much in 1 month if we need to stop because it's not working. Or I could try Clomid but her says it can take much longer to even see if Low T is the issue. I have also read potential side effects from Clomid.

28.8 E2 seems high to me (most research says 20-22 is perfect). Internist also said I don't need Arimidex (typically for people overweight) unless my E2 goes way up, which is kind of counter to what I have read. He knows I am pretty knowledgable though and is open to trying what I want to do. From everything I have read I think I would prefer injections over Androgel and most people seem to end up on injections anyway. Should I do Clomid for a while just to see? Try T injections for a month to see if it really does fix things?

What are your thoughts? I can give more info or other test results (I have had like 6 blood tests done this year) if needed. Just want to get as much info as I can to make a good educated decision. I can barely function at all at this point and the last 3 weeks my head and eyes are just feeling almost dizzy but not off balance or anything. Completely dead tired and sleep good at night.


#2

What are your procreative plans? Done having kids, or do you want to preserve your fertility?


#3

Done having children already have them.


#4

Links found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman
* advice for new guys - need more info
* things that damage your hormones
* protocol for injections
* thyroid basics - check body temperatures as suggested
* HPTA restart

Labs, have more?:
FT low
TT low
E2=28 high vs T levels
LH/FSH low
prolactin low-OK
CBC ?
hematocrit ?
fasting cholesterol - could be too low
fasting glucose ?
AST/ALT ?
AM cortisol [at 8AM please]
TSH high
fT4 OK
fT3 ?

If body temps are low, can be from not using iodized salt - might affect whole family.
Do you feel cold easily?
Outer eyebrows sparse?
Dry skin?
Thyroid enlarged, lumpy, sore, asymmetrical?

TSH should be nearer to 1.0, something is wrong.
Low thyroid function takes away your energy and affects every cell and organ in your body.

With low T, E2 should be low. Something is wrong and anastrozole will be essential


#5

Labs from FEB 23rd, 2016,

Sodium 142 136-145 (mmol/L)
Potassium 4.5 3.5-5.1 (mmol/L)
Chloride 105 98-107 (mmol/L)
ECO2 28.6 21.0-32.0 (mmol/L)
Glucose 92 74-106 (mg/dL)
BUN 20 H 7-18 (mg/dL)
Creatinine 0.96 0.80-1.30 (mg/dL)
BUN/Creatinine Ratio 20.8 8.0-27.0 (Ratio)
Calcium 9.1 8.5-10.1 (mg/dL)
Alkaline Phosphatase 61 46-116 (U/L)
ALT 23 16-63 (U/L)
AST 30 15-37 (U/L)
Bilirubin, Total 0.6 0.2-1.0 (mg/dL)
Total Protein 7.4 6.4-8.2 (g/dL)
Albumin 4.3 3.4-5.0 (g/dL)
Globulin, Total 3.1 1.5-4.5 (g/dL)
A/G Ratio 1.4 1.1-2.5 (Ratio)
GFR 94.7 >59.0 (mL/min/1.7)

Cholesterol 186 0-200 (mg/dL)
Triglycerides 126 0-150 (mg/dL)
HDL, Cholesterol 50 40-60 (mg/dL)
LDL (calculated) 111 0-160 (mg/dL)


#6

Had labs from Jan 2016 too:

TSH: 2.02 mcIU/mL
Hematocrit 45.30%
ALT 14 unit/L
AST 16 unit/L
Glucose Level 99 mg/dL

Just had cortisol done a few days ago and yes 8am.

Cortisol, AM 13.61 4.3-22.4 mcg/dL

I don't believe they have tested fT3.

So its nighttime here and I just checked my temp (I will check before getting out of bed in the morning) and it was 96.8. I recall last year when I got sick my temps were always in the 96. somthing range. I am typically hot. Like sitting here or at my desk I can just start dripping sweat without using energy. I don't really feel cold easily. Eyebrows are good. No dry skin.


#7

Woke up this morning and temp was 96.9 before sitting up or anything. However I am going to stop by the store at lunch today and buy a different thermometer cause I question this one. Not because of my temp but its a 3 second instant read and I have never felt it was accurate. Plus why not do a comparison just to make sure.


#8

Still need some help guys. I have another appointment with Dr. on Monday. I read the entire Thyroid sticky (that was long). What are my labs pointing to?


#9

I can ask for ft3 to be tested when I go to Dr. tomorrow. Other labs that I have not posted? I posted some other information. Can you look at this again and tell me what you think? I was thinking IR for a couple weeks to see if that gets temps and other things feeling better. Would you suggest starting there? Other thoughts and ideas about my situation? THANK'S!


#10

Do not expect your doctor to be concerned with your body temperatures and TSH etc. Some docs will but that is rare.

fT3 is important as if it is a good level and body temperatures are low, we can consider stress and rT3 issues.

Other listed lab items look very good.


#11

Ok so I will have them test fT3. Should I have rT3 tested now as well just to have it?

I see that stress seems to be the thing that affects adrenal fatigue. Adrenal fatigue seems to be a lifestyle change and months to try to help. Not sure if I could even get months at this point with how dead tired I am. One question I had (not that I want to do this) is how anti-depressants would factor into people that have AF? Less stress means AF should go away correct? I am not on and never have been on ssri's or anything else.

With the labs I have what do you think the path forward is? Obviously I have a low t factor but do you think that could be secondary?

I have been reading stop the thyroid madness. Should I have thyroid antibodies and some of the other things they list tested? Maybe to rule out Hasimoto?

Iodine replacement first to see if temps come up before doing anything else?

You mentioned with my T being low that E2 should be low as well. Ideas on this or where to go?

Last but not least while I am at the Dr. tomorrow, anything else I should have tested or talk about?

Thank's for all your help. I need to find some answers.


#12

From a cost factor point of view, see if iodine solves any problems. From a practical point of view, most doctors will not help. Labs after IR will be useful as they show what iodine cannot resolve. You would wait a while to let TSH normalize a IR increases TSH as a normal reflex.

Keep reading. Most of the benefits of this site are educational, providing you with knowledge to have resolve to obtain medical care and not fall prey to the ignorance of the medical community.