T Nation

New Guy Here, Can I Have a Consult?

Here’s my story. I was diagnosed with primary Hypogonadism in April 2012 after a Total test reading of 280. Urologist started me on 200 mg Test Cyp every two weeks. After a few weeks I began feeling worse. No energy, libido, junk not working and anxiety through the roof. Told my Doc and he was unconcerned. Got Total T tested again after three months and the total came back at 186. Doc started me on 300 mg Test Cyp every two weeks. Things got worse, brain fog and everything else. Found my way here and got some education. Asked Doc if I could divide my shots up to at least weekly. No dice, “It doesn’t work that way” he said. I was guessing my E2 was probably elevated and was a big part of my problem but he refused to test for it. At my six month Total Test lab, I was up to 420 but feeling horrible. I told the Doc this again and he tossed me a script for Viagra. Still refused to test for E2 or let me self inject. On the advice of a friend, I found my way to one of those Clinics. Before I went they had the below labs done. The new Doc put me on 105 mg Test Cyp weekly divided up with .35mg E3D, HGC 250 iu E3D and 1 mg Adex a week at .25 mg EOD. Feeling a little better now but it’s only been two weeks on the new protocol. I believe I’m finally on the right track though.

Just a little more history I think is probably relevant. In January of 2011 I lost my wife of 25 years very suddenly and unexpectedly. In the two weeks after her death I lost 30 lbs, basically stress and starvation. It’s been almost two years and things are a little better but stress, anxiety and depression still rule my life. I’ve just recently started seeing a therapist so I’m working on that part. I’m not telling you guys this to garner sympathy. I’ve learned here that severe stress can cause Adrenal Fatigue so I think this bit may be relevant as you take a look at my labs.

So, I’d like you guys to take a look at my labs and the meds/supps I’m on and tell me if you see any red flags besides the obvious (FT and E2). What else should I be doing for myself to start feeling better? I’m finally trying to take control of my health care and I would really appreciate any advice you guys might have for me.

Here we go…

49 yo W/M
6’ 175 lbs
32" waist
Lots of body hair except for back. Thinning on top.
Body fat is minimal but carried in gut and love handles
Health Conditions: Hypertension, Hypogonadism, Degenerative Disc Disease with a double cervical fusion (2006).

RX and OTC:
Vitamins:
B12 1000 mcg daily
C 1000 mg daily
D3 4000 IU daily
Fish Oil 1200 mg daily
Aspirin 81 mg daily

RX (Not including TRT)

Lisinopril 20 mg daily (for hypertention/high BP)

Pravastatin 40 mg daily (I’ve now stopped this with my PCP’s blessing and we’ll see how diet and exercise works to control Cholesterol)

Trazadone 50 mg nightly for sleep

Have used topical Rogain in the past but have stopped. No prostate drugs

I try to eat pretty healthy with a good balance of proteins, carbs and veggies

Training: P90X 3-5 times a week as time allows

Testes have started aching since starting new protocol, maybe they�?�¢??re waking up? Never before.
Morning wood has come back a bit this past week and I�?�¢??ve woken to a couple of Nocturnal erections.

This one’s for you KSMAN:

Waking temps 96.8 - 97.1

Mid day temps 97.8- 98.3

Waking temps are most often in the high 96’s with a one day high of 97.1. Mid day temps are usually in the high 97’s with a one day high of 98.3. These temps were taken over the past week. Haven’t seen a “98.6”

Iodine: Recently switched to Iodized salt. No Iodine is listed in any of my vitamins.

All labs are morning and fasting.

Chemistry General

Sodium 140 mmol/l (135-140)

Potassium 4.8 mmol/l (3.5-5.0)

Chloride 104 mmol/l (99-109)

CO2 27 mmol/l (22-32)

Anion Gap 9mmol/l (5-16)

Calc Osmolality 276 mOsm/k (266-309)

Glucose 67 mg/dl (65-99)

Bun 8 mg/dl (8-25)

Creatinine 1.36 mg/dl (0.70-1.30) FLAGGED HIGH

Bun/Cre Ratio 6 (7-24) FLAGGED LOW

Calcium 8.9 mg/dl (8.5-10.2)

Total Protein 6.1 g/dl (6.1-8.4)

T Bilirubin 0.7 mg/dl (0.1-1.5)

Sgot-Ast 78 Unit/L (10-45) FLAGGED HIGH

Alk Phos 46 IU/L (35-115)

SGPT-ALT 30 Unit/L (10-65)

Albumin 3.9 g/dl (3.5-5.0)

Globulin 2.2 g/dl (1.8-3.5)

A/G Ratio 1.8 (1.1-2.2)

Calc GFR N-Blk 56 ml/min (>60) FLAGGED LOW

Lipid Evaluation:

Cholesterol 156 mg/dl (0-199)

Triglycerides 47 mg/dl (0-149)

HDL 60 mg/dl (40-90)

LDL 87 mg/dl (0-130)

LDL-HDL ratio 1.4

Cholesterol-HDL ratio 2.6

Chemistry Special:

FSH 0.4 mIU/ml (1.0-12.0)

LH >0.2 mIU/ml (2.0-12.0)

Endocrinology

TSH 0.518 uIU/ml (0.450-5.100)

Free T4 1.03 ng/dl (0.58-1.64)

Free T3 3.3 pg/ml (2.3-4.2)

DHEA S 121 ug/dl (79-440)

E2 83 pg/ml (0-56) Male

Testosterone Free 19.7 pg/ml (5.0-40.0)

Testosterone Total 463 ng/dl (291-739)

HEMOTOLOGY

HEMOGRAM

WBC 6.7 K/MCL (3.8-11.0)

RBC 4.85 M/UL (4.20-5.70)

HGB 15.8 G/DL (13.2-17.0)

HCT 47 % (39-50)

MCV 97 FL (80-100)

MCH 32.5 PG (27.0-34.0)

MCHC 33.6 G/DL (32.0-35.5)

RDW 13.4 % (11.0-15.5)

PLATELET 188 K/MCL (150-400)

DIFFERENTIAL

NEUT 70% (40-75)

LYMPH 20% (15-48)

MONO 7% (0-12)

EOS 2% (0-7)

BASO 0% (0-2)

NEUT ABS 4.7 K/MCL (1.9-7.4)

LYMPH ABS 1.4 K/MCL (1.0-3.9)

MONO ABS 0.4 K/MCL (0.0-0.8)

EOS ABS 0.2 K/MCL (0.0-0.5)

BASO ABS 0.0 K/MCL (0.0-0.1)

Sorry for the long post but I’ve tried to get it right on the first try. Thanks for looking.

OPR8R

Anything odd about your CBC?
Please add hematocrit to above via [edit]

Suspect adrenal fatigue, need AM cortisol or saliva four sample test.

  • would increase rT3
  • that can create hypo thyroid symptoms when fT3, fT3 are perfect

Cannot explain lowish TSH. Thyroid gland normal size, symmetrical and smooth [no lumps]?

http://en.wikipedia.org/wiki/Aspartate_transaminase is not liver specific. If you has sore muscles from training or bruising that would cause a high level.

E2 is crazy high. One has to suspect liver problem, or something interfering with liver function.

Cholesterol was too low. 180 is ideal

You are very estrogen dominant and that can lead to endothelial dysfunction and high BP. If you lower E2, T should increase.

Dehydrated for the labs?

You are iodine deficient. Iodized salt will not fix that. Read the “thyroid basics” sticky. Read Wilson’s book referenced in the sticky.

Were you taking CoQ10 with the statin drug? If not, you could have had a dry cough or sore muscles from induced CoQ10 deficiency.

E2=83 would be expected to depress LH and FSH, leading to low T.

Thanks KSman…

I added my Hemotology to my original post. I don’t see a CBC listed though.

I will work on getting an AM Cortisol test.

“Cannot explain lowish TSH. Thyroid gland normal size, symmetrical and smooth [no lumps]?”

I had a physical last year and the doc felt around my throat. He apparently didn’t find anything unusual.

“E2 is crazy high. One has to suspect liver problem, or something interfering with liver function.”

You might have missed in my original post that these labs are after 6 months of a bad TRT protocol with a Urologist. I was on 200 mg Cyp every two weeks for three months. My Total T dropped so the doc put me on 300 mg every two weeks. I think this horrible protocol explains my “crazy high E2” and depressed LH and FSH.

“Cholesterol was too low. 180 is ideal”

Working on that, off the statin now to try to raise it up. Never took CoQ10 when I was on the statin. No coughs or sore muscles.

“Dehydrated for the labs?”

Not sure, it’s possible.

“You are iodine deficient”

Thought so, just wanted to hear it from you before I started taking a supplement. I’ll take care of that today.

Thanks again KSman…

[quote]OPR8R wrote:

Suggestions:

Vitamins:
B12 1000 mcg daily switch to Co Enzyme B complex
C 1000 mg daily Is it time released?
D3 4000 IU daily
Fish Oil 1200 mg daily
Aspirin 81 mg daily

Other stuff to consider Mineral complex, vitamin K complex, and antioxidants. DHEA 25mg ubiquinol

RX (Not including TRT)

Lisinopril 20 mg daily (for hypertention/high BP)

Pravastatin 40 mg daily (I’ve now stopped this with my PCP’s blessing and we’ll see how diet and exercise works to control Cholesterol)

Trazadone 50 mg nightly for sleep

Have used topical Rogain in the past but have stopped. No prostate drugs

I try to eat pretty healthy with a good balance of proteins, carbs and veggies

Training: P90X 3-5 times a week as time allows

Testes have started aching since starting new protocol, maybe they�??�??�??�??�?�¢??re waking up? Never before.
Morning wood has come back a bit this past week and I�??�??�??�??�?�¢??ve woken to a couple of Nocturnal erections.

This one’s for you KSMAN:

Waking temps 96.8 - 97.1

Mid day temps 97.8- 98.3

Waking temps are most often in the high 96’s with a one day high of 97.1. Mid day temps are usually in the high 97’s with a one day high of 98.3. These temps were taken over the past week. Haven’t seen a “98.6”

Iodine: Recently switched to Iodized salt. No Iodine is listed in any of my vitamins.

All labs are morning and fasting.

Chemistry General

Sodium 140 mmol/l (135-140)

Potassium 4.8 mmol/l (3.5-5.0)

Chloride 104 mmol/l (99-109)

CO2 27 mmol/l (22-32)

Anion Gap 9mmol/l (5-16)

Calc Osmolality 276 mOsm/k (266-309)

Glucose 67 mg/dl (65-99)

Bun 8 mg/dl (8-25)

Creatinine 1.36 mg/dl (0.70-1.30) FLAGGED HIGH

Bun/Cre Ratio 6 (7-24) FLAGGED LOW

Calcium 8.9 mg/dl (8.5-10.2)

Total Protein 6.1 g/dl (6.1-8.4)

T Bilirubin 0.7 mg/dl (0.1-1.5)

Sgot-Ast 78 Unit/L (10-45) FLAGGED HIGH

Alk Phos 46 IU/L (35-115)

SGPT-ALT 30 Unit/L (10-65)

Albumin 3.9 g/dl (3.5-5.0)

Globulin 2.2 g/dl (1.8-3.5)

A/G Ratio 1.8 (1.1-2.2)

Calc GFR N-Blk 56 ml/min (>60) FLAGGED LOW

!!!Kidney function requires further investigation.

Lipid Evaluation:

Cholesterol 156 mg/dl (0-199)

Triglycerides 47 mg/dl (0-149)

HDL 60 mg/dl (40-90)

LDL 87 mg/dl (0-130)

LDL-HDL ratio 1.4

Cholesterol-HDL ratio 2.6

!!!Try to stay around 180 (optimal range)

Chemistry Special:

FSH 0.4 mIU/ml (1.0-12.0)

LH >0.2 mIU/ml (2.0-12.0)

Endocrinology

TSH 0.518 uIU/ml (0.450-5.100)

Free T4 1.03 ng/dl (0.58-1.64)

Free T3 3.3 pg/ml (2.3-4.2)

DHEA S 121 ug/dl (79-440)

E2 83 pg/ml (0-56) Male

!!!You need a full thyroid panel with antibodies to rule out hashimoto. Hashimoto can switch from the TSH from hypo to hyper at times. An thyroid ultrasound is also needed to rule out anything secreting hormones and to detect goiter more accurately.

You are DHEA deficient, supplement.

Test IGF1 as well.

Testosterone Free 19.7 pg/ml (5.0-40.0)

Testosterone Total 463 ng/dl (291-739)

!!!Test is still too low you may be hyper metabolizing T

Test vitamin D as well.

HEMOTOLOGY

HEMOGRAM

WBC 6.7 K/MCL (3.8-11.0)

RBC 4.85 M/UL (4.20-5.70)

HGB 15.8 G/DL (13.2-17.0)

HCT 47 % (39-50)

MCV 97 FL (80-100)

MCH 32.5 PG (27.0-34.0)

MCHC 33.6 G/DL (32.0-35.5)

RDW 13.4 % (11.0-15.5)

PLATELET 188 K/MCL (150-400)

DIFFERENTIAL

NEUT 70% (40-75)

LYMPH 20% (15-48)

MONO 7% (0-12)

EOS 2% (0-7)

BASO 0% (0-2)

NEUT ABS 4.7 K/MCL (1.9-7.4)

LYMPH ABS 1.4 K/MCL (1.0-3.9)

MONO ABS 0.4 K/MCL (0.0-0.8)

EOS ABS 0.2 K/MCL (0.0-0.5)

BASO ABS 0.0 K/MCL (0.0-0.1)

Sorry for the long post but I’ve tried to get it right on the first try. Thanks for looking.

OPR8R
[/quote]

Suggestions added to your quote.