New Guy Situation & Labs - Need Feedback

WildcatBlue44 · March 2, 2011, 5:28pm

Greetings. I first want to say thanks for the sharing of information and knowledge. I have read the stickys (not all in one sitting, lol) and then threads from others in an attempt to educatate myself. This whole area of HRT is not one that comes easy to me in understanding, thus I’m still a babe in the woods even though I have spent many nights reading here and elsewhere on the net.

Compared to other sites of information and/or forums in re to HRT or TRT, I will say TNATION stickys and forum threads impressed me the most. Let me say thanks again before I recite my situation. Well here goes:

49 yrs, 9 mos
71.5 inches -height
40 inches -waist
243 lbs; down from 265 in 45 days under new plan of nutrition and exercise
Hairy torso front and back & arms; facial hair from bottom of neck to under eyes; legs not near as much; male pattern baldness began early 20’s and continued for 15 years until full horseshoe bald head.

Most fat carried in waist/visceral fat;the recent weight loss predominantly from waist (some face)

For last 7 - 8 months = Low libido; low energy; diminished focus/concentration in re to work; loss of male umph or zest = positive ADAM score. Also recently found out Atherosclerotic Vascular Disease Risk = plaque in arteries; Elevated LDL cholesterol and trigs; low HDL cholesteral; no heart-related symptomatic events; history of low HDL and High Trigs.

No prescriptions; No HRT; No hair loss drugs or prostrate drugs; Within last 30 or so days started (daily & OTC) Fish Oil = 3,000 mg EPA+DHA; 10,000 IU Vit D-3 in liquid drops; 1000 mg Niacin; 150 mg Ubiquinol; 100 mg Pycnogenol; Super fruit supplement containing acai, pomegrante; goji, mangosteen, and resvertol; 5 g Fiber supplement

See Below -lab results with ranges

Diet of last 45 days is from cardiologist: no grains/cerals except flaxseed; no table sugar, no high frutcose corn syrup, no corn starch; limit fruit to 1-2 servings daily of berries, plus avocado ok for good fats; limit 1-2 servings dairy (pasture fed and low temp pastuerized); raw nuts daily; flaxseed, olive and avododa oils daily; uncured and unprocessed meats daily A-OK, but not a license for over indulgence; most veggies daily A-OK (no potatoes, no corn, etc; water, more water and no soft drinks or fruit juices; Glass of red wine daily or raw cocoa.

Prior to the past 45 days would describe as Sumo wrestler diet, i.e., skip breakfast except for coffee, moderate lunch and heavy late supper, i.e., High amount of processed foods along with high carbs and high fats-

Currently 1 hour of cardio (walking like late to meeting) 6 days a week

Problem area = right testicle is currently shrinking and progressing upward in scrotum = showing signs of atrophy; left testicle full sized and descended fully in scrotum; some discomfort noticeable on occasion from area of right testicle, but would not classify as pain; not aware of with fever. Please note, had surgery at age 3 for right inguinal hernia repair (right testicle not properly descending)

Frequency and hardness of morning wood and nocturnal erections has diminished, but not eliminated, i.e., still frequently wake-up early morning/middle of night with erection and then desire to urinate, just not daily and not fully rigid erection as in past.

Additional info of note = started noticing lowered libido and diminshed sexual performance 7 - 8 months ago. In reflection, same time period shows reduced energy and ability to focus long hours at work = work performance diminished as well. Also same time period that I started noticing that right testicle always looked less descended compared to left testicle.

During this same time period I occasionally took an herbal product containg such things as Tribulas, Maca, Muira Puma, Tongat Ali, Catuba, Avena Sativa, etc., but not Yohimbe. Also on occasion wore contraption known as ball zinger (blakoe ring). Taken in an effort to increase libido. Did notice somewhat of a positive effect on libido and sexual performance, but did not take herbal supplements consistently because of not knowing their true content of ingredients and also seemed to be diminishing effect with continuous use.

Over last 50 days or so, have intentionally not taken any of the herbal supplements that increase libido, and have not worn the ball zinger ring. I refrained from doing so in order to get un-supplemented blood test results for TT and FT. During this last 50 days or so of no supplementation, I have noticed an acceleration in diminishing size of my right testicle along with the appearance of being even less descended.

Based on this information, I believe it possible that either the sporadic use of the herbal supplements and/or ball zinger did have somewhat of a positive effect on the health/appearance/functionality of right testicle. I can also say that they also had a positive effect on morning wood/nocturnal erections.

I am just in the beginning stage with a wellness doctor who has some HRT/TRT experience, is open-minded and receptive to my input, and posseses healthy self-esteem and not an oversized ego. The Male Hormone blood test results arrived and were jointly reviewed on 2/28.

No HRT/TRT started or strategy developed. In temporary holding pattern in order to develop proper strategy. I would seriously consider bringing in an outside doctor with extensive HRT/TRT experience in a consultant/advisor role. My take is the my wellness GP would not be offended and would be receptive.

Whew, the above sure was lengthy…is anyone still reading? Well, if so, onto the lab results (from mid-morning blood draw on 2/21/11 unless noted otherwise) with lab range:

TT = 320 ng/dL 249 - 836
FT = 6.9 pg/mL 6.8 - 21.5
DHT = 24 ng/dL 30 - 85
LH = 8.0 mIU/mL 1.7 - 8.6
FSH = 12.2 mIU/mL 1.5 - 12.4
E2 = 39.5 pg/mL 7.6 - 42.6 (Roche ECLIA Methodology)
SHBG = 21.8 nmol/L 14.5 - 48.4
Prolactin = 5.7 ng/mL 4.0 - 15.2
DHEA-S = 472.3 ug/mL 44.3 - 331.0
IGF-1 = 149 ng/mL 94 - 252

TSH = 1.010 uIU/mL 0.450 - 4.50
FT3 = 2.5 pg/mL 2.0 - 4.4
FT4 = 1.54 ng/dL 0.82 - 1.77

Homocyst(e)ine = 9.6 umoI/L 0.0 - 15.0
Insulin = 8.1 uIU/mL 0.0 - 24.9
HemoA1c = 5.7% 4.8 - 5.6
Fasting Glucose = 91 mg/dL 65 - 99
Creatine Kinase = 116 U/L 24 - 204

PSA = 0.6 ng/mL 0.0 - 4.0
CEA = 1.2 ng/mL 0.0 - 4.7
DRE = Negative

Magnesium = 2.2 mg/dL 1.6 - 2.6
Vit D 25 Hydxy (taken on 1/31 prior to starting Vit D-3 supplementation) = 17 ng/mL 32 - 100

ALP = 56 IU/L 25 - 150
AST = 18 IU/L 0 - 40
ALT = 34 IU/L 0 - 55

Next secion will show improvement from three weeks of Fish Oil, Niacin, diet, exercise, etc.

Total Cholesterol = 188 mg/dL 100 - 199
HDL-C = 32 (previously 27) > 39
Trigs = 164 (previously >300) <150
LDL-Calculated = 123 (previously 160+) <100
VLDL = 33 5 - 40
Lp(a) = 2 <30
CRP Cardiac = 2.72 0.0 - 3.0

WBC 7.4 x10E3/uL 4.0-10.5
RBC 5.45 x10E6/uL 4.10-5.60 01 (historically high end of range)
Hemoglobin 16.2 g/dL 12.5-17.0 (historically high end of range)
Hematocrit 49.2 % 36.0-50.0 (historically high end of range)
MCV 90 fL 80-98
MCH 29.7 pg 27.0-34.0
MCHC 32.9 g/dL 32.0-36.0
RDW 14.3 % 11.7-15.0
Platelets 264 x10E3/uL 140-415
Neutrophils 56 % 40-74
Lymphs 31 % 14-46
Monocytes 9 % 4-13
Eos 3 % 0-7
Basos 1 % 0-3
Neutrophils (Absolute) 4.1 x10E3/uL 1.8-7.8
Lymphs (Absolute) 2.3 x10E3/uL 0.7-4.5
Monocytes(Absolute) 0.7 x10E3/uL 0.1-1.0
Eos (Absolute) 0.2 x10E3/uL 0.0-0.4
Baso (Absolute) 0.1 x10E3/uL 0.0-0.2

BUN 12 mg/dL 6-24
Creatinine, Serum 1.10 mg/dL 0.76-1.27
eGFR >59 mL/min/1.73 >59
BUN/Creatinine Ratio 11 9-20
Sodium, Serum 143 mmol/L 135-145
Potassium, Serum 5.1 mmol/L 3.5-5.2
Chloride, Serum 104 mmol/L 97-108
Carbon Dioxide, Total 22 mmol/L 20-32
Calcium, Serum 9.2 mg/dL 8.7-10.2
Protein, Total, Serum 6.5 g/dL 6.0-8.5
Albumin, Serum 4.4 g/dL 3.5-5.5
Globulin, Total 2.1 g/dL 1.5-4.5
A/G Ratio 2.1 1.1-2.5
Bilirubin, Total 0.4 mg/dL 0.0-1.2

Urinalysis = 3+ for Occult Blood ( Hematuria = blood in urine), RBC = >30 and 2+ for Ketones; all other tests in urinalysis A OK with expected outcome/range. As a result of this new information, have appointment at radiology center for xray/scan.

Wow, that’s alot! I apologize for the overload of info, but thought it best to put it all on the table.

I am comfortable with the steps already begun to reduce cardiovascular risk and reduction of elevated cholesterol. I immediately scheduled for next week the xray/scan related to finding traces of blood in my urine.

But I am clueless on what to do or try in re to my lack of libido, loss of male umph, diminished sexual peformance and diminished work performance. While my TT and FT fell within lab range, based on my readoing here and elsewhere they are more in-line for a guy in his 80’s instead of 49.

I also want to provide the following: On 1/11/2011 I walked into a urgent health care clinic and asked for a CBC, Compr Met, Basic Lipids, TT & FT. I didn’t know what I was doing as far as getting the right labs, etc., but I did know that in the last 6 - 7 months my performance in the bedroom and the boardroom had taken a sharp turn downward.

The Lipid panel results led to my seeking out a wellness doctor who concentrates on reducing/managing cardiac risk. Come to find out, he also has some (but not extensive) experience in TRT/HRT. Oh, here are the TT and FT #'s from that 1/11/2011 blood draw (afternoon):

TT = 174 ng/dL 249 - 836
FT = 6.6 pg/mL 6.8 - 21.5

I figure the improvement shown in from the 2/21 blood draw is attributable to: 10:00 am vs. 1:30 pm blood draw; weight loss (belly) of 20+ lbs; exercise and better nutrition. While 2/21 TT and FT shows improvement, still significantly low for age 49.

Any suggestions or opinions on where to begin given my labs, symptoms, etc.? I’m hoping to try something prior to bringing-on extragenous Test in order to stimulate my testicles with particular attention to the right testicle to prevent it from going on a permanent vacation.

Given my LH and FSH readings, I’m not sure if starting off with hCG will provide helpful, although that it where I’d like to start along with taking an AI. My first objective is to see if I can get the right testicle to respond so that it stops shrinking and descends more, while at the same time producing more TT that is converted to more FT.

Any thoughts, recommendations of next steps, contact info for potential consulting physician with extensive HRT/TRT experience, etc. is very much appreciated. I don’t understand all this stuff, and as I previously mentioned, it is difficult for me to gain a full understanding. I want to learn more and I’m willing to put in the hours to do so.

I want to express a heartfelt thanks to any and all who respond—as you can probably guess, I’m quite concerned and a little frightened by the prospect of the continuing accelerated decline of my performance at work, in the bedroom, etc. I really don’t want to feel 80+ years old thirty years too soon.

I will keep a running history here of my progress (I have to be optimistic) so that maybe someone else can learn and to give back to the TNATION community—thanks again!

Edit to add that for a few weeks prior to my 2/21 blood draw, I have been taking a Male Focused Multi-Vitamin called Men’s Life Force from Source Naturals. My new wellness Doctor liked my above lab range DHEA-S results and was curious if the male focused multi-vitamin/supplement contained any. I’ve read the label, and while it does contain some ingredients that target male vitality, I didn’t see any DHEA specifically.

KSman · March 2, 2011, 6:31pm

You appear to have primary hypogonadism. It would be interesting to see if hCG would do something about size and hanging - to confirm or refute this. I do agree with your thought that hCG is not going to be a solution.

Your fT3 is low. You would appear to be not converting T4-T3 very well. Ask your doc for a trial of T3 only and note changes. You need to check waking body temperatures and report here. Doc examined your thyroid? every feel cold easily?

How do you react to stress? Wheat are your energy levels like and how that varies through the day?

Some here will say that you need to find and fix underlying issues. But with primary hypogonadism, fixing other things will not fix the hypogonadism. In that situation, there is no option other than TRT.

Your high hematocrit is a concern with prospective TRT.

Were you dehydrated for the lab work?

E2 is high. Relative to your FT, you are very estrogen dominant. That is not expected in your situation as there is so little FT for T–>E2 aromatization. One likely explanation is that your high DHEA is creating a lot of E2 in your adrenal glands. We could suspect that the high DHEA levels are supported by high pregnenolone levels. But that would be unexpected as well. You should test DHEA-S, TT, FT, E2, LH/FSH later on with only standard vitamins. We do not want to make conclusions based on aberrations. Suggest rT3 and morning cortisol testing as well.

Improve endothelial function and HDL with a high potency vit-B complex multi vitamin with trace minerals.

Drexel · March 2, 2011, 9:20pm

I have nothing substantive to add, just that coming from a cardiologist, that is a shockingly sensible diet recommendation. Most of them are stuck in the whole-grains-chicken-breast-and-no-fat-ever 1980s, and (ab)use statins to deal with the results. I wish my dad’s cardiologist had that much clue.

WildcatBlue44 · March 3, 2011, 3:42am

KSman, thank you very much for your reply and insight—much appreciated.

Even though it doesn’t appear that starting out with hCG monotherapy or with an AI will be the solution, would you lean toward giving it try? Because I believe there has been an acceleartion in shrinkage of the right testicle that corresponds with the timing of my discontinuing any use of the herbal supplements and ball zinger device, I’m thinking (or maybe better classified as hoping) that combining hCG with some of the herbal supplements and an AI might offer some benefit. It’s kind of like you put it—it would be interesting to see if there is any response—and I guess I’ll never now if I don’t try.

As to thyroid, my new wellness doc commented that based on the blood test results that my thyroid looked fine. I don’t recall ever feeling cold easily, and I tend to like the a/c colder than most people or less heat when it’s cold. I’ve never checked my waking temp, so I guess I need to go to CVS or Walgreens and buy a temp meter? I will also follow-up in re to my thyroid results tomorrow with the cardiologist that I’m using as a consultant. He is more forward thinking when it comes to thyroid issues when results fall within the lab range.

I am currently not responding well to stress, i.e., I am not always able to concentrate and stay focused on the task at hand at work. I have what most deem to be one of the more stressful occupations. I have felt quite a bit of stress over the past 7 - 9 months that I referred to above, be it work related or with a now ex-girlfriend. I unfortunately can freeze-up at times and just not take calls or respond to emails for a day. Of course, this only causes more stress. I then fight through it by trying to put out fires so to speak, but it is a struggle to keep up at times.

My energy levels have improved and are more consistent throughout the day now. I can see an improvement that correlates with the change in nutrition/diet, weight loss, exercise and Vit D-3 supplementation. While I am not my old self yet and stress is still a problem, there has been somewhat of a positive upswing in overall energy.

I appreciate your frankness in re to there being no option other than TRT given primary hypogonadism. I guess I’d still like to try a thing or two first in an effort to stimulate the right testicle. I just don’t know what other than hCG, herbs/zinc and an AI. I also have a concern that jumping straight into TRT will make the left testicle want to go on vacation.

I don’t believe I was dehydrated at the time of blood draw. My red blood count, hemoglobin and hematocrit have been at the high end of lab range for at least the last 6 or 7 years (prior to that I really did not pay attention because I wasn’t actually given my test results). The 2/21 readings are actually an improvement from the 1/11 CBC, as hematocrit was 49.9 then and hemoglobin was 16.9. I informed my new wellness doc of such at our first meeting and of my being aware of the most common side effect of TRT being increased red blood cells. He acknowledged and indicated that, yes, we’d have to closely monitor and I’d go to a phlebotomist when too high.

Yes, from your stickys I know that E2 is too high and that in the low 20’s should be my target range (or under 30). But without producing more T or bringing in T, would an AI, or Indol-3-Carbinol do me much good (more FT)? My doc didn’t test for pregenolone, progesterone or cortisol. I see you mention testing for morning cortisol and I’ve read about 4-times a day saliva testing of cortisol. Anything else besides morning cortisol and rT3 that would be helpful at this time?

Any high potency vit-B complex multi’s with trace minerals brand names you are able to toss out? Also, while I am comfortable with my new doc in that he’s onboard with my TT and FT being a problem even though they fall within lab range (for example he gave me ideal ranges for E2 of 20 - 30 and 15 - 30 for FT), I’m still thinking both he and I could benefit from a consulting doctor with more extensive experience. Any thoughts?

Thanks again!

WildcatBlue44 · March 3, 2011, 3:34am

Drexel, I appreciate your reply—thanks. The cardiologist is very forward thinking, a doctor who doesn’t stand still in time when advising his patients. I actually just found him on the net last month and came to the conclusion that he was a perfect fit as a consulting doctor (he’s out-of-state). He recognizes that prevention is better medicine than an angioplasy, stent or bypass…and that prescribing a statin isn’t the only prevention tool in the toolbox.

Similarly, I’m thinking I would benefit from finding a doctor who has extensive experience in HRT/TRT that does consulting work for out-of-state clients. I just don’t want to jump right into starting TRT/HRT without thoughtful consideration to various ideas, especially from those with considerable practical experience.

Thanks again.

KSman · March 3, 2011, 5:30am

You can do a trial of 250iu hCG for 80 days, 10,000iu will do that. If your testes do not improve in size or hang differently that is a negative result. If things get better and/or you feel better, that opens up possibilities, even if not viable as a mono therapy.

FT3=2.5 Many would expect that this is a problem and you would function better around FT3=3.1

From what you have stated, you could have adrenal fatigue and perhaps the 4 sample saliva test is warranted.

If cortisol is low. rT3 could be up and your effective fT3 can be lower than it appears. Waking body temps will help with this speculation.

Read this, fits with high RBC and hematocrit:

and
http://en.citizendium.org/wiki/Hemochromatosis

Note that it can cause testicular failure.
Fits with unexpected low T and high hematocrit

Need serum ferritin lab data!!!

Review your iron intake, red meat, fortified bread and cereals, rusting water pipes, vitamins. You may need to take action and blood donations or phlebotomy may be vital if this is the case.

Note the greatest news if true, but then one can take corrective action.

KSman · March 3, 2011, 5:33am