T Nation

Next Steps?


#1

Hoping to get an opinion on my lab work. Based on the results below my doctor is ready to put me on TRT. I asked for a LH/FSH test first and will get the results next week. Depending on the results of that test, is it worth checking anything else out before I get on TRT? Do any combination of the results below point to what the underlying issue might be, or something else I should be treating alongside low Test? Obviously, I would rather jump start my Test production rather than supplement indefinitely if possible.

My doc is on board with a T plus HCG treatment at whatever frequency I want, but I don't think an AI makes sense right now with my Estradiol so low? I expect to monitor and add an AI if gets above that optimal 22 range?

Age 34
Height 5' 10
Waist 38
Weight 185
Carry fat in my abdomen
Low libido, morning wood much less frequent, trouble concentrating. Low energy levels caused me to stop working out, which of course makes everything worse health wise. I suspect adrenal fatigue is part of the problem as well. I supplement with Rhodiola Rosea and recently got a new job in part to step out of that stressful environment.

Waking temp: 97.3 -97.7 range but I tend to get to 98.6F by the afternoon.

Labs Result (range)

Insulin 8.1 uU/mL (3 - 21.1)
Magnesium 2.1 mg/dL (1.6 - 2.6)
Uric Acid 6 mg/dL (3.5 - 7.2)
Cystatin C 0.98 mg/L (0.62 - 1.14)
C Reactive Protein-hs 2 mg/L (< 1)
Lp-Pla2 120.66 ng/mL (< 200)
GGT 25 U/L (12 - 64)

Vitamin B12 472 pg/mL (213 - 816)
Folate 9.8 ng/mL (7 - 31.4)
Homocysteine 11.8 umol/L ( < 11.4)
Vitamin D, 25-hydroxy 21 ng/mL (30 - 96)

TSH 3.03 uIU/mL (0.35 - 4.94)
fT3 3.05 pg/mL (1.71 - 3.71)
fT4 1.13 ng/dL (0.7 - 1.48)

Testosterone, Total 150.2 ng/dL (196 - 782)
Testosterone, Free 4.41 ng/dL (5.2 - 18)
Testosterone, Bioavailable 108 ng/dL (119 - 470)
Testosterone, Percentage Free 2.9% (1.5 - 3.1)

SHBG 11 nmol/L (12 - 59)
Estradiol 11 pg/mL (11 - 44)
Prolactin 9.5 ng/mL (3.46 - 19.4)
DHEA-Sulfate 327 ug/dL (168 - 592)
Cortisol 4.5 ug/dL (2.9 - 17.3)

Total PSA 0.54 ng/mL
Free PSA 0.12 ng/mL
% Free PSA 22.22%

CBC with Differential

White Blood Cell Count 7.18 K/uL (3.5 - 11)
Red Blood Cell Count 4.8 mil/uL (4.2 - 5.8)
Hemoglobin 14.5 g/dL (13 - 17.2)
Hematocrit 41.8 % (38 - 50.1)
MCV 87.1 fL (80 - 98)
MCH 30.2 pg (26 - 34)
MCHC 34.7 g/dL (32 - 36)
RDW 14 % (12 - 15.4)
Platelet Count 263 K/uL (150 - 400)
Segmented Neutrophils 56.1 % (35 - 75)
Lymphocytes 33.8 % (17 - 43)
Monocytes 7.9 % (0 - 12)
Eosinophils 1.5 % (0 - 6)
Basophils 0.7 % (0 - 2)

Comp. Metabolic Panel

Glucose 84 mg/dL (70 - 99)
Calcium 10 mg/dL (8.5 - 10.6)
BUN 21.6 mg/dL (8.4 - 25.7)
Creatinine 1.1 mg/dL (0.7 - 1.3)
BUN/Creatinine Ratio 20 (12 - 20)
Sodium 141 mmol/L (136 - 145)
Potassium 4.4 mmol/L (3.5 - 5.1)
Chloride 104 mmol/L (98 - 107)
Carbon Dioxide 26 mmol/L (22 - 31)
Protein, Total 7.7 g/dL (6.2 - 8.3)
Albumin 4.5 g/dL (3.4 - 5)
Billrubin, Total 0.4 mg/dL (0.2 - 1.2)
AST (SGOT) 22 U/L (5 - 34)
ALT (SGPT) 29 U/L (0 - 55)
Alkaline Phosphatase 70 U/L (40 - 150)

Iron Metabolism Studies

Ferritin 188 ng/mL (10 - 400)
Iron 61 ug/dL (65 - 175)
Transferrin 238 mg/dL (163 - 364)
Total Iron Binding Capacity 340 ug/dL (233 - 520)
Transferrin Saturation (%) 18% (20 - 50)

I have begun supplementing with 5000 IU of Vitamin D. I have decided to address the iron deficiency through adding more iron rich foods to my diet at this point.

Thanks for any help.


#2

Low hematocrit and low iron can sometimes be from a low level GI bleed from a digestive issue. Any food sensitivities?

C Reactive Protein-hs 2 mg/L (< 1)
– suggests inflammation from any source, including gums

Homocysteine 11.8 umol/L ( < 11.4)
– this is a problem, arterial inflammation that can lead to high blood pressure and worse over time

Your E2 is low because there is so little T to convert to E2 - T–>E2
So you can’t rule out needing an AI

TSH 3.03 uIU/mL (0.35 - 4.94)
fT3 3.05 pg/mL (1.71 - 3.71)
fT4 1.13 ng/dL (0.7 - 1.48)

Cortisol 4.5 ug/dL (2.9 - 17.3)
Done when?
You should do AM cortisol with 8AM lab work and a level of 10 would be good. Low cortisol can be from adrenal fatigue, see thyroid basics sticky.

TSH is way to high. Could be from iodine deficiency if you have not been using iodized salt.
Please check your oral body temperature when you first wake up AND ALSO mid-afternoon. Should be 97.7+ in AM and 98.6 PM.
Read the thyroid basics sticky.
rT3 may be blocking fT3 if temperatures are low. That can be from stress and/or chronic inflection/inflamation.
CBC does not indicate immune markers for infection
fT3 and fT4 are good, but rT3 can mess things up and lead to low body temperatures.

Read the advice for new guys sticky.
List all med conditions, meds, Rx and OTC, supplements etc.

Would be good to see fasting cholesterol and fasting glucose.

Many who come here have low thyroid function and low T.