T Nation

Opinion on Lab Work to Date - Low Test

Hey guys,

I read through some of the stickies but wanted to bounce some of my results and current treatment options I’m having done right now and make sure i’m not missing something. Hopefully this is concise enough.

Age - 31
Height - 5’9"
Weight - 187 lbs
Waist Size - 34-35"

Body & Facial Hair - Have normal hairiness and a full beard.

Testes Ache or Hurt - No.

Mood - Slight depression but not terrible.

Libido - Normal.

No body temperature issues - I’ll do the thermometer testing when I get back off of the rig.

No brittle nails or skin issues.

When my problems started, I had been on Finasteride for hair loss at 1mg daily for almost 9 months. I quit taking this 2 years ago and did not see any changes when coming off of it (for better or worse).

Symptoms: Started in 2014 with me gaining weight from 160 lbs to 185 lbs (pretty much all fat and I’m 5’9’’).
Noticed I was having a lot of trouble getting up in the mornings to go to work - even after sleeping all night. I started to lose my drive to get up off the couch and now I’ll sit at home a lot of my days off from work and watch a ton of TV. I get a lot more tired early in the evenings and do not stay out very late any more. Hangovers are a complete nightmare. Libido is reasonable and performance is normal - not changes in that. Do not feel like I have a serious problem building muscle while lifting.

Lab Results History: I started getting blood work thinking something was off back in 2015 and everything came up “normal” the entire time and everyone just said I was getting older (I am now 31). Finally this year they said I have low testosterone and referred me to a urologist who confirmed with blood work. Now to the numbers with tests (in chronological order):

Thyroid Peroxidase (TPO) Ab: 10 / Ref (0-34)
ThyroGlobulin Ab: <1.0 / Ref (0.0 - 0.9)
TSH: 2.360 / Ref (0.450-4.500)
Cortisol: 16.1 / Ref (2.3 - 19.4)
Serum Testosterone: 366 / Ref (348 - 1,197)
Free Testosterone (Direct): 19.1 / Ref (9.3-26.5)
Vitamin D was flagged as low - started 50,000 IU weekly for 6 weeks
Note these measurements were when I was lifting and doing cardio 5-6 times a week and at 172 lbs (~17% body fat).

TSH: 3.761 / Ref (0.550 - 4.780)

Serum Testosterone: 368 / Ref (348-1,197)
Free Testosterone: 7.95 / Ref (5 - 21)
TSH: 2.87 / Ref (0.450 - 4.500)
T4 Free (Direct): 1.14 / Ref (0.82 - 1.77)

Serum Testosterone: 247 / Ref (240 - 871)
TSH: 1.164 / Ref (0.450 - 4.500)
T3 Free: 2.7 / Ref (2.3 - 4.2)
T4 Free: 1.21 / Ref (0.8 - 1.79)
T4: 7.4 / Ref (4.5 - 10.9)
ThyroPeroxidase Ab: 17 / Ref ( <35)
ThryoGlobolun Ab: <20 / Ref ( <40)

Serum Testosterone: 279 / Ref ( 348 - 1,197)
Estradiol: 24 / Ref (7.6 - 42.6)
Prolactin: 7.7 / Ref (4.0 - 15.2)
Varicocele confirmed with ultrasound and some shrinkage of the left testicle - flagged as abnormal small on the left side and normal on the right.

Right now, I have started 25 mg clomid EOD and have completed my second week. I gained 10 lbs of pure fat and haven’t noticed any differences yet - i’ll be going back for blood work in two more weeks. I am scheduled to have a varicocelectomy next month when I get off of work to try and take care of that. The studies I have read said that on average men with lower testosterone that had the varicocelectomy had their total testosterone increase by 178 points on average.

I do know that I am missing FH/LSH (found this website only last week) and not sure why they weren’t ordered by my doc before starting the clomid.

Do any of you have any additional insights into the symptoms I’m seeing coincide with the blood work or does it look very likely low testosterone could be the sole contributor here?

Thanks very much in advance.

On clomid, test:
LH/FSH - need to see that clomid is working

TSH was horrible, should be close to 1.0
Could have been from iodine deficiency from not using iodized salt and/or vitamins not listing iodine+selenium.
Please provide history of using iodize salt.

Low thyroid function leads to low energy and weight gain.
Thyroid lab ranges are mostly useless and all kinds of ‘normal’ people are suffering.

Why was TSH lower 5/31/2017?
Were you getting iodine?
Is thyroid enlarged, lumpy, sore?
Feeling cold easier?
Outer eyebrows sparse?

fT3 and fT4 should be mid-range or a bit higher.

Eval your overall thyroid via oral body temps as below

You doctor is a bit lame not testing LH/FSH. We can assume that these could be elevated from the varicocele, but we do often here see guys who are primary and secondary.

Many need 5000iu/day Vit-D3

FT not tested
Serum E2 is a balance of FT–>E2 production and E2 clearance in the liver. E2 is quite high VS TT and FT–>E2 might be low suggesting low live clearance rates.

Have you any AST/ALT liver tests?

Please also post: as available:

  • fasting cholesterol,
  • fasting glucsose
  • RBC
  • total proteins
  • hematocrit

Please read the stickies found here: About the T Replacement Category

  • 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.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

Thanks for the response. I have no idea why the TSH is fluctuating so much between the tests. I initially suspected Thyroid as my mother had Hashimoto’s around the same age as me (she also has diabetes and sleep apnea, most likely a result of the thyroid issue and weight gain). The 3.7 number is pretty high but the latest at 1.164 actually looks pretty decent (Free T4 looks good and maybe Free T3 is a little on the lighter side, but doesn’t look too overwhelming). I didn’t do anything different between the two that I know of and have no intentional history of using any special salts or taking any selenium specifically. I’ll try your advice on the iodized salt and selenium that I saw in some of the threads. I also do not have any enlarged thyroid, painful thyroid, or feeling cold easier. Outer eyebrows also are about normal - so no obvious symptoms of thyroid specifically.

I will ask for FSH/LH for the next round of bloodwork while I’m on clomid and ask them to take a Free Testosterone measurement as well. I find it odd that while I have the same serum levels on the first two tests of testosterone (366 and 368) the free T changed from 19.1 to 7.95. I wonder if this has to do with lab measurement errors.

After I get this varicocele checked out and get a little further down the line, I’ll have another repeat round of TSH, Free T, and other things checked out as well as these tests. Here are the most recent of the other labs you requested that I left out.

RBC: 5.2 / Ref (4.5 - 5.9)
Hematocrit: 46.6 / Ref (41 - 53)
Proteins, Total: 7.2 / Ref (5.7 - 8.2)
ALT: 23 / Ref (10-49)
AST: 24 / Ref (0 - 33)
Hemoglobin A1C w/ estimated average glucose: 5.0 / Ref (< 5.7)
Estimated Average Glucose: 96.8
Glucose, Random: 76 / Ref (70 - 140)
I do not have a fasting cholesterol, but here is what they did take:
Triglycerides: 124 / Ref (<150)
HDL: 56 / Ref (>40)
LDL: 93 / Ref (<100)

I have kind of wondered about the finasteride use during the time that this stuff started happening. I do not have any serious sexual dysfunction that I can tell from it and did not observe a noticeable crash as many do after stopping taking it, but it did look like a gradual slow down of my system over the year and a half that I took it. Any thoughts or prognosis on that?

It is impossible to say how things will progress for any given individual.

Body temperatures are still needed, both AM and mid-afternoon.

Ask your mom if she used iodized salt and how much.

Those other labs look good.

You need TRT. Blood work for LH/FSH is next step. “Next round of labs” sounds very passive. You need to steer this ship.

Updated lab work / storyline below:

Took the clomid 0.25 EOD for the past 6 weeks or so now. On the first couple of days I took it, I had a lot more energy, stopped sleeping so much, and thought I was starting to drop a few pounds. After the first week though, I started ballooning up pretty fast and gained about 15 lbs of body fat and water weight (definitely some of both). I also started to get even more tired than I was before starting the clomid. I did notice that my testicles seemed to be getting bigger though.

Lab work taken on 8/10/2017:

Testosterone, Serum: 573 (348 - 1,197)
Testosterone, Free: 20.7 (8.7 - 25.1)
Estradiol: 46.2 (7.6 - 42.6)
LH: 9.5 (1.7 - 8.6)
FSH: 7.7 (1.5 - 12.4)
TSH: 2.01 (0.45 - 4.5)

I also had the varicocele repaired last week and let’s just say while it’s not the worst surgery i’ve ever had, it is super uncomfortable carrying around a swollen baseball in my pants all days.

After this blood work came back, I was prescribed 1 mg arimidex per week to try and keep the estradiol levels in the 20s.

Any additional thoughts on my experience with the clomid or the recent lab work @ksman?

Alright guys, figured i’d go ahead and post an update. I had my varicocelectomy about 3 weeks ago and everything went alright with that. It’s definitely an uncomfortable procedure to have for about 2 weeks afterwards (my left testicle swelled up to the size of a tennis ball) but all is back to normal now.

I ended up dropping my dose of clomid down to 12.5 mg three times a week and that got rid of the exhaustion i was experiencing. The swelling hasn’t really subsided in my love handles yet (note, extra body fat). I have intermittently started feeling better again after dropping the dose and there must be a sweet spot with the clomid for me at a lower dosage - we’ll see. Got new labs yesterday but they won’t be available for another week. I also have been taking 0.5 mg anastrazole two times a week to try and get the E2 back down.

@KSman I took some body temperatures yesterday and wonder if the thermometer i’m using is off, but here’s what I’m getting:

  1. AM body temperature: 96.0 F
  2. PM body temperature: 97.3 F

Another update with more lab work taken 09/06/2017
This was while taking 12.5 mg clomid 3x per week with 1 mg anastrazole per week. Based on the results I’m going to drop the the clomid to 12.5 once per week and take 0.5 mg anastrazole twice as we week and retest. I really want to get the E2 down. I asked for SHGB but they didn’t do it. I’m guessing based on the free testosterone number SHGB is low.

I’m also going To an integrative physician to take a look at my elevated TSH levels and lower quartile free t3 levels. Note the labs are retarded and order d total t3 instead of free on this last round again.

  1. total testosterone: 802 (348-1,147)
  2. e2: 48.9 (<42.6) HIGH
  3. free testosterone 33.9 (8-25)
  4. TSH 2.6 (0.5-4.5)
  5. LH 17.2 HIGH
  6. FSH 11.0 HIGH

nice jump in total test.

So I decided to taper off of the clomid slowly while taking anastrazole over the span of a couple of weeks. Redid blood work after tapering 37.5 mg/week to 25 mg/week to 12.5 mg/week all with anastrazole. I did not continue the anastrazole afterwards as I just realized the stickies recommended.

Definitely noticed my testes already seem less plump than they did while I was on the clomid. Will continue updating this thread as I continue to move through everything.

New blood work to come next week. Since I’m not really feeling any better consistently during/after the clomid, even with a pretty good rise in Test, I’m seeing a doctor about trying to bump my T3 (after confirming that I am in fact in the lower quartile for Free T3 (2.7)).

Your E2 is high because of high LH/FSH induced by Clomid.
T–>E2 in the testes is high and competitive drug anastrozole does not work inside the testes because intratesticular T levels can be up to ~100 times serum levels.

You cannot take anastrozole once a week.

Your doctor does not know that. This a very common problem discussed in the stickies. Also see the HPTA restart sticky.

fT3 was low, low body temperatures expected.
You can see if someone else can hit 98.6F during afternoon to have confidence in the thermometer. Avoid walking, talking, eating and drinking for 30 minutes.

TSH still high. Large dose iodine can make TSH high and then TSH labs have no value.

Describe what you are doing for iodine and selenium and how body temps have changed. Read all of the thyroid basics sticky.

Hi @KSman, I did go back to the doctor after I found out the Anastrazole had a 46 hour half life and told him I was breaking the doses up throughout the week. I also bumped the dosage up to 1mg, 2x per week and took at the same time as the clomid. I still wasn’t feeling all that hot and decided to come off while I went a different approach. I may (only may) consider trying nolvadex after I give the Thyroid stuff another run at a more moderate dose to try and keep E2 in check. It’s possible I may just go to TRT after the clomid comes out of my system and I see how the varicocelectomy turned out.

I took your advice about a month and a half ago and have been supplementing thyroid with the following:

  1. 150 mcg Iodine daily.
  2. 200 mg selenium daily.
  3. L-Tyrosine 250 mg daily.

I also noticed that my temperatures have been closer to optimum since I dropped the clomid (have physically felt warmer) and I have been losing weight despite any change in diet or exercise during the same period. I will continue monitoring the temperatures.

I’ll keep an eye on it and continue reporting back.

I do not know of any such connection.

Worded that sentence strangely, going to try Thyroid meds first to get FT3 in upper quartile and then once I get that done, if I’m still having issues, I’ll give the nolvadex or TRT another run at a lower dose and see if I can keep E2 in check.

Had some new labs run and here are the basic findings… still been feeling blah. Discontinued clomid.

  1. Low Total T4 (5.2 [6.0-10.0]) - added 50 mcg of levothyroxine and will continue monitoring.
  2. Total Testosterone was 592 (348-1,148).
  3. E2 was 26 (0.0-42.6)
  4. 55.9% on hematocrit - does this sound odd that my hematocrit would skyrocket on clomid only? Do I need to do anything about this? @KSman