Please Help Me Make Sense of These Labs - 58Y/O

Sorry… I think I’ve driven away some by my long message before the labs and specific info about me. I’ll reverse that now and hopefully it will make a difference.

Here are some details and my labs:

AGE: 58
HEIGHT : 6’0
WAIST : 38" (2 years ago 34")
WEIGHT : 198lbs (should be 175)
Note: although I don’t look “fat”, my BMI has
measured at around 27 as I recall…due to the
flabby subcutaneous fat layer that I have in my
torso and belly.

body hair normal (hairy back & chest),
head hair almost bald for the past 20 years
(notable: in the last year since being off
TRT, I’ve noticed that the sparse hair
that i DO have on my head has become even thinner…
meaning less follicles per square inch
(don’t know how I can tell, I just can))
eyebrow hair used to be pretty normal, started getting
really thin some years ago and then, when I went off
TRT, my eyebrows got super thin… like i’ve lost
many follicles there too. I mean ridiculously thin…
almost nonexistant.
facial hair… I guess normal. Have a beard that hasn’t
really changed (other than color) in 30

My worst fat is from my armpits to my beltline. Subcutaneous, not visceral.
Pretty strong abs, but you’d never know it because I’m plagued with this subcutaneous
jiggly fat on the torso and worst at the belly above the beltline.
Arms, shoulders pretty slender and strong.
Below the beltline, gluts-thighs-calfs good muscle and strong. Actually have
some definition there.

Never really get sick but have a few conditions: ADD,
sleep issues, psoriasis, acne, gastrointestinal issues.
Typically have high cholesterol (280, hereditary) but recently
tried 2 spaced courses of Cardarine hoping for fat loss and
my lipid scores ended up dropping thru the floor.
My typical resting heart rate= 68bpm Typical blood pressure reading:
75-83/120-125. Digital rectal always negative.

Currently, TCyp 100mg/week + 1mg Anastrozole/week (split doses)
12.5mg Progesterone cream applied nightly
No hair loss or prostate drugs ever.
Dextroamphetamine 10mg/day (for ADD diagnosed 1995)…I suspect this is a culprit here.
Trazadone 150 mg nightly for sleep,
Famotidine 40mg 2x/day for GI issues,
ibuprophen occaisionally,
daily multi-vit,
daily turmeric/curcurmin 1200mg.

DESCRIBE DIET [some create substantial damage with starvation diets]
Never went on starvation diets or YOYO diets, but am bad about eating
multiple small meals during the day due to the ADD meds that I take in the morning blowing my
appetite, plus the caffeine (coffee or tea). Sometimes I’ll have eggs and avocados for breakfast…irregular.
I have a good balanced dinner with protein, fats and carbs balanced. Gave
up alcohol about 6 months ago. Occasionally will have a few cocktails
when out at dinner. Tried gluten free in the past (never really made
me feel any better and didn’t clear up my skin), also tried KETO for
about 4 months recently. Initially lost some weight, then gained it back and
now it seems like I can’t shed any weight. Recently switched from coffee to green tea.
I certainly consume more sugar than I should.

DESCRIBE TRAINING [some ruin their hormones by over training]
5-6 days @60min / week HIIT (cycling and weights). Most of every
training session my heartrate is 150+ (without getting winded…
another benefit of Cardarine)

only a few times ever, mild, since being on TRT. Never with a fever.

Good wood when I was on TRT before. That was all but eliminated
in the last year since I went off TRT. Now it seems to be returning,
nocturnal and morning.

I’ve been monitoring my body temp when I wake and mid afternoon.
They are typically (on average) 97.2 waking and 98.3-98.6 by
mid afternoon.

NOTE: After starting with the Clomiphene again, I started to experience
paresthesia…very hot feet at night in bed that made me very
restless and could not sleep. So as recommended, I donated blood because
I suspected that my hematocrit levels were high. I also began taking
about 100mg daily aspirin before bed. So, of note here is that
the blood labs below were taken about 6 weeks after a blood donation.
I don’t know if that would have an effect, but some of the
labs are pretty screwy, like very high SHBG and out of range readings
for White Cell Count, Red Cell Count, Hemoglobin, BUN, TSH, FSH.

LABS 4/30/2018:

Test, total 713 (300-890ng/dL)
Test, Bio 226 (131-682 ng/dl)
Test, Free, Calc 75 (47-244 pg/ml)
Test, Free % 1.0% (1.6 - 2.9%)
SHBG 82 (11-80 nmol/L)
Q: will taking the TCyp naturally reduce the SHBG or do I need to
get Rx Danazol? Obviously my T is completely bound up.

Estradiol 13 (11 - 44 pg/ml)
Note: this lab has had it’s standard range changed in the
past few years. It used to be <75 pg/ml

LH 11.8 (0.6 - 12.1 mIU/mL)
FSH 12.2 (1.0 - 12.0 mIU/mL)
Progesterone 0.4 (0.0 - 0.2 ng/mL)
Androstenedione 0.651 (0.230 - 0.890 ng/mL)
IGF-1 144 (56 - 203 ng/mL)
DHT 592 (106 - 719 pg/mL)
DHEA Sulfate 256 (70 - 310 ug/dL)
Cortisol, Saliva, Midnight
63 (<100 ng/dL)
PSA Total, Diagnostic with Reflex to Free PSA
0.70 (0.00 - 4.00 ng/mL)
Prolactin 6.9 (3.5 - 19.4 ng/mL)
Homocysteine 13.0 (0.0 - 15.4 umol/L)

T3, Free 2.7 (1.7 - 3.7 pg/mL)
T4, Free 0.93 (0.70 - 1.48 ng/dL)
T4, Total 6.3 (4.9 - 11.7 ug/dL)
T3, Reverse 18.7 (9.0 - 27.0 ng/dL)
TSH 5.20 (0.35 - 4.94 uIU/mL)

CBC without Differential:
White Cell Count 2.9 (3.8 - 10.5 K/uL)
Red Cell Count 4.3 (4.4 - 5.8 M/uL)
Hemoglobin 13.4 (13.6 - 17.2 g/dL)
Hematocrit 41% (40 - 52%)
MCV 96 (80 - 97 fL)
MCHC 33 (32 - 36 g/dL)
RDW 13.5% (11.7 - 14.7%)
Platelet Count 245 (160 - 370 K/uL)
MPV 10.0 (7.4 - 10.4 fL)

Comprehensive Metabolic Panel:
Glucose 96 (70 - 99 mg/dL)
Creatinine 1.05 (0.73 - 1.18 mg/dL)
e-GFR 78 (60 - 120 mL/min/1.73 sqm)
BUN 21 (9 - 20 mg/dL)
Protein, Total 8.0 (6.4 - 8.3 g/dL)
Albumin 4.6 (3.5 - 5.0 g/dL)
Sodium 141 (136 - 145 mmol/L)
Potassium 4.4 (3.5 - 5.1 mmol/L)
Chloride 106 (98 - 107 mmol/L)
Carbon Dioxide 26 (22 - 29 mmol/L)
Anion Gap 9 (7 - 14 mmol/L)
Calcium 9.2 (8.4 - 10.2 mg/dL)
Bilirubin, Total 0.5 (0.0 - 1.4 mg/dL)
AST/SGOT 26 (5 - 34 U/L)
ALT/SGPT 23 (0 - 55 U/L)
Alkaline Phosphatase 49 (40 - 150 U/L)

Lipid Panel 4/30/18:
Cholesterol 189 (<200 mg/dL)
Cholesterol, Non-HDL 133 (0 - 159 mg/dL)
Cholesterol/HDL Ratio 3.4 (1.0 - 4.5)
HDL 56 (40 - 125 mg/dL)
LDL 121 (0 - 129 mg/dL)
Triglycerides 59 (<150 mg/dL)

Lipid Panel 8/2/17:
Cholesterol 251 (<200 mg/dL)
Cholesterol, Non-HDL 186 (0 - 159 mg/dL)
Cholesterol/HDL Ratio 3.9 (1.0 - 4.5)
HDL 65 (40 - 125 mg/dL)
LDL 178 (0 - 129 mg/dL)
Triglycerides 38 (<150 mg/dL)

Many thanks to any that reply here. It seems like
a complicated mess to me. Hopefully some of you will be willing
to impart some knowledge to get me on the right track. Obviously,
some of the blood labs are out of “normal” range. But others,
while inside the range (which I know may mean next to nothing), I don’t
know how a low side result of Test A relates to a high side result
of Test B. That’s why I come here.

Apologies for the long post.

Im a 58YO male that started my TRT journey a number of years
ago in 2012 with low end of “normal” total T/free T
and exibited most of the symptoms of low T with scoring on the AMS
and ADAM questionnaires (lack of well being, sleep problems,
libido, AM wood, irritability, lacking interest & energy, achieving less, lack of initiative,
decreased muscular strength, weight issues, concentration/memory) .
To note: I have a really good university
urologist that has been willing to go along with any ideas
i’ve brought to him from this forum and elsewhere. His knowledge probably
isn’t great about ALL of the intricacies, so i get my guidance
from places like this and take it to him. He’s been willing to
prescribe most anything that i’ve asked for, plus all
of the necessary labs… all of which (surprisingly to me after
hearing the situation of some of the guys here) are covered
with a small copay thru my insurance. I also see a sort of
hormone doc who mostly treats women but is pretty knowledgeable
about TRT, thyroid, adrenals, etc in males. I actually sought her out
after reading a bunch of stuff here by KSMan on iodine…she
was listed on one of the Wilson Syndrome sites as a local practitioner that
treated low body temp issues…which I had. She never put me on iodine, but put me
on thyroxine (T4) or Nature-Throid (T3/T4) as I recall. Symptoms at
the time were low energy, poor metabolism, inability to lose weight. Suspected
hypothyroidism. Separately, she also had me on Semorelin for a time…no noticeable effect.
Also she had/has me on Progesterone cream (12mg/nightly)…no noticeable effect. Maybe I’m a non-responder because
I never really felt any different no matter what I was taking. Or, I just haven’t found the right balance
of things yet.

In 2012 I originally started with Androgel and for about 6 mos I could feel it, felt decent I guess…not
awesome as I’ve heard some other guys say. Just a bit different…in a good way. After 6 months, because i had a 4YO son and the gel didn’t
seem to work as well, I switched to TCyp 25mg (2 times/week) + Anastrozole
(.5 mg 2 times/week) taken together. Although I’ve never experienced
the holy grail that i’ve heard others speak of (“I feel like I’m 25 again”,
“I’m tearing it up at the gym”, “I want sex all the time”, etc.) I
did get myself in fairly good shape…not great though for all of the
hours i was putting in. After awhile there I was also taking HcG
(because it was recommended here), but I never really felt any different with it.
Note: after 2+ years of just T, I never really experienced any testicular
atrophy. But, at times (maybe 4 times in 6 years), I have had slight testicular
pain that always went away after a few hours. Also at times during this period
I would also be taking Cabergoline andb Viagra.

Anyway, about a year ago, due to the extreme acne that I had
since starting TRT, I decided to go off TRT. Actually I stepped
down to taking Clomiphene 50mg EOD. No real change in the acne then, so after awhile I went off
TRT compeltely. That was for about 1 year. Skin cleared up, but then got
bad again (probably stress). During this time (although I always said
that I was never really sure if the T was working for me), I gained
quite a bit of weight, lost strength, libido suffered. Apparently my body was
indeed missing the T supplementation. So, due to all of this
and since I was having acne anyway, I decided to go back on TRT. Started
with the Clomiphene 50mg EOD + Arimidex 1mg/week for about 60 days and have recently
switched to TCyp 100mg/week + Arimidex 1mg/week (split doses). Note: blood labs
shown below were when I was ending the Clomiphene and before I restarted
injections of TCyp.

My desires are to be fit & strong physically and mentally, regain the
ability to have a proper weight (I work out 5-6 days/week (@60 min
of HIIT + weights), to feel “right”, to regain my libido and to
get a handle on my, what seems to be a, blown metabolism.

I think that’s everything.

Thanks again!

Might want to go ahead and edit some more. Put the labs up first.

With TRT, LH/FSH should -->zero.
Please explain. Are you using a SERM or labs? And E2 tested at that same time? Why were you taking Clomid on TRT?

Thyroid is now your major problem.
fT3 is the only active thyroid hormone and it is well below mid-range.
rT3 may be high, we see some lab companies with much lower ranges. With your exercise program and thyroid problems we do expect to see rT3 elevated.

Please provide your history of using iodized salt.
What mcg of iodine and selenium in your multi-vits? - history
Low thyroid function drives fat gain.

With your thyroid issues most perceivable benefits of TRT will be lost.

You need AM Cortisol done at 8AM or one hour after waking.

Less progesterone please.

Post CBC blood data with ranges.

Dextroamphetamine can stress adrenals. Was cortisol low at that time?

Thyroid: You need medication. Do not take T4 only medication. Do not take T4+T3 medication. Get on 25mcg T3 sustained release and take in AM. When you do thyroid labs, do labs before taking T3. This T3 SR is a compounding pharmacy only item in USA. You need to depress TSH do there is less T4 production, then there is less fT3–>rT3. Your T4 is also low, if you take T4, rT3 will increase.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • 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.

Thank you very much @KSman , I will do my best to answer your questions interspersed below.

And my liquid iodine arm patch test disappeared in less than 12 hrs.

Hi @KSman, just checking to see if you had any further comment on my answers to your questions. Also, at what point do I stop taking iodine?..or, is there a maintenance dose after reaching a certain saturation level?


KSMan wrote, "When one is iodine deficient, I advocate a 750mg IR program. Many can do this in 15 days. If you do this over 2 months, the result will be the same, however, benefits will be both delayed and less obvious. 50mg/day provided dramatic effects for me. However, I did need to reduce the dose after a week as my digestion was affected. Because I was on TRT and my TT, FT and E2 were all in good shape, I was in a position to feel good once my iodine levels were up; and my thyroid obviously responded well.

After iodine replenishment, I suggest lower maintenance doses. Myself, I take 6mg every two-three weeks. I disagree with ongoing high dose iodine as I see no reason to do that.

No one is allergic to elemental iodine."

Thanks very much NH… just what I was after. I had read all of the thyroid stickies, but didn’t seem to see what you just sent.

Much appreciated!

Thanks very much NH… just what I was after. I had read all of the thyroid stickies, but didn’t seem to see what you just sent.

Much appreciated!

No problem. It was buried a little bit in but it was fresh in my head as Im on day 4 of my IRT so had recently searched it out.