T Nation

Please Help Me Understand My Lab Results + Symptoms


#1

Male, 27, 175 cm, 60.6 kg, lean.
No disease.

Lab results:
TT 524.9 ng/dL (249 - 836; optimal: 799 – 1211)
FT 25.63 U (23.30-103.0)
FSH 3.79 mIU/mL (1.5 - 12.4; optimal: 9.2 – 12.4)
LH 3.27 mIU/mL (1.7 - 8.6; optimal: 1.5 – 9.3)
SHBG 71 nmol/l (16.6- 55.9; optimal: 10 – 30)
Estradiol 22 pg/ml (13 - 54; optimal: 20 – 30)
Progesterone 77 ng/dL (6 – 106; optimal: 27 – 90)
Prolactin < 0.52 ng/mL (2.5 – 16.98; optimal: 2.00 - 3.00)
DHEA-S 289 ug/dL (160 - 450; optimal: 350 - 500)
TSH 2.296 uIU/mL (0.27 - 4.2; optimal: 1.8 – 2.5)
T3 132.8 ng/dL (80 - 200; optimal: 100 - 180)
T4 7.3 ug/dL (4.5 – 11.0; optimal: 6.0 – 12.0)
Free T3 3.8 pg/ml (2.5 - 4.3; optimal: 3.0 - 4.0)
Free T4 1.03 ng/dL (0.9 - 1.7; optimal: 1.0 - 1.5)
GH 0.37 ng/ml (0.02 – 0.55)
Albumin 5.1 g/dL (3.8 - 5.0; optimal: 4.5 – 5.0)
ALT 21.2 U/L (0 - 44)
AST 22.29 U/L (0 - 40)
Cortisol 18.5 ug/dL (4.8 – 19.5)
Glucose 70.3 mg/dL (< 200)
Cholesterol 150.6 mg/dL (< 200)
LDL cholesterol 76.1 mg/dL (0 - 129; optimal: 100 - 129)
HDL cholesterol 49.8 mg/dL (> 39; optimal: > 60)
Triacylglycerol 46.9 mg/dL (< 200; optimal: < 100)
Atherogenic index 2.0 U (< 3.0 U)
Risk index 3.02 U (< 4.5 U)
IgM anti-Hbc negative

Meds: just stopped a 4 months course of cabergoline (had elevated prolactin)
Basic daily supplements: Zinc 15 mg, Selenium 50 ug, Vitamin D 1000IU, Iodine (kelp) 0.3 mg
Diet: More frequently: Alaska pollock, chicken breasts and thighs, Pangasius, spinach, rice, eggs, potato dumplings, tomatoes, peppers, carrots, cheese, Greek yoghurts, nectarines, plums, apples; Less frequently: pork, tuna, bacon, broccoli, cauliflower, potatoes, bananas, onion, Rural yoghurts.
Training: Compound lifts (lighter weights) + Pushups, Squats and Burpees, about 15-20 mins ED-EOD. Sprints 2 times a week for about 15-20 mins.
Sleep: 8-9h
Morning wood: sometimes do, sometimes don't
Nocturnal erections: yes
Oral temperature: 7AM: 96.62 F, 95.54 F; 3PM: 96.62 F

Symptoms:
- Literally close to zero libido. I feel only a small bit of "it".
- Very low sexual desire.
- Average ED problems. Problems to sustain erection.
- Moderately severe and persistent fatigue 24/7. Waking up unrested and unrefreshed.
- Feel pretty much like sedated rather than fully alive, wakeful and focused. This problem is persistent.
- Memory problems (long-term especially).

Please help.

My goal is to achieve very strong, healthy and sustainable libido and sexual desire, gradually fit to super-optimal (not lab ranges) levels of hormones, have more energy and less fatigue, be much more wakeful and focused, and have a clear mind without a brain fog.

All of that is bothering me tremendously for almost a year now. Especially that I have almost no libido at all, and a very low sexual desire.

Please give me some advices if you can:
- how to fix or improve my hormones' levels for better libido and well-being
- which other hormones/neurotransmitters could be the culprit behind symptoms
- which supplements to take
- what should I change in training and diet

Thank you for reading this. Doctors are ignoring my symptoms and my complaining. They're unwilling to provide any kind of help or explanation.


#2

Your thyroid labs and body temperatures are indicating low thyroid function that may cover many of your symptoms.

Have you always used iodized salt?
When did you start iodine+selenium supplements?

Describe how stress is a factor in your life and significant major stress events or past illnesses.

What symptoms drove: IgM anti-Hbc?

Cholesterol would be better nearer to 180, please junk up your diet. Extreme low fat diets can wreck hormones.

High SHBG with lowish E2 is abnormal. Any starvation diets? Liver [AST/ALT] not indicating liver issues. SHBG is made in the liver, goes up with more estrogens and down with more T.

TT is stronger than FT because of lots of T+SHBG that inflates TT number. Your T status is a lot lower than TT indicates.

Please read the stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Doctors: You are normal!


#3

First of all, thank you for your reply.

Yes I always did. On a label there is 20-34 mg/kg of iodine.

Iodine: 1 month ago, selenium: 7 months ago. I'm gonna try taking Iodoral 6.25 mg per day, to see if it improves my symptoms.

Well I was always stresfull when out of my comfort zone. I had problems to get and sustain a job. I also used to have panic attacks, but they're gone now. At the moment, the only thing I'm stressed about are my symptoms and dealing with them. I have elevated cortisol right? You know how to reduce it?

I'll reconsider my diet, but I think it's pretty good.

No starvation diets.

Here is my bloodwork from 7 months ago, compared to the current one:

TT 317.3 524.9 ng/dL
FT 25.00 25.63 U
FSH 3.15 3.79 mIU/mL
LH 2.18 3.27 mIU/mL
SHBG 44 71 nmol/l
Prolactin 5.33 < 0.52 ng/mL
TSH 1.262 2.296 uIU/mL
T3 130.2 132.8 ng/dL
T4 8.2 7.3 ug/dL
Albumin 5.2 5.1 g/dL

Why did my SHBG raised along with TT? I don't get it. I thought that caber slightly reduces SHBG. I didn't take anything else.

Important: Why is my FT frozen? Is it just because of SHBG, or could it be something more?


#4

Cabergoline has no direct effect on SHBG.
SHBG is created in the liver to scavenge steroid hormones.
Estrogens increase SHBG, T lowers.
SHBG is affected by other medical issues as well as starvation diets.

Your above mid-range fT3 and low body temperatures suggests that elevated rT3 could be blocking fT3, which can drive up TSH as hypothalamus can be partly blinded to your thyroid hormones by rT3.

Please read the thyroid basics sticky noting references to:
iodine
fT3
rT3
adrenal fatigue
Wilson's book
- then reread my posts


#5

So how should I reduce SHBG, then? Boron, Proviron, Danazol?

I'm aware of rT3 and I requested it, but my clinic probably can't request it from lab. Hypothetically, if my rT3 is elevated, is there any way to reduce it?

I already read a thyroid basic sticky before I posted.

Yeah, and I forgot to post these:

serotonin 311 nmol/l (50 - 1132)
dopamine 1495 nmol/l (340 – 3139 nmol/24h)

I was very interested in getting to know my neurotransmitters' levels but unfortunately, they only gave me these two... I guess it's expensive. I'm not happy with these levels, but frankly, I expected much worse.

Pretty please, could you recheck my lab's results from the first post and suggest/recommend some medications and/or hormones and/or supplements to correct my levels and to fix my symptoms?

That would be very nice.

I'll read other stickies as soon as I'll have some time for it.


#6

Please anyone, I need some recommendations from you for meds/supplements/other methods to improve my libido, orgasms, ED, fatigue, wakefulness, and ability to focus, with regard to my lab results. I can barely tolerate this state of my body. It's a nightmare.

In brief, I guess I need to:
- increase TT
- increase DHT (probably low because of low FT)
- increase FT (like 4-5 times)
- improve FSH and LH
- lower SHBG
- lower Progesterone?
- increase DHEA-S
- increase Free T4 and Free T3
- improve the conversion from T4 to T3?
- substantially reduce Cortisol
- increase HDL cholesterol and Total Cholesterol
- substantially increase Dopamine

I spent a lot of time collecting information and approaches of how to improve most of it, but I need your recommendations and suggestions as well, as adding your knowledge and experiences would lead to much more accurate, better and right approach.

Thanks for any advice you can give!


#7

If you could do all that, life you be just dandy. However, you're not a robot that can be programmed. TRT would for example, increase TT, DHT, and FT. Your FSH/LH would be gone but that's expected on TRT. TRT will lower your SHBG to a degree, but there is not magic bullet for that one. Your thyroid function can be improved by following KSman's suggestions on first diagnosing and then possibly adding an iodine supplement. Your HDL will decrease when you go on TRT. You need improve diet, fitness, and supplement with Omegas for cholesterol support.


#8

Thank you blshaw.

I'm considering enclomiphene rather than go TRT, because of it's positive effect on FSH/LH and some quite impressive elevation of TT/FT. It's waiting for approval now in Europe. Will take 12-15 months.

Do you think there would be any cons when using it? Could it negatively affect other hormones or have the same negative effect on libido like clomiphene has for some?


#9

There is nothing that you can do to directly reduce SHBG.
FT was low.
More FT will reduce SHBG

Cortisol is fine. Many would love to have cortisol at your level.
Was the lab work done early in the AM?
Best to do AM cortisol and do labs around 8AM

What symptoms drove: IgM anti-Hbc?

"SHBG levels increase with estrogenic states (oral contraceptives), pregnancy, hyperthyroidism, cirrhosis, anorexia nervosa, and certain drugs. Long-term calorie restriction of more than 50 percent increases SHBG, while lowering free and total testosterone and estradiol."

Have you been watching oral body temperatures and has iodine had any effect? See thyroid basics sticky.

Please read the thyroid basics sticky noting references to:
iodine
fT3
rT3
adrenal fatigue
Wilson's book
- then reread my posts


#10

Doesn't SHBG "steal" T (which binds to it) that would otherwise go to it's active form and thus act as some kind of partial "barrier" for FT to rise and thus, wouldn't be harder for FT to rise if SHBG is high already?

Please, do you know how could SHBG rose from 44 to 71 in 7 months if I only took cabergoline for 4m, changed diet, and started weightlifting and some exercise? How's that possible?

At 9:30 AM.

Sorry, but I don't know what's that.

My oral temperature levels actually worsen a bit after supplementation of 0.3 mg iodine. It's 94.46 F at 7AM and 94.28 F at 4AM now.


#11

I was wondering what motivated doc to order that lab work.

From my experience, AM cortisol ~10 can involve some lethargy. Average here? There is no such data. Like I said, yours looks good. And DHEA-S was fine too.

If iodine does not help, time for more labs.
I strongly suspect rT3, did you follow my lead on this earlier?

Based on your body and activity profile, I assume that your GH status, IGF-1 would be fine.

If you are converting to much fT4-->rT3, then making more T4 will lead to more fT3 and temperatures can drop.

Can someone else get 98.6 on that thermometer? Your temps are so low that I suspect device or method errors.

  • correct

SHBG increased, what did E2 do? - not checked
I pointed out earlier:
High SHBG with lowish E2 is abnormal. Any starvation diets? Liver [AST/ALT] not indicating liver issues. SHBG is made in the liver, goes up with more estrogens and down with more T.

So thyroid function is a key problem.
Cause for SHBG is not known.

Please read the thyroid basics sticky noting references to:
iodine
fT3
rT3
adrenal fatigue
Wilson's book
- then reread my posts

Things go wrong with total fasting cholesterol <160. So might be a factor. Is your diet too clean?

Supplements:

Are you getting EFA's and Vit-D3?


#12

Oh, there was no doc involved. It has to be related to one of the things I found in this forum and then ordered from clinic to measure it for me.

Don't have any other labworks with cortisol on it. But not many guys here have such a high cortisol. I personally don't think it's OK. Look at my Progesterone, the precursor. It's high. It should be balanced so that more DHEA than Progesterone should be converted from Pregnenolone, I think, and not vice versa. My DHEA-S is 289 ug/dL. Should be 350 – 500.
Do you know how to balance it so more DHEA and less Progesterone is created from Pregnenolone? Would be a nice improvement!

I would have to find another clinic+lab that measures rT3 to find out levels.

GH is 0.37 (0.02 – 0.55 ng/ml)
Clinic couldn't cover IGF-1.

You're right, it was a method error. I did it wrong.

How do I find it out then??? Where to ask? No starvation diets.

Maybe, but I should be getting cholesterol from eggs (~1-2 daily), nuts or bacon.

Getting 3000IU of D3.


#13

The E is EFA is Essential. Major component of brain and nerve tissue as well as cellular membranes where permeability is affected. EFAs during pregnancy and breast feeding affect the IQ's of children and perhaps some of the personality disorders and ADD that we see [my speculation]. Also affects cardio vascular health and function.

There is no obvious control loops involved for preg-->progesterone-VS-DHEA.
Strong progesterone suggests that pregnenolone must be adequate.
There are differences in how things work from one person to another and what you are looking as may simply be a result of that. Everything is controlled by enzymes and enzymes have a good amount of structural/genetic variability. You can try 25mg DHEA as compensation. Stress can increase cortisol and stress can lower cortisol in later stages of adrenal fatigue. Perhaps the balance you seek involves stress and some lifestyle factors.


#14

If this activity was slightly reduced, less progesterone would be out-converted, leaving more progesterone-->cortisol which can be outside of a control loop; while reducing DHEA production.


#15

Many enzymes include a metal atom at the catalytic reaction sites. Deficiencies of some trace elements can lead to problems. A multi-vit that lists many trace elements as well as iodine+selenium would be prudent. Does this affect you? - no way to really know.

I get freaked out when a pure water zealot tells me that they are only drinking distilled or RO [reverse osmosis] water. We are an end product of half a billion years of evolution that did not drink water devoid of minerals.

So body temperatures are low or what?
This is key measure of your metabolic state.


#16

I thought that EFA is just another name for omega3 fish oil. Sorry for my ignorance. Gonna read about what it really is.

Gonna take DHEA soon for sure.

Many thanks for that schema!!!

Don't know yet.


#17

Hello again!

Regarding DHEA supplementation:
There is some increase in Estrogen going on in men when supplementing with DHEA. And it's logical from the scheme you provided.

I have questions:
- What should I take along with DHEA to avoid this undesirable effect of increase in E2? Would DIM (Diindolylmethane) or Calcium-D-Glucarate serve well enough?
- How should the optimal dosing plan for DHEA look like? Would 25 mg daily in cycles: 28 days on and 14 days off, serve well? Or should I go for a higher dose, and/or different cycling?
- What's the optimal range for E2? 20 – 30 pg/mL?


#18

We all have a blend of genetic variations in the genes that create enzymes. Some men convert DHEA to E2 and some do not. You need to read things that you find as non absolutes.

DHEA every day. No cycles.

E2=22pg/ml is the target.

98.6?


#19

Well thanks. I'll try to keep my E2 at that level.

Didn't measure yet.

Do you also know about dopamine and its receptors? I have a serious problem. According to a doc, my DA receptors are upregulated quite a lot (it could be any from about 40% up and much more, and, especially D2), and to such extent that it's most likely the main cause of some of my symptoms (at least the first two).

Do you know how to effectively downregulate them?


#20

Prolactin reduces dopamine if elevated. Your prolactin is essentially undetectable and I do not know the implications of that.

I do not understand your problem. Too much dopamine activity?