T Nation

Please Help Me Understand My Lab Results!


#1

I got my lab results a month ago, and going online and get conflicting information.

FSH 21.4 (.7-11.1_ mlU/ML
LH 12.1 (.8-7.6) mlU/mL
Prolactin 8.7 (1.6-18.7 ng/mL)
SHBG 80(13-71 nmol/L)
Test 1026.9 (225-972 ng/dl)
Free Test 15.4 (12.0-25 pg/mL)
TSH (3rd Gen) 2.97 (.50-4.60 uU/mL)
TT4 7.3 (4.5-12 ug/dl)
T-Uptake 35 (24-35) %

I have a high SHBG which in turn causes my free test to be lower???
My body is making a lot of test, but converting the excess to estrogen??

I was on Testim for 3 years, and we are trying to have kids. So I went to a new Doc and I take 25mg clomid daily (stopped Testim). I have gained 20 lbs (was 165 with testim). Been on clomid for almost 3 months!!!

I was 10% bf at 165 (testim) and now 185 (18% bf).

I have lost muscle mass, but got stronger. I feel tired, and bloated! No matter what I do, I can't drop a pound! I want to lean out, but its not working. I can't put on muscle either.

I eat pretty clean, low carb except after workouts (1 cup of oatmeal with protein shake)

1 Cheat meal per week (I am a Personal Trainer too)

I am frustrated, can you guys help me out? I was taking Femara, but I really don't notice too much from it! Thanks


#2

Clomid is working well and your FSH and LH are high, causing high T-->E2 aromatization in your testes, exactly as high doses of hCG can also do. Higher E2 leads to higher SHBG. You need to reduce your clomid dose and/or use anastrozole. For your current T levels, 1.0 mg/week in divided doses would be helpful, but note that competitive aromatase inhibitors are note effective at controlling T-->E2 inside the testes.

Note that all SERMs increase E2 levels. While SERMs protect some tissues from the effects of E2, others are not protected and with clomid, some tissue have estrogen receptors activated by clomid instead protected from E2.

You appear to be a little bit hypothyroid. Are you using iodized salt? Ever feel cold when that does not make sense? How has that changed? Could be part of fat gain. Check body temp when you first wake up. SM around 97.8, near 97 is a problem.

High E2 will also contribute to fat gain/retention and bloat.

How do you feel on clomid? Moody? Libido? Tired and bloated can be from E2 or from the direct estrogenic effects of clomid. Clomid is a xeno estrogen. You could do a trial switching to nolvadex to see if you feel better with that. Clomid has a long history of use for fertility work, but is the wrong drug for males in some cases. What proportion of males are subject to adverse clomid side effects is not known.

Try nolvadex instead of clomid and with lesser amounts, you need to bring LH and FSH levels down closer to normal range. You can have negative effects on LH receptors from this just as with high dose hCG.

Reduce E2 to get near 22pg/ml with anastrozole. This may not work if gonadotrophins are too high.

Get E2 lab work and LH/FSH to guide anastrozole dose and SERM dose. Note that less SERM and lower T levels will reduce the need for anastrozole in peripheral tissue as well as reduce the amount of testicular T-->E2 that anastrozole cannot control.

Check your iodine intake.


#3

Ksman,

1) I am taking Femara, what would a good dosage be? What does an AI do, does it lower SHBG? What supplements can I take to help lower it?

2) I do get cold sometimes in the morning. How much salt should I use? What is the method behind that?

3) What supplements can I take to increase my thyroid? I have never had thyroid issues, does clomid cause this?

Thanks man, you really helped me out!


#4

Both anastrozole and femara are IA's - Aromatase Inhibotors

The dose of femara for TRT use is not well understood and it's dose-response seems to have a reputation of not been very predicable, whereas anastrozole has a very predictable dose-response. Femara can work, you have to find the does that works for you.

AI's do not lower SHBG. AI's lower E2 and lower E2 should lead to lower SHBG. There are not drugs or supplements that had direct action on SHBG.

Check body temp as I directed above.

You need iodine to support thyroid function and that is why one should use iodized salt and not sea salt or kosher salt. The point is not the salt, but the iodine. Many are becoming iodine deficient. Do not go onto thyroid meds if you have not been getting iodine in your diet, correct dietary iodine intake first.

Clomid has nothing to do with thyroid function.


#5

Ksman,

How much "Iodine Salt" should I have daily? I don't really have too much salt in my diet, but I will do to improve my thryoid function.

I use fat-burners/monsters daily. Could that also hurt my adrenal glands which would slow down my thyroid? I think my adrenal glands are abused (work long hours)

I should be on clomid for a couple months, then back on Testim. Trying to start a family :slight_smile:


#6

Just use iodized salt when you use salt. If you need more iodine than that, get it from sea food and iodine rich supplements.

Yes, stimulants are a major problem for adrenals, add caffeine to that list.

If you feel like crap on clomid, switch to nolvadex. If you cannot get it up with clomid, your sperm will have no where to go. Not all have those negative effects.


#7

Ksman,

Did bloodwork again:
Glucose 79 (<200 mg/dl)
FSH 17.1
LH (12.9)
Prolactin 9.4 (4.0-15.2 ng/mK
Test 1218 (400-1080 ng/dl)
TSH 2.72 (.47-4.53 uU/mL)
T4 10.5 (4.6-12.0 ug/dl)
T Uptake 36.8 (23.5-40.6)
Estradiol 45.5 pg/mL
Estrone by TMS 10.7 pg/mL
Total Estrogens 56.2 pg/mL
SHBG 79 (11-80 nmol/L)
Free Test 151 (47-244 pg/mL)

1) What AI should I take, and how much?
2) Is my estrogen high?
3) How is my thyroid? (just start taking 75mcg of iodine twice daily)
4) How do I increase my free test?
5) How much Fish-Oil/Vitamin D daily should I take?
6) What suppelmetns can help me?
DHEA/D-Asparacic Acid/Nettle root/Divanil
I read they lower SHBG??
7) I am feeling flat, can't get a good pump

I just got a multi-vitamin (take 3 in the morning/evening)

Thanks bro for helping me out!! I know its a lot of questions


#8

1- Arimidex/anastrozole, start with 1mg/wk in EOD dosing, understand over-responders
2- yes, try to get to E2=22pg/ml
3- May take longer, iodine may help. T4 has increased, looking for TSH to decrease. Feel different?
4- lower E2, SHBG will drop and that will increase FT
5- there are different fish oils http://en.wikipedia.org/wiki/Omega-3_fatty_acid. Vit-D 4000iu - 6000iu
6- anything to support general vitality, need trace elements too
7- that may come

Your high LH may be acting like large dose hCG and be creating high levels of T-->E in the testes. It is possible that anastrozole will not correct E2 levels with expected doses. You might consider a lower dose of clomid.

DHEA-S lab work would have been good. Total estrogens lab work is rather useless, same for estrone. SHBG is to of range, you cannot manipulate that directly. Best method to reduce is to reduce E2. While SHBG lab number confirms what we know from lower FT and high E2, we really do not need SHBG with those other tests.

How are your emotions? Clomid can make some guys sentimental and weepy.