T Nation

Pratherian Case File, Please Comment!

Went thru private md labs and will be getting blood work done for
A complete baseline according the the recommendations of the stickies.
Starved all night until 2pm today (working nights) got to lab corp and
they were closed for the holiday. Sigh. Will go again to tomorrow and
post results when they are done. Tests cost me 409$ bucks.
I may have overdone it, but it will be thorough .

Went back today and they took 7 vials of blood AND a
urine sample. Must have been one of the bundles
I picked. Will post results when I get them.
Maybe with better research I can get the exact
test numbers for lab corp for follow ups.

Do you have an active thread here? Keep that one goin ginstead of spreading case threads throughout

I am a complete noob to low t and I am 43 yrs old.
I have read all the stickies and you guys have provided a great deal of information. Thanks for that.

For a little background, I have been on the slow motion train wreck of low t symptoms for the past 10 years.
I have worked shift work for 22 years as well as tons of overtime, so I am sure that doesn’t help.
Kind of being in denial, I blamed all my symptoms on my job, stress, not eating right, long hours (12 hour shift),
Etc. a little over a year ago, I approached my primary doc about low t, after hearing commercials, etc.
My doc basically blew me off and said lose weight, exercise, and everything will be fine.
So after getting diet in check, going back to the gym, weights and cardio, I dropped from 240 to 212. My body
fat started at 33% and is down to 24%. 5 foot 8 inch frame.
Everything is NOT fine. I feel worse now, a year later.
I did blood work in early December and demanded that my doc check my testosterone level, and he reluctantly
agreed. At that time I knew nothing about free t or estrogen, and the doc did not order it.
When total t came back 418 on scale of 347 - 1147 (Labcorp) .
I had an appt. scheduled with my doc specifically to discuss my symptoms (you guys know them) but the day
before the appt. the doctor calls and tells me I am normal and I don’t need to come in, basically cancels my appt.
Being totally pissed and frustrated, I went through the process online with one of the big name clinics.
I don’t know if we are supposed to name them or not so I won’t. This clinic accepted my blood work, I had to send
In physical results, and get follow up psa test and igf-1 test. They did not request free t or estrogen, but said
they would test during follow up labs to " dial everything in."
They approved me for test cyp (200 mg/week) hcg, b-12. As an option, I was approved for GH (out of my
Price range) or semorelin/GRHP-6 (still fairly expensive).
I was ready to pull the trigger, even though like the rest of them, they dont take insurance, but my wife was more
apprehensive about how easy it was to do online without talking to a doctor face to face. She also wanted me to do whatever
I could to get this covered by insurance. (united health care).
So I agreed to a second opinion, to talk to a local urologist who is currently working with " multiple male patients on injectable
test." I have printed all the important info to take into this appt. Friday jan. the 6th. Of course I could have been a month into
treatment by now, and hopefully feeling better.
Anyhow, I have not really had anyone to discuss this with, as I don’t know anyone who is on trt, or nobody is talking about it.
I am open to any further advice on what to ask this urologist lady next Friday, and I apologize for this post being so long.
I am gonna ask her if she has any experience with the urine testing, and I have a lab corp very close.
Thanks for being here.

After seeing the urologist, she prescribed androgel. I also have some a-dex for estrogen control.
The urologist doesn’t test for estrogen and told me I need to seek expertise in Houston (50 miles away)
The urologist wants more blood work in a month using s different lab, qwest, I think.
I will also be doing follow up testing at lab corp to check E2 and do some additional tests recommended by PureChance.
I will post those results when I get them done.

OK VTBalla,
I will confine all future data to this thread as my case study.
Baseline results as follows. Lab testing done via Lab Corp.

LH 6.2 (scale of 1.7-8.6)mIU/mL
FSH 3.0 (scale of 1.5-12.4)mIU/mL
TT 519 (scale of 348-1197)ng/dL
FT% 19.1 (scale of 9-46)%
T F+W bound 99.1 (scale of 40-250)ng/dL
Estradiol (sensitive) 24 (scale of 3-70)pg/mL
DHEA-S 181.8 (scale of 88.9-427)ug/dL
IGF-1 211 (scale of 101-267)ng/mL
SHBG 46.2 (scale of 16.5-55.9)nmol/L
Free T4 1.31 (scale of .82-1.77)ng/dL
TSH 2.53 (scale of .45-4.5)uIU/mL
PSA .5
DRE EXCELLENT :slight_smile:
LDL calc 119 (scale of 0-99)
HDL 55 (>39)
Triglycerides 107 (0-149)
iron was good serum 142
Ferritin serum 92 (scale 30-400)

Please keep in mind this total T number is the highest of 3 tests while using
vitamin d, zinc, and zenerex

Your thoughts?

your T looks pretty good actually.

I would focus more attention on your thyroid and cortisol levels.

with your high TSH, you really need to get tests for Free T4, Free T, Reverse T3, 8am Cortisol (or 4 times daily saliva test), ferritin, D25-OH.

Your DHEA-S is low, but could be because of cortisol/thyroid issues.

have you read stopthethyroidmadness.com/things-we-have-learned? If not, check it out.

(you should also edit your post on top here and copy/paste your original thread - so that others can see those details.)

I agree with Pure Chance–sex hormones look pretty good. You could look into supplementing DHEA to bring that up. 25 mg/day to start, switching to 50 mg based on bloodwork on 25.

Get your thyroid tested more in depth.

I would NOT start on the androgel if I were you.

I have also been approved through one of the big clinics for injectable test cyp.
They do the hcg, b12, arimidex, routine.
I am gonna have hernia surgery next month and be on restrictions from lifting for a month or so, so I have not started.
Would you care to elaborate on your do not start androgel?
I am willing to get more testing done, but just when it seems I have found some answers, I find 20 more questions.
Just kinda frustrated.
Feel free to pm if needed, and I do appreciate you guys honest feedback.

PS added ferritin # above.

[quote]pratherian wrote:

Would you care to elaborate on your do not start androgel?

Because your TT is good, as well as decent FT and E2…as I stated, your problems appear to reside elsewhere…would you put a cast on your functional leg if you had a broken arm?

thyroid issues can cause or contribute to all of the symptoms you describe.

shift work can cause major adrenal strain, which in turn can cause high RT3 resulting in higher TSH.

getting more thyroid tests and treating those issues once you have the tests in hand may resolve all of your issues. your Testosterone levels are not in the toilet.

you should really get your cortisol levels checks as well.

Appt. with endocrine/thyroid specialist in Houston Jan. 31st.
Not gonna take anything until this appt.

An Endocrine/Thyroid Specialist or an Endocronologist? hopefully the first.

Good luck and keep us posted.

Dr. Jogi.
My sister is a nurse at M.D. Anderson. She referred me to this guy. Anyone in cyber land ever use this place?

nope, but I saw one of the top endo’s in DFW. he slapped a couple of patches on me and sent me away… only treated based on the number and lab provided ranges - no thought what so ever to my symptoms or continued quality of life complaints… no attempt to look into or find the cause or pursue alternatives…

do a search for endo or endocronologist on these forums and just read what people have to say… overall as a profession 99% of endos are strictly in the box (a really tini-tiny box) thinkers. TSH < 5 you’re fine - here’s an antidepressent.

Jogi might be the rare exception, but if not at least you won’t be blindsided when you see him.

I will give him one shot.
At least I can get the labs paid by ins.
Whatever, if anything they won’t cover, I will pay myself.
No stone left unturned.

Ok, went to thyroid Doc on Tuesday.
Was an interesting/tense discussion and I don’t think we hit it off too well.

He did blood work for TSH, free t3, free t4, but would not do reverse t3 because " it wasn’t necessary at this point".

Here are the results:

TSH 2.13 (.450-4.5)

Free T4 direct (serum) 1.46 (.82-1.77)

Free T3 (serum) 4.2 (2.0-4.4)

Thyroid peroxidase (tpo) ab 9 (0-34)

Also did am/pm cortisol test (thought it was the 4 times test but must have messed up)

Cortisol morning 2.1 (3.7-9.5) low
Cortisol night 1.1 (.4-1.0). High
DHEAS (saliva) 25.3. (2-23) high

I had been taking a 50 mg DHEA supp for the past month. I have backed off to EOD

My urologist wanted blood work for total T only taken from our local hospital.
I had total T, free T (direct) done immediately after.

Total T 233 (348-1197)
FreeT 4.5 (6.8-21.5)
Urologist won’t give me results until appt. feb 15th

Endo wants me to stop ALL supplements until follow up on march 5th, and wants me to try the lowest dose synthroid and said he
Was comfortable lowering TSH as long as it was above .5.
I am feeling like a frigging yo yo on a slow train to hell.
Any thoughts Gurus?

What time was your T test taken? It has dropped significantly.

Same with cortisol. It is low. You need to fix that first.

Your Free T3 levels are good–are you currently on thyroid meds? No need to start them if not, IMO.


Endo appt was at 8:40 am in Houston, I got back home a little after lunch. I have been a rotating shift worker for 22 years (12 hr shifts)
So at this point I don’t think my body knows if I am coming or going.
I showed the cortisol test to the endo and he basically said saliva tests are junk.
He also said DHEA in his opinion wouldn’t help anything.
I asked him if he was familiar with Dr. Chrisler or the protocols of any of the TRT gurus and he told me that he was having to compete
With clinics that did not have standards up to par with his.


Should I suck it up for another month with zero supps. ( stopped taking all boosters, zenerex, herbal crap, etc.)
I don’t know if that is what caused my drop, or if it is a different test lab corp ran. I really want to see the numbers from the urologist test and see if the total T correlates low.

All I know is I feel like crap and I am really tired of it.
And I am in the middle of working about 15 twelve hour days in a row coordinating a shutdown of my unit at work.

I appreciate you guys more than you know.

Saliva tests, IME, are bad for everything except for cortisol. At the very least, your doctor should have considered it and given you a blood test to correlate the two. He didn’t. That is concerning.

High TSH.
Taking T4 only medication.
Bad cortisol results.
Good Free T3.

We can therefore assume extremely high RT3.

you really need to work on fixing your adrenals and thyroid before tackling your hormone issues.

Endo dr/thyroid “specialist” has requested I take zero supplements/boosters/vitamins until my follow up appt. on march 5th.

I cannot express to you guys how frigging terrible I feel right now, I mean to the point I wanna call and tell him to phuck off, or sue for malpractice.
It has been 2 weeks so I guess I can make it 2 more.

Pure Chance, you mentioned getting adrenals straight first, any suggestions?

Endo poo-pooed dhea being low, as well as my cortisol tests. I am at a loss here.

I am looking at the possibility of going for a promotion and I don’t want to feel like a hammered dog turd.

What do?

I am a shift worker
4 on 4 off rotating days and nights
5 to 5
This probably will not change for 10-15 more years worst case.

Am I just screwed? I do my best to get enough sleep and eat right.
Gym 6 days a week with EOD cardio.