T Nation

Quirky Test Results


#1

I just received my test results from my new patient exam with a urologist. My follow up appointment isn't for another week, and I would appreciate any feedback that would help me be prepared with more informed questions. I'm 61 and have had the standard complaints: lethargy, brain fog, low libido, etc. My primary care doctor tested my thyroid hormones and referred me for a sleep lab, both of which were normal.

I know that my overall testosterone level result is low normal, but I don't fully understand some of these other results or how they relate to each other. Looks like there may be things going on that T alone won't fix.

Test: 366 (200-1000 mg/dl)

Free Test: 5.88 (no range or unit of measurement given)

Estradiol: 3 (0.5-5 ng/dl)

SHBG: 45 (10-55 nMol/L)

DHEA-S: 497 (1081-1985 ng/ml)

FSH: 12 (4-10 mI/ml)

IGF-1: 192 (48-194 mg/ml)

Prolactin: 11.5 (3.0-30 ng/ml)

DHT: 646 (112-995 pg/ml)


#2

TT=336 is rather low and older guys need higher levels to feel restored.
FT is low, but FT lab ranges can vary wildly from one laboratory to the next.

E2 looks highish, but range and units are odd and do not provide very good resolution.

SHBG is high and is partly responsible for your low FT. SHBG increases with more E2.

FSH=12 and TT=336 suggests that you have some primary hypogonadism.

To get prepared, read the advice for new guys stick. Note the first paragraph, you might have more than one issue and you can consider your iodine intake and check body temperatures.

You should have PSA numbers and get a DRE before starting TRT.

For TRT, you will need to start with 1.0mg anastrozole per week, see the stickies for more info.

Your TT is been exaggerated by high SHBG that creates more non-bioavailable T+SHBG. It is FT and T+albumin that has is bio-available and your FT is low!


#3

Thank you for your reply.

I saw the doctor yesterday and I’m frustrated with the outcome. The doctor wanted to try Clomid and Anastrazole before trying T, but when I asked about my low DHEA numbers he said he would go ahead and go directly to test. He prescribed me Androgel, 4 pumps daily, and told me to supplement my DHEA.

He ended up not giving me an AI though, and kind of blew me off when I asked why anastrazole was needed with Clomid but not with T replacement.

Then my insurance company demanded prior authorization to fill the Androgel script – meaning they want the doctor’s office to call them and convince them they should pay for it. For all I know I might not meet their criteria for “medical necessity.” To top it off, I only have one business day before I go out of town so it’s anyone’s guess whether I get my Androgel before I go.

When I call Monday I may ask them to prescribe me for injectibles, solving the insurance problem, and raise the AI issue again. I regret that I didn’t assert myself more about the AI, and ask about injection rather than gel.

I thought that this doctor would be good, since I know that he has prescribed AIs for people that had aromatization issues. But the way the practice is run is not very user friendly, and when I asked about my estradiol number, since it was in an unfamiliar unit of measurement, I got the dreaded “within range” answer. I guess time will tell.