T Nation

Return after Varicocele Surgery, Marginal Sperm Improvement

I had my morning Test taken.
308 - ng/dl TT (240 - 900 ng/dL )
Bio av - 200 ng/dl (48 - 317 ng/dL )
Free T 100.7 pg/ml (21.0 - 135.0 pg/mL)
SHBG is 13 nmol/L (9 - 54 nmol/L )
LH ~6.5 mIU/ml (0.6-12.1 mIU/mL )
FSH~ 17 mIU/ml =high (1.0 - 12.0 mIU/mL)
Vitamin D ~ 27 ng/ml (30 - 100 ng/mL)
Prolactin ~ 19 ng/ ml =high (2.1 - 17.7 ng/mL)
Thyroid Stim ~ 1.56 uIU/mL (0.36 - 3.74 uIU/mL)
Albumin- 4.2 g/dL (3.5 - 4.8 g/dL)

I had Varicocele surgery last Feb for pain / hypogonadism along with severely low sperm I’m talking like 1.0 10^6 in a sample w poor motility, even when before my surgery had a SA with 1.010^6 and even one SA 0 sperm in it . My doctors don’t know why , I even had a ultrasound that landed normal results and size. I’m seeing UPenn male andrology specialist in 2 weeks. Had genetic make up for Klinefelters and Y del all normal .

I’m over weight 250 lb 6 2”
High Triglycerides 295 mg/dL < 150 mg/dl HDL 24 mg/dL Standard Range > 40 mg/dL Non HDL Your Value 162 mg/dL Standard Range <160 mg/dL LDL Your Value 103 mg/dL Standard Range <130 mg/dL

Liver metabolic only thing is 57 for ALT which should be <56

Help what do you all think. I know I will need IVF but I got referred to UPenn cause my Urologist at home doesn’t know if that’s the whole story. UPenn will prob do a whole redo of my testing , I even read smell test and MRI. I had that SA done at 9 months and it will be a year year next week.

It would be nice to see reference ranges for all lab values and to be able to critic Free T levels. The low SHBG should be investigated and can be because of low thyroid hormones or may be do to genetics. I have low SHBG and is because I have diabetes which TRT improves and increases my SHBG.

Did you get your A1C tested?

If you go on TRT you will probably need very frequent (daily) injections or these large infrequent dosages that tend to get prescribed will hammer your SHBG into oblivion and you may not benefit at all.

Ok, I updated and no I have not taken a A1C lab test.

This isn’t considered low testosterone, yeah the Total T numbers are low, but the Free T isn’t low, your LH is good and most of your testosterone is bioavailable. Now if you don’t consistently have good T numbers, then this may be a problem.

If these tests are the direct immunoassay, than I don’t trust these Free T labs. Having high triglycerides raises your chance at metabolic syndrome and heart disease, you probably have fatty liver. I wouldn’t be at all surprised if have diabetes.

The diabetes is commonly associated with low SHBG, visceral obesity and insulin resistance. I have type 2 diabetes, SHBG at 13, Total T 91 ng/dL, A1C 8.3 and about to start insulin therapy before possibly restarting TRT if I can’t get my natural T to increase.

I’ll get my A1C tested. But my glucose is normal and rest of my liver panel was normal as well. I also got my urine tested and it did not flag anything either

Urine
Your Value
Clear
Standard Range
Clear, Slightly Cloudy, Hazy
Glucose, POC
Your Value
Negative
Standard Range
Negative
Bilirubin, Urine, POC
Your Value
Negative
Standard Range
Negative
Ketone, Urine, POC
Your Value
Negative
Standard Range
Negative
Specific Gravity, Urine, POC
Your Value
1.025
Standard Range
1.003 - 1.030
RBC, Urine, POC
Your Value
Negative
Standard Range
Negative
pH, UA
Your Value
6.5
Standard Range
5 - 7.5
Protein, Urine, POC
Your Value
Negative
Standard Range
Negative
Urobilinogen, Urine, POC
Your Value
0-0.2mg/dL
Standard Range
0.2 - 1.0
Nitrite, Urine, POC
Your Value
Negative
Standard Range
Negative, Indeterminate
Leukocytes, Urine, POC
Your Value
Negative
Standard Range
Negative

Liver

Glucose Your Value84 mg/dL Standard Range65 - 99 mg/dL
BUN Your Value13 mg/dL Standard Range7 - 28 mg/dL
Creatinine Your Value0.94 mg/dL Standard Range0.53 - 1.30 mg/dL
Sodium Your Value141 mmol/L Standard Range135 - 145 mmol/L
Potassium Your Value4.4 mmol/L Standard Range3.5 - 5.2 mmol/L
Chloride Your Value108 mmol/L Standard Range100 - 109 mmol/L
Carbon Dioxide Your Value31 mmol/L Standard Range23 - 31 mmol/L
Calcium Your Value9.2 mg/dL Standard Range8.5 - 10.1 mg/dL
Alkaline Phosphatase Your Value85 U/L Standard Range35 - 120 U/L
Albumin Your Value4.2 g/dL Standard Range3.5 - 4.8 g/dL
Bilirubin, Total Your Value0.4 mg/dL Standard Range0.2 - 1.0 mg/dL
Protein, Total Your Value7.5 g/dL Standard Range6.3 - 8.3 g/dL
AST Your Value32 U/L Standard Range<41 U/L
ALT Your Value57 U/L Standard Range<56 U/L
Anion Gap Your Value2 Standard Range3 - 11
GFR, Calculated Your Value109 mL/min/1.73m2 Standard Range>60 mL/min/1.73m2

Yeah the T numbers for total are not very consistent as I got a T total of 270 and 240 out of the normal range. I fluctuate , my doctor wants to put me on Anastrozol

Total T is the more consistent test, your levels fluctuate everyday.

So your doc wants to put you on anastrozole even though you have no estrogen testing, just insane!

I did get my Estradiol Reading and my Prolactin.
Estradiol
Your Value
23.4 pg/mL
Standard Range
<=31.5 pg/mL

Prolactin
Your Value
18.1 ng/mL
Standard Range
4.0 - 15.2 ng/mL

So you’re BELOW even the “normal” range and he still wants to put you on it? That is ludicrous.

You and your doc are about to have what we called growing up in the Mississippi Delta “One of them learnin experiences” (needs to be said in the most country accent you can make for full effect).

You mean for Estradiol ? What should I do just leave it ? Cause by all other accounts for Test I’m okay per what my doctor says, even though I’m not optimal I think my SHBG speaks volumes , I need to lose weight .

Your doc isn’t playing with a full deck, your doc is incredibly incompetent prescribing an AI with E2 at 23! You need to find another doc because this one isn’t going to work out.

Estradiol is known as estrogen.

So w my E2 in normal range, what would that do to me / what would you recommend for that.

Well your SHBG is low, but I think you can get away with E2 levels on the bottom end, I wouldn’t want mine lower than 20 because I see guys on these forums diagnosed with osteoporosis in the low-mid teens alongside low-T.

Remember normal range doesn’t mean it’s healthy for you, it means it’s normal for a percentage of those men that made up the normal ranges.

Yeah I don’t know why my SHBG is low and it’s throwing my Testosterone level off.

My previous male endocrinologist said I don’t need any Testosterone therapy. Was he fill of shit ? And this current guy wants me on anastozole to see if that improves sperm production

Our society has a stigma of steroids, older studies show cardiovascular risk for those on TRT which forced the FDA to put a warning label for TRT prescriptions, so naturally providers are going to be hesitant to prescribe a treatment which they believe might cause a heart attack or stroke.

There is no question, the cardiovascular risk is much higher in men with lower than normal testosterone versus those untreated. The problem is TRT is very controversial still and some docs get defensive even with you making the suggestion that your T might be low-T, they don’t even want to talk about it.

Most of the successful TRT experiences are not in sick care, but through private docs who are more up to date on TRT and prescribe it on a daily basis. It doesn’t sound like your current doc has ever gotten his feet wet in the TRT world and I think this is your problem.

All this will accomplish is make you feel like you are dying. The estrogen molecule puts minerals into bones and is good for your cardiovascular system and your doc wants to suppress it for fertility, your doc is crazy.

Okay, last question , you said earlier in the thread that Don’t necessarily have low T due to my Free and SHBG. The results I posted for the initial post was done with Eq Dialysis the prior ones w a low normal T was immunoassay. I’m wondering if I even need to go on any treatment without losing weight on my own.