Test Results Back, Now What?

Bigger Stronger Leaner Over 35 Lifter
1

Went to the doc last week as I haven’t been seeing results in body comp that I expected, feeling some fatigue, plus I was due for a physical. Got my results today. Total test was 283.7 out of a range of 400 - 1080.

I suspected low T before I went in, so I requested that they test free T and estradiol too. The doc was shaking his head before I even finished the question. He basically said there is no medical reason to test for either as I am young (37) and, unless I was taking supplemental estrogen, my estradiol should be fine. When I asked him to test that, he said “What… you mean estrogen?”. (Yeah I know, I am already looking for another doctor.)

He told me today (via the nurse) that I should come in to test FSH, prolactin and LH. I just got back from that and should have the results this week. Next step: MRI of pituitary.

Provided they don’t find something else, I appear to be a candidate for TRT… although I’ll be damned if I’d let this asshole oversee it. So what do I do? Ask to be referred to an endo? The only docs specializing in HRT in my area that I can find are ND’s and don’t accept insurance. While I won’t rule them out, I am having a hell of a time even finding a doctor (online) that might be receptive to doing HRT the right way.

Also, I am thinking of ordering a test from lef.org that will test E2, free T and progesterone. Anything else I should look at while I am at it?

Any thoughts would be appreciated.

2

Forgot to mention: I also had metabolic and lipid panels done and nothing came back out of range (well, BUN and CO2 a little high). I can post numbers if anyone wants.

3

Bump (I’ll just do this once).

Any thoughts on whether I should seek an endo, urologist or another specialist?

4

[quote]Tyler23 wrote:
Went to the doc last week as I haven’t been seeing results in body comp that I expected, feeling some fatigue, plus I was due for a physical. Got my results today. Total test was 283.7 out of a range of 400 - 1080.

I suspected low T before I went in, so I requested that they test free T and estradiol too. The doc was shaking his head before I even finished the question. He basically said there is no medical reason to test for either as I am young (37) and, unless I was taking supplemental estrogen, my estradiol should be fine. When I asked him to test that, he said “What… you mean estrogen?”. (Yeah I know, I am already looking for another doctor.)

He told me today (via the nurse) that I should come in to test FSH, prolactin and LH. I just got back from that and should have the results this week. Next step: MRI of pituitary.

Provided they don’t find something else, I appear to be a candidate for TRT… although I’ll be damned if I’d let this asshole oversee it. So what do I do? Ask to be referred to an endo? The only docs specializing in HRT in my area that I can find are ND’s and don’t accept insurance. While I won’t rule them out, I am having a hell of a time even finding a doctor (online) that might be receptive to doing HRT the right way.

Also, I am thinking of ordering a test from lef.org that will test E2, free T and progesterone. Anything else I should look at while I am at it?

Any thoughts would be appreciated. [/quote]

I really don’t think that you would have any better luck with an endo or urologist. Your doc obviously doesn’t know shit, so your only options appear to be…

A) Try visiting an anti-aging doc who knows what he is doing and attempt to submit the receipts to your insurance company.

B) See what your current doc has to say about testosterone replacement. As long as he isn’t trying to put pellets in your ass or make you come in for bi-weekly injections, you could feasibly use him for testosterone and lab work and get the rest of the goodies yourself. Research chemical Arimidex is cheap and easy to find and HCG can be found as well.

I think if you educate yourself, you could probably treat yourself much better than most endos out there.

5

Thanks Caged. I appreciate the response. I’ve been reading all I can find and, as best as my non-technical brain can handle, am starting to understand it a bit better.

I got the FSH, LH and prolactin results back already: all normal. So the doc now wants me in for an MRI of my pituitary to rule out any tumors. (Why he’ll approve a thousand dollar MRI but not a couple hundred bucks for free T and estradiol is beyond me).

At that point, according to the nurse, he would either refer me to someone else or put me on TRT (gel or shots). I already know he won’t consider Arimidex or HCG so I would be on my own there. I would maybe consider coughing up the dough for a trip to your neck of the woods to see Dr. Crisler once I get into this a bit more. I don’t think he accepts insurance, but I am not sure if the meds would be covered.

6

I got some more results back and am even more confused. This was a saliva test:

Estradiol (E2): 1.5pg/ml (range <2.5 males)
Progesterone: <10pg/ml (range <51 males)
Ratio of Pg/E2: 6.6 Low (range 200 - 300 males wtf??)
Testosterone: 72.4pg/ml (range 30.1 - 142.5 males)
DHEA: 152.6pg/ml (range 137 - 336 males)
AM Cortisol: 7.4nmb/L (range 5.1 - 40.2)

So now my T is well in range (previous blood test showed 283.7 in range of 400 - 1080), my Pg/E2 ratio is low (although I have no idea how normal is 200-300 considering the ranges for Pg and E2), and my cortisol is low normal. I also previously stated my FSH was normal, but it is actually low-normal at 2.2 mIU/mL out of 1.2 - 19.2.

Any thoughts on this? I am still waiting on results for Free T4, TSH, IGF and Vit D.

7

It all depends on the Dr… I dont think that one speciality is better than the other. Do some research on the forum and the boys should give some advice. I just started the process and found an endo. that is going to start treating me with test. next week.

8

Your serum T was total T [SHBG bound + weakly bound + free]. Your saliva T is not SHBG bound… it is a measure of free T.

I have no idea what saliva E2 level is optimal VS serum E2=22pg/ml. I am thinking 40% of the upper range which would be 1.0, but that may not be the case. If E2 is too high, combined with lower T, can have adverse effects.

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Sorry I missed these replies. There wasn’t much activity on the thread and I hadn’t checked in a couple days.

As for the doc, I found what seems to be a good one who is experienced in HRT. He is fully willing to put me on T and HCG and Arimidex if needed.

He is concerned though, about going ahead with T as my wife and I want another child. He was thinking perhaps HCG only to keep my boys humming along. No decisions yet, though as we are awaiting more test results. I’ve been reading up on HCG monotherapy. (KSman, if you have thoughts on this, I would love to hear them).

When I got my second T test back in the normal range, I was concerned that he would reverse his thinking. I emailed him and was pleased that his response was “your testosterone levels are still suboptimal for your age.”

10

Post the LH, FSH and prolactin levels and ranges.

TRT with hCG will maintain your testes. If sperm count becomes an issue, take a SERM when you want to concieve or HMG. Probably not needed. hCG has some ability to activate FSH receptors.

You can lower use adex to get serum E2=22pg/ml and see how your T responds.

If you use hCG alone, T levels depend on how your testes respond. Use 500iu EOD max. hCG can increase E2, so adex probably a good combo, again seeking serum E2=22pg/ml.

If using Quest Diagnostics, order the serum E2 ultra high sensitivity. The basic test will bottom out with a reading of <32.

If labcorp, the basic serum E2 is good.

What Rx or OTC drugs are you using? Some will increase E and drive down T. PM if needed.

11

Thanks a lot KSman. The E2, progesterone, etc. listed above were done by Labrix (saliva test).

Here are the stats you asked for (from LabDaq):

FSH 2.2 mIU/mL (1.2 - 19.2)
LH 3.8 mIU/mL (1.2 - 8.6)
Prolactin 7.0 ng/mL (2.0 - 13.0)

Also, just got back today the following (Quest):

IGF-I 148 ng/mL (106 - 255)
T4, Free 1.5 ng/mL (0.8 - 1.8 ng/dL)
TSH, 3rd Gen 1.2 mIU/L (0.40 - 4.50)
SHBG 24 nmol/L (8 - 48)
T3, Free 312 pg/dL (230 - 420)
Vit D, 25-OH Total 40 ng/mL (20 - 100)
25-OH D3 40 (endogenous)
25-OH D2 <4 (exogenous)

Rx drugs, only Propecia. OTC: TRIBEX, Rez-V (neither taken a few days before testing), ZMA, & melatonin.

Regarding HCG alone, I’ve been reading reports of people actually responding quite well at 250iu EOD (some even better than when they were on higher doses). I do know that if that’s the path my doctor and I go down, I would like to start out lower and adjust upwards rather than the other way around. Thanks again for the feedback.

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Tyler23- I have been down this road, I’m 44. My doc was clueless to all the things I wanted tested. I did all my testing with zrt labs online bloodspot & saliva (not too expensive). My trainer Mike Mahler was a big help and he suggested I change my diet. He has a GREAT e-book about diet and hormones.

Basically my T levels were in the dumper but everything else was on the money or better. Changing my diet to the 40/30/30 helped balance and stabilize insulin which corrected my T levels. I also added a magnesium gel at night. Got re-tested a few months later and my T was mid/upper normal up from being just below normal.

I do not have the exact #‘s in front of me. I feel better and it was an easy fix. Now if this economy would get crankin’ so my stress levels would come down… I hope this helps. Contact Mike Mahler. He knows his hormones.

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Thanks kb. I will look into that. The only thing that is perhaps different in my case (possibly) is that I had my T tested back in '04 and it was low normal at 258 ng/dL out of a range of 241 - 827. I didn’t look further into it then, although I wish I had.

I wasn’t low-carbing back then, but I have been since I started “trying” to cut 2 mos ago (before then I was bulking getting around 3,200 cals at 30% carbs). I am doubtful my T dropped that significantly in that amount of time.

14

Let’s see if this works (all lab results; yellow highlighted of interest).

Edit: guess you can’t post PDF pics.