T Nation

Total NOOB to TRT Need Help


#1

I am looking for help understanding my labs as I get ready to start TRT

I am 41, 6'2" and weigh 300 lbs. I travel for work, fat, former smoker, with very high blood pressure (on meds and controlled), and controlled cholesterol (taking meds).

I have 3 sets of labs:

Quest:

Glucose 95
Urea Nitrogen (BUN) 35
Creatine .81
eGFR non-Afr American 110
eGFR African American 128
Sodium 137
Potassium 4.1
Chloride 105
Carbon Dioxide 22
Calcium 9.2
Protien, total 7.2
Albumin 4.3
Globulin 2.9
Albumin/globulin ratio 1.5
Bilirubin, total 0.4
Alkaline Phosphatase 89
AST 23
ALT 42
T3 Reverse, LC/MS/MS 20
Estrogen, Total, Serum 230
IGF I, LC/MS 187
Z Score (male) 0.6

Estrone, LC/MS/MS 30
White blood cell count 7.7
Red blood cell count 5.02
Hemoglobin 14
Hematocrit 42.5
MCV 84.8
MCH 27.9
MCHC 32.9
RDW 13.7
Platelet count 224
absolute neurtophils 5298
absolute lymphocytes 2025
absolute moncytes 146
absolute eosinophils 169
absolute basophils 62
neutrophils 68.8
lymphocytes 26.3
monocytes 1.9
eosinphils 2.2
basophils 0.8
DHEA Sulfate 72

FSH 1.6
LH 1.5
Progesterone 0.6
Estradiol 42

Testosterone 355
Free Testosterone 82

The MD is starting me on 100 mg of testosterone with an estrogen blocker and a supplement of 10 mg of DHEA

I am supposed to also take 1000 mg of fish oil, 1000 mg of Vit D3, 1 pill of B active suppliment, a pill called Thyroid Complex, and A-C-E antioxidants

Any thoughts? I also have labs from Singulex Clinical Laboratory where everything is "at target" except:

Leptin @ 29.1
Cortisol A.M is at 5.5

These are apparently "at risk"

My third set of labs is from Health Diagnostic Laboratory Inc.

The concerning things in this set of labs are:

LDL-C Direct 100
ApoB 72
Lp(a)-P 169 (high risk)
Fibrinogen 460
hs-CRP 3.7 (high risk)
Lp-PLA(2) 236 (high risk)
Myeloperoxidase 401 (high risk)
L-arginine 23701 (high risk)
Insuline 23 (high risk)

This lab work was about 10 pages the stuff above are the only ones that are "at risk" or "high risk"

Again ANY thoughts, explanations, or advice is appreciated. I am looking for help to lead me in discussions with the MD.

Cheers!


#2

I know its a pain, but we really need lab ranges because we don't memorize them and they also vary from lab to lab.

You can use the "[edit]" in the lower RH corner of your post above and add lab ranges.

This looks high-ish, but need range: T3 Reverse, LC/MS/MS 20

You have low energy in the AM?: Cortisol A.M is at 5.5 [probably should be closer to 10]

hs-CRP 3.7 (high risk)
- this is a general inflammatory marker and could be from gum disease or many other problems. You need the cardio specific inflammatory marker homocysteine.

You have secondary hypogonadism and E2 is high, E2 may be why LH, FSH and T are low. E2 can be high because your liver is not clearing estrogens properly. Drugs [Rx and OTC] that you take, and alcohol, can interfere with estrogen clearance rates.

What drug are you taking to reduce cholesterol?
Please list all other drugs and time frames?

Supplements for your condition:
- fish oil, flax seed oil/meal, nuts
- DHEA to get high normal DHEA-s, suggest starting with 25mg
- 10,000 iu vit-D3, find tiny oil based capsules
- 100mg Ubiquinol form of Co-Q10 [not cheap!] Suggest LEF.org with a membership
- high potency B-complex multi-vits with trace elements including, chromium picolinate, iodine and selenium
- Vitamin C 1000mg during day and at night
- natural source vitamin E and other antioxidants
- if you have calcium deposits in your arteries, you need vitamin K2! [but need to first review your meds]

Need TT and FT in high normal or higher.
Get E2 near 22pg/ml, estrogens damage the endothelium, the one cell barrier between the blood and the arterial walls. Estrogens are balance by DHEA and T in males and DHEA and progesterone in women.

Statin drugs, cholesterol, change enzyme pathways in the liver that make cholesterol. Parts of those enzyme pathways also make CoQ10. You can get an CoQ10 deficiency and that slows down the mitochondria in your cells that make ATP, the universal currency of energy withing your cells. So statin drugs can slow down your metabolism. Muscles can hurt and heart muscles can be weakened. When that happens, one can have a nagging cough because the left ventricul cannot move blood out of the heart properly and blood pools in the lungs and pressure there pushed liquids out of the blood into the lungs and you get a cough. Note that this is exactly what happens with congestive heart failure. I have seen cases where Ubiquinol solves all of that. However, in your case, if your BP meds are also making you cough, things get less obvious.

If statins slow down your mitochondria, they are then not burning lipids in you blood and cholesterol levels increase.

You have not tested/reported:
-TSH
- fT3
- fT4 [please not T3, T4]

fT3 regulates your body temperature and over metabolic rate. How, by controlling mitochondrial metabolic rates. If fT3 is low and/or rT3 is blocking fT3 from entering your cells, your blood lipids and cholesterol will increase.

Detecting a pattern yet?

You have metabolic disorder, aka syndrome X.

Please read these stickies:
- advice for new guys, good basics and definitions
- things that damage your hormones

So get those thyroid labs done and posted here. Meanwhile we can get an overall measure of your thyroid function by checking your waking AND mid-afternoon body temperatures. Have you been using iodized salt continuously for years? If not, why and when. Iodine deficiency messed with thyroid function. More info in the 'thyroid basics' sticky.

There are 7 stickies in this forum

"I also have labs from Singulex Clinical Laboratory where everything is "at target""
Well many lab ranges are in appropriate. Are your thyroid labs hiding there. Please post the other lab results.

Low cortisol, low DHEA and elevated rT3 suggests adrenal fatigue. You can find out more about this in the 'thyroid basis" sticky. You should get Wilson's book titled 'adrenal fatigue' [- available at amazon]

So I know that all of this is overwhelming. You need to read this post carefully more than once and read the stickies.