T Nation

TRT Labwork


#1

First i want to thank everyone who has contributed in the TRT protocol which can be found on this forum and especially KSMAN. Thank you!

I am a 30 year old male and i live in Sweden and i plan to start TRT as soon as i get the labwork done and also input from this forum, trying to keep things safe and organised.

Most labwork can be done here in Sweden but it is difficult and VERY expensive.
So to get to the point i just want to make clear which of the following labwork is absolutely nessecary for me to get started here.

I have read all the stickies including the labwork sticky, but after reading several posts on this forun where people ask which labtests to get different things are recommended, therefore i created this thread for the same exact reason.
*PSA has not been written due to the fact that i am 30.

Please feel free to add/modify/delete any of the below tests:

"
Labs:
TT
FT
E2
LH/FSH
prolactin
CBC
hematocrit
Liver markers: AST/ALT
AM cortisol, do at 8AM
DHEA-S
vit-D25 hormone
TSH
fT3
fT4 [please not T3, T4]
cholesterol (Lipids: Fasting Cholesterol and related)
Pregnenolone
Glucose: Fasting levels indicate insulin function

Testing your body temperature: Get an oral "fever" thermometer. "

//Surre


#2

List looks good. If your body temps are low I would throw in rt3 for testing as well.


#3

You can skip Vit-D25 and see if you can take 5,000iu Vit-D3 every day. We can get that as tiny oil based capsules here.

DHEA is rarely low at your age. You might skip that for now.

You could check your body temperatures now. If good temperatures, you could skip the thyroid labs.

What are your symptoms?


#4

[quote]KSman wrote:
You can skip Vit-D25 and see if you can take 5,000iu Vit-D3 every day. We can get that as tiny oil based capsules here.

DHEA is rarely low at your age. You might skip that for now.

You could check your body temperatures now. If good temperatures, you could skip the thyroid labs.

What are your symptoms?[/quote]

Thanks for the replies. Will write all the additional info and stats as per the “Advice for new guys” sticky as soon as i get my temps down, and labworks done.
Just bought a oral thermometer today and will check first thing when i wake up tomorrow and mid-afternoon.

History/symptoms:

I was actually recommended to visit this forum regarding TRT from a Lyme disease forum, since many people who suffer from lyme disease state that the disease it self can cause low test. I would not say that this is a fact, since i dont have proof.
I know many lymedisease sufferers on the forums who are on TRT with great results, another reason why i am here, just looking to maximize the quality of my life and be somewhat “normal”.

Had lyme disease when i was 26, was basically bedridden for 6 months or so. Got abx treatment for about 6-7 months and the major lyme symptoms under control, stopped the treatment- felt somewhat “normal” again, still some minor issues with brainfog, low libido, low energy, morning wood -(often not), mood= usually nervous, stressed out, bad self-confidence.
I work out 5 days/week.
I have a fulltime job and i am newlywed so i need to to what i can to get back on track. I am more then willing to do TRT as soon as i get some labwork in and recommendations from this forum.

I apologize for the long post :confused:

//Surre


#5

As per the above post this would be the complete version including labs.
The overall goal here is to improve the quality of my life.

I do not have a TRT doc., it seems quite difficult here in Sweden and I could start this myself until my GP gets onboard, labs and other tests can be done as often as I need.
I greatly appreciate the input from this forum and the people here that help others. Thank you for your interest in my post.

Age = 30
Height = 5´10 ( 179 cm)
Waist = 100 cm (39.4´)
Weight = 209lb (95 kg)


Skin = Combination skin, oily nose and dry cheeks/forehead


Do you get cold easily/Not been using iodized salt long term/Thyroid looks enlarged?=

NO / Have been using iodized salt long for 2 years regurarly/ NO


Describe body and facial hair =

-Hair loss problems since young age have had 2 hair transplantation surgeries.

-Have beard (with some spots), hairy chest, legs, and arms. - No back hair. Some eyebrow sparseness

-How has it changed

  • Less hair on arms compared to 2 years ago, and i would say that overall hair growth is pretty slow compared to a few years back.

describe where you carry fat and how changed =

-Handles, unprorportional fat at thighs, hips -and butt-area compared to the rest of my body.
-. Have difficult loosing weight compared to 6 months ago. My weight is somewhat non-steady with fluctuations.


Health conditions, symptoms [history/current] =

-Lyme related symptoms but was never officially diagnosed. I would say 95% of those symptoms went away about 3-4 years ago after various antibiotic and natural-medicine type of treatments.

-Current symptoms include: vision ( not as good as used to), fatigued very often, exhaustion, some concentration difficulties, short-term memory worse, anxious, irritated, lack of motivation. Worse recovery durng/after weight-lifting sessions.


Average body temperatures:
(Thyroid labs were included the panel I ordered even though my temps look decent)

Waking up: 98.06
Mid afternoon: 98.6


Rx and OTC drugs, any hair loss drugs or prostate drugs=

-History = various medications when i had lyme related symptoms a few years back: Tetracyclins, penicillinâ??s, fluoroquinolone, Corticosteroid, anastelgics.

-Hair loss medication =Rogaine (minoxidil) used for a few days but stopped due to unwanted side effects.


Describe diet

-Have been on many starvation diets in the past.

-sweets, salads, rice, pasta, eggs, chicken, red meat and fast food at least twice a week. I have periods where go super-healthy for a while and then go back to above which is a mix of a healthy and unhealthy diet. Very rollercoaster type of diet I would say.

-Supps: Whey protein, creatine, BCAA, fishoil, multivitamin + recently added vitamin D3.

-I eat iodized salt, didnâ??t too much in the past but have been regularly part of diet for 2 years now.

-No drink or smoke. But i use something called -snus- here in Sweden which is tobacco- pouches you put under your lip.


Describe training =
Weightlifting 4-6 days/week, minimum or no cardio.


Testes ache= No


How have morning wood and nocturnal erections changed =

-Over the last 3-4 years almost no morning-nocturnal wood. I dont know if this is due to the fact that i have been with the same woman for many years( i blame myself, not her)…Long story short = we dont have sex.


Had some issues translating the labs, let me know if any of the words seem off

lab results:

TT: 15 ( 8.6 - 29 nmol/L)
SHGB: 23 ( 18-54 nmol/L)
E2: 108 ( 50-150 pmol/L)


Results based on calculation : (https://www.nebido.com/tools/index.php/en/default/index/free-calculator)

FT: 10.8 ng/dl = 2.5 %
BIO-T: 253 ng/dl = 58.5%


LH: 7.0 (1.7-8.6 E/L)
FSH: 2.9 (1.5 -12 E/L)
Prolactin: 7.6 ( 4 - 15 ug/L)

Thyroids:

TSH: 1.3 (0.4 - 3.5 mE/L)
FT3: 4.5 (3.5 - 5.4 pmol/L)
FT4: 11 (8-14 pmol/L)

Cortisol: 472 (135-540 nmol/L)
Colesterol: 4.5 ( 2.9 - 6.1 mmol/L)
HDL colesterol : 0.9 ( 0.8 -2.1 mmol/L)
LDL colesterol : 2.5 ( 1.2- 4.3 mmol/L)
HbA1c: 32 ( 27-42 mmol/mol)
Glucose: 5.4 (4.0- 6.0 mmol/L)

AST: 0.22 ( < 0.76 mikrokat/L)
ALT: 0.46 ( < 1.10 mikrokat/L)

Natrum: 139 ( 137-145 mmol/L)
Calium: 3.7 ( 3.5-4.6 mmol/L)
Creatinine: 102 ( < 100 mikromol/L)

Iron: 24 (9-34 mikromol/L)
Transferrin: 2.90 ( 1.90-3.30 g/L)
Ferritin: 212 (20-250 mikrog/L)
Folate (vitamin B9): 17 ( 7.0 > nmol/L)
Cobalt (vitamin B12): 340 ( 100-450 pmol/L)
Zink: 16 (12-18 mikromol/L)
Magnesium: 2.4 mmol/L ( no range provided from lab)
Vitamin D-25-OH : 46 ( 75-250 nmol/L)
CK, Creatine-kinase: 1.3 (0.8 -6.7 mikrokat/L)
Triglycerides: 2.2 (0.45-2.6 mmol/L)

Blood status:
Hemoglobin: 161 (134 -170 g/L)
Leukocytes: 7.8 ( 3.5-8.8 x10(9)/L)
Platelets: 239 ( 145-348 x10(9)/L)
Hematocrit, EVF : 0.48 ( 0.39-0.50 no unit provided from lab)
Erythtocytes: 5.5 ( 4.2-5.7 x10(12)/L)
MCH: 29 ( 27-33 pg)
MCV: 86 ( 82-98 fL)


Options/thoughts:

*What are my options here based on above info provided?

*I started taking vit D3 as per Ksmans recommendation. Should be good based on the extremely low vit D labresult I show.

*I also know that my non-steady diet needs to be in check so thatâ??s something I am currently working on.


#6

Cholesterol is good.
Thyroid function [body temperatures] appear good and thyroid lab numbers are good with fT3 and fT4 slightly low.

You need to increase vit-D3 intake. All the more in your climate. Suggest 5,000iu/day.

  • I see that you have started that after labs were done.

No sign of diabetes or insulin resistance.

You seem in a better state of health that I would have expected for your waist size.

Your prolactin and other things noted above cannot explain your low energy or weight gain.

E2 is not high, but high enough VS T levels to make you estrogen dominant and your fat patterns support estrogen dominance. Your weight/fat leads to more aromatase and conversion of T–>E2. This a self reinforcing conditions. Lowering E2 would be beneficial. 0.5mg anastrozole per week in EOD dosing could be tried.

Hematocrit is quite strong VS your T levels. May need to watch that if you get to TRT or otherwise recover T levels.

How is digestion? Any suspicion that antibiotics have created a problem? Have you every tried probiotics?

AST/ALT do not suggest any liver issues that might be reducing E2 clearance.

At time of labs we see strong LH compared to FSH. Suspect that the labs caught a pulse of LH and FT could be exaggerated. With natural guys, FT is pulsatile and labs can catch peaks or lows and we cannot attach too much meaning to the FT results.

SHBG is reasonable and we can expect to see good FT levels relative to your TT and assume that TT numbers are not exaggerated by increased T bound to SHBG. So your TT indicates that you have mid-range T levels and exposure and estrogen dominance will decrease the effect of that T level.

So what is the source of the fatigue? Nothing in the labs explain that. Whatever it is its affecting your libido and metabolic rate. So it could be a lingering effect of of Lyme disease or something else.

For something else we have to speculate and guess. Your metabolic rate is the net effect of things that influence your mitochondrial metabolic function. We have good support for fT3 and cortisol. But we have no idea if fT3 is getting blocked by rT3. Find out if you can get that tested. Probiotics can be tried. Vit-D25 could be better and you should try that. Vit-D25 is a hormone that is critical for DNA expression. Cell wall permeability is important and you can try fish oil, nut, flax seed oil/meal as sources of essential fatty acids [EFAs]. Also critical is CoQ10 which is made in the liver, you can look for supplements and Ubiquinol form is best and should be used as a trial. Also critical are antioxidants such as vit-C, NATURAL source vit-E, alpha-lipoic acid and acetyl-L-carnatine [ALC]. You will need to be your own lab rat and see if any of these are helpful.

Labs:
rT3 - reverse T3 [even though body temperatures are good]
IGF-1 - to evaluate growth hormone status
LH/FSH - wanting to see that LH does not repeat high.

Diet: best to avoid/reduce high glycemic foods [google that]
-sweets, rice, pasta, white bread

Are there any tests that can be done or have been done to detect if Lyme is lingering?

I think that TRT would help you loose weight and feel better. Your are clearly showing signs of hypogonadism. While your labs do not indicate that state, perhaps Lyme disease left you androgen resistant. If you had a cooperative doctor, this could be approached as a “trial”. If it works, that then become the diagnosis and you get the benefits and weight loss. If you feel worse, that can be the restored metabolic demands of the testosterone outstripping the ability of your body and that also tells us something. The added labs would be useful.


#7

Thank you so much for your extensive reply and i am getting a whole new perspective of things after reading what you wrote.

I agree with you regarding my labresults, but the way i feel mentally/physically are kind of the opposite. So i agree again with you with the post-lyme symptoms spooking, as they can basically mimic all kinds of weird stuff. I was actually surpised with the T lab results, as i thought that lyme had really taken its toll on my test-levels. So i guess thats positive thing.

-Getting a proper lyme disease test here in Sweden is difficult, the ones they order here are the ELISA which is not really good (sensitive enough to detect any ongoing lyme). The only option in my case is to go to Germany and get a Western Blot test for lyme. And i might need to do this since i visit Germany at least 2 times/year.

Vitamin/Diet suggestions are really good and makes sense. Iam taking the 5k IU D3´s along with my opti-men multivitamin and Fish oil. I am also making a purchase for the other supplements that you recommend.

Getting the LABS you suggested. Would you recommend i start the arimidex now or should i wait until the new lab results are in and we take it from there?

Thanks again for your input, means i am getting somewhere with my health for the first time in many years =)


#8

Hi KSman, I replied to you yesterday and it seems that the post got lost ( second time my post mystically dissapears :wink:

I agree with you where you are saying that my labs look “normal”. But the way i feel mentally/physically says otherwise, so i agree with you again that some post lyme sypmtoms might be spooking.
i actually thought that lyme had taken its toll on my testosterone, i was really surprised when the T lab results came back higher than expected.

At the moment it would not be possible to test for lyme here in Sweden unless you are showing extreme signs of sickness. I would have to go to germany for that, which might be an option since i visit 2 times/year.

-If things are simple enough as to lower E2 i will definately get some Arimidex and try that to see where i get.

How is digestion? Any suspicion that antibiotics have created a problem? Have you every tried probiotics?

  • Digestion is actually good. I took LOTS of different type of antibiotics when i was treated for lyme, so i am sure they have done their damage somehow especially the fluoroquinolones. Had issues with my eye sight for a while after taking that, the side effects from that antibiotic alone is worse than lyme disease in my case.

I have high hopes for the D3 i am currently taking along with my multivitamin and fish oil. Also making a purchase for the other supplements you recommended.

Will update the thread again as soon as i get the new labs in. It might take a while for the rT3 test because for some strange reason it isdifficult to find a private lab that does the rT3 test here in Sweden. The other tests is not an issue, will get those sooner and post here.

Once again thank you so much KSman for your extensive reply yesterday, it makes me think quite differently on things now.


#9

You will have to be careful with anastrozole. With your current state, you do not want to suffer from low E2 symptoms. Be aware of anastrozole over-responder implications. That would mean taking 1/4th the expected dose after stopping for 6 days.

In any case, lowering E2 a bit is not going to address your major issues, but might improve T and T:E.


#10

Yes. I will give that a try. Any idea of how long I should be using the AI? Should I get labs in between to check E2?

Thanks


#11

Yes, see where E2 goes.

Did you check body temps on some other days?


#12

I did not, it was only checked once. Will check for a few days straight to get some data and post here.


#13

KSman,

Been in touch with every major lab, both private and government labs. And nobody provides the rT3 test here in Sweden. They had it a few years back but was dropped for reasons unknown. When i called Karolinska lab (major university hospital lab) they told me that some controversy was associated with that specific test…Frustrating.


#14

My interest in rT3 is that is can be increased by stress and adrenal fatigue. Then it blocks some fT3 and can lower body temperatures. If rT3 is good and temperatures low, I suspect the above and rT3 labs rules that in or out. The difficulty is that the effects of moderately elevated rT3 is not understood. Docs look at in-range - out-of-range lack or while perspective* and I expect a linear effect.

  • noting that most docs really don’t do more than prescribe a drug or not

Stress:
"usually nervous, stressed out, bad self-confidence.
I work out 5 days/week.
"
work and life stress
illnesses
surgeries
acute or chronic inflammation
over training or training when your body is compromised


#15

Yep, i see what you mean. will post the temps here in a few days to gather som stats. Got in touch with a lab that might be able to send the rt3 lab abroad for testing. Hoping for the best