T Nation

TRT Vets! Please Review My Bloodwork

New here, been following this site for forever. Thought i’d reach out to the experts to get thoughts on my bloodwork. Please Review my blodwork that is attached here. Got these labs myself out of pocket, based off the recommended tests from this site. Any help is appreciated!

33 YEARS OLD
6’4”
230 LBS
165 LBM MASS – per inbody test
28% BODY FAT – per inbody test

TSH, THIRD GENERATION 0.914 UIU/ML 0.400-4.100

TESTOSTERONE PANEL
TESTOSTERONE 311 NG/DL 300-1080
SEX HORM BIND GLOBULIN 20.5 NMOL/L 16.5-55.9
CALC FREE TESTOSTERONE 78.7 PG/ML 47.0-244.0

DHEA SULFATE 398 UG/DL 103-446
IGF-I 156 NG/ML 72-202
CORTISOL, RANDOM 9.3 UG/DL 4.8-19.5
PROLACTIN 7.2 NG/ML 4.0-26.0
DHT 258 pg/mL 112-955
PROGESTERONE 0.22 H NG/ML MALE <.15 FEMALE .06-214
ESTRADIOL, ULTRASENS 16.3 pg/mL 10.0-42.0
VITAMIN D 30 NG/ML 30-100
LH 4.6 IU/L 1.2-8.6
FSH 1.6 IU/L 1.5-12.4
FREE T3 3.5 PG/ML 2.2-4.2
T4 (THYROXINE) 9.4 UG/DL 4.5-10.5
FREE T4 (THYROXINE) 1.48 NG/DL 0.80-1.90
THYROID PEROXIDASE AB 1 IU/ML <9

CBC PANEL
WBC 6.7 K/UL 4.0-11.0
RBC 5.50 M/UL 4.10-5.70
HEMOGLOBIN 16.7 G/DL 13.0-17.0
HEMATOCRIT 47.1 % 37.0-49.0
MCV 85.6 fL 80.0-100.0
MCH 30.4 PG 27.0-34.0
MCHC 35.5 G/DL 32.0-35.5
RDW 12.2 % 11.0-15.0
NEUTROPHILS 54.9 % 40.0-74.0

LYMPHOCYTES 32.2 % 19.0-48.0
MONOCYTES 8.5 % 4.0-13.0
EOSINOPHILS 3.4 % 0.0-7.0
BASOPHILS 1.0 % 0.0-2.0
PLATELET COUNT 210 K/UL 130-400

COMPREHENSIVE METABOLIC PANEL
GLUCOSE 88 MG/DL 70-99
BUN 11 MG/DL 6-20
CREATININE 0.90 MG/DL 0.80-1.40
eGFR AFRICAN AMER. 131 ML/MIN 1.73>60
eGFR NON-AFRICAN AMER. 113 ML/MIN 1.73>60
CALC BUN/CREAT 12 RATIO 6-28
SODIUM 142 MEQ/L 133-146
POTASSIUM 4.5 MEQ/L 3.5-5.4
CHLORIDE 101 MEQ/L 95-107
CARBON DIOXIDE 29 MEQ/L 19-31
CALCIUM 10.0 MG/DL 8.5-10.5
PROTEIN, TOTAL 7.8 G/DL 6.1-8.3
ALBUMIN 4.9 G/DL 3.5-5.2
CALC GLOBULIN 2.9 G/DL 1.9-3.7
CALC A/G RATIO 1.7 RATIO 1.0-2.6
BILIRUBIN, TOTAL 0.8 MG/DL <=1.2
ALKALINE PHOSPHATASE 84 U/L 40-112
AST 23 U/L 9-50
ALT 36 U/L 5-50

LIPID PANEL
CHOLESTEROL 166 MG/DL <200
TRIGLYCERIDES 122 MG/DL <150
HDL CHOLESTEROL 49 MG/DL >39
CALC LDL CHOL 93 MG/DL <100
RISK RATIO LDL/HDL 1.89 RATIO <3.55
PSA, TOTAL 0.86 NG/ML <=4.00

Background. Been active and lifted for all early life. Took 2 simple small cycles when i was 18 based off of dumb recs from friend. Followed neither up with PCT. Ever since i have felt like a zombie the last 15 years and do nothing but eat sleep repeat and still tired. Hired a trainer from age 28-31 and hired a meal prep company to try to get life back. Ate clean to a T and still couldn’t get below 20% BF and basically quit and haven’t lifted since.

Have not been to a DR yet? Should i go to clinic, urologist, or an endo? Should i try a restart first? No kids yet but still want some. I’m pretty much lost so any guidance is much appreciated. I just want to get back to 200lbs and get life back with energy etc. Thoughts?

You are low T, low D and high Calcium for your age. See a doc, try a restart, probably won’t work but worth a shot. Start lifting weights. Lower reps, higher weight, longer rest periods between sets is better for T. Don’t do any insane amounts of cardio. Get some sun and cut out processed foods.

I would look for someone who specializes in TRT/HRT, and by that I mean it is all they do. I’d be fine with someone who treats women too.

You can, but I think with your numbers you’ll be spinning your wheels.

Then you’ll want to use hCG periodically and definitely when actively attempting to conceive.

I’d start with 160mg test cypionate once a week and check total test, free test, E2 and CBC in six weeks.

Like others have said, probably a waste of time. Testosterone has been on the decline for two decades and is expect to drop even more by age 40, which then the decline can be more noticeable.

Testosterone sets the metabolic rates and thyroid follows suit, low T men have great difficulty losing weight, in fact a study had a group of low T men, group A were told not to exercise and the other non-TRT group were told to exercise.

The low T men lost no weight and some actually gained weight, the TRT group with no exercise lose inches around their wastes and gained muscle.

TRT will drop your SHBG a little, lower SHBG men do better on multiple injections per week, these large weekly injections can cause estrogen to be higher versus smaller more frequent injections and the latter can maintain steadier levels and higher levels at trough.

Go see a good doc. Where are you located? There are many good ones that specialize in only this (HRT) that do telemedicine. Some of them you only have to visit once and then they can do telemedicine from then on.

Get your vitamin D up. 5000iu daily of D3, take it with your fattiest (it’s fat soluble). D is critical for hormone production.

Thanks for the info everyone! I’m located in dallas Fort Worth. Was thinking of contacting defy as I’ve seen them mentioned here, but if there is dr or someone better here in dfw please let me know.

Do y’all think I’m secondary, or primary with my Lh and FSH scores? Also what do you guys think of my high progesterone, does that mean anything? is my free t pretty bad?

If this is your only blood work, get a few more.

Don’t jump On trt based upon 1 blood test. COMFIRM you’re low T w numerous tests first.

K, will do. Thank you.

Anyone have any thoughts if I’m primary or secondary? Or my high progesterone meaning?

You are secondary and maybe your testicles aren’t very sensitive to LH stimulation. I see some guys with higher testosterone in relation to their LH, this tells me their leydig cells in the testicles are sensitive.

It’s not like your SHBG is elevated binding much testosterone, so testosterone should be almost midrange alongside midrange LH levels. You look near infertile as well with lower FSH, definitely a pituitary failure.

We often see testicular failure showing an increased LH and FSH do to the testilces failing to respond. Don’t know about the high progesterone, it’s not overly high, just a little.

Thanks for response! I followed up with additional blood work as people stated and it confirmed the previous findings.

Total T = 321 (264-916)
Free T = 10 (8.7-25.1)
SHBG = 18.9 (16.5-55.9)
Estradiol Sens = 23.4 (8-35)
DHEA = 321.2 (138-475)
DHT = 26 (30-85) LOW
LH = 4.5 (1.7-8.6)
Prolactin = 8.8 (4-15.2)
IGF-1 = 180 (88-246)
TSH = .956 (.45-4.5)
Reverse T3 = 25.3 (9.2-24.1) HIGH
T3 free = 3.2 (2-4.4)
T4 thyroxine = 1.28 (.82-1.77)
Thyroid Peroxidase = 9 (0-34)
Vit D = 23.4 (30-100) LOW
PSA = 1.2 (0-4)
Ferritin = 196 (30-400)

Interesting you say i’m secondary when my LH and FSH scores are in the normal range? Wouldn’t that mean i’m primary? Thanks for help, just trying to learn!

There is a portion of that Free T3 that is unable to interact with the T3 receptors do to high Reverse T3, the amount of Free T3 that is active is less. You would be best served injection either EOD or everyday because SHBG will decrease and free hormone increase which is what low SHBG men tend to struggle with the most.

Your SHBG will probably end up somewhere in the low to mid teens, but improving thyroid can see an increase in SHBG. If unable to lower Reverse T3, T3 medicine would see SHBG increase.

A primary diagnosis is very high LH and low testosterone.