T Nation

*UPDATED* Lab Results- Opinions Needed


#1

Looking for opinions on recent lab results. I’m currently 43 years old. Long story short, I was first diagnosed with low T a few years ago and the doctor put me on T replacement. Things were going great but I was forced to get off after only 3 months. All of the low T symptoms slowly returned and I lost all desire to even go to the gym. I actually took an entire year off because I just didn’t even care about going; which is weird because I used to hit the gym 5 days a week religiously.

I recently went back to my primary care doctor to get a yearly physical, this is a different doctor than the one that treated me for low T. Durning the exam I started talking about my symptoms; always tired, no motivation, weight gain, no libido, etc. The doctor suggested we run a bunch of blood work to see if we could figure out what the cause might be. Pending the blood work results, he stated that he would be open to discussing TRT. After I got the results of the blood work, the Doctor had a few concerns; the biggest one was elevated Prolactin levels. In addition to that, my Vitamin D levels were low (always have been) and my HDL and LDL levels were off the charts. He ordered an MRI to see what was causing my Prolactin levels to be so high. The results of the MRI came back normal so then the doctor was willing to start me on TRT with MONTHLY injections of 200mg. I tried to get him to change the dosages but he was not willing. Rather than follow his protocol, I decided to make an appointment with my original TRT doc. After looking over my lab results, he agreed to start me at 150mg per week.

Below are my lab results. I guess I’m looking for others to look it over and see if anything stands out that might help point to the underlying cause of my low T. It would be nice to fix the issue rather than continuing to use testosterone for the rest of my life. These results are all before recently starting back on TRT.

Total Test: 187 ng/dL (Range: 348-1197)
Free Test: 6.6 pg/mL (Range: 6.8-21.5)
Vitamin D: 20.6 ng/mL (Range: 30.0-100.0)
Hematocrit: 45.6 (Range: 37.5-51.0)
TSH: 4.260 uIU/mL (Range: 0.450-4.500)
LH: 2.9 mIU/mL (Range: 1.7-8.6)
FSH: 10.1 mIU/mL (Range: 1.5-12.4)
Prolactin: 16.0 ng/mL (Range: 4.0-15.2)
Cholesterol, Total: 248 (Range: 100-199
Triglycerides: 574 (Range: 0-149)
HDL Cholesterol: 36 (Range: >39)
VLDL: reading not valid when Triglyceride level >400
One thing I will add about the Cholesterol and Triglyceride levels. The doctor seems to thing that the numbers reflect me taking a year off from the gym and not doing any exercise. He was convinced that getting me back in the gym would bring these numbers back down to where they were before.


#2

Yes they would definitely bring them back down.


#3

OP, if you’re looking for underlying reasons than take a look at your thyroid hormones in detail. Your tsh doesn’t look very good. Read the below sticky for more info

Had you tested your estradiol levels too? Your VitD, cholestrol and prolactin issues do really need to be fixed. Read here for more details

Alternative to TRT is SERM therapy, but I suspect how much effective a SERM restart will be for you at age 43. You may have to go long term on SERM to see any benefits, but it is definitely worth a chance if you want to avoid TRT.


#4

Restart is done when there is something to restart. FSH=10 confirms primary hypogonadism. TRT is the only option.


#5

LH is a better indicator of primary hypogonadism than FSH, but I take your point and still say that there’s nothing wrong with giving SERM therapy a try. I repeat again that OP may need to use it long term. Read the links below for details

http://www.scielo.br/pdf/ibju/v38n4/a11v38n4.pdf4


#6

Yes LH is what is needed for the testes to make T but LH is released in pulses and have a short half life, a blood test captures just a snapshot of pitiutary function. FSH has a longer half life and is never released when LH is not being released so it provides a better look at the gonadotropin production. Being on SERM is useless in such cases and may make it harder to treat as they can raise shbg thus inflating TT and e2 by overstimulating LH receptors when good levels are not useful for making T prior to any use anyway.


#7

I’d be a bit more concerned with your lipid profile. Those numbers are scary. You MUST have E2 tested. Be very careful injecting T without controlling E2.


#8

Do take the thyroid issue very seriously.
Thyroid may be a mess because of not using iodized salt.

That FSH level is worrying. Any testicular aching going on? Testicular cancers can release FSH, so now you have a symptom to check out.

Please see these links found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics
  • finding a TRT doc

#9

Even 2 years ago, my FSH levels were high, albeit not THIS high. Doctor never really said anything about it. I do not have any testicular aching going on at all but the testicular cancer point will have me looking into it.

Just to touch on a few of the other’s comments:

  1. I did try a restart but it didn’t do anything. Too much steroid use when I was younger without utilizing proper PCT is most likely the culprit I’m guessing.

  2. Vitamin D was addressed before and levels were brought back to normal. I stopped supplementing with Vitamin D and they crashed again. I am currently on 10,000 IU per day. I will retest with next labs.

  3. I haven’t had E2 tested lately but I plan on having it done on my next set of labs. Last time I had E2 checked it was 28. But that when I was also dosing Arimidex (.25 mg EOD) while on TRT.

  4. I had to come off of TRT before because my wife wanted to get pregnant. I was taking HCG along with the TRT but my sperm levels were beyond low when I did a semen analysis. The fertility clinic told me I had to stop the TRT if we had any hope. We have previously had an ectopic pregnancy…a few years before I even began TRT. I could have introduced HMG as well to aid in fertility, but the wife wanted me off everything.


#10

Testes have become dysfunction is my guess. FSH should be supporting spermatogenesis. By all means, get them checked out to rule out something bigger. Restart does not work when testes are damaged or atrophied as could be the case for your steroid use earlier. Improper steroid use can induce even Primary hypogonadism when doing longer cycles without hCG to keep testes functional. You should do TRT, but see if getting off results in normal sperm quality and count, i would not be too sure it’s going to happen now. But hope is what we survive on. Were you using hCG when you were on TRT? if not, in addition to previous history and TRT, testes could be damaged beyond recovery by this point. hCG is critical part of TRT when family is not complete. I even had some semen cryopreserved prior to TRT to be on the safer side as even hCG is not a sure shot defence mechanism.


#11

Yes, I was using HCG at 500 IU per week when I was on TRT. I was only on TRT for about 3 months though before I had to get off.


#12

Here are the lab results before I started any TRT. At the time, the doctor did not orders tests for FT, E2, LH or FSH because he said they don’t tell us anything. Yes…I got a new doctor, but here are the results just so you can see where they were before I started TRT. These were taken 2 years ago.

Bilirubin, Total
Results: .5 mg/dL
Range: 0.0-1.2

Hematocrit
Results: 44.9%
Range: 37.5-51.0

WBC
Results: 6.7 x10E3/uL
Range: 3.4-10.8

RBC
Results: 4.95 x 10E3/uL
Range: 4.14-5.80

THS
Results: 3.770 uIU/ml
Range: .450-4.500

Hemoglobin A1c
Results: 5.6%
Range: 4.8-5.6

Testosterone, Serum
Results: 265 ng/dL
Range: 348-1197

Cholesterol
Results: 207 mg/dL
Range: 100-199

Triglycerides
Results: 195 mg/dL
Range: 0-149

HDL
Results: 49 mg/dL
Range: >39

VLDL
Results: 39 mg/dL
Range: 5-40

LDL
Results: 119 mg/dL
Range: 0-99


#13

KSman had described how to approach restart in this thread

I feel your pain man, I was also in the similar dilemma a few years back but compared to you my situation wasn’t that gruesome. hMG, hCG both work in secondary hypogonadism but nothing could be sure in your case, you can just try to see. Though there have been a few cases reported in which SERM’s had raised t levels in hypergonadotropic hypogonadism like yours, and it can be inferred that if SERM can help than hMG/hCG or a combination could also work. But it is all guesswork, you may have to experiment it under your doctor’s supervision with labwork. And keep in mind that it’s a field that doesn’t have lots of research behind it and most docs will be as clueless as anyone.


#14

TSH was a mess years ago. TSH should be closer to 1.0
Ignore the thyroid lab ranges, they are misleading.

Please respond to my thyroid comments 3 days earlier.

Check oral body temperatures as per the thyroid sticky.

Thyroid can impact your sex hormones.


#15

KSman,

I have been taking my temps beginning this morning. I’m not sure how accurate the thermometer is but they were as follows:

5:30 AM upon waking: 96.8
6:30 AM after workout: 97.4
7:30 AM: 97.5
3:15 PM: 98.6
6:00 PM: 97.5

Also, I’m confused on what to make of my LH and FSH levels. From what I understand, in Primary Hypogonadism, LH levels are high and FSH are high. In Secondary Hypogonadism, both the LH and FSH levels are low. In my case, my LH is low 2.9, and my FSH is high 10.1. I guess I’m having trouble interpreting what that means.


#16

Your one 98.6F suggests that the thermometer is accurate.
Checking someone else’s body temperatures can be useful.

So you use iodized salt or not?


#17

I do not, I use Kosher salt…when I use salt. I really don’t add salt to any of my food, unless it’s steak. I bought a 3rd thermometer just to see if anything would change. Readings are a little different but my temps are still reading low all day. 96.5 upon waking today. This evening it was 98.1 after I was out working in the yard for an hour.


#18

So we have good reason to expect iodine deficiency.

Who else in your family is affected?
Wife and kids? Low iodine can affect IQ of children.
Iodine is very critical during pregnancy and breast feeding. Prenatal vitamins have more than typical RDA amounts.

Have you studied the thyroid basics sticky to see what you need to do?

Why did it take so long to get your attention re iodine? Not just you, its always a PIA to get this going.

If you do not use salt at the table, you need kelp capsules 500mcg [1/2mg].
Is salt used in the kitchen?
Throw that kosher salt out, it is harming your family.

See your doctor re high FSH and get screened for testicular cancer.


#19

Thanks KSman. Not married and do not have any kids. Yes, I have read the Thyroid sticky…multiple times. I have also researched many other resources on Hypothyroidism in order to get a better understanding of how everything works. I plan to get more labs done soon to test for FT3 and FT4 among other things. I’m guessing I’m Hypothyroid but we won’t know for sure until I get more testing. I will also talk with the doc about testicular cancer.

As far as the Iodine question, I must have missed it the first time you asked. Responded immediately after you asked the 2nd time though. I will say though, you ask why it’s so hard to get people on the Iodized salt kick? For one, people that don’t know about the iodized salt thing probably think it’s a weird question and has nothing to do with how they feel, and therefore don’t answer. Secondly, and I mean absolutely no disrespect, but you sound like a damn salesman for Morton salt. Seems like your recommended miracle cure for everyone is Iodine and adding more salt. I’m not saying you are wrong, but it’s really the one thing that stands out in all of your posts. I don’t think people take the salt thing seriously, so they ignore it. I mean, think about it, people come here looking for medical advice, and you tell them they need more salt? Most people would see that question and be like “WTF”? Again, I mean no disrespect, as your knowledge is very useful to the forum. I’m just trying to give you an honest opinion as to why you think it’s hard to get people on the iodized salt bandwagon.


#20

I vividly remember been told about iodine and goiter in health class in grade 5. That makes me an odd ball for sure.

Guys come here worried about testosterone. But thyroid is very critical to energy levels and vitality. Nothing magic about iodized salt, but the problems of not using it very real.

So how to sell these issues to guys who come here with testosterone tunnel vision?