T Nation

[Updated Labs] 23, TT = 358 ng/DL. Feel Low Symptoms, Bloodwork Results Inside


#1

Haven’t been feeling like myself lately, so I ordered a basic blood test just to see how my body is doing.

Symptoms: Lack of energy (fatigue), mood changes, brain fog, decreased sex drive, low motivation, sore longer after workouts + decrease strength

I workout 3-4 days a week with a good diet and get good sleep. I am aware that I do not have Free Test and Thyroid results.

Could someone please give me an opinion on my results? Taken 8am fasted.

Testosterone 478 (348-1197 ng/dL)
LH 2.8 (1.7-8.6 mIU/mL)
FSH 2.8 (1.5-12.4 mIU/mL)
Estradiol 10.2 (7.6-42.6 pg/mL)
AST (SGOT) 44 (0-40) IU/L)
ALT (SGPT) 26 (0-44 IU/L)

Full Results: http://imgur.com/a/yd1an
(CBC + Comp. Metabolic Panel)


Results After 4 Weeks Nolvadex (HPTA Restart)- Failed
#2

TT consistent with low LH/FSH
CBC consistent with low T

You also need to test prolactin to see if that is driving LH/FSH down/

We have seen a pattern of low thyroid function and low T.

  • not using iodized salt?
  • feel cold easier now?
  • outer eyebrows sparse?
  • other signs are the same as low-T

Any blows to head in time frame before all of this?
Describe when these problems seemed to start? Sudden or slow onset?

Please read theses stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • thyroid basics - check your oral body temperatures

#3

Thanks for the reply KSman, I really appreciate it. I am going to get an appointment with a endocrinologist to get a full hormone panel + full thyroid panel. I totally forgot that my father has thyroid issues and therefore it is best to get this checked as soon as possible in the case of genetic predisposition.

I will be back with results later on, looking forward to your advice when I have the new data.

Thanks again.


#4

Did your father use iodized salt?


#5

Cant tell if troll. But no, Thyroxine for Hypothyroidism.


#6

If your father did not use iodized salt, that would also have affected you in the family home and could be a common factor for you both. This is a troll free zone.


#7

Full results 8:00am fasted. Unfortunately doc wouldn’t get E2, but look above for last result.(12 days ago) Thank you in advance!

TESTOSTERONE,TOTAL 358 231-735 ng/dL
TESTOSTERONE, FREE 46.71 63.07-103.80 pg/mL
SHBG 63 17.3-65.8 nmol/L
LH 2 FEMALE: Follicular 1.9 - 12.5 Midcycle 8.7 - 76.3 Luteal 0.5 - 16.9 Pregnant 0.0 - 1.5 Postmenopausal 5.0 - 52.3 Contraceptives 0.7 - 5.6 mIU/mL
FSH 2.1 FEMALE: Follicular 2.5 - 10.2 Midcycle 3.4 - 33.4 Luteal 1.5 - 9.1 Pregnant <0.2 Postmenopausal 23.0 - 116.3 mIU/mL

TSH 1.2 0.350-5.500 uIu/mL
T3 97 80.0-204.0 ng/dL
T3, FREE 3.1 2.3-4.2 pg/mL
T3 UPTAKE 33 22.0-35.0 %
T4 7.2 4.5-12.0 ug/dL

LIPIDS
CHOLESTEROL 156 100-199 mg/dL
TRIGLYCERIDES 57 0-149 mg/dL
HDL CHOL. 47 40-59 mg/dL
VLDL CHOL. (CALCULATED) 11.4 5.0-40.0 mg/dL
LDL CHOL. (CALCULATED) 97.6 0.0-130.0 mg/dL
T. CHOL/ HDL RATIO 3.3 0.0-4.4

CBC
WBC 5.6 4.0-11.0 x10^3/uL
RBC 4.68 4.00-6.20 x10^3/uL
HGB 14.7 11.0-18.8 g/dL
HCT 43.6 35.0-55.0 %
MCV 93 80-100 fL
MCH 31.4 26.0-34.0 pg
MCHC 33.7 31.0-35.0 g/dL
RDW 10.9 10.0-20.0 %
PLT 204 140.0-440.0 x10^3/uL
MPV 9.9 6.0-10.0 fL
NEU% 49.8 50.0-80.0 %
LYM% 36.1 25.0-50.0 %
MON% 10.7 2.0-10.0 %
EOS% 2.9 0.0-5.0 %
BAS% 0.5 0.0-2.0 %
NEU# 2.77 2.00-8.00 x10^3/uL
LYM# 2.01 1.00-5.00 x10^3/uL
MON# 0.6 0.10-1.00 x10^3/uL
EOS# 0.16 0.00-0.40 x10^3/uL
BAS# 0.03 0.00-20.00 x10^3/uL

CMP
GLUCOSE 86 65-95 mg/dL
BUN 16 26-May mg/dL
CREATININE, SERUM 1.1 0.50-1.50 mg/dL
BUN/CREATININE RATIO 14.5 8.0-27.0
PROTEIN-TOTAL 8.2 5.0-24.0 mg/dL
ALBUMIN 4.95 3.50-5.50 g/dL
GLOBULIN 3.2 1.5-4.5 g/dL
ALBUMIN/GLOBULIN RATIO 1.52 1.10-2.50
AST (SGOT) 55 Oct-50 U/L
ALT (SGPT) 35 0-40 U/L
BILIRUBIN TOTAL 0.7 0.2-1.2 mg/dL
ALK PHOSPHATASE 49 20-125 U/L
CALCIUM 10.1 8.5-10.6 mg/dL
SODIUM 138 135-148 meq/L
POTASSIUM 4.6 3.5-5.5 meq/L
CHLORIDE 101 96-109 meq/L


#8

LH/FSH low.

AST/ALT may be elevated by training and/or sore muscles. Best to back off for lab work.

Cholesterol looks good, but total cholesterol may be getting too low that can affect hormones and general health.

Thyroid: T3, T4 are below midrange.
Have you been using iodized salt and/or vitamins that list iodine+selenium?

fT3 is near midrange which should support good body temperatures, please check as per the thyroid basics sticky and we will see if all is well.

So you are on thyroid meds? "Thyroxine for Hypothyroidism"
Labs then look like things are reasonably controlled. Body temps can indicate where you are and drive dose refinements. You still need iodine in your diet. As you are “feeling” low, these factors need to be considered as possible issues along side your low T.

Not trolling: Not using iodized salt can cause hypothyroidism and then high TSH can lead to nodules that can progress to hyperthyroidism. And a lack of selenium along the progression can lead to thyroid autoimmune diseases.

E2=10.2 is consistent with your low FT
FT and TT are consistent with LH/FSH
SHBG is insanely high relative to E2
Low FT can increase SHBG, but does not explain this.
https://en.wikipedia.org/wiki/Sex_hormone-binding_globulin#Conditions_associated_with_high_or_low_levels

So liver is of interest and AST/ALT were not low, but certainly do not suggest any pathology.
Any OTC or Rx medications, exposure to chemicals/pollution?

In any case, you are secondary and E2 is not the cause.
Prolactin unknown.

When a younger guy is secondary, prolactin should be tested. If elevated, this can be from a prolactin secreting pituitary adinoma. If that happens and ignored, can become large and press on optic nerves when a loss of width of peripheral vision can occur. All of that can be easily managed with 0.5mg/week Dostinex/cabergoline. If prolactin is elevated, pituitary should be imaged with MRI. Sometimes a non prolactin adinoma can occur that a MRI can image. And pituitary can be damages by blow[s] to the head and the timeline of any of those relative to when problems are perceived to have started is important.

Some guys in your age group simply have unexplained collapse of their hormones. The options then are hCG only which works well with many younger males. Otherwise TRT with T+hCG.

Fixing your T status will greatly improve your quality of life [QOL]. Look to see if thyroid needs any fine tuning. You will need to watch SHBG and should track TT, FT and SHBG until you see how these are moving together.

Most of the above considerations are in the suggested stickies.


#9

AST/ALT was high because of a workout day before.
I do take a daily multivitamin that has iodine + selenium. Also take fish oil, D3, and green tea extract.
I have also bought salt with iodine.
I have ordered a thermometer and will track temperatures.
I am not on thyroid meds, my father is on thyroxine.
I do not take any OTC or Rx meds, and no exposure to chemicals/pollution.

Next steps:
Follow up with Doctor, talk about my results and get a test for Prolactin levels to check for pituitary and go from there. Also, test morning body temps.

Again, thank you for your drive to provide the community with your research and knowledge. I read all of the stickies and now have a good amount of knowledge going forward. You make me want to help people.

Be back soon with an update.


#10

Thanks +++

twenty characters…


#11

Hey KSman,

I got my prolactin tested yesterday at the follow up. The follow up went horribly, the doc said that since my Total Test(low) was in normal range, my Free Test(which is below range) and SHGB(upper range) did not even matter to look at. I then asked about LH(low) and FSH(low), and doc said that these are female hormones and that you do not need to worry about them. Doc told me to exercise more (LOL) and referred me to a urologist. I was expecting this to happen, but I was disappointed nerveless. Oh well, at least I got my prolactin test out of it.

PROLACTIN 9.90 ng/mL MALE: 2.0 - 18

Since my prolactin is not at crazy levels, we can eliminate the pituitary tumor, correct? Should I still try to get an MRI for damage to the gland? Any thoughts at this level of prolactin?

Now back to the thyroid. I only have waking morning temps for two days now:
96.6
96.8

My multivitamin taken daily includes:
Iodine (from Potassium Iodide) 225 mcg
Selenium (from Selenium Glycinate Complex) 200 mcg

I also use iodized salt now.

Would you recommend me to take Iodoral or some kind of Iodine supplement? (or stay at baseline TSH for possible upcoming endo/urolgist visits/blood tests?)

My real question is, where do we go from here? I would like to get to the answer as to WHY my levels are low, before considering any type of treatment.

If I was to schedule an endo or urologist visit, what kind of blood tests should I now get, besides the obvious TT, FT, E2, SHBG, LH, FSH, Thyroid (do I need more in depth?), Lipids, CBC, CMP)
-what should we be looking at for now as an actual cause to my issue.

As always, thanks man, I really appreciate it. Please let me know if you need any more information.


#12

See the thyroid basics sticky.
You could test fT4, rT3, AM cortisol [8AM please], DHEA-s

Those sources of iodine are maintenance doses that may be unable to pull you out of the hole.

fT3 is mid-range and should support good body temperatures. rT3 may be elevated from stress factors, see references to adrenal fatigue, Wilson’s book fT3, stress in the sticky.

With high SHBG, TT has more T+SHBG that is not bio-available. Your doctor lacks the interest and the knowledge to read between the lines.


#13

I did the two week course of IR (50mg/day)

Before Iodine (mornings): Average: 96.72
96.6, 96.8, 96.2, 97.5, 96.7, 97.0, 96.3

After Iodine (mornings): Average: 96.90
96.8, 97.0, 97.1, 96.8, 96.8

My body seems to get up to a temp of 98.3 during mid afternoon. I felt really good the first 4-5 days but then I went back to normal (lower energy etc). I will try and see if my doc can get me rT3 lab work.

Interested in a HPTA restart. I have an appointment next week with a urologist who specializes in HRT, so I’m getting all my shit together for the best outcome.
I’ve read your sticky, please confirm if this sounds good.

week 1-4: 250iu hCG SC EOD
(labs for TT, FT, E2) if improved continue

week 5-8: 20 mg Nolvadex EOD (Do I need to taper- how long?)
(labs for LH/FSH, TT, FT, E2)

Week 1-8: .14mg Anastrozole EOD

Week 9-10: Taper Anastrozole

(labs at around week 13-14)

Do i need to taper the Nolva at the end of week 8 for another 1-2 weeks? or completly stop at week 8?

Thanks KSman


#14

@KSman

Can you give some recommendations on tapering Nolvadex in your HPTA restart protocol? Check my post above please.

Do I taper within the allotted 4 weeks? Or do I take 20mg Nolva for those 4 weeks and then taper that dose for an extra 2 weeks?


#15

You need to be on steady for a while then taper. Time on depends on if hCG has been used to precondition the testes. It you have the time to be on SERM for four weeks then taper, and are feeling good with what is happening, it would be a reasonable thing to do. There are many ways to do this. I provide rough guidelines.