T Nation

What Blood Tests are Essential?


#1

Hi

I recently saw an andrologist about reduced pleasurable sensation & discomfort/pain, and low libido. He refered me to get a blood test to check for low Test. I'm going to see my GP (I'm from the UK), who should now have the letter from the Andro Dr. Now, the Andro may have recommended to my GP that I be tested for TT, FT, LH, FSH, E2, Prolactin etc.

However, I suspect he has just put TT (maybe FT too). I want to make sure the testing is not a waste of time. My questions are:

-From what I've read here, the bare minimum that must be tested to get a meaningful result is TT, FT, and E2. Is that right?

-Any other tests that are vital or really 'should' be done?

  • In my experience, my GP will be extremely resistant to 'granting' any patient requested tests. Any advice on how to handle this, what to say, how to reason with them would be most appreciated also.

FYI, I'm male, early thirties, 5'10", 155.

As I said, I'm really anticipating having to fight for anything other than what the Andro has recommended (last week GP already implied I'm lucky to be getting tested at all, as it's not something they'd normally do)

Cheers

Dipman


#2

TT and FT are vital, E2 is very important.

LH, FSH, and TSH are absolutely vital; LH and FSH can tell you if the issue is with your gonads or with your HPTA, and TSH gives some indication of the likelihood that you're suffering from hypothyroidism. Ideally, you'd get fT3 and fT4 to supplement the TSH test.

Well, you could get on your knees and beg...

But, in all seriousness, if you're persistent enough most GPs will relent just to get you off their case. It helps greatly to be informed.

Did you read the stickies?


#3

Thank you. I'm going to just go for the TT, FT, and E2 at the moment, as this seems the path of least resistance re: the GP. If the results come back low, I will move on to requesting further invest (LH/FSH, thyroid, adrenals).

lol, I asked my doc for a vit D and he flat at told me that there isn't a reliable test for it. When I came back with the name of the test (25 OH vit D), he then stated 'no need as no one in this country is deficient'. Sometimes they come out with stuff that is so weird/wrong that I don't know what to say.

Yes, read the stickies. Just wanted to be sure I had understood them properly.


#4

That's surprising. E2 is usually tough to get, and TSH/fT4 are usually trivial (a thyroid panel is a very common test performed on people who are exhibiting signs of hypothyroidism, e.g. depression, low energy, brain fog, poor metabolism, etc. - not all signs are present in someone with hypoT, though). fT3 can be tough to get.

You should also consider getting SHBG levels tested. Testosterone binds to SHBG and becomes essentially unusable by your body. E2 increases SHBG.

I... but... holy shit, man. Your GP is dumber than a second grader. Do you have any means of switching to a different one? The 25-hydroxy vitamin D test (25-OH Vit D) is plenty reliable.

A lot of people are Vit. D deficient. It's been in the (U.S.) news fairly regularly: people are advised to take at least 1,000 I.U. daily if they work indoors, and 2,000 I.U. if they live towards the north (e.g. Minnesota, where I live). Statistically speaking, you will probably be within the lab range. Keep in mind that most lab ranges are simply averages taken from 'healthy' people - but if everyone, including healthy people, are deficient... well, you get the idea. Anyway, I recommend supplementing with 6,000 I.U. daily regardless of the test results (unless you're crazy low). Vit D toxicity is pretty much not attainable unless you're taking obscenely high doses (100,000 I.U./day or something insane like that).

Yeah, there's a lot of info there, it's difficult to understand it all. If you have some free time, you might want to consider looking through some of the other threads here and see if there's anything relevant for your case.


#5

Many of the symptoms of hypogonadism and hypothyroidism are the same.


#6

yet another sample for the Stupid Doc thread.

the sticky about finding an HRT doctor has some good advice about how to discuss the issues with your doc. Focus on symptoms and keep hammering those home - ask for tests to rule out possibilities so that the doctor can focus on the real problem. You have to handle doctors as though they are fve year old about to throw a tantrum, and basically have to guide them along at times and work the conversation so that they think that it was their idea to requests the tests in the first place. Not an easy task especially in the UK.

unless you are sunbathing nude each day, it probably wouldn't hurt to take 6,000iu D3 daily.


#7

The trip to the doc went well (or at least better than expected). I asked for T, FT, E2 and DHT, and am getting the results tomorrow, when I'll discuss 'what next' with the doc. Many thanks to all who have already responded to my original Qs.

I should also add that I'm also considering anti-depressants. I'm certainly not keen on SSRIs (at least as mono-therapy) for obvious reasons. Any suggestions on this?

I've been doing a bit of reading around this whole area, and have some more Qs. Briefly, I would like opinions on next actions dependant on results.

As for desired outcome, I guess it's the same as anyone in my situation: I'd prefer treatment that is short term/one-off rather than long term and treats the underlying problem rather than just the symptoms.

Also I'll post seperately below with my symptons a bit more fully explained, and give a bit of history as well as diet/lifestyle things. Anyways, here's what I've come up with, along with some questions:

***Firstly, if tests come back fine, then I'm guessing I should look at getting tested for thyroid.
-Would this would be TSH and fT4 at a minimum?
- Any other areas to look at given symptoms?

*** If T/FT low, I should ask for LH to be tested to determine if primary or secondary.
-Should FSH be tested too, or will LH do? They always see mentioned in the same breath

***And/also Prolactin if levels T levels low.
-But if E2 levels ok, can Prolactin still be high?

***As you'll see below, I've been through lots of stress, and so am wondering whether DHEA-S or cortisol/saliva test would be worth while. Is there anything medically actionable from the results?

***My best guess at what's going on, from what I've read and personal reflection is either
Crushing levels of stress>depression>lowered DA>elevated Prolactin>reduced GnRH>reduced LH>reduced T>depression>...vicious cycle.
Or this is a post SSRI thing.
-Does that make sense, or is it broscience?

Ok, well I'll post back soon with the results.


#8

Current Symtoms
Low libido (ranges from 'not as good as before' to zero), a degree of anhedonia, brain fog, 'just not feeling myself', very easily stressed to point of 'I can't think straight/can't take this', ADD-like symptoms, periodic depression.

On the plus side, no ED, sometimes feel fine/good/ok, except for low libido and still a nagging 'things aren't right'.

Based off Ksman's sticky:
Symptoms: Why are you here
-Brain fog, no one knows what that means but everyone knows if they have it! [yep]
-Social withdrawal - "I would rather not go out" [yep]
-Why do I have boobs? [puffy nipples unless cold, but had this since adolecence]
-Why do I carry fat like a woman? [nope, except above]
-Why am I a moody bitch? [grumpy more than in past, but 'unemotionality' more of an issue]
-Can't get it up? [no probs here thankfully, but not quite so quick of the mark sometimes]
-It is up, now it's gone. [sometimes]
-My penis is numb -your nerves love T too. [not totally numb, but less nice sensations, some pain/discomfort]
-My testes are softer and smaller [think so, not sure]
-My testes ache 24x7 [maybe a bit, not aching though]
-Nocturnal erections [yep, sometimes]-
"morning wood" -things are working [yep]
-Why do really hot looking women and girls now look like art instead of lust? [this is a strange one. A bit of both, and actually the thing that is most worriesome is the art bit]
-Loss of hair on lower legs, skin below the knees is smooth and shiny. [no, but bit of loss on upper legs]
-Why do I feel cold easily or all of the time? [no, though did have this a while back]
-Why do really stressful situations leave me feeling physically beat up. [yes, physically shaking sometimes]
-I am not depressed, I just don't care about anything, no joy, no motivation, no reward [too absolute a statement, but some degree of this is one of my main bugbears]

Did the Braverman assessment, for what it's worth. Unsure whether this is quack medicine, legit, or somewhere inbetween, but anyways I came out as clearly DA dominant (with ACh a close second) but relatively balanced overall. Dificiencies were again, DA and Ach, DA being the biggest, but with smaller deficiencies for SE and GABA too.

History
~3 years ago, I developed a pretty severe angxiety disorder, linked to . The stress of this, lack of sleep >depression and libido divebombed. Went on prozac for 4 months. Didn't help anxiety, lifted depression somewhat but went off it as 'life felt boring'. Have gradually recovered from those 'dark days' (current symptoms excepted) with help of vit D, conquering anxiety dissorder (cutting coffe for 2 weeks gave my space to start to tackle it), change to diet (lowish/med carb paleo), some CBT, and personal reflection.

When I first went paleo it was low carb this time last year, I got pretty lean and by last summer I was in the best shape (although not biggest) I'd been for a long while. The 'slightly puffy nipples' I have had since adolecence thing went away, but libido wasn't improved.

Diet Lifestyle
Diet is paleo ish, moderate carb. More likely hypo rather than hyper caloric, but nowhere near CR-like levels.

Supps: 10,000Ius/day vit d (+K2),6 caps of FO, 400mg Mg Cit, 500mg C, 15mcg Iodine. Strangely, although the FO make me feel better physically and mentally, they seem to somewhat attenuate my libido.

Drugs: Coffee and smoking (yeah I know)are my vices. I don't drink much at all. Again, perhaps strangly, if I get drunk enough to wake up both hung over and half-cut at the same time, my libido seems almost back to normal for a short while (albeit I feel like crap otherwise).


#9

@Akaji, lol, yeah I was so shocked by my doc that I couldn't even argue, it just stopped me short. I'm registered at a practice with multiple GPs, and so I try and avoid him now. The vit D thing was not the only problem I had with him.

Anyways, I just started taking 5,000IUs (now up to 10,000 for winter). No suprise here, but it made me feel better almost straight away. Ironically, in retrospect I can see that at the time a test wouldn't have been too useful, as I was almost certainly low. Still...


#10

your symptoms seems to be a combination of possibly:
low testosterone
hypothyroidism
low cortisol

if those test out low, are then treated correctly, you could see dramatic improvements.


#11

Ok, results are in. They're in mol/L, so I've converted them using data found online, so if any results look really out, it may be my maths rather than my physiology...

Test Unit Result Lab Range Conversion Unit US Measurements
Total Testosterone nmol/L 29 (10-30) [28.843] {0.0347} 836.44ng/dL
Free Testosterone pmol/L 411 (245-785) [0.0288] {0.0347} 11.85pg/mL
Oestradiol pmol/L 58 (0-160) [0.272] {3.67} 15.79pg/mL
SHGB nmol/L 65 (6-45) [0.025] {40} 1.625ng/dL

Total Test looks good/not bad, E2 looks good (maybe a little low?), SHGB is clearly very high, and FT thus seems to be pretty low too. Opinions?

At the appointment the GP (not the 'no one has low vit D' one thankfully) had sent the results back to the lab (or an endo?) for a second opinion, and stated we'd talk it over in 2 weeks, so I said that's fine, and asked for a print of to look at myself in the meantime. however, later on that day, the practice assisstant/nurse called me at GPs request to set up another/unspecified blood test ASAP 'concerning my testosterone levels' so not sure what that is about.


#12

Please take your waking body temp for a few days and report.

http://www.digitalnaturopath.com/cond/C654345.html


#13

a lot of docs like to see back to back blood tests to rule out possibly daily variations in T levels (to prove that the levels are chronically low). Or since your levels came back looking pretty good, he might be checking into other things that can cause your symptoms since your T looks good (like TSH, Cortisol, ferritin, etc. etc. etc.) to get the full picture. tests are always valuable in confirming or helping to rule out possible causes.


#14

TT levels are quite steady, averaging out the hour to hour changes in FT.

FT ranges vary greatly from lab to lab. In this case, you should translate the SI ranges as well.

For a given T production rate, more SHBG will lead to more SHBG-T, increasing TT. Thus the TT reading can be inflated.

Low E2 and high SHBG seems contradictory. FT seems consistent with high SHBG. See what other causes of high SHBG fit your symptoms.