Initial tests - thoughts?

Thread starter #1
Dear Members,

First post, would appreciate your input on my initial lab results (below). I’m aware that they’re far from full and will get more labs done soon. Labcorp flagged the Free T, is that necessary a sign for need for TRT (together with low tot T)? Estradiol seems high compared to T levels, right?

Background:
-33yo male
-long history with sports, currently 4/week gym, healthy lifestyle overall, no vitamin deficiencies
-no steroid/medical problems history

Symptoms:
-low libido but no ED, lost most of morning erections over the past year or so
-sleep 8-9h/day but still tired, 10-11h seems sufficient, wake up 3-5times/night
-developed small (but clearly visible) gyno (estradiol?) over the past year or two
-overall tired a lot of time, hard to get excited of new things, meeting new people
-possibly easily irritated/quick mood changes, hard to say myself
-trouble losing fat/gaining muscle

Labs by Labcorp:
Taken in the morning after no excess exercise the day before, good sleep

Total Testosterone, Serum (ng/dl) 360 range 264-916

Free Testosterone(Direct) (pg/ml) 7.3 range 8.7-25.1

DHEA-Sulfate DHEA-Sulfate (ug/dl) 258.3 range 138-475

Estradiol Roche ECLIA method. (pg/ml) 18.1 range 7.6-42.6
 
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#2
Mustang, welcome to EM! Thanks for joining and posting your info & labs.

Yes, your total test serum is on the low end. Not in the tank, but definitely nowhere near optimal. Running approx. tad over 2% on Free Test ... 2% to 3% is usually right % bracket, but you're going to want an improved Total Serum result to make that number ideal, maybe 16pg/ml to 22pg/ml, +/- a few points depending on where you and your physician see optimal wellness (?)

As you noted, other labs are needed ... First, see where your LH/FSH sits to determine Primary or Secondary. On your E2, needing to see a "Sensitive" or "Ultra-sensitive" lab if the one you posted is only a basic E2 (?). I suspect you might also have something lagging with the thyroid, so please run: TSH, Free T4, Free T3, Reverse T3, and Antibodies (TPO & TgAb). In conjunction with thyroid, would also like to see Iron Serum, TIBC Or UIBC, Ferritin, and electrolytes. Beyond that, all CBC's, lipids, and metabolic should be checked, as well as PSA ...
 
Thread starter #3
Hi Chris - it says Roche ELICA (updated it on the op). By a quick research that might be the wrong test for men? Ordered the labs muself via life extension but will definitely get the next labs via educated doc. Will definitely also request the thyroid panel to be included.
 
#4
Hi Chris - it says Roche ELICA (updated it on the op). By a quick research that might be the wrong test for men? Ordered the labs muself via life extension but will definitely get the next labs via educated doc. Will definitely also request the thyroid panel to be included.
The Roche ELICA is the standard E2 labs, you need the LC/MS/MS method or sensitive test. If you don't already have it I would suggest running SHBG as well, SHBG scavenages sex hormones and tells us how well you hold onto your testosterone. It's also dictates dosing and injection frequencies.
 
Thread starter #5
Update: will meet with Dr Berger (found him thanks to this forum) next week and hopefully he’ll be able to order all the right tests and assess my situation. Days go by really slowly right now reading all the stuff on the forums.. thank you all for your input, stay tuned for updates!
 
#6
Update: will meet with Dr Berger (found him thanks to this forum) next week and hopefully he'll be able to order all the right tests and assess my situation. Days go by really slowly right now reading all the stuff on the forums.. thank you all for your input, stay tuned for updates!
No matter how good your doctor is, you have to be your own advocate in matters of health. Reading material here, considering how it applies to you, going into appointments armed with knowledge - all of that will help you play this game. All the best.
 
Thread starter #7
Recent lab results attached.

Few notes:
-total T up slightly from previous test (still low)
-Free T down from previous test (flagged)
-no SHBG, LH/FSH was ordered by the doc
-estradiol not the sensitive test - total estradiol flagged as hight, any thoughts?
-BUN flagged as high, eGFR seems low. Should I be worried?

1.jpg 2.jpg
 
#8
IMO, a BUN result that is slightly over the top usually just reflects hydration, and/or can also happen when high amounts of protein are in your diet. If you're not experiencing any pain and/or issues, coloration difference in urine, etc., then it's probably no big deal, BUT, have your physician sign off on that.

And after that, start looking for a physician that will be more apt and in-tune with assessing, diagnosing, and treating hormonal deficiencies and imbalances. You need all the other labs that everyone has talked about, and they need to be the correct tests, i.e., E2 sensitive, etc. You need a doctor that really knows more about the variables involved with this type of treatment.
 
Thread starter #9
Well noted. Measuring LH/FSH is clear but why is SHBG important to know again (when Free T is already known)? Below Systemlord already stated it but didn’t fully explain how it dictates the dosing and injection frequencies? Thanks again.
 
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