I seem to be a candidate for TRT, doc is concerned w/ hematocrit. (30y/o - all symptoms - low free T)

[weakwrists]

Hello,
I am 30 y/o, have had symptoms my entire life, almost all of them.
My most recent labs with pertinent info:
Hematocrit - 49.7%
Prolactin - 19.6ng/ml
Estradiol 40.8 pg/ml
Total Testosterone - 569 ng/dl
SHBG - 41.2 nmol/l
Calculated Free T - 10.7

My previous lab which only tested total T and SHBG gave me a free T of 8.5
So, it seems like I have high prolactin, high estradiol, high SHBG and low free T. My doc explained to me that I can produce T no problem, but the high shbg is limiting the amount I can use. I also have high estrogen which he wants to see cut in half, and high prolactin which he thinks will go down as my free T increases.

The one concern he has is my hematocrit. He says that while on TRT, that will raise, and if it get's too high can increase risk for strokes. He says one cause of it is not getting enough oxygen while sleeping and that I might have sleep apnea. So before starting me on TRT he referred me to a sleep doctor to do a sleep study and see. My appt with the sleep doc is tomorrow morning. I don't think I have sleep apnea, I don't snore (I even recorded my sleep audio last two nights to see, no snoring at all), and I dont think that I stop breathing at times when sleeping.. but I guess that could be what's happening. I do sleep on my side, sometimes on my stomach and wonder if that has anything to do with it.

Anyways, I'm just wondering if anyone else here has been down this path with the hematocrit, and what info you have about it? If it's not something related to my sleep, what do you think could be causing the higher hematocrit? It's not that I have a very high amount right now, but that while on TRT it may become high. How much higher can I expect it to go while on TRT?

Obviously I should find out a lot more tomorrow, I just have a weird feeling about this sleep doctor place, the website just seems like it's trying to sell me something, and I searched the head doctors name and, while mostly good reviews, there were some that just said "scam". I feel like my goal tomorrow is to just portray to the guy that I really doubt I have sleep apnea and for him to let my TRT doctor know that he agrees so we can start exploring TRT more and other ways to manage the hematocrit.

 

[fifty]

Sleep apnea is a weird business. That being said it helped reduce my hematocrit over a couple months.

 

[Vince Carter]

Then, too, there's the thinking that it's Platelets and not HCT...misdiagnosing PolyCythemia Vera for what is actually a benign Erythrocytosis. PCV is an increase in all blood factors, not just HCT.

 

[weakwrists]

Here's my full lab results, if it helps paint a better picture.

Test - Result - Reference range
WBC - 5.1 x10E3/uL - 3.4-10.8
RBC - 5.71 x10E6/uL - 4.14-5.80
Hemoblobin - 16.8 g/dL - 13.0-17.1
Hematocrit - 49.7% - 37.5-51.0
MCV - 87 fL - 79-97
MCH - 29.4pg - 26.6-33.0
MCHC - 33.8g/dL - 31.5-35.7
RDW - 14.4% - 12.3-15.4
Platelets - 180 x10E3/uL - 150-379
Neutrophils - 57% - Not estab.
Lymphs - 34% - Not estab.
Monocytes - 8& - Not estab.
Eos - 8% - Not estab.
Basos - 0% - Not estab.
Neutrophils (absolute) - 2.9 x10E3/uL - 1.4-7.0
Lymphs (absolute) - 1.7 x10E3/uL - 0.7-3.1
Monocytes (absolute) - 0.4 x10E3/uL - 0.1-0.9
Eos (absolute) - 0.1 x10E3/uL - 0.0-0.4
Baso (absolute) - 0.0 x10E3/uL - 0.0-0.2
Immature granulocytes - 0% - not estab.
Immature Grans (absolute) - 0.0 x10E3/uL - 0.0-0.1
Iron Bind.Cap.(TIBC) - 267 ug/dL - 250-450
UIBC - 192 ug/dL - 111-343
Iron - 75 ug/dL - 38-169
Iron Saturation - 28% - 15-55
Hemoglobin Alc - 5.0% - 4.8-5.6
Testosterone, Serum - 569 ng/dL - 264-916
TSH - 3.280 uIU/mL - 0.450-4.500
Lutenizing Hormone - 6.6 mIU/mL - 1.7-8.6
Prolactin - 19.6 ng/mL - 4.0-15.2
Estradiol - 40.8 pg/mL - 7.6-42.6
Prostate-Specific Ag, Serum - 0.6 ng/mL - 0.0-4.0
AST (SGOT) - 25 IU/L - 0-40
ALT (SGPT) - 37 IU/L - 0-44
SHBG - 41.2 nmol/L - 16.5-55.9

 

[testiculus]

You need a full thyroid panel. Your TSH is abnormal if confirmed in a repeat test. Thyroid should be addressed before pursuing TRT. Are you overweight? If so, loosing weight will drop the estradiol. Doing a sleep study is the right answer for someone with your hematocrit. You can have sleep apnea and be completely unaware of it.

 

[Vince Carter]

The 5 recommended tests for Thyroid would be:

TSH
Free T3
Free T4
Antibodies
Reverse T3

 

[weakwrists]

I did a different tyroid panel a few weeks ago, before I started looking into and pursuing TRT.

Free T3 - 3.2 pg/mL
Free T4 - 1.3 ng/dL
TPO Antibodies - 15 IU/mL
TSH - 1.5 uU/mL

Those seem very normal to me, right? It is interesting that my TSH changed so much from each test. They were done by different labs.

 

[weakwrists]

I was very overweight 10 years ago, but lost 150lbs. I gained a little back, but for the most part have maintained. I am very active and exercise every day even I very much feel all the symptoms of low T and have made it hard to maintain motivation, they have gotten worse over the years. I eat very healthy, I used to smoke, but I quit, almost never drink nowadays too.

 

[Vince]

You also had the wrong estrogen test. You need the sensitive with test for men. LC/MS/MS

 

[broker]

Interesting that both your LH and Prolactin are high.

 

[weakwrists]

Interesting that both your LH and Prolactin are high.

Oops. I put a typo in the range there for LH, I just fixed it. So, not high according to the range

 

[weakwrists]

You also had the wrong estrogen test. You need the sensitive with test for men. LC/MS/MS

Interesting, will speak with doc about this next time I go in

 

[CoastWatcher]

Interesting, will speak with doc about this next time I go in

Critical as you move closer to, and possibly initiate, TRT - Test with the appropriate estradiolmtest. Sensitive, LC, MS/MS, e2 test is appropriate for men.

 

[CoastWatcher]

Interesting that both your LH and Prolactin are high.

That’s a good observation. Proclatin, when elevated, can hammer libido. A higher LH value begins to raise the possibility of primary hypogonadism.

 

[weakwrists]

So, I saw sleep doc this morning. I will do a 3 day at home sleep study to make sure I don't have sleep apnea (I really don't think I do, but maybe), then go from there. Good to know for sure if it's an issue or not I suppose.