At wit's end trying to make sense of my labs

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JDH

New Member

6 years of progressively worse mental fog/lack of clarity, lack of motivation, low physical energy, tiredness, irritability, feeling of not being in control of emotions, decrease in libido, decrease in erection firmness and sensation, and weight gain. Unexpectedly poor results with strict diet (by a dietitian) and exercise (with a trainer 4x per week for 2 years). The primary complaints are related to mental and physical fatigue and lack of interest/motivation.

Since beginning TRT, I generally feel better. The biggest improvement is with motivation, sex drive, interest in things I enjoy, less irritability, and being less insecure with my body. The persistent problem is simply feeling physically sleepy despite good rest and feeling mentally energized, if that makes sense. The persistent sleepiness feels more like exhaustion for 3 days out of the week.

This part is hard to describe. Though I do feel much better overall, the times when I feel "like myself" are like flickers. Like when there's a word on the tip of your tongue, but you can't quite say it. Or when you recognize an actor, but you just can't quite remember where you saw him. Or deja vu. It's a constant feeling of "almost but not quite." Not sure how to describe this better.

The numbers:

tT03/13/1708:58354300-1080 ng/dlfT03/13/1708:5810647-244 pg/mlfT403/13/1708:580.97.8-1.8 ng/dlTSH03/13/1708:581.204.3-5.0 uIU/mlALB03/13/1708:584.54.2-5.2 g/dltT04/04/1709:02340300-1080 ng/dlfT04/04/1709:0210147-244 pg/mlTSH04/04/1709:021.95.3-5.0 uIU/mltT04/13/1714:05108241-827 ng/dlFSH05/09/1712:166.31.4-18.1 mIU/mlLH05/09/1712:164.61.5-9.3 mIU/mls E205/09/1712:162510-40 pg/mlPSA05/09/1712:160.720-4.0 nl/mlPRO05/09/1712:166.92.1-17.7 nmol/mlSHBG05/09/1712:1620.117.3-65.8 nmol/l05/09/17Test Cyp 100mg05/16/17Test Cyp 100mgTT05/23/1708:45284241-827 ng/dl05/23/17
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05/31/17
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tT06/02/1708:45466300-1080 ng/dlfT06/02/1708:4515747-244 pg/mls E206/02/1708:453910-40 pg/ml06/07/17Test Cyp 100mg06/14/17Test Cyp 100mg

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Relevant demo information:


325' 11"21823Restless Leg Syndrome
ADHD
Chronic dry skin
Mirapex .25mg daily
Vyvanse 50mg daily
B complex
K2 multivitamin
D3

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CONCERNS ABOUT BASELINES:

  • Baseline morning total T technically WNL (for the average diabetic 85 year-old), and that obliterates my odds of finding a non-skeptic physician or having anything covered by insurance outside of a primary care setting.


  • The results for total T, free T, albumin, and SHBG do not check out with one another. If you calculate free T using the total T, SHBG, and albumin values, free T is actually 85.2-89.1 pg/mL. If you use the free T results to solve for SHBG, it puts SHBG at 12.4 nmol/L.


  • Afternoon total T falls off a cliff by mid-day. A decline of ~70% is approximately double the typical decline in half the normal time. I believe this would support the possibility of the SHBG test result being incorrectly high. It's also worth noting that I ate lunch immediately AFTER this blood draw.


  • LH and FSH results suggest that my body is not recognizing that it has a deficiency, but I don't know why.
  • Estradiol looks great, but I don't know enough about T:E ratios to understand this in context.

CONCERNS ABOUT TROUGH:

  • Trough of 284 prior to third injection is obviously not good. Subjectively, it's actually still an improvement over pre-TRT if only because it's stable instead of crashing every single day.


CONCERNS ABOUT "PEAK":

I realize 46 hours after a shot is not ideal for finding a peak, but I had a work emergency the day before. All the same...

  • Again, the values for total and free do not add up. Assuming albumin at 4.5, that puts SHBG down to 8 nmol/L. Single digits are "crisis" territory, right?


  • Estradiol is elevated but staying in proportion with my previous levels relative to total T.


  • By this point, I'm seeing side effects like dark, concentrated urine for 2-3 days after injection and more oily skin.

HYPOTHESIS

Based on what I've learned up to now, it appears that my primary issue is a combination of high aromatization and metabolic clearance. That could explain the drastic diurnal pattern at baseline. I have seen some research on metabolic clearance correlating with age and SHBG:albumin ratio that would suggest that my clearance rate is high or very high, but I have not been able to find a usable formula to calculate the actual rate or assess whether it's inappropriately high.

If either of those is the case, then more frequent injections would be extremely beneficial.

PLEASE HELP (and thanks in advance for getting this far!)

Honestly, I'm sick to death of researching this, and I just need some help. Then I need to back that up with hard science, otherwise nobody will listen to me. Here are my main questions:

1) Am I on the right track? If I'm totally misreading the results, I need to understand why.

2) What does the LH level mean, and does it matter?

3) Why are free T levels not checking out with the formula? Is a sensitive free T test more or less reliable than SHBG? How do I determine which test result is faulty?

4) Why are my total and free T levels so low just 46 hours after an injection?

5) Does the estradiol increase or level raise any red flags, and does that answer change when SHBG is between 20 and 8?

6) Am I missing anything important? Am I too concerned about things that are not actual problems?
 
Defy Medical TRT clinic doctor

ERO

Member
Your SHBG is at the bottom of the normal range so injecting more than once a week should make a big difference for you. At least every 3.5 days to start. This will result in a lot less change between peak and trough. Getting down to 284 before your next injection is not going to feel good for anybody.
 

CoastWatcher

Moderator
ERO is correct - your SHBG is like a blinking light asking for attention. The value that you posted is very close to what I presented. Weekly, then twice weekly injections, weren't enough to counter the basement level SHBG. Daily, small injections turned things around while lowering my estradiol without an AI.

I'm not suggesting you'll have to inject every morning (though it's no challenge to do so), but I believe you will have to move to multiple injections per week. The interesting thing that's seen so frequently is that these smaller, multiple injections frequently result in less total testosterone being injected on a weekly basis.
 
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