Lab results primary, secondary, etc?

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jkhelp

New Member
Hi everyone,

I am a 34 y/o male. I have been on anti depressants (wellbutrin) for over a year now after dealing with depression and anxiety since around 2014. I have noticed very little change in symptoms over this past year and have a few new ones.

I exercise 5-6 x week and count my macros pretty well. I have no real stress to speak of in my life, great marriage, kids college is paid for, retired and waiting for the wife to retire, etc yet, my most all my joints hurt, my libido is awful, still feel down/depressed, apathetic, and a general loss of interest in things I used to love.

Given the symptoms and lack of effectiveness of the antidepressants I opted to get some blood work done.
The doc said the results were normal, but after a bit of research I found that some of the numbers do not make a lot of sense. My total test seems very low for my age range and the FSH and A/G seem odd. Doc acknowledged that the free t3 was low, but said that the TSH is the more important of the thyroid function (i found this to not be entirely true in my research). After reading some others accounts of symptoms and lab results on this site, as well as a few others, it seems like there could be something going on that TRT or HCG mono could address.

Sorry for being so lengthy, just trying to get as much out of the way as possible. my lab results are attached. I also just did a second set of labs yesterday to check free test, shbg....

Based on the labs attached, is my doc right or should I find a new doctor?
 

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Vince

Super Moderator
LH and FSH need to be run to determine if you're primary or secondary.
If someone is dealing with primary hypogonadism, it's the testicles. In secondary hypogonadism the it's in the pituitary. The LH and FSH values prior to the start of TRT. What were those numbers were they elevated, significantly? If so, it is a case of primary hypogonadism. If they were at the low end of the reference range you are, more than likely, dealing with secondary hypogonadism.
 

jkhelp

New Member
If someone is dealing with primary hypogonadism, it's the testicles. In secondary hypogonadism the it's in the pituitary. The LH and FSH values prior to the start of TRT. What were those numbers were they elevated, significantly? If so, it is a case of primary hypogonadism. If they were at the low end of the reference range you are, more than likely, dealing with secondary hypogonadism.


Vince, please forgive me. I am a very new to all of this. Are the values for FSH and LH on the lab results I attached not conclusive?

Based on the labs I attached I have low free t3, low test (seemingly for my age), and low FSH

Are the attachments not visible?

edit: the lab work attached to the OP is prior to an HRT
 

CoastWatcher

Moderator
Your doctor is clearly uninformed if he told you TSH was the most important test used to evaluate thyroid function. The other thyroid panel results certainly indicate that further investigation is necessary. Were free testosterone and SHBG run? Can you tell us where you live?
 

jkhelp

New Member
Your doctor is clearly uninformed if he told you TSH was the most important test used to evaluate thyroid function. The other thyroid panel results certainly indicate that further investigation is necessary. Were free testosterone and SHBG run? Can you tell us where you live?

I am beginning to question his abilities with regards to these particular issues. Free and SHBG were not run with the first set of labs, which was done two weeks ago. So, I had another blood draw done on 9/25 to test free and SHBG.

I currently live in Tokyo Japan, but my doctor is British.

I would call it Primary, LH is 4.19 right at the top of the ref scale
thank you for your feedback Vince C


OT but you are 34 and already retired? If that isn’t a type I can only say “well done”
lol, not a typo. a lot of planning since the age of 16 coupled with a few lucky breaks. retired is the one thing I knew I wanted to be as an adult.
 

CoastWatcher

Moderator
I am beginning to question his abilities with regards to these particular issues. Free and SHBG were not run with the first set of labs, which was done two weeks ago. So, I had another blood draw done on 9/25 to test free and SHBG.

I currently live in Tokyo Japan, but my doctor is British.


thank you for your feedback Vince C



lol, not a typo. a lot of planning since the age of 16 coupled with a few lucky breaks. retired is the one thing I knew I wanted to be as an adult.
We have the name of a Japanese doctor who is highly regarded in this particular field. Co-wrote one of the seminal papers on the need to abandon the old, every-two-week injection schedule. I will track down the reference. Now, I have no idea if he is involved in clinical medicine, as opposed to research. Still...it might lead you to someone who knows how this game is played.
 

jkhelp

New Member
We have the name of a Japanese doctor who is highly regarded in this particular field. Co-wrote one of the seminal papers on the need to abandon the old, every-two-week injection schedule. I will track down the reference. Now, I have no idea if he is involved in clinical medicine, as opposed to research. Still...it might lead you to someone who knows how this game is played.

Yea, that would be great. I* actually read a paper with a few Japanese contributors, but I am not sure if it the same person. I am still waiting for the results of the second set of labs. My hope is the results are more conclusive and the doc pays more attention/opens his eyes. Otherwise, I will be looking for a new doc. Trying to stay with a doc that my health care provider will cover.
 

CoastWatcher

Moderator
Yea, that would be great. I* actually read a paper with a few Japanese contributors, but I am not sure if it the same person. I am still waiting for the results of the second set of labs. My hope is the results are more conclusive and the doc pays more attention/opens his eyes. Otherwise, I will be looking for a new doc. Trying to stay with a doc that my health care provider will cover.

I will, as noted, track down the reference. Your doctor, I feel confident in asserting, is simply ignorant when it comes to this particular set of issues. I wish it were as simple as opening his eyes and paying more attention; sadly, we see it all the time.
 

jkhelp

New Member
doc says free test is normal (but he also said that 376 total was normal and it was 350 total this time.....i can't find where 11.1 pg/ml is normal anywhere), and apparently he didn't submit for SHBG. test, LH, FSH are all lower this go around. labs are two weeks after the first ones posted and both were done in the morning after fasting for 12 hours. Is his claim of 11.1 being normal another glaring clue to his ineptitude for these sorts of conditions?

He says he wouldn't rule out TRT, but advises to try non-replacement (lifestyle) methods, which is quite funny given that I hit the gym at least 5 days a week and eat the same gahdamn rice, chicken, fish, lean beef, eggs, oatmeal and veggies week in and week out. Maybe I should pick up smoking and drinking on a daily basis while eating nachos :rolleyes:

The kicker is, he wants to refer me to another dr in the clinic that has a "particular interest" in these things and he is a visiting physician (urologist/Prof Horie this guy http://www.juntendo.ac.jp/english/research/horie_shigeo.html ).......that will be back around Oct 27th

Edit: he is going to have his reception contact the Professor to try and get me in at his regular place of work.

 
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jkhelp

New Member
Doc started me on TRT, but it seems he is stuck in the past as far as treatment procedures.


He said he wanted to start out doing 250mg Test E once a month (which they administered at the clinic)...........soooooo yea, I am seeking a second opinion on more effective treatment methods
 

jkhelp

New Member
Second opinion option didn't work out due to the other available clinic/hospital wanting to start from scratch (even though I had already started trt) Looks like it won't be a problem anyway based on the most recent visit to my doc.

After one month, I had my test levels checked again and received a second 250mg test e injection. My test level was 276, which prompted the doctor to move to test e 2 x month @ 250mg, rechecking lab work before each injection. Next injection is Dec 8th.
 

CoastWatcher

Moderator
Here is the study, conducted in Japan, that conclusively showed injections every two weeks are doomed to utter failure.
 

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jkhelp

New Member
Awesome, thank you for that. I will certainly pass this along. It has become apparent to me that they are not well versed in TRT, but they are at least trying, which is way better than nothing. They are certainly willing to make adjustments to the frequency and dosage. Being a guinea pig isn't my first choice, and if I had a better option I would certainly pursue it. Yet, I will play the hand I am dealt for now.
 

jkhelp

New Member
As of now, no, but that is only because they want to get the frequency and dosage correct.

Having said that, they are reinventing the wheel and/or not up-to-date with modern practices. I am not sure which, but I have already noticed a difference just from the last two injections.....problem being that it only lasts about a week and then I feel like I am losing my mind again.

We have already discussed receiving a larger supply from the clinic and performing self injections as to limit the need for clinical visits. I wish they would just do the 100mg 1 x wk and go from there, but I guess I understand their logic in that they are ill informed.

Also, CoastWatcher, did I understand that study correctly and the Doctors came to the conclusion that test e is not a reliable means of TRT?

Oh, my doc also offered me the option of Nebido.....what are your thoughts?

TIA
 

CoastWatcher

Moderator
As of now, no, but that is only because they want to get the frequency and dosage correct.

Having said that, they are reinventing the wheel and/or not up-to-date with modern practices. I am not sure which, but I have already noticed a difference just from the last two injections.....problem being that it only lasts about a week and then I feel like I am losing my mind again.

We have already discussed receiving a larger supply from the clinic and performing self injections as to limit the need for clinical visits. I wish they would just do the 100mg 1 x wk and go from there, but I guess I understand their logic in that they are ill informed.

Also, CoastWatcher, did I understand that study correctly and the Doctors came to the conclusion that test e is not a reliable means of TRT?

Oh, my doc also offered me the option of Nebido.....what are your thoughts?

TIA

Test-E, enanthate? No...that's what I've injected with here in Canada for over three years. It's the standard injectable ester in use throughout the world save for the United States which typically prescribes cypionate. It's just fine. Now, Nebido, in my opinion, is another matter completely. Testosterone undecanoate, with its long half-life, robs the patient and the doctor of the ability to promptly adjust the protocol in the face of side-effects. You essentially buy a ticket on the Nebido train and are taken where it wants to go. Levels may soar, followed by estradiol, but you have to wait and wait before adjustments can be made. Not what I'd want. With enanthate or cypionate you can correct your course far more easily.
 

jkhelp

New Member
Your thought process on nebido makes sense and is how I felt after reading about it. I like the idea of being able to fine tune things and much faster.

I took the final portion of the study write-up to indicate that no current (at that time / 2005/6) methods of treatment existed in terms of quality of life improvement, which seems odd given everything else that I have read and experienced thus far.

The doc seems to be open and flexible to most anything, but I may have little choice how we get to our final destination.
 
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