Initial Blood Work - First Course of Action?

So, I had some ED and libido issues. Went to a low T clinic to get tested. Result of test came back at 285, which they were going to use to justify further tests. I immediately started hunting and found a legit doctor.

Initial tests have returned, and they are not what I expected to say the least. If anything, this has certainly warned me away from the free T clinic variety of treatment (they originally report test value of 285ng/dL). The summary is that I have borderline low HDL, very high Homocystein, high AST and slightly high ALT, slightly high RT3, in-range but low B12, barely Vitamin D deficient, very high E2. I have a follow-up appointment on Thursday. I have been taking Vitamin D, Iodine, and Selenium since immediately after having my blood drawn (so the past 2 weeks or so), and have seen a very minimal improvement in the ED/libido department, but even that improvement is inconsistent at best. I would love to hear thoughts on recommended steps forward that I may keep in mind for my follow-up.


Full results are:


_Test/SHBG_
T: 596 (250-1100)
Free T: 123.7 (35-155)
SHBG: 15 (10-50)
Cholestorol Total: 141 (<200)
**HDL Cholesterol: 40 (>40)**
Direct LDL: 91 (<100)
**Homocysteine: 18.7 (<11.4)**
Apolipoprotein A1: 108 (94-176)
Apolipoprotein B: 64 (52-109)


_Comprehensive Metabolic Panel_
Glucose: 92 (65-99)
Urea Nitrogen: 20 (7-25)
Creatinine: 0.91 (0.60-1.35)
eGFR NON-AFR 114 (>=60)
eGFR AFR: 132 (>=60)
Sodium: 139 (135-146)
Potassium: 4.4 (3.5-5.3)
Chloride: 101 (98-110)
Carbon Dioxide: 29 (20-31)
Calcium: 10.1 (8.6-10.3)
Protein, Total: 7.5 (6.1-8.1)
Albumin: 4.8 (3.6-5.1)
Globulin: 2.7 (1.9-3.7)
Albumin/Globulin Ratio: 1.8 (1.0-2.5)
Bilirubin, Total: 0.7 (0.2-1.2)
Alkalin Phosphatas: 51 (40-115)
**AST: 50 (10-40)
ALT: 48 (9-46)**
Hemoglobin Alc: 5.1 (<5.7)
Magnesium: 2.1 (1.5-2.5)
Phosphate (as phosphorus): 3.6 (2.5-4.5)
Uric Acid: 5 (4-8)
Bilirubin, Direct: 0.2 (<=0.2)
Amylase: 36 (21-101)
TSH: 0.72 (.40-4.5)


T4: 8.8 (4.5-12)
T4 Free: 1.4 (0.8-1.8)
T3: 112 (76-181)
T3 Free: 3.5 (2.3-4.2)
**RT3: 27 (8-25)**
Thyroid Peroxidase Antibodies: <1 (<9)
Thyroglobulin antibodies: <1 (<=1)
Thyroglobulin: 4.9 (2.8-40.9)
Progesterone: <.1 (<=0.3)


White count: 7.4 (3.8-10.8)
Red Count: 5.50 (4.20-5.80)
Hemoglobin: 16.6 (13.2-17.1)
Hematocrit: 46.3 (38.5-50)
MCV: 84.2 (80-100)
MCH: 30.2 (27-33)
MCHC: 35.9 (32-36)
RDW: 12.6 (1-15)
Platelet Count: 23 (140-400)
MPV: 11.2 (7.5-12.5)
Absolute Neutrophils: 4810 (1500-7800)
Absolute Lymphocytes: 1835 (850-3900)
Absolute Monocytes: 651 (200-950)
Absolute Eosinophils: 67 (15-500)
Absolute Basophils: 37 (0-200)


Ferritin: 264 (20-345)
**Vitamin B12 375 (200-1100)**
Folate Serum: 10.3 (>5.4)
C-Reactive Protein: 1.8 (<8)
Cortisol Total: 14.1 (4-22)
DHEA Sulfate: 158 (85-690)
FSH: 3.1 (1.6-8)
Growth Hormone: 2.7 (<=7.1)


**Vitamin D, 25-OH, Total, IA: 19 (30-100)**


**Estradiol, Ultrasensitive: 49 (<=29)**


IGF 1, LC/MS: 245 (63-373)


PSA, Total: 0.5 (<=4)
Insulin, Free/Bioactive: 5.8 (1.5-14.9)

I wouldn't consider TRT at your levels, I would raise your levels naturally. We do have some threads on the subject, that would be my advice.

I suppose i should have given a bit kore unformatuon on myh current thoughts and give somr soecific questions. I agree I do not need TRT in any form st this time, I was wondering:

1. What effect can I expect Vitamin D supplementatiokn have on E2 and homocystein levels?

2. Given how high homocystein and E2 levels are, would you expect any prescription medications to be required to address the issue or should I be able to resolve with supplements? If so, specific recommendations?

3. The slightly high liver enzymes are concerning because I just have no idea what to make of them. Any knowledge of it these could be out of what just due to hormone imbalance or shouldni be expecting another more concerning root cause?

4. Do you see any sign of thyroid issues based on my results?

I think Thyroid looks fine. As for the liver, are you in the gym, weight lifter, exercise, etc etc....<<< these can skew liver enzymes and give some elevated AST/ALT readings.

TRT14 said:

I suppose i should have given a bit kore unformatuon on myh current thoughts and give somr soecific questions. I agree I do not need TRT in any form st this time, I was wondering:

1. What effect can I expect Vitamin D supplementatiokn have on E2 and homocystein levels?

2. Given how high homocystein and E2 levels are, would you expect any prescription medications to be required to address the issue or should I be able to resolve with supplements? If so, specific recommendations?

3. The slightly high liver enzymes are concerning because I just have no idea what to make of them. Any knowledge of it these could be out of what just due to hormone imbalance or shouldni be expecting another more concerning root cause?

4. Do you see any sign of thyroid issues based on my results?

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The higher the plasma homocysteine (a new risk factor) level is, the more people suffer from cardiovascular disease. Homocysteine is an amino acid that causes damage to arterial walls. It is higher in people who don't get enough folate (e.g. green leafy vegetables) and vitamins B6, B12

Right, but I was a bit confused because my folate and B12 are in range. I supposed B12 is a bit low, and B6 was not tested, but given the hkmkocysteon levels being so high I feel like there is probably somethijng else going on given mjy current B12 and folate numbers.

Vince Carter said:

I think Thyroid looks fine. As for the liver, are you in the gym, weight lifter, exercise, etc etc....<<< these can skew liver enzymes and give some elevated AST/ALT readings.

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Honestly not nearly as much as I should be. Once or twice a week. But when work ramps up iflt could be two or three weeks without seeing the gym. When I do lift I tend to lift heavy and don't do much cardio. I purposely did not work out a few days leading up to my test and it was done fasted.

Update, I started the following protocol:

Supplements:
25mg DHEA
fish oil
Vit-C
Vit-E
Vit-D3
high potency IRON-FREE B-complex multi-vit with 25mg zinc plus trace elements including iodine+selenium.



Rx:
0.25 mg anastrozole twice a week
5mcg T3 2x per day

The first day on this pretty much all of my issues were resolved. I give credit to the quick drop in E2 due to the anastrozole.

The only question/concern I had was whether or not you guys thought the T3 was advisable. I have searched a lot but seem to get conflicting information regarding whether or not long-term T3 supplementation will have a negative effect on my natural thyroid production. Any guidance here considering my T3/T4/RT3 numbers aren't really THAT far off?

I dont see a Thyroid problem, as I said. If you take the T3 perhaps once per day in the AM, I think if anythign you just watch out if you feel jittery. I'm not sure a long term issue but then again I don't see a Thyroid problem for you.

I think your MD is trying to optimise your T3 level. Your level isn't really low but most hormone MD's like to optimise it closer to the top of the range than you have. Most of us feel better with higher T3 and some don't notice a thing. It won't hurt trying it for a while.

.25mg twice /week of anastrozole might be too much. It's worse to have E2 too low than it is too high. (your not that high) Do you have high E2 symptoms? You need to answer that objectively.

For your elevated ALT + AST did you drink alcohol during the 3 days before your labs? Do you have hepatitis, celiac disease or cytomegalovirus?

ratbag said:

I think your MD is trying to optimise your T3 level. Your level isn't really low but most hormone MD's like to optimise it closer to the top of the range than you have. Most of us feel better with higher T3 and some don't notice a thing. It won't hurt trying it for a while.

.25mg twice /week of anastrozole might be too much. It's worse to have E2 too low than it is too high. (your not that high) Do you have high E2 symptoms? You need to answer that objectively.

For your elevated ALT + AST did you drink alcohol during the 3 days before your labs? Do you have hepatitis, celiac disease or cytomegalovirus?

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Doc said one slightly high reading of ALT and SAT shouldn't concern me too much. We are going to do anoither full panel in a couple of months and will revisit it. But no, no workout or alcohol ikn. The fee days leading up to it. I don't have any if the illness you mentioned....as far as I know...

Yes, I had systems of high E2 which is what started this process (originally thought it might be low T... low libido, ED, etc.). All of the symptoms cleared up within half a day of taking the anastrozole. I'm going to stick with 2x per week now and judge how I'm feeling, according to doc I should only need to take it for a couple of months, thrn switch to DIM.

I think he is trying to optimize T3 and offered it as an optional "improvement with no real risk." I just wanted to get additional opinions on the the risk side of things. If it might **** my system long term, I would rather just keep my average natural T3 level.

So, I have been on the RX and supplement protocol mentioned above.

I have a few days of feeling great, but apparently fell through the E2 sweet spot. I felt like I crashed my E2 after my second dose of AI, and felt terrible, so I decided to hold off an AI and iimmediately went and got my E2 (and Test because I was curious) tested.

Results for E2 were as expected, but the interesting thing I can't explain are the Test results are back to bring low...

12/13/17
T: 368 (264-916)
FT: 12.5 (9.3-26.5)
E2: 9.4 (8-35)

So, my T, FT, and E2 were ALL low, which makes no since to me given the protocol I've been on.

Could anastrozole causing the crash in E2 also leave to a T crash? If not, my T numbers seem to fluctuate wildly... any thoughts as to an explanation?

The DHEA will lower your total testosterone. In men it converted to testosterone into estrogen, and you're on a estrogen blocker?

Yes, my E2 was high and my DHEA-s was low in i initial labs. Hence the AI and DHEA. I thought that DHEA should increase both T and E2, as it was a precursor to both in some way?

TRT14 said:

Yes, my E2 was high and my DHEA-s was low in i initial labs. Hence the AI and DHEA. I thought that DHEA should increase both T and E2, as it was a precursor to both in some way?

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No dhea will not increase T in men, but it will lower your testosterone. Only men on TRT should supplement with DHEA.