New Member - Pre-Treatment Labs... Input Welcome

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technomentor

New Member
New member looking for advice on whether TRT would help me. My post content is based on Nelson Vergel's post -- so I read up first. I'll spilt in to two separate posts due to length.

Health & Quality of Life Information
- 53 YO Male, 5'-11", 180 lbs
- Waist size: 36"
- Lost/gained weight: no
- Last complete physical: multiple in past year as I work to diagnose my unsatisfactory health status
- Prostate exam (DRE): yes, 9-2017
- PSA check: yes, 0.6 ng/mL (Roche ECLIA) RR: 0.0-4.0
- T treatment: no, never in the past
- Urinate ok (fully void): yes
- Nighttime urination: 1-2 times, used to be 3-4, now watch when I drink last
- Painful urination: no
- Blood in urine: no (confirmed via urinalysis and occasional test strips)
- UTI/Prostatitis: UTI's yes, diagnosed with epididymitis 7-2016; completed (3) rounds of antibiotics from PCP and then Uristatin & Phytogen from my Naturopath to finally get rid of it
- Acne history: moderate case as a teenager, took prescription meds (tetracycline) for awhile
- Cold intolerance: "no," but I really dislike cold showers and in particular cold pools (had a bad experience as a kid in summer camp)
- Bruise easily: no

Symptoms / Sleep / Mental
- Low libido, Fatigue, Lethargy, Brain fog - yes to all
- Panic attacks (3 major last year ended up in ER; 2 smaller this year, but know how to manage now and feeling less anxious through mindfulness)
- Decreased sexual potency (erection quality): erections fine
- Do you have morning erections? Infrequent
If yes, how many times per week (estimate)? 1-2
- Testicles size: definitely smaller
- Sleep disturbances: Unrestful sleep (listen to guided meditation to help get to sleep (thanks Alexa), but can't stay asleep)
- Generalized muscle aches and pains: nothing notable not related to exercise or activity
- Joint pain: left hip, right knee <-- pretty sure I know causes
- Diabetes: no, test results all normal; does run in family on mother's side
- Previous heart attack: no; but father died of MI at age 40 -- been paranoid it would happen to me
- Previous clotting issues: no
- Leg/ankle swelling: no
- Sensitive or swollen nipples: no
- Lumps around your nipples: no
- Are you losing your hair: yes, faster in last 6-9 months
- Have you ever taken Propecia or Proscar (finasteride): no
- Traumatic head injury: yes, knocked unconscious with baseball bad in elementary school; left temple
- Have you taken pain killers (opiates) for several months: no
- Stress levels: significant in previous years going back to 2004; led large organizations (100+ people) or held global position; leader allowed me to change roles this year due to health issues. Stress levels mostly self-induced - high performing, perfectionist (or at least I used to be)

Sleep
- Have you ever been diagnosed with sleep apnea via a sleep study? No, but have had a sleep study done
- Take frequent naps: no, because I know it messes with circadian rhythm (seriously want to nap mid-day though)
- Do you feel refreshed when you wake up in the morning: no
- Average hours of sleep per night: target: 7, typical 5-6
- Do you usually go to bed after 10 pm: Did for MANY years (claimed I was a night owl), now I try and go off grid about 8:30 PM, prep for sleep, meditate, and in bed by 10 PM

Diet and Exercise
- Exercise: walking 10,000 steps per day; about to start weight training and cardio again but motivation is lacking
- Diet: switched to a healthy diet following my scare in 2017 (the ER visits). By healthy I mean - stopped sodas, refined sugars/junk food; little to no processed foods, try and cook fresh foods -- approx. 40% carbs, 30% protein, 30% fats
Fluids: 1-2 L/day; just can't do 3L (90 oz.) as recommended cause I have to pee all day

Medications
Self-prescribed based on research on ExcelMale and PeakTestosterone

- DHEA (25 mg), qd - to boost level from 320.9 in to mid 350-500 range
- Pregnenolone (100 mcg), qd - to boost level from 18 to 125-175 range
- Started DHEA based on Gene Devine's DHEA Supplementation thread as presented by Dr. Neal Rouzier M.D., plus a few other posts/websites
- Started pregnenolone since mine is very low, and it along with DHEA are are two of the hormone pathways -- or so I have read
- Both meds started 5-28-2018

Supplements
- Multi-Vitamin: 2-Per Day, bid
- Vitamin D3 (4000 IU): included in 2-Per Day <-- I was deficient last year, < 30, now at 50
- CoQ10: (100mg), bid - heart health
- Turmeric/curcumin (450mg), bid - 95% standardized version - reduce inflammation, cancer fighting
- Fish Oil (EPA: 800 mg/DHA: 600 mg), bid - Dr. Tobias, heart health
- Magnesium Citrate (300 mg morning, 100 mg evening) - heart health, blood pressure
- Vitamin K2 (100 mcg as MK7), qd - balance D3 intake
- Pomegranate (500 mg), qd - heart health, reverses plaque build-up
- Saw Palmetto (320 mcg), qd - DHT level ok, understand that SP inhibits conversion of T --> DHT; recently read SP may not be a great idea
 
Defy Medical TRT clinic doctor

technomentor

New Member
Pre-Treatment Lab Tests

Complete Blood Count (CBC) (almost all resultswithin RR)
- WBC: 4.3 K/UL (RR:3.8-10.8)
- RBC: 4.2 M/UL (RR:4.2-5.8)
- Hematocrit: 42.5%(RR: 38.5-51.0)
- Hemoglobin: 14.1g/dL (RR: 13.0-17.5)
- MCV: 101.8 fL (RR:80.0-100.0) <-- high, this one hasshown up high 2-3 times in past 3-4 yrs

Kidney / Liver Panel (all results within RR)
- Creatine: 1.00mg/dL (RR: 0.6-1.2)
- BUN: 9.0 mg/dL(RR: 7.0-25.0)
- AST: 13.0 U/L (RR:0-41)
- ALT: 13.0 U/L (RR:0-45)
- Bilirubin, Total: 0.7 mg/dL (RR: 0.2-1.3)
- Glucose: 85.0 mg/dL (RR: 65.0-99.0)

Lipid Panel (tests from 4-5-2018)
- Cholesterol,Total: 226 mg/dL (RR: 100-199) <-- high
- HDL: 56 mg/dL (RR:40-125)
- Triglycerides: 87mg/dL (RR: 40-125)
- Cholesterol/HDLRatio: 4
- NMR Lipoprotein: indicates Pattern A (large) lipids, the good size :)

Thyroid Panel
- TSH: 1.89 uIU/mL (RR: 0.45-4.5)
- T3 Free (Triidothyroinine): 3.0 pg/mL (RR: 2.0-4.4)
- T4Free (Throxine): 1.3 ng/dL (RR: 0.82-1.77)
- Reverse T3: 26.2 ng/dL (RR: 9.2-24.1) <-- high
- Thyroglobulin Antibody: 1.3 IU/mL (0.0-0.9) <-- high
- Thyroid Peroxidase Antibody: 8 IU/mL (RR: 0-34)

Male Hormone Panel
TestDate: 5-3-2017
Lab: LabCorp, all Reference Ranges (RR) are LC
- Estradiol (not sensitive): <5.0 pg/mL, (Roche ECLIA) (RR: 7.6-42.6) <-- I know, I need sensitive
- Testosterone, Free: 9.6 pg/dL (RR: 7.2-24.0)
- Testosterone, Total: 339 ng/dL (RR: 264-916) <-- about 1/2 recommended value of 600
- DHEAs: 320.9 mcg/dL (RR: 71.6-375.4)
- FSH: 5.3 mIUmL (RR: 1.5-12.4)
- LH: 4.8 mIU/mL (RR: 1.7-8.6)
- Pregnenolone: 18 ng/dL (RR: <151) <-- low?
- DHT: 37 ng/dL (RR: 30-85)
- Progesterone: 0.1 ng/mL (RR: 0.0-0.5) <-- low end of range
- SHBG: 40.8 nmol/L (RR: 19.3-76.4)
- PSA: 0.6 ng/mL (RR: 0.0-4.0)

Vitamins/Minerals/Other
- Vitamin D3: 50.5 ng/dL (RR: 29.0-96.0)
- Zinc: 68 mcg/dL (RR: 56-134)
- CoQ10: 0.95 mcg/dL (RR: 0.37-2.20)
- Magnesium RBC: 5.0 mg/dL (RR: 4.2-6.8)
- Iron: 103 mcg/dL (RR: 50-180) <-- test date 7-27-2017
 

Vince

Super Moderator
I would stop the DHEA if you're not on testosterone. It's just going to lower your T and raise your estrogen levels. You definitely have some type of thyroid problem going on with so high reverse T3. Before considering trt I would get the thyroid issues taken care of first.
 

Systemlord

Member
The hair loss comment triggered a thyroid alert, cause is high Reverse T3. When testosterone is near the bottom ranges and SHBG is better than midrange, this is far from ideal as most of your free T is in a bound state. Thyroid medication will increase SHBG, you will need TRT and moderate doses once or twice weekly with the latter prefered. I would be surprised if you even needed an AI so as long as you didn't shoot for very high Total T.
 

madman

Super Moderator
Pre-Treatment Lab Tests

Complete Blood Count (CBC) (almost all resultswithin RR)
- WBC: 4.3 K/UL (RR:3.8-10.8)
- RBC: 4.2 M/UL (RR:4.2-5.8)
- Hematocrit: 42.5%(RR: 38.5-51.0)
- Hemoglobin: 14.1g/dL (RR: 13.0-17.5)
- MCV: 101.8 fL (RR:80.0-100.0) <-- high, this one hasshown up high 2-3 times in past 3-4 yrs

Kidney / Liver Panel (all results within RR)
- Creatine: 1.00mg/dL (RR: 0.6-1.2)
- BUN: 9.0 mg/dL(RR: 7.0-25.0)
- AST: 13.0 U/L (RR:0-41)
- ALT: 13.0 U/L (RR:0-45)
- Bilirubin, Total: 0.7 mg/dL (RR: 0.2-1.3)
- Glucose: 85.0 mg/dL (RR: 65.0-99.0)

Lipid Panel (tests from 4-5-2018)
- Cholesterol,Total: 226 mg/dL (RR: 100-199) <-- high
- HDL: 56 mg/dL (RR:40-125)
- Triglycerides: 87mg/dL (RR: 40-125)
- Cholesterol/HDLRatio: 4
- NMR Lipoprotein: indicates Pattern A (large) lipids, the good size :)

Thyroid Panel
- TSH: 1.89 uIU/mL (RR: 0.45-4.5)
- T3 Free (Triidothyroinine): 3.0 pg/mL (RR: 2.0-4.4)
- T4Free (Throxine): 1.3 ng/dL (RR: 0.82-1.77)
- Reverse T3: 26.2 ng/dL (RR: 9.2-24.1) <-- high
- Thyroglobulin Antibody: 1.3 IU/mL (0.0-0.9) <-- high
- Thyroid Peroxidase Antibody: 8 IU/mL (RR: 0-34)

Male Hormone Panel
TestDate: 5-3-2017
Lab: LabCorp, all Reference Ranges (RR) are LC
- Estradiol (not sensitive): <5.0 pg/mL, (Roche ECLIA) (RR: 7.6-42.6) <-- I know, I need sensitive
- Testosterone, Free: 9.6 pg/dL (RR: 7.2-24.0)
- Testosterone, Total: 339 ng/dL (RR: 264-916) <-- about 1/2 recommended value of 600
- DHEAs: 320.9 mcg/dL (RR: 71.6-375.4)
- FSH: 5.3 mIUmL (RR: 1.5-12.4)
- LH: 4.8 mIU/mL (RR: 1.7-8.6)
- Pregnenolone: 18 ng/dL (RR: <151) <-- low?
- DHT: 37 ng/dL (RR: 30-85)
- Progesterone: 0.1 ng/mL (RR: 0.0-0.5) <-- low end of range
- SHBG: 40.8 nmol/L (RR: 19.3-76.4)
- PSA: 0.6 ng/mL (RR: 0.0-4.0)

Vitamins/Minerals/Other
- Vitamin D3: 50.5 ng/dL (RR: 29.0-96.0)
- Zinc: 68 mcg/dL (RR: 56-134)
- CoQ10: 0.95 mcg/dL (RR: 0.37-2.20)
- Magnesium RBC: 5.0 mg/dL (RR: 4.2-6.8)
- Iron: 103 mcg/dL (RR: 50-180) <-- test date 7-27-2017




Your free t is very low and your total is low/normal and regarding shbg it is in a healthy range just BELOW mid-normal as your shbg is 40.8 nmol/L and range is (19.3-76.4) so the mean (mid-normal) would be 47.8.

Aside from thyroid needing to be addressed your testosterone levels are far from ideal.

Your hemoglobin and RBC (red blood cells) are borderline low.....do you know where your ferritin sits as you may have low iron?

When one starts trt hemoglobin/hematocrit will increase within the first 3 months of therapy and can take 9-12 months to reach peak levels.
 

technomentor

New Member
Your hemoglobin and RBC (red blood cells) are borderline low.....do you know where your ferritin sits as you may have low iron?

Thanks madman. I do not know my ferritin level, but plan to have it checked. While researching thyroid function and high RT3, the following tests were noted:

- Vitamin B12 (using MMA test) - low B12 can cause high MCV, deficiency/low values also present themselves in symptoms I have had
- Folate
- Ferritin
- Homocysteine - to check levels of inflammation
- Selenium - key nutrient for thyroid function; T4 --> T3 conversion
- Zinc - which I already had done

I found a good article by Dr. Westin Childs on reverse T3 - causes, treatments, and I am aware of several other thyroid related sites mentioned frequently on ExcelMale I'll be reading up on.

I would stop the DHEA if you're not on testosterone. You definitely have some type of thyroid problem going on with so high reverse T3. Before considering trt I would get the thyroid issues taken care of first.

Vince...Thanks for the suggestion. I will stop as you suggested and focus on thyroid first.

Systemlord...Thanks to you too for the input.

Since my PCP has not been of much help, I talked with my insurance company to understand what is covered and started searching for doctors in the Houston area. I have reviewed the ExcelMale list of doctors and at least one of them, Mohit Khera takes my insurance. I have also read up on with Defy Medical, Dr. John Crisler, and PrimeBody.

My Wellness doctor had suggested/offered TRT, but I declined at the time as I wanted to do more research. The only testing he did was TT and FT. Nothing as comprehensive as what is listed as pre-treatment recommendations on this site. He had also done thyroid, but only TSH which was "normal."

I'll post updates as things progress.
 

1Draw

Member
Find a new Doctor and start taking a T3 med. Your RT3 is not going away and it won’t get better until you take positive action. Dr Childs covers this pretty well. Your primary DR may prescribe this and you can at least get started.
 

technomentor

New Member
Thyroid Plan Follow-up

Thanks 1Draw -- the quick feedback confirms I came to the right place for input.

Here's a follow-up question/thought I have about my thyroid results...

Question
- Is it appropriate to seek a formal treatment plan after only one test?

Alternate Approach
- complete additional tests for B12, folate, selenium, homocysteine, ferritin to obtain baseline of other factors that affect thyroid. Look for items not in optimal range.
- take multi-vitamin for next 60 days; it contains higher than RDA doses for zinc, selenium, B12 and 100% RDA for folate and iodine; and near the dosage levels Dr. Childs recommends in his post
- retest using same thyroid panel in 60 days (the recommended retest frequency per Dr. Child's)
- If values still outside of ideal range, then start "formal" treatment program

Thoughts
- This round of testing indicates something is off, no question
- I've only had the thyroid panel testing done one time, which doesn't necessarily indicate a "condition" / constitute a trend
- I have not taken any multi-vitamins for over a year, which means my levels of zinc, selenium, iodine, B12, folate, etc. have all had to come from food -- and the consensus is these days that our food sources are mostly inadequate and supplementation is needed

Rationale
Addressing the key inputs (zinc, iodine, selenium, etc.) my thyroid needs may enable it to function "normally.

Oh....and I did just complete a comprehensive food allergy test and learned there are a half-dozen foods I need to avoid. Ones that have been a key staple in my "healthier" diet that will be eliminated and thus help with inflammation.

What are thoughts about this approach?
 

1Draw

Member
Biggest question is how do you feel? If you have good energy, libido, positive thoughts not depressed, sleep good, no body aches then you can go the natural route. I had a smart DR tell me once he didn’t care about blood test but how I felt. Pretty astute I thought and very wise. IMHO, your symptoms won’t improve until you get your RT3 less than 15.
 

1Draw

Member
A blood test is what is going on in your blood at the time you have your blood draw. It is not a trend, its a pretty reliable fact. What your blood levels were 6 months ago has no bearing on what your blood levels are when you have blood drawn. From what I have learned, you can't fix a thyroid problem with natural means. You have to have the proper thyroid meds, be it T4, T3 or a combination. Only way to lower RT3 is with T3 meds. If it were me, I would take the labs to your PCP and have him/her prescribe you either Cytomel or the generic Liothronine.

You definitely have low T and low free T but, it could be thyroid related. See this link:

https://www.restartmed.com/thyroid-symptoms-men/

I would follow Vince's advice and take care of the thyroid first then see where your T levels are. At least with a healthy functioning thyroid, you will get an accurate picture of your T levels.

Keep us posted and good luck!
 
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