Lots of bw results, what else to check before TRT?

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Ace

New Member
Hi, I registered because I've noticed a few familiar usernames who have helped me in the past on another forum.

Quick stats - 27, 5'8, 165lb, low teens bf%

I've gone just over 2 years trying to find a doctor willing to put me on TRT, one finally did but I'm yet to start. I wanted to try to find a cause first but no luck and I'm tired of searching. In about 12 hours or so I'll probably have my first injection of Test E unless something jumps out at someone from my results and I'm convinced otherwise. Here are all my results since the start of this journey.


02/Nov/11
T.Testosterone - 9.7L nmol/L (range 12.0-32.0)
SHBG - 12 nmol/L (10-73)
Free Androgen Index - 81 (35-85)
TSH - 3.5 mU/L (0.40-3.50)

Haemogloblin - 160 (130-180)
RCC - 5.5 (4.3-6.0)
Haematocrit - 0.47 (0.37-0.53)
MCV - 85 (80-100)
MCH - 29 (27-33)
MCHC - 341 (310-360)
RDW - 12 (10-16)
WCC - 7.3 (4.0-11.0)
Neutrophils - 4.6 (2.0-7.5)
Lymphocytes - 2.0 (1.0-4.0)
Monocytes - 0.6 (<1.1)
Eosinophils - 0.1 (<0.6)
Basophils - <0.1 (<0.3)
Platelets - 214 (150-450)
ESR - 2 (1-15)


Random Glucose - 5.5 (3.6-7.8
Sodium - 140 (135-146)
Potassium - 5.3 (3.6-5.5)
Chloride - 99 (98-110)
Bicarbonate - 33 (22-32)
Urea - 5.7 (2.2-8.3)
Creat. - 107 (60-120)
eGFR - 74 (>89)
Total Protein - 77 (63-80)
Albumin - 52 (37-50)
Globulin - 25 (20-36)
ALP - 87 (25-110)
GGT - 26 (10-49)
ALT - 43 (5-40)
AST - 31 (5-40)
LDH - 163 (100-310)
T Bilirubin - 29 (1-20)


06/Jan/12
T.Testosterone - 9.5 (12-32)
FSH - 1.8 (1-10)
LH - 3.9 (2-12)
TSH - 3.9 (0.4-3.5)
Free T4 - 14.7 (10-23)

02/Feb/12
T.Testosterone - 12 (12-32)
FSH - 1.9 (1-10)
LH - 5.2 (2-12)
Prolactin - 297 (<380)
Growth Hormone - <0.5 (no range)
IGF-1 - 42nmol/L (15-43)

TSH - 3.8 (0.4-3.5)
Free T4 - 13.9 (10-23)
Microsomal Ab - 10 (0-35)
Thyroglobulin Ab - 10 (0-115)

Iron - 13.9 (9.5-29.9)
Transferin - 2.4 (2-3.6)
Trans Sat - 29% (18-46)
Ferritin - 108 (30-400)


21/Feb/12
T.Testosterone - 8.08 (5.6-23.6)
FSH - 2.2 (0-9)
LH - 2.5 (1-7)
Prolactin - 246 (0-372)
GH - <0.2 (0-10)
IGF-1 - 39 (13-47)
25 OH Vit D - 72 (31-107)

Sodium - 139 (135-145)
Potassium - 4.1 (3.6-5.1)
Chloride - 99 (95-107)
Hco3 - 30 (22-32)
Urea - 7.4 (2.9-7.1)
Creatinine - 93 (60-110)
GFR - 86 (no range specified)
Protein - 73 (61-79)
Albumin - 45 (33-38
Bili Total - 21 (0-25)
ALP - 75 (38-126)
ALT - 46 (<45)
AST - 34 (<45)
GGT - 31 (0-50)
Calcium - 2.41 (2.25-2.58)
Ca Corr - 2.31 (2.25-2.58)
Magnesium - 0.7 (0.74-1.03)


05/Jun/12
T.Testosterone - 9.3 (12-32)
SHBG - 13 (10-73)
TSH - 6.4 (0.4-3.5)
Free T4 - 15.3 (10-23)

04/Sep/12
TSH - 3.2 (0.4 - 3.5)
FreeT4 - 15.4 (10-23)
Free T3 - 4.9 (3.9-6.8


26/Feb/13
Testosterone - 8.5 (8.3-29)
Free Testosterone - 29.1 (25-120)
FSH - 2 (<7)
LH - 1.6 (<7)
OEST2 - 71 (<150)

TSH - 5.5 (0.5-4.5)
FT4 - 16 (10-20)
FT3 - 4.4 (3.5-6)

Prolactin - 214 (40-450)
Serum CRP - <4 (<6)

Sodium - 137 (135-145)
Potassium - 4.2 (3.6-5.4)
Chloride - 99 (97-110)
Bicarbonate - 24 (21-30)
Anion Gap - 18 (10-20)
Urea - 10.9 (2.5-7.5)
Creatinine - 100 (40-120)
eGFR - >90
Bilirubin - 28 (<20)
AST - 32 (<35)
ALT - 38 (<40)
GGT - 12 (<40)
Alkaline Phosphatase - 69 (35-110)
Protein - 76 (65-85)
Albumin - 51 (35-49)
Globulin - 25 (22-38)


HB - 151 (130-180)
RCC - 5.1 (4.5-6.5)
HCT - 0.45 (0.4-0.54)
MCV - 87 (79.99)
MCH - 29 (27-34)
MCHC - 337 (320-360)
RDW - 13.8 (10-17)
PLAT - 200 (150-400)
WBC - 6.8 (4-11)
NEUT - 3.7 (2-7.5)
LYMP - 2.3 (1-4)
MONO - 0.6 (0.2-1)
EOS - 0.1 (<0.7)
BASO - 0.0 (<0.2)


13/March/13
Fast. Glucose - 5 (3.6-6.0)
Total Protein - 77 (66-83)
Albumin - 47 (37-50)
Globulin - 30 (23-39)
ALP - 65 (35-110)
GGT - 15 (5-50)
ALT - 39 (5-40)
AST - 27 (10-40)
LDH - 178 (120-250)
T Bilirubin - 32 (4-20)


Haemoglobin - 146 (130-180)
RCC - 5.2 (4.5-6.5)
Haematocrit - 0.45 (0.39-0.54)
MCV - 86 (80-100)
MCH - 28 (27-32)
MCHC - 327 (310-360)
RDW - 13 (10-15)
WCC - 5.9 (4-11)
Neutrophils - 3.7 (2-7.5)
Lymphocytes - 1.7 (1-4)
Monocytes - 0.5 (0-1)
Eosinophils - <0.1 (0-0.5)
Basophils - <0.1 - (0-0.3)
Platelets - 204 (150-450)


Vitamin B12 - 604 (>144)
RBC Folate - 2136 (>776)


Cholesterol - 5.33 (2.3-5.5
Triglyceride - 0.43 (0-2)
HDL - 1.98 (1-3)
LDL - 3.2 (0.5-3.5)
Chol/HDL Ratio - 2.7 (0-4.5)

P-Zinc - 16 (9-19)

R-U-Creatinine - 5.4 nmol/L (no range given)
Urine Iodine - 88 (>100 not deficient, 50-100 mild deficiency)


16/May/13
TSH - 3.9 (0.4-3.5)
Free T4 - 14.6 (10-23)


24/September/13
TSH - 3.5 (0.4-3.5)
Free T4 - 15.8 (10-23)
Microsomal Ab - 5 (0-35)
Thyroglobulin Ab - <30 (0-115)


Sodium - 140 (135-145)
Potassium - 4.5 (3.5-4.5)
Chloride - 101 (95-110)
Bicarbonate - 27 (20-32)
Urea - 10 (3.0-7.5) High
Creat. - 93 (60-110)
eGFR - >90 (>89)
Total Protein - 73 (66-83)
Albumin - 45 (36-47)
Globulin - 28 (26-41)
ALP - 58 (35-110)
GGT - 14 (5-50)
ALT - 33 (5-40)
AST - 25 (10-40)
LDH - 145 (120-250)
T Bilirubin - 20 (4-20)


Haemoglobin - 148 (130-180
RCC - 5.1 (4.5-6.5)
Haemotocrit - 0.44 (0.39-0.54)
MCV - 88 (80-100)
MCH - 29 (27-32)
MCHC - 333 (310-360)
RDW - 12 (10-15)
WCC - 6 (4-11)
Neutrophils - 3.6 (2.0-7.5)
Lymphocytes - 1.8 (1-4)
Monocytes - 0.5 (0-1)
Eosinphils - 0.1 (0-0.5)
Basophils - <0.1 (0-0.3)
Platelets - 183 (150-450)
ESR - 2 (1-10)

C Reactive Protein - 0 (0-5)

EBV VCA IgG - Detected
EBVNA - Detected
EBV IgM - Not Detected
Evidence of past, not present EBV infection


05/October/2013


Total Protein - 68 (6-83)
Albumin - 44 (36-47)
Alpha 1 - 2 (1-3)
Alpha 2 - 6 (4-10)
Beta - 6 (5-11)
Gamma - 10 (7-16)

Cortisol - 433 (100-690) 9am reading

IgG - 11.3 (6.2-14.4)
IgA - 1.02 (1.24-4.16)
IgM - 0.64 (0.48-3.1)

RF Latex - 2 (0-13)


12/November/13

Cortisol 8am - 644nmol/L (135-600)
12pm - 616 (100-400)
4pm - 568 (100-400)

27/November/13

ACTH - 4.9 (1.6-14)

Testosterone - 11.5 (11.5-32)
Free Test - 274 (260-740)
SHBG - 23 (10-73)
DHEAS - 8.1 (2-11)
FSH - 1.8 (1-10)
LH - 2.3 (2-12)
Androsterone Glucuronide - 144 (108-158)
TSH - 6.8 (0.4-3.5) (I started taking iodine a few days before this test and from what I've read a spike in TSH is normal at first. I have stopped taking it for about a week now as I've noticed I get really tired after consumption)


I also had a semen analysis done and I'm fertile.


My LH/FSH readings point towards me being secondary. But the doctor who prescribed me TRT said my LH and FSH are high for my total T indicating my testicles aren't working properly and therefore primary hypogonadism. Thoughts on this? Any input is appreciated.
 
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Ace

New Member
Forgot to mention I also had a skull xray (not MRI) to determine if there was any expansion of the pituitary area. It was determined that it appears normal.
 

Excel Male

Administrator
Staff member
You have secondary hypogonadism (low T, low normal LH & FSH). The great thing is that you have spent energy in multiple tests!

Your highest TT in the past year is about 333 and your low 230 ng/dL. Even conservative docs consider TT< 350 ng/dL low.

If you have taken the ADAM questionnaire and got the 4 items mentioned below, in the US they would prescribe T even at your young age. 100-200 mg/week of T cypionate or enanthate would be the starting dose in the US. Keep in mind that your fertility may be impaired unless you bring in HCG into your protocol.

ADAM (1).jpg
 
Last edited by a moderator:

Vettester Chris

Super Moderator
Ace, glad you joined and took the time to post your labs. There's lots to digest, so I'll tackle a couple of them with you, and hopefully others with have some comments as well.

Just to clarify, if I'm looking at this correctly, these are all baseline labs before any exogenous testosterone, correct? If so, I don't get your physician's comments about your LH/FSH being high in comparison to the total serum(?). On the contrary, testosterone is produced when LH is secreted by the pituitary. The relation of LH and testosterone is contingent on a negative feedback loop mechanism. What you have described is 'Secondary'. I also don't quite get the xray over the MRI, but OK. If you have a tumor/adenoma, I would believe an MRI would be the route to go for confirmation.

Your cortisol is noted high, but it looks to be blood serum. If possible, I would highly suggest you to get a 4x Saliva panel. This has become the gold standard for accuracy, and I will be able to look at it a little deeper with you if you can put it together. ZRT and Canary Club have them for approx. $125. I'm sure it still be elevated, but a true circadian profile with the 4x kit will tell us the exact pattern throughout a 24 hour period.

Lastly, your thyroid ... On the labs where you were able to get your FT4 and FT3 ... Your FT4 was at 42% of the range value, and your FT3 was at 25.6%. Couple of things ... If everything is functioning normally and T3 is getting into the cells properly, you would probably want to see both values in the 50% to 80% range of the lab value. I see both antibodies labs were taken and that area appears to be OK. Hypothyroidism and Hypogonadism can feed off of each other, so it's not uncommon to see the correlation. You would probably benefit from a NDT medication regiment as well to get T4 and T3 up, which in turn should reduce your TSH. However, prior to this, you need to ensure your adrenal function is stable, and (IMO) I would like to see your iron and magnesium up a bit. A Reverse T3 lab would also be beneficial at this time to compare with a current FT3 assay ...
 

Ace

New Member
Hi, thank you for the reply.

I was just on my way out to have a final chat with my GP (not the doc who prescribed me TRT) before deciding whether to get my first shot.


So what makes you say I have primary hypogonadism? If this is really the case I'd have no problem committing to TRT. But I have been under the assumption that it was secondary which is why I was hesitant to start injecting. I wanted to try to fix it by other, less invasive means since TRT is a pretty big commitment.

The doc has prescribed me 250mg Test E every 2 weeks which I know isn't optimal but I'll speak to him about splitting that dose and doing it weekly.


Edit - posted before I read Vettester's response
 

Ace

New Member
Ace, glad you joined and took the time to post your labs. There's lots to digest, so I'll tackle a couple of them with you, and hopefully others with have some comments as well.

Just to clarify, if I'm looking at this correctly, these are all baseline labs before any exogenous testosterone, correct? If so, I don't get your physician's comments about your LH/FSH being high in comparison to the total serum(?). On the contrary, testosterone is produced when LH is secreted by the pituitary. The relation of LH and testosterone is contingent on a negative feedback loop mechanism. What you have described is 'Secondary'. I also don't quite get the xray over the MRI, but OK. If you have a tumor/adenoma, I would believe an MRI would be the route to go for confirmation.

Your cortisol is noted high, but it looks to be blood serum. If possible, I would highly suggest you to get a 4x Saliva panel. This has become the gold standard for accuracy, and I will be able to look at it a little deeper with you if you can put it together. ZRT and Canary Club have them for approx. $125. I'm sure it still be elevated, but a true circadian profile with the 4x kit will tell us the exact pattern throughout a 24 hour period.

Lastly, your thyroid ... On the labs where you were able to get your FT4 and FT3 ... Your FT4 was at 42% of the range value, and your FT3 was at 25.6%. Couple of things ... If everything is functioning normally and T3 is getting into the cells properly, you would probably want to see both values in the 50% to 80% range of the lab value. I see both antibodies labs were taken and that area appears to be OK. Hypothyroidism and Hypogonadism can feed off of each other, so it's not uncommon to see the correlation. You would probably benefit from a NDT medication regiment as well to get T4 and T3 up, which in turn should reduce your TSH. However, prior to this, you need to ensure your adrenal function is stable, and (IMO) I would like to see your iron and magnesium up a bit. A Reverse T3 lab would also be beneficial at this time to compare with a current FT3 assay ...

Correct these are all baselines. Haven't ever taken any external testosterone, pro hormones or anything of the sort. I'm also not on any other medications.

And yes I was always under the impression that this is secondary but Excel Male has said primary as well as this doctor. I've been to numerous doctors/endos and most of them don't really want to dig any further as they're under the assumption that my testosterone is normal, or they simply don't know what to look for.

Cortisol was blood serum. I'm not sure if I'll be able to get the saliva testing done, not at this time anyway. There's Canary club in Australia surprisingly, which is where I'm from so I could get it done in the future. Wish I knew about it earlier. Edit - whoops, apparently not, it's a restaurant/bar by the same name.

I've been offered T4 meds before which I refused, when I mentioned Armour Thyroid they didn't know what it was. I've tried asking for RT3 testing but they wouldn't check it. I assume they don't know what it is or they thinks it's not important. I've been taking selenium 150mcg per doctors suggestion for a few months now along with magnesium, zinc, D3 with minor improvements.

How much would addressing these issues first (cortisol, thyroid) raise my testosterone levels though?

Appreciate your reply.
 

Vettester Chris

Super Moderator
Ace, I'll have to make this kind of quick ... I might be missing something on the posted results, so maybe Excel saw something I didn't. Actually, looking at your results in 2012, your LH was a bit higher with low serum. I was going by your most recent labs.

Doubtful any correction to the thyroid or cortisol will fix the testosterone situation. Yeah, best to stay away from T4 only medications. If they don't know about NDT meds or RT3, then you are in a predicament. Maybe some others in Australia can chime in on a good route to go with this.
 

Ace

New Member
Ace, I'll have to make this kind of quick ... I might be missing something on the posted results, so maybe Excel saw something I didn't. Actually, looking at your results in 2012, your LH was a bit higher with low serum. I was going by your most recent labs.

Doubtful any correction to the thyroid or cortisol will fix the testosterone situation. Yeah, best to stay away from T4 only medications. If they don't know about NDT meds or RT3, then you are in a predicament. Maybe some others in Australia can chime in on a good route to go with this.

Well I hope he gives his reasoning. I've put off taking the shot until tomorrow (my timezone).

I wish I remembered what the reasoning my doctor gave me for his primary diagnosis but it was nearly 3 weeks ago and the memory isn't that great.
He also said my testicles feel a bit soft too.
 

Ace

New Member
Right, well that's good and bad news. Good because theoretically one day a restart might be possible. Bad because I still don't know where the problem lies which makes my decision harder. My doc did say I'd be hard pressed to find an endo who's willing to get to the root of the problem especially in this country. And at the moment finances are a problem.

I've looked at clomid restarts but from what I've heard/seen they usually don't stick for more than a few months plus I'm not keen on risking my eyesight.

Thanks for the responses guys.
 

Ace

New Member
No I haven't, but I have heard of it. But like I said I'm hesitant to use clomid. I would try this if a) I had more time at this stage (I won't go into the reason for lack of time), and b) if I started TRT and needed to come off.

Also this isn't too comforting:
"It is more likely to be helpful to those who used testosterone and anabolics for muscle building purposes and who were not hypogonadal before starting their muscle building cycles."

And in my country getting these meds legally or otherwise might be an issue.


I'd be keen to try triptoerlin - http://www.ergo-log.com/triptorelin.html
I've seen anecdotal evidence that it works for around 7-8 months before levels start dropping off again so maybe 2 shots a year could work. BUt I've also heard it can cause further shut down too. Once again sourcing it might be a problem.
 
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