Latest labs 5/21/14

Gents,

Attached are my latest labs. comments please and yes I know they did the wrong Estrogen even though it was marked as Ultra-sensitive. Looks like I need to donate too.

This is on 180mg 2x week sub-q, Monday AM and Thursday PM Test Cyp and HCG 150iu M-F.

Labs were done prior to Monday AM injection.

Tom

Be careful with donating blood. Your iron and ferritin are low even with your high hematocrit. You may have to take an iron supplement (low dose, be careful since it can have liver toxicity). Are you feeling tired? Do you eat meat? Meat, liver and cooking in iron skillets can provide iron in your diet.

You should also watch your diet since your lipids are high. Less sugar, more fiber and protein. Healthy breakfast.

You need an ultrasensitive E2 next time.

Also, get your thyroid checked. It surprises me that your iron and ferritin are low with your numbers. http://www.stopthethyroidmadness.com/ferritin/

Tom - Beyond Nelson's comments I see Prolactin is slightly elevated as well.

For some men this can hamper libido and erectile quality.

A low dose of Cabergoline like .25 mg on injection days can bring this down and provide some real nice benefits.

Might want to consider.

Nelson Vergel said:

Be careful with donating blood. Your iron and ferritin are low even with your high hematocrit. You may have to take an iron supplement (low dose, be careful since it can have liver toxicity). Are you feeling tired? Do you eat meat? Meat, liver and cooking in iron skillets can provide iron in your diet.

You should also watch your diet since your lipids are high. Less sugar, more fiber and protein. Healthy breakfast.

You need an ultrasensitive E2 next time.

Also, get your thyroid checked. It surprises me that your iron and ferritin are low with your numbers. http://www.stopthethyroidmadness.com/ferritin/

Click to expand...

I will delay any blood donation till Doctor recommends, I do see both of those low iron and ferritin. I am on for the past 8 weeks a total Paleo diet, nothing but grains, fruits, meats, basically a hunter gather diet per my gastro doc so I am not sure where the low values are coming from.

I think I am going to have to do even more with diet given the lipids. I eat very healthy so not sure where that is coming from. Can't get much healthier than paleo grains, organic yogurt, and 4 kids of fresh fruit for breakfast

I requested ultrasensitive E2 and will again on next lab work

My Thyroid basic numbers were in there, T3 1.12, range .48 - 1.59 ng/mL, T4 6.4, range 4.9 - 11/7 ug/dL, and TSH 2.53, range 0.35 - 4.94 uIU/mL

Gene Devine said:

Tom - Beyond Nelson's comments I see Prolactin is slightly elevated as well.

For some men this can hamper libido and erectile quality.

A low dose of Cabergoline like .25 mg on injection days can bring this down and provide some real nice benefits.

Might want to consider.

Click to expand...

Gene - I will discuss with Doc tomorrow when he has his review with me, thanks for the input, I also see the DHT is 1510 with a range of 112-955 pg/mL

DHT elevated is not a bad thing if you don't have symptoms and given you shave your head and hair loss not an issue I wouldn't worry about it.

You do need another E2 lab this time "sensitive" to get an accurate read.

Gene Devine said:

DHT elevated is not a bad thing if you don't have symptoms and given you shave your head and hair loss not an issue I wouldn't worry about it.

You do need another E2 lab this time "sensitive" to get an accurate read.

Click to expand...

True on the DHT, hair on my head is long gone although could use less on the bod,

I ordered the correct one, lab didn't do correct one, I will ask for another lab.

Tom, thanks for posting your labs. Your ferritin, as mentioned, is quite low, as is your iron serum. Would like to also see TIBC to see how well you can bind iron with transferrin in the body. If all checks out, you need to discuss an elemental iron therapy program with your physician; one that will also include an ample amount of Vitamin C. This replenishment will be essential for a variety of reasons, one particularly being the productivity of your thyroid ... I can't imagine your energy levels are doing very well, but curious to what you're feeling? Do you notice any deviation in your temperature from waking up to going to bed?

... On your thyroid, good information provided, but I need more. Find a way to get Free T4, Free T3, Reverse T3 and antibodies (TPO, TgAb). Your labs appear to be total T4 and T3. Although, there's a trend that I would expect to see with those labs (based on your ferritin/iron), the free and unbound thyroid hormone will give the true accuracy of what's actually bio-available.

The trend I am speaking of is the lab numbers and where they sit in respect to the reference range span. Your T4 is right about 22% of it's reference range, T3 is at 57.5% of the range. I suspect the free and unbound values will be similar, but let's rule out the speculation. What you're ideally looking for when everything is running correctly is both labs to be in the 50% to 80% range, and Reverse T3 within an exceptional range that would show T4 is converting to T3 at a normal, healthy rate.

When there's a problem, like iron, ferritin, and/or cortisol (plus others areas where stress, pathology, metabolic syndrome), you will in most cases see T3 much higher in its range compared to T4, or call it T3 is noticeably to the right of T4, which is usually a sign the T3 is pooling and not effectively getting into the cells of the body. Adequate iron and ferritin are needed as a transport agent. The body's ability to react to a situation or complication is to produce higher levels of RT3, which basically is the brakes on the positive charge of ATP until the body gets corrected. Sometimes these corrections don't get resolved, even though the body continuously seeks homeostasis. In these situations, people can go years, or even all their lives never getting the type of well being that they are capable of achieving.

Your TSH reflects that T4, the storage hormone is on the low end, so the feedback loop is signaling as it should to make more hormone. IMO, it's about where it should be with the scores of your Total T4 and T3. I would also suggest getting a 4x Saliva Cortisol test. You might be surprised to see the correlation of adrenal issues tend to be a topic when iron and ferritin are in question. Getting to the right area with your iron and ferritin could take a few months, so be patient. The trick is getting on the right elemental iron regiment, and trust me when I say, make sure Vitamin C is ramped up, and even Vitamin E in some cases with various iron supplements. You will also want to make sure you include B12 (methylcobalamin is my pick for various reasons), and definitely make sure you have adequate Vitamin D3.

Hope some of this makes some sense. Nelson provided a link to STTM.com. Definitely do your research and feel free to ask any questions. Keep in mind, I'm just one guy on a forum with hopefully a few ideas to consider. Your best bet is always to align with a qualified physician who can and will make your concerns his or her priority. Also, apologies if this turns out to be a run-on paragraph. I can never get paragraph breaks with my tablet!

Chris,

Thanks for the reply. I will look to get those labs done along with the ultra sensitive E2, so we can determine where to go with all of this. Really appreciate all of the insights from everyone.

Also on your temperature question, I am quite warm going to sleep and cool in the AM but there is a marked difference there.

As to how I feel, always a bit tired, forcing myself to at least walk is getting me some level of exercise, since lifting is an experience in pain ten minutes into any type of workout. As we dig into all this I am hoping something in there will click and get me back into the gym without the pain.

Doc is going to request

Ultra Sensitive Estradiol E2
TIBC
Free T4, Free T3, Reverse T3 and antibodies (TPO, TgAb)

Then we will use the combo to make any changes.

More waiting.

Got the new script for Labs and will be getting them done Wednesday, anyone know if fasting is required for these 7?

Tom

I think it is best to fast before most bloodwork.

You should get cortisol checked with your symptoms. They are probably related to low iron/ferritin. I have same prob due to y too frequent phlebotomies. Really just run out of energy unexpectedly. It will take several mths to v raise ferritin.

With low cortisol after moderate workout I felt like I had been hit by a bus for several days. Not just tired or drsined.

Confirm through bloodwork before taking anything.

Good luck

Cortisol will be the next test once we have the rest of these tested and reviewed, oh and I do normally fast for all blood work but wanted to have the option open to not if I could since the wait always seems to take forever.

Understand completely. I try to schedule mine for early morning so its easier to fast.

The only fasted labs are lipids. There is a study that shows that fasted testosterone testing is about 20 percent higher than after breakfast, so some doctors may prefer to run T in a fasted state.

The only reference I found about fasting and thyroid tests is this one from Kobbo et al on 2004:


West Virginia University School of Medicine, Morgantown, USA.
The West Virginia Medical Journal [2004, 100(4):138-142]



Difficulty in treatment decisions can arise when TSH levels measured on the same patient on the same day but at different times show considerable variability. This study was a prospective, observational evaluation of 100 consecutive adult patients who had serum TSH tests ordered by attending physicians at an outpatient clinic. Early morning fasting serum TSH levels were compared to late morning non-fasting serum TSH levels in the same patients on the same day The late morning non-fasting TSH tests declined in 97 of 100 subjects by an average of 26.39% when compared to early morning, fasting, TSH test results. This lead to reclassification of 6% of patients from presumptive subclinical hypothyroidism to "normal." Since the time of day of phlebotomy or the fasting or non-fasting status of the patient, or both, can significantly affect serum TSH test results, the diagnosis of subclinical hypothyroidism should not be made only on a fasting TSH measurement. Further studies are needed to determine the independent effects of the time of phlebotomy and fasting/non-fasting status on TSH levels.

I thought lipids were the only one but that study is interesting Nelson. Thank you for that.

jger242 said:

You should get cortisol checked with your symptoms.

With low cortisol after moderate workout I felt like I had been hit by a bus for several days. Not just tired or drsined.

Click to expand...

Now you have me thinking, ferritin has never been checked before but for almost two years working out is an experience in exhaustion similar to your hit by a bus, so I haven't been able to do hardly anything but walk so I will be very interested to see what the Doc says after these results come in

It is always good to check ferritin or CPK if you feel tired or extra sore, respectively.

CPK? Nelson can you elaborate?

Tom, as noted in my previous post, your ferritin is way too low, and iron serum is suboptimal. Like I had mentioned, get your TIBC to make sure iron will bind adequately as you explore some form of elemental iron supplementation.

Cortisol has been mentioned a couple times now, and I would personally try to make that happen sooner than later. The 4x saliva panel is the gold standard with many of the leading physicians like Dr. Lam. Seeing the circadian profile with your cortisol levels throughout the entire day will be very beneficial when looking at the broader picture of your entire program. Again, this is one of the KEY variables with the thyroid and getting T3 to effectively work in the cells of the body, and helping keep Reverse T3 levels in a normal ratio with T3. STTM has TONS of information on this, and you will find a lot of supportive and relevant information with Dr. Lam and Dr. Rind.

Will keep an eye out for your future labs. BTW, as Nelson mentioned, the lipid profile needs fasting, and glucose will usually fall in that category as well. In fact, in that West Virginia Medical Journal fasting study on TSH that Nelson posted, you could probably contribute the variance to glucose, as glucose would promote ATP production, thus increased productivity of free T3. That's my theory anyways on why fasting would cause a deviation in TSH, but possibly there are further studies that would shed more light.