Blood results from PCP and Defy + backstory

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Riptide

New Member
Hi everyone,
I am posting utilizing a format that they use over at T-Nation, I'm not aware of politics between the two boards so sorry if I am stepping on anyone's toes, I certainly don't mean to, you can scroll down to the blood work if you want, otherwise the other data here just provides health history and context.

**-age** : 27 , 28 in January
**-height** 5' 7"
**-waist** 30 inches
**-weight** 170 lbs
**-describe body and facial hair** Have had a full beard since I was 21, medium arm and body hair otherwise. (Voice is low if that matters)
**-describe where you carry fat and how changed** Carry fat around my stomach, love handles, and chest--I've always had to eat ridiculously healthy to maintain a healthy body-fat, eating even one week of "normal food" i.e. the food others my age eat will destroy any abdominal/chest definition at once.
**-health conditions, symptoms [history]** : Currently the worst symptom is ED--I still feel "horny" once or twice a day (a bit less than normal but nothing drastic), but I can't get and/or maintain erections with sex with my gf (we have an otherwise loving relationship and I'm attracted to her). I've had ED issues to some extent since I was 18 (nearly 10 years), but they have gotten progressively worse over time. I also have been having a harder time sleeping through the night over the last 2-3 years, and I feel less motivated and more "moody" overall. I've struggled with minor depression and anxiety in the past, but I've always self managed through nutrition (I love the superfood supplement "green vibrance), meditation, exercise, and my own musical outlets. That's to say the seasonal depression (SAD) or otherwise environmental depression I sometimes get feels different than my current symptoms which have been more along the lines of crying more easily, getting angry disproportionately easily etc. On a scale from 1 (no symptoms ) to 10 (crippling symptoms) I'd rank my ED symptoms an 8/10, my sleep symptoms a 4/10 and my mood symptoms a 6/10.

**-Rx and OTC drugs, any hair loss drugs or prostate drugs ever**
Non Hormone related: I was prescribed xanax as needed to fly, I hardly have ever needed it.
I have no "allergies" but I felt horrible once on tramadol so I was advised to list this.

OTC drugs: from 18-22 y/o I took natural sports supplements like creatine, glutamine, bcaa, vitamins and low-caffeine pre-workout powders. I currently don't drink caffeine because I don't handle it well (way , way , way too hyper when I drink it--36 hours no sleep on a cup of tea--although within 3-4 days I tolerate it well). I drink green vibrance which is a whole food green superfood supplement (all organic). I also used to take my own pre workout mix which had arginine, taurine, glutamine, creatine, bcaa powder, l-citruline malate, green tea, and beta alanine. I don't currently take this.

Hormone related Rx history:
1.I saw a dr. at 18 and got tested at 250 ng/dl with a range around 200-850 ng/dl (this was 10 years ago).
2. He referred me to a urologist who ran the total T test again and got something in the 600 ng/dl range with the same 200-850 reference range (going on memory here but it was close to that). So the urologist sent me on my way no help offered for my symptoms which were primarily ED (I could get hard but not stay hard) other than the offer of Viagra --which I turned down. He said to come back if things got worse.

3.So I lived with the symptoms for a while and maybe a year and a half or two years later came back at age 20 presenting the same symptoms. He retested and said I was in the "low-normal range," for total testosterone levels. He prescribed a pill called Clomid , one pill every 2 days-- I think it was a 25 mg pill? I came back a month later and he said the tests still showed "low-normal" testosterone so he offered me hcg injectiions.
4. I did 3x a week hcg injections for 6 weeks with a small skinny needle in my stomach, I forget the exact dose--I want to say 400 units each time x3 a week.
5. After this 6 weeks we retested and again he said I was in the "low-normal range" again, not sure the exact numbers there but we know the 600 ng/dl test was "normal" in his words--so presumably lower than this.
6. I was sent on my way and offered viagra again--he said he couldn't give me T at my age (again, I was 20 by this time)--but said I would probably need a T cream or gel when I got older. I turned down the viagra as I'm a pro musician as well and have always been fearful of the potential hearing loss side effects, and to be (embarrassingly) honest, I didn't have anyone to have sex with at the time anyhow!

7. Fast forward to today (another 8 years later) As symptoms have worsened I went to see a new doctor who tested a few standard labs and read **only** my total testosterone in terms of hormones, after this I arranged my own tests for a wider array of labs at the suggestion of Defy medical who I am hopefully going to work with soon. Below are my lab results from the past week or two (two sets of dates--first from my PCP and second--a few days later by the same lab on the order of Defy). Above them are my best memories of testosterone data from younger in life.

*No hair loss supplements or other prescriptions other than retin-a for acne when I was younger with doxycycline (12 years old).

**-lab results with ranges**:

Total Testosterone at 18 (10 years ago): mid 200s ng/dl reference range 200-850 ng/dl (around this +-20 ng/dl)
Total Testosterone at 18 retest a few weeks later: mid 600s ng/dl reference range 200-850 ng/dl
Total Testosterone age 20 "low-normal" and continued to be "low-normal" in doctors words throughout clomid and hcg therapy. (Sorry for the lack of exact #'s here--this is provided for general reference only)

Recent labs (taken within a few days of each other)--exact #s with ranges (again, above was only from memory for reference, as a scientist I am dissapointed by this , but the #s I provided above I believe to be very close).

First set done by PCP: (Taken early morning)
CBC,Platelet,Auto DIff (ASAP)

Test nam ;Result Unit Range
WBC: 4.8 K/uL 4.0-9.8
RBC 5.07 M/uL 4.47-5.92
Hgb 15.4 g/dl 13.3-17.4
Hct 45.1 % 39.5-50.0
MCV 89.0 fL 79.2-93.7
MCH 30.4 pg 27.2-32.4
MCHC 34.1 g/dl 31.4-36.2
Plt 210 K/uL 151-362
RDW 13.2 % 11.6-13.9
MPV 10.7 fL 8.5-11.9
%Neut 39.9 % 43.0-73.8 Flag: Low
%Ly 45.4 % 17.0-43.9 Flag: High
%Mo 13.0 % 4.6-13.0
%Eo 1.5 % 0.0-4.5
%Ba 0.2 % 0.0-1.0
%Neut 1.9 K/uL 1.3-6.5
#Ly 2.2 K/uL 1.0-2.9
#Mo 0.6 K/uL 0.3-0.9
#Eo 0.1 K/uL 0.0-0.3
#Ba 0.0 K/ul 0.0-0.1
--
TSH, High Sensitivity 1.567 uIU/mL 0.550-4.780
--
Testosterone Total serum 491 ng/dL 87-814 (early morning)
---
Comprehensive Metabolic Panel

Sodium 140 nmol/L 133-143
Potassium 4.1 nmol/L 3.5-5.0
Chloride 104 nmol/L 98-108
CO2 29 nmol/L 22-30
BUN 15 mg/dL 7-22
Creatinine 0.91 mg/dL 0.70-1.30
Calcium 9.9 mg/dL 8.6-10.5
Glucose 131 mg/dL 70-99 Flag: High (But I did not fast first and dr said that was expected)
Albumin 4.8 g/dL 3.5-5.0
Alkaline Phosphatase 69 U/L 32-126
ALT 26 U/L 10-52
AST 20 U/L 14-40
Bilirubin Total 2.4 mg/dk <1.5 Flag High (ran bilirubin direct after which PCP said was fine, my family all have high bilirubin as well)
Total Protein 7.5 g/dL 6.4-8.3
Est GFR, African American >60 mL/min/1>60 .73sqM
Est GFR, non African American >60 mL/min/1>60 .73sqM
------
Bilirubin Direct 0.4 mg/dL <0.3 Flag: High (Dr said don't worry unless over 0.6; Bilirubin high in my family)
----
FOLLOWING tests taken 3 days later on order of Defy medical
Lipid Panel:
Cholesterol 130 mg/dl <200
Triglycerides 53 mg/dl <150
HDL 47 mg/dl >40.0
Calculated LDL 72 mg/dl 0-99
Tot Chol/hdl 2.8 <4.5
non HDL cholesterol 83 mg/dl <130
-----
DHEA-Sulfate 277 mcg/dL 80-560
----
(second test) Testosterone serum: 536 (491 tested three days earlier in morning) ng/dl 87-814
%Free Test 1.93 % 0.9-2.8
Free* Test 10.34 ng/dL 1.74-15.20
SHBG 38.5 nmol/L 10-57
-------
LH 4.2 mIU/ml Males 20-70 years 1.5-9.3
-----
PSA 0.64 ng/ml <4.00
-----
IGF1 149 ng/mL 83.6-259
-----
Estradiol ultra sensitive: 14.2 pg/mL Male <11.8-39.8
----

In addition here were my recent vitals from my PCP:
Blood pressure : 120/70 (This is normal for me, between 115/68 and 128/72)
Pulse: 76 (resting is lower, this is normal for the day)
SpO2 98%
Temperature 97.0 (more on this below, I usually run cold)

I know you all will want more with temperature to access thyroid functionality. I am often around 97.0-97.5 in the morning, and later in the day I will *sometimes* be a bit hotter, but for the most part I stay under 98 at all times. I've always ran a lower temperature my whole life often in the mid 97's no matter what time of the day I take my temperature.

I'd be happy to provide specifics on diet and training but essentially I work out on average 2-3 times a week cardio+ weights, and eat a very clean 4-5 small meal diet with plenty of water rich in veggies, healthy fats, lean meats (poultry/wild game) and organic food when I can afford it.

My ED problems also are *slightly* better first thing in the morning --where I can almost get hard if I have heavy stimulation--and slightly better right after the gym. Any other time and it's non existent in terms of erectile function--I can't even masturbate in the evening to orgasm--other-times I can masturbate to orgasm with a semi-erect or flaccid penis.

I also use iodized salt at least relatively regularly (though I limit sodium in general) so I don't think this is an iodine deficiency.

I'm sure the folks at Defy will have some advice when I have my consult, I'm just curious what the community thinks given my symptoms, bloodwork, and previous history with symptoms and two (seemingly common) treatments that I've gone through to boost hormones.

Thanks!
 
Defy Medical TRT clinic doctor
Your free testosterone is on the low end where most men start to experience symptoms, most men need free testosterone 3/4 to the top of the ranges to feel good. Your estrogen provides a window into your free testosterone, we convert free testosterone into estrogen so if the source is low than we can expect to see estrogen low as well.

Low estrogen is bad news for erections and orgasm quality, lower free testosterone doesn't help either. IGF-1 is a little low for your age, TRT may increase IGF-1 and peptides can naturally increase IGF-1 and growth hormone.

My IGF-1 is (153) about the same as yours, yet I'm 46 years old.

Sick care doctors focus heavily on the numbers and don't care about your symptoms because guidelines are very strict, you're not low enough for a sick care doctor to prescribe TRT because you are right at the tipping point.

Defy Medical is another story.
 
Last edited:
Thanks Systemlord for your feedback, I appreciate that.

I know the folks at Defy said they treat symptoms and that they prefer working with patients with 550 ng/dl or less (which is me)--but also would consider others related to symptoms.

I know also that this will ultimately be up to my doctor, but do you think they will consider my past experience with the other therapies I've tried? I guess I'd be willing to give Hcg another shot, but Clomid made me feel horrible (it made it hard to see when I drove/made me moody), and HCG wasn't horrible but didn't seem to help/didn't help my numbers.

I'm just pretty frustrated at this point and feel like it's been 10 years with worsening symptoms and no help :/ I don't know if defy will also consider me too young for trt...
 
With LH @ 4.2, in order for HCG to stimulate your testes more than they already are I would think the dose would have to be over 500iu. I think with SHBG over mid range you can’t produce enough testosterone on your own or with help of HCG/clomid to overide the SHBG to get free testosterone higher.
 
So, what do you all think in terms of solutions? Do you think Defy will be likely to offer the next step--T injections given my past failures with clomid and hcg? Or would some folks run a higher dose of hcg first? I know ultimately this is a personal decision, and I've tried to educate myself the best I can--my girlfriend and family are in my corner regardless--but I just wanted to make sure I wasn't missing something obvious before I tried TRT.

I also feel like at this point, even if I decided to "wait" another 5 years, I don't see my symptoms improving through my 30s magically--and if the only place to go from here is down that's a really scary thought given my symptoms!
 
Waiting 5 years isn't going to change anything, if anything things will worsen. SHBG increases with age and testosterone decreases with age. Clomid would never have worked because it increases SHBG which only worsens your situation, great for a low SHBG guy though.

The problem with HCG is it suppresses to half of the testicles and has a low chance of success. HCG doesn't always activate all the hormonal pathways like TRT. Higher dose HCG also can cause problems with estrogen conversion that can get out of control quickly.

Add to that that some guys just don't tolerate HCG well.
 
Huh, okay, so then given that info and my labs/age and that I'm consulting with Defy this week, should I then try to push to start TRT or is that unnecessary given my previous history with hcg/clomid--i.e. do I need to be very hands on with pushing for this, or do people that work with them think that at this point TRT will be the logical option for progressive/experienced drs like them?

Sorry if that's an odd question, I've just been reading folks here say how important being your own advocate is in medicine in general--but specifically with TRT/hormone replacement.
 
I don't think your estrogen is low compared to your testosterone.
I would definitely recommend trying low dose clomid again, you may have been taking to high of dose which causes severe symptoms. I would cover all my options before starting trt, you're just too young. Younger men usually do better on clomid then older men if properly treated.
 
Thanks for your input ! I would be open to trying hcg again but my side effects from clomid were so nasty (and according to my dr I was on the lowest effective dose)--the headaches, vision issues, sleeping issues, moodiness--it was honestly one of the worst medical experiences I've had and I honestly think I'd walk if I had to do it again. Is this common and are there comparable alternatives?
 
Thanks for your input ! I would be open to trying hcg again but my side effects from clomid were so nasty (and according to my dr I was on the lowest effective dose)--the headaches, vision issues, sleeping issues, moodiness--it was honestly one of the worst medical experiences I've had and I honestly think I'd walk if I had to do it again. Is this common and are there comparable alternatives?
What was your protocol when you were on clomid?
 
It was one pill every other day, and I believe it was either 25mg or 20mg, I remember my dr saying it was the lowest dose he could prescribe me (this is big pharma not a compounding pharmacy of course). After I did a course of it my test results hadn't improved and he moved on to hcg as he thought I was a non-responder. But on top of that, I personally hated every minute of how I felt.
 
Clomid; 25mg/D is usually problematic as the direct stim to the testes creates an Estrogen (high) problem in many guys. 12.5/D or even EOD tends to mitigate that. For the same reason HCG (mono) tends to fail, too.
With either treatment their success is predicated on if the testes are the problem, stimulating those isn't likely to change the landscape.
 
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