Bloodwork help-Total T, Free T, DHT, Estradiol all low

[angry polak]

Hello, I'm new here and was hoping to get some help understanding my blood results and maybe establish what some prudent next steps would be.

Background: I've been working out a few years and while I have gotten stronger, I seem to struggle to build muscle get really lean. When I bulk, I gain more fat than muscle. When I cut, I lose more muscle than fat. This is with a good diet and lifting routine. I don't feel "abnormal", but I had some funds available and decided to run bloods to see if there was anything hormonal causing me to "spin my wheels".

Diet: I track my calories. When I bulk I aim for +250 and when I cut I aim for -500. Macros are good. With protein I aim for around 1g/lb. Carbs and fat are split nearly 50/50 between remaining calories. I go up to 1.5g/lb when cutting. Long story short, I don't go to extremes on either end.

Sleep: I've used a sleep tracking app since May 2016. Since then my average time in bed is 7:46. My average "sleep quality" is 80%. Although my sleep seems good I can't remember the last time I work up with that "ahhhh" feeling (aka feeling well rested).

Exercise: I use a routine that performs both heavy lifts and hypertrophy lifts. I do as little cardio as possible, but I'm not inactive and end up running a handful of 5k's and 1/2 marathons with my wife each year.

Sexual: I don't tend to initiate sex with my wife, but I have no problem performing once initiated. I always thought lack of taking initiative was a preference thing, but as I'm reading more it could be a result of low libido.

I'm 34. On the day of the test I weighed 190.3 and registered 17.8%BF on an Omron. I took the blood test at 8:30 am and was fasted. I have been eating at maintenance or +250 calories (recomp or lean bulk) since March. Basically, my body should have been "primed" for best possible results.

I am hoping I can get some feedback. Is there anything I can do to improve my numbers naturally? Are there other tests I need to run to get a better picture of what's going on? Should I be making an appointment an appointment with an endo RIGHT NOW? Anything is appreciated here as I navigate some new waters.

I tried to keep my background brief to not drag on in the first post, but I can expound on any facet if it helps.

 

[a_crossfitter]

First of all, why are you seeking feedback to "improve" your numbers? Are you not feeling well?

 

[angry polak]

First of all, why are you seeking feedback to "improve" your numbers? Are you not feeling well?

Hello. Good question. I feel “normal” in the sense I can’t remember the last time I felt differently than I do now. However, this is my first time running bloods and I had a number of important hormonal areas register as low.

-Do I feel “normal” because I am?
-Do I feel “normal” just because I’ve had low T for so long I don’t remember what “real normal” feels like?
-Do I feel “normal” because, while low, my Total T, Free T, and Estradiol is pretty balanced (if there is any part of my draw I could say I’m happy with, it’s the fact I’m fairly hormonally balanced)?

I don’t really know any of these answers and was hoping to maybe get some insight by sharing my results. I can say that I know being outside the target range (low or high) can have health consequences, so I would like to increase my numbers across the board if possible for that reason alone.

After making my initial post I did call Life Extension to utilize the free consultation that came with the blood test I purchased. They said my hormone panel was low but balanced. They suggested I supplement with DHEA and Pregnenolone to provide “building blocks” for all the hormones. They also suggested Mucuna supplementation. They suggested I try all three for 6 weeks and have my test run again.

I’m obviously taking into consideration these recommendations came from a (reputable) supplement and blood test company. So everything that was recommended can be provided by Life Extension.

 

[a_crossfitter]

Good to know that you feel good! Unfortunately, because of this being the first time you get this type of blood work, you will never know if your specific numbers have been declining or not (same holds true for me although I have a strong suspicion that I am a naturally lower T guy).

Honestly, if you feel fine, I would do as life extension has recommended. I wouldn't mess with your hormones yet...

 

[a_crossfitter]

....on a side note, it seems like you do not wake up rested and that might be a contributing factor to your numbers.

 

[Vince Carter]

Your Creatinine (Kidney) and AST/ALT (liver) values are elevated most likely due to gym and weight training. I typically advise CBC/CMP be taken with about 72hrs off the gym cycle as these values can be influenced by that activity and give false positives.

Besides your hormonal issues, DHEA maybe 25mg and Pregnenolone 5-10mg would be a place to start. Set your expectations low as this stuff really is unlikely to appreciably change your numbers.

 

[angry polak]

Your Creatinine (Kidney) and AST/ALT (liver) values are elevated most likely due to gym and weight training. I typically advise CBC/CMP be taken with about 72hrs off the gym cycle as these values can be influenced by that activity and give false positives.

Besides your hormonal issues, DHEA maybe 25mg and Pregnenolone 5-10mg would be a place to start. Set your expectations low as this stuff really is unlikely to appreciably change your numbers.

Thanks for the feedback! While I didn't work out over the weekend before the draw, I did do 3x3 on Deadlifts on Friday (so max effort on a huge muscle group). I'd figured 48 hours was enough gap to not skew results.

As far as DHEA/Preg supplementation...I'm keeping expectations low.

Good to know that you feel good! Unfortunately, because of this being the first time you get this type of blood work, you will never know if your specific numbers have been declining or not (same holds true for me although I have a strong suspicion that I am a naturally lower T guy).

Honestly, if you feel fine, I would do as life extension has recommended. I wouldn't mess with your hormones yet...

This is true. The good news on my current plan is I'll get bloods run again in the near future and I'll have two data points to work from!

 

[JPB]

Liver values can take 1-2 weeks to come down after intense weight training. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2291230/

Your DHEA is indeed on the low side. Your LH is on the low side. I would think you would be a good candidate for Clomid therapy.

 

[CoastWatcher]

Your doctor ordered Total Estrogens. That's a test of absolutely no value for men; it presents no actionable information and was a money waster. The incorrect estradiol test was run, the ECLIA assay. Down the road, you want to run Estradiol Sensitive, LC, MS/MS. The one you presented is for women.

However,mid your estradiol is as low as it *may* be (given what was reported) that could be contributing to your issues.

 

[angry polak]

Liver values can take 1-2 weeks to come down after intense weight training.

Your DHEA is indeed on the low side. Your LH is on the low side. I would think you would be a good candidate for Clomid therapy.

Thank you for the link. Between you and Vince Carter I feel pretty confident those elevated levels are from my weight lifting. It does make me wonder, however, if I should be taking a dedicated liver support supplement due to the overall "strain" exercise causes.

I've been reading up on what some of the typical treatments are for secondary hypogonadism (which it appears I'm most likely dealing with). I'm assuming you're referencing a low-dose Clomid protocol to try and "re-start" my system? If so, it's something I'm certainly interesting in trying if these supplements don't have an impact.

Your doctor ordered Total Estrogens. That's a test of absolutely no value for men; it presents no actionable information and was a money waster. The incorrect estradiol test was run, the ECLIA assay. Down the road, you want to run Estradiol Sensitive, LC, MS/MS. The one you presented is for women.

However,mid your estradiol is as low as it *may* be (given what was reported) that could be contributing to your issues.

To be clear, I purchased this panel myself for the sake of knowledge. I had not seen a doctor for anything prior to this, though I am planning to make an appointment soon after seeing the results. I had heard that Labcorp was a good source for testing and Life Extension was a good vendor to purchase from, so I got the "Male Elite Blood Panel". Unfortunately I didn't learn about the sensitive test until after. I do plan to make a better purchase when I follow up.

I know estradiol plays an important part in how I feel (energy, libido, etc). However, when I read information on low estradiol, I took it to mean "low relative to other hormones". So if my total test was 600 and my estradiol was <5.1, then I'd likely see symptoms of low estradiol. Since my total test is low and my other hormones (Free T, Estradiol, DHT) are all proportionately low, I actually figured that's why I feel relatively normal.

Please know I'm not challenging your comment. I'm actually trying to understand if absolute values matter more than relative values.

Right now I see everything as being low and (ideally) I'd increase everything linearly...not just one or two factors. But I'd love to know if I need to focus on fractions of my hormone panel instead (increase total T and estradiol, increase total T and lower SHBG, etc.). I'm new to this and it's a lot of information to absorb. It reminds me of a maze. One start and one finish with lots of possible routes to get through it, but lots of possible dead ends too.

 

[Vince Carter]

LEF hasn't gotten onboard with LC/MS/MS testing that I'm aware and should be avoided for that reason.

 

[angry polak]

Ferritin 315 concerns me the most
Along with EOS elevated, AG ratio, creatine
There are signs of potential dehydration with some type of infection.
Liver function may be from heavy workout night before if not they something else is off needing proper intervention
Have you ever had head trauma?
The estradiol is not the proper assay for e2 evaluation
Highly suspect adrenals have not recovered and reason no symptoms is you may be running on adrenaline masking the low cortisol as commonly missed

I got this comment on a different forum. I didn't know if anyone would be willing to weigh in over here. And for the sake of reducing redundancy, my reply is below:

Thank you so much for the reply. I'll try and give feedback in the order you commented.

-What about those numbers is concerning? I know ferritin can relate to iron retention, but I don't know much what the rest "says" (or how it may relate to ferritin and an underlying issue). The consultation I had from my blood draw suggested I simply donate blood if ferritin remained high on my follow-up test. I will note the week prior to testing I ran out of multivitamins. Since I was going on vacation and my new order had not arrived, I packed my wife's vitamins. They are grocery store basic and have 18mg iron. I took them every other day because I knew men don't typically need to supplement iron. I don't know if that could impact these panels at the rate being seen, but I wanted to mention it.

-I drink at least 1 gallon of water daily, often 1.5-2 gallons. I have a 1/2 gallon jug and fill it with water from home (reverse osmosis filtered) and then fill it again at work from the fountain.

-I tested on Monday and hadn't lifted since Friday. I did perform heavy deadlifts on Friday.

-Two months after I began working out (June 2014), I experienced an extreme and sudden headache while lifting. It would recur any time I tried lifting heavy. I went to the Dr. because my father had suffered an aneurysm a few years prior. Bloods were taken and an MRI was performed (I'm going to provide comparisons on the bloods below) and both came back clean. It was determined that I was suffering tension headaches. Likely triggered by improper breathing when lifting and spiking BP. I took around 6 weeks off. When I returned I focused on performing proper warm up and breathing and have never had an issue since. Other than that I've not been treated for anything relating to "head trauma".

-I learned that about the estradiol test after I took the labs. I purchased the panel through Life Extension as a "complete wellness panel". When I retest I plan to purchase the "sensitive" test.

-I'd love to hear your thoughts on adrenals and how they could relate to my experience. I do consume caffeine. I don't typically suffer "brain fog" but I don't always feel well rested. I checked my body temp at waking this morning and it was 97.2. I did try in Jan-March to supplement with lugols iodine (5%) and didn't notice much perceived change or change in body temp so I stopped. I'll also add that I have had fibrous gyno since I was a teen (I'm 34 now). Part of why I supplemented with iodine was there's anecdotal evidence it can help with gyno/fibrocystic tissue.

My bloods from 2014 were not tailored to a hormone panel, but the following comparisons can be made (2014 left and 2017 right):
-Ferritin: N/A vs 315
-EOS: 3.1% vs 12%
-A/G: 2.2 vs 2.3
-Creatinine: 1.24 vs 1.21
AST: 24 vs 50
ALT: 23 vs 80
TSH: 1.41 (same both times)
T4 (free): 1.3 vs 1.42

Changes I am making since receiving my results:
-Reduce sugar intake (was averaging 125-150g for 365-385g total carbs)
-Add "Inhibit P" supplement (P5P, Mucuna)
-Add Sup3r DHEA @ .25ml (topical application of 25mg DHEA & 5mg Pregnenolone)
-Add Garden of Life Probiotic

I was planning to test again in 6 weeks. I was planning to run the sensitive estradiol test and drop PSA (cost savings).

With the additional info I'm open to any feedback you may have. Other changes to make, other tests to add, anything really. The time is greatly appreciated!

One more potentially important note. I was eating slightly above maintenance (lean bulk) and wanted a nutrient partitioner/GDA. In an effort to save money I just bought some cinnamon bark from my local Walmart. About two weeks before testing I started taking 1 cap (500mg) with each meal. After about a week I would have dizzy spells upon standing. I thought it was the cinnamon dropping blood sugar TOO low so I discontinued use. Symptoms stopped.

After seeing my liver values (even with lifting in consideration), I'm wondering if it was coumarin content and not blood sugar imparting my symptoms.

 

[JPB]

I did not see a response in regards to head trauma. Your LH levels are very low, and there are not many hormones in your system to inhibit the HPTA. The hypothalamus and pituitary are in the brain. While Clomid can stimulate the HPTA to some degree, it does this through estrogen inhibition. There is a possibility there is some sort of lesion in the brain inhibiting your LH. You need to be working with a doctor on this.

 

[angry polak]

I did not see a response in regards to head trauma. Your LH levels are very low, and there are not many hormones in your system to inhibit the HPTA. The hypothalamus and pituitary are in the brain. While Clomid can stimulate the HPTA to some degree, it does this through estrogen inhibition. There is a possibility there is some sort of lesion in the brain inhibiting your LH. You need to be working with a doctor on this.

My reply to "head trauma" was the part where I discussed tension headaches. Aside from that I don't have a history of head trauma (treated or untreated). I did have an MRI performed in 2014 and it was deemed clear. I know a lot can change in three years, but I can also say I don't FEEL different now from then, or if anything I feel better now from more time spent focusing on s healthy lifestyle. I ran these tests because I've never run a full panel and I had some money to burn, not because how I physically felt had changed.

Out of curiosity, what leads you to something like a brain problem (trauma, lesion) from my results? I'm honestly asking because if/when I go to a Dr I want to have as much info as possible to insist on proper diagnosis/treatment.

The person I quoted also hinted at adrenal fatigue as the possible cause. Do you have any thoughts on that? Is it worth trying to continue with the changes I planned (which coincide nicely with "adrenal recovery" practices I'm finding) and retesting in about 6 weeks? Or is it best advised to just go straight to the doctor.

One last comment, I'm not trying to avoid going to s doctor. It's just that communities like this seem to be well versed in this information. Sometimes more so than local practitioners. I just want to be armed with as much information as possible. So again, the insight is appreciated!

 

[JPB]

My reply to "head trauma" was the part where I discussed tension headaches. Aside from that I don't have a history of head trauma (treated or untreated). I did have an MRI performed in 2014 and it was deemed clear.

Out of curiosity, what leads you to something like a brain problem (trauma, lesion) from my results? I'm honestly asking because if/when I go to a Dr I want to have as much info as possible to insist on proper diagnosis/treatment.

The person I quoted also hinted at adrenal fatigue as the possible cause. Do you have any thoughts on that? Is it worth trying to continue with the changes I planned (which coincide nicely with "adrenal recovery" practices I'm finding) and retesting in about 6 weeks? Or is it best advised to just go straight to the doctor.

As discussed, the low LH and other hormones suggest secondary hypogonadism which could be related to head trauma, concussion, a tumor, or something like that. Or it could just be a stress related issue, or frankly due to unknown causes. But the low values with all other low hormone values suggest it is not from negative feedback loop. I'm not trying to give you a panic, there are just some other things one may want to rule out ...

Adrenal fatigue is a tricky thing to deal with, primarily rest will help, less caffeine, etc. Improving nutrition and taking some DHEA may help. So working on these things you mention is fine.

 

[angry polak]

As discussed, the low LH and other hormones suggest secondary hypogonadism which could be related to head trauma, concussion, a tumor, or something like that. Or it could just be a stress related issue, or frankly due to unknown causes. But the low values with all other low hormone values suggest it is not from negative feedback loop. I'm not trying to give you a panic, there are just some other things one may want to rule out ...

Adrenal fatigue is a tricky thing to deal with, primarily rest will help, less caffeine, etc. Improving nutrition and taking some DHEA may help. So working on these things you mention is fine.

Thank you for the follow-up. I don't think there is really an "ideal" scenario here anyway. I potentially have an issue and need to see if there is an underlying cause. And then address that cause instead of just "fixing" the issues downstream. If a full investigation leaves me with "unknown causes" (which does happen), then it may be ok to move on to just trying to fix the downstream issues.

I'm not panicking. I am hopeful I'm not walking around with an un-diagnosed malignant brain tumor, but it's good to know it's a possibility and should be checked out. I know that's a dramatic example, but I'd rather hear all the possibilities and rule them out then just go searching for HRT and miss something that could effect my life even more dramatically down the road.

 

[angry polak]

I have two questions from all these discussions:

Should I start investigations into things like "head trauma" with a primary care physician or endo? Wasn't really sure where to best start. I'm on a HSA plan, so I'd hate to pay a few hundred bucks to either for an appointment only to be recommended to go somewhere else.

Second, I know I need a different E2 test, but what all should I get checked on my follow-up bloodwork? I'm planning to go in 6 weeks. I think I want to see if my liver and blood values changed and if my overall hormone panel improved.

- Total and free testosterone (LC/MS assay. No upper limit restriction)
- DHEA-S
- Sex hormone binding globulin
- Estradiol (sensitive- LC/MS assay)
- CBC (includes glucose, hematocrit and immune cells)
- CMP (includes liver and kidney function)
- Lipids (LDL and HDL cholesterol and triglycerides)

 

[JPB]

I think it is clear you need to work with a doctor. Perhaps they would MRI scan the pituitary. In a blood test, a pituitary problem may be indicated by high prolactin. There are doctors here as part of Defy and that would be a place to start if you are at a loss otherwise.

 

[angry polak]

Ok, so I have some updates.

I did a 4 point cortisol test in August. All results were in range. 1st AM measurement was a bit below the average, but in range. Everything else plotted pretty much along the average curve.

I got my bloods run again last week. All of my elevated liver values were back in range. My hormone panel improved, though I'm not sure how I feel about that. My LH and FSH went up. I had a nearly 50% improvement in total test and all the cascading values were up as well. However, I don't feel appreciably different than I did when I tested in July. From what I've read on here, I'm wondering if it's because my T/E ratio doesn't look to have changed much even though all the numbers are up.

All in all, I'm kind of unsure if I should be happy with my results or still look to speak with an Endo.

Changes I made to get these results: added probiotic, upped saturated and mono fat macros, ran NAC for 30 days (as a just in case for elevated liver values), and added DHEA (50mg) and pregnenolone (15mg).

Both tests were taken at 8:00 on a Monday morning. Both tests were taken fasted. Both tests were taken nearly 72 hours from my last gym session.

Test--7/12/17 Results--10/2/17 Results
LH--1.9--4.8
FSH--3.0--5.4
Total Test--330--472.8
Free Test--4.3--10.5
Estradiol--<5.1*--10.3
DHEAS--155--228.8
SHBG--30.1--33.5

*I didn't take the sensitive test for estradiol in July.

I know I'm not the first to go down this road, so any thoughts or feedback are appreciated.

 

[Deleted member 16042]

Besides still being farily low in the T range, If your second E2 number is from the sensitive test, it is quite low.