Feedback on Bloodwork - Going to see Doc

[testlar17]

Hi Everyone,
Just got my bloodwork done. I'm going to see the TRT specialist and would like your feedback to get on TRT. I'm 44, 5'7" 150lbs (fit, work out several times per week...have been athletic all my life), and experiencing classic symptoms (fatigue, libido, disturbed sleep, physical performance decline, etc.).

My GP didn't order all of the suggested tests so I will list what has been done so far and will get the other tests done in my follow up:

*Hematocrit 46 (37-51)
*PSA - will do test in follow up
*Estradiol - will do test in follow up
*Blood pressure - normal
*Estimated Glomerular (eGFR) - 100
*TSH - 1.5 (.45 - 4.5)
*Total Testosterone - 527 (348 - 1197)
*Free Testosterone - 11 (6.8-21.5) What is my percentage of free test - can't figure out how to calculate. I saw the link Nelson posted for the free test calculator but I'm missing the SHBG test value that is required for calculation.
*HDL - 37

My concern is that the doc will say that I'm in the normal range and dismiss my symptoms. I know some docs will make a determination for TRT based solely on T value and others will look the T but will also consider the symptoms. As I am "low normal," I'm hoping he'll consider the symptoms. I would appreciate your advice on constructing a good argument when I speak with me doc.

Thanks!
Lars

 

[BBaller]

Hi Lars,

Welcome to Excel Male! Congrats on having what sound like healthy fitness habits.

May not be what you want to hear, but at 544 total T at 44 years old, I think many doctors would have a hard time justifying TRT as medically indicated. Even though they are on the low-ish range of normal, and progressive physicians don't just chase numbers, I'm not sure many doctors would go this route.

But I'm fairly new here, so other guys may be in a better position to issue recommendations on framing the conversation with your doctor to at least get a fair hearing. Good luck!

 

[testlar17]

Hi BBaller,
Thanks for the comments. I understand that the range is statistically defined - the normal range includes those who are low (Normal does not necessary mean healthy or optimal). This will be part of my discussion with the doc. Also, my understanding is that some docs who specialize in TRT may want to see their patients in the 600-700 range. I'm hoping that the doc will be open minded.
Lars

 

[Vince]

testlar, it would be nice if you could raise your testosterone naturally, instead of injecting for the rest of your life. I would talk to my doctor about raising my T naturally. What's causing your low T?

 

[Gene Devine]

I agree with BBaller as well.

Your serum levels are pretty decent for a guy your age plus the symptoms you have can be caused by other circumstances as well.

I'd look deeper at your Thyroid to be honest.

While TSH is fine it's doesn't tell you the complete picture of what's going on with your Thyroid.

You'd want to test for:

Free T4
Free T3
Reverse T3
Antibodies

Hypothyroidism has many of the same symptoms as Hypogonadism.

Of course, just life events and stress can cause your symptoms as well.

I wouldn't expect a GP to write a script with where your levels are but there are probably anti aging clinics that would and get you close to 1000.

Just my $0.02

 

[Nelson Vergel]

Hi Everyone,
Just got my bloodwork done. I'm going to see the TRT specialist and would like your feedback to get on TRT. I'm 44, 5'7" 150lbs (fit, work out several times per week...have been athletic all my life), and experiencing classic symptoms (fatigue, libido, disturbed sleep, physical performance decline, etc.).

My GP didn't order all of the suggested tests so I will list what has been done so far and will get the other tests done in my follow up:

*Hematocrit 46 (37-51)
*PSA - will do test in follow up
*Estradiol - will do test in follow up
*Blood pressure - normal
*Estimated Glomerular (eGFR) - 100
*TSH - 1.5 (.45 - 4.5)
*Total Testosterone - 527 (348 - 1197)
*Free Testosterone - 11 (6.8-21.5) What is my percentage of free test - can't figure out how to calculate. I saw the link Nelson posted for the free test calculator but I'm missing the SHBG test value that is required for calculation.
*HDL - 37

My concern is that the doc will say that I'm in the normal range and dismiss my symptoms. I know some docs will make a determination for TRT based solely on T value and others will look the T but will also consider the symptoms. As I am "low normal," I'm hoping he'll consider the symptoms. I would appreciate your advice on constructing a good argument when I speak with me doc.

Thanks!
Lars

Lars

Tell me more about your sleep quality, hours, time that you go to bed, how long it takes you to fall asleep, how many times do you pee at night, etc

Are you going through a particular stressor?

I would not use TRT with your numbers until you explore sleep quality or sleep apnea. Your age, height/weight and TT & FT are such that I would be more conservative at first.

Your TSH is 1.5 so I doubt that you have hypothyrodism but what Gene said about free T3 and free T4 may not be a bad idea.

Are you taking any medication or supplement? I noticed your HDL is low.

 

[Vettester Chris]

*Total Testosterone - 527 (348 - 1197)
*Free Testosterone - 11 (6.8-21.5) What is my percentage of free test - can't figure out how to calculate. I saw the link Nelson posted for the free test calculator but I'm missing the SHBG test value that is required for calculation.
*HDL - 37

Lars, thanks for posting your labs!

Your Free Test is a 2.1%. Take your Free Test / Total Serum = Free Test % (2.0872%). 2% to 3% is usually the place to be for most men IMO. If under 2%, then some steps might be taken to reduce SHBG, just depending on where you and your doctor need it to be.

Agree with the thyroid labs mentioned above. Let us know ...

 

[testlar17]

Hi Vince - not sure about the cause of my low T. I had a blood test about 4 years ago and the values came back about the same. I'm thinking that this may be my base point.

 

[testlar17]

Thanks for the feedback Gene. I'll talk with the doc about Hypothyroidism. Yes, I may have to look for a TRT specialist who is not so set on a given number and who may be more open to treating the symptoms.
Lars

 

[testlar17]

Hi Nelson,
My sleep sucks. I get about 5 hours a night. I fall asleep fairly quickly and sleep through the night and do not get up to pee.

No particular stressors and I don't feel anxious. I am moody at times - there are days when I'm am irritable and lack patience.

I'm not taking any medication.

My GP did ask about sleep when I went in for my blood test. I have a follow up with my GP to review the bloodwork. Will discuss some of the points raised and see what he thinks.
Lars

 

[testlar17]

Hi Vettester Chris - Thanks for calculating my Free Test and explaining the formula. Looks like I'm on the lower end of normal. I'll ask my doc about this in my follow up.

 

[Vettester Chris]

Lars, sometimes just getting your Vitamin D3 in the upper range will have a positive effect on lower SHBG, thus increasing Free Test a bit.

 

[testlar17]

Thanks Vettester Chris. Will have my vitamin D checked.

 

[testlar17]

Hi Everyone,
This is a follow up to my earlier post. I got additional bloodwork and would greatly appreciate your feedback. Just a quick recap, this was my first bloodwork:

*Hematocrit 46 (37-51)
*PSA - will do test in follow up
*Estradiol - will do test in follow up
*Blood pressure - normal
*Estimated Glomerular (eGFR) - 100
*TSH - 1.5 (.45 - 4.5)
*Total Testosterone - 527 (348 - 1197)
*Free Testosterone - 11 (6.8-21.5) What is my percentage of free test - can't figure out how to calculate. I saw the link Nelson posted for the free test calculator but I'm missing the SHBG test value that is required for calculation.
*HDL - 37

These is my follow up bloodwork (please note that the above/original bloodwork was done by Labcorp around 5pm and the below/new bloodwork was done by Quest at 11am):

*IGF I, LC/MS - 116 (52-328 ng/ml)
*Dihydrotestosteronne - 21 (16-79 ng/ml)
*IGF Binding Protein 3 - 2.6 (3.3-6.7 mg/L)
*DHEA - 287 (70-495 mcg/dL)
*Estradiol - 15 (< or = 39)
*Total Test - 282 (250-1100 ng/dL)
*Free Test - 47 (46-224 pg/mL)
*Bioavailable Test - 96.6 (110-575 ngdL)
*SHBG - 23 (10-50 nmol/L)
*Albumin - 4.5 (3.6-5.1 g/dL)
*Vitamin D - 23 (30-100 ng/mL)

I would appreciate your feedback/interpretation of my bloodwork. I have a follow with my doc to discuss a treatment plan. Any thoughts on a treatment protocol? It seems the standard protocol would be:

*100 to 200mg of test per week
*500iu of Hcg per week
*.25 of mg of Arimidex

What would you add or change given my bloodwork? I just want to be armed with the knowledge/experience of this board so that I can make good decisions when talking with my doc. Thanks in advance!
Lars

 

[Vettester Chris]

Your E2 appears to be a standard female assay? IMO, it's virtually impossible to truly assess E2 for men without using the the E2 sensitive or Ultra-sensitive male specific assay. That being said, I would personally put aside any AI unless it's warranted for the need to reduce and/or sustain your E2 at a certain serum level. If you keep your program in "balance" (balance being the magic word), you "might not" need any AI. Keep in mind, estrogen is highly important in men, just as it is with women, but obviously at different levels.

The body will usually gravitate towards homeostasis, so finding the right balance of hormones upstream will in many cases influence an optimal balance downstream ... Think about it, find 10 guys that are in their 20's with perfect/optimal natural testosterone & DHEA levels, and ask them if they take an AI??

Your SHBG is coming out pretty good IMO, as is the albumin, which also contributes weakly to the binding of androgen. However, for a myriad of reasons, please look into a therapeutic regiment of Vitamin D.

Before doing any treatment, I'd suggest you determine if you're Primary or Secondary Hypo?!?! That will make a difference in your protocol; HCG administration in particular. Looking for the LH & FSH labs if you have them? When/if a treatment protocol is administered, my suggestion is to start on the LOW end of everything, run your follow up labs at six (6) weeks, make your adjustments from there (if needed) ...

 

[Vettester Chris]

Also, the PSA lab plus the other thyroid labs noted above should be in the mix ...

 

[testlar17]

Hi Vettester Chris,
As always, good feedback. I did the follow up with my doc. My doc suggested 150mg of test. Consistent with your comments, he suggested that we hold off on hcg/AI until my follow up visit in about 5 weeks to see how my body is adjusting.

Interestingly, he said that my IGF values indicate that I am also a candidate for HGH. I have not done much research on IGF/HGH so I'm less knowledgeable on these topics - will need to do further reading. However, we're taking the conservative route first and see how I respond to test.

 

[ERO]

HGH at a clinic is going to run like $1,500 to $2,000 a month, just so you know. My 2-cents would be to get the TRT dialed in before adding another variable like HCG. Also, I would split the 150mg dose and do 75mg every 3.5 days for less E2 and more even levels.

 

[testlar17]

Hi Ero - Your comments are spot on! The doc joked that we should take the "poor man's" protocol (testosterone) first. Thanks for the suggestion - I am splitting the 150mg (Wed and Sunday).