Help Analyzing Initial Defy Medical Labs (plus additional labs)

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Donovan P

New Member
I recently had my initial labs done with Defy; I have an appointment with Dr. Saya in the beginning of September. I am also attaching other labs I had done in February, March, and just a couple weeks ago in July (all in 2018); and a recent DEXA and RMR test. I am not well versed in a lot of this and am still learning. Any and all insight and advice is greatly appreciated.

I have had the symptoms outlined below, to varying degrees, since my early twenties. It is only recently that I have suspected hormonal issues may be at play. I am just now starting to do significant research into the Low T / Hormone 'space', if you will.

Symptoms

Sexual

- Very, very low libido. I'm 27 years old and in a city surrounded by beautiful young girls to whom I am very attracted...I just don't feel much of a desire to pursue sex.

- Inability to achieve strong erections when I do have sex or masturbate. Cannot get hard enough to physically have sex after the first round.

Cognitive

- Omnipresent mental haze. It's like this "foggy" feeling, sort of like when you wake up in the middle of the night and you have to go to the bathroom and you're not fully conscious. It isn't quite as bad as that, but similar, and it's always there.

- Moderate to significant difficulty concentrating. I have tried mindfulness mediation, various Smartphone apps, etc., in attempt to build up my ability to focus on a given task at hand with little success.

Psychological

- Flat affect.
- Persistent depressive mood. My happiness 'set point' is just generally very low.
- Highly prone to neurotic reactions when little things don't go as planned, my 'routine' is interrupted, etc.
- Frequently experience distressing / anxious thoughts.

Physical

- My hair has thinned dramatically since high school (Norwood 2). Hair loss does not run in my family; my 60 year old father has a thicker head of hair than me. I recently started Minoxidil 5%.

Demographic Facts and Lifestyle

- 27 year old caucasian male

- 5'8.5 163 lbs, 15% body fat per recent DEXA Scan (attached)

- Lift weights 4-5 times per week and do cardiovascular exercise 2-3 times per week. Have made some gains from starting point, but stalling out at a relatively beginner level of strength and muscular development, despite effective programming, sufficient calorie intake, and militant consistency.

- Eat 2800 to 2900 calories per day: high protein, high carb, moderate fat. About 165g protein, 65g fat, and 400-425g carb. My maintenance calories are relatively high in relation to my bodyweight. 4-5 Servings of fruit per day, 2-4 servings of vegetables per day, lots of lean chicken and beef, oats, eggs and egg whites, greek yogurt, rice, pasta, and potatoes. High sodium intake (4000-5000mg). Fiber intake between 25-50g per day.

- Drink 72-96 oz of water per day.

- No tobacco or illegal drug use. Very minor alcohol use.

- I do not currently use any sports supplements (did use whey protein and creatine monohydrate in the past) and have never used steroids.

- Work a 7AM-4:30PM white collar job. Relatively low stress, sometimes moderately stressful.
 

Attachments

  • 08:04:2018 Defy Labs.pdf
    645.2 KB · Views: 158
  • 07:2018 Bloodwork.pdf
    73.4 KB · Views: 122
  • Bloodwork 03-2018.pdf
    1.5 MB · Views: 123
  • 02:2018 Bloodwork copy.pdf
    4.7 MB · Views: 122
  • 07.20.2018 DEXA Scan.pdf
    3.4 MB · Views: 128
  • 07.20.2018 RMR.pdf
    1.7 MB · Views: 100
Defy Medical TRT clinic doctor
M

MarkM

Guest
Lots of information there..........it looks like you have something going on with the liver. You AST and ALT are the high end of the range or over on a couple of blood tests as is you A/G ratio (Albumin/Globulin). Have you been dealing with any kind of infection or injury? Have you been a binge alcoholic drinker at times? You probably have a fatty liver but this probably needs to be discussed when you have your consult with Defy.

I'd ask for a complete thyroid panel. Your TSH is moving up and your Free T4 is on the low end. You complete thyroid panel would include: TSH, Free T3, Free T4, Reverse T3, and both thyroid antibodies. A thyroid that is not performing properly can give you many of the symptoms you say you have and are very close to low T symptoms.

Your iron and ferritin look good which is a positive.

Your Total T is on the low end and not optimal under any circumstance and your Free T is also very low. Your E2 Sensitive is low as expected with your low T. SHBG is actually high for your age sitting at 46.7 with an upper range of 55.9. If you get on TRT the SHBG is going to determine what type of protocol you need to be on. With it being high you will likely need one larger injection per week.

Your DHEA is over the range at almost 573. If, when, you begin injecting exogenous testosterone you will be a jump in your E2, which should be okay and help you feel better because your current E2 of 11.5 is too low. It is unlikely that you will need an AI, aromatase inhibitor, in your protocol.

You have chosen medical group, Defy, to assist you in improving your well-being. They are the experts and will guide you verse a simple layman's thought on your blood work. Hopefully I have given you some questions that you will want to cover with Defy in your consult.

Good luck and welcome to the forum.
 
M

MarkM

Guest
LH was 4.1 on range of 1.7 - 8.6 on his most recent lab. No other LH testing and I did not see any FSH testing.
 

Systemlord

Member
Your pituitary gland should be cranking out more LH to increase Free T, showing the pituitary gland to be the weak link. Clomid can work if HPTA is disrupted, but if weak levels will drop right back down to baseline after ceasing Clomid which happens more often than not.
 

Donovan P

New Member
Thanks very much to all of you.

"Lots of information there..........it looks like you have something going on with the liver. You AST and ALT are the high end of the range or over on a couple of blood tests as is you A/G ratio (Albumin/Globulin). Have you been dealing with any kind of infection or injury? No. Have you been a binge alcoholic drinker at times? Yes. Between the ages of 16-21 I drank very heavily. You probably have a fatty liver but this probably needs to be discussed when you have your consult with Defy."

I am going to do additional research into the elevated liver values, and fatty liver specifically. Thank you for the input.

"I probably missed it on your labs but what's your LH and FSH levels at."The labs I've done have not included FSH. LH was 4.1 on the labs taken on 08/04/18.
 
Last edited:

1Draw

Member
Thanks very much to all of you.

"Lots of information there..........it looks like you have something going on with the liver. You AST and ALT are the high end of the range or over on a couple of blood tests as is you A/G ratio (Albumin/Globulin). Have you been dealing with any kind of infection or injury? No. Have you been a binge alcoholic drinker at times? Yes. Between the ages of 16-21 I drank very heavily. You probably have a fatty liver but this probably needs to be discussed when you have your consult with Defy."

I am going to do additional research into the elevated liver values, and fatty liver specifically. Thank you for the input.

"I probably missed it on your labs but what's your LH and FSH levels at."The labs I've done have not included FSH. LH was 4.1 on the labs taken on 08/04/18.


I would get Defy to run full thyroid panel before your consult as MarkM suggested. High Reverse T3 along with low T4 and T3 does cause hepatic cirrhosis. Your symptoms can be caused by low testosterone and hypothyroidism both very similar. My suggestion is the treat the low thyroid first before starting any T therapy.
 

Donovan P

New Member
UPDATE - I had my consult with Dr. Saya this past Tuesday. Wonderful doctor. Very knowledgeable and thorough, but also easy to talk to.

Dr. Saya advised that my liver enzymes do not concern him at this time. Though ALT is technically above the reference range, he said it isn't high enough to really worry. We will monitor and if further elevation occurs, will act at that time. I asked about the possibility of Non-Alcoholic Fatty Liver Disease; he doubted this is at play, given that I am not overweight, eat relatively healthily, and exercise regularly. He did, however, recommend a supplement for liver protection (Metabolic Detox). I ultimately decided not to use this since I was unable to identify sufficient medical evidence demonstrating that the primary ingredient (milk thistle) effectively improves liver health.

He had similar thoughts on the "elevated” BUN and A/G ratio; no concerns at all. I eat a high protein diet, and it is most likely a false positive attributable to that. He actually intimated that a BUN of 25 is not really high at all. Similarly, both A and G, themselves, are within range, it's just the ratio that's slightly high.

Dr. Saya also said he did not suspect that I have any thyroid issues.

Dr. Saya acknowledged that my testosterone levels are very low, and my suspicion that they are the cause of my symptoms is warranted. He noted that SHBG is high for my age, and combined with Total T in the low 300s, causing pitiful Free T of 7.8 pg/mL. He believes my hypogonadism is a mix of primary and secondary. He intimated that he generally has guys in their 20s do a Clomid stimulation before going down the TRT route. However, given where my SHBG is right now, he was extremely doubtful that Clomid would produce a good outcome. For that reason, he gave me the option to go straight on TRT. I accepted.

So my TRT journey begins! I elected to go with injectable testosterone. My starting protocol is:
  • Testosterone Cypionate - 200 mg/ml - .35 ml , IM or SQ, every 3.5 days
  • HCG - 400 IU, SQ, every 3.5 days
  • No AI - monitor E2
I placed my order with Empower Pharmacy, including the recommended syringes and needles, and am waiting to receive my medications.

I am feeling incredibly hopeful, the most hopeful I have felt in a very, very long time. Simultaneously, I'm also trying to temper my expectations, recognizing that T is not a panacea. But when you struggle for a long time, and you're given a reason to be hopeful, it's a feeling unlike anything else!
 

Systemlord

Member
It's likely you won't need an AI do to your low body fat percentage, you aren't expect to convert a lot of your testosterone into estrogen, also SHBG will be binding up some of it as well.

I would give anything to have a little more SHBG, mine's low and estrogen is a problem which probably has more to do with my 33% body fat.
 

Donovan P

New Member
It's likely you won't need an AI do to your low body fat percentage, you aren't expect to convert a lot of your testosterone into estrogen, also SHBG will be binding up some of it as well.

I would give anything to have a little more SHBG, mine's low and estrogen is a problem which probably has more to do with my 33% body fat.

I hope you're right about the AI. I'm optimistic TRT will makes it easier to further improve my body composition as well.

SHBG seems to be a bit of a mystery. Hopefully as more studies are done and doctors obtain more longitudinal, clinical data treating TRT patients we will have more answers.

Donovan, good luck as you begin your TRT journey. Keep us posted.

Thank you Mark! I will.
 
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