Help with blood test results and erectile dysfunction

[TestBoosted]

If continuous glucose monitors are available over-the-counter where you live, you should wear one for some time. If they aren't available OTC, see if your doctor will prescribe one for you. The minute to minute biofeedback on your glucose levels is invaluable for someone seeking to improve their metabolic health. You will find yourself naturally making impactful dietary modifications, simply because you will not enjoy seeing your blood sugar spike to levels that are damaging to your arteries and organs.

Even as a carnivore, I was able to make improvements to optimize my diet via the use of CGM (I had been eating too much protein and making extra sugar via gluconeogenesis, resolved by decreasing protein/fat ratio). I cannot emphasize enough how useful CGMs are for troubleshooting diet.

Thank you so much friend. I will look into your suggestion of continuous blood glucose monitors.

You have really given me a lot of valuable information. The more I am reading about the link between high estrogen, high triglycerides, low HDL and low SHBG, the more I believe I have insulin resistance, which may be contributing to my ED. It is finally all making sense now.

It's a pity that I didn't learn about it years ago, hopefully most of the damage is reversible. Thank you for giving me all these useful pointers.

 

[TestBoosted]

I think you are focused too narrowly on the particulars of your protocol and need to investigate the root cause of your excessive aromatization. Your HDL and triglycerides are abysmal and suggest serious metabolic dysfunction. Insulin strongly promotes the expression of aromatase enzyme. Excess body fat also produces more aromatase.

I am less interested in your TRT protocol and more interested in everything else. What are you eating, how are you sleeping, what do you do for exercise, and what does your percent body fat look like? Alcohol or cannabis consumption? Something is broken here.

Hi friend,

As previously stated, I tested for my SHBG level and it came to 16.3 pmol\L which is on the low side.

I took your advice and also tested for insulin resistance. And you were correct in that I am insulin resistant. Please see the blood test results attached.

My course of action is the below:

High triglycerides and low HDL
------------------------------------------

i) Started taking Omega 3 with EHA and DPA, 2000mg twice daily.

ii) Will speak to a clinical dietician to help me make better food choices for my ailments and to lose a few pounds.

iii) Will start doing more aerobic exercise, preferably 150 minutes per week.

iv) Will speak with a cardiologist to see if I should change my current treatment for cholesterol (Atorvastation 20mg every day). Maybe I can be given a medication that controls triglycerides as well (e.g. fibrates).

Obviously I will only resort to medication if I need it, will try to control it via diet and exercise first.


Insulin resistance
---------------------------

i) Started taking Berberine, 500mg twice daily.

ii) Will talk to endocrinologist to see if I need some medication (e.g. metformin) if I can't control the insulin resistance via diet and exercise alone.

----------------------------------------------------------------------------

I will try to control the cholesterol and insulin resistance via diet and exercise alone, so the first person I am going to speak to is the dietician. After around 4 months, I will retest my hormones, insulin resistance and cholesterol to see if there was any improvement. Only then will I think of adding medications, however in the meantime I will be taking Omega 3 and Berberine supplements.

Do you think that my course of action is sound or would you do something differently please?

Last but not least, I would like to thank you and all the other persons who replied from the bottom of my heart. You have given me invaluable information about my health. You have explained it in clear terms and thanks to you I am finally able to start connecting the dots about my ED and my current state of health. With this information, I am now able to work on my health and improve it. There aren't enough words to thank you for this.

 

[Guided_by_Voices]

Hi friend,

As previously stated, I tested for my SHBG level and it came to 16.3 pmol\L which is on the low side.

I took your advice and also tested for insulin resistance. And you were correct in that I am insulin resistant. Please see the blood test results attached.

My course of action is the below:

High triglycerides and low HDL
------------------------------------------

i) Started taking Omega 3 with EHA and DPA, 2000mg twice daily.

ii) Will speak to a clinical dietician to help me make better food choices for my ailments and to lose a few pounds.

iii) Will start doing more aerobic exercise, preferably 150 minutes per week.

iv) Will speak with a cardiologist to see if I should change my current treatment for cholesterol (Atorvastation 20mg every day). Maybe I can be given a medication that controls triglycerides as well (e.g. fibrates).

Obviously I will only resort to medication if I need it, will try to control it via diet and exercise first.


Insulin resistance
---------------------------

i) Started taking Berberine, 500mg twice daily.

ii) Will talk to endocrinologist to see if I need some medication (e.g. metformin) if I can't control the insulin resistance via diet and exercise alone.

----------------------------------------------------------------------------

I will try to control the cholesterol and insulin resistance via diet and exercise alone, so the first person I am going to speak to is the dietician. After around 4 months, I will retest my hormones, insulin resistance and cholesterol to see if there was any improvement. Only then will I think of adding medications, however in the meantime I will be taking Omega 3 and Berberine supplements.

Do you think that my course of action is sound or would you do something differently please?

Last but not least, I would like to thank you and all the other persons who replied from the bottom of my heart. You have given me invaluable information about my health. You have explained it in clear terms and thanks to you I am finally able to start connecting the dots about my ED and my current state of health. With this information, I am now able to work on my health and improve it. There aren't enough words to thank you for this.

Several things:

- Time Restricted Eating is essential no matter what. Specifically, start by eating within an 8 hour time window so that your are only drinking water for 16 hours per day. Part of insulin resistance appears to be that cells are over-stimulated by constant exposure to insulin, so you want give them a long period each day where your body does not secrete insulin. Never use artificial sweeteners either. Longer fasts can ehlp as well.
- Eliminate all seed oils from your diet
- I agree that eliminating blood sugar spikes is key as well, and that means staying fairly low-carb to start with
- I would time your meals around activity and take a short walk (5-10 minutes) before and after every meal. This has been shown to lower blood sugar as much as metformin.
- Part of insulin sensitivity is having someplace for blood sugar to go, and having more muscle mass is good for that, so I suggest strength training, probably even more so than "cardio". Eating right after a workout will promote insulin sensitivity in general, and specifically via something called NIMGU (Non-Insulin Mediated Glucose Uptake)
- In my opinion, most people who try metformin start with too high of a dose. If you try it, I would start with 250mg before your higher carb/protein meals and see how you do.
- Chromium Picolinate is a worthwhile supplement, as well as vitamin D/K2, and magnesium to start with.
-Statins are known to increase insulin resistance so you may want to research that. I suggest the book The Clot Thickens by Dr. Malcolm Kendrick to get fluent in all things heart health. But statins could be a big part of your problem. At least stopping them for a while to see if you improve seems worth investigating.

Regarding nutritionists and cardiologists, in the US most of them are likely to make you worse. Everything I wrote above is either counter to or missing from mainstream nutritional advice. Things may be different where you are, but consider starting with the basics above and then see where your Fasting Insulin is, which is the key metric in my opinion.

 

[FunkOdyssey]

Great suggestions from Guided above. The Clot Thickens is a must read. Chromium can be effective, but can also cause major insomnia in some; watch for that. Time restricted eating, definitely.

Things may be different where you are, but consider starting with the basics above and then see where your Fasting Insulin is, which is the key metric in my opinion.

Absolutely agree. He actually provided a fasting insulin level in his most recent lab results above, and it was just as terrible as you would expect given the triglycerides and HDL: 15.4 mIU/L.

This is why you can't go by fasting glucose and HbA1c alone (these didn't look too bad on his first labs). On the long road to diabetes, the body is able to compensate for rising insulin resistance and keep blood sugar relatively normal, by producing more and more insulin, until its capacity is eventually exhausted. If you want to find out how hard your body is working in the background to deal with the insulin resistance, you check fasting insulin.

Regarding nutritionists and cardiologists, in the US most of them are likely to make you worse. Everything I wrote above is either counter to or missing from mainstream nutritional advice.

Yes. It pays to educate yourself on metabolic health and the influence of diet, because good guidance from professionals is very hard to come by. There is more than one way to skin the cat of improving insulin sensitivity with diet, but as a general rule of thumb, you cannot go wrong by reducing carbohydrate consumption. Start with the worst offenders (sugar sweetened beverages, processed foods, refined carbohydrates of any kind). Get your hands on a CGM, and survey the damage minute-by-minute as you eat through a typical day. The data you glean this way will be more useful than any generic advice a provider can give you.

You may follow this path, of replacing carbohydrates with protein and fat, to its logical conclusion, and join me in the keto / carnivore club with a fasting insulin around 2-3 mIU/L. Or, you might stop in a more moderate place that still substantially improves your situation. You'll be in much better shape than you are now either way.

If you are still convinced you want to reduce your LDL cholesterol after reading The Clot Thickens, but you want to minimize the damage to your metabolic health, ask your cardiologist about swapping the statin out for a PCSK9 inhibitor like repatha.

Congrats on attacking the root cause of your problem here and not trying to paper over it with anastrozole or similar. Your rate of aromatization and symptomatic benefits from TRT should significantly improve as your insulin levels come down.