Lab Review

[Coopsdaddy]

January 2018 to present,I decided to stsrt a new post because i couldnt get the uploading files figured out,so here goes.
42years old
6ft
165
Take
Multi
22mg zinc
400mg mag
2000mg Omega 3
B complex
1000mg Vc
5-10000 Vd3
600mg Alpha lipoic acid
800mg Ashwagandha
Lugols iodine 12.5 mg
2ea brazel nuts

I have been struggling for years but the last few years my fatigue,mood,energy is very bad.Cant gain any muscle without a bunch of excess belly fat.I have 3 kids,busy schedule,some neuropathy in hands and feet from some cervical spine issues and that really affect my sleep,but we are not to the point for a disc replacement or fusion yet.I workout 4-5 days per week and my nutrition is great in my opinion,i dont eat fast food,pop,suger,and only have a beer on special occasions.I say around (25-40 %carbs)(25-30%protein)(25-30%fat)depending on if i workout that day.Just got on trt at 100 mg per week but 6 week labs were high per doc so he wanted me to change to every ten days or 50 mg every 5 days(bassically 10mg per day).I have actually been doing 80mg(20ml)every 3.5 days.
My sex drive is good,never had erection problems and still dont but most of the time im to dam tired.I have a appt at the oncologist because they want to see about my rbc/wbc count.I also have a fallow up appt at the endocrinologist next month,I really want to see if its a thyroid issue.I havent had a sleep study but i dont snore or have sleep apnea
I going to request my thyroid,testosterone,psa,shbg,vit d,zinc,mag and what ever else is recommended
Lab work:
wbc 4.5 Range:4.3-11.0 Date:6.26.2018
rbc 4.13 Range:4.44-5.67 Date:6.26.2018
Hemoglobin 14.3 Range:13.4-17.4
Hematocrit: 47.1 Range: 40.2 - 50.8 Date: 06.26.2018
Hematocrit: 42.6 Range: 40.2 - 50.8 Date: 05.24.2018
Cholesterol: 144 Range: 100 - 200 Date: 05.24.2018
Triglyceride: 32 Range: 30 - 150 Date: 05.24.2018
Non-HDL Cholesterol: 67 Range: n/a Date: 05.24.2018
Cholesterol/HDL Ratio: 1.87 Range: 0.0 - 4.97 Date: 05.24.2018
LDL Cholesterol: 61 Range: 0 - 130 Date: 05.24.2018
HDL Cholesterol: 77 Range: 40 - 125 Date: 05.24.2018
Glucose:97 Range:70-100 Date:5.24.2018
Thyroid T4 Free: 0.78 Range: 0.70 - 1.48 Date: 06.08.2018
T3 Free: 1.83 Range: 1.71 - 3.71 Date: 06.08.2018
TSH: 1.495 Range: 0.350 - 4.940 Date: 06.08.2018
T3 Reverse: 15.8 Range: 9.0 - 27.0 Date: 06.08.2018
Thryo Auto AB: 0.03 Range: 0.00 - 0.50 Date: 06.08.2018
Thryo Perx AB: 57.86 Range: 0.00 - 100.00 Date: 06.08.2018
Testos Tot Male: 989.0 Range: 300.0 - 890.0 Date: 06.08.2018
Testos Free: 150.0 Range: 47.0 - 244 Date: 06.08.2018
Testos Total: 1291 Range: 240.24 - 870.68 Date: 06.08.2018
Bio T Calc: 647.54 Range: 100.0 - 400.0 Date: 06.08.2018
SHBG: 45.6 Range: 11.2 - 78.1 Date: 06.08.2018
Estradiol: 17 Range: 11 - 44 Date: 06.08.2018
DHEA Sulphate: 227 Range: 140 - 484 Date: 06.08.2018
Cortisol AM: 10.4 Range: 3.7 - 19.4 Date: 06.08.2018
Testos Total: 198 Range: 241 - 827 Date: 04.10.2018
Testos Total: 129 Range: 241 - 827 Date: 04.06.2018
PSA: 0.41 Range: 0.00 - 4.00 Date: 05.24.2018
PSA: 0.26 Range: 0.00 - 4.00 Date: 04.10.2018
Ferritin:156 range:25-300 Date:1.20.2018
Iron:128 Range:40-180 Date:1.20.2018

 

[MarkM]

Coopsdaddy,

You may wish to remove the file, black out your name and birth date, and then re-post.

 

[MarkM]

Lots of information in these labs and it is possible I will miss something with all that data.

The low WBC and RBC jumps right out at you. Are you taking an anti-inflammatory by chance? Your hemoglobin and hematocrit looks good but could start inching up on you after you have been on TRT for a while.

Your lipid panel looks really good. LDL and triglycerides look outstanding and super HDL. Do you take any statins?

Glucose at 99 is okay but you really want that down in the low 80"s. I didn't see an A1C measurement.

Test levels look good. Total T is over the range but not terrible and Free T is mid range if I recall and has lots of room to go up. I would be more concerned about increasing the Free T a little bit more to the upper end of normal and not worry so much about the Total T being high. Most of it is inactive and it is the Free T that makes things happen for you.

SHBG looks good in the mid range. Injections twice a week, every 3.5 days should work nicely for you. You could probably go every 3 days or EOD if you wanted but every 3.5 days works for a lot of people, myself included.

Estradiol at 17 pg/ml. DO you know if that is the Sensitive assay, LC/MS/MS? I could not tell by reviewing the labs or maybe I just missed it. If it is the Roche ECLIA test it is the wrong one. If it is the sensitive test you don't want that estradiol going any lower. Would be best to push it up to 25 to 30 pg/ml unless you feel good with it being that low. It's how you feel that most important verse a number.

Cortisol AM looks low t 10.4 but that really depends on the actual time of day the blood was drawn and as I understand it the only way to truly measure cortisol is with a saliva test. But it still looks low.

I think the reason you may be struggling with fatigue, mood, and energy is it doesn't seem like your thyroid is performing well. Free T3 and Free T4 are low, especially Free T3. Your TPO anti-bodies are high and your Reverse T3, while the number itself is not terribly high at 15.8, your Free T3:Reverse T3 ratio is sitting at 13.9 and it should be greater than 20.

So, you have something going on with the WBC and RBC so having that looked at is a good thing. I see you already have an appointment with the oncologist. A poorly performing thyroid can make you feel like you are feeling. I bet if you address the thyroid you will feel like a new person. Be patient, correcting an under performing thyroid can be difficult without a knowledgeable and well-versed thyroid specialist.

These are things you probably already know and I am sure I haven't noted anything new for you. I am surely no expert but sometimes its nice to have another layman offer what they can see.

 

[Deleted member 16042]

Just got on trt at 100 mg per week but 6 week labs were high per doc so he wanted me to change to every ten days or 50 mg every 5 days(bassically 10mg per day).

I have actually been doing 80mg(20ml)every 3.5 days.

This is confusing.

-Are you on injections?

-If so, of what substance at what concentration... most commonly in the US is T cyp 200mg per ml. 20ml would be 4000 mg.

-So, how do you come up with 20ml = 80mg?

80 mg E 3.5 =160/week. That is not 100/week.

If you are on 100/week but have been actually taking 160, you might try actually using 100

Your SHBG looks high enough to do OK on E 3.5 frequency.

Thyroid is a bit puzzling to me. Your free T3 and T4 are low, and RT3 too high but your TSH is not calling for your thyroid to make more accordingly. Looks like you need to sort this out.

 

[Coopsdaddy]

Estrodol was not sensitive even though i ask for that,no statins ever.
My script is for this once per week but i split to every 3.5 days.
test cyp 200mg/ml
100mg per week (0.5ml)
This is what I started with (0.25ml) every 3.5 days equals 100mg/0.5ml total for the week.
I tested high and they wanted to lower dose,now i am doing this.
(0.20ml)every 3.5 days equals 80 mg/0.4ml total for the week.

 

[Deleted member 16042]

Great, thanks. Probably better to just relate dosage in mg and leave ml out of it. Your initial post stated 20ml, not 0.2ml

So, IMO, reducing to 80mg/week is a significant drop of 20%. You may be fine, but might also experience some troublesome symptoms from the reduction.

I have been dropping dosage for months and am down to 84mg/week. The last drop from 96mg/ week which is 12.5% reduction has been very unpleasant.

Good luck!

 

[Coopsdaddy]

Like trt is there a good starting protocal for thyroid,meds and dosage to start with?I am just trying to educate myself before my next endo app in 3 weeks.I am going to have labs done for my testosterone,what other labs should i ask for considering my last thyroid labs were in early june?

 

[Coopsdaddy]

Going to doctor fri(oncologist and endocrinologist)
What labs would you recommend for me to get rechecked?

 

[Coopsdaddy]

Got some labs last week but they wouldnt order all the labs,im going to talk to them friday and ask why,possably look for another doc if they dont listen.I did get a few labs to review,tsh went up quite a bit,reason?
Hows the free t look?
Tsh 3.173 (0.350-4.940)
Total test 865 (300-890)in trough
Free test 115 (47-244)
Hematocrit 42(40.2-50.8)

 

[MarkM]

Free Test is low at 115 considering the middle of the range is 145.5. You want to be in the upper end of normal, say close to the 218 mark or even higher. Is your SHBG high?

TSH looks too high. You might want to consider a complete thyroid panel; TSH, Free T3, Free T4, reverse T3, and the two antibodies.

 

[Systemlord]

Thyroid hormones aren't static and they do fluctuate a little, however if they fluctuate too much you will have symptoms. Thyroid problems are intermittent, one test could look alright and the next test could catch the thyroid acting up. These tests are a moment frozen in time of a target that is constantly on the move, like one freeze frame in a movie several hours long.

I've never seen a large fluctuation in my TSH, , plus or minus .3 points. Large fluctuations isn't good, so being in ranges doesn't automatically mean you're fine and dandy.

 

[Coopsdaddy]

Tsh changed quite a bit form last test,just wandering why so much,only change on my end is started lugols iodine and 2 brazel nuts daily.
My shbg was 45 last time but not checked this time.Is larger dose test the only way to get free test up?I guarantee they wont up dose sense im at the upper lever of there so called range.

 

[MarkM]

If you are using LabCorp the range for SHBG is 19.3 - 76.4 nmol/l. The dead center of the range is 47.85 and if you are 45 then you are right there in the middle. So it's not high. You'll probably do best with a injection protocol of E3.5D. You might need to increase your dose a small amount to push the Free up a little.

Remind me of your dose......didn't you recently drop your dose considerably? If so might have dropped it too much. Your hematocrit looks real good so you have room from that point of view. If I recall the estradiol was on the low side, and if so, you have room for that to inch some too.

TSH is high enough that your body is telling it to produce more thyroid hormones. You might still want to consider a complete thyroid panel; TSH, Free T3, Free T4, reverse T3, and the two antibodies. If you are having a thyroid not perform well it can give you low T symptoms and create havoc on your body. Have you checked your iron and ferritin levels? If they are low they can also impact your thyroid functioning.

 

[Coopsdaddy]

Shbg range is 11-78
Iron 112 (40-180)
saturation 32 (15-50)
Ferritin 70 (30-356
I did lower from 100mg 80 mg every week,i do split it every 3.5 days.My level was 989 in the trough and endocrinologist wanted me to lower it,once again just going off the lab ranges.
I will request another full thyroid panel or buy one out of pocket

 

[MarkM]

While iron and ferritin could be higher they are not terrible. Ferritin needs to be at a minimum of 80 for the thyroid to work like it is designed so I would try to push it up over 100. Iron, may the 150 range. It is a pretty inexpensive supplement.