Looking for opinions, feedback and sugestions on recent blood work

[T4 Life]

Hello everyone and thanks to all of you that support and have made this site possible.

History: 3 years ago I was started on androgel by my GP because of a total T of 228 things got better like I always tend to read happens but the the drop came so I asked (almost had to beg) for an estradiol ultra sensitive test and it came back at 50 so I thought that may be the cause of the drop in the way I was feeling by this time I had already switched to T cyp shots which I was surprised to get from my family GP (I didn't think he would let me do at home shots)because the gel only got me up to 457 total T and that was on 6 pumps of 1.62% daily which became a real pain to do everyday, he also had me on levothyroxine .25mcg then armour up to 60 mg which got my TSH down to 3.63 from 5.27 that was short lived (several months) and I really didn't feel any better or notice any improvement anyway when I asked for arimidex he refused and discharged me as he stated he would not prescribe medication to treat cancer to me. However he did give me a referral to an Endo. As of August 2013 I've been getting my T cyp and anastrozole scripts from him, no hcg I haven't asked yet but I'm contemplating because of the obvious atrophy and I believe something is missing hormonal as well. He took me off armour and prefers synthroid and will not prescribe armour he had me on 50 mcg synthroid for two months and I discontinued to take it because all I felt was a constant rapid heartbeat ,anxiety and nervous, he said I need to be on it for six months at least for it to work I disagree and asked for the armour back he won't do it. I prefer the more natural approach in everything so I started taking nascent iodine started at 2 drops then to four for the last 2 months hoping it would bring my TSH down and my Free T4 up but it didn't happen it went down from 6.69 to 6.60. With that said I'm now at a loss and don't really know how to proceed my endo says that total T at 646 last blood test is perfect I disagree (I prefer to go by how I feel and he prefers to dictate by the test results)He diagnosed me as being Hypogonadal (didn't say primary or secondary) My protocol for the past several months has been:

T cyp 100mg sub Q every 5 days
Anastrozole .50mg sporadically because I've crashed before (very hard for me to dial in even at .25 mgs) if I stay steady on it so I try to take only when I feel overly sensitive and emotional or I just can't get hard enough which is where I am usually and about now. A part of me says up my dose but then I fear more conversion might take place and my endo might freak out (I suspect) he doesn't like it when I ask for estradiol ultra testing so that makes it harder to dial in.

Methyl B-12 1000 mcg 1xday going to 2000 mcg as recommended I reduced my dose because I thought it was the cause of my shoulder and back acne. (I stopped drinking apple cider vinegar at 1 tbs a day and I see an improvement)

Vit B6 100mg 1xday
Selenium 200mcg 1xday
L-Methylfolate 7.5 mg 1xday
Nascent iodine 6 drops 1xday
Coconut oil 1 tbs 1xday in oatmeal

I was also diagnosed with MTHFR Compound Heterozygous C677T and A1298C in September 2014

I've been trying (my goal) to get to 800 Total T and E2 between 20 and 30 as recommended (life extension) but I have my doubts because I'm almost there and I'm not as hard as I need to be when the time comes that's my main problem as well as muscle weakness (that's another story) I'm concerned about my thyroid and don't know how to proceed(no antibodies for hashimotos, already tested no nodules or goiter)so should I get back on synthroid there has to be a better way. My RDW has been on the rise (anisocytosis) but my MCV is always within range I found that it may be due to B-12 and B-9 deficiency which I'm already taking. I'm going to ask my endo for a Methylmalonic Acid urine test and another for a Pernicious Anemia panel and see how that goes I have an appointment coming up in April.

I'm sorry this got so long It kind of got outta hand I was trying to keep it short.

Thank you for taking the time to read this and I look forward to reading your responses,

Louie



COMMENTS: FASTING:YES Male Age: 50, 5'10, 190 lbs
Test Name In Range Out Of Range Reference Range Lab
COMPREHENSIVE METABOLIC TP
PANEL
GLUCOSE 100 H 65-99 mg/dL
Fasting reference interval
UREA NITROGEN (BUN) 14 7-25 mg/dL
CREATININE 1.07 0.70-1.33 mg/dL
For patients >49 years of age, the reference limit
for Creatinine is approximately 13% higher for people
identified as African-American.
eGFR NON-AFR. AMERICAN 81 > OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN 93 > OR = 60 mL/min/1.73m2
BUN/CREATININE RATIO NOT APPLICABLE 6-22 (calc)
SODIUM 141 135-146 mmol/L
POTASSIUM 4.7 3.5-5.3 mmol/L
CHLORIDE 104 98-110 mmol/L
CARBON DIOXIDE 25 19-30 mmol/L
CALCIUM 9.5 8.6-10.3 mg/dL
PROTEIN, TOTAL 7.3 6.1-8.1 g/dL
ALBUMIN 5.1 3.6-5.1 g/dL
GLOBULIN 2.2 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 2.3 1.0-2.5 (calc)
BILIRUBIN, TOTAL 1.3 H 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 42 40-115 U/L
AST 27 10-35 U/L
ALT 28 9-46 U/L
TSH 6.60 H 0.40-4.50 mIU/L TP
T4, FREE 0.9 0.8-1.8 ng/dL TP
CBC (INCLUDES DIFF/PLT) TP
WHITE BLOOD CELL COUNT 5.4 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.78 4.20-5.80 Million/uL
HEMOGLOBIN 17.0 13.2-17.1 g/dL
HEMATOCRIT 52.1 H 38.5-50.0 %
MCV 90.2 80.0-100.0 fL
MCH 29.4 27.0-33.0 pg
MCHC 32.6 32.0-36.0 g/dL
RDW 17.1 H 11.0-15.0 %
PLATELET COUNT 246 140-400 Thousand/uL
ABSOLUTE NEUTROPHILS 3569 1500-7800 cells/uL
ABSOLUTE LYMPHOCYTES 1258 850-3900 cells/uL
ABSOLUTE MONOCYTES 437 200-950 cells/uL
ABSOLUTE EOSINOPHILS 113 15-500 cells/uL
ABSOLUTE BASOPHILS 22 0-200 cells/uL
NEUTROPHILS 66.1 %
LYMPHOCYTES 23.3 %
MONOCYTES 8.1 %
EOSINOPHILS 2.1 %
BASOPHILS 0.4 %


TESTOSTERONE, TOTAL,723 250-827 ng/dL


PSA, TOTAL 1.4 < OR = 4.0 ng/mL TP


TESTOSTERONE, FREE, LC/MS/MS 85.5 46.0-224.0 pg/mL


ESTRADIOL, ULTRASENSITIVE LC/MS/MS 18 < OR = 29 pg/mL

 

[Nelson Vergel]

You know already you need to go back to armour for your thyroid. Chris will probably add more to this discussion about thyroid.

Your total testosterone and estradiol are good. So are your liver and kidney function. Your free testosterone is under 2 % of total, so you may have high sex hormone binding globulin. It would be interesting to see what happens to SHBG once you get on optimized thyroid replacement. I bet it will go down which will free up some more testosterone.

 

[Vettester Chris]

Yeah, there's a variety of angles we need to explore on your thyroid. For starters, the 60mg is at one grain, and it might need to have been titrated to get T4 and T3 serum levels at a good level where you were seeing benefits. Right now your FT4 is at 10% of reference range, but no FT3 or Reverse T3. I can't imagine your FT3 is going to look too much better, but would like to see it.

Some other factors would have been making sure there is sufficient selenium and iodine in your supplement regiment, as well as ensuring there are no complications with cortisol, iron, ferritin, D3, and some of the electrolytes that help keep thyroid hormone converting and getting into the cells effectively. Just looked back up and see you have selenium on the list, and B12 is definitely a winner as well. On a side note with B12, I find methylcobalamin to be the best choice when choosing between cynacobalamin, similar to my preference on NDT to the synthetic T4 only treatments for thyroid.

Good to know on the MTHFR discovery. Keep an eye on your iron, and possible copper elevation that can effect ferritin levels to decrease. It would be good to see your current iron serum, TIBC, ferritin & magneisum, along with the thyroid labs: FT3, FT4, Reverse T3, and another TSH at the time of these labs. The MTHFR defect can also cause other imbalances, inflammation and other complications that can promote undesired stress. Knowing MTHFR is evident, would probably be good to know how your adrenals are functioning (?) ...

 

[T4 Life]

Nelson,

Thank you for your input. I remember reading that SHBG does increase with age, like you said maybe if I get my thyroid properly treated my free T will go up and things will get better. My endo wants me on Synthroid he said if I get treated anywhere else for thyroid that he will no longer be able to treat me so I feel like I'm half way out the door already.

 

[T4 Life]

Chris,

Thank you for your response. I guess I was placing to much emphasis on my RDW which has been steadily rising from 13.4 in 2010 to 17.1 in 2015 can this have any effect on they way my body is responding to TRT? from what I read it is not normal to have a variation of large and small red blood cells. (Anisocytosis) A possibility is that if the RDW level is increased and the MCV level is normal this can be caused by the beginning stages of a decrease in vitamin B-12 or folic acid in the body it can also be caused by the beginning stages of iron deficiency anemia. So I thought I was on the right track. What is your opinion besides the testing your already recommended should I ask for testing for Vit B-12 and folic acid (B-9) as well and go from there? By the way what level of Thyroid hormones should I be aiming for? rignt now my TSH is 6.60 and Free T4 is at 0.9

 

[Vettester Chris]

T4, IMO if you're running labs, then yes, throw in the B12 and folic acid if it's not a huge deal. Being that you're supplementing the "B" vitamins, I would suspect them to be elevated. At this point, I'd really be more curious how your iron, ferritin & the other labs are looking.

On the thyroid levels ... In "most" cases, it's good to aim for a 50% to 80% of the reference range on BOTH Free T4 and Free T3 (both relatively close together .. e.g., FT4 might be at 62%, FT3 at 58%), but I can't stress enough about Reverse T3 and making sure that it's in a 20:1 or even 25:1 ratio with Free T3.

If areas like cortisol or the iron subject are not in balance, FT3 will tend to pool; meaning it builds up and doesn't get in the body. T4 will increase the conversion of RT3 to keep this in check until the problem(s) get resolved.

On TSH, if everything is in order, Dr. Bruce Rind has noted that the optimal range is 1.3 to 1.8. If you're on a decent NDT regiment, and everything is functioning "correctly", I have seen plenty of other guys that have TSH anywhere from 0.5 to 1.8. Just depends on your protocol and what "zone" is optimal. You want to feel good, but not to the point where "hyper" like symptoms are evident.

 

[T4 Life]

I'm not familiar with cortisol testing what test should I be seeking serum/urine?

 

[Vettester Chris]

I'm not familiar with cortisol testing what test should I be seeking serum/urine?

Saliva 4x Cortisol w/DHEA Correlation.

 

[T4 Life]

I looked for it at Quest I came close with this below but no W/DHEA Correlation would you happen to know if they do this test.

I just can't find it ?Cortisol, LC/MS/MS, Saliva, 4 Samples[h=4]Test Code[/b]18921

 

[Vettester Chris]

Refer to the ZRT link, the top diurnal lab is what you need https://store.zrtlab.com/cortisol-tests

 

[Nelson Vergel]

Labcorp does not include DHEA in cortisol saliva testing.

Like Chris said, ZRT does. So does Genova.

This is how it works

Are you tired even with normal testosterone? Adrenal fatigue may be the problem.