Meeting with Defy soon. Any feedback on numbers or questions to ask?

[Moonshot]

I'm meeting with Defy Medical soon, and would love to get feedback on my blood work numbers and any questions you think I should ask during my consult.

I'm 46 and have had issues with fatigue, lowered libido, hair loss, gaining body fat, and recovering from lifting workouts. I first had my testosterone checked by my PCP last January--she only had total T done and it came back 386 ng/dL with a reference range of 348-1197. Her opinion of course was "your testosterone is normal". Doing my own research of course I find out maybe that's normal--for an 80 year old.

I just had new blood work done for my consult with Defy, some highlights:

- Total T: 442, ref. range 348-1197
- Free T: 6.8 pg/mL, ref. range 6.8-21.5
- SHBG: 45.2 nmol/L, ref. range 16.5-55.9
- Glucose: 51 mg/dL, ref. range 65-99

I've attached pics of the full results.

Thoughts?

 

[BigFilly]

Moonshot, your lab values look almost identical to mine when I met with Defy back in January of this year. I had the same symptoms you are having and I'm 36 years old. The only questions I had for them was if hcg is absolutely required. For me, fertility is not a concern as I've had a vasectomy...so the only benefit (at surface level) that I would gain from hcg is that my testicles wouldn't atrophy. Coincidentally, in Louisiana where I live, you can't have hcg shipped via mail, so I may have been in a jam if I had opted to take hcg. Otherwise, they're pretty thorough and cover a great deal of info during your one hour consult.

 

[johndoesmith]

I'm meeting with Defy Medical soon, and would love to get feedback on my blood work numbers and any questions you think I should ask during my consult.

I'm 46 and have had issues with fatigue, lowered libido, hair loss, gaining body fat, and recovering from lifting workouts. I first had my testosterone checked by my PCP last January--she only had total T done and it came back 386 ng/dL with a reference range of 348-1197. Her opinion of course was "your testosterone is normal". Doing my own research of course I find out maybe that's normal--for an 80 year old.

I just had new blood work done for my consult with Defy, some highlights:

- Total T: 442, ref. range 348-1197
- Free T: 6.8 pg/mL, ref. range 6.8-21.5
- SHBG: 45.2 nmol/L, ref. range 16.5-55.9
- Glucose: 51 mg/dL, ref. range 65-99

I've attached pics of the full results.

Thoughts?

High SHBG, low free test and presumably low free E2.

Hypoglycemia for some reason. Do you feel woozy and weak in the morning? That's an awfully low glucose level.

Insulin is a regulator of SHBG. Insulin resistance(high insulin levels) is known to cause low SHBG, so it stands to reason that the opposite would cause high SHBG.

Height, weight, activity level, and diet? My guess is that you're really thin, active, and probably don't eat too many carbs.

 

[Vince]

You definitely need a full thyroid panel, with a TSH of 3.125, you could have a thyroid disorder.

 

[Moonshot]

Hypoglycemia for some reason. Do you feel woozy and weak in the morning? That's an awfully low glucose level.

Thanks for the feedback, johndoesmith. I would not say I feel woozy/weak in the morning most days, maybe once in a while. I'm usually OK in the mornings, it's usually the evenings where I start dozing off, anywhere from 6PM to 10PM--watching a movie or reading at home, but also sometimes when I'm at a work dinner with colleagues or driving. Before anyone points it out, I'm aware of the danger of falling asleep at the wheel, and manage it by either not driving at night, stopping for the night at a motel (if on a long road trip), or pulling over to nap for an hour or two before continuing.

I don't have any trouble sleeping, but I often don't get enough sleep. Function of my work schedule--it varies by project but right now I will generally be up by 5:30am, or 4:30 on workout days, and often stay up until 11pm if I don't collapse before then.

Height, weight, activity level, and diet? My guess is that you're really thin, active, and probably don't eat too many carbs.

I am 6'1" and 215 lbs. now, with some belly fat and love handles. I've been as much as 238 about a year ago, and my college weight was a thin 180--college athlete and pretty active back then but zero weight training. A year ago I started dieting by skipping meals and dropped from 238 to 199, now I'm back up to 215.

I'm not incredibly active now. I lift free weights, mostly compound lifts (squat, bench, press, deadlift), 2-3 times a week. No cardio at all. My Apple devices say I averaged 5,500 daily steps this month.

Diet is high protein, low carb. I travel and eat out a lot for work, so have things like steak, Indian food with minimal rice, eggs or egg sandwiches for breakfast, and one or two 50-60g whey protein shakes per day, and occasionally a whey protein bar. Spinach or other salads about 4 times a week. We order out on Friday nights, and my wife cooks a generally healthy, balanced meal once or twice a week when I'm home (mostly on the weekends).

I'm far from perfect though--I'll sometimes have ice cream or pizza or some other high carb/sugar thing. Alcohol is not a regular thing, there may be an odd work dinner with 1-3 drinks but I probably average less than 1 drink a week overall. About two 16 oz. cups of coffee per day. No sugared sodas or other high calorie beverages, maybe once or twice a week will have a 20 oz. diet soda.

Supplements include creatine, BCAAs, beta alanine, HMB, betaine anhydrous, R-ALA, Vitamin D3, Vitamin C, Turmeric, Fish Oil, and recently I added Zinc and CoQ 10. I use Minoxidil to delay hair loss and was using Propecia (finasteride) for about a year but recently stopped as I realized through my research that it may be contributing to my issues.

 

[Moonshot]

Moonshot, your lab values look almost identical to mine when I met with Defy back in January of this year. I had the same symptoms you are having and I'm 36 years old. The only questions I had for them was if hcg is absolutely required. For me, fertility is not a concern as I've had a vasectomy...so the only benefit (at surface level) that I would gain from hcg is that my testicles wouldn't atrophy. Coincidentally, in Louisiana where I live, you can't have hcg shipped via mail, so I may have been in a jam if I had opted to take hcg. Otherwise, they're pretty thorough and cover a great deal of info during your one hour consult.

Thanks BigFilly. Fertility is not an issue, I have two kids and my wife and I have no plans for more. I don't think testicle atrophy/shrinkage will be an issue either, unless it was extreme.

 

[Moonshot]

You definitely need a full thyroid panel, with a TSH of 3.125, you could have a thyroid disorder.

Why is that value alarming? I'm not familiar at all with this value, but I ask since it seems like it's well within the reference range. Not that I trust reference ranges, just want to educate myself, and figure out if I should order more blood work before meeting with Defy.

 

[FeelingLost]

Why is that value alarming? I'm not familiar at all with this value, but I ask since it seems like it's well within the reference range. Not that I trust reference ranges, just want to educate myself, and figure out if I should order more blood work before meeting with Defy.

When I was researching my blood test results back in December I believe I read the mean TSH in America is 1.5 also many seem to think the old TSH test with the range of 0.45 to 4.5 or was it 5 was out dated. Many felt like PCP's were relying on the TSH test and not looking farther if you fell into that old range even when you were asking about all the symptoms of hypothyroidism.

As I understand it a full thyroid panel for hypothyroidism should at least have these 6 key thyroid lab tests: TSH, Free T4, Free T3, Reverse T3, Thyroid Peroxidase Antibodies, Thyroglobulin Antibodies not to mention a good doc to look over these test results.

hth

 

[Vince]

If your TSH levels are higher than 2.0, it may be a sign of thyroid problems. Even if the doctor says the TSH tests prove that your thyroid function is normal, ask him to run the tests listed above--the ones that actually measure thyroid function, rather than just measuring the amount of thyroid-activating hormone. You want the most accurate measurement of your thyroid function, and the tests listed above will provide the clearest diagnosis possible. https://www.excelmale.com/forum/sho...-Using-TSH-to-Diagnose-Hypothyrodism-is-Wrong

 

[Moonshot]

Thanks, FeelingLost and Vince. I just set up another blood draw for the full Thyroid panel on Thursday. I'll bring it up with Defy next week, and update the thread once I have the blood work results.

 

[Vince Carter]

Why is that value alarming? I'm not familiar at all with this value, but I ask since it seems like it's well within the reference range. Not that I trust reference ranges, just want to educate myself, and figure out if I should order more blood work before meeting with Defy.

It's a sign that you could have Thyroid hormone problem, its indicative that the body thinks it's low and the Pituitary is driving the Thyroid higher as in "make more!". Anything over a 2 as Vince stated needs the full battery of tests to investigate. Just like your Dr said your Test is 386 on a 348 scale...its sure not "good". Lab ranges are something you'll learn are rarely "good".

 

[Moonshot]

I'm reading some articles on it, it seems like there is some debate as to what the right threshold is to worry about. It sounds like some say anything over 2 is bad, others say 4, others say 10. Some say 4 or 10 except if you're a pregnant female, and 2.5 for them. I think the full panel as you guys have recommended will help, to see if those other values come back abnormal. I'll also get another reading on TSH, which apparently may be different since it is not a steady value, but rather goes in "pulses".

It also sounds like the treatment is something I could try out, and stop if it does not improve my symptoms, but it may be hard to isolate if I'm also starting TRT at the same time.

 

[CoastWatcher]

I'm reading some articles on it, it seems like there is some debate as to what the right threshold is to worry about. It sounds like some say anything over 2 is bad, others say 4, others say 10. Some say 4 or 10 except if you're a pregnant female, and 2.5 for them. I think the full panel as you guys have recommended will help, to see if those other values come back abnormal. I'll also get another reading on TSH, which apparently may be different since it is not a steady value, but rather goes in "pulses".

It also sounds like the treatment is something I could try out, and stop if it does not improve my symptoms, but it may be hard to isolate if I'm also starting TRT at the same time.

The medical staff at Defy treats patients with thyroid issues. Make sure it is addressed during your consultation.

 

[Moonshot]

I just got back my Thyroid panel, here are the results:

- TSH: 2.53 uIU/mL, range 0.450 - 4.500
- Thyroxine (T4) Free, Direct, S: 1.18 ng/dL, range 0.82 - 1.77
- Reverse T3, Serum: 13.4 ng/dL, range 9.2 - 24.1
- Thyroglobulin Antibody, <1.0 IU/mL, range 0.0 - 0.9
- Thyroid Peroxidase (TPO) Ab: 13 UI/mL, range 0 - 34
- Triiodothyronine,Free,Serum: 2.7 pg/mL, range 2.0 - 4.4

The TSH seems to have gone down a fair amount, and I don't know what's considered a red flag, but the rest of the Thyroid panel appears to be within reference ranges. Also, my Serum Glucose went up to 89 mg/dL, ref. range 65 - 99, so that low reading of 51 went away with this draw. A year ago at my physical, the glucose value was 86, so 51 is the odd man out.

It may not be relevant to TRT, but since I gathered all the comparable values together from last year, I'll also add that my lipid values improved from January 2016, which may correspond with my weight loss--back at that time I was near my peak weight of about 230-235 lbs., and over the past year I dieted down to 199, then started gaining (hopefully some muscle with my lifting, but definitely some fat), and was around 215 at the time of the newer draw. Value comparisons:

Total Cholesterol: 181 -> 155 (range 100-199)
Triglycerides: 103 -> 38 (range 0-149)
HDL Cholesterol: 49 -> 62 (range > 39)
VLDL Cholesterol Cal: 21 -> 8 (range 5-40)
LDL Cholesterol Calc: 111 -> 85 (range 0-99)
T. Chol/HDL Ratio: 3.7 -> 2.5 (range 0.0-5.0)

My total T went up from 386 to 442 over that timeframe, which perhaps is also related to fat loss, and other dietary improvements--I've been trying to eat more broccoli, cauliflower, steak, and other "T friendly" foods, so perhaps that helped some. The draw last year was also taken earlier in the morning, so the apples to apples difference may be more pronounced.

Any feedback on these new numbers?

 

[johndoesmith]

I just got back my Thyroid panel, here are the results:

- TSH: 2.53 uIU/mL, range 0.450 - 4.500
- Thyroxine (T4) Free, Direct, S: 1.18 ng/dL, range 0.82 - 1.77
- Reverse T3, Serum: 13.4 ng/dL, range 9.2 - 24.1
- Thyroglobulin Antibody, <1.0 IU/mL, range 0.0 - 0.9
- Thyroid Peroxidase (TPO) Ab: 13 UI/mL, range 0 - 34
- Triiodothyronine,Free,Serum: 2.7 pg/mL, range 2.0 - 4.4

The TSH seems to have gone down a fair amount, and I don't know what's considered a red flag, but the rest of the Thyroid panel appears to be within reference ranges. Also, my Serum Glucose went up to 89 mg/dL, ref. range 65 - 99, so that low reading of 51 went away with this draw. A year ago at my physical, the glucose value was 86, so 51 is the odd man out.

It may not be relevant to TRT, but since I gathered all the comparable values together from last year, I'll also add that my lipid values improved from January 2016, which may correspond with my weight loss--back at that time I was near my peak weight of about 230-235 lbs., and over the past year I dieted down to 199, then started gaining (hopefully some muscle with my lifting, but definitely some fat), and was around 215 at the time of the newer draw. Value comparisons:

Total Cholesterol: 181 -> 155 (range 100-199)
Triglycerides: 103 -> 38 (range 0-149)
HDL Cholesterol: 49 -> 62 (range > 39)
VLDL Cholesterol Cal: 21 -> 8 (range 5-40)
LDL Cholesterol Calc: 111 -> 85 (range 0-99)
T. Chol/HDL Ratio: 3.7 -> 2.5 (range 0.0-5.0)

My total T went up from 386 to 442 over that timeframe, which perhaps is also related to fat loss, and other dietary improvements--I've been trying to eat more broccoli, cauliflower, steak, and other "T friendly" foods, so perhaps that helped some. The draw last year was also taken earlier in the morning, so the apples to apples difference may be more pronounced.

Any feedback on these new numbers?

That is one impressive improvement to your lipid panel. Amazing.

What's sad is that your test level only went up by what is generally considered to be normal fluctuation, margin error, and noise. That is not a meaningful increase in testosterone. There is almost no difference.

 

[CoastWatcher]

I just got back my Thyroid panel, here are the results:

- TSH: 2.53 uIU/mL, range 0.450 - 4.500
- Thyroxine (T4) Free, Direct, S: 1.18 ng/dL, range 0.82 - 1.77
- Reverse T3, Serum: 13.4 ng/dL, range 9.2 - 24.1
- Thyroglobulin Antibody, <1.0 IU/mL, range 0.0 - 0.9
- Thyroid Peroxidase (TPO) Ab: 13 UI/mL, range 0 - 34
- Triiodothyronine,Free,Serum: 2.7 pg/mL, range 2.0 - 4.4

The TSH seems to have gone down a fair amount, and I don't know what's considered a red flag, but the rest of the Thyroid panel appears to be within reference ranges. Also, my Serum Glucose went up to 89 mg/dL, ref. range 65 - 99, so that low reading of 51 went away with this draw. A year ago at my physical, the glucose value was 86, so 51 is the odd man out.

It may not be relevant to TRT, but since I gathered all the comparable values together from last year, I'll also add that my lipid values improved from January 2016, which may correspond with my weight loss--back at that time I was near my peak weight of about 230-235 lbs., and over the past year I dieted down to 199, then started gaining (hopefully some muscle with my lifting, but definitely some fat), and was around 215 at the time of the newer draw. Value comparisons:

Total Cholesterol: 181 -> 155 (range 100-199)
Triglycerides: 103 -> 38 (range 0-149)
HDL Cholesterol: 49 -> 62 (range > 39)
VLDL Cholesterol Cal: 21 -> 8 (range 5-40)
LDL Cholesterol Calc: 111 -> 85 (range 0-99)
T. Chol/HDL Ratio: 3.7 -> 2.5 (range 0.0-5.0)

My total T went up from 386 to 442 over that timeframe, which perhaps is also related to fat loss, and other dietary improvements--I've been trying to eat more broccoli, cauliflower, steak, and other "T friendly" foods, so perhaps that helped some. The draw last year was also taken earlier in the morning, so the apples to apples difference may be more pronounced.

Any feedback on these new numbers?

As johndoesmith noted, your testosterone essentially didn't move much...actually, at all. How do you feel?

 

[Moonshot]

Just wanted to say thanks to everyone who provided feedback. Based on my test results and symptoms, Defy recommended TRT and I had my first injections last night. I was put on Test Cypionate (70mg twice a week), HCG, and Anastrozole (Arimidex).

The additional thyroid panel I had in advance of the consult paid off as well, the doctor told me he would have asked me to do that, but based on the results of the additional panel he prescribed me Thyroid meds (Nature-Throid). He also said my DHEA was low and gave me a DHEA prescription.