NEED HELP....Who is right???? Horrible Labs

[Bigsteve0824]

OK, I’ve decided to just forget about doctors and clinics for a bit and try the real experts on this forum and see what my real issues are. First, a little about myself, I’m a 61 year old male, never really been sick with anything. About 3 years ago I developed ED and of course my doctor prescribed the magic pills. They worked for a bit but then progressively not much at all except headaches. About the same time I started getting tired and just feeling crummy, my doctor did blood work and said all was good. I asked about my testosterone level and he said he hadn’t tested it, so I asked him to test it and he did. Likewise he said “looks good for a guy your age”! Well the clincher in the comment was the part that said “your age”. Which meant 297 was ok with him as far as a testosterone reading. I took his word for it and drug along for another 2 months till I heard a commercial on the radio about symptoms of low T and so on. I called the clinic, made an appointment, they did their own blood analysis and sad “Wow your doctor doesn’t have a clue”. Now before you ask for other blood numbers from back then, I’m sorry I wasn’t smart enough about it to ask and just went with what they told me which seemed fair since they said my T level reading was a mere 278. I started on their TRT program 2 days later with a once per week injection of 125mg of Testosterone Cypionate. I felt better within 3 weeks, at 4 weeks they did more blood work and I was almost 600, but they wanted me at 800 or more. Again, I didn’t ask a lot of questions just thought, Wow if I’m feeling better now how good am I going to feel at twice the dosage 250mg which is what they put me on per week with one shot. Well, the answer was, I felt amazing and week after week I felt better. I hit a little hiccup at the 14-month mark and my nipples got sore and ankles had some swelling so they increased my anastrozole 1mg to 3 pills per week, 1 every other day and reduced my T dose to 200mg still once per week, that was after blood work came back with a level of 1100 plus. It was fine for about 4 months then started regressing. Extremely tired, fatigued, short of breath, constantly sick with something, just horrible. I talked to my family practitioner; of course he is not a big fan of testosterone treatment anyway and said he feels the treatment has my blood counts all messed up. However, the physician’s assistant at the clinic insisted on the Ferritin level to be added to my most recent labs and as you can see it showed a mere 7 and she immediately went into a tirade of me needing an iron infusion and immediately. Of course she couldn’t order one and in the 2 plus years I’ve been going there I’ve never once seen a doctor let alone the doctor whose name is on every order and every insurance EOB. Some of you are probably thinking, are you serious? This is a large functioning facility, literally 4 locations I know of, and thousands of patients. Their reviews are good for the most part, and if not it’s usually about the staff not the program. The staff itself is another issue, it’s several young ladies who all seem to think they are doctors and my office visits consist of the following. Walk in, take me right back to exam room put oxygen sensor and pulse sensor on my finger, sometimes take blood pressure (about 50% of the time), say how you feeling? If I say good, they say left cheek or right cheek today, I drop my pants a bit, they inject,and I leave. Total time in exam room less than 3 minutes. If I say I feel bad, they ask how I feel and I tell them, then they add or subtract an anastrozole and say let’s see how that does. Well along with feeling horrible now and no one seeming to know why or care why I very seldom ejaculate anymore plus my ED is worse than ever. But right now I just need someone to look at my blood work who knows the program and help me understand what’s going on. My family doctor reluctantly ordered the iron infusion once he seen the Ferritin level but insists there is more to it meaning with the TRT program, and after 2 of 3 infusions I still feel horrible, and show no improvement. So take a look at my blood work comment without being too critical of me being dumb, I generally just trust people but I’m really starting to feel like a person they are just practicing on. So help me out.The last straw was how bad I feel and the TRT Clinic says the low Ferritin is the cause of it and they also say the low level has nothing to do with the TRT Program but I read in several forums low Ferritin can defineately go with a bad managed TRT Program.

Reading Range Result
Cholesterol, Total 200 <200 mg/dl Above high Normal
HDL Cholesterol 34 >40mg/dl Below low normal
Triglycerides 92 <150 mg/dl
LDL-Cholesterol 146 Above high normal
CHOL/HDLC Ratio 5.9 <5.0 Above high normal
NON HDL Cholesterol 166 <130 mg/dl (calc) Above high normal
Glucose 122 65-99 mg/dl Above high normal
Urea Nitrogen (BUN) 20 7-25 mg/dl
Creatinine 1.17 .70-1.25 mg/dl
Sodium 137 135-146 mmol/L
Potassium 3.7 3.5-5.3 mmol/L
Chloride 97 98-110 mmol/L Below low normal
Carbon Dioxide 23 20-31 mmol/L
Calcium 9.6 8.6-10.3 mg/dl
Protein, Total 7.2 6.1-8.1 g/dl
Albumin 4.3 3.6-5.1 g/dl
Globulin 2.9 1.9-3.7 g/dl (calc)
Albumin/Glob Ratio 1.5 1.0-2.5 (calc)
Bilirubin, Total 0.6 0.2-1.2 mg/dl
Alkaline Phosphatase 36 40-115 Below low normal
AST 37 10-35 U/L Above high normal
ALT 35 9-46 U/L
DHEA,LC/MS/MS <10 61-1636 ng/dl Below low normal
Cortisol, Free,LC/MS/MS .12 .07-.93 mcg/dl
CBC (Includes Diff/Plt)
White Blood Cell Count 9.1 3.8-10.8 Thousand/uL
Red Blood Cell Count 6.57 4.20-5.80 Million/uL Above high normal
Hemoglobin 14.7 13.2-17.1 g/dl
Hematocrit 48.0 38.5-50.0 %
MCV 73.1 80.0-100.0 fL Below low normal
MCH 22.4 27.0-33.0 pg Below low normal
MCHC 30.6 32.0-36.0 g/dl Below low normal
RDW 18.6 11.0-15.0% Above high normal
Platelet Count 397 140-400 Thousand/uL
MPV 10.4 7.5-12.5 fL
Absolute Neutrophils 5651 1500-7800 cells/uL
Absolute Lymphocytes 2084 850-3900 cells/uL
Absolute Monocytes 892 200-950 cells/uL
Absolute Eosinophils 373 15-500 cells/uL
Absolute Basophils 100 0-200 cells/uL
Neutrophils 62.1 %
Lymphocytes 22.9 %
Monocytes 9.8 %
Eosinophils 4.1 %
Basophils 1.1 %
Ferritin 7 20-380 ng/mL Below low normal
Folate, Serum 9.6 ng/mL
T3, Total 157 76-181 ng/dL
T4, Free 1.0 0.8-1.8 ng/dL
TSH 1.55 0.40-4.50 mlU/L
Vitamin B12 453 200-1100 pg/mL
Estradiol 17 <39 pg/mL
T3, FREE 3.5 2.3-4.2 pg/mL
Vitamin D, 25-OH 31 30-100 ng/mL
PSA, Total 0.7 <4.0 ng/mL
PSA, FREE 0.4 ng/mL
PSA, % FREE 57 >25% (calc)
Hemoglobin A1c 6.2 <5.7% of total Hgb Above high normal
Testostrone,Total 1262 250-1100 ng/dL Above high normal
Testostrone, Free 190.5 46.0-224.0 pg/mL
Testostrone, BI 366.8 110.0-575.0 ng/dL
Sex Hormone Binding 39 22-77 nmol/L
Albumin,Serum 4.2 3.6-5.1 g/dL

 

[ratbag]

Were these labs taken just before injection? Did you fast 12 hours before labs?

Your glucose and A1c are high which indicates diabetes
Ferritin, dhea, VitD, FT4, and cortisol are too low and will need to be addressed

Your protocol can be improved by injecting 2 x per week instead of once. You also need an E2 sensitive test because your dosing of anastrozole appears excessive. Without this lab you are only guessing as to the direction you should take.

 

[Bigsteve0824]

Yes, just before injection. Yes on Fast. Have another panel set for Thursday after 3rd iron infusion, will update numbers then.

 

[madman]

Now before you ask for other blood numbers from back then, I’m sorry I wasn’t smart enough about it to ask and just went with what they told me which seemed fair since they said my T level reading was a mere 278. I started on their TRT program 2 days later with a once per week injection of 125mg of Testosterone Cypionate. I felt better within 3 weeks, at 4 weeks they did more blood work and I was almost 600, but they wanted me at 800 or more. Again, I didn’t ask a lot of questions just thought, Wow if I’m feeling better now how good am I going to feel at twice the dosage 250mg which is what they put me on per week with one shot. Well, the answer was, I felt amazing and week after week I felt better.


*250mg is a rather large dose for trt unless one had really high SHBG and it is a given that one will experience elevated e2.....hence why they had you on an aromatase inhibitor.


I hit a little hiccup at the 14-month mark and my nipples got sore and ankles had some swelling so they increased my anastrozole 1mg to 3 pills per week, 1 every other day and reduced my T dose to 200mg still once per week, that was after blood work came back with a level of 1100 plus.


*You were experiencing high e2 symptoms so they not only decreased your T dose but upped your a.i. dose which would most likely crash any man's e2.


It was fine for about 4 months then started regressing. Extremely tired, fatigued, short of breath, constantly sick with something, just horrible.


*Crashed e2, crashed ferritin?


I talked to my family practitioner; of course he is not a big fan of testosterone treatment anyway and said he feels the treatment has my blood counts all messed up. However, the physician’s assistant at the clinic insisted on the Ferritin level to be added to my most recent labs and as you can see it showed a mere 7 and she immediately went into a tirade of me needing an iron infusion and immediately.


*Looking over your CBC you definitely crashed your ferritin.....how often were you donating blood?


The last straw was how bad I feel and the TRT Clinic says the low Ferritin is the cause of it and they also say the low level has nothing to do with the TRT Program but I read in several forums low Ferritin can definitely go with a bad managed TRT Program.


*Looks like you had the wrong estradiol test as you need the estradiol (sensitive assay) and I would say you definitely feel shitty due to crashed e2 from overuse of the anastrozole and to top it off seeing as your ferritin is crashed it can have many negative effects especially related to thyroid function hence why you feel like dirt.


*Your lipids and blood sugar are horrible.

*Vitamin D, DHEA, cortisol are low and your b12 could be increased.

*Your platelets are right near the high end.....do you take a fish oil (EPA/DHA) supplement @ 3 grams/day?

 

[madman]

Will reply back Monday!

 

[Bigsteve0824]

I currently take no supplements except Vitamin D which they did just start. About 6-7 months ago when I felt the best that had me do 3 blood dumps. 1 every month for 3 months but then said the readings were much better and didn’t need anymore. Last one was 4 months ago. So I will get the other estrodiol (sensitive assay) test this week along with new Numbers for all once I get my 3rd iron infusion.

 

[dnfuss]

What is your diabetes treatment protocol?

 

[Bigsteve0824]

I have no diabetes protocol. Until just the last few months when all this took place I had no blood work indicating diabetes issues.

 

[Systemlord]

These clinics are the worst at TRT and are only after your money and have you come in for one large injection a week which is far from idea, they do that for their conveyance, not yours.

You want to control hematocrit, hemoglobin and RBC, smaller more frequent injections is how you do that. You need ferritin for thyroid hormone production. You should be injecting two 50mg doses weekly given your SHBG level.

This clinic really screwed you up!

 

[dnfuss]

A fasting glucose of 122 mg/dl and an HgbA1c of 6.2% are unambiguous indicia of diabetes. Take your condition as a challenge. Diabetics who achieve normal blood sugars can lead long and healthy lives. Here's a good place to start learning about diabetes and controlling blood sugar: https://bit.ly/2KOlqeJ