Planning on starting TRT next week just want to get any random thoughts on blood work

[shinexcel]

I am 29 and weight about 185lbs. been lifting for 3 years.
My testosterone has measured low various times over the years. As much as I should have done something about it I simply had not. I have a suspicion it has been this way ever since losing >100lbs 5 years or so ago. End of last year I finally decided to do something about it and was taking Clomid. It raised my Test but did not seem to improve symptoms. This particular doctor was not on board with giving me injections.

Anyways I found a doctor that seemed to really be on the same page with me. Fine with injections and willing to prescribe a AI if needed.

Some of my bloods:
(10/20/15)
Free 31 (35-115)
Total 276 (276-1100)
TSH 2.07(.4-4.5)

(11/19/15)
Total 384(280-1100)
FSH 4.3(1.4-18.1)
LH 1.6
Prolactin 4.7(2.1-17.7)

(12/24/15) ON CLOMID
Estradiol 35 (<41)
FSH 5 (1.2-18.1)
LH 4.8 (1.5-9.3)
Total 1092 (280-1100)

(3/25/16)
Free .75 (.61-1.12)

Total 252 (280-1100)

TSH 4 (.34-5.6)

Cortisol 23.8 (6.7-22.6)

LH 1.3 (1.2-8.6)

FSH 2.63 (1.27-19.26)

Estradiol 16 (<41)

IGFBP 28 (0-40)

Prolactin 3.38 (4.04-15.2)

TSH and Free seem odd. Also cortisol? Having a hard time finding information on combining all of these factors.
I have all the symptoms and have had them for years now.

 

[Vince]

Before you start TRT, you should do a complete thyroid panel. http://pro2services.com/Lectures/Spring/Thyroid/ThyTests.htm

 

[John O'Connor]

I agree - on the full thyroid panel. Ask them to include Reverse T3 also.
Anti-TPO will be definitive test for Hashimoto's thyroiditis.

Also check Vitamin D. There is a big link between thyroid and low Vit D.
TSH of 4.0 is elevated, but not excessively and it can vary throughout the day.

And have complete blood work Nelson recommends:
https://www.excelmale.com/forum/sho...ne-Replacement-Therapy&highlight=blood+nelson

Can anyone advise whether it would be better to get off of Clomid 1st to get more accurate baseline numbers? That is assuming you are still on Clomid or were for the above blood work.

Having baselines of SHBG, DHEA-S, etc. will help dial in your levels once on TRT.
Also if your estradiol above was not the "sensitive" version, then you need that re-done anyway.

 

[John O'Connor]

LH 1.3 (1.2-8.6)
FSH 2.63 (1.27-19.26)
Also does Clomid boost LH & FSH? Were you taking Clomid at the time of this blood work?

Cortisol 23.8 (6.7-22.6)
If someone can explain the cortisol numbers I'd appreciate that too.

 

[CoastWatcher]

If your protocol involves injecting or applying testosterone, as opposed to your Clomid efforts, a PSA is required. You need a baseline and then regular monitoring.

 

[shinexcel]

This was off clomid for several months. Will talk to the doctor Tuesday about full thyroid.
Updated first post with older bloods, not much info there though.

 

[shinexcel]

Second talk with this doctor was not as eventful.
Was prescribed 100 test cyp 1x a week. Wasn't comfortable with every 3 days or so but from what I have read tons of people have no problem with once a week.
An MRI of my pituitary.
25mg a day of Levothyroxine because of the TSH. Really not into this one. Said that flat out. Don't plan on filling the script.
Also did a overnight dexamethasone suppression test. Well see how that comes back. This was to help diagnose the cortisol.
Didn't want me to get any more bloods until I was injecting for 2 months.
Ugh anxiety is high.

 

[John O'Connor]

Many doctors don't understand the Reverse T3, but the other elements of the thyroid panel (Free T3, Free T4, Anti-TPO & recheck of TSH) are all standard clinical guidelines. IMO, its crazy for any doctor to prescribe Synthroid without first checking these numbers.

As for the weekly testosterone cypionate. He is following the clinical guidelines written in 2010. Try to explain to him that cypionate peaks at 48-72 hours, and has an 8 day half-life.

Taking weekly injections will lead to your highest levels on day 3 (peak) and lowest levels on day 8 (trough) just before your next injection. Your daily levels will likely fluctuate 500+ points from peak to trough. Example 500 (trough) - 1,000 (peak).

Injecting E3.5D, dramatically reduces this wide fluctuation. Your peaks are lower because you are injecting 1/2 the dose, so your peak would likely be closer to 750, and trough might be 600.

Another benefit of this is it reduces the chance of needing an AI (aromatase inhibitor). Significant spikes in Testosterone, cause significant spikes in Estrogen via increased aromatase as a result of the increased testosterone levels.

I highly recommend you get ALL of your baseline numbers before starting this process, as you will have no idea what your normal levels are once you start cypionate. SHBG, DHEA-S, and make sure to check Estradiol-sensitive. The test you listed above is not the sensitive version - and it is shown to be unreliable for measuring men's estradiol levels.

If I were you, I'd pay out of pocket for the full thyroid, & full recommended pre-TRT blood panel before starting this process. But in reality your doctor should order these for you. And as I mentioned above - check Vitamin D.

Send him a copy of this thread, and invite him to ask questions. Good luck!

 

[shinexcel]

Thanks for the great response. Going to take time to process it.
I would be doing at home injections so I suppose I can follow my own protocol on that one.

 

[John O'Connor]

Its really best for you and your doctor to be on the same page. Just as I advised this guy earlier today when he suggested E3.5D injections, but not telling his doctor. You guys have very similar situations, but in both cases educating your doctors, or finding a new doctor that is willing to learn is your best option. https://www.excelmale.com/forum/sho...-Got-my-Full-Panel-Way-Low-Testosterone/page2

 

[shinexcel]

Alright, putting everything (except for the cortisol test and mri scan, as I am sure they will come back up in the future and will be good to have them done.) on hold.
I was kinda off put by how defensive my doc got when I made the suggestion of twice a week and with how quickly the thyroid prescription was wrote.

I kinda have a feeling I really want to understand the why of it more first. Even if TRT ends up being the solution down the road.

I figure I can still get out of bed which is better than most.

I can afford to pay out of pocket for all the tests but would much rather have a doctor a trust be part of the equation. I think its time I really start calling around.

 

[ERO]

I would call Defy Medical and talk to them. Many of use use and recommend them highly.

 

[shinexcel]

Definitely going to Friday or Monday. Even just to see what they say. I am not wanting to jump on TRT without being sure its the right choice. This thread and site have given me a lot to consider first. Really appreciate it.

 

[shinexcel]

Got some new labs but not exactly what I was looking for. I guess its time to pay for my lab work out of pocket. Tired of doctors not ordering exactly what I ask for.

05/02/2016

T3 Reverse 28 (8-25)
T3 Total 61 (76-181)
T4 Total 6.7 (4.5-12)
TSH 2.1 (.4-4.5)
Total Testosterone 285 (250-1100)
Free Testosterone 30.4 (35-155)
B12 626 (200-1100)
Vit D 56 (30-100)
Prolactin 3.5 (2.0-18)
FSH 3.5 (1.6-8)
LH 1 (1.5-9.3)
Estrodiol <15 (<39)
DHEA 335 (85-690)



At least have DHEA RT3 and vit d now. Also the estrodiol being so low seems interesting.

 

[Dr Justin Saya MD]

That is the standard (not sensitive E2) - as you mentioned pay out of pocket for the sensitive.

Need to get FT3 and FT4, but with low total T3 and low-ish total T4 ALONG with high rT3, it appears you should start by treating the hypothyroidism BEFORE treating the Hypogonadism...the low thyroid function may indeed be the cause of the low LH/FSH (secondary Hypogonadism).

Suggest ordering FT3, FT4, anti-TPO antibodies, and anti-thyroglobulin antibodies for a more complete thyroid picture (also working with a physician knowledgeable in this area as well as Hypogonadism treatment would be imperative).

Best of luck!

 

[shinexcel]

Anyone ever see any research that the reason could simply be maintaining a significant weight loss for 5+ years?
I have seen research that shows significant hormonal changes from weight loss and then never fully recovering even when eating a new maintenance calories. Potentially this scenario long term could really beat things down?

Got a new endo visit scheduled