Please help - feeling pretty bad - here's my results

[Chopsuey]

Hey guys,

Please see below for my blood test results, not sure were to go from here. Symptoms include 0 libido, ED, brain fog and fatigue.

I'm Canadian but I translated the values into US one's to make it easier for everyone.

Total Testosterone: 735 ng/dl (25.5nmol/l)
Free testoserone: 495 pmol/l (not sure how to convert this one, ref range was 196-636 and they said they used a calculation from total test and SHBG so not sure if they actually tested it or just calculated it, have to call the lab for this one)
SHBG: 42 nmol/l
Estradiol: 30.5pg/ml(112 pmol/l) Pretty pist about this, I paid for the sensitive test and they did the regular test by accident. It takes two weeks to get the results for the sensitive one in Canada so going to retest but will only know in 2-3 weeks.
Prolactin: 8 ug/l

Protocol:
60mg testosterone injection twice a week for a total of 120mg a week
HCG 3 x 350 (total 1050 units per week)
AI: None except DIM 200mg a day

On my last labs my DHEA was around 110 which was very low.

I can't really figure out what's going on, from my guess my estrogen levels is too low, maybe I should add some DHEA?

I also don't understand SHBG, I think it's high but not sure what that means.

Also my test dose use to be alot higher and I cut it down, now it seems a bit low, should I increase it to 150mg a week?

Right now my doctor has very limited knowledge(started on the 200mg once a week) and lets me do what I want but since I live in Canada it's a huge pain to get these tests all the time, I have to go through a naturopath so any help to point me in the right direction would be much appreciated.

 

[Systemlord]

All your levels are pretty good except I don't see any thyroid labs which is concerning, hypothyroidism has similar symptoms to low testosterone.

How long you been on this protocol?

 

[Chopsuey]

Hi Systemlord,

I do have hashimoto's but I've been dealing with that for years and all my thyroid values are in the optimal range as of 2 months ago, have another run of tests in 3 weeks from now but my levels have been consistent for a while now. (TSH 1.4, free t4 in upper range, antibodies in range as well on 75mcg synthroid per day)

I've been on/off testosterone for 8 years(starting abusing steroids in my early 20's which lead to trt)

I've been on this current protocol for about 2 months now without any alterations. Before I was on a higher dose of testosterone and felt better but still had ED issues/libido issues and was using an AI.

 

[madman]

Hey guys,

Please see below for my blood test results, not sure were to go from here. Symptoms include 0 libido, ED, brain fog and fatigue.

I'm Canadian but I translated the values into US one's to make it easier for everyone.

Total Testosterone: 735 ng/dl (25.5nmol/l)
Free testoserone: 495 pmol/l (not sure how to convert this one, ref range was 196-636 and they said they used a calculation from total test and SHBG so not sure if they actually tested it or just calculated it, have to call the lab for this one)
SHBG: 42 nmol/l
Estradiol: 30.5pg/ml(112 pmol/l) Pretty pist about this, I paid for the sensitive test and they did the regular test by accident. It takes two weeks to get the results for the sensitive one in Canada so going to retest but will only know in 2-3 weeks.
Prolactin: 8 ug/l

Protocol:
60mg testosterone injection twice a week for a total of 120mg a week
HCG 3 x 350 (total 1050 units per week)
AI: None except DIM 200mg a day

On my last labs my DHEA was around 110 which was very low.

I can't really figure out what's going on, from my guess my estrogen levels is too low, maybe I should add some DHEA?

I also don't understand SHBG, I think it's high but not sure what that means.

Also my test dose use to be alot higher and I cut it down, now it seems a bit low, should I increase it to 150mg a week?

Right now my doctor has very limited knowledge(started on the 200mg once a week) and lets me do what I want but since I live in Canada it's a huge pain to get these tests all the time, I have to go through a naturopath so any help to point me in the right direction would be much appreciated.

Your total t/free t levels look good and your shbg is roughly mid-normal (not high) and as far as the negative symptoms you are experiencing I would say are related to your e2 whether too low or high and the only way to truly know is to get the e2 (sensitive assay) which has not been available in Canada until recently and is only done through Dynacare in certain provinces.

Yes you could try increasing your dose slightly but it is pointless until you find out where your e2 really sits and you will have to get it retested otherwise you are just guessing at best.

As far as having to use a naturopath to get testing done.....why?

I go to my family physician and have total t/free t/estradiol/shbg written on a requisition and than went to Dynacare for labs and all tests were covered by O.H.I.P.

Mind you the estradiol test at the time was the standard assay and not the sensitive as I am not sure if that would be covered.

In the past I had total t/free t/estradiol/shbg/dht done at the other main lab LIFELABS and I had to pay out of pocket for shbg and free t tests so now I always use DYNACARE.

Have the estradiol sensitive assay done and decide from there on your next move to address e2.

 

[Chopsuey]

Your total t/free t levels look good and your shbg is roughly mid-normal (not high) and as far as the negative symptoms you are experiencing I would say are related to your e2 whether too low or high and the only way to truly know is to get the e2 (sensitive assay) which has not been available in Canada until recently and is only done through Dynacare in certain provinces.

Yes you could try increasing your dose slightly but it is pointless until you find out where your e2 really sits and you will have to get it retested otherwise you are just guessing at best.

As far as having to use a naturopath to get testing done.....why?

I go to my family physician and have total t/free t/estradiol/shbg written on a requisition and than went to Dynacare for labs and all tests were covered by O.H.I.P.

Mind you the estradiol test at the time was the standard assay and not the sensitive as I am not sure if that would be covered.

In the past I had total t/free t/estradiol/shbg/dht done at the other main lab LIFELABS and I had to pay out of pocket for shbg and free t tests so now I always use DYNACARE.

Have the estradiol sensitive assay done and decide from there on your next move to address e2.

Hi madman. Thank you for detailed response.

Regarding naturopath I can only see my endo every 3.5 months due to his busy schedule so I want more tests in between. Also when I brought up the sensitive estrogen test he laughed and said there wasn't going to be a difference.

Need to find new doc but meanwhile I've been using naturopath as they can order the sensitive test via dynacare. That's the one I ordered but the tech made a mistake.

My last estrogen sensitive test was 13 but I was using an ai and more testosterone.

I guess I'll just have to wait this out and retest the sensitive estrogen before adjusting my protocol

 

[1Draw]

Hi Systemlord,

I do have hashimoto's but I've been dealing with that for years and all my thyroid values are in the optimal range as of 2 months ago, have another run of tests in 3 weeks from now but my levels have been consistent for a while now. (TSH 1.4, free t4 in upper range, antibodies in range as well on 75mcg synthroid per day)

I've been on/off testosterone for 8 years(starting abusing steroids in my early 20's which lead to trt)

I've been on this current protocol for about 2 months now without any alterations. Before I was on a higher dose of testosterone and felt better but still had ED issues/libido issues and was using an AI.

Have you had T3 and Reverse T3 labs done? Considering your symptoms I would definitely check those. Here is good info on Synthroid:
https://stopthethyroidmadness.com/t4-only-meds-dont-work/

 

[Chopsuey]

that's interesting, I didn't know thyroid could cause those problems.

My doc refuses to test rt3 for some reason and will rarely test t3 across the 2 years I've been seeing her.

She also refuses to prescribe anything then synthroid which is frustrating. Looks like I need a new doc for that too.

Meanwhile I'll see if I can get the rt3 via private testing

 

[Systemlord]

that's interesting, I didn't know thyroid could cause those problems.

My doc refuses to test rt3 for some reason and will rarely test t3 across the 2 years I've been seeing her.

She also refuses to prescribe anything then synthroid which is frustrating. Looks like I need a new doc for that too.

Meanwhile I'll see if I can get the rt3 via private testing

That is very troubling, Free T3 (not T3) is the only active thyroid hormone and it's where the rubber meets the road, it's what free testosterone is to total testosterone. You must know if you are converting Free T4 --> Free T3 properly, Free T3 could be low and you would never know. Reverse T3 if high could cause problems, strange they would refuse such an important test.

You can't manage thyroid treatment without these tests!

 

[1Draw]

Time to find a new Doctor. Where in Canada do you live? We have some well treated Canadians here that may be able to help.

 

[Tommy Wall]

I think many family main stream docs simply don´t know a lot about Thyriod issues. THS FT4 FT3 should be minimum to check. I also have to beg for these tests. Oh your TSH is within range so youre find. It sucks really

 

[Vince]

I think many family main stream docs simply don´t know a lot about Thyriod issues. THS FT4 FT3 should be minimum to check. I also have to beg for these tests. Oh your TSH is within range so youre find. It sucks really

How right you are. It took me 5 years before I found a doctor that would precribe

liothyronine (Cytomel) for me. ​

 

[Chopsuey]

Time to find a new Doctor. Where in Canada do you live? We have some well treated Canadians here that may be able to help.

I live in Winnipeg, Manitoba. The endo I'm seeing is apparently one of the top ones but I've had a miserable experience so far and talking to other people that see's her they all say the same thing. Not sure how to find a good one though as I believe I need a referral from my GP to see an endo and thats the one he sent me to.

 

[Chopsuey]

That is very troubling, Free T3 (not T3) is the only active thyroid hormone and it's where the rubber meets the road, it's what free testosterone is to total testosterone. You must know if you are converting Free T4 --> Free T3 properly, Free T3 could be low and you would never know. Reverse T3 if high could cause problems, strange they would refuse such an important test.

You can't manage thyroid treatment without these tests!

Yes I agree, I've brought this up several times and it's always been dismissed.I was pretty brain fogged and tired when this all started and I should of took more charge but I trusted this doc(unfortunately), time to find a new one as it seems everything has been stalling for over a year now and still feel like crap.

 

[CoastWatcher]

Yes I agree, I've brought this up several times and it's always been dismissed.I was pretty brain fogged and tired when this all started and I should of took more charge but I trusted this doc, time to find a new one as it seems everything has been stalling for over a year now and still feel like crap.

You are not responsible for the fact that your doctor is clueless. For some time I was "treated" by an endocrinologist, held an endowed chair in Toronto, and the results were discouraging. Too many of us have encountered what you're dealing with now. You have to be your own advocate. All the best to you...

 

[ratbag]

I can't say I agree with your Free T. I believe the rule of thumb is that if you have the symptoms you have and your FT is not at the top of range , it should be. Also you should try taking some DHEA daily to try and raise it some. All the top TRT MD's would ask you to try it. Some don't deal well with it but some like myself found huge improvements taking DHEA. Endocrinologists are the worst MD's in the world for one reason... they only go by lab results and they only use synthroid. This we have learned is a major shortcoming to treating thyroid problems. If you have hashi's you should be on selenium as well. I'm in Canada too and your estradiol looks ok considering it's not the sensitive test. My guess is you need more testosterone, if you can, try raising it to 65mg twice weekly and see how you feel.

 

[Systemlord]

I can't say I agree with your Free T. I believe the rule of thumb is that if you have the symptoms you have and your FT is not at the top of range , it should be. Also you should try taking some DHEA daily to try and raise it some. All the top TRT MD's would ask you to try it. Some don't deal well with it but some like myself found huge improvements taking DHEA. Endocrinologists are the worst MD's in the world for one reason... they only go by lab results and they only use synthroid. This we have learned is a major shortcoming to treating thyroid problems. If you have hashi's you should be on selenium as well. I'm in Canada too and your estradiol looks ok considering it's not the sensitive test. My guess is you need more testosterone, if you can, try raising it to 65mg twice weekly and see how you feel.

They don't call it reference range endocrinology for nothing, that's why they aren't able to have critical thinking a reasoning and act like robots. If measuring Free T3 and Reverse T3 was cheap I'm sure they would be testing for it, I think the refusal is do to cost.

 

[Chopsuey]

Thanks for all the replies. I have an appointment on Monday for the sensitive estradiol re-test.

Talked to my GP and said it could take month's to get in for a new endo so I found a naturopath that specializes in thyroid disease that looks on top of things. I'll see what she has to say, I might do better on armour or a combo of t4/t3? As well will get the free t3 and reverse t3 tested at the same time(along with all the rest of the panel for thyroid)

I'll update back here and see how it goes.

 

[Chopsuey]

Hey guys,

Here's an update on my progress:

I increased my dose to 140mg a week(split in two shots) and added in 20mg preg and 20mg dhea per day.

Just got back my estradiol sensitive test, it's at 37.4 , I'm guessing the increase is because this is after almost 2 months of NO ai and increase test dose.

Should I add in an AI or leave it? I think this is still ok without ai?

Regarding thyroid I reduced my dose of syntheroid to 50mcg and will add in t3 30mcgs split through out the day.

I'm getting the following tests in 2 weeks:

Free t3
Free t4
TSH
Reverse t3

After about a month I'm going to retest all hormones(testosterone,estradiol,SHBG,prolactin etc), that should give enough time for everything in my protocol adjustments to reflect on bloodwork.

So far still feel crappy but just started the new thyroid medication and preg/dhea.

I'll keep documenting my progress in here and hopefully I figure it out and help others in the process.

 

[FeelingLost]

I increased my dose to 140mg a week(split in two shots) and added in 20mg preg and 20mg dhea per day.

How long ago?

If you are not getting high E2 signs I would not take the AI just because. When I get high E2 symptoms it is so obvious it a no brainer I need to take 1 and just 1 AI to see if that fixes it. I will usually wait 3-4 days before taking another and only if I still have the symptoms.

 

[OMI100]

I will piggy-back off of 1Draw
My MANTRA...
Shot gun approach
If you see anything of interest then read up
Also one site I came across that appears to focus on Hasimotos's.
May be worth a look on your part:
*********************
https://thyroidpharmacist.com/about/

Look through the articles.
********************************
First step is education....
********************************
Cannot tell how much research you have done on TRT.
If not a lot, I recommend you get a few books.
Get a few good books and educate yourself now:
1. Get Nelsons book "Testosterone: A Man's Guide".
2. Get Lee Myer's book "Natural Versus Testosterone Therapy".
3. Get “Testosterone for life - Dr. Abraham Morgentaller “.
4. Get “The Definitive Testosterone Replacement Therapy MANual: How to OptimizeYour Testosterone For Lifelong Health And Happiness” by Jay Campbell.
These books will give you a much better understanding of TRT....
********************************
ExcelMale.com Guide to Testosterone Replacement
https://www.excelmale.com/forum/showthread.php?5823-ExcelMale-com-Guide-to-Testosterone-Replacement
**********************************
One other forum that has great info that might be useful to you is:
http://www.peaktestosterone.com/
GREAT article onE2 – A MUST READ
http://www.peaktestosterone.com/Hdr_Estrogen.aspx
********************************
Dr Saya's Videos on Testosterone Therapy and Side Effect Management
https://www.excelmale.com/forum/showthread.php?15207-Dr-Saya-s-Videos-on-Testosterone-Therapy-and-Side-Effect-Management
**********************************
Second step might be to have a look at your thyroid and see if any issues there.
********************************
Do some research.
I do like Tiredthyroid as a starting point.
Easy to read sections.
References at the bottom of each section (and NOT from people wearing "tinfoil" hats)
See below:
Basic sources to research Thyroid issues and testing:
******************************************
https://stopthethyroidmadness.com/
Spend time here and get the 2 books, “STTM: The Revised Book” and “STTMII:Authored by Doctors”.
*******************************************
http://www.tiredthyroid.com/
Great simple to understand articles.
Get her book.... “Tired Thyroid: From Hyper to Hypo to Healing—Breaking the TSHRule”, https://read.amazon.com/kp/embed?asi...Channel=system
A lot of clear researched information that is easy toread and understand.
***************************
https://hypothyroidmom.com/
Good info here. Look around.
*************************
https://www.restartmed.com/?s=thyroid
A LOT of good articles and a youtube page.
Spend time here looking around and reading after getting labs back.
************************************
Do you have Hypothyroidism?
The Complete Hypothyroidism User Guide for Patients (2018 Edition)
https://www.restartmed.com/hypothyroidism/
*********************************
Need information on thyroid testing....
Read here:
http://www.tiredthyroid.com/what-labs.html
And here:
http://www.tiredthyroid.com/optimal-labs.html
and here:
https://stopthethyroidmadness.com/recommended-labwork/
and here:
https://www.restartmed.com/thyroid-tests/
and here:
https://www.restartmed.com/hormone-testing/
And here:
https://www.restartmed.com/normal-thyroid-levels/
**************************************
Some additional links to read before you receive the books you have already ordered
Go here:
http://www.allthingsmale.com/publications.html
and download:
TRT: Recipe For Success
Print out.
and
HCG Update.
and the TRT Power Point presentation.

Dr. Crisler is one of the "TRT Cutting Edge DR's" here in the states....
Also go here:
http://www.drjohncrisler.com/the-cri...part-deux.html
and also print out the article.
***************************
ALSO look at the videos that are posted on this site. A LOT of great info to take in....
******************************
Now you will have a great reference library and knowledge base to go forward on!