Repeat blood test results, seeing endo in about two months

[AlcahueteJ]

This is my second set of blood tests, similar to the first test. First appointment I can get with the endocrinologist is in March.

5'9" 158 lbs., very lean. Work out six days a week. 2 - 3 days lifting, 3 - 4 days running

Albumin - 4.7 g/dL
Iron - 94 ug/dL

CalcTIBC - 308 ug/dL
TRF - 237 mg/dL

LH - 3.7 mIU/mL
Prolactin - 4.9 ng/dL
TSH - 1.1 uIU/mL

Testosterone - 158 ng/dL
SHGB - 56 nmol/L
calcFT - 20 pg/mL

CRP - 0.6 mg/L
Albumin - 0.5 mg/dL
Creatine - 60 mg/dL
Alb/creatine - 8.3 mg/g

Thoughts?

 

[CoastWatcher]

Welcome to Excelmale. Can you provide some context? Age? Symptoms? Any other medication/supplements that you are taking? And, if you'd provide the ranges for the tests above it would be a help.

 

[AlcahueteJ]

This is my second set of blood tests, similar to the first test. First appointment I can get with the endocrinologist is in March.

5'9" 158 lbs., very lean. Work out six days a week. 2 - 3 days lifting, 3 - 4 days running

Albumin - 4.7 g/dL (3.5 to 4.2)
Iron - 94 ug/dL(45 to 160)

CalcTIBC - 308 ug/dL (260 to 470)
TRF - 237 mg/dL (200 to 360)

LH - 3.7 mIU/mL (2 to 10)
Prolactin - 4.9 ng/dL (4 to 15)
TSH - 1.1 uIU/mL (0.27 to 4.2)

Testosterone - 158 ng/dL (280 to 800)
SHGB - 56 nmol/L) (14 to 48)
calcFT - 20 pg/mL (60 to 185)

CRP - 0.6 mg/L (0 to 5.0)
Albumin - 0.5 mg/dL
Creatine - 60 mg/dL
Alb/creatine - 8.3 mg/g (0 to 30)

Thoughts?

Ranges are in bold next to the results above.

33 years old. Symptoms are decreased libido (no sex drive is the reason I finally went), lack of motivation for activities I used to enjoy (increasingly less social the last few years), strength levels have started to drop the last year, diagnosed with anxiety at 30, no energy and lack of motivation to work out (but I still go).

No medications, supplements currently taking are 1000 - 2000 IUs of vitamin D, multi-vitamin, 6 grams of fish oil, glucosamine/chondrites/MSM. Whey/casein protein powder daily.

I weighed 185 lbs. three years ago, decreased body fat and lost weight slowly over two years, despite efforts to drop more bodyfat the last year, weight has been maintained at ~158 - 160 lbs. the last year. Weight crept up to ~163 over the summer after a broken foot, tried to maintain weight during that time, but weight only slowly increased.

Social drinking, ~14 beers per week.

Cholesterol was also taken in May of 2015. 214 total, HDL was 104.

I don't know the ranges from 2008, but testosterone was measured at 627 back then, at 26 years old and 173 lbs. Was training much more in terms of volume then, training for a triathlon.

 

[Nelson Vergel]

I am not clear about what you need with that very limited blood test list.

 

[AlcahueteJ]

I am not clear about what you need with that very limited blood test list.

What other information would be helpful?

Unfortunately though, no other blood work is scheduled, at least not until the appointment with the endocrinologist.

Based on the limited blood work, there are signs testosterone is low correct? (Outside of the fact that the blood test itself tested total testosterone at 158 ng/dL).

Could it be prolonged dieting, and/or low body fat?

 

[Vince Carter]

I don't think there's much to be said besides consider the care you're being given...60 days to get in to this endo (which is probably a fruitless endeavour for TRT)...you need to find a new Dr as step 1, the rest of it is all secondary, I mean you can read the lab values and your symptoms and know you've got problems. All I can say is why put up with that "Dr"....?

 

[AlcahueteJ]

The doctor is my primary, and he actually mentioned TRT as possible treatment, and then I was referred to the endocrinologist to go over specifics. The endo specializes in male hypogonadism, most specialists at this hospital can take some time as they're booked (I've seen many for multiple). The doctors here in Boston are good, but I obviously can't speak to how good they are with regards to male hypogonadism just yet.

I'm asking the question because I have to wait until March, and still have many questions. I will try the specialist first, and after that if I feel the need, I will seek other doctors.

Thank you for the quick replies by the way, this website came highly recommended, and I appreciate the resource and input.

In addition to that, can male hypogonadism (or levels as low as mine < 200) be diet induced and/or caused by low bodyfat? I've found limited studies, and have tried searching for this question, but most topics are related to bodybuilders who have used steroids.

 

[Vince]

The doctor is my primary, and he actually mentioned TRT as possible treatment, and then I was referred to the endocrinologist to go over specifics. The endo specializes in male hypogonadism, most specialists at this hospital can take some time as they're booked (I've seen many for multiple). The doctors here in Boston are good, but I obviously can't speak to how good they are with regards to male hypogonadism just yet.

I'm asking the question because I have to wait until March, and still have many questions. I will try the specialist first, and after that if I feel the need, I will seek other doctors.

Thank you for the quick replies by the way, this website came highly recommended, and I appreciate the resource and input.

In addition to that, can male hypogonadism (or levels as low as mine < 200) be diet induced? I've found limited studies, and have tried searching for this question, but most topics are related to bodybuilders who have used steroids.

Your testosterone is very low, wonder why? Hopefully your doctors will give you some answers. Proper testing is always a must, but I'm sure you know that already. https://www.excelmale.com/forum/sho...e-When-Using-Testosterone-Replacement-Therapy

 

[JPB]

Prolonged calorie deficits and dieting can definitely crash testosterone levels

 

[ERO]

in general, Endos and successful TRT don't often go together. Unless you are wedded to that plan, why not consider Defy Medical? I am not affiliated with them but many of us on the forum use and recommend them. That and you could be talking to a TRT expert in days instead of waiting another 2 months.

 

[AlcahueteJ]

Prolonged calorie deficits and dieting can definitely crash testosterone levels

My weight has been stable for about a year. It crept up about 5 pounds when I broke my foot in May, and I noticed was putting on weight at the same calories/day that I was maintains a year prior during this time.


What about trying to maintain a low body fat year round, say, lower than your specific body/genetics is comfortable with? Any studies linking specific body fat percentages (or at least those measured with at least a 2 compartment DEXA scan, preferably a 4 compartment)?

If low body fat can cause testosterone levels as low as mine (158 ng/dL) can it be reversed by gaining weight, or is medication/therapy definitely needed at those levels?

in general, Endos and successful TRT don't often go together. Unless you are wedded to that plan, why not consider Defy Medical? I am not affiliated with them but many of us on the forum use and recommend them. That and you could be talking to a TRT expert in days instead of waiting another 2 months.

At the moment, I would like to see what this specific endocrinologist says. The hospitals here are excellent, and they have treated me with superb care for a variety of issues for years now. TRT was actually mentioned without me prompting the doctor, in fact, I had never heard of it until he mentioned it. At this point, the only drawback is availability and time. I imagine more blood work will follow prior to the appointment.

I am not opposed to Defy Medical, but if I can stay within my network that I have a history with, and that insurance covers, than that is preferable.

 

[Lukas]

Hey man. I have been looking for anyone with levels as low as mine. I am 24 years old with low testosterone of 104 ng/dl. It has me very worried.

 

[AlcahueteJ]

Hey man. I have been looking for anyone with levels as low as mine. I am 24 years old with low testosterone of 104 ng/dl. It has me very worried.

Have you went to a doctor yet?

Just an update since I've had my appointment.

I'm having an MRI of my pituitary done to make sure there isn't a tumor, and I had additional blood work done (my initial blood work is posted above). Pending the outcome of the MRI, I am meeting with the endo again in a week and a half.

Clomid is being recommended, and he said he's had success with this in other patients, so I could try this first. Especially considering I'm young male seeking to maintain fertility. However, my first concern is to simply feel better and regain my sex drive. I'm being given the option though of injections (self-administered), patches/gel, or Clomid. The choice is mine.

Here is the new blood work

WBC: 4.5 K/uL (range 4.0 - 10.0)
RBC: 4.34 m/uL(range 4.6 - 6.1)
Hgb: 13.4 g/dL (range 13.7 - 17.5)
Hct: 40.7 % (range 40 - 51)
MCV: 94 fL (range 82 - 98)
MCH: 30.9 pg (range 26 - 32)
MCHC: 32.9 g/dL (range 32 - 37)
RDW: 13.0 % (range 10.5 - 15.5)
RDWSD: 44.6 fL (range 35.1 - 46.3)

Plt Ct: 176 k/uL (range 150 - 400)
Iron: 90 ug/dL (range 45 - 160)
calTIBC: 308 ug/dL (range 260 - 470)
Ferritn: 53 ng/mL (range 30 - 400)

TRF: 237 mg/dL (range 200 - 360)
TSH: 1.3 uIU/mL (range 0.27 - 4.2)
Free T4: 1.0 ng/dL (range 0.93 - 1.7)

Insulin-like Growth Factor-1: PND

Studies seem promising for Clomid, but anecdotally I haven't seen much that indicates Clomid can improve symptoms.

Recommendations? Give Clomid a shot? If so, how long? And if it works, how long do you stay on it? And are there any studies indicating testosterone levels remain high/symptoms are relieved long term after stopping Clomid?

Thank you in advance!

 

[CoastWatcher]

Have you went to a doctor yet?

Just an update since I've had my appointment.

I'm having an MRI of my pituitary done to make sure there isn't a tumor, and I had additional blood work done (my initial blood work is posted above). Pending the outcome of the MRI, I am meeting with the endo again in a week and a half.

Clomid is being recommended, and he said he's had success with this in other patients, so I could try this first. Especially considering I'm young male seeking to maintain fertility. However, my first concern is to simply feel better and regain my sex drive. I'm being given the option though of injections (self-administered), patches/gel, or Clomid. The choice is mine.

Here is the new blood work

WBC: 4.5 K/uL (range 4.0 - 10.0)
RBC: 4.34 m/uL(range 4.6 - 6.1)
Hgb: 13.4 g/dL (range 13.7 - 17.5)
Hct: 40.7 % (range 40 - 51)
MCV: 94 fL (range 82 - 98)
MCH: 30.9 pg (range 26 - 32)
MCHC: 32.9 g/dL (range 32 - 37)
RDW: 13.0 % (range 10.5 - 15.5)
RDWSD: 44.6 fL (range 35.1 - 46.3)

Plt Ct: 176 k/uL (range 150 - 400)
Iron: 90 ug/dL (range 45 - 160)
calTIBC: 308 ug/dL (range 260 - 470)
Ferritn: 53 ng/mL (range 30 - 400)

TRF: 237 mg/dL (range 200 - 360)
TSH: 1.3 uIU/mL (range 0.27 - 4.2)
Free T4: 1.0 ng/dL (range 0.93 - 1.7)

Insulin-like Growth Factor-1: PND

Studies seem promising for Clomid, but anecdotally I haven't seen much that indicates Clomid can improve symptoms.

Recommendations? Give Clomid a shot? If so, how long? And if it works, how long do you stay on it? And are there any studies indicating testosterone levels remain high/symptoms are relieved long term after stopping Clomid?

Thank you in advance!

Before responding to your question, was a psa run in order to establish a baseline should you choose to begin exogenous testosterone therapy? Has HCG been discussed as an adjunctive treatment to maintain your fertility if testosterone is administered?

Dr. Justin Saya has noted that when Clomid works, and it can work, it is important for the patient to realize he needs to be patient, it is not a quick solution to the problems he is dealing with.

 

[AlcahueteJ]

Before responding to your question, was a psa run in order to establish a baseline should you choose to begin exogenous testosterone therapy? Has HCG been discussed as an adjunctive treatment to maintain your fertility if testosterone is administered?

Dr. Justin Saya has noted that when Clomid works, and it can work, it is important for the patient to realize he needs to be patient, it is not a quick solution to the problems he is dealing with.

I imagine and would hope a psa would be run if I chose injections, but we will discuss side effects...etc. in the follow-up I believe when I choose which path to take. HCG was discussed, and it was made clear fertility can be restored if injections are the route chosen.

 

[CoastWatcher]

I imagine and would hope a psa would be run if I chose injections, but we will discuss side effects...etc. in the follow-up I believe when I choose which path to take. HCG was discussed, and it was made clear fertility can be restored if injections are the route chosen.

What details did your doctor provide in regard to Clomid therapy? How much, how often, what success has he had with these protocols? Finally, was TSH the only thyroid test administered? That provides an incomplete picture of how your thyroid gland may be operating. A full work-up, would include ft3, ft4, rt3, and an antibody test (the latter to rule out Hashimoto's Thyroiditis).

 

[AlcahueteJ]

What details did your doctor provide in regard to Clomid therapy? How much, how often, what success has he had with these protocols? Finally, was TSH the only thyroid test administered? That provides an incomplete picture of how your thyroid gland may be operating. A full work-up, would include ft3, ft4, rt3, and an antibody test (the latter to rule out Hashimoto's Thyroiditis).

Free T4 is in normal range (listed above) but no FT3 or RT3 unfortunately, or antibody test. I can ask about it though.

No details yet about Clomid, but again, I imagine we'll discuss this if I choose that route.

 

[AlcahueteJ]

Another question. I have read (at higher doses) Clomid can increase anxiety. I have been diagnosed with anxiety (managing it and doing well with meditation and exercise, no medication), should I still go forward with low dose Clomid if that's the route I choose?

The doctor is aware of the anxiety, and the history was discussed.

 

[ERO]

Clomid does cause anxiety in some patients. I believe that may be due to the fact that it can also cause E2 to rise quite a bit if not managed well. As Dr. Saya pointed out, for Clomid to work, you truly need a doctors that is an expert in using it.

 

[AlcahueteJ]

Clomid does cause anxiety in some patients. I believe that may be due to the fact that it can also cause E2 to rise quite a bit if not managed well. As Dr. Saya pointed out, for Clomid to work, you truly need a doctors that is an expert in using it.

Ok, thanks for the reply.

I'll have to pick his brain at our next appointment and run all of these questions by him, including how long/often he's used Clomid.

My SHBG levels are already high (outside of the range) should this be a concern as well?