Up coming Consult with DEFY.... Look at my labs for concerns I should address with Dr Saya.

[Weasel]

While I'm waiting for my consult with Dr Saya would you guys look over my labs and bring to light any concerns that I should bring up.

I'm 31, 6'2" at 230lbs. body fat is around 13-15%
Current protocol is 125mg test cyp weekly and 500iu HCG EOD. No AI. These numbers would have been my close lowest trough point.

My goals for switching to DEFY are to have a better sense of well being, better sleep, maintain/increase lean muscle mass and fat loss.


My concerns so far that i will brine up are: possible sluggish thyroid, prolactin on the high end, and elevated e2. I'm sure this is the wrong test though as they've yet to get it right since 2012 even with the CPT code. I feel better now with higher e2 than I did when the test read 22. Low DHEAS and low VIT D. Ferritin is low. CHOL isn't Ideal.

What else should I be ready to discuss?


TSH 1.43 (0.465-4.68)
T3, REVERSE 14 (8-25)
FREE T3 2.6 (2.3-4.2)
T3 TOTAL 84 (76-181)
FT4 1.19 (.85-2.37)
THYROID PEROXIDASE <1 (<=9)
THYROGLOBIN ANTIBODIES <1(<1)
THYROID PEROXIDASE ANTIBODIES<1 (<=9)

PROGESTERONE 0.3 <=1.4

PSA 0.417(0.0-4.0)

IGF I 200 (53-331)
Z SCORE .06 (2.0)

SHBG 26 (10-50)
DHT 71 (16-79)

DHEA-S 144 (106-464)
VIT D TOTAL 39.2 (30-100) (with 2500mg supplement daily)
B12 651 (194-934)
FERRITIN 17.1 (17.9-464)
TIBC, CALC 390.2 (261-462)
TRANSFERRIN 278.69 (206-381)
IRON 76 (49-181)
IRON SATURATION 19% (11-56)
ALT 40 (13-69)
AST 33 (15-46

TESTOSTERONE TOTAL 699 (300-623)
TESTOSTERONE FREE 169.8 (46-224.0)
LH 0.825 (1.51-9.360
FSH <0.66 (1.55-9.74)
PROLACTIN 12.7 (17.9)

ESTRONE 25 (<=68)
ESTROIL <0.10
ESTRADIOL 42 <=29

CORT AM 9.88(4.5-22.7)

EGFR 78
EGFR- CREATININE 1.1 (.7-1.4)
C-REATIVE PROTEIN <5 (<=10)
GLUCOSE 107 (70-100) always slightly high fasting but good the rest of the day

CHOL 182 (<=200)
HDL 40 (>40)
LDL 129 (<=100)
TRIGLYCERIDE 70 (<150)
HEMOGLOBIN A1C 5.2%
RBC 5.62 (3.95-5.79)
HEMATOCRIT 49 (38-52)
HOMOCYSTEINE 5.9 (<=11.4)

 

[ERO]

For better sleep, ask about supplementing with DHEA at dinner time. DHEA opposes Cortisol, and a Cortisol spike at night instead of when you get up in the AM is the cause of a lot of sleep issues. Everybody is different, but my sleep improved big-time when I started taking my DHEA with dinner instead of with breakfast.

 

[Vince Carter]

I want to comment on the Prolactin...it's not high. A common misnomer is that low is good, and it's not. I'm dealing with low Prolactin now and investigating it as a low libido source. I don't think anyone is medically going to concur that you have an issue in that single area.

I think given the lab range <=29 you did in fact get the correct Estradiol LC/MS/MS test. It's elevated especially in relation to your TT.
DHEA is something to supplement and Dr Saya recommends it, the oral micronized seems to be the best delivery system for that.

 

[Weasel]

Thanks guys,

Anyone care to comment on Thyroid numbers? If I remember right, there's guy that goes by Chris something around here they is the resident thyroid guru. I was hoping he would chime in.

 

[John O'Connor]

Thyroid looks good. I'm not familiar with reading reverse T3, but yours seems relatively low, which is what you want per this video https://www.youtube.com/watch?v=ol16BZqVM48

Vitamin D is involved in absorbing Iron (ferritin), calcium, zinc, magnesium, phosporus. So getting Vitamin D higher (above 50 is good, and 65-80 is optimal) could improve those numbers.
https://en.wikipedia.org/wiki/Vitamin_D

Also - you would really struggle to have 13-15% body fat if your thyroid was lagging. Weight gain is one of the most common indicators that thyroid is off.

 

[Weasel]

Thanks John,

Anyone else care to comment, thyroid in particular?

IGF-1 numbers? would I see any benefit from Sermorelin?

 

[ERO]

Many of the members here have used the Sermorelin and none of us recommend it. Very expensive, no real "bang for the buck."

 

[Weasel]

Many of the members here have used the Sermorelin and none of us recommend it. Very expensive, no real "bang for the buck."

Excellent info, Just what I was wanting. Thanks ERO.

 

[Vettester Chris]

The FT3/RT3 ratio is a tad bit low at 18.6, but it's not alarming. Would be better though if it was > 20. As noted, there probably needs to be some attention directed towards the adrenals and your cortisol. Get that worked through and that will probably help the RT3 subject. However, the 1x morning cortisol serum lab isn't sufficient. To see the full picture get a 4x saliva kit w/ DHEA correlation analysis. Want to see not only the AM, but the 2 mid-day and evening samples.

Thyroid levels (FT3 and FT4) are low. Best is when they're both in the 50% to 80% of reference range, HOWEVER, that of course is WHEN FT3 is adequately getting into the cells. Cortisol and Iron can usually be the primary culprits preventing this from happening. Knowing you have an initial concern with your adrenals, this should be considered when you and your physician are, or might be considering thyroid treatment/medication. If FT3 can't get into the body, then it pools, and then you have other problems. Again, keep this in mind, and research it tooth and nail to understand how it all comes together. The thyroid can be a little bit complicated, because it is quite dependent on other variables like cortisol, iron/ferritin, D3, mag, etc., to get into the body.

 

[Vettester Chris]

Also, antibodies look great!

 

[Weasel]

Thank you Chris, Those were my initial thoughts when I did a little digging. These Saliva results show my cort as being on the high end all day. Perhaps the culprit?


What are your thoughts on Iodine supplementation?

Here are my saliva cortisol results from a couple months ago.


Test Name Result Units Range
Cortisol (Saliva) 9.4 ng/mL 3.7-9.5 (morning)
Cortisol (Saliva) 2.5 ng/mL 1.2-3.0 (noon)
Cortisol (Saliva) 1.4 ng/mL 0.6-1.9 (evening)
Cortisol (Saliva) 0.7 ng/mL 0.4-1.0 (night

 

[Vettester Chris]

Thank you Chris, Those were my initial thoughts when I did a little digging. These Saliva results show my cort as being on the high end all day. Perhaps the culprit?


What are your thoughts on Iodine supplementation?

Here are my saliva cortisol results from a couple months ago.


Test Name Result Units Range
Cortisol (Saliva) 9.4 ng/mL 3.7-9.5 (morning)
Cortisol (Saliva) 2.5 ng/mL 1.2-3.0 (noon)
Cortisol (Saliva) 1.4 ng/mL 0.6-1.9 (evening)
Cortisol (Saliva) 0.7 ng/mL 0.4-1.0 (night

By chance did they provide a DHEA result with correlation to cortisol analysis. IMO, I think the cortisol trend is pretty darn good .. The evening is mid-range of the reference. Your other DHEA serum lab shows on the low end. As mentioned by others, I think I would talk to your physician about supplementing DHEA, and I totally agree that administering at night time, or even at dinner time would be a good idea to try.

Iodine IMO is key, as is selenium. I had a period of subclinical hypo, where my TSH was over 5. FT3 and FT4 for the most part looked OK. Just taking the kelp put the TSH in the mid 2's with nothing else. I don't think a lot of people (including myself) convert adequately from T4 to T3. First time I took it, I had a warm sensation that same night. I still get that on occasion.

 

[Weasel]

By chance did they provide a DHEA result with correlation to cortisol analysis. IMO, I think the cortisol trend is pretty darn good .. The evening is mid-range of the reference. Your other DHEA serum lab shows on the low end. As mentioned by others, I think I would talk to your physician about supplementing DHEA, and I totally agree that administering at night time, or even at dinner time would be a good idea to try.

Iodine IMO is key, as is selenium. I had a period of subclinical hypo, where my TSH was over 5. FT3 and FT4 for the most part looked OK. Just taking the kelp put the TSH in the mid 2's with nothing else. I don't think a lot of people (including myself) convert adequately from T4 to T3. First time I took it, I had a warm sensation that same night. I still get that on occasion.

Im not sure what I would be looking for with the DHEA and CORT correlation analysis so I'm going to say no. I will be discussing DHEA with my Dr. Saya as well as Iodine.

Chris, What would you suggest for a daily dose of Iodine? I've read things that recommend both ends of the spectrum. Some as high as 50mg daily to load and others saying that large quantities will CAUSE hypthyroidism.

Whats your take?

 

[Vettester Chris]

Im not sure what I would be looking for with the DHEA and CORT correlation analysis so I'm going to say no. I will be discussing DHEA with my Dr. Saya as well as Iodine.

Chris, What would you suggest for a daily dose of Iodine? I've read things that recommend both ends of the spectrum. Some as high as 50mg daily to load and others saying that large quantities will CAUSE hypthyroidism.

Whats your take?

The DHEA/Cortisol correlation will provide a greater snapshot of how the adrenals are handling stress. Depending on the amount of stress one is dealing with, the body will obviously require more cortisol. Like most things, it's not like there's an endless amount of this hormone just sitting idle. It comes from Pregnenolone ... Pregnenolone is the foundation for both cortisol and DHEA.

When demand is high for cortisol, Pregnenolone will convert more that pathway, and DHEA will suffer. If you've heard anything about Pregnenolone Steal (?), this taps into that subject ... Dr. Lam is a good resource to study on this, and ZRT Labs will have more on the correlation analysis. The STTM book has a really great section just devoted to this subject, and going in-depth on the circadian profile and different scenarios thereof.

On the Iodine ... Well, you'll be talking with Dr. Saya, so you have a real pro at your disposal to talk with. I'd suggest keeping it simple. There are some people and even doctor protocols that suggest administering massive doses. For me, 1 tablet of 225mcg Kelp EOD is fine. I think that and a small amount of selenium is the ticket for supplements, then of course any thyroid meds if prescribed ... Hope that helps

 

[Weasel]

The DHEA/Cortisol correlation will provide a greater snapshot of how the adrenals are handling stress. Depending on the amount of stress one is dealing with, the body will obviously require more cortisol. Like most things, it's not like there's an endless amount of this hormone just sitting idle. It comes from Pregnenolone ... Pregnenolone is the foundation for both cortisol and DHEA.

When demand is high for cortisol, Pregnenolone will convert more that pathway, and DHEA will suffer. If you've heard anything about Pregnenolone Steal (?), this taps into that subject ... Dr. Lam is a good resource to study on this, and ZRT Labs will have more on the correlation analysis. The STTM book has a really great section just devoted to this subject, and going in-depth on the circadian profile and different scenarios thereof.

On the Iodine ... Well, you'll be talking with Dr. Saya, so you have a real pro at your disposal to talk with. I'd suggest keeping it simple. There are some people and even doctor protocols that suggest administering massive doses. For me, 1 tablet of 225mcg Kelp EOD is fine. I think that and a small amount of selenium is the ticket for supplements, then of course any thyroid meds if prescribed ... Hope that helps

Thanks Chris, Much appreciated.

 

[Weasel]

OK here's my list of concerns for Dr Saya.

Ferritin (iron supplement?)
Sluggish Thyroid (cause/cure)
Fasting glucose elevated
AI (necessary)
Vit D
DHEA( supplement)
CHOL

What other concerns should I be addressing with him? I just want to make sure I've got my ducks in a row when my appt comes up. I always seem to forget things until after the fact.

Thanks guys.

 

[Fireproof]

OK here's my list of concerns for Dr Saya.

Ferritin (iron supplement?)
Sluggish Thyroid (cause/cure)
Fasting glucose elevated
AI (necessary)
Vit D
DHEA( supplement)
CHOL

What other concerns should I be addressing with him? I just want to make sure I've got my ducks in a row when my appt comes up. I always seem to forget things until after the fact.

Thanks guys.

He'll consider and comment on just about everything as long as there are lab results to provide data. My one mistake was I should've asked for a full thyroid panel. I've been on thyroid medication and want him to start overseeing that as well, but didn't think to test for Free T3 and Free T4 - therefore he didn't have enough info to assess at the time. So we'll be adding that to my follow up labs...

 

[Weasel]

He'll consider and comment on just about everything as long as there are lab results to provide data. My one mistake was I should've asked for a full thyroid panel. I've been on thyroid medication and want him to start overseeing that as well, but didn't think to test for Free T3 and Free T4 - therefore he didn't have enough info to assess at the time. So we'll be adding that to my follow up labs...

That's great to hear. They have every lab ever ran on me dating back to 2012 prior to TRT. Over 65 pages!

I cannot wait to meet with a Dr. that knows what they are doing and will actually address concerns. It will be a different experience for me...

 

[Nelson Vergel]

Prolactin is fine. Free T3 on the low side of the range. Ferritin low. Free T is good at above 2% of TT. Your LH tells me you could increase your T dose for full suppression of LH. Hematocrit is good, so is estradiol. HDL is on the low side but that may be TRT induced. Liver and kidneys good.

http://www.parkhurstexchange.com/hematology/2010-03-09?zid=

 

[Weasel]

Thanks for the response Nelson.

If I begin iron supplementation, do I run the risk of increasing Hemoglobin and hemocrit?

Any recommendations for a good Iron supplement?