29 yr old, candidate for TRT?

[atlien2488]

Total T: 291
free T: (Last time was 9) For some reason can’t see it on this lab report but I have an apt today to talk to doc, he has the official copy
LH: 2.2 (1.7-8.6)
Prolactin: 5.1 (4-15.2)
estradiol: 6.4 (7.6-42) Low
SHBG: 32 (16.5-56)

I'm 29, very active and this year so far have felt really ****ty. Anyone with experience can let me know what they think of those numbers I would be very appreciative. thanks.

 

[Laxarcher13]

I’m seeing an endo for it right now. Trt is healthy, it’s like taking a super-vitamin. I’m just saying this Incase your on the fence. Try your best to be prescribed

 

[JVee63]

Total T: 291
free T: (Last time was 9) For some reason can’t see it on this lab report but I have an apt today to talk to doc, he has the official copy
LH: 2.2 (1.7-8.6)
Prolactin: 5.1 (4-15.2)
estradiol: 6.4 (7.6-42) Low
SHBG: 32 (16.5-56)

I'm 29, very active and this year so far have felt really ****ty. Anyone with experience can let me know what they think of those numbers I would be very appreciative. thanks.

I've been on trt for 10 years, so I have no problem with it. With that said, exhaust all possible causes before beginning trt. It is not a panacea and I would hate for you to have to commit yourself to injecting for the next 50 years.

 

[JVee63]

I’m seeing an endo for it right now. Trt is healthy, it’s like taking a super-vitamin. I’m just saying this Incase your on the fence. Try your best to be prescribed

This is not really true at all. Trt as prescribed and followed by a vast majority of patients is not done properly and can be quite unhealthy.

 

[atlien2488]

Yeah I want to avoid it if I can but what other options are there? Clomid mono therapy? If I felt okay I wouldn't really think twice about the numbers but I really don't so I'm still on the fence about it.

 

[trn450]

Yeah I want to avoid it if I can but what other options are there? Clomid mono therapy? If I felt okay I wouldn't really think twice about the numbers but I really don't so I'm still on the fence about it.

What are your primary symptoms? Feeling like **** is very vague.

How is your sleep?

What is your body fat percentage? (don't guess, people suck at guessing)

How much alcohol do you drink?

Do you have prior head injuries?

Aside of lifestyle, have you run prior cycles? When was your last?

What time of day did you have the labs drawn? Should be drawn at about 8:00 AM or they are not going to be reliable.

Is this your first or second (confirmatory) testosterone check?

Did they also check FSH/LH? If so, what were the values?

 

[trn450]

This is not really true at all. Trt as prescribed and followed by a vast majority of patients is not done properly and can be quite unhealthy.

I'm not sure unhealthy is the word you're looking for. But, you can create problems with it.

The VA did a recent study that looked at people who were (a) untreated, (b) treated but with ineffectively low doses, and (c) adequately treated. In a progressive fashion, the better a person was treated the better the outcomes -- including cardiovascular. So, unhealthy is likely not the correct word in the context of legitimate "replacement".

 

[JVee63]

I'm not sure unhealthy is the word you're looking for. But, you can create problems with it.

The VA did a recent study that looked at people who were (a) untreated, (b) treated but with ineffectively low doses, and (c) adequately treated. In a progressive fashion, the better a person was treated the better the outcomes -- including cardiovascular. So, unhealthy is likely not the correct word in the context of legitimate "replacement".

Unchecked H&H, poor knowlede of the proper use of AI's and yoyoing hormone levels due to poor implementation can all lead to physical and or psychological issues that are in fact unhealthy.

 

[atlien2488]

Most likely gonna do it with my circumstance

Full numbers:
Still need to get t3 and further thyroid scores

Total T: 291 (264-916)
free T: 9 (9.3-26.5)
LH: 2.2 (1.7-8.6)
Prolactin: 5.1 (4-15.2)
estradiol: 6.4 (7.6-42) Low
SHBG: 32 (16.5-56)
TSH- .473 (.45-5.0)

CMP:
Glucose: 81 (65-99)
Urea Nitrogen: 12 (6-20)
Creatinine: 1.09 (.76-1.27)
EGFR (non black)- 92 (>59ml/min/1.73)
EGFR (black)- 106 (>59ml/min/1.73)
BUN/Creatinine Ratio- 11 (9-20)
Sodium- 141 (134-144)
Potassium 4.0 (3.5-5.2)
Chloride- 102 (96-106)
Total CO2- 25 (18-29 mmol/L)
Anion GAP 14 (10-18)
Calcium- 9.0 (8.7- 10.2)
Protein, TOTAL- 6.2 (6.0-8.5)
Albumin, S 4.3 (3.5-5.5)
Globulin 1.9 (1.5-4.5)
A/G 2.3 (1.2-2.2) High
Bilirubin 0.5 (0.0-1.2)
Alkptase 38 (39-117)
AST (GOT) 19 (0-40 IU/L)
ALT (GPT) 23 (0-44 IU/L)

CBC:
WBC:5.8 (3.4-10.8)
RBC: 4.77 (4.14-5.80)
HGB: 14.9 (12.6-17.7)

HCT: 42.3 (37.5-51%)
MCV: 89 (79-97)
MCH: 31.2 (26.6-33)
MCHC: 35.2 (31.5-35.7)
RDW: 13.4 (12.3-15.4)
Placelet CT: 216 (150-379)

MY Lipid profile is skewed because I accidently ate before this particular test. My doctor said my values were normal considering how soon after I took it
:
Cholesterol: 193 (100-199)
Triglyceride 164 (H) (0-149)
HDL Cholesterol:37 (L) (>39mg/dl)
VLDL: 33 (5-40)
LDL Cholesterol : 123 (H) (0-99)
CHOL/HDL Ratio 5.2 (H) (0.0-5.0 units)

 

[The Matrix]

Multiple markers are pointing low cortisol as well as hypochlorhidria. These factors will leaky to high probability of dysbiosis of the bowel and yeast which can cause issues with liver enzyme and gi mucosa barrier intergrity. I see this pattern in heavy metals as well. If you are at the VA, where were you stationed if you went over seas. I see a lot of soldiers who are loaded in xylene, benzene and other petroleum toxins from being around burning oil fields. Full evaluation of lifestyle, emotional, structure,
environmental as well as pathogenic imbalances need to be investigated.
These all can have impact on HPTA.

 

[trn450]

Unchecked H&H, poor knowlede of the proper use of AI's and yoyoing hormone levels due to poor implementation can all lead to physical and or psychological issues that are in fact unhealthy.

Sure, we can come up with an extreme case that's bad. Just like drinking too much water, too fast is bad for you.

I've worked as a physician inside the VA Healthcare system. I am fully confident that most of those physicians responsible for that 80,000+ vets on TRT fell on the side of relatively incompetent in TRT implementation. Yet, even the people who were treated inappropriately did better than those who were not treated. A truly and symptomatic hypogonadal person, in my estimation, is likely better off physiologically and absolutely better off psychologically than someone who is untreated, even under less-than-ideal circumstances the majority of the time.

Now, if we go to the other extreme that BBers on these forums do where they're trying to get the largest possible dose that their physician is willing to prescribe, and that is likely outside of their bodies own physiologic norms even if technically near the upper limit of the reference range, then sure... excess T -> E conversion, drug-induced polycythemia, etc. can cause some detrimental effects. Would they be deleterious? I'm not sure I can answer that question. It's plausible to suggest, but I'm still not sure that's true.

Psychological issues in baseline psychologically normal males is not something I'd be concerned with. There is no shortage of studies already demonstrating that testosterone induced "roid rage" is a myth. But, when it comes to anxiety and depression BDI scores improve about 10 points on average after therapy is initiating--and they persist! That's often the difference between no depression and depression, or "I want to kill myself depression" and "I just feel down". Huuuuuuge differences.

The biggest thing people have to risk is starting TRT when it's not necessary. That's what people should be avoiding. And, physicians who play loose with peoples HPGA to keep patients happy are doing them a disservice and I'd argue violating their fundamental oaths.

 

[trn450]

Multiple markers are pointing low cortisol as well as hypochlorhidria. These factors will leaky to high probability of dysbiosis of the bowel and yeast which can cause issues with liver enzyme and gi mucosa barrier intergrity. I see this pattern in heavy metals as well. If you are at the VA, where were you stationed if you went over seas. I see a lot of soldiers who are loaded in xylene, benzene and other petroleum toxins from being around burning oil fields. Full evaluation of lifestyle, emotional, structure,
environmental as well as pathogenic imbalances need to be investigated.
These all can have impact on HPTA.

The are of medicine (at least it seems mostly closely aligned with functional medicine / naturopathy based on what I've read) you're involved in is still new to me. Learning more as time allows. Would you be willing to elaborate, or at least dictate the thought process, on how you gather low cortisol and hypochloridia from that lab panel?

 

[trn450]

Most likely gonna do it with my circumstance

Full numbers:
Still need to get t3 and further thyroid scores

Total T: 291 (264-916)
free T: 9 (9.3-26.5)
LH: 2.2 (1.7-8.6)
Prolactin: 5.1 (4-15.2)
estradiol: 6.4 (7.6-42) Low
SHBG: 32 (16.5-56)

I'll let The Matrix elaborate, if he sees fit on the rest. I personally didn't see anything too remarkable the CMP, CBC, and TSH.

But, although many people would decry this as "normal" due to the fact that the total T is within the reference range, I'm one of the few who sees evidence of a central hypogonadism pattern in these numbers. I'm more suspicious in total T values < 400 in young males, and especially values in the 200s where LH is inappropriately low (albeit low-normal).

Having said that, your physician is the one who has to diagnose this in the context of your total health history and symptoms.

P.S. Don't forget that if a diagnosis of central hypogonadism is made, a pituitary MRI is indicated. It's a pet peeve of mine that this is often left out of the workup. Sure, the prevalence is low, but I personally wouldn't want to miss a pituitary tumor (which doesn't necessarily have to be an active prolactinoma, BTW).

 

[atlien2488]

Yeah ive been eating really healthy for awhile, i meditate, exercise, hydrate constantly....been eating a lot of healthy fats and i live in the pac. Nw where theres no pollution. Never worked overseas with heavy metals or anything like that...
And yeah i ive been dealing with a great deal of depression, anxiety and foggy headedness. Im gonna go through with it and see if i do a complete 180. Some guilty feelings and overwhelmed by the responsibility but its whats best for me i think...my numbers have been really low for awhile and ive felt this way long before i was getting comprehensive tests so hopefully things go well..

 

[trn450]

Yeah ive been eating really healthy for awhile, i meditate, exercise, hydrate constantly....been eating a lot of healthy fats and i live in the pac. Nw where theres no pollution. Never worked overseas with heavy metals or anything like that...
And yeah i ive been dealing with a great deal of depression, anxiety and foggy headedness. Im gonna go through with it and see if i do a complete 180. Some guilty feelings and overwhelmed by the responsibility but its whats best for me i think...my numbers have been really low for awhile and ive felt this way long before i was getting comprehensive tests so hopefully things go well..

I killed my HPGA at a young age due to the pro hormones in the early 2000s. Left me an absolute wreck for about 5 years. The anxiety and depression alone hit a point that it was almost crippling. Getting on TRT literally turned my life around. 100mg/wk and I was a new man.

If a person has done their diligence in the workup and have lifestyle optimized, and are symptomatic then I'm a huge advocate for taking the next step and starting out on TRT. Like I said, it turned my life around and I've seen it do the same for others.

 

[atlien2488]

Thanks trn.....thats reassuring. How often do you take hcg if at all with the trt? We had discussed taking hcg only but my doc says its pretty hit or miss in that regard

 

[The Matrix]

MCHC is on the high side of normal.
There may be a functional b6 deficiency present.
This would often result in the up regulation of the CBS Pathway due to increased of oxdiative stress
Globulin levels are low from low stomach acid
A/g ratio going high is body trying to unload somethings or could be cellular dehydration
Platelets are tanked and alk phos is low
Alk phos Low usually means issue with LPS (lipopolysacchrides) coming from
Heavy metals or gut dysbiosis.
I would suggest an organic acid test by Great Plains and Dutch hormone profile complete
Hormone profile urine. This helps to complete the full picture in complex cases.
It’s all roses and picket fence, but In many cases TRT is just like any other band aid approach it only holds for a little while. If you are over 35 then I say go for it. A lot of doctors, I am training are holding off on TRT and looking to find the root cause instead of jumping on TRT band wagon

 

[trn450]

Thanks trn.....thats reassuring. How often do you take hcg if at all with the trt? We had discussed taking hcg only but my doc says its pretty hit or miss in that regard

I personally have not been using HCG. I enjoy the shrunken testicles and my libido is mostly good so long as I have E under control. They're much less cumbersome. lol. At 100mg/wk, I basically only need to drop a 0.5mg tab of anastrozole every once in a while to keep things under control. When I'm leaner, I basically don't even need it. I have gone years without needing a single dose of anti-E. AT one point I ran as high as 200mg/wk for TRT at one point, and I was constantly battling estrogen... wasn't worth it for me, personally. I didn't want to do the whole T/HCG/AI combo if I didn't have to.

 

[trn450]

MCHC is on the high side of normal.
There may be a functional b6 deficiency present.
This would often result in the up regulation of the CBS Pathway due to increased of oxdiative stress
Globulin levels are low from low stomach acid
A/g ratio going high is body trying to unload somethings or could be cellular dehydration
Platelets are tanked and alk phos is low
Alk phos Low usually means issue with LPS (lipopolysacchrides) coming from
Heavy metals or gut dysbiosis.
I would suggest an organic acid test by Great Plains and Dutch hormone profile complete
Hormone profile urine. This helps to complete the full picture in complex cases.
It’s all roses and picket fence, but In many cases TRT is just like any other band aid approach it only holds for a little while. If you are over 35 then I say go for it. A lot of doctors, I am training are holding off on TRT and looking to find the root cause instead of jumping on TRT band wagon

Interesting, thanks for your take. Many of these interpretations are completely new to me. I'm assuming that there are well defined mechanisms for most of these in physiology texts. I'll have to look for them.

I've got to say, the one that really throws me off is the idea that platelet count of 216 is "tanked". o_0 That looks like as normal a platelet count as I've ever seen.

Having said that, if you're actually having success in reversing things like long-term drug-induced central hypogonadism that's pretty impressive and you should be publishing. At a minimum case reports.