Advice please on my recent LAB test results!

[livelonger]

I am new to HRT/etc., so any helpful advice or comments are appreciated.

I'm 44 years of age, male, with history of advanced neurological lyme disease and high diastolic/systolic blood pressure but otherwise in excellent health. I take azithromycin 250 mg bid (continuous, long term therapy), and 80 mg of propranolol (Inderal) qid to control tachycardia and high bp.

Here are my prelim. lab results (draw was 9 A.M. fasting):

Testosterone 208 (reference range: 241-827) ng/dL <--- LOW
Estradiol < 32 (ref. range: 0-54) pg/mL

LH 3.0 (ref. range: 1.5-9.3) mIU/mL <--- LOW
FSH 4.3 (ref. range: 1.6-8.0) mIU/mL
Prolactin 4.6 ng/mL (ref. range: 2-10)
ACTH (a.m.) 10 (reference range: 7-50) pg/mL <--- LOW
TSH (ultrasensitive) 1.90 (ref. range: 0.40 - 4.50 mIU/L)
HGH < 0.1 <--- LOW ?
Cortisol 8.4 (ref. range:4-22) mcg/dL <---LOW

DHEA-S 488 (ref. range: 45-345) mcg/dL <---HIGH
PSA, Total 0.7 (0-4) ng/mL

Enhanced E2/Estradiol - Pending
Free/Bioavailable Testosterone - Pending
IGF-1 - Pending

Cholesterol 246 (reference range: 125-200) mg/dL
HDL 36 mg/dL
LDL 166 mg/dL
Triglycerides 220 (25-150) mg/dL

I was taking 100 mg of dhea daily but will drop dhea entirely since the test results were high.

My preliminary conclusion from these numbers is that I most likely have primary and secondary hypogonadism, as well as secondary adrenal insufficiency.

I should get the rest of the lab results next week. My first impression is to ask for 250 mg testosterone cyp. injections weekly, along with daily hydrocortisone therapy. Any other considerations/recommendations?

Should I consider HGH as well, or other adjunct therapies?

THANKS!

 

[JanSz]

I am new to HRT/etc., so any helpful advice or comments are appreciated.

I'm 44 years of age, male, with history of advanced neurological lyme disease and high diastolic/systolic blood pressure but otherwise in excellent health. I take azithromycin 250 mg bid (continuous, long term therapy), and 80 mg of propranolol (Inderal) qid to control tachycardia and high bp.

Here are my prelim. lab results (draw was 9 A.M. fasting):

Testosterone 208 (reference range: 241-827) ng/dL <--- LOW
Estradiol < 32 (ref. range: 0-54) pg/mL

LH 3.0 (ref. range: 1.5-9.3) mIU/mL <--- LOW
FSH 4.3 (ref. range: 1.6-8.0) mIU/mL
Prolactin 4.6 ng/mL (ref. range: 2-10)
ACTH (a.m.) 10 (reference range: 7-50) pg/mL <--- LOW
TSH (ultrasensitive) 1.90 (ref. range: 0.40 - 4.50 mIU/L)
HGH < 0.1 <--- LOW ?
Cortisol 8.4 (ref. range:4-22) mcg/dL <---LOW

DHEA-S 488 (ref. range: 45-345) mcg/dL <---HIGH
PSA, Total 0.7 (0-4) ng/mL

Enhanced E2/Estradiol - Pending
Free/Bioavailable Testosterone - Pending
IGF-1 - Pending

Cholesterol 246 (reference range: 125-200) mg/dL
HDL 36 mg/dL
LDL 166 mg/dL
Triglycerides 220 (25-150) mg/dL

I was taking 100 mg of dhea daily but will drop dhea entirely since the test results were high.

My preliminary conclusion from these numbers is that I most likely have primary and secondary hypogonadism, as well as secondary adrenal insufficiency.

I should get the rest of the lab results next week. My first impression is to ask for 250 mg testosterone cyp. injections weekly, along with daily hydrocortisone therapy. Any other considerations/recommendations?

Should I consider HGH as well, or other adjunct therapies?

THANKS!

When supplying external Testosterone your goal is
FreeT~250 per dr Shippen
FreeT~300 per dr Delgado
do not test for freeT unless you can go to Quest Diagnostics, blood drawn at Quest and do
Testosterone, Free, Bio/Total (LC/MS/MS)
complete as written name must be on a script.
If you can do that then do also
Estradiol, Free, LC/MS/MS (36169X)
and keep both E2 and freeT slightly below top range
otherwise
use dr Shippen's chart shown on my post #41
http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-2.html
To find starting dose of Testosterone go to table post #40
Do E3D schedule. Use accelerated schedule to get sooner to more steady blood T levels.
Use HCG and keep Liquidex handy
I do T+hcg+liquidex at same sitting, then two days free.
I do 500iu hcg, some do T and 350iu in days between
I do 0.6cc LiqiuDex measured with insuline syringe
You may want to use 0.3cc
Recheck after 6 weeks to 3 months.
4 weeks when on accelerated schedule.
Keep diary of what you are doing.
---------------------------------------------------------
Test for
FreeT3
FreeT4
thyroid antibody
---------------------------------------------------------
Do not drop DHEA pills, you really want to be at about 500-650
---------------------------------------------------------
Cholesterol is not right
possibly use
600mg Red Yeast Rice
and
Super Omega-3 EPA/DHA with Sesame Lignans & Olive Fruit Extract
Super Omega-3 Epa/Dha With Sesame Lignans & Olive Fruit Extract, 120 Softgels
---------------------------------------------------------
Consider doing blood test, see list in post#44
latter also EstroEssence
there are other tests there.
----
Why do not you just add the two below and ask questions latter;
Breast Health Formula, 60 Vegetarian Capsules
Breast Health Formula, use 2 pills, latter 4 pills
----
Resveratrol Caps, 100 Mg 60 Vegetarian Capsules
Resveratrol Caps
100 mg, 60 vegetarian capsules
use 4 pills
---------------------------------------------------------
If you end up with doubts about your adrenals;
20mg/day Cortef divided dose, keep that for 6 months, better a year then try to wean out.
Possibly go to 30 mg Corteff with (infrequently) 10-20mg additional dose on days of high stress, flu etc.
If that does not give you satisfaction
switch to longer lasting cortisone (Medrol) and/or add Florinef.
Make sure you are resting enough.
-------------------------------------------------------------------------------------------------------

 

[cpeil2]

I am new to HRT/etc., so any helpful advice or comments are appreciated.

I'm 44 years of age, male, with history of advanced neurological lyme disease and high diastolic/systolic blood pressure but otherwise in excellent health. I take azithromycin 250 mg bid (continuous, long term therapy), and 80 mg of propranolol (Inderal) qid to control tachycardia and high bp.

Here are my prelim. lab results (draw was 9 A.M. fasting):

Testosterone 208 (reference range: 241-827) ng/dL <--- LOW
Estradiol < 32 (ref. range: 0-54) pg/mL

LH 3.0 (ref. range: 1.5-9.3) mIU/mL <--- LOW
FSH 4.3 (ref. range: 1.6-8.0) mIU/mL
Prolactin 4.6 ng/mL (ref. range: 2-10)
ACTH (a.m.) 10 (reference range: 7-50) pg/mL <--- LOW
TSH (ultrasensitive) 1.90 (ref. range: 0.40 - 4.50 mIU/L)
HGH < 0.1 <--- LOW ?
Cortisol 8.4 (ref. range:4-22) mcg/dL <---LOW

DHEA-S 488 (ref. range: 45-345) mcg/dL <---HIGH
PSA, Total 0.7 (0-4) ng/mL

Enhanced E2/Estradiol - Pending
Free/Bioavailable Testosterone - Pending
IGF-1 - Pending

Cholesterol 246 (reference range: 125-200) mg/dL
HDL 36 mg/dL
LDL 166 mg/dL
Triglycerides 220 (25-150) mg/dL

I was taking 100 mg of dhea daily but will drop dhea entirely since the test results were high.

My preliminary conclusion from these numbers is that I most likely have primary and secondary hypogonadism, as well as secondary adrenal insufficiency.

I should get the rest of the lab results next week. My first impression is to ask for 250 mg testosterone cyp. injections weekly, along with daily hydrocortisone therapy. Any other considerations/recommendations?

Should I consider HGH as well, or other adjunct therapies?

THANKS!

What about your lipid profile? Do you have a plan for bringing that into line? This seems like a priority in view of the arrhythmia and the high BP.

 

[livelonger]

Agreed. My plan is to increase the omega-3 fish oils to 4 g /day; and increase the trans-resveratrols to 300 mg /day. The weekly testosterone shots along with dietary improvements and increased exercise should bring the triglycerides/cholesterol issue under control.

 

[MarkLA]

My preliminary conclusion from these numbers is that I most likely have primary and secondary hypogonadism...

What makes you think you're primary? Usually with primary LH is very high because the body is trying to stimulate non-functioning testicles to produce.

Mark

 

[hardasnails1973]

Agreed. My plan is to increase the omega-3 fish oils to 4 g /day; and increase the trans-resveratrols to 300 mg /day. The weekly testosterone shots along with dietary improvements and increased exercise should bring the triglycerides/cholesterol issue under control.

Yep classic case of metabolic syndrome and insulin resistance at its finest !! metformin might be suggested once glucose test comes back. I would look into glucose tolerance test to rule out prediabetes. Notice no thyroid investgation was ever done ? I bank on low thyroid as source of the problem and addressing that would have may be resolved the entire problem

 

[JanSz]

Yep classic case of metabolic syndrome and insulin resistance at its finest !! metformin might be suggested once glucose test comes back. I would look into glucose tolerance test to rule out prediabetes. Notice no thyroid investgation was ever done ? I bank on low thyroid as source of the problem and addressing that would have may be resolved the entire problem

Livelonger;

Make sure that you also do (post #44)
(GDX - Metabolic Analysis Profile) including (GDX - Cellular Energy Profile)


http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-2.html

Look how mine report looks like;

http://anabolicminds.com/forum/male-anti-aging/77385-jansz-metabolic-analysis.html

 

[livelonger]

Yep classic case of metabolic syndrome and insulin resistance at its finest !! metformin might be suggested once glucose test comes back. I would look into glucose tolerance test to rule out prediabetes. Notice no thyroid investgation was ever done ? I bank on low thyroid as source of the problem and addressing that would have may be resolved the entire problem

My thyroid tests came back (TSH/t3/t4/TPO) in the 'normal range' (but TSH a tad on the low end). Dont have the papers here with me now, or I'd post the numbers.

Why do you think that (thyroid) may account for the 'entire problem'? I'm not clear on how what you mean to say.

 

[livelonger]

Here are the thyroid test details:

TPO < 10.0 (0.0-35.0) IU/mL
Free T3 33.5 (25.0-35.0) %
Free T4 1.5 (0.8-1.8) ng/dL
TSH (ultrasensitive) 1.9 (0.40-4.50) mIU/L

 

[hardasnails1973]

Here are the thyroid test details:

TPO < 10.0 (0.0-35.0) IU/mL
Free T3 33.5 (25.0-35.0) %
Free T4 1.5 (0.8-1.8) ng/dL
TSH (ultrasensitive) 1.9 (0.40-4.50) mIU/L

That is not free t3


WE need to also account your body composition plays a major factor as well as well as genetics. Let say majority of people that have high choleserol is more likely to be low thyroid or high insulin..Glucose tolerance test will rule this out and hope in the future it becomes mandatory testing once a year for every one.

 

[livelonger]

Sorry, I misread the printout. It should have been T3 Uptake (not free T3).

As for the lipid results: Elevated cholesterol (and triglycerides) is strongly associated with low testosterone levels and low GH/IGF-1. There is every reason to believe these lipids will significantly drop after the hormones are returned to healthy levels.

 

[hardasnails1973]

Sorry, I misread the printout. It should have been T3 Uptake (not free T3).

As for the lipid results: Elevated cholesterol (and triglycerides) is strongly associated with low testosterone levels and low GH/IGF-1. There is every reason to believe these lipids will significantly drop after the hormones are returned to healthy levels.

Hormonal imbalances also induce insulin resistance and testostoerone increases insulin sensitivity, but also his life style and many other factors come into play as well..

 

[JanSz]

Sorry, I misread the printout. It should have been T3 Uptake (not free T3).

As for the lipid results: Elevated cholesterol (and triglycerides) is strongly associated with low testosterone levels and low GH/IGF-1. There is every reason to believe these lipids will significantly drop after the hormones are returned to healthy levels.

FreeT3 is important, probably most important of all thyroid numbers, get it.

 

[livelonger]

FreeT3 is important, probably most important of all thyroid numbers, get it.

The doc unfortunately did not order Free T3 (T3 uptake instead which was 33.5 (ref: 25-35) (%).

My Enhanced Estradiol just came back: 18 (ref: 10-40) pg mL. Seems high relative to my T (208). I've been taking 300-400 mg of trans-resveratrols daily - or I'm sure the E would be even higher.

Doc has reversed course and now taken stance that TRT would be harmful to my heart (couldn't believe I heard the words from his mouth). He is a DO, what should I expect? Referred me to an Endo who rejected me cause they don't take my insurance. Back to square one.

Bioavailable T and IGF-1 still pending.

 

[Contraband]

Doc has reversed course and now taken stance that TRT would be harmful to my heart (couldn't believe I heard the words from his mouth).

Bioavailable T and IGF-1 still pending.

Might just be the dumbest thing i have heard in weeks.

Maybe all year actually.

And this is your Doctor.

 

[JanSz]

The doc unfortunately did not order Free T3 (T3 uptake instead which was 33.5 (ref: 25-35) (%).

My Enhanced Estradiol just came back: 18 (ref: 10-40) pg mL. Seems high relative to my T (208). I've been taking 300-400 mg of trans-resveratrols daily - or I'm sure the E would be even higher.

Doc has reversed course and now taken stance that TRT would be harmful to my heart (couldn't believe I heard the words from his mouth). He is a DO, what should I expect? Referred me to an Endo who rejected me cause they don't take my insurance. Back to square one.

Bioavailable T and IGF-1 still pending.

Post #56
how to find another doctor

http://anabolicminds.com/forum/male-anti-aging/66268-jans-bloodtest-april13-2.html

also
can anyone recommend a DR. in the CO springs/denver area? - Anabolic Steroids and Bodybuilding

 

[JanSz]

Might just be the dumbest thing i have heard in weeks.

Maybe all year actually.

And this is your Doctor.

I have good one too.

One of our guys have a medical doctor (teaching professor) for a father.
The father is doing same thing to his son.

In Finland, IIRC.
===========================
Twighligt zone

 

[livelonger]

I just found a Pituitary specialist in my area which I've been able to make an appt. with. I also called my previous internist in another city and he Rx'd me test cyp for pick up at the pharmacy locally, to get my testosterone off of the floor. Hopefully, my mental/physical energy will improve, as it's been a tough battle at times.

It appears to me from the low Testosterone and low LH/FSH/TSH/ACTH/PRL and A.M. Cortisol labs that I have hypogonadism secondary to hypopituitarism.

I'm going to request all the tests be rerun along with the free T3 and more complete metabolics.

One other thing I'm wondering about is Inderal (propranolol) that I take 4x daily (80 mg per dose). I have had a hard time finding info on it's effects on the endocrine system. All I found was a side note in an article about it reducing melatonin production. Does anyone know if propranolol has any other impacts on the the endo system? Specifically, I'm interested in it's impact on LH/FSH/ACTH and Cortisol levels. I'm aware of it's ability to limit thyroid storm.

 

[MarkLA]

I just found a Pituitary specialist in my area which I've been able to make an appt. with. I also called my previous internist in another city and he Rx'd me test cyp for pick up at the pharmacy locally, to get my testosterone off of the floor. Hopefully, my mental/physical energy will improve, as it's been a tough battle at times.

It appears to me from the low Testosterone and low LH/FSH/TSH/ACTH/PRL and A.M. Cortisol labs that I have hypogonadism secondary to hypopituitarism.

I'm going to request all the tests be rerun along with the free T3 and more complete metabolics.

You may want to wait and get the new tests done before you start taking the test cyp otherwise you're not going to have a natural baseline.

Mark

 

[livelonger]

You may want to wait and get the new tests done before you start taking the test cyp otherwise you're not going to have a natural baseline.

Mark

My appt. with the pituitary specialist is over a month away. There is no way I can make it that long, unfortunately.

I can see from these forums that it is going to be a long journey no matter what approach is taken. And, in the end, it looks like (from my very low testoserone level) I'm going to be prescribed T anyway as part of the package.

It should also help to lower the triglyceride's/LDL's and my high BP, as well as get my motivation going again (I noticed it tanked a while back). If I'm lucky, I might even see morning wood again occasionally (been a long long time now).