Labs tests in - Free T low - Need advice on what to do next

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    Labs tests in - Free T low - Need advice on what to do next


    I have been experiencing symptoms of low testosterone for years, low sex drive, problems maintaining an erection, lack of interest, memory problems.

    A year ago, I decided to have my testosterone levels tested after finding that most of my symptoms matched that of Low T.

    Test Results (July 2009)
    Free Testosterone - 27.9 pmol/L (30.9-147.5)

    I was out of the country then and the doctor there prescribed oral testosterone. Tried that for a couple of months with no noticeable effect (understandable due to the difficulty in absorption of oral test). Decided to stop due to concerns of liver damage.

    Got a second set of labs earlier this year.

    Test Results (Mar 2010)
    Total testosterone - 268 (240-950)
    Free Testosterone - 9.4 (9-30)
    Prolactin - 9 (3-13)
    Creatinine - 1.1 (0.6-1.3)

    These labs got me referred to an endocrinologist where I got further tests done.

    Test Results (Apr 2010)
    Total Testosterone - 333 (250-1100)
    Free Testosterone - 69.9 (46-224)
    Bioavailable Test - 153 (110-575)
    SBGH - 16 (7-49)
    Albumin, serum - 4.8 (3.6-5.1)
    Cortisol - 20.7 (4-22)
    FSH - 2.8 (1.6-8.0)
    LH - 3.0 (1.5-9.3)

    Endo was initially reluctant to prescribe anything since my test levels were within "reference rage" albeit at the lower extreme of the range. However, after discussing the situation, he agreed to prescribe 2.5g Androgel daily.
    I tried this for a month with slight improvement in symptoms but nothing significant. After realizing that such a low dose TRT would shut down natural production without providing sufficient exogenous testosterone and thus possibly lowering my testosterone levels, I decided to stop using it until I got a better doctor.

    I got a pituitary and brain contrast MRI. MRI showed no significant findings and results were normal.

    Got a more comprehensive round of labs done

    Lab test June 2010
    Total Testosterone - 14.5 nmol/L (6.0-30.0)
    *Strangely elevated considering the low levels of previous tests. Lab error?

    Free Testosterone - 41.9 pmol/L (30.9-147.5)
    Cortisol - 419 (120-620)
    Oestradiol, serum - 90 (Male reference range <130) *Sensitive test Not Available
    Free T4 - 11.4 (9-25)
    Free T3 - 4.3 (3.5-6.5)
    Vitamin B12 - 263 pmol/L (>185)
    Prolactin - 20.4 (1.6-18.8) *Elevated and higher than previous tests
    FSH - 3.0 (1-12)
    LH - 6.0 (1-12)
    25-hydroxy Vitamin D - 95.7 (60-160)
    Progesterone - 3.0 (0.5-5.0)
    Quantitative HCG (Male) - <2.0 (<2.1)
    Thyroglobulin antibody - <100 (<100)

    Copper - 11.2 (11.8-22.8)
    Zinc - 15.0 (9-18)
    Magnesium - 1.05 (.70-.95)
    Total Bilirubin - 14 (<21)
    Direct Bilirubin - 5 (<8)
    INdirect Bilirubin - 9 (<14)

    CBC - NORMAL

    Glucose - 4.6 (3.9-5.5)
    Sodium - 143 (135-145)
    Potassium - 4.5 (3.5-5.1)
    Chloride - 103 (95.110)
    Creatinine - 96 (50-116)
    Uric Acid - .49 (.18-.47)
    Calcium - 2.4 (2.1-2.55)

    Total Protein - 71 (60-82)
    Albumin - 43 (35-50)
    Globulin - 28 (35-50)
    GGT - 16 (<51)
    AST - 29 (<41)
    ALT - 16 (<51)

    Serum Iron - 21.5 (10-30)
    Serum Homocysteine - 45 (5-15)

    PSA - 0.4 (0-2.5)
    C-Reactive Protein - 0.5 (<1.0 Low Risk)
    HbA1c - 5.4% (6.0% Non-diabetic range)

    Thyroid Stimulating Hormone - 0.89 (0.4-4.7)
    Carcino Embryonic Antigen - 2.9 (<5.1)
    Alpha-feto protein - 3 (<11)
    Rheumatoid Factor - 41 (<20)

    Ferritin - 122 (20-300)
    DHEA-Sulphate - 359 ug/mL (259-596)

    IGF-1 - 225 (117-329)
    Insulin - 4 (<11)

    Based on the lab test results, it looks like my vitamin and mineral levels are not deficient. LH of 6 even seems to be within the optimal range?

    The only surprise thrown up by these results are the total testosterone levels of 14.5 nmol/L which is equivalent to 425 in regular units. Could this be from the androgel even though I had stopped using it a couple of weeks before the test? However, my Free Testerone is still very low and so if the total testosterone results are to be believed, maybe my E2 levels are elevated resulting in T being converted to E? SBGH and Albumin levels are within normal range and relatively low so those aren't the problems.

    Now, I have an appointment with a different endo in a couple of days and I would greatly appreciate any advice on what to do and what questions to ask.
    Should I try to get a sensitive E2 test, total-free-bioavailable testosterone test done just to determine what the actual levels are?
    Do you think that TRT along with HCG would be the best route for me? I'm 27 and would like to have kids in the future, but I'm willing to sacrifice my natural T production if it means felling better and getting out of this funk. After all, there's always deposit at the sperm bank as a matter of last resort in case I'm unable to restart my natural T.

    It's been a difficult year of jumping from doctor to doctor and seemingly getting nowhere. I would appreciate the expert advice of anyone here with some ideas on what I should do.

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    Bump?
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    Quote Originally Posted by sp00ked View Post
    Bump?
    Thyroid is low..
    too much zic supplementation
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Thanks Matrix. I hadn't taken any supplements 1 month prior to the latest lab tests, so no zinc supplementation.

    Is my TSH levels low and could that be the cause of my problems? What do you think of the testosterone levels, am I going down the right path or barking up a wrong tree?

    I just got back from the endo appointment and he is of the opinion that as long as levels are within the reference range, everything is perfectly normal. He didn't even bother to look at the lab results and just dismissed my problems condescendingly.

    As a last gasp option, I'm thinking of seeing Dr Chrisler since I'll be passing by Chicago in a couple of weeks. I heard he comes highly recommended on this board?
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    Quote Originally Posted by sp00ked View Post
    Thanks Matrix. I hadn't taken any supplements 1 month prior to the latest lab tests, so no zinc supplementation.

    Is my TSH levels low and could that be the cause of my problems? What do you think of the testosterone levels, am I going down the right path or barking up a wrong tree?

    I just got back from the endo appointment and he is of the opinion that as long as levels are within the reference range, everything is perfectly normal. He didn't even bother to look at the lab results and just dismissed my problems condescendingly.

    As a last gasp option, I'm thinking of seeing Dr Chrisler since I'll be passing by Chicago in a couple of weeks. I heard he comes highly recommended on this board?
    Sorry that you are being abused by the medical community. You are definitely not alone. Basically, the endos you saw should have their license revoked. Especially the first one that prescribed you 2.5 grams a day. That is just ridiculous. Make sure you let everyone know how inept that doctor is by giving him bad reviews on the various doctor rating sites. Prospective patients do look at those sites and are influenced by the ratings.

    Anyways, you have a few problems going on. First of all, your low normal vit b12 and high homocysteine is possibly pointing to the early stages of a vit b12 deficiency. You need a "Methylmalonic acid" test to rule out a vit b12 deficiency.

    You need to investigate the high rheumatoid factor. A high value is not a good thing to ignore. Most likely, you have an autoimmune disease you are unaware of. Autoimmune disease in men is relatively rare. Here is the kicker: hypogonadism is one of the leading causes of autoimmune diseases in men. Conversely, autoimmune disorders lead to low testosterone levels and increased aromatization. You need to see a GOOD rheumatologist and find out what's going on. Preferably, you need to find one that is familiar with autoimmune diseases in men.

    Lastly, pursue testosterone therapy. If you do indeed have an autoimmune disease, the testosterone should help modulate the disease activity. It should also prevent you from developing more immune system problems. Even if you don't end up having autoimmune problems, your low normal free testosterone and obvious hypogonadism related symptoms are enough to warrant at the very least a trial run of trt. And not that crap 2.5 grams of androgel a day. More like 100mg test cyp a week along with some hcg. Pick up the book "Testosterone for Life" by Abraham Mortengaler (Harvard doctor). It will help reinforce your decision to pursue trt and educate you on proper trt.
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    Wow, Appreciate the great advice weierstrass. I've learnt more from the post than from my past 3 doctor visits combined. The endo literally didn't even bother looking at my test results yesterday.

    My B12 levels are 263 pmol/L or 356 pg/mL (200-900). Is it considered low normal?
    After reading up on the link between high homocysteine and Folic acid/B12 levels, I've decided to take 2500mcg B12 daily + 600mcg Folic Acid. Considering how significant a risk factor it is in cardiovascular disease, I really need to keep it in check and will probably get it tested again in a couple of months.

    Again, great call on hypogonadism and autoimmune disease being closely related. I had no idea until you brought it up and had just brushed off the high rheumatoid factor as being unrelated, which it still could be, but should be looked into.

    Do you think I should see a rheumatologist first before seeing an anti-aging doctor for a trial run of TRT?

    The way I look at TRT is that I might as well do a trial run of 3-6 months and see if it alleviates my symptoms. If it does, then great. If it doesn't, the worse I could do is to just go off it and search for a different explanation. From what I understand, most people have been able to restart their natural production without any problems, especially after such a short cycle.
    Dr Crisler advocates the use of Androgel since it's a daily dose and mimics the natural peaks and troughs of test production. Do you have any reason for choosing test cyp over androgel, besides the cost?

    Again, thanks a lot for all your help!
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    Quote Originally Posted by sp00ked View Post
    Thanks Matrix. I hadn't taken any supplements 1 month prior to the latest lab tests, so no zinc supplementation.

    Is my TSH levels low and could that be the cause of my problems? What do you think of the testosterone levels, am I going down the right path or barking up a wrong tree?

    I just got back from the endo appointment and he is of the opinion that as long as levels are within the reference range, everything is perfectly normal. He didn't even bother to look at the lab results and just dismissed my problems condescendingly.

    As a last gasp option, I'm thinking of seeing Dr Chrisler since I'll be passing by Chicago in a couple of weeks. I heard he comes highly recommended on this board?
    If you are in the area yes he would be good , Dr overbeck is good as well on east coast and takes a extremely comprehensive approach from a holisitic point looking at all facet not just hormones rather gut, immune, brain and lifestyle approaches. I prefer to look for cause not mask it with bandaids. To many guys I run to are on TRT for no reason because dr are just lazy..Dr O takes many participating insurance as well.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
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    Unfortunately, I'm in the Minneapolis so going to the east coast isn't as easy an option for me as Chicago, which is just an 8 hour drive away.

    What do you think of supplements such as Tongkat Ali and tribulus. Are they something worth exploring before TRT?
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    Quote Originally Posted by sp00ked View Post
    Wow, Appreciate the great advice weierstrass. I've learnt more from the post than from my past 3 doctor visits combined. The endo literally didn't even bother looking at my test results yesterday.

    My B12 levels are 263 pmol/L or 356 pg/mL (200-900). Is it considered low normal?
    After reading up on the link between high homocysteine and Folic acid/B12 levels, I've decided to take 2500mcg B12 daily + 600mcg Folic Acid. Considering how significant a risk factor it is in cardiovascular disease, I really need to keep it in check and will probably get it tested again in a couple of months.

    Again, great call on hypogonadism and autoimmune disease being closely related. I had no idea until you brought it up and had just brushed off the high rheumatoid factor as being unrelated, which it still could be, but should be looked into.

    Do you think I should see a rheumatologist first before seeing an anti-aging doctor for a trial run of TRT?

    The way I look at TRT is that I might as well do a trial run of 3-6 months and see if it alleviates my symptoms. If it does, then great. If it doesn't, the worse I could do is to just go off it and search for a different explanation. From what I understand, most people have been able to restart their natural production without any problems, especially after such a short cycle.
    Dr Crisler advocates the use of Androgel since it's a daily dose and mimics the natural peaks and troughs of test production. Do you have any reason for choosing test cyp over androgel, besides the cost?

    Again, thanks a lot for all your help!

    Quest's vit b12 test ranges from 200-1100, so I guessed that it was the same with your test's range. Regardless, your homocysteine levels are high and approximately 50% of people with vit b12 deficiency have normal levels. Without the Methylmalonic acid test you can't know for sure. Supplementing is a good idea.

    See a rheumatologist as soon as possible. It would probably be better to go prior to starting trt, but it shouldn't make that much of a difference.

    My preference for injections is just a personal one (although, a review paper on trt concluded that most men end up preferring injections). Injections are much less of a hassle than daily transdermal applications and there is no chance of transfer to others. Plus, there is a 20-30% chance of the transdermals not absorbing. Injections are the fastest and surest ways to mid/upper normal T levels. If you want to try Androgel first, then try it. Some people are very happy with it. In fact, my brother uses Androgel and is doing great.

    And yes, a trial run of trt will not permanently shut you down. Your levels will return back to base line after approximately the same amount of time that you were on trt.
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    Interestingly for homocysteine levels, increased protein intake has been shown to lower or not affect homocysteine levels. I would have thought higher protein = higher homocysteine.

    My dad tried the long-release, 3 month dose injection of test and he said it hurt like hell. Maybe it's just that particular preparation and large dosage.

    Thanks again for everything. I'm more confident in getting at least a trial run of trt. No 27 year old wants to risk becoming infertile but if it helps me feel better, I'm willing to take the risk
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    Quote Originally Posted by sp00ked View Post
    Unfortunately, I'm in the Minneapolis so going to the east coast isn't as easy an option for me as Chicago, which is just an 8 hour drive away.

    What do you think of supplements such as Tongkat Ali and tribulus. Are they something worth exploring before TRT?
    Would not mess with them 2 unpredictable.
    I am not a medical Dr, please keep in mind that this answer is for information purposes only, and is not intended to diagnose, treat or replace sound medical advice from your physician or health care provider.
  

  
 

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