Secondary Hypogonadism Protocol

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  1. Secondary Hypogonadism Protocol


    Hi,

    First post here :-)

    I've been reading messages for the last few days and getting educated. I'm 35, my T is 187 (165 on another test day), sex drive non-existent so I know I need help. I have no steriod history, not taking any other meds. I did take propecia for a short time a few years ago, but do not now.

    I had blood work done and saw an Endo already. I have LH of 2.3. I had a Pituitary MRI which came back normal, so the diagnosis Idiopathic Secondary Hypogonadism. Idiopathic = it's low but we don't know why.

    I see a new doc on Sat and am going to ask him to test Estradiol to make sure that's not involved. I'm annoyed the first doc did not check this. I figure I should be prepared when I go to see the second doc so I can manage the process and tell him what I think the troubleshooting methodology should be/what the treatment should be.

    My goal is to get into the normal range -- maybe 600-900 T without screwing up the rest of my system. If this can be done without directly taking T forever, great. If not then I'll take the T.

    Here's what I'm thinking:

    1. If Estradiol >30 ask for Arimidex 0.25mg E3D. Then should I wait to see if this increases my natural T or should I get T now as well?

    2. If Estradiol <30
    a. Ask for 10% compounded cream. I have insurance, but they are a PITA getting them to pay for Androgel. I'm ok paying out of pocket and like that there's less volume of the stuff to apply. I'm trying to minimize needles.

    b. Check T in 3 weeks. Adjust dosage up or down.

    c. Check again in 2 months. If OK, ask for HcG 250iu E3D. (I know this is a needle).

    I'd appreciate any suggestions. I know FAR more than I did a week ago from my reading but there's a lot to learn.

    Following is my bloodwork:

    I should also add that I weight train and eat protein/low carb. For some reason, the docs like to stick me in the office without telling me to fast first. Thus I think the BUN would probably be closer to normal if I were fasting.

    I'm putting a ** near anything out of range.

    Glucose 86
    Sodium 142
    Potassium 3.7
    Chloride 101
    Carbon Dioxide 27
    Anion Gap 14
    **UREA Nitrogen 35
    Creatinine 1.2
    Calcium 9.8
    Bilirubin, total 0.3
    Protein Total 7.0
    Albumin 4.7
    Alkaline Phosphotase 82
    **Aspartate Aminotransfera 47
    **Alanine Aminotransferase 54

    Cortisol 15.3
    FSH 5.6
    LH 2.3

    Prolactin 10.5

    Thyroxine 6.5
    T Uptake 31.0
    Adjusted T4 6.7
    TSH 1.26

    **Testosterone Total 165
    **Testosterone Free 20.7
    **Testosterone Free 1.25%

    Somatomedin-C (IGF-1) 239

    PSA 0.12

    WBC 5.2
    RBC 4.86
    Hemoglobin 15.4
    Hemocrit 47.1
    MCV 96.9
    MCH 31.7
    MCHC 32.8
    RBC Distribution Width 13.7
    Platelet Count 156000
    Mean Platelet Vol 9.4

    Diffs Automated

    Polys 53
    Lymphs 28
    Monos 7
    Eos 12
    Basos 1
    ABS Polys 2.7
    ABS Lymphs 1.5
    ABS Monos 0.4
    **ABS EOS 0.6
    ABS Basos 0.1
    RBC Morphology Normal
    Type of Differential Auto


  2. Quote Originally Posted by MarkLA View Post
    Hi,

    First post here :-)

    I've been reading messages for the last few days and getting educated. I'm 35, my T is 187 (165 on another test day), sex drive non-existent so I know I need help. I have no steriod history, not taking any other meds. I did take propecia for a short time a few years ago, but do not now.

    I had blood work done and saw an Endo already. I have LH of 2.3. I had a Pituitary MRI which came back normal, so the diagnosis Idiopathic Secondary Hypogonadism. Idiopathic = it's low but we don't know why.

    I see a new doc on Sat and am going to ask him to test Estradiol to make sure that's not involved. I'm annoyed the first doc did not check this. I figure I should be prepared when I go to see the second doc so I can manage the process and tell him what I think the troubleshooting methodology should be/what the treatment should be.

    My goal is to get into the normal range -- maybe 600-900 T without screwing up the rest of my system. If this can be done without directly taking T forever, great. If not then I'll take the T.

    Here's what I'm thinking:

    1. If Estradiol >30 ask for Arimidex 0.25mg E3D. Then should I wait to see if this increases my natural T or should I get T now as well?

    2. If Estradiol <30
    a. Ask for 10% compounded cream. I have insurance, but they are a PITA getting them to pay for Androgel. I'm ok paying out of pocket and like that there's less volume of the stuff to apply. I'm trying to minimize needles.

    b. Check T in 3 weeks. Adjust dosage up or down.

    c. Check again in 2 months. If OK, ask for HcG 250iu E3D. (I know this is a needle).

    I'd appreciate any suggestions. I know FAR more than I did a week ago from my reading but there's a lot to learn.

    Following is my bloodwork:

    I should also add that I weight train and eat protein/low carb. For some reason, the docs like to stick me in the office without telling me to fast first. Thus I think the BUN would probably be closer to normal if I were fasting.

    I'm putting a ** near anything out of range.

    Glucose 86
    Sodium 142
    Potassium 3.7
    Chloride 101
    Carbon Dioxide 27
    Anion Gap 14
    **UREA Nitrogen 35
    Creatinine 1.2
    Calcium 9.8
    Bilirubin, total 0.3
    Protein Total 7.0
    Albumin 4.7
    Alkaline Phosphotase 82
    **Aspartate Aminotransfera 47
    **Alanine Aminotransferase 54

    Cortisol 15.3
    FSH 5.6
    LH 2.3

    Prolactin 10.5

    Thyroxine 6.5
    T Uptake 31.0
    Adjusted T4 6.7
    TSH 1.26

    **Testosterone Total 165
    **Testosterone Free 20.7
    **Testosterone Free 1.25%

    Somatomedin-C (IGF-1) 239

    PSA 0.12

    WBC 5.2
    RBC 4.86
    Hemoglobin 15.4
    Hemocrit 47.1
    MCV 96.9
    MCH 31.7
    MCHC 32.8
    RBC Distribution Width 13.7
    Platelet Count 156000
    Mean Platelet Vol 9.4

    Diffs Automated

    Polys 53
    Lymphs 28
    Monos 7
    Eos 12
    Basos 1
    ABS Polys 2.7
    ABS Lymphs 1.5
    ABS Monos 0.4
    **ABS EOS 0.6
    ABS Basos 0.1
    RBC Morphology Normal
    Type of Differential Auto
    ranges be nice !!
    •   
       


  3. **Testosterone Total 165
    **Testosterone Free 20.7
    **Testosterone Free 1.25%

    We need ranges.

    Assuming standard ranges of FT, that isn't all that bad as TT.

    Estrogen isn't the problem buddy with a TT of that low. There is no way your E2 level can be that high with that little of aromatization going on plus a better FT level compared to TT. Estrogen alone doesn't cause hypogonadism directly, although it can play a part.

  4. I am also curious to know how your DR arrived at the conclusion of secondary hypogonadism with those LH and FSH numbers, given pituitary came back fine.

  5. Quote Originally Posted by plymouth city View Post
    **Testosterone Total 165
    **Testosterone Free 20.7
    **Testosterone Free 1.25%

    We need ranges.

    Assuming standard ranges of FT, that isn't all that bad as TT.

    Estrogen isn't the problem buddy with a TT of that low. There is no way your E2 level can be that high with that little of aromatization going on plus a better FT level compared to TT. Estrogen alone doesn't cause hypogonadism directly, although it can play a part.
    Here we go with ranges. I will include the non T ones too..

    Testosterone 165 ng/dL (range 250-1100)
    Testosterone Free 20.7 pg/mL (range 35-155)
    Testosterone Free % 1.25 (range 1.5-2.2)

    Somatomedin-C 239 ng/mL (range 106-255)
    Cortisol 15.3 MCG/DL (range 6-19 MCG/DL Morning, 3-14 Afternoon. This was afternoon)
    FSH 5.6 MIU/ML (Males 1 to 8 MIU/ML)
    LH 2.3 MIU/ML (Males 2-12 MIU/ML)
    Prolactin 10.5 NG/ML (range 3.0-14.7)
    Thyroxine 6.5 MCG/DL (range 4.5-12.5)
    T Uptake 31.0% (range 25-35)
    Adjusted T4 6.7 MCG/DL (range 4.4-11.4)
    TSH 1.26 MCU/ML (range 0.39-4.60)

    I appreciate your help.

    Mark

  6. Quote Originally Posted by plymouth city View Post
    I am also curious to know how your DR arrived at the conclusion of secondary hypogonadism with those LH and FSH numbers, given pituitary came back fine.
    The logic was:

    1. Total T is below the range. I have 165 ng/dL and range is 250-1100. Therefore diagnosis of hypogonadism. Plus I'm 35 not 75, so I'd figure I should be closer to the top of the range than the bottom.

    2. Primary or Secondary: The testicles produce T because they get the LH signal from the pituitary. If the problem was in the testicles (Primary hypogonadism) then we'd expect to see a high LH value. i.e. The testicles are getting LH but not doing their job and producing T, so the body sends more and more LH. So if we saw low T and high LH then we'd infer that the testicles are not responding (Primary hypogonadism).

    However in my case, the T is low but the LH is also low, so the problem is not in the testicles but in the pituitary end of things. They did a pituitary MRI to rule out a tumor.

    So that's the Dr's logic, which made sense to me. What I am missing?

    Thanks for the help,
    Mark

  7. Quote Originally Posted by MarkLA View Post
    The logic was:

    1. Total T is below the range. I have 165 ng/dL and range is 250-1100. Therefore diagnosis of hypogonadism. Plus I'm 35 not 75, so I'd figure I should be closer to the top of the range than the bottom.

    2. Primary or Secondary: The testicles produce T because they get the LH signal from the pituitary. If the problem was in the testicles (Primary hypogonadism) then we'd expect to see a high LH value. i.e. The testicles are getting LH but not doing their job and producing T, so the body sends more and more LH. So if we saw low T and high LH then we'd infer that the testicles are not responding (Primary hypogonadism).

    However in my case, the T is low but the LH is also low, so the problem is not in the testicles but in the pituitary end of things. They did a pituitary MRI to rule out a tumor.

    So that's the Dr's logic, which made sense to me. What I am missing?

    Thanks for the help,
    Mark

    Looks like a classic case of secondary hypogonadism.

  8. Quote Originally Posted by MarkLA View Post
    Here we go with ranges. I will include the non T ones too..

    Testosterone 165 ng/dL (range 250-1100)
    Testosterone Free 20.7 pg/mL (range 35-155)
    Testosterone Free % 1.25 (range 1.5-2.2)

    Somatomedin-C 239 ng/mL (range 106-255)
    Cortisol 15.3 MCG/DL (range 6-19 MCG/DL Morning, 3-14 Afternoon. This was afternoon)
    FSH 5.6 MIU/ML (Males 1 to 8 MIU/ML)
    LH 2.3 MIU/ML (Males 2-12 MIU/ML)
    Prolactin 10.5 NG/ML (range 3.0-14.7)
    Thyroxine 6.5 MCG/DL (range 4.5-12.5)
    T Uptake 31.0% (range 25-35)
    Adjusted T4 6.7 MCG/DL (range 4.4-11.4)
    TSH 1.26 MCU/ML (range 0.39-4.60)

    I appreciate your help.

    Mark
    You be better off if you did blood test as listed on post #44
    Jan's BloodTest April13/2007

    Absent that, if you decide doing nothing else but small part of hormones then if you give me your lattest SHBG then I could calculate for you weekly testosterone dose.

    I am discounting your fear of needles since you already decided to do HCG. The Depo_T injection you also should do using the smallest needle (31ga 5/15"long) and SubQ injections around navel.

    The T dose that I could calculate or you can do it, since all info is posted in above thread, that dose is preliminary only, good for 2 - 3 months. You have to do blood testing again, (shorter test).

    ============================== =====
    Dostinex may be in your future, your Prolactin is in teens.
    ============================== =======
    FreeT4 is not high enough, what about FreeT3???

  9. Quote Originally Posted by JanSz View Post
    You be better off if you did blood test as listed on post #44
    Jan's BloodTest April13/2007

    Absent that, if you decide doing nothing else but small part of hormones then if you give me your lattest SHBG then I could calculate for you weekly testosterone dose.

    I am discounting your fear of needles since you already decided to do HCG. The Depo_T injection you also should do using the smallest needle (31ga 5/15"long) and SubQ injections around navel.

    The T dose that I could calculate or you can do it, since all info is posted in above thread, that dose is preliminary only, good for 2 - 3 months. You have to do blood testing again, (shorter test).

    ============================== =====
    Dostinex may be in your future, your Prolactin is in teens.
    ============================== =======
    FreeT4 is not high enough, what about FreeT3???
    Thanks much. I checked and I don't have SHBG on any test.

    I'm going to see the new doc this Sat and can ask for new tests. Since I don't know him, I'm a tad reluctant to go in too demanding, although I feel funny even writing that, so I guess I will go in with a list. Ideally, I want to get only what I need and not repeat the other tests unnecessarily since they were done within the last 6 weeks.

    As far as Thyroid I have the following info from another test. No Free T3, but it does have total T3.

    (from another test)
    TSH 1.16 mIU/ml (0.35-5.5)
    Total T3 0.74 ng/mL (0.6-1.81)
    Free T4 1.32 ng/dL (0.72-1.56)

    I know what you're saying about the shots and I respect that. I am not fearful enough to avoid doing it but if I can get the same benefit from cream, why not?

    In any case, I'm very curious to hear your advice. I can go on Saturday and ask for more tests, also I can ask for more tests and a prescription or two. This doc is a urologist not an endo and I'm told he'll be pretty reasonable to work with..

    Thanks again,
    Mark

  10. Quote Originally Posted by MarkLA View Post
    Thanks much. I checked and I don't have SHBG on any test.

    I'm going to see the new doc this Sat and can ask for new tests. Since I don't know him, I'm a tad reluctant to go in too demanding, although I feel funny even writing that, so I guess I will go in with a list. Ideally, I want to get only what I need and not repeat the other tests unnecessarily since they were done within the last 6 weeks.

    As far as Thyroid I have the following info from another test. No Free T3, but it does have total T3.

    (from another test)
    TSH 1.16 mIU/ml (0.35-5.5)
    Total T3 0.74 ng/mL (0.6-1.81)
    Free T4 1.32 ng/dL (0.72-1.56)

    I know what you're saying about the shots and I respect that. I am not fearful enough to avoid doing it but if I can get the same benefit from cream, why not?

    In any case, I'm very curious to hear your advice. I can go on Saturday and ask for more tests, also I can ask for more tests and a prescription or two. This doc is a urologist not an endo and I'm told he'll be pretty reasonable to work with..

    Thanks again,
    Mark
    So far I am hearing only the words in red.
    There is your chance.

    It is all up to you,
    but without providing information thru testing the rest is hand vaving, useless chatter.
    •   
       


  11. Quote Originally Posted by JanSz View Post
    So far I am hearing only the words in red.
    There is your chance.

    It is all up to you,
    but without providing information thru testing the rest is hand vaving, useless chatter.
    JanSz,

    You're right.

    I'll go on Sat and try to get the other relevant tests. I looked at your list. Following is what I'm going to ask for to add to my current test results.

    If the doc is ignorant, I'm going to have to bring him up to speed on why these values are needed, so I'd appreciate any help in filling in the gaps of my understanding.

    SHBG - Calculate free T more accurately than lab measured free T

    60 Estradiol, Free, LC/MS/MS (36169X) - get baseline value of aromatization before supplementation starts

    40 T3 Free
    41 T3 uptake
    42 T3,Total

    Dihydrotestosterone, Free, Serum (36168X)

    Mark

  12. Your right cpeil, forgive me my estrogen dominant brain has gotten primary and secondary mixed up

    Mark, let us not forget that SHBG itself is often VERY difficult to measure correctly, even with quest's standards.

    The most accurate way to measure bio indentical hormones, the gold standard, is urines. Urines, if I remember correctly, do not measure SHBG. There is much invalidity in bloods, even by Quest standards. I think that Urines may very well be the gold standard in hormone measurement.

    It is these reasons in itself why we must not use SHBG as a marker on how to treat a HRT program and adjust dosages. Get Bioavailable T and E in line and let things like SHBG fall where it may.

    Besides, how do we treat SHBG with consistency? There is really little to do to raise/lower it. Chrysin cream has shown a little promise in lowering it, yet it is inconsistent.

  13. Quote Originally Posted by plymouth city View Post
    It is these reasons in itself why we must not use SHBG as a marker on how to treat a HRT program and adjust dosages. Get Bioavailable T and E in line and let things like SHBG fall where it may.
    Hi Plymouth,

    Thanks for your response. It sounds like your advice is to go get the Estradiol (I already have T) so I have a baseline before taking anything and then just start the TRT with whatever dosage guestimate the doc and I come up with.

    Once I have been under treatment for a while I can get more blood work done and then adjust the T up and down, manage Prolactin, etc if needed at that point.

    Is that about right?

    Thanks,
    Mark

  14. Quote Originally Posted by MarkLA View Post
    Hi Plymouth,

    Thanks for your response. It sounds like your advice is to go get the Estradiol (I already have T) so I have a baseline before taking anything and then just start the TRT with whatever dosage guestimate the doc and I come up with.

    Once I have been under treatment for a while I can get more blood work done and then adjust the T up and down, manage Prolactin, etc if needed at that point.

    Is that about right?

    Thanks,
    Mark
    Yes!

    We absolutely need a baseline E number to go from before we administer TRT therapy. Doing without an E number would be like trying to find your way in the dark without a flashlight.

    I suggest you read, re read and study Dr Johns TRT paper until you can recite it verbatem. http://anabolicminds.com/forum/male-...e-success.html

  15. "with whatever dosage guestimate the doc and I come up with"

    Most seem to need 100mg of T per weekly in shots. Androgel is more person respondent, but we can start with 5g and go from there.

    Remember, a person absorbs 70mg from a 100mg shot. Androgel can vary from person to person, but 5g is a good starting dose.

    Dr John in his paper - "There simply is no way to predict how a particular patient will respond—not Medical History (i.e. number or severity of symptoms), body weight, baseline hormone levels, even anabolic steroid history. I have had very slight gentlemen barely elevate on 100mg of test cyp per week, and massively muscled former steroid athletes who went to nearly two times the top of “normal” range on the same dosage (they had similar baselines). Likewise, one man may see only a modest increase in DHT on 5gms of Androgel, another may become quite supraphysiological on same.

    I start my guys out on either testosterone cream/gel 5mgs QD or testosterone cypionate 100mg per week. The IM test cyp must be administered in weekly injections, as opposed to taking twice the dosage every other week. Some physicians even dose every third or fourth week, producing wide swings in serum androgen levels. This puts the patient on an emotional roller coaster, increases the risk of developing polycythemia, greatly accentuates aromatase activity, and actually leaves them lower than they were when they started for the last half of the cycle. In order to get the serum androgen concentration to a stable level more quickly, I “frontload” 200mg the first injection (unless converting over from a gel/cream)."

  16. Quote Originally Posted by MarkLA View Post
    JanSz,

    You're right.

    I'll go on Sat and try to get the other relevant tests. I looked at your list. Following is what I'm going to ask for to add to my current test results.

    If the doc is ignorant, I'm going to have to bring him up to speed on why these values are needed, so I'd appreciate any help in filling in the gaps of my understanding.

    SHBG - Calculate free T more accurately than lab measured free T

    60 Estradiol, Free, LC/MS/MS (36169X) - get baseline value of aromatization before supplementation starts

    40 T3 Free
    41 T3 uptake
    42 T3,Total

    Dihydrotestosterone, Free, Serum (36168X)

    Mark
    It doesnt make much difference, money or accuracy vise, but rather than asking for SHBG directly I would ask for
    Testosterone, Free, Bio/Total (LC/MS/MS)

    you are getting more information, but more important newest methodology is being used in testing, the (LC/MS/MS), so more accurate results (hopefully).
    -------------
    The
    60 Estradiol, Free, LC/MS/MS (36169X)

    is probably good enough, but again, I like also to know

    Estrogens, Fractionated, LC/MS/MS (36742X)
    Estrogen, Total, Serum (439X)

    in ideal world one would also check 2/16 ratio using RheiLabs.

    Interesting,
    on 2/16 topic
    I found in Great Smokies (now Genova Diagnostics) and in reference yesterday posted by hardasnails

    DIM is not mentioned at all while adjusting 2/16 ratio.
    I3C still there.
    I will keep using DualAction from LEF for adjusting 2/16 purpose.

    Genova Diagnostics Estrogen Metabolism Index

    Estrogen Metabolism Index

    Flaxseed (lignans), soy products (isoflavones), cruciferous vegetables (indole-3-carbinol), vigorous exercise, and omega-3 fatty acids are interventions that may reduce the risk of estrogen-dependent disease by favorably modifying the 2:16alpha-OHE1 ratio. Using this assessment, practitioners can monitor the physiological impact of these and other treatments (including hormone replacement therapy), gaining added insight into their clinical safety and effectiveness.
    ============================== ============================== ==================
    Speaking of accuracy of tests;
    Direct Free Testosterone using RIA methods is useless, unles performed in research llaboratories.
    Total lack of accuracy applies only to laboratories commonly accesible to "regular" patients.
    That is because laboratories are using cookie cutter test, better explained in one of the links.

    Quest Diagnostic FreeT and BAT (when derived via calculation) are not accused of such inaccuracy.
    Testosterone, Free, Bio/Total (LC/MS/MS)
    is a good acceptable test troughout.
    --------------------------
    I do not buy into inaccuracies of other tests,

    unless proven otherwise using references to relevant studies.

    I heard this story about inaccuracies of:

    TotalEstrogens
    DHT
    progesterone
    pregnenolone

    probably other.

    I expect that someone somewhere proved that
    accuracy claimed by laboratory is (say) 0.5%
    and somebody find out that it is 10X less (say) 5%
    If true, I do not think this will make enough difference to abandon the testing completely and go by subjective feelings or some other theory.
  17. More test results


    I went to see the Urologist.

    He's not a hormone guy, but I was able to get SOME additional tests. I think I have a lead on a hormone place here to go visit (http://www.hormoneandlongevitycenter.com) so that'll be my next stop.


    I'd appreciate any comments on this bloodwork:

    **DHT 107 (ng/dL range 25-75)
    Estradiol 13 (pg/mL range 13-54)
    SHBG 29 (nmol/L range 8-48)

    Thanks
    Mark


    Reposting my old bloodwork for convenience:

    Glucose 86 mg/dL (70-110)
    Sodium 142 mmol/L (135-145)
    Potassium 3.7 mmol/L (3.5-4.5)
    Chloride 101 mmol/L (101-111)
    Carbon Dioxide 27 mmol/L (23-31)
    Anion Gap 14 mmol/L
    **UREA Nitrogen 35 MG/DL (range 5-25)
    Creatinine 1.2 mg/dL (0.4-1.5)
    Calcium 9.8 mg/dL (8.3-10.7)
    Bilirubin, total 0.3 mg/dL (0.1-1.2)
    Protein Total 7.0 G/DL (6.0-8.5)
    Albumin 4.7 G/DL (3.5-5.5)
    Alkaline Phosphotase 82 U/L (<125)
    **Aspartate Aminotransfera 47 (range < 46 U/L)
    **Alanine Aminotransferase 54 (range < 53 U/L)


    **Testosterone 165 ng/dL (range 250-1100)
    **Testosterone Free 20.7 pg/mL (range 35-155)
    **Testosterone Free 1.25% (range 1.5 - 2.2)

    Somatomedin-C 239 ng/mL (range 106-255)
    **Cortisol 15.3 MCG/DL (range 6-19 MCG/DL Morning, 3-14 Afternoon. This was afternoon)

    FSH 5.6 MIU/ML (Males 1 to 8 MIU/ML)
    LH 2.3 MIU/ML (Males 2-12 MIU/ML)
    Prolactin 10.5 NG/ML (range 3.0-14.7)
    Thyroxine 6.5 MCG/DL (range 4.5-12.5)
    T Uptake 31.0% (range 25-35)
    Adjusted T4 6.7 MCG/DL (range 4.4-11.4)
    TSH 1.26 MCU/ML (range 0.39-4.60)

    (from another test)
    TSH 1.16 mIU/ml (0.35-5.5)
    Total T3 0.74 ng/mL (0.6-1.81)
    Free T4 1.32 ng/dL (0.72-1.56)


    PSA 0.12 ng/ML (0-4)

    WBC 5.2 (4-11) 1000/UL
    RBC 4.86 (3.97-5.65) MILL/UL
    Hemoglobin 15.4 (13-17) G/DL
    Hemocrit 47.1 (37.5-49.9) %
    MCV 96.9 (80-100) FL
    MCH 31.7 (27-33) PG
    MCHC 32.8 (32-36) %
    RBC Distribution Width 13.7 (11.5-14.5) %
    Platelet Count 156000 (150000-450000) /UL
    Mean Platelet Vol 9.4 (7.4-10.4) FL

    Diffs Automated

    Polys 53%
    Lymphs 28%
    Monos 7%
    Eos 12%
    Basos 1%
    ABS Polys 2.7 (1.8 to 2.8) 1000/UL
    ABS Lymphs 1.5 (1.0-4.5) 1000/UL
    ABS Monos 0.4 (<0.8) 1000/UL
    **ABS EOS 0.6 (<0.4) 1000/UL
    ABS Basos 0.1 (<0.2) 1000/UL
    RBC Morphology Normal
    Type of Differential Auto

    Lipid panel/Glucose (FASTING - from another day)
    Total Cholesterol 131 mg/dL
    Triglycerides 107 mg/dL
    Glucose 87 mg/dL
    HDL 48 mg/dL
    LDL 61 mg/dL
    CLD 21 mg/dL
    TC/HDL 2.7 md/dL

  18. Quote Originally Posted by MarkLA View Post
    I went to see the Urologist.

    He's not a hormone guy, but I was able to get SOME additional tests. I think I have a lead on a hormone place here to go visit ((Holtorf Medical Group, Inc - Torrance, CA) Hormone Doctor - Hormone and Longevity Medical Center) so that'll be my next stop.


    I'd appreciate any comments on this bloodwork:

    **DHT 107 (ng/dL range 25-75)
    Estradiol 13 (pg/mL range 13-54)
    SHBG 29 (nmol/L range 8-48)


    Thanks
    Mark


    Reposting my old bloodwork for convenience:

    Glucose 86 mg/dL (70-110)
    Sodium 142 mmol/L (135-145)
    Potassium 3.7 mmol/L (3.5-4.5)
    Chloride 101 mmol/L (101-111)
    Carbon Dioxide 27 mmol/L (23-31)
    Anion Gap 14 mmol/L
    **UREA Nitrogen 35 MG/DL (range 5-25)
    Creatinine 1.2 mg/dL (0.4-1.5)
    Calcium 9.8 mg/dL (8.3-10.7)
    Bilirubin, total 0.3 mg/dL (0.1-1.2)
    Protein Total 7.0 G/DL (6.0-8.5)
    Albumin 4.7 G/DL (3.5-5.5)
    Alkaline Phosphotase 82 U/L (<125)
    **Aspartate Aminotransfera 47 (range < 46 U/L)
    **Alanine Aminotransferase 54 (range < 53 U/L)


    **Testosterone 165 ng/dL (range 250-1100)
    **Testosterone Free 20.7 pg/mL (range 35-155)
    **Testosterone Free 1.25% (range 1.5 - 2.2)


    Somatomedin-C 239 ng/mL (range 106-255)
    **Cortisol 15.3 MCG/DL (range 6-19 MCG/DL Morning, 3-14 Afternoon. This was afternoon)

    FSH 5.6 MIU/ML (Males 1 to 8 MIU/ML)
    LH 2.3 MIU/ML (Males 2-12 MIU/ML)
    Prolactin 10.5 NG/ML (range 3.0-14.7)

    Thyroxine 6.5 MCG/DL (range 4.5-12.5)
    T Uptake 31.0% (range 25-35)
    Adjusted T4 6.7 MCG/DL (range 4.4-11.4)
    TSH 1.26 MCU/ML (range 0.39-4.60)

    (from another test)
    TSH 1.16 mIU/ml (0.35-5.5)
    Total T3 0.74 ng/mL (0.6-1.81)
    Free T4 1.32 ng/dL (0.72-1.56)


    PSA 0.12 ng/ML (0-4)

    WBC 5.2 (4-11) 1000/UL
    RBC 4.86 (3.97-5.65) MILL/UL
    Hemoglobin 15.4 (13-17) G/DL
    Hemocrit 47.1 (37.5-49.9) %
    MCV 96.9 (80-100) FL
    MCH 31.7 (27-33) PG
    MCHC 32.8 (32-36) %
    RBC Distribution Width 13.7 (11.5-14.5) %
    Platelet Count 156000 (150000-450000) /UL
    Mean Platelet Vol 9.4 (7.4-10.4) FL

    Diffs Automated

    Polys 53%
    Lymphs 28%
    Monos 7%
    Eos 12%
    Basos 1%
    ABS Polys 2.7 (1.8 to 2.8) 1000/UL
    ABS Lymphs 1.5 (1.0-4.5) 1000/UL
    ABS Monos 0.4 (<0.8) 1000/UL
    **ABS EOS 0.6 (<0.4) 1000/UL
    ABS Basos 0.1 (<0.2) 1000/UL
    RBC Morphology Normal
    Type of Differential Auto

    Lipid panel/Glucose (FASTING - from another day)
    Total Cholesterol 131 mg/dL
    Triglycerides 107 mg/dL
    Glucose 87 mg/dL
    HDL 48 mg/dL
    LDL 61 mg/dL
    CLD 21 mg/dL
    TC/HDL 2.7 md/dL
    Your DHT is over the range. At this moment I would not do anything about it except note that transdermal testosterone delivery is not for you.

    Estradiol and SHBG are in nice location.
    When you start on Depo-Testosterone supplementation your E2 may raise and SHBG may fall, just as you wish they would.
    Keep Arimidex or better yet Liquidex handy, one newer know for sure.

    Whith your FSH and LH levels I think your testis are doing what they could.
    If you wish you may want to spend couple months just on HCG to prove to yourself what may happen. I would stay away from any Clomid or Novarel.
    If you give hcg try then use
    Novarel 250iu E2D every other day.
    Retest in two to three monts see where you are.

    If you go T+hcg route ether right away or after hcg trial then your preliminary T dose is:

    Routine E3D every three days, T&hcg shots on same day.
    Two days in between free of shots.
    HCG dose=500iu

    preliminary T dose:
    you want
    FreeT~250
    to get there you need
    TT~975
    per chart #41
    Jan's BloodTest April13/2007
    your weekly dose od 200mg/mL Depo-Testosterone is
    135mg=135mg/200mg/mL=0.675mL=0.675cc=67.5 units on syringe
    for E3D schedule each T shot is
    67.5/7*3=28.9~29units

    When disolving Novarel use 5mL of water, so the 500iu would fit into your 3/10cc syringe I am about to recomend.

    For both T&hcg shots you may use
    BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b
    BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b Price: $25.95

    or you can use

    Colostomy Supplies, Pet Diabetic Supplies
    Easy Touch U-100 Insulin Syringe 31 Gauge 3/10cc 5/16 inch Short Needle 100/Box Sale Price: $13.99

    SubQ shots around navel.

    Retest 2 to 3 monts latter.
    Use my list. You may want to expand my list on thyroid and cholesterol area.
    No need to repeat CBC panel.
    ============================== ============================== ===
    Your cholesterol is low, lot of fish oil

    get freeT3

  19. Quote Originally Posted by JanSz View Post
    Your DHT is over the range. At this moment I would not do anything about it except note that transdermal testosterone delivery is not for you.

    Estradiol and SHBG are in nice location.
    When you start on Depo-Testosterone supplementation your E2 may raise and SHBG may fall, just as you wish they would.
    Keep Arimidex or better yet Liquidex handy, one newer know for sure.

    Whith your FSH and LH levels I think your testis are doing what they could.
    If you wish you may want to spend couple months just on HCG to prove to yourself what may happen. I would stay away from any Clomid or Novarel.
    If you give hcg try then use
    Novarel 250iu E2D every other day.
    Retest in two to three monts see where you are.

    If you go T+hcg route ether right away or after hcg trial then your preliminary T dose is:

    Routine E3D every three days, T&hcg shots on same day.
    Two days in between free of shots.
    HCG dose=500iu

    preliminary T dose:
    you want
    FreeT~250
    to get there you need
    TT~975
    per chart #41
    Jan's BloodTest April13/2007
    your weekly dose od 200mg/mL Depo-Testosterone is
    135mg=135mg/200mg/mL=0.675mL=0.675cc=67.5 units on syringe
    for E3D schedule each T shot is
    67.5/7*3=28.9~29units

    When disolving Novarel use 5mL of water, so the 500iu would fit into your 3/10cc syringe I am about to recomend.

    For both T&hcg shots you may use
    BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b
    BD Ultrafine II U-100 Insulin Syringe 31 Gauge 3/10cc 5/16inch Short Needle--1/2 Unit Markings 100/b Price: $25.95

    or you can use

    Colostomy Supplies, Pet Diabetic Supplies
    Easy Touch U-100 Insulin Syringe 31 Gauge 3/10cc 5/16 inch Short Needle 100/Box Sale Price: $13.99

    SubQ shots around navel.

    Retest 2 to 3 monts latter.
    Use my list. You may want to expand my list on thyroid and cholesterol area.
    No need to repeat CBC panel.
    ============================== ============================== ===
    Your cholesterol is low, lot of fish oil

    get freeT3
    How does fish oil raise cholestrol? Like to know answer to that one..
    His t4 tot3 ratio is off due to adrenal imbalances look at the potassium level

  20. Quote Originally Posted by hardasnails1973 View Post
    How does fish oil raise cholestrol? Like to know answer to that one..His t4 tot3 ratio is off due to adrenal imbalances look at the potassium level
    Raising cholesterol is your specialty.

    Have at it.

    If you have any reference any help on this topic do not hold it, have at it.
    ====================
    IIRC your doc had you thru some specialized analysis in that direction, Fatty Acid Analysis

  21. Quote Originally Posted by JanSz View Post
    Raising cholesterol is your specialty.

    Have at it.

    If you have any reference any help on this topic do not hold it, have at it.
    ====================
    IIRC your doc had you thru some specialized analysis in that direction, Fatty Acid Analysis
    Yep and cholesterol tested low. at 135 and now is 126 so when I look a biodeficiemcy of estrodial due to receptor sites being over run by 16 and 4 aOHE is the likely suspect ans probably the main cause for my adrenal fatigue.. If my hypothesis is correct its Estrogen domaince induced by alterations in 16 and 4 aOHE metabolism due to high fat diets as well as iodine deficiency. Since homocysteine is low this would reflect the DNa alterations in methyation due to these estrogen. Another factor is elevated Liporoptein A induced by estrogens, elevated shbg again increased estrogens due to alteration in liver metabolism. We know that estrogen increases cholestrol, triglycerides, ldl all which I have low levels up, as well as low cortisol. Dim was found to almost double free levels of cortisol why by freeing up cortisol receptors bounded by these estrogens. Before all this crap started I was a BIg ALA freak for 2-3 years but i did not ever know about biotin needed to balance it. IF you have biotin defieincy this causes alteration in fatty liver and insulin deficincy resulting in low choleterol. My lowest cholesrtol ever was 88 and dr said that was awesome..Well being on a ketogenic diet due to ALA acted similar to a high fat diet which causes fluctuation in 2 and 16 aOHE ratio. Now couple that with cooking food in plastic 4 times a day you got a serious xeno estrogen and endogenous estrogen over load..If can link ketogenic diets with elevated 16:2 ratio that will be the root cause..If my prostrate was swelled 80% and it was not because of e2 and DHT then it had to be the hydrox estrones !! and my Tits are so sore and e2 is completely in check then what else could it be estrone have same affinity for e2 receptors in many diffrent tissue and i had high serum estrone and low normal e2. I think my point is very well made and backed up!!

  22. Quote Originally Posted by JanSz View Post
    I would stay away from any Clomid or Novarel.
    If you give hcg try then use
    Novarel 250iu E2D every other day.
    You said stay away from Clomid or Novarel, I think you meant Nolvadex, right? That would make sense as E2 is not my problem.

    Quote Originally Posted by JanSz View Post
    Your cholesterol is low, lot of fish oil

    get freeT3
    I thought 130 was good cholesterol? I currently eat 4 Carlson's Salmon oil soft gels each morning. That is 4g fat, 720mg EPA, 500 DHA. Should I eat more?

  23. Quote Originally Posted by hardasnails1973 View Post
    Yep and cholesterol tested low. at 135 and now is 126 so when I look a biodeficiemcy of estrodial due to receptor sites being over run by 16 and 4 aOHE is the likely suspect ans probably the main cause for my adrenal fatigue..
    HAN, I've read your comments (and your own thread) with interest and appreciate your insights. Honestly, much of it is over my head, but I am learning little by little

    More than 6 months ago I used to take a bunch of supplements which I thought were making me healthier. Now all I am taking is Calcium-Magnesium-Zinc, Glucosamine, Fish oil, Iron Free Multi (Centrum Silver) and aspirin.

    I'm wondering whether one of the other items I used to take may have screwed me up my T level in the first place. I also used to take Finasteride years ago. I STILL eat very clean - low carb/more protein/fats (peanut-almond butter). I don't eat much red meat and what I do eat is very lean.

    In a way, perhaps the original cause is irrelevant. Maybe I should just focus on adjusting the levels from where they are. However, since you've been taking so many supplements, I figured it wouldn't hurt to run the list by you and see if anything jumps out. I took this stuff or variations of it for a few years up until probably Feb of this year.


    Here's the old list:

    Acetyl L-Carnitine
    Vitamin E Gamma Tocopherol
    Carnosine
    Vitamin C
    TMG (trimethylglycine)
    N-Acytl Cysteine
    Ginko Biloba
    Coenzyme Q-10
    Folic Acid
    Alpha Lipoic Acid
    Quercetin
    Bromelain
    Aspirin
    Calcium
    Magnesium
    Zinc
    Glucosamine Sulfate
    Multi-vitamin & mineral
    Salmon Oil
    Garlic

    P.S. I stopped eating out of microwave & plastic wrap 5 times per day, although my Estradiol looks like it wasn't the problem anyway. I figure it's better to be safe. "Glass: It's the new plastic!"

  24. Quote Originally Posted by MarkLA View Post
    You said stay away from Clomid or Novarel, I think you meant Nolvadex, right? That would make sense as E2 is not my problem.
    Yes, I ment Nolvadex, sorry.

    I thought 130 was good cholesterol? I currently eat 4 Carlson's Salmon oil soft gels each morning. That is 4g fat, 720mg EPA, 500 DHA. Should I eat more?
    You want cholesterol (180-200)

    130 is too low.

    I am trying to figure out how one could raise cholesterol, it appears more difficult than getting it down.

  25. Quote Originally Posted by JanSz View Post
    Your DHT is over the range. At this moment I would not do anything about it except note that transdermal testosterone delivery is not for you.


    Not true. Pregnenolone cream would fix that DHT up nicely, and the added bonus of an increase in androgens.

  26. You also want to avoid taking minerals with calcium as calcium will block absorbtion.

  27. Quote Originally Posted by MarkLA View Post



    I thought 130 was good cholesterol? I currently eat 4 Carlson's Salmon oil soft gels each morning. That is 4g fat, 720mg EPA, 500 DHA. Should I eat more?

    Think butter, steaks.

  28. Quote Originally Posted by plymouth city View Post
    Not true. Pregnenolone cream would fix that DHT up nicely, and the added bonus of an increase in androgens.
    I know that (goddamn) finasteride which lowers DHT results in a T increase of 15%. Does Pregenolone result in a similar boost? If so, it's sounds helpful but not an answer in itself as my T needs to go 500% higher..

    What do you think?

    Mark

  29. Quote Originally Posted by cpeil2 View Post
    Think butter, steaks.
    Right, so I understand that cholesterol is the precursor to all hormones.

    I want my T level to be fixed, hopefully with the minimal intervention required. I also want to live a nice long life and not keel over of a heart attack. My cholesterol, per the heart doc is good but not aberrently low.

    I also know that supplemental T actually lowers cholesterol.

    Maybe there's just a tradeoff betwen good hormones and heart health.

    So I'm confused.

  30. Quote Originally Posted by MarkLA View Post
    Right, so I understand that cholesterol is the precursor to all hormones.

    I want my T level to be fixed, hopefully with the minimal intervention required. I also want to live a nice long life and not keel over of a heart attack. My cholesterol, per the heart doc is good but not aberrently low.

    I also know that supplemental T actually lowers cholesterol.

    Maybe there's just a tradeoff betwen good hormones and heart health.

    So I'm confused.
    I should have said "butter and steaks, within reason."

    Some would disagree with your doc that your cholesterol level is not too low.

    But that doesn't mean it should be really high either. A total cholesterol of 160-180 will promote a healthier hormone level without comprising heart health. And don't forget, total cholesterol doesn't tell the whole story. HDL and LDL levels yield a lot more information than total cholesterol does. In fact, some docs, unless a total cholestrol level is extremely low (kind of like yours) or extremely high, disregard it altogether.

    Obviously, with your total cholesterol level, you have more room to play around with your saturated fat intake than someone with total cholesterol of 300.
  

  
 

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