Blood Test Results and Appointment with Dr. Mariano

[Mbmartin]

Hey guys,

Been a while since I posted. I just recently had some blood work done and I'm looking for some feedback regarding the results, the direction I should head in, etc.

Test: Value: Range:
Total Testosterone 25.2 10-30nmol/L
Free Testosterone 884 200-800pmol/L
Bioavailable 22.1 5-20nmol/L
SHBG 9 10-70nnol/L
TSH 1 0.38-5.5mU/L
Free T3 6.7 3.5-6.5pmol/L
Free T4 14.5 10.5-20pmol/L
DHEA-S 8 5.2-14.2umol/L
Estradiol <100 <220pmol/L
Prolactin 13 <15ug/L
Albumin 46 35-50g/L
Sodium 143 134-145mmol/L
Potassium 4.4 3.5-5mmol/L
WBC 3.6 4-10giga/L (had a cold when I was tested; does this typically result in lower or higher WBC? I would've thought higher)

Note: I cannot get the ultra-sensitive estradiol test here in Vancouver, Canada.
At the time of the test I was on:
60mg depo-test IM E3D
75mcg synthroid (T4)/day (50mcg in AM, 25mcg @ noon)
15mcg of cytomel (T3)/day (5mcg 3x/day)
25mg HC/day (10mg AM, 10mg noon, 5mg pm) -> Should I lower this to 20mg/day given my WBC count?
0.25mg/day Arimidex (Liquid)
20mg of Cialis E3D (Liquid)

Chief complaints: Brain fog, no libido, no spontaneous erections, no motivation, anhedonia. Curiously I do have morning erections at ~60-70%.

I've finally set up an appointment to fly in and see Dr. Mariano in Monterey, and that's on March 21st. I'm collecting all previous blood work from the past 5 years as well as writing up an extensive medical history. Is there anything else I should do to prepare? I don't want to waste any of my or his time, and I can't continue to live my life the way I am now.

 

[JanSz]

Hey guys,

Been a while since I posted. I just recently had some blood work done and I'm looking for some feedback regarding the results, the direction I should head in, etc.

Test: Value: Range:
Total Testosterone 25.2 10-30nmol/L
Free Testosterone 884 200-800pmol/L
Bioavailable 22.1 5-20nmol/L
SHBG 9 10-70nnol/L
TSH 1 0.38-5.5mU/L
Free T3 6.7 3.5-6.5pmol/L
Free T4 14.5 10.5-20pmol/L
DHEA-S 8 5.2-14.2umol/L
Estradiol <100 <220pmol/L
Prolactin 13 <15ug/L
Albumin 46 35-50g/L
Sodium 143 134-145mmol/L
Potassium 4.4 3.5-5mmol/L
WBC 3.6 4-10giga/L (had a cold when I was tested; does this typically result in lower or higher WBC? I would've thought higher)

Note: I cannot get the ultra-sensitive estradiol test here in Vancouver, Canada.
At the time of the test I was on:
60mg depo-test IM E3D
75mcg synthroid (T4)/day (50mcg in AM, 25mcg @ noon)
15mcg of cytomel (T3)/day (5mcg 3x/day)
25mg HC/day (10mg AM, 10mg noon, 5mg pm) -> Should I lower this to 20mg/day given my WBC count?
0.25mg/day Arimidex (Liquid)
20mg of Cialis E3D (Liquid)

Chief complaints: Brain fog, no libido, no spontaneous erections, no motivation, anhedonia. Curiously I do have morning erections at ~60-70%.

I've finally set up an appointment to fly in and see Dr. Mariano in Monterey, and that's on March 21st. I'm collecting all previous blood work from the past 5 years as well as writing up an extensive medical history. Is there anything else I should do to prepare? I don't want to waste any of my or his time, and I can't continue to live my life the way I am now.

Your testosterone dose is either ok or only about 5-10% to high. May want to keep the weekly dose and switch to EOD injections. Your SHBG is real low, present E3D shots may contribute to bad feeling. If you can get it use HCG on days in between.
HCG dose 380-750iu.

Switch to Armour if you can.
If not ease on T3, proportionally to your results.
Aim at 80-95% of range.

Most likely your biggest problem is unknown E2.
Make good faith effort to get E2 reading.
(Stop Liquidex for testing period of 1-6 days and watch out if you are getting any better.
If yes, figure out how to decrease dose.
If no, increase Liquidex dose by 3-5 units on insuline syringe)
I use Liquidex EOD, on days of T shot.



Would help to know your DHT status.

Your very low SHBG suggest some metabolic issues.

Check your cholesterol.

Test NutrEval from Genova Diagnostics would be of real help if you could do it.
.
.
25mg HC/day (10mg AM, 10mg noon, 5mg pm)
(Make experiment, use 15mg AM, 10mg noon)

Have you ever had:
Thyroid Peroxidase and Thyroglobulin Antibodies
and rT3 done?

 

[jinxie]

That's same damn good looking blood. Before I got to your meds, I was thinking, what could be wrong with this guy???

I agree with Jan's comments. I'd take the Depo T down to 100 mgs/week to drop the T a tad.

I think 25 mgs of HC is safe, if that's what you feel you need for now.

You can get estradiol drawn while you are in the US, perhaps.

Good luck and I hope you start feeling better.

 

[phatkid77]

another canuck.... dame E2 **** eh!!
dont drop to 100mg test....did nothing for me...150mg is about right...

phats

 

[jinxie]

another canuck.... dame E2 **** eh!!
dont drop to 100mg test....did nothing for me...150mg is about right...

phats

As far as test dosage is concerned, it's highly personal. Based on his numbers, he probably should back off a little IMO. That's what Dr. M will tell him. I'm at 100 mgs/week.

 

[phatkid77]

our lower SHBG is causing the high bio available test, must be something in canada...haha

phats

 

[jinxie]

our lower SHBG is causing the high bio available test, must be something in canada...haha

phats

Whatever it is, it's damn impressive. It's too bad the bloak ain't feeling good, as his numbers look damn good. Some of the best I've ever seen on the boards for someone that is taking responsible doses. Hopefully the doc can help him bring it together.

 

[JanSz]

That's same damn good looking blood. Before I got to your meds, I was thinking, what could be wrong with this guy???

I agree with Jan's comments. I'd take the Depo T down to 100 mgs/week to drop the T a tad.

I think 25 mgs of HC is safe, if that's what you feel you need for now.

You can get estradiol drawn while you are in the US, perhaps.

Good luck and I hope you start feeling better.

Hi said:
At the time of the test I was on:
60mg depo-test IM E3D

I said:
only about 5-10% to high. May want to keep the weekly dose and switch to EOD injections.
-----------------------------------------------
He is just about right on BAT. Most likely no change in dose is need.
His SHBG is v low, he may benefit more from EOD schedule.

In numbers 5-10% drop,
If on current E3D schedule
drop from 60 to (57 - 54)
--
If on E2D schedule

(60*7/3)=40 (36-38)

On weekly basis

60*7/3=140
57*7/3=133
54*7/3=126
-------
40*7/2=140
38*7/2=133
36*7/2=126
=======================================
Many people have problem getting adjusted because they are not able to make small changes.
.
.

 

[Mbmartin]

Thanks for the replies everybody,

I plan on backing off to 55mg depo-test E3D for now. I've already tried 40, 45, 50, 55, 60, 65, and 70mg E3D, however (and every possible amount/combo for E5D, E7D, etc). After I see Dr. Mariano I might switch to EOD injections as Jan suggests, mostly just because of my low low SHBG. I'm also going to reduce arimidex to 0.25mg EOD instead of ED. I've done this all before, though.

I don't really understand it; I eat a great diet (i.e. tons of fish oil, low-GI carbs, good protein), work out 3-4 days/week, get tons of rest, blah blah blah ad nauseum, and yet nothing works. Sure, I look pretty good, but I don't really care anymore. I couldn't get a boner to save my life.

After 5 years of this I'm finally at the point where I just feel defeated. I used to go to bed thinking "No matter how bad today is, tomorrow is a new day, and you can make it a good one," but now I'm hanging on by a thread here. Thankfully my visit to see Dr. Mariano is in 10 days, but I honestly don't know what else can be done at this point.

Sorry for the rant/moan. Just tired of being tired.

 

[JanSz]

Thanks for the replies everybody,

I plan on backing off to 55mg depo-test E3D for now. I've already tried 40, 45, 50, 55, 60, 65, and 70mg E3D, however (and every possible amount/combo for E5D, E7D, etc). After I see Dr. Mariano I might switch to EOD injections as Jan suggests, mostly just because of my low low SHBG. I'm also going to reduce arimidex to 0.25mg EOD instead of ED. I've done this all before, though.

I don't really understand it; I eat a great diet (i.e. tons of fish oil, low-GI carbs, good protein), work out 3-4 days/week, get tons of rest, blah blah blah ad nauseum, and yet nothing works. Sure, I look pretty good, but I don't really care anymore. I couldn't get a boner to save my life.

After 5 years of this I'm finally at the point where I just feel defeated. I used to go to bed thinking "No matter how bad today is, tomorrow is a new day, and you can make it a good one," but now I'm hanging on by a thread here. Thankfully my visit to see Dr. Mariano is in 10 days, but I honestly don't know what else can be done at this point.

Sorry for the rant/moan. Just tired of being tired.

Wonder if your could get boner if you did this tests at Quest.

Estradiol, Free, LC/MS/MS (36169X)
Dihydrotestosterone, Free, Serum (36168X)

and get results that would fit here:

FreeE2( 0.45 -0.6)
FreeDHT(5-7)



.
.

 

[jinxie]

Thanks for the replies everybody,

I plan on backing off to 55mg depo-test E3D for now. I've already tried 40, 45, 50, 55, 60, 65, and 70mg E3D, however (and every possible amount/combo for E5D, E7D, etc). After I see Dr. Mariano I might switch to EOD injections as Jan suggests, mostly just because of my low low SHBG. I'm also going to reduce arimidex to 0.25mg EOD instead of ED. I've done this all before, though.

I don't really understand it; I eat a great diet (i.e. tons of fish oil, low-GI carbs, good protein), work out 3-4 days/week, get tons of rest, blah blah blah ad nauseum, and yet nothing works. Sure, I look pretty good, but I don't really care anymore. I couldn't get a boner to save my life.

After 5 years of this I'm finally at the point where I just feel defeated. I used to go to bed thinking "No matter how bad today is, tomorrow is a new day, and you can make it a good one," but now I'm hanging on by a thread here. Thankfully my visit to see Dr. Mariano is in 10 days, but I honestly don't know what else can be done at this point.

Sorry for the rant/moan. Just tired of being tired.

I feel for you man. I suffer from a lot of your symptoms. Things in the sexual department have improved some since TRT, but I still have a lot of fatigue (lack of restorative sleep) and issues with cognition and memory.

Hang in there (by that thread). I hope Dr. Mariano can help you. The fact that you are already on a solid plan should streamline the process.

Best,
J

 

[aculpep]

I know the feeling... hang in there.

I'm wondering if this has anything to do with dopamine levels since the only time I've had any luck is when I took a larger shot of T-cyp (150mg). My Dr says it causes the body to release dopamine and that week I actually thought about sex a lot which was a nice change. Haven't had the same luck since though and my E2 levels are normal. So don't let anyone tell you it's always E2 problems causing this.

I'm going to try a few more things and if I hit on anything that works I'll post it.

It sucks I know.

[/I]

Thanks for the replies everybody,

I plan on backing off to 55mg depo-test E3D for now. I've already tried 40, 45, 50, 55, 60, 65, and 70mg E3D, however (and every possible amount/combo for E5D, E7D, etc). After I see Dr. Mariano I might switch to EOD injections as Jan suggests, mostly just because of my low low SHBG. I'm also going to reduce arimidex to 0.25mg EOD instead of ED. I've done this all before, though.

I don't really understand it; I eat a great diet (i.e. tons of fish oil, low-GI carbs, good protein), work out 3-4 days/week, get tons of rest, blah blah blah ad nauseum, and yet nothing works. Sure, I look pretty good, but I don't really care anymore. I couldn't get a boner to save my life.

After 5 years of this I'm finally at the point where I just feel defeated. I used to go to bed thinking "No matter how bad today is, tomorrow is a new day, and you can make it a good one," but now I'm hanging on by a thread here. Thankfully my visit to see Dr. Mariano is in 10 days, but I honestly don't know what else can be done at this point.

Sorry for the rant/moan. Just tired of being tired.

 

[JanSz]

I know the feeling... hang in there.

I'm wondering if this has anything to do with dopamine levels since the only time I've had any luck is when I took a larger shot of T-cyp (150mg). My Dr says it causes the body to release dopamine and that week I actually thought about sex a lot which was a nice change. Haven't had the same luck since though and my E2 levels are normal. So don't let anyone tell you it's always E2 problems causing this.

I'm going to try a few more things and if I hit on anything that works I'll post it.

It sucks I know.

[/I]

Depending your level of couriousity,
you can do at Genova Diagnostics one of three tests,
in sequence of complexity and information that those tests provide:


Metabolic Analisys Profile (most basic)

ONE

NutrEval (most complex)

Each of those tests have
Neurotransmitter Metabolites
section

Each test provides discussion on resons and remedial actions.
Each test ends up with a list os supplements to take, daily doses and any suggested additional testing.

 

[The Matrix]

since being up in north you need vitamin D levels checked. You taking tons of fish oils is why your WBC count is in the crapper. The fish oils in excess can be immune suppressive. These dip****s taking tons of fish oils with possible automimmune diseases are only hurting them selves and other levels are being affected. Lower ur T will take stress off the adrenals and my result in lower your cortisol dosage. Alot of i have come across with estrogen problem are abusers of fish oils or there body tends not to burn them off and stores them instead. Jansz you know what I am talking about especially. This alteration in the cell membrane causes one to become zinc defienct resulting in what appears to be hypopituotatism and its just a huge imbalance that was never investigated or 90% of drs have their head up their assess which is 90% of the time.

 

[jinxie]

Thanks for the replies everybody,

I plan on backing off to 55mg depo-test E3D for now. I've already tried 40, 45, 50, 55, 60, 65, and 70mg E3D, however (and every possible amount/combo for E5D, E7D, etc). After I see Dr. Mariano I might switch to EOD injections as Jan suggests, mostly just because of my low low SHBG. I'm also going to reduce arimidex to 0.25mg EOD instead of ED. I've done this all before, though.

I don't really understand it; I eat a great diet (i.e. tons of fish oil, low-GI carbs, good protein), work out 3-4 days/week, get tons of rest, blah blah blah ad nauseum, and yet nothing works. Sure, I look pretty good, but I don't really care anymore. I couldn't get a boner to save my life.

After 5 years of this I'm finally at the point where I just feel defeated. I used to go to bed thinking "No matter how bad today is, tomorrow is a new day, and you can make it a good one," but now I'm hanging on by a thread here. Thankfully my visit to see Dr. Mariano is in 10 days, but I honestly don't know what else can be done at this point.

Sorry for the rant/moan. Just tired of being tired.

MBMartin, how was your appt? Any progress?

 

[keith1958]

I felt better doing once a week injections.

 

[Gutterpump]

your bloodwork looks excellent, maybe prolactin can be lowered a little? It's not too high though. I'd be curious to see what could be wrong as well.

Hopefully if I ever move back to Canada, I won't have the same problems with testing. I didn't know it was an issue up there.

ps: I also have low SHBG so maybe it is a Canadian thing hehe.

 

[Mbmartin]

The appointment was far from what I expected but still worthwhile. Dr. Mariano placed me on 1-3mg of Tenex (guanfacine) per day at bed time. It lets me sleep for 6-7.5 hours without waking up once (which is AMAZING!), but I still have no libido and all that. This is a process that takes time, so I'll just have to give it some more.

In sum, I feel better physically and emotionally, but still my primary complaint of no libido lingers.

At least I can rest easy knowing that my serum levels of testosterone, thyroid, etc are where they should be (i.e. I don't need to fret or make constant adjustments).

Hope you guys are all doing O.K.!

Morgan

EDIT: I forgot to add that Dr. Mariano believes the primary problem to be naturally excessive norepinephrine levels (e.g. as a result of an over-responsive CNS) and hypothyroidism. Implicit in this is that I never needed TRT to begin with; had my adrenal and thyroid issues been addressed when I was 17 I may never have needed to be on testosterone replacement. Now that I've been on it for so long - and tried to come off unsuccessfully twice - I need to stay on testosterone replacement indefinitely.

 

[Mbmartin]

TheMatrix,

Can you elucidate on the fish oil problems (i.e. with scientific papers/research)? It's not that I don't believe you or that I'm not receptive to your ideas, it just runs counter to what you typically read (i.e. that fish oil is basically a panacea).

 

[JanSz]

TheMatrix,

Can you elucidate on the fish oil problems (i.e. with scientific papers/research)? It's not that I don't believe you or that I'm not receptive to your ideas, it just runs counter to what you typically read (i.e. that fish oil is basically a panacea).

It is not only about fish oils, it is mostly about everything.
Someone who leads educated healthy life and have a good diet by the book, will still end up with number of defficiencies.

Everyone is an unique individual, books and routines are about average individuals.
Nobody is average, everyone is unique.

To sort things out, eat reasonable diet that you can hold on to indefinately.
Do not eat any supplements.

Do Genova Diagnostic battery of tests called NutrEval.
Nutritional Evaluation.
The report will end up with personalized supplements list.

Olympic contenders were using this first, now for 11k is open to the public.

NutrEval/ONE
Richard Gherhauser MD, MPH
Peak Performance program
Canyon Ranch, Tucson Arizona
Canyon Ranch in Tucson Arizona - Yahoo! Search Results
Canyon Ranch Resorts, Tucson - Sport Peak Performance Package
-----------------------------
Without fluf can be had for couple 100's bucks.
With insurance, almost for nothing.
.
This set of tests is less than 2 years old, not many know about it.

 

[Random987]

How do you arrange the Genova tests? From the webpage you have to be a licensed professional.

Thanks

Do Genova Diagnostic battery of tests called NutrEval.
Nutritional Evaluation.
The report will end up with personalized supplements list.

Olympic contenders were using this first, now for 11k is open to the public.

NutrEval/ONE
Richard Gherhauser MD, MPH
Peak Performance program
Canyon Ranch, Tucson Arizona
Canyon Ranch in Tucson Arizona - Yahoo! Search Results
Canyon Ranch Resorts, Tucson - Sport Peak Performance Package
-----------------------------
Without fluf can be had for couple 100's bucks.
With insurance, almost for nothing.
.
This set of tests is less than 2 years old, not many know about it.

 

[JanSz]

How do you arrange the Genova tests? From the webpage you have to be a licensed professional.

Thanks

Yes, they do bussiness only with licenced proffesionals.
MD, OD, nurses, nutritionists, chiropractors.

They do not do bussiness in NY State
In UK they sell their tests without scripts.

They will provide names of docs that they deal with in your zip code area.
.
.

 

[Eisenhower]

Can you explain what you mean when you say your visit with Dr. Mariano was far from what you expected? I have an appt. with him in a couple weeks and want to know what to expect.

Thanks,
Eisenhower

 

[brentf13]

I know what's wrong with you because I was in the exact same boat. Plain and simple: Depression. I took me two years of tinkering with my hormones to finally realize that my original Dr was right. I stopped and started TRT several times and I would always be completely "fixed" for a few days and then back to the same no matter how much I manipulated my hormones. It took me seeing Dr Crisler to finally piece it all together. What was happening to me was I was responding to the dopamine rush from starting TRT several times so the antidepressant effect was what was correcting me but not T itself. I kept thinking that I was passing through some type of hormonal sweet spot but what was really happening was just a dopamine rush. I would feel like my brain was once again connected with my body. Most of the time I would have a numb empty feeling and nothing in life, sexual or not, would stimulate me. The interesting part is my body felt like hell before TRT and knowing what I know now depression can totally screw with your body physically. For example you can end up with digestive problems or in our case poor HPTA function. As men we ignore everything except sex. It wasn't until my libido and sexual function tanked that I started looking for answers. Anyone who has never experienced a clinical depression doesn't understand because the term is a poor one for the condition. Depression isn't a sad mood it's a partial disconnect from poor transmission of signals.

 

[JanSz]

I know what's wrong with you because I was in the exact same boat. Plain and simple: Depression. I took me two years of tinkering with my hormones to finally realize that my original Dr was right. I stopped and started TRT several times and I would always be completely "fixed" for a few days and then back to the same no matter how much I manipulated my hormones. It took me seeing Dr Crisler to finally piece it all together. What was happening to me was I was responding to the dopamine rush from starting TRT several times so the antidepressant effect was what was correcting me but not T itself. I kept thinking that I was passing through some type of hormonal sweet spot but what was really happening was just a dopamine rush. I would feel like my brain was once again connected with my body. Most of the time I would have a numb empty feeling and nothing in life, sexual or not, would stimulate me. The interesting part is my body felt like hell before TRT and knowing what I know now depression can totally screw with your body physically. For example you can end up with digestive problems or in our case poor HPTA function. As men we ignore everything except sex. It wasn't until my libido and sexual function tanked that I started looking for answers. Anyone who has never experienced a clinical depression doesn't understand because the term is a poor one for the condition. Depression isn't a sad mood it's a partial disconnect from poor transmission of signals.

Boy, you are writting about me.

Forget sex, with TRT I am now calm, cool an collected.
I was a total mess before.
.
.

 

[brentf13]

It's true too. Us men aren't concerned about anything until it impacts sex. No emotions? Who cares. Nothing is fun anymore? Whatever... No libido or ED? WTF, where is the Dr's number!!!!! When I think back now I wonder what the hell I was thinking. I was emotionally dead for 10 years before it finally hit me in the sexual department. Then I was looking for answers!!!

 

[Gutterpump]

If you think dopamine is an issue, test neurotransmitters or try 2.5mg - 10mg of deprenyl (selegeline) daily - 5 days on 2 days off. Will really ramp up dopamine levels, especially if taken with a bit of L-dopa.

It could be a seratonin issue as well...try some 5HTP, or if you have tested positive for seratonin issues - might want to see if you doc can prescribe some trazodone and try that out...SSRI's are no good.

 

[The Matrix]

with out proper inuslin regulation 5htp with not do crrap to get across the blood brain barrier, TRUST ME I KNOW!!

 

[Gutterpump]

Trazodone might be better then, or maybe 5HTP while supplementing with R-ALA..Personally I feel much better on a lower-carb (or low-GI) diet anyhow, which automatically fixes any possibly underlying insulin issues.

I think stablon is superior for daily use (for seratonin) as it's non-sedating and has other benefits in the long term. 12.5mg 4x pd seems to be the sweet spot in dosing. I guess it depends on if you want to try the euro pharm approach. A lot of dr's are good, but they don't know your body as well as you do, and creating (or more specifically, tweaking) your own protocol depending on how you feel is sometimes best, within reason.

 

[rmac1]

JanZs,

Did you say it was 11k for the nutreval test by genova diagnostics? I find that hard to imagine. How much would this test even help someone in the long run?

 

[The Matrix]

JanZs,

Did you say it was 11k for the nutreval test by genova diagnostics? I find that hard to imagine. How much would this test even help someone in the long run?

With there prepayment program its 175 bucks LOL
HAve your dr call and ask for the information. Some insurances will honor it.

These are labs that I use
neuroscience - brain, Food allergies.
genova - adrenal saliva, RBC fatty acid, amino acid urine.
rhiens - hormones assesmment via urine
Spectracell - nutritional analysis
Great plains - organic acid test
ARL - hair anaysis

 

[rmac1]

For others not feeling so right on trt, I would look into detoxification pathways like glutathione or something. The world is basically a toxic wastedump now, so anyone with impaired detoxification will be low with energy, despite good hormone levels.

 

[Gutterpump]

JanZs,

Did you say it was 11k for the nutreval test by genova diagnostics? I find that hard to imagine. How much would this test even help someone in the long run?

This is a less expensive and great alternative to the nutreval test:

http://www.integrativepsychiatry.net/intracellular_vitamin_analysis_spectracell.html