labs some advice please

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    labs some advice please


    Lab results / doctor's visit:

    Short version guys i am put on 5 mg hydrocortison by the doc in the morning and 2,5 mg in the afternoon, dhea which i will receive later don't know exact dosage, and have to buy vit D and selenium myself

    Outstanding lab values (will post later full version):



    Elements urine
    calcium low
    selenium low

    Have different scales/ranges for the same elements will post later.

    T3 in urine LOW
    DHEA in urine LOW
    17-OH-steroids LOW (KETO good)

    Cortisol urine LOW

    Feces:
    low PH
    Lactobacils LOW
    Yeasts/Fungi NONE
    Bifido HIGH
    Sec IgA HIGH

    Conclusion:

    Doc doesn't know why i have sex issues apart from cortisol. I told him TT is low, but he insists FT is what counts. I am hoping HC will increase conversion of FT4 to FT3. This is what next blood test will be showing hopefully. Hopefully if T3 comes up TSH will be lower and energy up. Have to increase elements which increase conversion. I was scared that TT was low and ****ed up it, is too low indeed, while two years ago it was 792 ng/dl. Hopefully increasing cortisol/T3 will balance sex hormones. Urine DHEA was low and Blood DHEA-sulphate is low, have to figure out why doc wants me on DHEA.


    BLOOD TEST

    Hematology
    Leukocytes 5.7 scale 4.0-10.0 x 10E9/l
    Erytrocytes 4.90 scale 4.6-6.0 x10E12/l
    Hemoglobin 9.4 scale 8.7-10.9 mmol/l
    Hematocryte 0.44 scale 0.42-0.54 l/l
    MCV 90 scale 87-98 fl
    MCH 1.92 scale 1.70-2.10 fmol
    MCHC 21.4 scale 19.0-22.0 mmol/l
    Trombocytes 260 scale 160-350 x10E9/l
    Neutrophile granulocytes 73.0 scale 45.0-75.0 %
    Lymfocytes 20.0 scale 17.0-43.0 %
    Monocytes 5.0 scale 3.5-7.5 %
    Eosinofile granulocytes 1.0 scale 0.3-4.6 %
    Basophile granulocytes 0.0* scale 0.3-1.2 %

    Clinical chemy
    Sedimentation 2 scale 1-10 mm/hr
    Ferritin 135 scale 20-350 ng/ml
    Glucose 7.1* 4.0-6.5 mmol/l (not sober)
    Ureum 6.1 scale 3.0-7.0 mmol/l
    Kreatinine 108 scale 70-115 um/l
    Urinacid 0.35 scale 0.20-0.45 mmol/l
    Calcium 2.52 scale 2.15-2.65 mmol/l
    Phosphate (s) 1.12 scale 0.70-1.40 mmol/l
    Alkalic phosphatase 67 scale 30-100 U/l
    Gamma GT 18 scale 0-45 U/l
    Total bilirubin 15 scale 3-20 umol/l
    Bilirubin direct 11.7* scale 0.0-4.0 umol/l
    AST (ASAT/SGOT) 23 scale 0-30 U/l
    ALT (ALAT/SGPT) 18 scale 0-30 U/l
    LDH 152 scale 60-240 U/l
    Total protein 74 scale 60-80 g/l
    Albumin 44 scale 35-50 g/l
    Cholesterol 4.80 scale 3.20-6.50 mmol/l
    HDL-cholesterol 1.77 scale 0.90-2.50 mmol/l
    Triglycerides 1.2 scale 0.3-2.2 mmol/l
    Iron binding capacity 23.9 scale 20.0-58.7 umol/l
    Iron 26.1 scale 14.0-36.0 umol/l
    Total iron binding capacity 50.0 scale 45.0-95.0 umol/l
    HbA1c 5.4 scale 4.0-6.0 %
    FT3 4.16 scale 4.00-7.85 pmol/l
    FT4 20.6 scale 10.3-24.5 pmol/l
    TSH 2.600 scale 0.40-4.00 uIU/ml
    DHEA-sulphate 8.22 scale 0.94-11.7 umol/l
    Anti TPO <10.0 scale 0-12 IU/ml
    CRP-HS <0.20 scale 0.00-1.00 mg/L

    Vitamins
    Folic acid 4.4* scale 16.3-42.7 ug/l
    Vitamin B12 682 scale 540-2702 ug/l
    Free Carnitine 8.4 scale 7.0-17.0 mg/l
    Acyl Carnitine 0.8* scale 0.9-2.3 mg/l
    Total Carnitine 9.2 scale 7.9-19.3 mg/l
    Vitamin D 17.6* 32.8-86.8 ug/l

    Vitamins (other units)
    Folic acid 410.0* scale 37-97 nmol/l
    Vitamin B12 505 scale 400-2000 pmol/l
    Free Carnitine 52.0 scale 43.4-105.5 umol/l
    Acyl Carnitine 5.0* scale 5.6-14.3 umol/l
    Total Carnitine 57.0 scale 49.0-119.7 umol/l
    Acyl/total Carnitine 0.09* scale 0.12-0.30 -
    Vitamin D 44.0* scale 82-217 nmol/l

    Serology
    IgF-1 (Somatomedine C) 32.9 scale 10.0-75.0 nmol/l
    IGFBP-3 169.0 scale 100.9-271.3 nmol/l

    Endocrinology
    Estradiol 0.05 scale 0.01-0.21 nmol/l
    Prolactin 0.168 scale 0.05-0.35 U/l
    Progesteron 0.5* scale 0.6-79.6 nmol/l

    Diverse
    Testosterone (serum) 13.80 scale 8-35 nmol/l
    Free testosterone (serum) 0.66 scale 0.24-1.04 nmol/l
    SHBG 21 scale 13-55 nmol/l

    URINE TEST

    Elements urine
    Sodium 3649 scale 920-5750 mg/l
    Potassium 2337 scale 1360-3130 mg/l
    Calcium 83* scale 100-320 mg/l
    Magnesium 93 scale 15-290 mg/l
    Iron 1 scale 0-800 ug/l
    Zinc 0.34 scale 0.30-1.00 mg/l
    Mercury 0.7 scale 0.0-5.0 ug/l
    Copper 6 scale <70 ug/l
    Selenium 16 scale 15-160 ug/l

    Diverse urine
    Sodium 6970 scale 1380-8625 mg/24hr
    Potassium 4464 scale 2040-4695 mg/24hr
    Calcium 159 scale 150-480 mg/24hr
    Magnesium 178 scale 23-435 mg/24hr
    Iron <5 scale 0-1200 ug/24hr
    Zinc 0.65 scale 0.50-1.50 mg/24hr
    Mercury 1.3 scale 0-7.5 ug/24hr
    Copper 11 scale <105 ug/24hr
    Selenium 30.6 scale 22.5-240 ug/24hr

    Diverse urine
    Volume 1910 scale 600-2500 ml
    T3 779* scale 800-1800 pmol/24hr
    T4 1904 scale 1800-3000 pmol/24hr
    T3 % average reference value 59.9 %
    T4 % average reference value 79.3 %
    T3/T4 ratio 0.41* scale 0.63-1.00 ratio
    DHEA 0.19 scale 0.06-3.20 mg/24hr
    17-keto steroids 7.7 scale 7.0-20.0 mg/24hr
    17-OH-steroids 3.8 scale 6.0-21.0 mg/24hr
    Aldosteron 5.9 no range given ug/24hr
    Cortisol 36.0 scale 21.0-85.0 ug/24hr


    FECES TEST

    Digestion parameters
    pH 6.0-6.8 value 5.7 not normal
    Consistency thick value thick normal
    Color brown value darkbrown/black not normal
    Starchfiber none value none normal
    Plantfiber 2-10 value 20/small plantfibers not normal
    Musclefiber none value none normal
    Fatcontent <3 gr/100 gr value 2.3 normal

    Aerobe flora
    Enterobacteriaceae 1.0*10^5 - 2.0*10^7 value 3.0*10^5 normal
    E.coli 1.0*10^5 - 2.0*10^7 value 3.0*10^5 normal
    Enterococcen 1.0*10^5 - 1.0*10^7 value 6.0*10^4 acceptable
    Lactobacils 1.0*10^4 - 1.0*10^7 value <1.0*10^3 not normal

    Yeasts and fungi
    Yeasts none value none normal
    Fungi none value none normal

    Anaerobe flora
    Bifidobacterium 1.0*10^8 - 3.0*10^8 value 6.4*10^9 not normal

    Extra analysis
    Giardia negative value negative normal
    Cryptosporidium negative value negative normal
    Occult blood negative value negative normal
    Lactoferrin negative value negative normal
    Antigliadine <100 U/l value 1 normal
    t-Transglutaminase <= 100 U/l value 7 normal
    secretoir IgA 500-2040 ugml value 2628 not normal
    M2-PK <=6 U/ml value 2.2 normal
    Calprotectine <= 50mg/kg value 33 normal
    TNF a(alpha) <20 pg/ml value negative normal

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    WTF

    Someone is using my values under a username i don't know?

    MODS??
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    Endocrinology
    Estradiol 0.05 scale 0.01-0.21 nmol/l
    Prolactin 0.168 scale 0.05-0.35 U/l
    Progesteron 0.5* scale 0.6-79.6 nmol/l

    Diverse
    Testosterone (serum) 13.80 scale 8-35 nmol/l
    Free testosterone (serum) 0.66 scale 0.24-1.04 nmol/l
    SHBG 21 scale 13-55 nmol/l
    ==================
    Do not use FreeT assay, they are always wrong.

    Your FreeT is very low.

    FreeT~90 on dr Shippen's chart
    you want to have it at minimum at 160
    better at 300
    •   
       

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    Quote Originally Posted by JanSz View Post
    Endocrinology
    Estradiol 0.05 scale 0.01-0.21 nmol/l
    Prolactin 0.168 scale 0.05-0.35 U/l
    Progesteron 0.5* scale 0.6-79.6 nmol/l

    Diverse
    Testosterone (serum) 13.80 scale 8-35 nmol/l
    Free testosterone (serum) 0.66 scale 0.24-1.04 nmol/l
    SHBG 21 scale 13-55 nmol/l
    ==================
    Do not use FreeT assay, they are always wrong.

    Your FreeT is very low.

    FreeT~90 on dr Shippen's chart
    you want to have it at minimum at 160
    better at 300
    Can you comment on my post with other lab values in my original thread? It's also in this section. Thanks.

    How come the 0.66 isn't high enough? In this scale it's mid way of the range? Thx.
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    Quote Originally Posted by cumkwakka View Post
    Can you comment on my post with other lab values in my original thread? It's also in this section. Thanks.

    How come the 0.66 isn't high enough? In this scale it's mid way of the range? Thx.
    Do not use FreeT assays, they are always wrong.
    Except for one and only test from Quest Diagnostics.

    Use dr Shippen's chart,
    or
    internet calculator.

    Internet calculator may give you precise numbers but I find a lots of opportunities to make mistake while converting units.
    So stay with the chart.
    Being correct to the decimal point is not important.

    On dr Shippen's chart you want to have it at minimum at 160
    better at 300
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    Quote Originally Posted by JanSz View Post
    Do not use FreeT assays, they are always wrong.
    Except for one and only test from Quest Diagnostics.

    Use dr Shippen's chart,
    or
    internet calculator.

    Internet calculator may give you precise numbers but I find a lots of opportunities to make mistake while converting units.
    So stay with the chart.
    Being correct to the decimal point is not important.

    On dr Shippen's chart you want to have it at minimum at 160
    better at 300
    Ok. Do you believe my total testosterone chart to be correct then? It calculates to 400 ng/dl.

    My SHBG is 21 which is low in any case, does this value also not sound correct to you? Or am I wrong in assuming that if SHBG is low like on my test, my free test should be quite high as well?

    Thanks.
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    Quote Originally Posted by cumkwakka View Post
    Ok. Do you believe my total testosterone chart to be correct then? It calculates to 400 ng/dl.

    My SHBG is 21 which is low in any case, does this value also not sound correct to you? Or am I wrong in assuming that if SHBG is low like on my test, my free test should be quite high as well?

    Thanks.
    I do not belive anything.
    I am taking at face value the numbers that you have posted.
    If you have a reson to doubt these numbers, repeat the blood test.
    ----
    Testosterone (serum) 13.80 scale 8-35 nmol/l
    SHBG 21 scale 13-55 nmol/l
    ----
    and apply them to dr Shippen's chart.
    Using that chart ou do not have to make units convesions.

    SHBG=21
    is a very nice and desirable number.
    It is the TT that is low.

    Looking at chart, your TT is less than 400 ng/dl,
    but sort of close.
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    Quote Originally Posted by JanSz View Post
    I do not belive anything.
    I am taking at face value the numbers that you have posted.
    If you have a reson to doubt these numbers, repeat the blood test.
    ----
    Testosterone (serum) 13.80 scale 8-35 nmol/l
    SHBG 21 scale 13-55 nmol/l
    ----
    and apply them to dr Shippen's chart.
    Using that chart ou do not have to make units convesions.

    SHBG=21
    is a very nice and desirable number.
    It is the TT that is low.

    Looking at chart, your TT is less than 400 ng/dl,
    but sort of close.
    I have zero reason to doubt them. Why should I? Just because it isn't Quest labs? Or Dr. Shippen's?

    With TT low and SHBG low, my FT should be good, as is reflected in my lab result for FT (mid-range). So basically you believe that my FT test results is screwed.

    Okay. I get this. What about my other lab values, thyroid cortisol etc..
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    Make sure that you are convinceed that your FreeT is very low.
    Your E2 is also low, I think.

    -------------------------------
    on 5 mg hydrocortison by the doc in the morning and 2,5 mg in the afternoon
    Elements urine
    calcium low
    selenium low
    T3 in urine LOW
    ----------------------------
    Glucose 7.1* 4.0-6.5 mmol/l (not sober)
    HbA1c 5.4 scale 4.0-6.0 %
    FT3 4.16 scale 4.00-7.85 pmol/l
    FT4 20.6 scale 10.3-24.5 pmol/l
    Bilirubin direct 11.7* scale 0.0-4.0 umol/l
    Folic acid 4.4* scale 16.3-42.7 ug/l
    Vitamin B12 682 scale 540-2702 ug/l
    Acyl Carnitine 0.8* scale 0.9-2.3 mg/l
    Vitamin D 17.6* 32.8-86.8 ug/l
    Lactobacils 1.0*10^4 - 1.0*10^7 value <1.0*10^3 not normal
    Bifidobacterium 1.0*10^8 - 3.0*10^8 value 6.4*10^9 not normal

    ============================== =========================

    Get some good vitamins to address deficiencies.
    Get good probiotics and enzymes
    Do not go drunk for a blood test
    Get calcium and selenium supplementation
    FreeT3 very low, (iodine, selenium, zinc, copper) and Armour thyroid

    ------------------------------------------------------
    What is your
    LH, FSH, prolactin, DHT?

    Your estradiol may be low, it may increase once your FreeT gets up
    --------------------
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    Quote Originally Posted by JanSz View Post
    Make sure that you are convinceed that your FreeT is very low.
    Your E2 is also low, I think.

    -------------------------------
    on 5 mg hydrocortison by the doc in the morning and 2,5 mg in the afternoon
    Elements urine
    calcium low
    selenium low
    T3 in urine LOW
    ----------------------------
    Glucose 7.1* 4.0-6.5 mmol/l (not sober)
    HbA1c 5.4 scale 4.0-6.0 %
    FT3 4.16 scale 4.00-7.85 pmol/l
    FT4 20.6 scale 10.3-24.5 pmol/l
    Bilirubin direct 11.7* scale 0.0-4.0 umol/l
    Folic acid 4.4* scale 16.3-42.7 ug/l
    Vitamin B12 682 scale 540-2702 ug/l
    Acyl Carnitine 0.8* scale 0.9-2.3 mg/l
    Vitamin D 17.6* 32.8-86.8 ug/l
    Lactobacils 1.0*10^4 - 1.0*10^7 value <1.0*10^3 not normal
    Bifidobacterium 1.0*10^8 - 3.0*10^8 value 6.4*10^9 not normal

    ============================== =========================

    Get some good vitamins to address deficiencies.
    Get good probiotics and enzymes
    Do not go drunk for a bllood test
    Get calcium and selenium supplementation
    Thyroid looks ok, leave it alone
    ------------------------------------------------------
    What is your
    LH, FSH, prolactin, DHT?

    Your estradiol may be low, it may increase once your FreeT gets up
    --------------------
    I will have to base everything upon this lab for the coming time. I am glad I can take anything from my doctor and might have to supp later on myself with extra stuff if needed. Thanks for further investigation. Please base everything below upon the testing as if the testing were correct, i don't care at the moment if testing is superbly correct, as long as it's okay testing and the doc can provide me the right meds and follow up.

    Thyroid: do you believe once i supp the cortisol, my T3 will come up, T4 will thus go down and TSH will drop, and continue producing T4 normal?

    LH and FSH was not tested, this was the first test to determine the overall picture and where the problem lies.

    Prolactin: see below, midrange
    DHT: was asked for by the doc in the form which wasn't on the form, but couldn't be tested for some reason

    BLOOD TEST

    Hematology
    Leukocytes 5.7 scale 4.0-10.0 x 10E9/l
    Erytrocytes 4.90 scale 4.6-6.0 x10E12/l
    Hemoglobin 9.4 scale 8.7-10.9 mmol/l
    Hematocryte 0.44 scale 0.42-0.54 l/l
    MCV 90 scale 87-98 fl
    MCH 1.92 scale 1.70-2.10 fmol
    MCHC 21.4 scale 19.0-22.0 mmol/l
    Trombocytes 260 scale 160-350 x10E9/l
    Neutrophile granulocytes 73.0 scale 45.0-75.0 %
    Lymfocytes 20.0 scale 17.0-43.0 %
    Monocytes 5.0 scale 3.5-7.5 %
    Eosinofile granulocytes 1.0 scale 0.3-4.6 %
    Basophile granulocytes 0.0* scale 0.3-1.2 %

    Clinical chemy
    Sedimentation 2 scale 1-10 mm/hr
    Ferritin 135 scale 20-350 ng/ml
    Glucose 7.1* 4.0-6.5 mmol/l (not sober)
    Ureum 6.1 scale 3.0-7.0 mmol/l
    Kreatinine 108 scale 70-115 um/l
    Urinacid 0.35 scale 0.20-0.45 mmol/l
    Calcium 2.52 scale 2.15-2.65 mmol/l
    Phosphate (s) 1.12 scale 0.70-1.40 mmol/l
    Alkalic phosphatase 67 scale 30-100 U/l
    Gamma GT 18 scale 0-45 U/l
    Total bilirubin 15 scale 3-20 umol/l
    Bilirubin direct 11.7* scale 0.0-4.0 umol/l
    AST (ASAT/SGOT) 23 scale 0-30 U/l
    ALT (ALAT/SGPT) 18 scale 0-30 U/l
    LDH 152 scale 60-240 U/l
    Total protein 74 scale 60-80 g/l
    Albumin 44 scale 35-50 g/l
    Cholesterol 4.80 scale 3.20-6.50 mmol/l
    HDL-cholesterol 1.77 scale 0.90-2.50 mmol/l
    Triglycerides 1.2 scale 0.3-2.2 mmol/l
    Iron binding capacity 23.9 scale 20.0-58.7 umol/l
    Iron 26.1 scale 14.0-36.0 umol/l
    Total iron binding capacity 50.0 scale 45.0-95.0 umol/l
    HbA1c 5.4 scale 4.0-6.0 %
    FT3 4.16 scale 4.00-7.85 pmol/l
    FT4 20.6 scale 10.3-24.5 pmol/l
    TSH 2.600 scale 0.40-4.00 uIU/ml
    DHEA-sulphate 8.22 scale 0.94-11.7 umol/l
    Anti TPO <10.0 scale 0-12 IU/ml
    CRP-HS <0.20 scale 0.00-1.00 mg/L

    Vitamins
    Folic acid 4.4* scale 16.3-42.7 ug/l
    Vitamin B12 682 scale 540-2702 ug/l
    Free Carnitine 8.4 scale 7.0-17.0 mg/l
    Acyl Carnitine 0.8* scale 0.9-2.3 mg/l
    Total Carnitine 9.2 scale 7.9-19.3 mg/l
    Vitamin D 17.6* 32.8-86.8 ug/l

    Vitamins (other units)
    Folic acid 410.0* scale 37-97 nmol/l
    Vitamin B12 505 scale 400-2000 pmol/l
    Free Carnitine 52.0 scale 43.4-105.5 umol/l
    Acyl Carnitine 5.0* scale 5.6-14.3 umol/l
    Total Carnitine 57.0 scale 49.0-119.7 umol/l
    Acyl/total Carnitine 0.09* scale 0.12-0.30 -
    Vitamin D 44.0* scale 82-217 nmol/l

    Serology
    IgF-1 (Somatomedine C) 32.9 scale 10.0-75.0 nmol/l
    IGFBP-3 169.0 scale 100.9-271.3 nmol/l

    Endocrinology
    Estradiol 0.05 scale 0.01-0.21 nmol/l
    Prolactin 0.168 scale 0.05-0.35 U/l
    Progesteron 0.5* scale 0.6-79.6 nmol/l

    Diverse
    Testosterone (serum) 13.80 scale 8-35 nmol/l
    Free testosterone (serum) 0.66 scale 0.24-1.04 nmol/l
    SHBG 21 scale 13-55 nmol/l

    URINE TEST

    Elements urine
    Sodium 3649 scale 920-5750 mg/l
    Potassium 2337 scale 1360-3130 mg/l
    Calcium 83* scale 100-320 mg/l
    Magnesium 93 scale 15-290 mg/l
    Iron 1 scale 0-800 ug/l
    Zinc 0.34 scale 0.30-1.00 mg/l
    Mercury 0.7 scale 0.0-5.0 ug/l
    Copper 6 scale <70 ug/l
    Selenium 16 scale 15-160 ug/l

    Diverse urine
    Sodium 6970 scale 1380-8625 mg/24hr
    Potassium 4464 scale 2040-4695 mg/24hr
    Calcium 159 scale 150-480 mg/24hr
    Magnesium 178 scale 23-435 mg/24hr
    Iron <5 scale 0-1200 ug/24hr
    Zinc 0.65 scale 0.50-1.50 mg/24hr
    Mercury 1.3 scale 0-7.5 ug/24hr
    Copper 11 scale <105 ug/24hr
    Selenium 30.6 scale 22.5-240 ug/24hr

    Diverse urine
    Volume 1910 scale 600-2500 ml
    T3 779* scale 800-1800 pmol/24hr
    T4 1904 scale 1800-3000 pmol/24hr
    T3 % average reference value 59.9 %
    T4 % average reference value 79.3 %
    T3/T4 ratio 0.41* scale 0.63-1.00 ratio
    DHEA 0.19 scale 0.06-3.20 mg/24hr
    17-keto steroids 7.7 scale 7.0-20.0 mg/24hr
    17-OH-steroids 3.8 scale 6.0-21.0 mg/24hr
    Aldosteron 5.9 no range given ug/24hr
    Cortisol 36.0 scale 21.0-85.0 ug/24hr


    FECES TEST

    Digestion parameters
    pH 6.0-6.8 value 5.7 not normal
    Consistency thick value thick normal
    Color brown value darkbrown/black not normal
    Starchfiber none value none normal
    Plantfiber 2-10 value 20/small plantfibers not normal
    Musclefiber none value none normal
    Fatcontent <3 gr/100 gr value 2.3 normal

    Aerobe flora
    Enterobacteriaceae 1.0*10^5 - 2.0*10^7 value 3.0*10^5 normal
    E.coli 1.0*10^5 - 2.0*10^7 value 3.0*10^5 normal
    Enterococcen 1.0*10^5 - 1.0*10^7 value 6.0*10^4 acceptable
    Lactobacils 1.0*10^4 - 1.0*10^7 value <1.0*10^3 not normal

    Yeasts and fungi
    Yeasts none value none normal
    Fungi none value none normal

    Anaerobe flora
    Bifidobacterium 1.0*10^8 - 3.0*10^8 value 6.4*10^9 not normal

    Extra analysis
    Giardia negative value negative normal
    Cryptosporidium negative value negative normal
    Occult blood negative value negative normal
    Lactoferrin negative value negative normal
    Antigliadine <100 U/l value 1 normal
    t-Transglutaminase <= 100 U/l value 7 normal
    secretoir IgA 500-2040 ugml value 2628 not normal
    M2-PK <=6 U/ml value 2.2 normal
    Calprotectine <= 50mg/kg value 33 normal
    TNF a(alpha) <20 pg/ml value negative normal

    Jansz: Thanks again!
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    I misread at first, then edited my post about your FreeT3
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    Yout Total testosterone is low.
    You may choose few routes.
    Adjust everything that is discovered to be out of line,
    hoping that your TT will go up.

    Assume that you are secondary, use HCG in a hope that you will raise your TT that way.

    Get a check on your DHT status.
    If DHT is within range, use T injections to raise TT.
    If DHT is low, use transdermal T delivery to raise TT.

    Use mixed approach, HCG, transdermal-T, injections-T if waranted.

    Good luck.
  

  
 

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