Need Feedback--Lab Results show Low Total T, Free T, DHT, Estriadiol

[Angrypolak]

Background: I've been working out a few years and while I have gotten stronger, I seem to struggle to build muscle and get my strength past 225 (bench), 315 (squat), 405 (deadlift). This is with a good diet and lifting routine. I had some funds available and decided to run bloods to see if there was anything hormonal causing me to "spin my wheels".

Diet: I track my calories. When I bulk I aim for +250 and when I cut I aim for -500. Macros are good. With protein I aim for around 1g/lb. Carbs and fat are split nearly 50/50 between remaining calories. I go up to 1.5g/lb when cutting. Long story short, I don't go to extremes on either end.

Sleep: I've used a sleep tracking app since May 2016. Since then my average time in bed is 7:46. My average "sleep quality" is 80%.

Exercise: I follow a PHAT based routine, so I perform both heavy lifts and hypertrophy lifts. I do as little cardio as possible, but I'm not inactive and end up running a handful of 5k's and 1/2 marathons with my wife each year.

I'm 34. On the day of the test I weighed 190.3 and registered 17.8%BF on an Omron. I took the blood test at 8:30 am and was fasted. I have been eating at maintenance or +250 calories (recomp or lean bulk) since March. Basically, my body should have been "primed" for best possible results.

I am hoping I can get some feedback. Is there anything I can do to improve my numbers naturally? Are there other tests I need to run to get a better picture? Should I be making an appointment an appointment with an endo RIGHT NOW? Anything is appreciated here as I navigate some new waters.

Also, I tried to keep my background stuff brief, but can expound on any facet if it helps.

 

[Mr.TT]

Have you used AAS or Pro-Hormones products?
Are you using any Meds? Prescribed, Over the Counter, or Other??

You look "Shut Down".
Your liver is annoyed.

Do you have any know medical conditions?

 

[Angrypolak]

Have you used AAS or Pro-Hormones products?
Are you using any Meds? Prescribed, Over the Counter, or Other??

You look "Shut Down".
Your liver is annoyed.

Do you have any know medical conditions?

Never used AAS.

I did a short run with Ostarine last year and followed it with Nolva as PCT. That was probably around May. I did an Epi/1 run for 8 weeks in January of this year. I ran Nolva and Sup3r PCT after that one. I don't have a long history of using hormonal products and I never came out of either run+pct feeling different than I did going in.

Haven't touched anything hormonal since March. Labs were run last Monday (7-3).

Only meds I take is a low dose aspirin. Supplements are creatine, multi, ashwagandha, forskolin, boron, taurine, cinnamon bark.

My problem is that when I took this test I felt "normal". As in, this is the way I felt last several months, this is the way I felt prior to Epi/1 run, and this is honestly the way I've felt for as long as I can remember.

I know the sex aspect is important too. On that end I rarely initiate, typically my wife does, but have no performance problems once going. Since I never had "performance problems", I figuring initiating sex (or not) was more a preference thing than a libido thing. But again, that's "normal" for as long as I can remember.

 

[Angrypolak]

I purchased the blood test through Life Extension which includes a complementary consultation. The feedback I got from that was to try DHEA and Pregnenalone supplentation as a first step to correct my hormone panel. Since they are a (respected) supplement company, I'm left wondering if that's my best first step or the best first step I can purchase from them?

 

[Mr.TT]

Well, a little DHEA and Pregnenolone is easy (and legal) to do. I take oral 12.5mg DHEA and 12.5mg Pregnenolone, and it pushed my DHEA sulfate just above MAX range. So, for me, it took very little and it absorbed easily.

Your liver enzymes concern me.

For three weeks now, I have been taking 500mg (twice a day) of homemade Liposomal Curcumin and 80mg of Chromium Picolinate. Wow, it feels like amphetamines ( DO NOT OVER DO THIS STUFF). Without changing my diet, I'm losing body fat quickly. I'm playing with Liposomal Curcumin because I want to lower my blood GLUCOSE and TRIGLYCERIDES. The reason I mention this is, 1 Liposomal Curcumin is good for your liver, and 2 it boosts your blood Nitric Oxide levels.

I have also, (years ago) played with Sublingual hCG, and It increased my TT and FT ( and E2, expect to need a tiny amount of Aromasin).
Otherwise, I would consider a SERM (clomid and/or Nolva) and maybe a tiny amount of Aromasin) to see if you can get your LH up ( and to stay up).

https://www.privatemdlabs.com/lab_tests.php?view=all&show=1032&category=14&search=#1032
Ask for a discount coupon.

 

[The_Old_Guy]

330ng/dl for a 34 year old is low (Captain Obvious checking in). Mine was something like 350 at age 48 - and I hopped on TRT. Same as you, felt great, no problem getting lean, kept increasing strength (not huge jumps unless on PH's, but good enough) etc... While supplementing with DHEA/Preg may help in some areas - you should really think about investigating the cause of the Low T with a Doc (like a Pituitary Adenoma, etc...) and if it's just Secondary Hypogonadism, get on Testosterone. Believe me, you will start "initiating" all on your own You may still want to supplement with DHEA/Preg, but those will not get you anywhere close to the therapeutic range for Testosterone (which Dr. Rand McClean says is 800ng/dl and above). There's some studies posted on here on how much topical DHEA increased old men's T - and it wasn't by much.

That Free T assay, being "Direct", must have a different range than what I got - mine was 76pg/ml in a 35-155 range (Labcorp)???

 

[Angrypolak]

Mr.TT The_Old_Guy

First, thank you both for the feedback!

I think I may have gotten some clarity on the liver enzymes being elevated. I was on vacation the week before taking this test. While I was good on my macros/calories, I didn't eat quite as "clean" as I normally do. Anticipating that, I purchased some cinnamon bark at my local super market. The goal was to help with insulin control, so I took 500mg before each meal. By the end of the week I was experiencing some dizziness when I stood up after sitting for a while. I discontinued use of the cinnamon bark and the problem went away. I'm sharing all of this because another problem with cinnamon supplementation is the coumarin content, if high, can cause liver distress.

I'm planning to do a follow-up blood test in a few weeks to see how I impact my hormone panel. I'm going to do the liver function test again too. If improved, I'm going to chalk it up the cinnamon bark. If not, I'm probably going to take the results to my Dr. and ask for a bit more investigating be done.

As for the hormones, I agree completely they are low. What was interesting is that while low, the ratios among the numbers themselves are good. The thought with trying the DHEA and Preg was I'd just be giving my body a bit more "raw material". If my numbers do go up and go up linearly, it may be a better option than TRT solely because it doesn't leave me chasing the hormonal imbalances that can sometimes come with it.

Another possible cause of my low numbers could be high prolactin, cortisol, or a bit of both. I didn't get tested for either, so no data sadly. I've been taking ashwaganda and rhodiola for a while. I'm going to start supplementing mucuna as well. As an aside, examine shows DHEA supplementation can lower cortisol.

I don't want to dismiss something like Pituitary Adenoma, but I haven't suffered any of the other typical symptoms so I'm hopeful that's not the cause. And if root cause is Secondary Hypogonadism, I will jump into TRT. I figure if follow up bloods show my first step doesn't work, I'll at least be able to share with the Dr. what I've tried. Plus I'll have two data points to share instead of just one.

 

[The Matrix]

Ferritin 315 concerns me the most
Along with EOS elevated, AG ratio, creatine
There are signs of potential dehydration with some type of infection.
Liver function may be from heavy workout night before if not they something else is off needing proper intervention
Have you ever had head trauma?
The estradiol is not the proper assay for e2 evaluation
Highly suspect adrenals have not recovered and reason no symptoms is you may be running on adrenaline masking the low cortisol as commonly missed

 

[Angrypolak]

Ferritin 315 concerns me the most
Along with EOS elevated, AG ratio, creatine
There are signs of potential dehydration with some type of infection.
Liver function may be from heavy workout night before if not they something else is off needing proper intervention
Have you ever had head trauma?
The estradiol is not the proper assay for e2 evaluation
Highly suspect adrenals have not recovered and reason no symptoms is you may be running on adrenaline masking the low cortisol as commonly missed

Thank you so much for the reply. I'll try and give feedback in the order you commented.

-What about those numbers is concerning? I know ferritin can relate to iron retention, but I don't know much what the rest "says" (or how it may relate to ferritin and an underlying issue). The consultation I had from my blood draw suggested I simply donate blood if ferritin remained high on my follow-up test. I will note the week prior to testing I ran out of multivitamins. Since I was going on vacation and my new order had not arrived, I packed my wife's vitamins. They are grocery store basic and have 18mg iron. I took them every other day because I knew men don't typically need to supplement iron. I don't know if that could impact these panels at the rate being seen, but I wanted to mention it.

-I drink at least 1 gallon of water daily, often 1.5-2 gallons. I have a 1/2 gallon jug and fill it with water from home (reverse osmosis filtered) and then fill it again at work from the fountain.

-I tested on Monday and hadn't lifted since Friday. I did perform heavy deadlifts on Friday.

-Two months after I began working out (June 2014), I experienced an extreme and sudden headache while lifting. It would recur any time I tried lifting heavy. I went to the Dr. because my father had suffered an aneurysm a few years prior. Bloods were taken and an MRI was performed (I'm going to provide comparisons on the bloods below) and both came back clean. It was determined that I was suffering tension headaches. Likely triggered by improper breathing when lifting and spiking BP. I took around 6 weeks off. When I returned I focused on performing proper warm up and breathing and have never had an issue since. Other than that I've not been treated for anything relating to "head trauma".

-I learned that about the estradiol test after I took the labs. I purchased the panel through Life Extension as a "complete wellness panel". When I retest I plan to purchase the "sensitive" test.

-I'd love to hear your thoughts on adrenals and how they could relate to my experience. I do consume caffeine. I don't typically suffer "brain fog" but I don't always feel well rested. I checked my body temp at waking this morning and it was 97.2. I did try in Jan-March to supplement with lugols iodine (5%) and didn't notice much perceived change or change in body temp so I stopped. I'll also add that I have had fibrous gyno since I was a teen (I'm 34 now). Part of why I supplemented with iodine was there's anecdotal evidence it can help with gyno/fibrocystic tissue.

My bloods from 2014 were not tailored to a hormone panel, but the following comparisons can be made (2014 left and 2017 right):
-Ferritin: N/A vs 315
-EOS: 3.1% vs 12%
-A/G: 2.2 vs 2.3
-Creatinine: 1.24 vs 1.21
AST: 24 vs 50
ALT: 23 vs 80
TSH: 1.41 (same both times)
T4 (free): 1.3 vs 1.42

Changes I am making since receiving my results:
-Reduce sugar intake (was averaging 125-150g for 365-385g total carbs)
-Add "Inhibit P" supplement (P5P, Mucuna)
-Add Sup3r DHEA @ .25ml (topical application of 25mg DHEA & 5mg Pregnenolone)
-Add Garden of Life Probiotic

I was planning to test again in 6 weeks. I was planning to run the sensitive estradiol test and drop PSA (cost savings).

With the additional info I'm open to any feedback you may have. Other changes to make, other tests to add, anything really. The time is greatly appreciated!

 

[Angrypolak]

One more potentially important note. I was eating slightly above maintenance (lean bulk) and wanted a nutrient partitioner/GDA. In an effort to save money I just bought some cinnamon bark from my local Walmart. About two weeks before testing I started taking 1 cap (500mg) with each meal. After about a week I would have dizzy spells upon standing. I thought it was the cinnamon dropping blood sugar TOO low so I discontinued use. Symptoms stopped.

After seeing my liver values (even with lifting in consideration), I'm wondering if it was coumarin content and not blood sugar imparting my symptoms.

 

[Angrypolak]

I have two questions from all these discussions:

Should I start investigations into things like "head trauma" with a primary care physician or endo? Wasn't really sure where to best start. I'm on a HSA plan, so I'd hate to pay a few hundred bucks to either for an appointment only to be recommended to go somewhere else.

Second, I know I need a different E2 test, but what all should I get checked on my follow-up bloodwork? I'm planning to go in 6 weeks. I think I want to see if my liver and blood values changed and if my overall hormone panel improved.

- Total and free testosterone (LC/MS assay. No upper limit restriction)
- DHEA-S
- Sex hormone binding globulin
- Estradiol (sensitive- LC/MS assay)
- CBC (includes glucose, hematocrit and immune cells)
- CMP (includes liver and kidney function)
- Lipids (LDL and HDL cholesterol and triglycerides)

 

[kenpoengineer]

I suggest going to ExcelMale dot com and research bloodwork. They have an excellent post on proper bloodwork recommendation.

 

[The_Old_Guy]

- Total and free testosterone (LC/MS assay. No upper limit restriction)
- DHEA-S
- Sex hormone binding globulin
- Estradiol (sensitive- LC/MS assay)
- CBC (includes glucose, hematocrit and immune cells)
- CMP (includes liver and kidney function)
- Lipids (LDL and HDL cholesterol and triglycerides)

That looks like the discountedlabs.com TRT follow-up panel w/ DHEA-S added?

 

[Angrypolak]

That looks like the discountedlabs.com TRT follow-up panel w/ DHEA-S added?

It is. I was on the fence about adding LH, cortisol, or prolactin.

 

[Angrypolak]

Ok, so I have some updates.

I did a 4 point cortisol test in August. All results were in range. 1st AM measurement was a bit below the average, but in range. Everything else plotted pretty much along the average curve.

I got my bloods run again last week. All of my elevated liver values were back in range. My hormone panel improved, though I'm not sure how I feel about that. My LH and FSH went up. I had a nearly 50% improvement in total test and all the cascading values were up as well. However, I don't feel appreciably different than I did when I tested in July. I'm kind of unsure if I should be happy with my results or still look to speak with an Endo.

Changes I made to get these results: added probiotic, upped saturated and mono fat macros, ran NAC for 30 days (as a just in case for elevated liver values), and added DHEA (50mg) and pregnenolone (12.5mg).

Both tests were taken at 8:00 on a Monday morning. Both tests were taken fasted. Both tests were taken nearly 72 hours from my last gym session.

Test--7/12/17 Results--10/2/17 Results
LH--1.9--4.8
FSH--3.0--5.4
Total Test--330--472.8
Free Test--4.3--10.5
Estradiol--<5.1*--10.3
DHEAS--155--228.8
SHBG--30.1--33.5

*I didn't take the sensitive test for estradiol in July.

I know I'm not the first to go down this road, so any thoughts or input are appreciated!