First pre-cycle blood test - underlying issues to resolve first?

**Thunderwood** · 12-19-2015, 06:39 PM

Hi everyone

I’m looking to begin my first cycle in the new year, so I've got some pre-cycle blood work done as a base. As part of the service, a qualified MD has reviewed the results and flagged some concerns (their highlights in red), and given some written feedback, which I’ve copied below.

I’d be hugely grateful for any comments in the context of starting AAS. I was thinking of sharing these results with my GP too if necessary, and am happy to put things off until it’s sorted. In terms of the things I’ve noticed:

At the moment from my understanding I might be looking at pre-clinical hypothyroidism since my TSH levels are high, but T3/T4 is normal?
I'm concerned about Haematocrit and iron levels are already quite high before jumping on. I’m not on any form of iron supplementation (not even a multi-vit).
I’m also confused that LH has shown as insufficient and Oestradiol is low, but these haven’t been flagged? Is that just a result of the testing procedure or something I need to follow up on?

For reference I’m 32/m with 10 years training

Full Blood Count

Test	Result	Range	Unit
Haemoglobin	167	125 - 180	g/L
Red Blood Cells	5.49	4.50 - 6.50	x1012/L
Haematocrit	0.480	0.380 - 0.500	L/L
Mean Cell Volume	87.0	81 – 98	fl
Red Cell Distribution	13.4	11.9 - 14.4	%
Mean Cell Haemoglobin	30.5	27.0 - 33.0	pg
Platelets	194	150 - 450	x109/L
White Blood Cells	5.1	4.0 - 10.0	x109/L
Neutrophils	L 1.77	2.0 - 7.5	x109/L
Lymphocytes	2.65	1.0 - 4.0	x109/L
Monocytes	0.54	0 - 0.8	x109/L
Eosinophils	0.07	0 - 0.4	x109/L
Basophils	0.04	0 - 0.2	x109/L

Film Report Red cells, White cells and Platelets appear normal.

Biochemistry

Iron

H 27.4

6.6 - 26.0

umol/L

Kidney Function

Total Protein	75.0	64 - 82	g/L
Albumin	48.6	34 - 52	g/L
Globulin	26.4	20 - 40	g/L
Creatinine	108	<115	umol/L
eGFR(MDRB)(Caucasian Only)	73	>60 unless evidence of CKD	ml/min/1.73m2

Liver Function

Total Protein	75.0	64 - 82	g/L
Albumin	48.6	34 - 50	g/L
Globulin	26.4	20 - 40	g/L
ALT	29	<50	IU/L
AST	32	<50	IU/L
ALP	47	<129	IU/L
GGT	11	<85	IU/L
Total Bilirubin	14.1	<17.0	umol/L

Lipids

Cholesterol	4.94	<5.0	mmol/L
HDL	1.31	>1.0	mmol/L
Triglycerides	1.14	<2.0	mmol/L
LDL	H 3.11	<3.0	mmol/L
Chol:HDL ratio	3.77	<4.0	ratio

Hormones

FSH	2.1	1.5- 12.4	IU/L
LH	Insuff	1.7 - 8.6	IU/L
Oestradiol	<18.35	28.0-156.0	pmol/L
Testosterone	22.7	8.0 - 29.0	nmol/L
SHBG (Sex Hormone Binding)	49	14.5-48.4	nmol/L
Free-Testosterone(Calculated)	0.37	0.3 - 1.0	nmol/L
Testosterone-Bioavailable	H 9.67	2.1 - 8.7	nmo/L

Thyroid Function

Free T4	19.55	12 - 22	pmol/L
Free T3	4.75	3.1 - 6.8	pmol/L
TSH	H 4.36	0.27 - 4.20	IU/L

Markers

PSA (Prostate)

0.798

<1.4

ug/L

Doctor's notes:

The Thyroid Stimulating Hormone (TSH) is elevated. If you are already taking a form of thyroxine, it is possible that that your dose is too low or that you have forgotten to take it on occasion. It may be that an increase in dose is in order – if adjusted it would be sensible to repeat thyroid function (TFT) testing in around 2 months time. If you are not taking thyroxine, and this is the first time TSH has been noted to be high, it is possible that 'non-thyroidal illness' or other medication effects are the cause of the elevation. It may be that hypothyroidism (underactive thyroid gland) is about to develop. In these scenarios, it would be advisable to repeat thyroid function tests in 3 months time. If this a repeat elevated TSH, it would be a good idea to consider checking thyroid antibodies if not previously tested. If antibody testing is positive, an annual check of TFT would be in order as your risk of developing thyroid disease would be higher than average. I would suggest undertaking this repeat test sooner if symptoms develop. The usual advice is to consider commencing thyroxine if TSH rises above 10 mU/L. Some authorities advise commencing thyroxine at lower TSH levels.

The neutrophil (a type of white cell) count is low but this may not be a concern, particularly as the total white cell count is within normal limits. A common explanation would be a recent infection (eg common cold) causing a temporary drop in the level. Repeat testing in a few weeks time would be useful to check the level was not falling, particularly if you have any specific concerns about immune cell function (eg frequent colds and other minor infections).

Although the free testosterone level is within normal limits, it is now generally agreed that the 'bioavailable testosterone' is a more accurate estimation of the true testosterone level in the blood. By this reckoning, you have a slight excess of testosterone - but I do not think this is a cause for concern.

The slight elevation in iron may be a consequence of taking iron supplementation. Occasionally high iron levels in the blood can indicate haemachromatosis, and other causes of iron overload, though these are rare conditions and more of the tests of iron storage would be usually be out of range too. Further testing would depend upon any symptoms you may have and your medical history – if you have concerns, I suggest you talk to your usual doctor.

The total cholesterol level of 4.94 is good, though the LDL (the component of cholesterol that is associated with development of cardiovascular disease) is on the high side at 3.11. However, the HDL (the component of cholesterol thought to be protective against heart disease) is also high (good news) at 1.31. The ratio formed by dividing cholesterol by HDL is probably the better guide to primary risk from cholesterol (ie the risk from cholesterol alone, if there is no established heart disease, high blood pressure or diabetes for example) - at 3.77 it is below the ideal score of 4 or lower, which implies your risk of developing heart disease from cholesterol induced damage alone is possibly not as high as the headline total implies. Your absolute risk of developing heart and vascular disease is dependent on a number of factors however, including weight, blood pressure, whether you smoke or are diabetic or not, and family history.

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Thanks