Advice on low test and lab results

[wpackof9]

I've had several years of low energy, being introverted and low libido thinking I was just getting 'older', but finally decided to suck it up and ask a doctor. I'm not the type of person to do this without doing any research, so I've read just about anything I can get my hands on about low test to be more informed and understand what might or might not be wrong with me. Upon talking to my doctor he decided to get the usual blood tests. Below were the initial results:

LH = 3.4 mUI/ml
Test (total) = 182 ng/dl
Cholesterol = 191 mg/dl
Tri = 243 mg/dl
HDL = 26 mg/dl

I thought this test just confirmed what I already knew... my test IS low and my lipid panel is out of whack as well. The cholesterol #'s threw me a little because I workout, eat right and take descent care of myself... I'm 6'1" and 220lbs with 17% body fat. I supplement my diet by taking a fish oil pill twice daily and also eat plenty of almonds, fish, etc... so I didn't understand why my HDL would be so low, but found some interesting articles on how cholesterol and test are related.

So a day later my doctor contacts me and says "Testosterone level came back appearing mildly low. Per our endocrinologists' recommendations, we need to recheck the testosterone level and some other hormone levels at 8 AM." I was actually relieved that the past few years wasn't all in my head... there was a problem and now the doctors were going to narrow in an fix it. A few days later I went in to get more blood drawn and the second set of results were:

Prolactin = 7 ng/dl
LH = 3.9 mUI/ml
Test (total) = 246 ng/dl
Test (free) = 85.4 pg/ml (UF or ETD method)

While the prolactin and LH seem normal to me the test still seems very low and the test (free) I'm not sure about because more sites are rated by RIA method. Either way, the total test is still low from every document, forum and study I can find. Then this jewel of an email response came in from my Dr:

"A repeat total testosterone level using an ultrasensitive technique showed the total testosterone was at a higher level (246) than initially measured (182). More importantly, the free, functional testosterone was normal at 85.4. The normal LH and Prolactin hormone results indicate there is not a secondary cause for low testosterone anyway. Our endocrinologists feel that the free testosterone measurement is a more accurate measure of testosterone level. Since it's normal, it appears that you do not have low testosterone and testosterone replacement therapy would not be helpful. Furthermore, testosterone replacement therapy can increase one's chance of developing prostate cancer. I believe the low energy/low libido may be related to high body weight as well. Fat tissue tends to create estrogen which could be affecting the libido. Weight loss and exercise should be helpful. I recommend targeting your weight in the 190-200 lb range."

To which I was completely at a loss for words... and still am. Not only did they basically tell me nothing was wrong and it IS all in my head, but I was then insulted by being told I was fat and just needed to lose weight. Not to mention they're either ignorant, stupid or completely out of touch if they still think that TRT causes prostate cancer. I'm completely frustrated right now and am not exactly sure of what my next move should be.

Is it worth it to take a stand... confront them on how wrong I think them to be? Easier just to take my results and get another doctor? And why did they give up so easily... if in fact estrogen is the problem then why wasn't that tested for? Why just two tests... why not take a sample over 4-6 weeks to get a better baseline?

Please... any and all advice is much appreciated... as you can probably tell I'm very frustrated.

[bass]

welcome Wpack! if you have more blood work post it all with ranges, and i mean all. then the guys here will be able to give you better analysis.

[wpackof9]

Thanks bass... the two tests were the only blood work they were currently willing to do. I've re-posted below with ranges.

(First Tests)
LH = 3.4 mUI/ml (range 1.0-12.0)
Test (total) = 182 ng/dl (range >220)
Cholesterol = 191 mg/dl (range <239)
Tri = 243 mg/dl (range < 199)
HDL = 26 mg/dl (range > 40)
LDL = 116 mgdl <range < 129)

(Second Tests)
Prolactin = 7 ng/dl (range 2-18)
LH = 3.9 mUI/ml (range 1.0-12.0)
Test (total) = 246 ng/dl (range 250-1100)
Test (free) = 85.4 pg/ml (range 35.0-155.0) (UF or ETD method)

[Brazensol]

Save yourself a lot of frustration and find another doc who will treat you right. The endo has already convinced your doc that you are fine and I doubt you will ever convince him otherwise.

[steroid.com 1]

The Endo is right about Free Test assay being a more accurate panel to make assessment.

85.4 is mid range and not that bad to be honest.

LH is a tad low but nothing alarming.

The total test is low and there are a number of reasons for this and honestly you'd like to see this in 80% of the reference range.

I would have liked to have seen more blood work done especially E2 and a complete Thyroid panel (Hypothyroidism has most of the same symptoms of Hypogonadism).

I agree with Brazensol that it will now be impossible to convince these Doc's to conduct further BW and put you on a TRT protocol.

I can tell you that my Doc would run more BW and would probably put you on a TRT program.

BTW, Testosterone Replacement does not cause prostate cancer.

[kelkel]

^^^This. It's time for another doctor who will treat you as a person and for your symptoms, not just by what your BW says. Don't waste more time. Move on. Read the Finding a Physician Sticky as well as all the others. It's great to see you've taken the time to educate yourself and not go in blind, as so many do.

Great post WP and welcome to the forum. Keep us posted on what steps you take on this thread please..

[wpackof9]

Thanks everyone... appreciate the advice. I am going to have one more conversation with my Dr and ask him to consult with another Endo that is more update to date on hrt/trt... but at the same time I'm also looking into independent hrt/trt dr and clinics. I'm in the San Jose, CA (Bay Area)... so anyone experience or reference referrals to a Dr that someone has, or is, being treated by would be appreciated. I went to the lef.org site and found a list of locations, but little information about their knowledge and experience. My preference would be to hear someone's success story and a good reference so that I'm not cold calling trying to figure out who is good and who is nutball trying to inject me with vitamin C.

Yes... I did just find a location from lef.org that believe vitamin C injections are the cure to all evils.

[Brazensol]

Vit. C is a wonderful supplement but perhaps when it comes to the cure of all evils it is "not all that and a bag of chips"! Vit. D seems to have surpassed C for being a super supplement and probably rightfully so. Unfortunately for us there just isn't one "super sup" that can do it all. They are all important in there own right.

I think the problem with endo's is that they are great with diabetes but everything else (trt, hrt) is just not "sexy" enough to get the attention it needs. At least not yet.

[wpackof9]

After going through 2 more doctors I finally had enough and demanded to be referred to an Endo. I'm not sold on him yet, but his specialty is supposed to be hormones. My new lab results from 8/20 are below.

TT = 173 ng/dl (range > 220)
SHBG = 13.5 nmol/l (range 10 - 60)
Albumin = 4.5 g/dl (range 3.7 - 5.7)
TSH = 2.88 uIU/ml (range .10 - 5.50)
TPO AB = 13 IU/ml (range < 35)
Creatinine = 1.27 mg/dl (range < 1.34)
LH = 3.7 mIU/ml (range 1.0 - 12)

His response to my results was that my IGF-1 is elevated. All the research and documentation I can find tells me that 'duh, yeah, it would be... I work out, eat meat, drink milk and supplement creatine'. Did I find another clueless doctor, or is his evaluation valid? I'm also annoyed because we talked about doing E2 test... but apparently he didn't order it. I made friends with another low-T guy who has similar symptoms to me and his problem was T was being converted to E2. I'm no genius at this stuff, but it makes more sense to me that E2 is high and is causing me problems than IGF-1.

Thoughts?

Also, if I take my TT, SHBG and Albumin I should be able to calculate that out to bioavailable T and it comes to:

Free Test = 4.95 ng/dL (2.78 %)
BioAvailable = 121 ng/dL (68.1 %)

However, I can't find any ranges to know if these are good, bad, ugly or otherwise. Anyone got any references?

[kelkel]

TSH is up a bit. More modern range is .3 - 3.0. Need to see a full panel to access is more though. Go to www.stopthethyroidmadness.com and read up a bit. SHBG is low as your T is low. That free test level is good actually (using your #s.) And yes, getting your E2 tested is a very important factor in this as you know. Make sure it's a sensitive assay.

[chrishansen83]

Hi wpack,

2.78% free is pretty good, the standard is around 2-2.5% AFAIK.

The problem is, this doesn't matter, because the total is way too low.

I don't know why did he think that your IGF-1 is high, it actually could be quite the opposite!

Do you have any skin problems (seborrheic dermatitis, eczema)?

I too, have low SHBG and that could be a sign of low growth hormone (GH),

From wikipedia (Growth_hormone_deficiency):

In adulthood

The incidence of genuine adult-onset GHD, normally due to pituitary tumours, is estimated at 10 per million.

Recognised effects include:

Increased 5-alpha-reductase
Reduced sex hormone-binding globulin (SHBG)
Reduced muscle mass and strength
Baldness in men
Reduced bone mass and osteoporosis
Reduced energy
Impaired concentration and memory loss
Increased body fat, particularly around the waistline
Lipid abnormalities, particularly raised LDL cholesterol
Increased levels of fibrinogen and plasminogen activator inhibitor
Cardiac dysfunction, including a thickened intima media

High triglicerides are bad for you.

Unfortunately, most doctors don't give a damn about your health, they'll tell you that it's "normal", case closed.

The hardest part of this journey is to find a really good doctor.

It will cost you a lot of time and money, just don't give up!

This is the BEST investment of your life, ever!

I'd say, get hold of a doc. who knows his stuff on HRT/Male health, at the next blood test definitely ask for IGF-1, it's only around 50 USD but it worths it even short term (Low IGF-1 + High triglycerides => heart failure => death).

Good luck!