thoughts on my six week bloodwork?

[jacobk91]

If you dont care about my story you can skip this wall of text and go down to my test results, but im sure some people might be interested.

First ill tell you my story if you havent seen my thread from a month or so ago. i am 20 years old, almost 21, and I started trt 6 weeks ago with an endocrinologist who had no idea what he was doing. he didnt test for estrodial, use an ai, or know what hcg was. since then i have found a good TRT doctor who actually knows what she is doing and ditched the other one. She is a4m certified, prescribes hcg for trt, and arimadex. And best of all, my insurance covers her! I have been on 100mg of test cyp a week. no ai or hcg yet.

Before starting TRT i had literally zero sex drive, was fatigued and tired all the time, and had a really hard time putting on mass. I had severe erection problems and could only successfully have intercourse with my girlfriend about half of the times i tried. (was never able to at nighttime)

Since my 4th week on TRT my sex drive has gone from non existent to through the roof! I feel much less fatigued all the time and i dont need 12 hours of sleep a night to be able to function. I no longer have erectile disfuction at all! i can get it up whenever and wherever! overall ive felt the best in the last 3 weeks that i have in my whole life. enough of my story and to the results now.

Here is my bloodwork PRIOR to starting to TRT for reference:

TESTOSTERONE , FREE, BIO AND TOTAL

Testosterone, Total
Your Value: 361
standard range: 250 - 1100
Units: ng/dL

Testosterone, Free
Your Value: 34.7
standard range: 46.0 - 224.0
Units: pg/mL

Testosterone, Bioavailable
Your Value: 76.0
standard range: 110.0 - 575.0
Units: ng/dL

SHBG Your Value: 46 standard range: 10 - 50 Units: nmol/L

Albumin, Serum Your Value: 4.8 standard range: 3.6 - 5.1 Units: g/dL

LH

Your Value: 3.9
standard range: 0.8 - 7.6
Units: mIU/ml

FSH

Your Value: 6.1
standard range: 0.0 - 14.0
Units: mIU/mL

Prolactin

Your Value: 8.6
standard range: 4.4 - 16.4
Units: ng/mL

TSH

your value: 1.17

standard range: 0.40 - 4.00

units: uIU/mL


Estradiol, Sensitive:
Result: 5
Units: pg/ml
Reference interval: 3-70

-------------------------------------------------------------------------
Now here is my bloodwork after 6 weeks of 100mg test cyp a week (taken in one injection once a week)
the blood was drawn two days after my 6th injection first thing in the morning and fasted. Some of the tests arent things i usually get tested but we were checking some other things as well but i figured i would just post everything here.

format is like this:
RESULT REF RANGE UNITS

DIHYDROTESTOSTERONE,
LC/MS/MS 79 16-79 ng/dL

Androstenedione 101 50 - 220 ng/dL

Ferritin 238.1 24.0 - 336.0 ng/mL

Vit D,25OH,Total 30 30 - 100 ng/mL

Vit D,25OH,D3 30 ng/mL

Vit D,25OH,D2 <4 ng/mL


TESTOSTERONE

Component Your Value Standard Range Units

Testosterone, Total 1365 250 - 1100 ng/dL (too high?)
Free Testosterone 283.6 35.0 - 155.0 pg/mL (too high?)


ESTRADIOL


Estradiol 41 0 - 56 pg/mL
Estradiol

Normal Ranges
Males Adult ND - 56 pg/mL
Females
Follicular ND - 160 pg/mL
Preovulatory 34 - 400 pg/mL
Luteal Phase 27 - 246 pg/mL

IGF - 1

IgF-1 138 83 - 456 ng/mL (is this low for my age? almost 21 y/o)



A1C Hemoglobin 4.9 4.0 - 6.0 %

CBC with platelet and differential

WBC 2.9 4.5 - 10.0 K/uL
RBC 4.86 4.60 - 6.20 M/uL
Hgb 15.4 14.0 - 17.0 g/dL
Hct 45.4 40.0 - 54.0 %
MCV 93.5 81.3 - 94.2 fL
MCH 31.7 27.0 - 32.5 pg
MCHC 33.8 32.0 - 36.0 g/dL
RDW 12.1 10.5 - 16.0 %
Platelet Count 125 150 - 450 K/uL
Neutrophils 52 30 - 80 %
Lymphocytes 37 20 - 40 %
Monocytes 10 0 - 12 %
Eosinophils 1 0 - 7 %
Basophils 1.0 0.0 - 1.9 %
Absolute Neutrophils 1.5 1.5 - 8.0 K/uL

LIPID PANEL
Triglycerides 32 30 - 200 mg/dL
Cholesterol 127 150 - 240 mg/dL
HDL Cholesterol 40 mg/dL
HDL Normal > 40 mg/dL
LDL Cholesterol 81 3 - 130 mg/dL
Chol/HDL 3.2 0.0 - 5.0
LDL/HDL 2.0 0.0 - 3.0

THYROID

Thyroxine (t4) 7.2 4.2 - 12.0 ug/dL
T3, Total 73 84 - 172 ng/dL (low?)
TSH 1.24 0.40 - 4.00 uIU/mL

Comprehensive metabolic panel

Glucose 72 65 - 99 mg/dL
BUN 27 8 - 23 mg/dL
Creatinine 1.08 0.64 - 1.27 mg/dL
Sodium 139 135 - 148 mEq/L
Potassium 4.1 3.5 - 5.3 mEq/L
Chloride 103 98 - 111 mEq/L
CO2 31 22 - 33 mEq/L
Total Protein 7.3 6.0 - 8.0 g/dL
Albumin 4.8 3.4 - 4.8 g/dL
A/G Ratio 1.92 1.00 - 2.00 mg/dL
Calcium 9.4 8.5 - 10.3 mg/dL
AST (SGOT) 44 5 - 40 U/L
Alkaline Phosphatase 75 30 - 120 U/L
Bilirubin Total 1.8 0.2 - 1.3 mg/dL
ALT (SGPT) 72 7 - 51 U/L
GFR >60 >=60 mL/min /1.73m Squared

any input from the vets is appreciated!

[steroid.com 1]

OK, some initial thoughts/comments; I will leave some for the other guys like Vette, Kel, HRT...

First and foremost, a 21 otherwise healthy male should not present blood work like yours on the initial pull. Generally, these point to some pathology as you are still maturing and your serum levels should be peaked. Did you discuss any medical condition as to why you present like you do and if so what was that discussion?

Your initial BW presents tanked Testosterone and E2 values while SHBG and Albumin are elevated; a pretty standard picture for this scenario.

Prolactin appears normal level so the question of a Pituitary tumor may be lessened but not out of the question.

Your Testosterone levels NOW are way too high even though you injected ~48 hours prior to the pull...hell, you haven't even peaked yet!

IMO, your E2 is too elevated and a small dose of an AI may be considered at this juncture.

As you noted, your IGF-1 score is way too low, like your testosterone, for a guy your age...something is amiss.

Here's where I think you and your Doc need to dig deeper:

THYROID
TSH 1.24 0.40 - 4.00 uIU/mL
This is fine, but as we know, TSH is not a good panel to evaluate Thyroid health.

Thyroxine (t4) 7.2 4.2 - 12.0 ug/dL
This is mid range and fine but better in the upper range.

T3, Total 73 84 - 172 ng/dL (low?)
Your conversion from T4 to T3 is very poor and you are below the reference range and it's here that I think you need to find out why. T3 is the biologically available form of Thyroxine that your body needs and uses and it's tanked and you need to know why.

It may/possibly suggest that you are in a state of Hypothyroidism which in and of itself can cause Hypogonadism and the reason for your original testosterone levels.

Have you discussed this as a possibility with your Physician?

[kelkel]

Jacob do us a favor and post the link to your original thread that we participated in. We need to refresh ourselves on it like GD referenced so we can dig into it. It would have been great to have updated that thread actually. GD your thinking sub-clinical hypothyroidism I assume?

kel

[jacobk91]

my responses in bold.

OK, some initial thoughts/comments; I will leave some for the other guys like Vette, Kel, HRT...

First and foremost, a 21 otherwise healthy male should not present blood work like yours on the initial pull. Generally, these point to some pathology as you are still maturing and your serum levels should be peaked. Did you discuss any medical condition as to why you present like you do and if so what was that discussion?

with my old retard doc, no. but with my new one yes. not much was discussed about cause but thats why she ran all these additional tests and we are going to try to figure out why this is happening on my follow up visit which is next week.

Your initial BW presents tanked Testosterone and E2 values while SHBG and Albumin are elevated; a pretty standard picture for this scenario.

Prolactin appears normal level so the question of a Pituitary tumor may be lessened but not out of the question.
thats good news right?

Your Testosterone levels NOW are way too high even though you injected ~48 hours prior to the pull...hell, you haven't even peaked yet!
Yes i realized that, we will probably lower my dose on my follow up next week. would 75mg be good? i hope i didnt get spoiled and not feel as good when we lower the dose

IMO, your E2 is too elevated and a small dose of an AI may be considered at this juncture.
it should be between 30 and 40 right?

As you noted, your IGF-1 score is way too low, like your testosterone, for a guy your age...something is amiss.
for some reason she suspected it might be low but didnt say why. ill ask her about it next week.

Here's where I think you and your Doc need to dig deeper:

THYROID
TSH 1.24 0.40 - 4.00 uIU/mL
This is fine, but as we know, TSH is not a good panel to evaluate Thyroid health.

Thyroxine (t4) 7.2 4.2 - 12.0 ug/dL
This is mid range and fine but better in the upper range.

T3, Total 73 84 - 172 ng/dL (low?)
Your conversion from T4 to T3 is very poor and you are below the reference range and it's here that I think you need to find out why. T3 is the biologically available form of Thyroxine that your body needs and uses and it's tanked and you need to know why.

It may/possibly suggest that you are in a state of Hypothyroidism which in and of itself can cause Hypogonadism and the reason for your original testosterone levels.

Have you discussed this as a possibility with your Physician?
no, but i defnitely will now. my old doctor told me my thyroid was fine but i guess he was an idiot. thanks guys. i will update this thread after i go visit her next week.

thanks for your responses, is there anything else i should ask her about?

here are link to my original threads

Jacob do us a favor and post the link to your original thread that we participated in. We need to refresh ourselves on it like GD referenced so we can dig into it. It would have been great to have updated that thread actually. GD your thinking sub-clinical hypothyroidism I assume?

kel

http://forums.steroid.com/showthread...=#.UDvQ7qPhfFE
http://forums.steroid.com/showthread...=#.UDvREqPhfFE

[steroid.com 1]

Jacob do us a favor and post the link to your original thread that we participated in. We need to refresh ourselves on it like GD referenced so we can dig into it. It would have been great to have updated that thread actually. GD your thinking sub-clinical hypothyroidism I assume?

kel

Maybe kel...would love to know what his Cortisol levels are!

He's poorly converting FT4 to FT3 and there any number of reasons for that to happen.

He needs to have FT3 optimized.

For Thyroid they also need to look at RT3 (bet this is where the problem is) and Thyroid Antibodies as well to get a complete picture.

Something is up with his Thyroid and he probably feels like he does because of the low FT3 assay.

Jacko - Go to http://www.stopthethyroidmadness.com and do a search on Low T3 and learn...

[jacobk91]

Maybe kel...would love to know what his Cortisol levels are!

He's poorly converting FT4 to FT3 and there any number of reasons for that to happen.

He needs to have FT3 optimized.

For Thyroid they also need to look at RT3 (bet this is where the problem is) and Thyroid Antibodies as well to get a complete picture.

Something is up with his Thyroid and he probably feels like he does because of the low FT3 assay.

Jacko - Go to http://www.stopthethyroidmadness.com and do a search on Low T3 and learn...

i had my cortisol levels tested before trt but idk what they are now. my cortisol test is in one of those older threads

im definitely going to look into my thyroid.

you said my estradiol is too high, but if we lower my dose of test, is there a chance i wont need an ai for now?

i understand that i will need an ai eventually though when we add in hcg

[Brohim]

trt at 21, wow! Your T3 is def. below the range and like others said is connected to your other systems. Correcting that problem may help with your low Test. I would do some research and go over it with your doctor. Good luck

[jacobk91]

trt at 21, wow! Your T3 is def. below the range and like others said is connected to your other systems. Correcting that problem may help with your low Test. I would do some research and go over it with your doctor. Good luck

im planning on it. im just scared of going off of test because right now i actually feel good.

[Brohim]

im planning on it. im just scared of going off of test because right now i actually feel good.

how good do you feel? I would imagine if you had low test and now it's 1,000+ you must feel great. lol

your e2 needs to be 20-30 though.

[Vettester]

Jacob, hats off to you that at least you're doing the follow up labs at six (6) weeks! Hell, some guys don't do them for months or even longer, and have no idea where they sit. This is exactly why we run them at this stage ... Best to get a handle on it sooner than later!

Can't add much more on the thyroid to what the others have said. Definitely read the link that GD provided, and dig a little deeper with your doctor on it.

It's good that you are feeling better, BUT, I assure you that keeping your test that high for any real length of time is going to come back and bite you. Your free test percentage is good, so if you can sustain in the 600-800 range on total serum, you should have a program that will work with you for the long-run. Not to say that you can't run a little extra here and there for a 10-to-12 week blast, but use the first year to get yourself dialed in and balanced.

Agree with Brohim, you should look to aim for the 20's or 30's with your E2. You're not too far of the mark. A little AI at this stage might be a good thing. If anything, you could even get the Liquidex from AR-R and start with .25mg. I wouldn't go anymore than .25mg x 2/wk at this point, and run another E2 (or full set of labs) in 4 weeks.

Also, pickup some Vitamin D3 and run approx. 5,000iu/day. As expected, your level is low, and it's easy to get in range. This will also help to lower your SHBG a bit, which isn't excessive high or anything, but could stand to come down a bit. This would also promote more free testosterone , which would mean you could substantially lower your serum level and still receive an optimal level of bio-available and free testosterone (If that makes any sense? ... Trust me, it works).

OK, the one thing I want to touch on is your ALT/AST enzyme scores. Are you taking any oral medications? How is your liquor consumption (I dare ask someone just turning 21 LOL)? Both are IMO right that level that has me scratching my head. Anyways, as you know, a healthy liver is going to be needed for a healthy life. BUN is also a bit elevated, but you just may need some more hydration, or your diet involves a lot of protein. Again, nothing alarming IMO, but something that might get compared to the next round of assays.

[jacobk91]

my responses are in bold

Jacob, hats off to you that at least you're doing the follow up labs at six (6) weeks! Hell, some guys don't do them for months or even longer, and have no idea where they sit. This is exactly why we run them at this stage ... Best to get a handle on it sooner than later!
ya, i wanna make sure i do this right!


Can't add much more on the thyroid to what the others have said. Definitely read the link that GD provided, and dig a little deeper with your doctor on it.
my doctor specializes in hormone replacement and thyroid stuff so hopefully she will know what to do

It's good that you are feeling better, BUT, I assure you that keeping your test that high for any real length of time is going to come back and bite you. Your free test percentage is good, so if you can sustain in the 600-800 range on total serum, you should have a program that will work with you for the long-run. Not to say that you can't run a little extra here and there for a 10-to-12 week blast, but use the first year to get yourself dialed in and balanced.
ya im sure we will lower my dose when i go to see her next thursday. until then ill just keep doing 100 mg a week for one more week since im enjoying feeling good.

Agree with Brohim, you should look to aim for the 20's or 30's with your E2. You're not too far of the mark. A little AI at this stage might be a good thing. If anything, you could even get the Liquidex from AR-R and start with .25mg. I wouldn't go anymore than .25mg x 2/wk at this point, and run another E2 (or full set of labs) in 4 weeks.
i actually already have some liquidex from ar-r. should i start on it now or wait until i see what the doc says in 2 weeks? you said .25mg twice a week. what days should i take it?

Also, pickup some Vitamin D3 and run approx. 5,000iu/day. As expected, your level is low, and it's easy to get in range. This will also help to lower your SHBG a bit, which isn't excessive high or anything, but could stand to come down a bit. This would also promote more free testosterone , which would mean you could substantially lower your serum level and still receive an optimal level of bio-available and free testosterone (If that makes any sense? ... Trust me, it works).
will do, i was just holding on on vit d supplementation until i found out what my levels were.


OK, the one thing I want to touch on is your ALT/AST enzyme scores. Are you taking any oral medications? How is your liquor consumption (I dare ask someone just turning 21 LOL)? Both are IMO right that level that has me scratching my head. Anyways, as you know, a healthy liver is going to be needed for a healthy life. BUN is also a bit elevated, but you just may need some more hydration, or your diet involves a lot of protein. Again, nothing alarming IMO, but something that might get compared to the next round of assays.
the only oral medications i take are zoloft, but its a pretty high dose. 200mg a day. other than that i take creatine and my protien intake is pretty high since im cutting. about 1.6 grams per lbs. i drink 2 gallons of water daily though. could that still be the cause?
I literally have had almost zero alcohol in my entire life, i dont drink AT ALL. ever.

[jacobk91]

oh, and i realized i forgot to post my cortisol. this was my cortisol before starting TRT. it was fasted first thing in the morning after waking up..

Cortisol 15.5 ug/dL
REFERENCE RANGE FOR 8 AM (7-9AM) SPECIMEN 3.0 - 25.0 ug/dL
REFERENCE RANGE FOR 4 PM (3-5PM) SPECIMEN 3.0 - 17.0 ug/dL

i dont have any number from after starting but this test was about two months ago before trt started

[Vettester]

It's probably your protein intake elevating the BUN test a bit. Should be OK.

If you're seeing the doctor soon, hold off on the AI and see what she can tell you. For dosages, it's best to take your cyp 2x per week (if possible), then take the .25mg dosages the day after your injections. Peak life of cypionate tends to intersect fairly well with AI half life in that range, making the protocol just that much more efficient.

[HRTstudent]

If you feel good then that's what matters most.

You should try lowering the dose and see if you get the same improvements.

I suspect your e2 increasing since starting TRT is probably a major player in your erectile issues. Don't overdo it if you try an AI... or its very likely you will revert back to those erectile problems.

If you're feeling good then enjoy it... that's why we go on TRT. Try not to go on a wild goose chase and getting every number in "optimal" range while driving yourself mad. Stay healthy and monitor your bloodwork with a good doc.

[kelkel]

^^^Very good advice. To often we shoot for perfection here and it's just not prudent. We don't need to micromanage everything.

[xtitan1]

Very similar situation with me. I'm 24 with poor ft3 to ft4 conversion, low vitamin d, slightly elevated alt level, low t, 12 hours of sleep.

Just so you know, total t4 and t3 are not the same thing as free t4 and t3. Make sure you get the latter.

Also did I read that your WBC is low?

[jacobk91]

so i saw the doctor today. she lowered my test dose to 50mg a week, injected twice a week at 25mg a time. (is this too low?) She said my estradial should go down too since we are lowering the dose by half. She said her goal is to keep my test in the 800s to 900s. Once we get there she says we can start hcg too.

She prescribed me naturethroid for my thyroid issue. 1/2 grain taken once a day in the monring. it contains 4.5 mcg t3 and 19 mcg t4. Can i expect a metabolism increase from this? how much do you think if any?

Ive also been referred to a hematologist because my wbc and platelet count has been getting consistently lower for the last three years every year and that worries her. she said worst case was lukemia.

thanks ahead of time for any advice! please let me know your thoughts!

[jacobk91]

Bump. Also she said my cholesterol is too low and wants me to raise it by eating more saturated fats and cholesterol. Animal fats and fried foods.