Question about my blood work results - low HDL concerns...

[nycdave]

Guys -

A question for you. I am currently on HRT - using test cyp at 200 mg/wk dosage via IM injection at home. I take 100 mg every 4 days and have been doing this for approx 10 months. My doc is concerned about my HDL Cholesterol being "unsustainably low". Wonder if you could take a look at my numbers below and give me your thoughts on this? I was also on Letro prior to this bloodwork to get rid of some gyno issues but had stop taking it about 2 weeks prior. Would the Letro have caused these low HDL levels? Am concerned that my doc may try to reduce my test levels. My current levels along with a reference range:

Glucose 93 (65-99)
Sodium 139 (135-146)
Urea Nitrogen 25 (7-25)
Creatinine 1.11 (0.6-1.35)
Protein 6.9 (6.1-8.1)
Lipid Panel:
Cholesterol, Total 239 (125-200)
HDL Cholesterol 19 (>= 40)
LDL Cholesterol, Calculated 146 (<130)
Triglycerides 372 (<150)
Non HDL Cholesterol 220

Testosterone 896 (241-827)
Estrogen <50 (130 or less)

There were many other test results including urinalysis and CBC. Let me know if you would like to see those panel results also to give you more info. Appreciate you taking a look at this gents. This forum is outstanding and your wisdom has been of great help to me. Thank you.

[kelkel]

Well, some docs will give you 10 points to your HDL totals due to exogenous test. Will Letro cause it? Maybe slightly. Studies go back and forth on Letro's effects on lipids. Bottom line is that they need to study it more. It may have a detrimental effect. Emphasis on may. Read this study:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361692/

Your estrogen assay does not appear to be a sensitive one so it's hard to gauge. Estrogen and HDL are linked. Meaning that if your estrogen was a bit higher your HDL would be as well. It's your body searching for balance. It's all about balance. Some people have a naturally higher level despite proper exercise and nutrition throughout their lifetime (me) and meds will help. I personally use a non-statin so any excess is excreted out of my system.

Consider adding micronized dhea at 25mg to your protocol. It will help with lipids and is a good asset to any TRT protocol as well. Take it in the a.m. as it can have a mild stimulatory effect. Test your dhea-S as well during your next BW and then titrate up to 50 if warranted. Also consider micro. pregnenolone at 50mg per day as well. Read GD's sticky please.

Yes, it would be good to see the rest of your BW.

kel

[HRTstudent]

Are you taking any other supplements? HDL is negatively effected by androgens.

I ask about supplements because many people may inadvertently consume supplements that contain potent oral androgens, especially sport or bodybuilding supplements. These oral androgens can have a profound impact on HDL levels.

[FRDave]

My HDL levels are mid 20's but my LDL levels are great so my Dr. wasn't too worried. Says it can also be hereditary. I have tried to raise it by doing everything I have read/researched, but have failed in all attempts.
Dave

[nycdave]

No, not currently taking other supplements except muscle milk every morning with six eggs. My complete bloodwork:

Glucose 93 (65-99)
Sodium 139 (135-146)
Potassium 4.5 (3.5 - 5.3)
Chloride 101 (98-110)
Carbon Dioxide 26 (21-33)
Urea Nitrogen 25 (7-25)
Creatinine 1.11 (0.6- 1.35)
Calcium 9.2 (8.6-103)
Protein 6.9 (6.1-8.1)
Albumin 4.3 (3.6-5.1)
Globulin 2.6 (1.9-3.7)
Bilirubin 0.5 (0.2-1.2)
Alkaline Phosphatase 51 (40-115)
AST 46 (10-40)
ALT 47 (9-60)
AGFR non afr american 79 (>60)
Lipid Panel:
Cholesterol, total 239 (125-200)
HDL 19 (>= 40)
LDL Cholesterol 146 (<130)
Triglycerides 372 (<150)
Non HDL Cholesterol 220

CBC:
WBC 7.1 (3.8-10.8)
RBC 5.28 (4.2 - 5.8)
hemoglobin 15.9 (13.2-17.1)
hematocrit 48.2 (38.5-50)
MCV 91.4 (80-100)
MCH 30.2 (27-33)
MCHC 33 (32-36)
RDW 15.9 (11-15)
Platelet count 318 (140-400)
MPV 7.8 (7.5- 11.5)
Total Neutrophils 61.3 (38-80)
total Lymphocytes 27.9 (15-49)
Urinalysis:
Glucose Negative (negative)
Bilirubin Negative (negative)
Ketones Negative (negative)
Specific Gravity 1.019 (1.001-1.035)
Blood negative (negative)
PH 5.5 (5.0-8.0)
Protein, Total, QL Negative (negative)
Nitrate Negative (negative)
Leukocyte Esterase Negative (negative)

Testosterone , total 896 (241-827)
Estrogen <50 (130 or less)

Apologies for the length of this. Let me know if you have further thoughts. Thank you guys very much for the advice so far.

[AnabolicDoc]

No, not currently taking other supplements except muscle milk every morning with six eggs. My complete bloodwork:

Glucose 93 (65-99)
Sodium 139 (135-146)
Potassium 4.5 (3.5 - 5.3)
Chloride 101 (98-110)
Carbon Dioxide 26 (21-33)
Urea Nitrogen 25 (7-25)
Creatinine 1.11 (0.6- 1.35)
Calcium 9.2 (8.6-103)
Protein 6.9 (6.1-8.1)
Albumin 4.3 (3.6-5.1)
Globulin 2.6 (1.9-3.7)
Bilirubin 0.5 (0.2-1.2)
Alkaline Phosphatase 51 (40-115)
AST 46 (10-40)
ALT 47 (9-60)
AGFR non afr american 79 (>60)
Lipid Panel:
Cholesterol, total 239 (125-200)
HDL 19 (>= 40)
LDL Cholesterol 146 (<130)
Triglycerides 372 (<150)
Non HDL Cholesterol 220

CBC:
WBC 7.1 (3.8-10.8)
RBC 5.28 (4.2 - 5.8)
hemoglobin 15.9 (13.2-17.1)
hematocrit 48.2 (38.5-50)
MCV 91.4 (80-100)
MCH 30.2 (27-33)
MCHC 33 (32-36)
RDW 15.9 (11-15)
Platelet count 318 (140-400)
MPV 7.8 (7.5- 11.5)
Total Neutrophils 61.3 (38-80)
total Lymphocytes 27.9 (15-49)
Urinalysis:
Glucose Negative (negative)
Bilirubin Negative (negative)
Ketones Negative (negative)
Specific Gravity 1.019 (1.001-1.035)
Blood negative (negative)
PH 5.5 (5.0-8.0)
Protein, Total, QL Negative (negative)
Nitrate Negative (negative)
Leukocyte Esterase Negative (negative)

Testosterone , total 896 (241-827)
Estrogen <50 (130 or less)

Apologies for the length of this. Let me know if you have further thoughts. Thank you guys very much for the advice so far.

A HDL level less than 40 is considered a 1 point cardiac risk factor, equivalent to untreated hypertension or diabetes. A level over 60 is considered a negative cardiac risk factor so that if you have diabetes and an HDL > 60, you are considered to have no cardiac risk factors or a score of zero. My point is that you are appropriately concerned about your HDL level.

That being said, taking AAS will drastically lower ones HDL and in your case can put you at risk of sudden cardiac death. One of the most effective ways to raise one's HDL is niacin. There really is no benefit to the prescription variants, just get some extended-release flush-free niacin. Start with 250mg per day, taken at bedtime. Double it every week or two as tolerated, up to 2gm daily. If you take the immediate-release form, then you can take up to 3gm daily in divided doses (3x per day).

Personally I can't tolerate more than 250mg eod bc I get severe cramps, which is the major reason for discontinuation for most ppl taking niacin. Of course it does have other adverse reactions, namely elevated LFTs or liver failure but this is uncommon and generally only seen at higher doses.

The makers of Lovaza (a prescription fish oil) claim that taken at 4gm per day (where each gram of fish oil contains almost 900mg of DHA + EPA) can boost HDL levels by 8%. The problem is that the DHA in Lovaza has been shown to raise LDLs by as much as 30% in many individuals if not taken concomitantly with a statin (such as Lipitor). Statins can also mildly boost HDLs. I don't know for sure if this HDL boosting effect of Lovaza pertains to equivalent amounts of other omega-3s. There are two other prescription fish oil products that contain less DHA. There is Vascazen which is mostly EPA, then DHA and also contains some other omega-3s. Newly released is Vascepa which is almost entirely EPA. These last two should not increase LDLs while hopefully also increasing HDLs and letting triglycerides, which is the primary indication for these three prescriptions

I hear excellent things about krill oil to but can't tell you for sure if it will increase HDLs.

I have seen French-Americans with HDL levels approaching 120, which they changed was due to the typical French diet. I've heard about this elsewhere but don't know to much more about it. Maybe it's something worth looking into.

[Allaaro]

Don't forget that the absolute best way to raise HDL levels....for me and what my doc said, is a healthy diet, sleep and cardio. Simple....but get those 3 perfect as can be and the numbers will get better.

[nyjetsfan]

A HDL level less than 40 is considered a 1 point cardiac risk factor, equivalent to untreated hypertension or diabetes. A level over 60 is considered a negative cardiac risk factor so that if you have diabetes and an HDL > 60, you are considered to have no cardiac risk factors or a score of zero. My point is that you are appropriately concerned about your HDL level.

That being said, taking AAS will drastically lower ones HDL and in your case can put you at risk of sudden cardiac death. One of the most effective ways to raise one's HDL is niacin. There really is no benefit to the prescription variants, just get some extended-release flush-free niacin. Start with 250mg per day, taken at bedtime. Double it every week or two as tolerated, up to 2gm daily. If you take the immediate-release form, then you can take up to 3gm daily in divided doses (3x per day).

Personally I can't tolerate more than 250mg eod bc I get severe cramps, which is the major reason for discontinuation for most ppl taking niacin. Of course it does have other adverse reactions, namely elevated LFTs or liver failure but this is uncommon and generally only seen at higher doses.

The makers of Lovaza (a prescription fish oil) claim that taken at 4gm per day (where each gram of fish oil contains almost 900mg of DHA + EPA) can boost HDL levels by 8%. The problem is that the DHA in Lovaza has been shown to raise LDLs by as much as 30% in many individuals if not taken concomitantly with a statin (such as Lipitor). Statins can also mildly boost HDLs. I don't know for sure if this HDL boosting effect of Lovaza pertains to equivalent amounts of other omega-3s. There are two other prescription fish oil products that contain less DHA. There is Vascazen which is mostly EPA, then DHA and also contains some other omega-3s. Newly released is Vascepa which is almost entirely EPA. These last two should not increase LDLs while hopefully also increasing HDLs and letting triglycerides, which is the primary indication for these three prescriptions

I hear excellent things about krill oil to but can't tell you for sure if it will increase HDLs.

I have seen French-Americans with HDL levels approaching 120, which they changed was due to the typical French diet. I've heard about this elsewhere but don't know to much more about it. Maybe it's something worth looking into.

Just to add to this: I take Niaspan for Low HDL. It's a perscription extended released niacin. This could do the trick.

[AnabolicDoc]

Niaspan is great if your insurance covers it with a low copay. For many ppl it's not covered or the copay is too high, which forces them to buy the OTC extended release varieties

[kelkel]

Doc which do you prefer? Extended or immediate release?

[AnabolicDoc]

Extended release tends to be tolerated much better. There's no need for the prescription variant unless it's covered by your insurance with a low copay. I would start with 250-500mg every day at bedtime. If you develop flushing, then take an aspirin (325mg) 30 min before taking the niacin. [Note: do not take aspirin if you have known medical reasons not to, such as aspirin allergy, history of gastric bleeding, bleeding disorders, etc.]

Take the 250-500mg for 4 weeks. If no side effects, increase by 250-500mg/day every 2-4 weeks as you can tolerate it or until your HDL is at least greater than 40. If you have other cardiac risk factors (elevated LDL, diabetes, hypertension, history of stroke or heart attack), then shoot for an HDL greater than 60.

This pace of increase is slower than what I suggested in my earlier post and should be more tolerable.

[nycdave]

Thank you everyone for the advice. Im going to give Niacin a shot and will report back. I need to have bw done in about a month so will know if there is an impact. My diet is decent but certainly not perfect and rest is so-so. Hopefully this will help.