Can I get you guys to have a look over my bloods please and let me know your thoughts

[NJA82]

Hi guys, Long post here but i wanted to cover what i could. Been suffering from the symptoms of low T for a fair while and because of my age ( 30 ) i didnt really pursue any medical advice until i really started to feel crap and bit the bullet and went and asked for bloods to be done.

My stats, 30 yo, 178cm tall, 84kg, rarely drink, dont smoke, never done AAS of any kind, eat clean and a perfect 50/30/20 C/P/F macro breakdown nearly everyday strict, lift 4 times a week at a moderate pace, dont train to failure etc. in general i look after myself the best i can so i doubt its anything im doing to myself causing any issues.

My GP has no idea at all on this kinda stuff as you will see by the blood work that follows.

Labs taken on the 8 Nov 12 referred by my GP taken at 0750 am.

-Total testosterone 11.9 ( 10 – 35 nmol/L )
-FSH 3 U/L ( < 9 )
-LH 1 U/L ( < 8 )
-Electrolytes Na 140 ( 134 – 146 nmol/L )
K 4.4 ( 3.4 – 5.5 nmol/L )
Cl 105 ( 95 – 108 nmol/L )
HCO3 25 ( 22 – 32 nmol/L )
Urea 6.8 ( 3.0 – 8.0 nmol/L )
Creat 76 ( 40 – 120 umol/L )

-Liver function Bili 9 ( < 21 umol/L )
ALP 86 ( 35 – 110 U/L )
GGT 15 ( < 41 U/L )
ALT 38 ( < 56 U/L )
ALB 50 ( 38 – 50 g/L )
TP 68 ( 65 – 85 g/L )

-Glucose ( fasted ) 4.5 nmol/L ( < 5.5 )
-Lipids Chol 4.4 ( < 5.5 nmol/L )
Trig 0.7 ( <2.0 nmol/L )
HDL-C 1.8 ( > 0.9 nmol/L )
LDL-C 2.3 ( < 3.4 nmol/L )

-Haemoglobin 144 ( 135 – 170 g/L )
-MCV 91 ( 82 – 97 fL )
-RDW 14 ( < 16 % )
-MCHC 344 ( 320 – 360 g/L )

-White cells 6.1 ( 4.0 – 11.0 g/L )
-Neut 53% 3.2 ( 1.8 – 7.5 g/L )
-Lymph 39% 2.4 ( 1.0 – 4.0 g/L )
-Mono 6% 0.4 ( 0.1 – 1.2 g/L )
-Eosin 2% 0.1 ( < 0.7 g/L )


Next lot of labs taken on 15 Dec 12 reffered by my GP taken at 0740 am.

-Total testosterone 3.1 ( 10.0 – 35.0 nmol/L )
-SBHG 48 ( 10 – 50 nmol/L )
-Calculated free testosterone 44 ( 225 – 725 pmol/L )
-FAI 6.5 ( 20.0 – 160.0 )
-FSH 2 U/L ( < 9 )
-LH 1 U/L ( < 8 )
-Prolactin 91 mU/L ( < 330 )

Note added from pathology: Results suggestive of hypogonadotrophic hypogonadism. Suggest repeat testosterone and consider measuring prolactin, AM cortisol, Iron studies and thyroid function including FT4 if not on androgen therapy.

-PSA 0.3 ( Upper limit 2.5 ug/L )

-HAEMOGLOBIN 138 ( 135 – 170 g/L )
-MCV 92 ( 82 – 97 fL )
-RDW 12 ( < 16 % )
-MCHC 342 ( 320 – 360 g/L )

-WHITE CELLS 5.6 ( 4.0 – 11.0 g/L )
-Neut 58% 3.2 ( 1.8 – 7.5 g/L )
-Lymph 35% 2.0 ( 1.0 – 4.0 g/L )
-Mono 6% 0.3 ( 0.1 – 1.2 g/L )
-Eosin 1% 0.1 ( < 0.7 g/L )

C-REACTIVE PROTEIN <1 ( < 10 )

TSH 1.84 ( 0.40 – 4.00 mU/L )



Next labs were taken on the 25 Jan 13 reffered by my GP, taken at 0800 am

-Cortisol 421 ( AM RANGE 150 – 600 nmol/L )
-FSH 2 U/L ( < 9 )
-LH 1 U/L ( < 8 )
-Prolactin 110 mU/L ( < 330 )
-TSH 1.44 ( 0.40 – 4.00 mU/L )
-FT4 14 ( 10 – 20 pmol/L )
-Total testosterone 5.5 ( 10.0 – 35.0 nmol/L )
-SHBG 45 ( 10 – 50 nmol/L )
-Calculated free testosterone 85 ( 225 – 725 pmol/L )
-FAI 12.2 ( 20.0 – 160.0 )

Note from pathology, Low testosterone with inappropriately low LH and FSH is consistent with hypogonadtrophic hypogonadism. Normal prolactin and reasonable cortisol level noted. Suggest endocrine review with endocrinologist.

Cumulative iron studies;
-Iron 17 ( 12 – 31 umol/L )
-Transferrin 26 ( 20 – 45 umol/L )
-TFN Satn % 33 ( 15 – 55 )
-Ferritin 255 ( 30 – 400 ug/L )

Reffered to endo and he requested an MRI on the pituitary and a semen analysis which both came back fine. He also requested some more bloods but this is where im confused, he didn’t check for much as you will see as follows;

Labs done on the 9 APR 13 at 0900 am

-Total testosterone 13.8 ( 10.0 – 35.0 nmol/L )
-Fetoprotein 2 ( <10 kIU/L )
-FSH 3 U/L ( < 9 )
-LH 2 U/L ( < 8 )
-Prolactin 97 ( < 330 mU/L )

After these results came back the endo and my GP have both told me im perfectly fine and sent me on my way... i know im not fine and im not letting it rest with this.

I cant see anywhere where they have tested me for any estrogen counts? Im thinking my problem could be high estrogen levels.. I know that they havent tested me for EVERYTHING here but im working on getting another opinion from a more specialized doctor in the HRT field but it might not be till July until i can see him.

Any help you guys can offer would be much appreciated. Thanks.

[phaedo]

after these results came back the endo and my GP have both told me im perfectly fine and sent me on my way...

That's silly, because the labs are clearly indicative of hypogonadtrophic hypogonadism. Did you tell your general physician and endocrinologist your symptoms (low libido, energy, lack of ambition, etc.?) You shouldn't be needing TRT at your age, however, how long have you been suffering from these symptoms?

From your semen analysis, what was your sperm count?

Yes, I suggest you get an estrogen lab (sensitive assay). I'd also request DHEA, DHT, and vitamin D.

Have you been stressed lately? Anxiety over life events (work, relationships, etc.)? I'd suggest a ACTH stimulation test for adrenal response, function, and possible insufficiency. I sorta buy into the adrenal fatigue idea, though the medical literature doesn't specify all too well what that entails.

[NJA82]

Been suffering from these symptoms for the past few years, have really noticed it a lot more in the last 12-18 months though.

Stress wise havent really got anything that causes me major stresses, enough to cause this i wouldnt think anyway. Just the normal stuff everyday life throws at you... I can say though that im less stressed at the moment in life than I have been several years back where things were very tough yet even then my libido, mood, energy levels etc. werent really affected from the high stress. So i know my body fairly well and how it responds to stress so im leaning away from it being caused from any psychological reasons.

Semen analysis came back very high, sperm count was 174.50 million/ml but volume was very low as has been since i been suffering from these problems. Volume was only 1.5ml and that is pretty standard for me these days.

In regards to not needing TRT at my age, this would be ideal for me, i really dont want to have to go down that path if i dont have to. After this run around with the doctors over the past 6 months im just about over it though and just accepting it for now as bad as it is...

[Vettester]

So that everyone is clear, his latest labs would equal 397ng/dl going by our standard unit of measurement in the US.

This IMO, is low, but not in the tank. Not saying that you shouldn't want to get this higher ... It's pretty obvious that your low LH is the culprit, which would put you in the secondary hypogonadism category. The good news, your leydig cells appear to be quite healthy. I've seen many guys come here with similar LH scores, but their serum levels are in the 200's. So, if it does come down to getting on therapy at some point, you have a few options including HCG .

Your physician did right with ordering an MRI. Glad to hear nothing negative was discovered with the results. The question now is what to do going forward. It doesn't sound like your physicians know more than just the basics. I don't know anything about your country's laws, or how easy/difficult it is to seek out quality healthcare. If you were in the US, I would have better answers.

Last note of observation ... Your SHBG is a tad bit high. You would see the benefit of increased free testosterone by lowering it to mid-range levels (20-25ish). Phaedo tapped on something above ... Your vitamin D should be checked. Optimizing this sterol hormone will add increased benefit to help balance your SHBG; allowing more testosterone to be unbound and available for bio-use. You can also look at the implementation of nettle root, which is also proven to lower SHBG.

[NJA82]

Thanks for the awesome informative replies guys! Appreciated!

Vet, that is great news to hear that there is a possibility of an alternative treatment other than lifetime trt.

In Aus it is quite difficult to find a good GP that understands this condition and how to approach it and assess it. I have found a urologist that specializes in andrology and i will be trying to get an appointment with him in July when i am home on holidays as he is in my home town.

In regards to the vitamin D and estrogen being checked, unfortunately where i am at the moment getting blood tests isnt easy as the GP i have been going through is my only option and now he is pretty much convinced there is nothing wrong with me getting anything done while i am here is going to be difficult. Sucks but these are the sacrifices one makes for his country i guess....

Interestingly i have started taking a vitamin D supplement and have been taking it at 3000iu a day and also a zinc supplement which i also have been taking at 50mg per day which i have not supplemented either vitamin up until now ( on top of my usual vitamins i take which are pretty well dosed according to austinites thread ) and i have noticed a difference... Im pretty sure it isnt a placebo effect as there are several symptoms that have improved. Will continue doing so until i can get to another GP and try to continue with sorting this all out.

Thanks for your help so far guys, i will look into getting some nettle root and some DHEA ( which is prescription only in my country for some reason ) and see how that goes for now. It is painful kinda working blind not being able to get easy blood work but its all i can do for now.