Request help in interpreting blood test results

[Negncic]

Hello,
I am a 47 year old male 6'1 220lbs, who has been suffering from fatigue,decreased libido, strength loss, trouble concentrating for some time. Starting february of 2012, I started dieting and working out and lost 70lbs by May of this year but nothing since. I started to notice these symptoms last November, but I kept making excuses as to why I felt like crap.
I just received my blood test and I am supposed to see my Dr. On Monday to discuss TRT. I know very little about this, and would like any suggestions as to what I should be asking my doctor based on my results. Results are as follows:

Total testosterone 472. Range 249-836
Free testosterone 6.27. Range. 7.20-23
Cholesterol 145
Triglycerides 150
Hdl cholesterol 44
LDL cholesterol 71
Chol/Hdl ratio 3.3 range <7.4
LDL/Hdl ratio 1.61 range <3.56
Vldl, calculated 30 range 7-32
Estradiol test was not done
Tsh level is high 4.5. Range .270-4.200
T4 6.7 range 4.5-12
T3 uptake 34.5 range 24.3-39
Thyroxine free ft4 1.40 range .83-1.62
Free t4 index 2.3 range 1.5-3.8
T3 total 110 range 80-200
Psa .23
Bun high 26. Range 6-20
Creatinine .92 range .90-1.30
Egfr 88 range >6o
Bun/creat ratio 28.3. Range 10-28.0
Vitamin b12 904 range 211-911
Total protein 6.6 range 5.9-8.4
Albumin 4.4 range 3.5-5.2
Globulin 2.2 range 1.7-3.7
A/g ratio 2.0. Range 1.1-2.9
Glucose 69 range 70-99
Sodium 141 range 133-145
Potassium 4 range 3.3-5.3
Co2 25 range 22-29
Calcium 9.3 range 8.6-10.2
Bilirubin total .4 range .1-1.0
Alk phos 62 range 40-156
Ast 16 <40
Alt 23 <41
Vitamin d low 26.6 range 32-100 (surprised as I take 6 orange triad pills daily
Frolic acid 12.05 range >5
Hemoglobin 5. Range <5.7
WBC 8.10 range 3.40-11.80
RBc 4.80 range 4.20-5.90
Hgb 15.1 range 12.3-17
Hct 46.3 range 39.3-52.5
Mcv 96.5 range 80-100
Mch 31.5 range 25-34.1
Mchc 32.6 range 29-35
Rdw 13.0 range 10.9-16.9
Polys 52.2 range 36-78
Lymphs 34.9 range 12-48
Monos 9.1 range 0.0-13.0
Eos 3.2 range 0.0-8.0
Basos .4 range 0.0-2.0
Immature granulocytes .2 range 0.0-1.6
Platelet count 193 range 144-400
Mpv 10.5 range .2-11.9

Before I go ahead with TRT is there anything we should be checking prior?
Thank you

[powerlifterty16]

your t level is slightly low, but not too bad especially for your age..for comparison im 23 and mine is lower by far
your tsh is too high, and before considering trt you need to get a free t/free t3 and total t4/t3.....your symptoms may be low t since your total t is still low(not too low) and your free t is below range, but other things may be at work....u need e2 checked.

[Negncic]

Thank you for responding. My t3/t4 levels were in range. I just added them to my first post

[powerlifterty16]

t4 and t3 look low to me...keep in mind your testosterone is technically in range..but being in range isnt all there is to it!

[bass]

more BW is needed to make a good assessment. E2 is one of the most important test that needs to be done, also SHBG. if you arte binding in these two areas your Free T will suffer. also need to know your LH and FSH levels. thyroid could be your biggest problem. if you have the complete list of BW done post it all with ranges, I mean all even if they are in range.

[Negncic]

Thanks for your response. I updated my first post to show all the blood tests that were done.

[Vettester]

Your serum level is semi-low, but that is compounded with the fact that your free test is hanging around 1.3% (ideally should be in the 2%-3% range). Permitting your albumin is within range, you're SHBG is more than likely sitting in the low 60n/mol range, which as eluded by bass is the culprit. Vitamin D therapy or even a script of Drisdol will help this category, but you probably need to also evaluate your dieting and lifestyle patterns.

You need to get with a good physician, possibly A4M certified, who can address this, your thyroid (hypothyroidism), and other areas such as DHEA, E2, and as bass mentioned, LH/FSH, which will help determine if your feedback loop is functioning properly between your testes & pituitary.

[Negncic]

So, before discussing TRT options with the Dr. I should get the following tests:
E2,shbg,thyroid,dhea,lh/fsh. As far as my diet I have been eating 2200 calories, trying to hit 220g of protein and 80 g of fats. I have been working out since Feb 2012 and have been doing P90x for the past 6 months. I have stopped drinking alcohol also. My only vice right know is cigars.
Thank you for the help I would have been very disappointed to have started TRT needlessly.

[Negncic]

I saw my doctor after the above blood test and he prescribed A gel. I went with Tetim as that is covered by my insurance. Based on the recommendations here, I asked if we could do an estrogen check prior to me starting the Testim and he agreed here are my results.

FSH 7.0. Range 1.4-18.1
Lh 5.06. Range 1.5-9.3
Estrogens total serum ria 121. Adult male range less than 200

My question is , should I start the Testim as recommended by my DR, ask for more tests, or seek out an endocrinologist? No steroid or pro hormone use in my past.

Thank you

[Vettester]

Your LH & FSH levels are fine. There's really nothing here indicating that you need testosterone treatment, which of course is administered when diagnosed with "low" testosterone.

[powerlifterty16]

idk if i agree, a 472 level is not sickeningly low, but it's still low, and his free t is terrible.

[Negncic]

Do you think my DR. Jumped the gun on prescribing Testim even though my free T numbers are low? I just started seeing this Dr. And I am still trying to get a read on him.
Thank you

[SEOINAGE]

Honestly they sometimes do what the patient wants. Is it possible to talk to him about ways to raise your free t, maybe look more into thyroid function etc as well. Maybe not taking thyroid meds, but looking at thyroid antibodies to see if you have hashimoto's as there can be ways to fix this without medication.

[jasondd1]

Id get rt3 and thyroid antibodies checked. You can go to a private online facility. Google private labs md.com

[FRDave]

Need blood work showing SHBG and E2 as these two will bind up your free test. Total estrogens don't tell much...

[Negncic]

Forgot to add
Dhea 1.040. Range .630-4.7

I never asked my doctor for a test level check nor did I ask for test replacement. I only told him my symptoms and he suggested both.

[Vettester]

idk if i agree, a 472 level is not sickeningly low, but it's still low, and his free t is terrible.

Then fix the free T issue, and address E2, thyroid and other variables first. Providing TRT won't fix the balance ratio of free test %, and it's just going to cause a greater impact on other factors like E2. His HPTA function is one area that looks fine. Why mess that up?

[Negncic]

Then fix the free T issue, and address E2, thyroid and other variables first. Providing TRT won't fix the balance ratio of free test %, and it's just going to cause a greater impact on other factors like E2. His HPTA function is one area that looks fine. Why mess that up?

Thanks to your advice, I found a Dr. Is going to find out what my free T is low before throwing Testim at it. She is going to do the tests that should have been done prior, e2,HSBC, thyroid antibodies, prolactin, etc. thank you for the wise advice.

[bass]

Thanks to your advice, I found a Dr. Is going to find out what my free T is low before throwing Testim at it. She is going to do the tests that should have been done prior, e2,HSBC, thyroid antibodies, prolactin, etc. thank you for the wise advice.

excellent! keep us posted.

[Negncic]

Updated tests

Thyroglobulin. <15 Range. <60
Thyroid per oxidase. 32.1. Range <60
Pregnenolone. 14. Range 13-208
Shbg. 59. Range 10-50
Tsh 3rd generation. 1.43. Range 10-50
T4 free. 1.43. Range. .8-1.8
T3 free. 3.6. Range. 2.3-4.2
Cortisol. 16.7. Range. 3-22.4
Estradiol. 28.6. Range. <39.8
Prolactin. 6.5 range. 2.1-17.7
Total testosterone . 643. Range. 348-1197
Free testosterone. 13.2. Range. 6.8-21.5

Meeting with the Dr in a few days. Free test results are much better. Is there anything I should make sure I ask the Dr?
Thanks for all the help.

[jomamma007]

is that on testim?

How do You FEEL?

definitely need to take some vitamin d3 to get that SHBG down.

[Negncic]

is that on testim?

How do You FEEL?

definitely need to take some vitamin d3 to get that SHBG down.

Haven't used the testim. Definitely feel better, but still sluggish. Started d3 last test

[Vettester]

As I noted in the earlier post, I expected your SHBG to be low 60'sh, you messed me up with a 59, lol Vitamin D will help, and look into supplementing some Stinging Nettle Root for a bit.

Your pregnenolone is tanked, that's to be expected as we get older. Did I overlook a DHEA-S assay? I mentioned DHEA in my previous post as well. Supplement both pregnenolone and DHEA, along with B12 methylcobalamin and you will probably see some night and day results! DHEA is capsule form should be micronized. I actually go with with Keto7 DHEA, which is the key metabolite associated with adrenal balance, and a litany of other attributes to help with cognitive and thyroid support to name a few ... Plus no androgen conversion downstream. Either method, go a little slow, it can be a little overwhelming.

The E2 lab isn't a sensitive scale assay, so it's difficult to make any comments. The variances between a standard E2 assay and a sensitive/ultra-sensitive assay can be substantial, making it impossible to manage a male's E2 level (optimally) with a female standard lab. See if your doctor can request a sensitive lab for you, or possibly look at LabCorp, which has them readily available.

Your prolactin looks great, right where you want it!

Your test serum score improved nicely. Optimizing your free testosterone will get you right where you need to be. As noted before, your LH/FSH values are fine, and obviously your endogenous serum increase is evidence thereof. If you take the testim, or any other exogenous test, your LH and FSH will go bye bye, and you will need TRT for life. No need to ruin a good thing if it's functioning correctly.

[Negncic]

Dhea 1.040. Range .630-4.7

Vettester, I can't thank you enough for the great advice you have given me. Without the advice given me here, I would have taken the Testim, and not only still felt crappy but be on test for the rest of my life, needlessly. During my last visit, the Dr mentioned possibly supplementing with dhea depending on the test results. I am going ahead with your suggestions and am looking forward to the results. You guys are providing a great service here, keep up the good work!
Thank you