My "comprehensive" Pre-TRT Lab Results - Plz Advise

[FlyStar]

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Hormones

Testosterone , total
216 (286 - 802) ng/dL

Testosterone, free
34.17 (34.51 - 107.78) pg/mL

Testosterone, bioavailable
138 (138 - 430) ng/dL

SHBG
16.0 (14.5 - 48.4) nmol/L

E2 (Estrogen)
32.6 (7.6 - 43.0) pg/mL

LH
4.0 (1.7 - 8.6) mIU/mL

FSH
3.5 (1.5 - 12.4) mIU/mL

Prolactin
16.7 (3.46 - 19.4) ng/mL

Cortisol (AM) (had sex a little less than 48 hours prior to testing)
8.30 (3.7 - 19.4) ug/dL

IGF-1
160.3 (150 - 350) ng/mL

Thyroid Panel

TSH
4.54 (0.27 - 4.20) uIU/mL

T3, free
3.6 (2.0 - 4.4) pg/mL

T4, free
1.24 (0.93 - 1.70) ng/dL

Lipid panel

Cholesterol
216.1 mg/dL

Desirable: <200
Borderline: 200 - 239
High risk: >240

HDL
32.7 mg/dL

Low: <130
High: >60

LDL
139.5 (<130) mg/dL

VLDL
27.90 (<40.0) mg/dL

Tg (Triglyceride)
219.5 (<200) mg/dL

CBC

HB (Hemoglobin)
12.5 (14 - 18) g/dL

Hematocrit
45.1 (42 - 50) %

RBC
4.79 (4.5 - 6.2) x10*6/uL

WBC
5.60 (5.0 - 10.0) x10*3/uL

WBC & diff / Lymphocyte
40.6 (20 - 40) %

MCH
26.0 (27 - 31) pg

MCHC
29.5 (32 - 36) g/dL

MCV
94.2 (80 - 95) fL

RDW
10.1 (2 - 20) %

Platelet count
250.0 (150 - 400) x10_3/uL

ESR
(up to 10) mm/hr

Clotting time
(2 - 6) mins

Bleeding time
(1 - 6) mins

CMP

-General

Glucose (fasting)
98 (65 - 99) mg/dL

Calcium
8.60 (8.40 - 10.2) mg/dL

-Liver

ALP
82.0 (40 - 130) U/L

ALT (SGBT)
40.2 (Up to 41) U/L

AST (SGOT)
24.9 (Up to 40) U/L

Bilirubin, total
0.80 (up to 1.1) mg/dL

Bilirubin, direct
0.20 (up to 0.25) mg/dL

Bilirubin, indirect
0.60 (0.1 - 0.75) mg/dL

-Kidney

Urea Nitrogen (BUN)
43.5 (<50) mg/dL

Creatinine
0.862 (<1.1) mg/dL

-Electrolytes

Potassium
4.60 (3.60 - 5.5) mmol/L

Sodium
141.0 (135.0 - 152.0) mmol/L

Chloride
99.0 (98.0 - 110.0) mmol/L

-Proteins

Albumin
4.40 (3.6 - 4.6) g/dL

Protein, total
7.30 (6.4 - 8.3) g/dL

==================================================

Why I'm here:

1) Interested in starting TRT due to very low testosterone . Looking for advice.

2) Concern about my thyroid. I'm "subclinical" hypothyroidism, according to the lab results. Which basically means I have hypothyroidism, since the lab rages are too high.

My concern is if it will cause problems later on if I start normal TRT protocol without doing anything about my thyroid issue (is it an issue?)...or will TRT fix the thyroid issue?

Stats:

Age: 33
Height: 6'5
Weight: 264 lb
Body fat: %27
Waist: 44"

What got me to suspect low testosterone: (before getting blood work done)

- Difficulty / inability to gain muscle.
- Easily gain fat.
- Almost all gained fat goes straight to hips, buttocks and thighs.
- Almost %100 of IMS symptoms.
- Loss of libido
- Jewels shrinkage

Lifestyle:

Past 3 years...don't drink. Don't smoke.
Before that...smoked for 17 years. Drank for about 14 years or so but just during weekends and socially.

Diet:

Used to be 6 meals a day, well thought out, strict, daily diet plans for most of my life until about 4 years ago when I started eating like the average American.

About %60 of my food is now fried. Every meal has white carbs. Drinking fruit juice all day.

Past sample diet plan:



Above is something I strictly followed for at least 10 years. Switched macros up every couple of months or so.

Training:

Now, zero.
4 years ago...a well though out, strict weight lifting regiment for 17 years.

Bodybuilding was my passion so I made sure I did everything correctly. I knew the harms of over training so I was sure not to over train.

A little history:

I started bodybuilding at 13. Seriously when I was 15. So as far as I can remember, I'd been bodybuilding my entire life.

For 15 years, I religiously followed a bodybuilding and nutrition regiment. I knew so much about the two, I honestly felt almost all trainers, bodybuilders and nutritionists were idiots.

But unfortunately, no matter how much effort and dedication I put in...it never really paid off. People that barely knew anything about bodybuilding, almost zilch about nutrition and were half assing their workouts, were making gains in less than a year what took me 15 years. And I'm not talking about your genetic freaks. I'm talking about your average Joe.

With clothes on, people couldn't even tell I worked out. What's more frustrating was when I told people about that, they said "you must be doing something wrong" "you gotta change your diet" "change your training" "you have to hit your muscles slower, faster"...etc. And all I could think was "Really dude? You really think in 15 years I haven't tried every single variable? You think the reason I haven't packed on slabs of muscle is because I didn't go slower on the weights or that I didn't eat an extra spoon of peanut butter?"

About 12 years into bodybuilding natty, I decided to start cycling. Unfortunately, I never done blood work beforehand.

I made nice gains, nothing spectacular, just satisfactory. But for the first time in my life, people were coming at me with "wow!" while checking out my physique. The compliments meant that results weren't bad at all.

Cycle ended. Ran PCT. Went back to my natty regiment.
Unfortunately, I lost most of the gains I'd made in about 6 months even though I tried all I could to maintain and add to the gains.

2 years after my first cycle, I started another one. 6 months after ending it, like the first time, I was left with nothing to brag about.

Typical stats off-cycle:

Weight: 214 lb
Body fat: %16

1st cycle:

Week 1 - 4: D bol 35mg ED
Week 1 - 12: Test E 500mg EW (250mg x 2)

PCT (1st cycle):

HCG 1000 IU ED for 10 days, 4 days after last pin of Test E, then...

Clomid:
100/100/50/50
Nolvadex :
40/40/20/20

2nd cycle:

Week 1-2: Anadrol 50mg ED
Week 3-4: Anadrol 100mg ED
Week 1-12: Deca 500mg EW
Week 1-15: Test C 600mg EW
Week 1-16: Eq 600mg EW

PCT (2nd cycle):

HCG 1000 IU ED for 10 days, 4 days after last pin of Test E, then...

Nolvadex: 20/20/20/10/10
Clomid: 50/50/50/25/25

About a year after my 2nd cycle, I moved, started traveling a lot, hence I wasn't able to maintain my bodybuilding and nutrition regiment. I stopped going to the gym. And since I wasn't working out, I felt dieting and 6 healthy meals a day was useless. So for the first time in my life (well, sorta), I started eating junk food. Plan was to get back on track soon as I settled down.

Settling down didn't come till 3 months later. But by then, I'd already broken my habit. I was too lazy and too demotivated to get back to my healthy lifestyle.

4 years later, today, I'm yet to get back to working out and eating healthy. I've been leading a pretty sedentary lifestyle and my diet consists of a lot of fried food and white carbs. Needless to say, 15 years of gains went down the drain. I now stand at the above stats. Used to hover at around %15-18 body fat.

So now I'm looking into TRT and getting back on track with training and nutrition. I'm hoping TRT will enable me to see gains that I should have seen at the gym a long time ago. As well as fix all the other issues in "what got me to suspect low testosterone"

As you can see from the lab results, my testosterone is too low. Cause is something I'm yet to determine. I'm hoping you guys can chime in. Judging by the difficulty in gaining muscle, I really think I've always had below average testosterone levels , but then I can't be sure since I'd never done blood test until now.

Thank you for taking the time to read my post and for any point in the right direction!

[Mr.BB]

About the thyroid, its the other way around, the thyroid may fix the testosterone problem, as its supressive. More info here: Stop the Thyroid Madnessâ„¢ - Hypothyroidism and thyroid mistreatment

Bet you dont feel good as with that low hemoglobin it means you have anemia, shame you didnt test iron and b12. You need to show this bloodwork to your doctor as anemia is not something to be taken lightly IMHO.

Fix your health problems first, and then you can think about TRT thats my 2 cents.

[kelkel]

Agree with BB. Address the thyroid first, see what happens and then move forward. Both hypothyroidism and sub-clinical hypo can reduce your test levels (via your cholesterol pathways, specifically progesterone) as well as elevate your prolactin, which can also suppress T levels via LH suppression. So it gets you both ways.

Hyperprolactinemia in association with subclinical hypothyroidism

Naturally your past AAS usage could have caused this as well. Sometimes guys just don't return to their prior sufficient levels, even with pct. In this case it appears you were doing a version of Scally's Power PCT. You mention being very dedicated yet still not making good gains. Maybe there's been an underlying problem all along? So many things can cause low T from what we've already mentioned to head or testicular trauma, pathologies, varicoceles and so on. But these are usually indicated, at least to some extent via BW.

Yes, your T levels stink right now but like BB said, the only thing jumping out is your thyroid at the moment. Unless you have older blood work to compare current BW to it's hard to guess.

Welcome to the forum Flystar. One of the most comprehensive first posts I've seen. Well done.

[jasondd1]

Hey kel are you judging his thyroid mostly on his tsh levels? I'm assuming because the other numbers seem ok, Thyroid has always confused the shit out of me.

[kelkel]

Hey kel are you judging his thyroid mostly on his tsh levels? I'm assuming because the other numbers seem ok, Thyroid has always confused the shit out of me.

Negative. TSH is an indicator but that's all. If I went by TSH alone for my own numbers I'd be screwed!

[FlyStar]

Negative. TSH is an indicator but that's all. If I went by TSH alone for my own numbers I'd be screwed!

Agree with BB. Address the thyroid first, see what happens and then move forward. Both hypothyroidism and sub-clinical hypo can reduce your test levels (via your cholesterol pathways, specifically progesterone) as well as elevate your prolactin, which can also suppress T levels via LH suppression. So it gets you both ways.

Naturally your past AAS usage could have caused this as well. Sometimes guys just don't return to their prior sufficient levels, even with pct. In this case it appears you were doing a version of Scally's Power PCT. You mention being very dedicated yet still not making good gains. Maybe there's been an underlying problem all along? So many things can cause low T from what we've already mentioned to head or testicular trauma, pathologies, varicoceles and so on. But these are usually indicated, at least to some extent via BW.

Yes, your T levels stink right now but like BB said, the only thing jumping out is your thyroid at the moment. Unless you have older blood work to compare current BW to it's hard to guess.

Welcome to the forum Flystar. One of the most comprehensive first posts I've seen. Well done.

Negative. TSH is an indicator but that's all. If I went by TSH alone for my own numbers I'd be screwed!

Thank you for your input and the welcome Kelkel. And yeah I know...i've been sleeping on the reply.
I missed my appointment to get rT3, iron and b12 done and now the doctor is on vacation. Meanwhile im learning.
You said youre not judging my thyroid situation based mostly on my TSH. Could i ask what youre going by then? Appreciate any input!

[Mr.BB]

Thank you for your input and the welcome Kelkel. And yeah I know...i've been sleeping on the reply.
I missed my appointment to get rT3, iron and b12 done and now the doctor is on vacation. Meanwhile im learning.
You said youre not judging my thyroid situation based mostly on my TSH. Could i ask what youre going by then? Appreciate any input!

Have you fixed your anemia?

Maybe I wasnt clear in my 1st post, let me try again:

Forget about testosterone and thyroid and go to the doctor to treat your anemia, it is a serious problem.

[FlyStar]

Negative. TSH is an indicator but that's all. If I went by TSH alone for my own numbers I'd be screwed!

Have you fixed your anemia?

Maybe I wasnt clear in my 1st post, let me try again:

Forget about testosterone and thyroid and go to the doctor to treat your anemia, it is a serious problem.

Hey Mr. BB. Doc says a slightly lower than the ref range Hemoglobin is nothing to be concerned about especially when there are no symptoms. It could be normal for me.

[Mr.BB]

Hey Mr. BB. Doc says a slightly lower than the ref range Hemoglobin is nothing to be concerned about especially when there are no symptoms. It could be normal for me.

I disagre. In chronic anemia, overtime you learn to adapt to low hemoglobin and symptoms "appear" to be normal, but nevertheless puts extra stress on heart and organs.

It is a symptom that something is wrong with you, your thyroid might be the culprit for it, or something else, I fail to understand how your doc is not concerned about it by at least prescribing iron, folate and B12.

How can you expect to have will to workout when you are having problems supplying oxygen to your muscles and organs? What happens when you go up a flight of stairs? This lack of oxygen can be responsible for half the problems you mentioned above.

[FlyStar]

I disagre. In chronic anemia, overtime you learn to adapt to low hemoglobin and symptoms "appear" to be normal, but nevertheless puts extra stress on heart and organs.

It is a symptom that something is wrong with you, your thyroid might be the culprit for it, or something else, I fail to understand how your doc is not concerned about it by at least prescribing iron, folate and B12.

How can you expect to have will to workout when you are having problems supplying oxygen to your muscles and organs? What happens when you go up a flight of stairs? This lack of oxygen can be responsible for half the problems you mentioned above.

Yeah. Makes sense. I will go back to him and ask to further look into it. Considering how disconcerned he was, i'm guessing he will just prescribe vitamins, like you mentioned. But what does that mean? What if i took the vitamins and everything got back to normal and when i get off them, things go back to the way they are now?

He might ask me to go back to him after some time on the vitamins and do a blood test to see if things improved, but i dobt he will ask to get off them and come back for another blood test to see how my body is doing on its own.

Actually, I have no problems at all with willpower. I'm the most motivated gym rat no matter which gym i go to. Run (or used to) an hour a day, 6 days a week, work out for an hour, 4 days a week and play basketball whenever i find time. Been religiously doing that for 15 years.

Granted, i've been inactive lately but thats not due to lack of will power. Got plenty of will power to start doin those things right now. It's due to demotivation, and common sense really, cz no matter how much work i put in, it doesnt show in the mirror. Hence why i suspected low test and me being here.

Anyway, the anemia thing. Is vitamins viable "treatment". Is it temperament? Like i said, if things go back to normal with vitamins, will there be no requirement to dig further in for the underlying cause, or is lack of vitamins considered to be the underlying cause?

Thanks for your input buddy!

[Mr.BB]

Its not just vitamins. Iron, folate and B12 are necessary vitamins for healthy blood. And yes, defficiency in this "vitamins" is the number 1 cause for anemia, and supplementing this will elevate your hemoglobin.

To me, just find it strange that you are worried at low hormone levels but not worried about low hemoglobin which is responsible to carry oxygen to every cell in your body. Like, whats the use of being pumped with testosterone if dont have enough oxygen in your muscles, etc.??

Your TSH and hemoglobin values really point out to thyroid problem, but I would like to do a stool occult blood test, ferritin test and b12 test, call me crazy...

Also thyroid antibodies blood test would be something I would want to see.

But at 1st glance, yes your thyroid might be the culprit for the anemia: Effect of Thyroid Dysfunctions on Blood Cell Count and Red Blood Cell Indice (edit: and for low T too)