HELP TRT vets! Please review my bloodwork

[joseroge]

New here, been following this site for forever. Thought i'd reach out to the experts to get thoughts on my bloodwork. Please Review my blodwork that is attached here. Got these labs myself out of pocket, based off the recommended tests from this site. Any help is appreciated!

33 YEARS OLD
6’4”
230 LBS
165 LBM MASS – per inbody test
28% BODY FAT – per inbody test

TSH, THIRD GENERATION 0.914 UIU/ML 0.400-4.100

TESTOSTERONE PANEL
TESTOSTERONE 311 NG/DL 300-1080
SEX HORM BIND GLOBULIN 20.5 NMOL/L 16.5-55.9
CALC FREE TESTOSTERONE 78.7 PG/ML 47.0-244.0

DHEA SULFATE 398 UG/DL 103-446
IGF-I 156 NG/ML 72-202
CORTISOL, RANDOM 9.3 UG/DL 4.8-19.5
PROLACTIN 7.2 NG/ML 4.0-26.0
DHT 258 pg/mL 112-955
PROGESTERONE 0.22 H NG/ML MALE <.15 FEMALE .06-214
ESTRADIOL, ULTRASENS 16.3 pg/mL 10.0-42.0
VITAMIN D 30 NG/ML 30-100
LH 4.6 IU/L 1.2-8.6
FSH 1.6 IU/L 1.5-12.4
FREE T3 3.5 PG/ML 2.2-4.2
T4 (THYROXINE) 9.4 UG/DL 4.5-10.5
FREE T4 (THYROXINE) 1.48 NG/DL 0.80-1.90
THYROID PEROXIDASE AB 1 IU/ML <9

CBC PANEL
WBC 6.7 K/UL 4.0-11.0
RBC 5.50 M/UL 4.10-5.70
HEMOGLOBIN 16.7 G/DL 13.0-17.0
HEMATOCRIT 47.1 % 37.0-49.0
MCV 85.6 fL 80.0-100.0
MCH 30.4 PG 27.0-34.0
MCHC 35.5 G/DL 32.0-35.5
RDW 12.2 % 11.0-15.0
NEUTROPHILS 54.9 % 40.0-74.0

LYMPHOCYTES 32.2 % 19.0-48.0
MONOCYTES 8.5 % 4.0-13.0
EOSINOPHILS 3.4 % 0.0-7.0
BASOPHILS 1.0 % 0.0-2.0
PLATELET COUNT 210 K/UL 130-400

COMPREHENSIVE METABOLIC PANEL
GLUCOSE 88 MG/DL 70-99
BUN 11 MG/DL 6-20
CREATININE 0.90 MG/DL 0.80-1.40
eGFR AFRICAN AMER. 131 ML/MIN 1.73>60
eGFR NON-AFRICAN AMER. 113 ML/MIN 1.73>60
CALC BUN/CREAT 12 RATIO 6-28
SODIUM 142 MEQ/L 133-146
POTASSIUM 4.5 MEQ/L 3.5-5.4
CHLORIDE 101 MEQ/L 95-107
CARBON DIOXIDE 29 MEQ/L 19-31
CALCIUM 10.0 MG/DL 8.5-10.5
PROTEIN, TOTAL 7.8 G/DL 6.1-8.3
ALBUMIN 4.9 G/DL 3.5-5.2
CALC GLOBULIN 2.9 G/DL 1.9-3.7
CALC A/G RATIO 1.7 RATIO 1.0-2.6
BILIRUBIN, TOTAL 0.8 MG/DL <=1.2
ALKALINE PHOSPHATASE 84 U/L 40-112
AST 23 U/L 9-50
ALT 36 U/L 5-50

LIPID PANEL
CHOLESTEROL 166 MG/DL <200
TRIGLYCERIDES 122 MG/DL <150
HDL CHOLESTEROL 49 MG/DL >39
CALC LDL CHOL 93 MG/DL <100
RISK RATIO LDL/HDL 1.89 RATIO <3.55
PSA, TOTAL 0.86 NG/ML <=4.00



Bloodwork.doc

[joseroge]

Background. Been active and lifted for all early life. Took 2 simple small cycles when i was 18 based off of dumb recs from friend. Followed neither up with PCT. Ever since i have felt like a zombie the last 15 years and do nothing but eat sleep repeat and still tired. Hired a trainer from age 28-31 and hired a meal prep company to try to get life back. Ate clean to a T and still couldn't get below 20% BF and basically quit and haven't lifted since. Have not been to a DR yet? Should i go to clinic, urologist, or an endo? Should i try a restart first? I just want to get back to 200lbs and get life back with energy etc. Thoughts?

[Youthful55guy]

New here, been following this site for forever. Thought i'd reach out to the experts to get thoughts on my bloodwork. Please Review my blodwork that is attached here. Got these labs myself out of pocket, based off the recommended tests from this site. Any help is appreciated!

TESTOSTERONE 311 NG/DL 300-1080 - Definitely at the low end of normal. Given that you have normal levels of gonadotropins (LH & FSH), this would indicate that your low T issues are testicular in origin. Have you ever had a testicular injury? You might want to see a urologist about this. Some testicular problems are treatable with surgery. If not, then a lifetime of TRT is probably in your future. Per your second post, given that your gonadotropins are in the normal range, a "restart" is not going to do anything because you are already "started". That is you manufacture and secrete normal levels of LH & FSH. There's nothing more that can be accomplished with mucking with the hypothalamus-pituitary axis. From what I see, you problem is with how the testicles use those gonadotropins. We call this being "Primary" hypogonadotropic. Restarts only help with "Secondary" hypogonadism.

SEX HORM BIND GLOBULIN 20.5 NMOL/L 16.5-55.9 - Looks good. perhaps a bit low, but not in the problematic range. It will probably increase slightly when E2 improves once you normalize T. See discussion below. E2 is made from T. E2 helps to drive SHBG production. SHBG is a 2-edge sword. Low levels means faster T metabolism and excretion so lower levels of T. High SHBG binds T and prevents it from crossing the blood-brain barrier where we need it to feel normal.

DHEA SULFATE 398 UG/DL 103-446 - I don't monitor this hormone. But your level looks good.

IGF-I 156 NG/ML 72-202 - low end of normal. Probably not the root of you problems, but raising it can help with recovery from workouts. I'd not focus on this right now. It may improve on it's own once you normalize your T levels. T drives E production and E levels (within normal ranges) helps to improve GH production, which drives IGF-1 production. Also, normalizing T will help with workout recovery. When you are in an over-exercised state, it lowers IGF-BP3, which is the binding protein that extends the half-life of IGF-1. Lower IGF-BP3 means that IGF-1 gets metabolized and excreted quicker. So faster recovery = higher IGF-BP3 = higher IGF-1 = even faster recovery.

CORTISOL, RANDOM 9.3 UG/DL 4.8-19.5 - Looks good, but I don't normally monitor it and honestly don't know much about what's good, bad, and ugly.

PROLACTIN 7.2 NG/ML 4.0-26.0 - Nothing to worry about. Additional monitoring completely optional unless you venture down the road of peptide use to bolster GH/IGF-1. Some peptides can elevate prolactin.

DHT 258 pg/mL 112-955 - On the low end of normal. This could be one of the issues with why you feel so bad. DHT is highly androgenic and is a necessary hormone for guys to feel like guys. More than likely it will normalize once you normalize T because T is a precursor hormone for the making of DHT. In fact, high DHT is often a problem once you start TRT. If DHT goes out of range on the high side, it can cause several dose-limiting side effects, mainly RBC production, prostate enlargement (BHP), and hail loss.

PROGESTERONE 0.22 H NG/ML MALE <.15 FEMALE .06-214 - I don't normally monitor this hormone. Yours seems a bit high. Not sure what's driving this. High P4 levels are usually only problematic whit guys taking very large doses of T without adequate E2 control. High E2 itself is usually not a problem, but when combined with high P4 it can cause gynecomastia (bitch tits). When further combined with high prolactin, it can lead to lactation (not a pretty sight in guys). Your prolactin is good, so a milking machine is probably not in your future.

ESTRADIOL, ULTRASENS 16.3 pg/mL 10.0-42.0 - Lower than I like to see but that's probably a result of lowish T levels. E2 is made from T. I feel best when my E2 is around 30-35. Low E2 can have symptoms similar to low T, especially ED and ejaculatory problems.

VITAMIN D 30 NG/ML 30-100 - Low end of acceptable. Recommend 5,000 IU of D3 per day and retesting after a couple months or whenever you do your next lab draw. I like to see levels closer to 60 Ng/mL.

LH & FSH - They are in range, indicating that the pituitary is probably not the source of your problems. However, these labs are difficult to interpret because these hormones are released episodically so it's hit or miss. Best if the lab draw is right away in the morning as soon as the lab opens it's doors. Best to make an appointment because you'll be competing with the fasting Lipid lab draws.


Thyroid Labs & TSH - All good. Nothing to worry about. Additional monitoring completely optional and probably a waste of money.

CBC PANEL - All good. Nothing to worry about. Annual monitoring optional unless you start doing TRT or synthetic steroids. If you do, then I recommend at least 2X per year monitoring of hemoglobin/hematocrit. Need to control hemoglobin/hematocrit while on TRT through regular blood donations OR control of DHT (which will probably go out of range a couple months after starting TRT. DHT drives RBC production more than T.

COMPREHENSIVE METABOLIC PANEL - All good. Nothing to worry about. Annual monitoring optional unless you start doing synthetic steroids.

LIPID PANEL - All good. Nothing to worry about. Advise annual monitoring.

PSA, TOTAL 0.86 NG/ML <=4.00 - Excellent. Prostate cancer probably not in your near future. Advise annual monitoring of it.

See above comments in bold/blue font.

[joseroge]

Wow thanks for the very detailed response. I’m still trying to decipher through it all. Thanks a bunch for help.