Any advice on this blood-work. Need Help!!!!!

[jaybird151]

Total test: 766 ng/dl range -- 348-1197
Free Test: high 34.85 ng/dl range -- 5-21
% Free Test High 4.55% range 1.5 - 4.2
Estradiol: 25.6 pg/ml range -- 7.6-42.6
Estrone, Serum high 124 pg/ml range -- 12-72

Vitamin b-12(low) 188 pg/ml range -- 211-946


Feel like shit. Currently on 100mg per week HRT.

Current Dr. wants to reduce my dosage to 50mg per week and wants to bring my FT in at 15ng/dl based on a range of 5-21 ng/dl. This DR. is not concerned at all with TT and only wants to look at FT and wants it at 15ng/dl.

As you can see my E2 is in range but my E1 is way too high. I thought that testosterone could not convert to E1 and that DHEA was the culprit of this, but he wants to cut my dosage in half and said that will bring down my FT and my E1. ?????????

Also was just started on B-12 injections by this current Dr.

Advice on another board was to get DHEA and SHBG checked and to also get checked for Hypopituitarism. Getting additional blood work done in a few days to check DHEA and SHBG.

I am not sure why my TT is in range but my FT is so high.
Also do not understand how my E1 is so high but E2 is ok? DHEA issue maybe?


Not sure what to do at this point, but i feel awful as of now.

Any help or direction would be greatly appreciated.

Thanks,

J

[kelkel]

Check the bloodwork in the Finding a Physician Sticky or at www.lef.com using the male hormone panel. Be sure to run a full thyroid panel. There has to be a reason you feel like crap and full BW would be a good start. Remember to get DHT and vit D also. Your doctor is correct that total T is not that important. Free is where you get the bang for the buck and with your free level high I'd bet your shbg runs low (shbg binds T.) Your E2 is perfect. Not really sure why he's having issues with Estrone.

Are you primary or secondary? Did you ever have an MRI to rule in/out pituitary issues? When was this BW pulled relative to your last injection?

[jaybird151]

I will look at getting that bloodwork

Primary or secondary? Not sure what you mean here.

I have not had an MRI done.

This bloodwork was pulled around 80 hrs after an injection of 50mg ( i do 50 mg twice a week).


What could make that E1 so high? Should i be concerned about it or not worry about it at all?

If my SHBG is low and that is causing my FT to be so high, what can i do to raise my SHBG?


in the first bloodwork i had done ( to diagnoise the low T), i had a TSH of 1.16 with a range of .4-4.5 miu/L.

I have also attached the first blood-work i had done, not sure if this gives anymore info. ( this was done to diagnoise the low T).



Do you have any thoughts on the DR wanting to cut my dosage in half to 50mg per week?

thanks

J

[kelkel]

Primary/Secondary hypogonadal. Primary is testical failure. Secondary is pituitary related.
Twice a week protocol is great! I do it as do several others here.
No clue on the estrone but I personally don't know anyone who worries about it.
First you need BW to actually see where your shbg is. Lowering your T will normally raise it a bit.
Excellent TSH.
Cutting the dosage in half is a bit much, IMO. I'd bet 40mg x 2 per week would put you where you need to be.

Really need to see LH/FSH levels pre-TRT to get an indication of pituitary function..Once trt starts they basically zero out. Are there any more parts to your protocol such as HCG or AI's?

[jaybird151]

I am not sure if i am primary or secondary, i just know that i had low test and felt like death and started HRT.

I am going to get some more blood work done here soon, specifically for the SHBG. After some more reading online i am thinking that it is going to be on the low side like you were thinking.

I do not have any blood-work showing LH/FSH values for pre HRT.

Not using any HCG or AI at this time.

I was reading a thread on musclechatroom.com about trying to bring your E2 in around the same value of your SHBG. Any thoughts on that?

Based on where my test levels are at and my E2 not being too high i, in theory, should be feeling pretty good. However, that is not the case as i do not feel good at all.

Another guy on another forum said that after i get my B-12 values back up i should feel 100x better.

[HRTstudent]

How long have you been on Testosterone?

Do you take any other drugs or supplements?

That b12 is abysmal... Id get your vitamin D checked as well.

How is your general state of health? bodyfat? stress in life? How active are you? How much sun/outdoors do you get?

[jaybird151]

How long have you been on Testosterone ?
----- roughly 7 weeks
Do you take any other dru88 or supplements ?
----- no

That b12 is abysmal... Id get your vitamin D checked as well.
------ ok

How is your general state of health? bodyfat? stress in life? How active are you? How much sun/outdoors do you get?
---health-- ok i never get sick. But overall feeling of just not feeling good. This all started about 8 months ago. got a stomach virus that lasted longer than normal along with EXTREME brain-fog and a overall feeling of just not being there mentally. Stomach issue went away but the other symptoms stayed. Started HRT after finding that i had low test and the brain fog and other symptoms went away. 4 weeks into the HRT started feeling bad again, not as bad as before, but still do not feel normal. Tired, some lethargy, stiff back of neck and just kind of feel out if it.---------------- I guess that i should also add that the DR. said i had a Goiter thyroid and did an ultrasound and did not see any growths or areas of concern.-----------
---bodyfat--- maybe 13%ish
---- stress--- high
---- active--- i usually am very active but over the last year i have not been due to feeling awful all the time. So lately not very active at all.
----Sun--- average i would say.

[jaybird151]

How long have you been on Testosterone ?
----- roughly 7 weeks
Do you take any other dru.. or supplements ?
----- no

That b12 is abysmal... Id get your vitamin D checked as well.
------ ok

How is your general state of health? bodyfat? stress in life? How active are you? How much sun/outdoors do you get?
---health-- ok i never get sick. But overall feeling of just not feeling good. This all started about 8 months ago. got a stomach virus that lasted longer than normal along with EXTREME brain-fog and an overall feeling of just not being there mentally. Stomach issue went away but the other symptoms stayed. Started HRT after finding that i had low test and the brain fog and other symptoms went away. 4 weeks into the HRT started feeling bad again, not as bad as before, but still do not feel normal. Tired, some lethargy, stiff back of neck and just kind of feel out if it.---------------- I guess that i should also add that the DR. said i had a Goiter thyroid and did an ultrasound and did not see any growths or areas of concern.-----------
---bodyfat--- maybe 13%ish
---- stress--- high
---- active--- i usually am very active but over the last year i have not been due to feeling awful all the time. So lately not very active at all.
----Sun--- average i would say.

[Brohim]

Get your thyroid checked if you feel tired and sluggish. Your test/e2 #'s look fine. And maybe look into B12 injection

[jaybird151]

Get your thyroid checked if you feel tired and sluggish. Your test/e2 #'s look fine. And maybe look into B12 injection

TSh came back at 1.16 ( range .4-4.5)

Havent had a full thyroid panel though, will look into that.

This current DR. started me on B-12 injections.

[Vettester]

Agree with the advise and recommendations you're getting from others.

Yes, it would be good to check further upstream for DHEA and even prenenolone (better known as the mother of all other hormones). Both hormones play a big role with energy levels and cognitive function. Seems when B12 is low, there tends to be a deficiency in either or both pregnenolone and DHEA (just an observation over the years).

The E2 assay will be the most concentrated assay used for men, as it is the more abundant of the estrogens. It would be good to get a fuller picture with possibly adding a prolactin and a progesterone lab.

Also, are you taking injections, gels, patches? Different applications sometimes effects the conversion process. Are you taking any AI's at this time?

[jaybird151]

Agree with the advise and recommendations you're getting from others.

Yes, it would be good to check further upstream for DHEA and even prenenolone (better known as the mother of all other hormones). Both hormones play a big role with energy levels and cognitive function. Seems when B12 is low, there tends to be a deficiency in either or both pregnenolone and DHEA (just an observation over the years).

The E2 assay will be the most concentrated assay used for men, as it is the more abundant of the estrogens. It would be good to get a fuller picture with possibly adding a prolactin and a progesterone lab.

Also, are you taking injections, gels, patches? Different applications sometimes effects the conversion process. Are you taking any AI's at this time?

I will look into those labs as well.

Injections 50mg 2x per week

No AI at this time.

[jaybird151]

Short recap

DR. wanted me to drop to 50mg per week and i did that. Felt like absolute shit for this past 6 weeks. Did 1 50mg shot and then had blood drawn 7 days later ( he reccomended only shooting once per week, even though i previously told him i felt like it needed to be done 2x per week and i felt better when i did it that way), basically was doing this to prove a point that the levels would decline in that time period.

Fast forward to the next appointment

Long story short, my levels came back low and he insinguated that i didnt even take a shot in order to fudge the tests, he then said that he was no longer going to allow me to shoot myself AND he was moving it to 100 mg once every two weeks. Unfcking real. On top of all of that i had to fight to get DHEA and SHBG pulled as he didn't want to pull that, as well as some other stuff that i requested be pulled was not there when i got the results. In the meeting he wouldn't address the low SHBG and listen to anything i was saying. Needless to say the meeting did not go well, and to keep a long story short i left with a copy of my blood-work and a few choice words for him. Currently looking for a new DR.

Symptoms i started feeling again from dropping down to 50mg per week

--- digestive issues escalated ( awful dirreaha every single morning for around 3-4 hrs)
--- stomach feels constantly bloated and full even though i am hardly eating anything each day
--- almost 6 weeks of this and weight has not dropped at all
--- just feel like shit all around
--- awful anxiety, almost unbearable
-- also i have had some times when i make a facial expression that i do not mean to make -- ie drooping my chin or buggin out my eyes. not sure wtf this is due to, but i dont notice that i am doing it at first and then catch myself and have to conciously stop doing it.
--- brain fog
--- stiff neck in the rear base of it

Blood work attached

Total test --- 198 LOW range 348-1197

TSH -- 1.59 range .45 - 4.5
T4-- 1.33 range .82 - 1.77
T3--- 114 range 71- 180
DHEA-Sulfate 295.6 range 88.9 - 427
DHEA Serum 108 range 31 - 701
SHBG --- 16 LOW range 16.5-55.9


I am possibly thinging maybe insulin resistance????????? low SHBG and the bloating of the stomach is leading me to think this may be a possibility. Thoughts ?????

I read a few threads on another board about people that have a low SHBG and when doing TRT they still feel like shit. A few people on that thread said they felt better when they got their Estradiol down to match the value of their SHBG.
So agaain my Estradoil ( while taking 100mg per week) was 25.6 and my SHBG was 16. If i were to try and lower the Estradoil to that 16 #, do you think that is worth a try. But then again that will increase an already high free test as well as lower an already low SHBG.

Is my DHEA serum of 108 with a range of 31- 701 ok? Seems to me that one would want it somewhere in the middle and not near the lower end. Can that be making me feel this way????? Not sure.




I have bumped my dose back to 50mg 2x per week and i am looking for another Dr. as of now.



Need to figure this shit out though, i feel like total ass everyday.

Going to pull the following blood-work in a few weeks once my levels get back up to where i had them while on 100mg per week. Anything else here that i should pull for now?

---- Vitamin D
---- DHT
---- Insulin
---- Androstenedione
---- prenenolone

What would be the best way to test cortisol levels? Maybe adrenal fatigue is playing a part here, not sure. Or Addisons or Cushings maybe?
--- bloodwork
--- Cortisol 24 hr piss test
--- Cortisol saliva test

Once i get this bloodwork and find another DR. i am going to order a MRI to check for the Hypopitutary thing.


Any thoughts will be appreciated.

[kelkel]

Well, your doc is a retard as you already know. Hopefully you have enough in stock to keep going until you find your next one. Check the sticky out and see if it helps you in that aspect. It is great to see that you are pro-active and doing your research. I guess your doc just couldn't handle and educated patient that didn't just follow his advice like a lemming. Disgusting to me quite honestly.

Regarding cortisol testing BW is more common but saliva is reportedly more accurate. Re DHEA begin supplementing with 50mg daily of a micronized product so it will survive the first pass. GD turned me on to LEF foundations DHEA. All are micronized.

Hard to figure why you feel like crap. Your protocol of 50 x 2 is great but has to be validated by consistent BW. HCG should be added as soon as you land a good doc. I don't necessarily agree with SHBG matching E2 levels and don't know where that theory could have come from.


These factors increase SHBG: (pasted from an article I'd saved)

• Aging

• GH Deficiency

• Estrogens

• Androgen deficiency

• Hyperthyroidism

• Hepatitis-C

• Porphyria

DECREASE it:

• Obesity

• Hyperinsulinema

• Glucocorticoids

• Androgens

• Progestins

• Hypothyroidism

• GH excess

Take a look at the below articles on Insulin and see if it relates as well as the article on METs Syndrome. May find something relevent there as well. Let us know if you think something relates.


http://jcem.endojournals.org/content/93/5/1834.long

http://en.wikipedia.org/wiki/Metabolic_syndrome

[jaybird151]

Thanks for the response


i will take a look at those links and start on the DHEA.


Have another app. with a new DR, but it is not until December, hopefully this person somewhat knows what they are doing and will go the direction that i need them to go.

[HRTstudent]

Your biggest problem right now is you're on a shitty protocol for you, and your doctor is not worth keeping. Do not go back to him. Write him a letter, report him to the medical board, but do not go back to him. Its a waste of your time and energy only at this point.

Everything will seem worse if you are basically giving yourself TRT at hypogonadal doses... I mean, you're basically just "taking" side effects in a shot at this point.

[Brohim]

I'm amazed on how uneducated these doc's are when it comes to TRT! 50mg a week, WOW. I would report him to the medical board, especially the way he treated you is not very professional at all. He gave you a wrong dose then berated you for following his advice.

[kelkel]

Your biggest problem right now is you're on a shitty protocol for you, and your doctor is not worth keeping. Do not go back to him. Write him a letter, report him to the medical board, but do not go back to him. Its a waste of your time and energy only at this point.

Everything will seem worse if you are basically giving yourself TRT at hypogonadal doses... I mean, you're basically just "taking" side effects in a shot at this point.

Where do you come up with these great lines? You're like the Clint Eastwood of catch phrases here. Awesome and I'm stealing it!

[jaybird151]

Your biggest problem right now is you're on a shitty protocol for you, and your doctor is not worth keeping. Do not go back to him. Write him a letter, report him to the medical board, but do not go back to him. Its a waste of your time and energy only at this point.

Everything will seem worse if you are basically giving yourself TRT at hypogonadal doses... I mean, you're basically just "taking" side effects in a shot at this point.

I hear ya.

i was trying to do what he wanted, and then show him that what he wanted was not correct. in the process of that getting him to do what i wanted.

My plan didn't exactly go as i had hoped for, although all of the nurses seemed pretty amused when i drilled into him about it all. i kept the story short; however, at one point during the exchange i was prepared to lay his ass out and wasn't sure at the time if it was going to actually come to it or not. Lucky for him and me it didn't.

Once he said he wasn't allowing me to do the injections myself and was moving it to 100 mg every two weeks, well at that point, it was over and went downhill very quickly to say the least.

If i felt half way decent at all i would have tried to get a few nurse's #'s out of it. hahah, but that is the last thing on my mind atm.

[HRTstudent]

Where do you come up with these great lines? You're like the Clint Eastwood of catch phrases here. Awesome and I'm stealing it!

lol, thanks for the kind words

I hear ya.

i was trying to do what he wanted, and then show him that what he wanted was not correct. in the process of that getting him to do what i wanted.

My plan didn't exactly go as i had hoped for, although all of the nurses seemed pretty amused when i drilled into him about it all. i kept the story short; however, at one point during the exchange i was prepared to lay his ass out and wasn't sure at the time if it was going to actually come to it or not. Lucky for him and me it didn't.

Once he said he wasn't allowing me to do the injections myself and was moving it to 100 mg every two weeks, well at that point, it was over and went downhill very quickly to say the least.

If i felt half way decent at all i would have tried to get a few nurse's #'s out of it. hahah, but that is the last thing on my mind atm.

I know you feel like you're in a pit right now. I've been there too where you are at the mercy of BAD doctors, beyond just incompetent. It SUCKS. That's why I can only emphasize finding a true expert in male TRT as soon as possible.

If you still have testosterone Rx then its worth considering picking up where you left off on the 2 times a shot weekly. Doing once everyone 2 weeks is flat out ignorant and stupid for a dr to recommend. But 50mg twice per week is a very decent dose and would get just about everyone to at least mid-range testosterone levels. For many, 50mg twice a week is great at getting into that 650+ range.

I'm not telling you to ignore your doctors orders, but I am telling you to get a good doctor ASAP!