New to HRT Questions & My Blood Work => Input from you guys

[Termin8r27]

Ok, so I found this site when doing some searching. Seems like there are some pretty knowledgeable folks here and wanted to get your take/advice if possible. Apologies for the novel...
FWIW, I have some pretty good baseline knowledge - am a Kinesiology major and do actively research on a daily basis all health related things.

I'm 32 almost 33. Been physically active all my life in competitive sports and took up casual bodybuilding in my late teens. I was always super skinny - about 6'4" 120lbs @ 15, started 'bodybuilding' (naturally) @ 16 and by 18 was 6'5" and about 220lbs...still pretty lean. Around that time I bumped into some serious gym guys...did tons of research on anabolics and eventually tried a few shots of each (totaling about 3weeks) Sustenon, Deca and Test Cyp, but the parents found out and shut that down.

I continued the natural bodybuilding lifestyle into college, got up to almost 300lbs, but bodyfat was getting sloppy...around %18-30. Putting on mass has always been extremely difficult and sporadic along with strength, but I always remained super disciplined - no alcohol, eating regularly, supplements, etc. I ended up blowing out my knee playing hoops and have been on and off until a few years ago.

Fast forward to today - I've been back in it seriously for a few years...still very slow going at gaining any muscle or strength. Felt like I always have. I tried a couple PH's - Dimeth and Bold. Dimeth made me feel awesome, but always felt horrible coming off - always did a proper PCT. I currently measure 6'4" now and about 270lbs @ ~%20 BF.

I finally got up the nerve to see an endo (I also developed some gyno in my teens before taking anything) and below are my results. She did another blood test a few days ago to test Test, LH, Prostate and Estrogen one more time, but the plan is for me to think about it and get on HRT on my next visit, July 12th if I want.

Cortisol Total 16.7mcg/dL
Estradiol 37pg/mL
LH 6.2mlU/mL
Test Total 186ng/dL
Free Test % 2.83%
Free Test 52.6pg/mL
Vitamin D 24ng/mL

Everything else was pretty normal and in range.

I've fathered a couple kids pretty easily and seem to have an ok sex life. It does seem to be more of an issue the past couple years...just not as interesting or easy as it used to be. My appetite is definitely much less than it used to be, but it's always been mostly slow in the mornings and seems to be more of a chore sometimes.

Seems like my LH is relatively high, along with my Estrogen - could this be a combo of Testicles failing or never working properly and not generating enough Total Test and also too much Aromatization?
FWIW - my dad and brothers all have issues putting on muscle and all devoped gyno in their teens. My dad, his fater and his father's father all got prostate cancer as well - could this be from the wonky Aromatization and Estrogen?
My Free Test % is *high* but I guess my Free Test # of 52.6 is on the low side, right?

Thanks!

[Vettester]

First of all, welcome to the forum! The LH is working and test serum is low, so primary hypogonadism could be your cause. You're E2 isn't bad at all, but that's all subject to change when you start taking TRT.

Did they run any other tests? Thyroid, IGF, DHEA, lipids, and one that really stands out: PSA? You mentioned the family history, so I'm sure a doc would be all over this with at least a PSA.

What is the next step for you and your doctor? Your Test score is low, are they talking to you about TRT? Maybe running more tests? BTW, have you taken HCG in the past? Just curious.

[cjw2021]

Wow, if gyno runs in your family as well as prostate cancer, I would definitely expect this low testosterone thing to be hereditary.

[Termin8r27]

First of all, welcome to the forum! The LH is working and test serum is low, so primary hypogonadism could be your cause. You're E2 isn't bad at all, but that's all subject to change when you start taking TRT.

Did they run any other tests? Thyroid, IGF, DHEA, lipids, and one that really stands out: PSA? You mentioned the family history, so I'm sure a doc would be all over this with at least a PSA.

What is the next step for you and your doctor? Your Test score is low, are they talking to you about TRT? Maybe running more tests? BTW, have you taken HCG in the past? Just curious.

Thanks!

From what I'd read, it seemed like I was in the 'upper 1/3' for Estrogen and was a person who made more Estrogen than normal - that 37pm/ml was too high...?

Yep, they did the full gamut of Thyroid, lipids, etc - those all came out in normal range. They didn't do HGH, IGF or DHEA though.

Never taken HCG in the past.

My 2nd visit, they ran Test, Estrogen, PSA, DHT and something else (forgot) again to make sure test was consistent and yes, that the PSA wasn't a problem. I go back on July 12th.

She said 'I want to try you on TRT patches and therapy since you are so low.' She believes its genetic and we're all possibly low producers in my family - hypogonadism like you mentioned. I told her I didn't want to mess with patches and have young kids so no gels/creams. I said I'd want shots if anything. From all I've read so far, it looks like I'd want to take:
Test shot
HCG (don't want total shutdown and no nuts)
AI

Honestly it all took me by surprise...I'd thougt about TRT and read some, but really didn't think I had a problem...I guess I'm so used to how I feel...? =/

[n00bs]

Remember prostate problems come from oestrogen... So implementing oestrogen control is important if you have history in your family.

Im not sure of your labs as no ranges posted andi dont know how to convert the units to one si am fmailure iwth.. But if you are primary then you ar elucky as there is not a long list of problems that comes with findging "why this is happening"... worrying about thyroid and adrenal problems ect.

Would simply be 1 shot every 10 weeks or
gel daily or
1 shot every other day possibly bi shots weekly depending on your mood and how you take it.

Plus some vitamins and herbs for prostate support.

Hope everyting works out for you... Good you are getting it sorted! hCG wont be worth your while if your primary develops more.. Primary means you are getting the LH signal but the leydig cells have died so nothing to make testosterone... You canback fill the other hormone pathways with transdermal creams ect though...

[Termin8r27]

Remember prostate problems come from oestrogen... So implementing oestrogen control is important if you have history in your family.

Im not sure of your labs as no ranges posted andi dont know how to convert the units to one si am fmailure iwth.. But if you are primary then you ar elucky as there is not a long list of problems that comes with findging "why this is happening"... worrying about thyroid and adrenal problems ect.

Would simply be 1 shot every 10 weeks or
gel daily or
1 shot every other day possibly bi shots weekly depending on your mood and how you take it.

Plus some vitamins and herbs for prostate support.

Hope everyting works out for you... Good you are getting it sorted! hCG wont be worth your while if your primary develops more.. Primary means you are getting the LH signal but the leydig cells have died so nothing to make testosterone... You canback fill the other hormone pathways with transdermal creams ect though...

That's what I seem to be finding on Estrogen & Prostate.

That's good info on the Primary and how it relates to HCG therapy...I didn't really think of that.

Here's my blood work with ranges as well:
Cortisol Total 16.7mcg/dL ?
Estradiol 37pg/mL 13-54pg/mL
LH 6.2mlU/mL 1.5-9.3mlU/mL
Test Total 186ng/dL 450-1,200ng/dL
Free Test % 2.83% ?
Free Test 52.6pg/mL 50-244pg/mL
T4, FREE 1.2ng/dL 0.8-1.8ng/dL
TSH, 3rd Gen. 2.61mgU/L 0.40-4.50mlU/L
Vitamin D 24ng/mL 30-100ng/mL

[Vettester]

That's kind of why I asked on the HCG. I was thinking that if you had taken it in the past you may have desensitized your leydig cells. Since you haven't taken HCG, that rules that out.

[Termin8r27]

That's kind of why I asked on the HCG. I was thinking that if you had taken it in the past you may have desensitized your leydig cells. Since you haven't taken HCG, that rules that out.

Aaah, got it.

Thx

[rmacgurn]

That's what I seem to be finding on Estrogen & Prostate.

That's good info on the Primary and how it relates to HCG therapy...I didn't really think of that.

Here's my blood work with ranges as well:
Cortisol Total 16.7mcg/dL ?
Estradiol 37pg/mL 13-54pg/mL
LH 6.2mlU/mL 1.5-9.3mlU/mL
Test Total 186ng/dL 450-1,200ng/dL
Free Test % 2.83% ?
Free Test 52.6pg/mL 50-244pg/mL
T4, FREE 1.2ng/dL 0.8-1.8ng/dL
TSH, 3rd Gen. 2.61mgU/L 0.40-4.50mlU/L
Vitamin D 24ng/mL 30-100ng/mL

I have some other thoughts for you to explore...

your Vit D levels are low, which related to several things, including conversion of Cholesterol to sex hormones, bone density, heart health and cancer...yes cancer. Normally D is made in the skin from sun exposure and from ingestion of fortified foods, like milk. levels under 30 increase risk of bone density problems, and now heart health and cancer. recent studies done at John Hopkins are trying to correlate exactly how this occurs but it seems to be related to Estr levels, and SHBG. Anyway taking some sun without sunscreen (or under SPF8) a few min a day, or taking D3 supplements will correct this issue. Then Ii suspect your E2 and SHBG levels will change also.

Lastly you did not post DHT and if prostate is an issue (regardless of PSA level now), keeping an eye on DHT and E2 together is more important as it requires elevations in both to create problems here.

good luck

[Termin8r27]

I have some other thoughts for you to explore...

your Vit D levels are low, which related to several things, including conversion of Cholesterol to sex hormones, bone density, heart health and cancer...yes cancer. Normally D is made in the skin from sun exposure and from ingestion of fortified foods, like milk. levels under 30 increase risk of bone density problems, and now heart health and cancer. recent studies done at John Hopkins are trying to correlate exactly how this occurs but it seems to be related to Estr levels, and SHBG. Anyway taking some sun without sunscreen (or under SPF8) a few min a day, or taking D3 supplements will correct this issue. Then Ii suspect your E2 and SHBG levels will change also.

Lastly you did not post DHT and if prostate is an issue (regardless of PSA level now), keeping an eye on DHT and E2 together is more important as it requires elevations in both to create problems here.

good luck

Thanks for the insight!

FWIW I live in TX and have been in the sun at least once a week for weeks now. The vitamin D kind of baffles me. We're doing a bone density test on the 12th as well... so I want to ask her more about that. I have dairy every day and drink at least 2 glasses of milk every day as well.

I was honestly so in shock from my previous appt I didn't really look at the blood test sheet this time around. I know they are testing Test again along with PSA's. They could be testing DHEA, SHBG and DHT, but I haven't had those tested yet...

[quietasamouse]

As far as the vitamin D goes- they put me on it as well. Like you, I was surprised, as so much of my protein is dairy based. Hard to separate out the Vitamin D from the T, but I will vouch for the increase in general well-being with the combo.

And feeling better is what this is all about.

Qaam

[Termin8r27]

I just got done with my follow up apt. I thought we were going to review labs and discuss therapy, but now they want me to get an MRI of the Pituitary to make sure it's not a problem there as well.

The Dr didn't even meet with me, it was her PA. She asked me if I had any questions, I did and brought an outline of questions/concerns and thoughts on therapy. She said ask away and then interrupted me a few seconds in to give me her speach. Basically they'll only do patches or gels, no injections. They also won't prescribe or at least talk about prescribing an AI or HCG. Not happy with them at all now.

I found a natural bio health place here in town, of course insurance won't cover it, but had a long talk on the phone and made an apt. They'll prescribe Test injections, an AI or anything else I'd need, I just have to pay out of pocket. Starting to think this is the route to go and say f#ck it to the Endo...?

Thoughts?

Here's my new bloods, with FSH, PSA and SHBG now too.
FSH 2.6mlU/mL (1.6-8.0)
LH 4.7mlU/mL (1.5-9.3)
PSA, Total 0.4 (< OR = 4.0ng/mL)
SHBG 9nmol/L (8-48)
Test Total 147ng/dL (450-1,100)
% Free Test 2.27 %
Test Free 33.4pg/mL (50-244)

[Vettester]

You noticed that the PA interrupted you a few seconds into your statement of concerns. The reason why ... They don't care about what your concerns are! They're in control here and they hope you don't see through the their ignorance! They only do Gels, no AI and no HCG? This is the equivalent of dating a girl that is telling you up front that you will only get a kiss on the cheek for as long as you go out.

Dump this place and move on! I know exactly what you're saying about the out of pocket stuff. I'm in the same boat ... If only my health provider were up to snuff in the real world of HRT ... I'd be $$$ ahead big time! But reality hits, they're not in the real world, and decisions need to made with how you want to maintain your health.

[Vettester]

BTW, let them run the MRI, then dump em!

[Termin8r27]

You noticed that the PA interrupted you a few seconds into your statement of concerns. The reason why ... They don't care about what your concerns are! They're in control here and they hope you don't see through the their ignorance! They only do Gels, no AI and no HCG? This is the equivalent of dating a girl that is telling you up front that you will only get a kiss on the cheek for as long as you go out.

Dump this place and move on! I know exactly what you're saying about the out of pocket stuff. I'm in the same boat ... If only my health provider were up to snuff in the real world of HRT ... I'd be $$$ ahead big time! But reality hits, they're not in the real world, and decisions need to made with how you want to maintain your health.

BTW, let them run the MRI, then dump em!

Yeah, I'm getting that now. This isn't something that mainstream medicine is equipped, nor willing to acknowledge/deal with.

I really like the other place I talked to...guess I will be taking my business to them...

I felt the same thing...take advantage and get the MRI done to make sure that the Pituitary is fine.

[BillyBob210]

My last labs showed my vatamin D at 30 on a scale that begins at 32. Picking up the supps today. I will let you know if I feel any difference. I too drink a lot of milk and spend alot of time in the sun, so it makes no sense.

[Termin8r27]

My last labs showed my vatamin D at 30 on a scale that begins at 32. Picking up the supps today. I will let you know if I feel any difference. I too drink a lot of milk and spend alot of time in the sun, so it makes no sense.

Interesting indeed.

Good luck!

[BillyBob210]

http://www.vitamindcouncil.org/newsl...2007-mar.shtml