Help Interpreting Blood Work

[HRTstudent]

Nate, this following article is from another chatroom....I thought it might be something you should read:

1) It could be adrenal stress, and this could be made worse with TRT unless you take some very simple and inexpensive precautions. In fact, in some cases, adrenal stress can be the cause of low T in the first place. When you are under stress, your adrenals steal pregnenolone and to a lesser extent DHEA away from other hormonal pathways to make cortisol. That is why excessive exercise and/or stress can decrease T. You need pregnenolone to make DHEA and DHEA to make testosterone.

You may want to consider adding 30 mg of oral pregnenolone and 25 mg of oral DHEA to your supllement schedule. It's best to take these in the evening. If your are really stressed, and really deficient in preg or DHEA, then doubling the dose for a week or so may be helpful but don't go higher than that without supervision and hormonal tests as high DHEA can also drive up E and that can cause other issues.

2) It could be that your are also have some thyroid issues going on. Thryoid problems can mimic low T in many symptoms (ED, low energy, brain fog, inability to lose abdominal fat, etc.). You may want to have a complete thyroid panel done which absolutlely must include free T3 and rT3. Your ratio should be at least 20:1 of T3 to rT3. A lot of docs (especially endos) do not believe in T3 and somehow think that supplementing with T4 will fix the problem. I highly recommend not listening to that advice (if you do indeed have thyroid issues) and supplement with Armour or some other biological product that contains all four of the thyroid hormones.

Do you know your TSH? If it is consistently above 2 or so, it may indicate a problem. So TSH is often the first round of testing. Oh, ignore the "normal ranges", anything consistently about 1.5 to 2 should be further evaluated.

Again, watch out for docs that want to give you synthetic T4, yes it will bring down the TSH but it will not fix an rT3 problem and may make it worse.

This is good advice in general, although id like to expound upon a couple things....

While the pregnenolone pathway does lead to DHEA and then on to testosterone, it's very unlikely that taking pregnenolone will raise either of these to any substantial degree, if at all. I haven't seen anyone report this, and pregnenolone in excess usually results in more progesterone. It certainly had no effect on my DHEA levels despite different doses over different time periods.

To be sure, blood tests for DHEA are reliable and accurate. Just be sure to check for DHEA-s (sulfate)! Just plain DHEA levels vary widely throughout the day, so clinically, we don't look at that, but rather we look at DHEA-s. Any major lab would offer this test.

Pregnenolone blood tests, on the other hand, are less exact. Some say they are useless, but if you have insurance it's worth investigating IMO.

If you start DHEA make sure you choose a micronized version for its increased absorption. Also, take it with a fatty meal because, as a lipid soluble hormone, this will increase its absorption.

And I totally agree on getting a full thyroid panel done. Be sure to get: Total T4, Total T3, Free T3, Free T4, and TSH. Most docs will simply look at TSH because it's what they are trained to do and what insurance wants them to do. But it doesn't give an adequate picture of the thyroid ESPECIALLY when one suspects there may be an issue with the thyroid.

[Nate02]

Nate, this following article is from another chatroom....I thought it might be something you should read:

1) It could be adrenal stress, and this could be made worse with TRT unless you take some very simple and inexpensive precautions. In fact, in some cases, adrenal stress can be the cause of low T in the first place. When you are under stress, your adrenals steal pregnenolone and to a lesser extent DHEA away from other hormonal pathways to make cortisol. That is why excessive exercise and/or stress can decrease T. You need pregnenolone to make DHEA and DHEA to make testosterone.

Can TRT cause adrenal fatigue? I ask because when I had my cortisol tested prior to TRT it was 21 mg/dL at 8 AM. I have done thorough research, and I have learned that cortisol can be high right before dropping into adrenal fatigue. I doubt that starting TRT could affect my cortisol that much, right? I am just on two pumps of Androgel 1.62% a day aka the starter dose.

You may want to consider adding 30 mg of oral pregnenolone and 25 mg of oral DHEA to your supllement schedule. It's best to take these in the evening. If your are really stressed, and really deficient in preg or DHEA, then doubling the dose for a week or so may be helpful but don't go higher than that without supervision and hormonal tests as high DHEA can also drive up E and that can cause other issues.

I have considered doing that. I did have my DHEA tested with my cortisol and I have normal DHEA. Mid-ranged according to the reference scale.

2) It could be that your are also have some thyroid issues going on. Thryoid problems can mimic low T in many symptoms (ED, low energy, brain fog, inability to lose abdominal fat, etc.). You may want to have a complete thyroid panel done which absolutlely must include free T3 and rT3. Your ratio should be at least 20:1 of T3 to rT3. A lot of docs (especially endos) do not believe in T3 and somehow think that supplementing with T4 will fix the problem. I highly recommend not listening to that advice (if you do indeed have thyroid issues) and supplement with Armour or some other biological product that contains all four of the thyroid hormones.

Do you know your TSH? If it is consistently above 2 or so, it may indicate a problem. So TSH is often the first round of testing. Oh, ignore the "normal ranges", anything consistently about 1.5 to 2 should be further evaluated.

Again, watch out for docs that want to give you synthetic T4, yes it will bring down the TSH but it will not fix an rT3 problem and may make it worse.

I do not have thyroid issues anymore. I take Synthroid and and my thyroid levels fall in the normal range. Please read the initial post.

Pregnenolone is a what most would consider a safe drug. Of course I would absolutely talk to your doctor about it before you start.

But, you said you have axiety and Dr Crisler has touted he benefits of pregnenolone (oral specifically) on helping many of his patients with anxiety. The micronized lipid matrix (MLM) pregnenolone seems to be the most highly acclaimed due to its purported enhanced absorption.

I will most likely take pregnenolone, but right now I only have 50 milligrams and I am not comfortable taking such an amount. I will buy a lesser amount. The effect it has on anxiety is desirable in my situation.

Also, it's very cheap! A 150mg x 60 tablet would last you at least a month (300mg is probably more than most take, although I don't know what Dr Crisler recommends) and it's about 30 USD. If you took 150mg a day, that's only 15 bucks a month, which may be cheaper than taking some Rx anxiolytic with a copay.

That is good news.

This is good advice in general, although id like to expound upon a couple things....

While the pregnenolone pathway does lead to DHEA and then on to testosterone, it's very unlikely that taking pregnenolone will raise either of these to any substantial degree, if at all. I haven't seen anyone report this, and pregnenolone in excess usually results in more progesterone. It certainly had no effect on my DHEA levels despite different doses over different time periods.

Good to know.

To be sure, blood tests for DHEA are reliable and accurate. Just be sure to check for DHEA-s (sulfate)! Just plain DHEA levels vary widely throughout the day, so clinically, we don't look at that, but rather we look at DHEA-s. Any major lab would offer this test.

Please read above.

Pregnenolone blood tests, on the other hand, are less exact. Some say they are useless, but if you have insurance it's worth investigating IMO.

If you start DHEA make sure you choose a micronized version for its increased absorption. Also, take it with a fatty meal because, as a lipid soluble hormone, this will increase its absorption.

I will look into it.

And I totally agree on getting a full thyroid panel done. Be sure to get: Total T4, Total T3, Free T3, Free T4, and TSH. Most docs will simply look at TSH because it's what they are trained to do and what insurance wants them to do. But it doesn't give an adequate picture of the thyroid ESPECIALLY when one suspects there may be an issue with the thyroid.

Please read above.

Thank you both for your response. I am really curious as to find if TRT can cause adrenal fatigue.