Blood Panel Results - a few things are off

[LittleJohnny]

I just back these results yesterday. Today I went and gave a pint of blood for starters due to the high Hematocrit and so forth. I waited too long between donations.

The test blood was drawn 6 days after my last 140mg Test shot and 5 days after my last .25mg dose of Adex.

For the last 2 months my protocol has been 140mg cyp e7d and .25mg Adex e7d. I'm 53 years old, 6' 4", 250 lbs.

I understand the hematocrit, hemoglobin, RBC, and bilirubin being high due to not donating enough blood (4 months since last time). But the thyroid, E2, and Free Test seem odd. My TSH is high, but the T3 & T4 are normal. The E2 appears pretty low considering the small doe of Adex I'm taking. And my Free Test is way high. Any thoughts?

CBC With Differential/Platelet
WBC 6.0 3.4-10.8 x10E3/uL
RBC 6.51 HIGH 4.14-5.80 x10E6/uL
Hemoglobin 17.9 HIGH 12.6-17.7 g/dL
Hematocrit 53.4 HIGH 37.5-51.0 %
MCV 82 79-97 fL
MCH 27.5 26.6-33.0 pg
MCHC 33.5 31.5-35.7 g/dL
RDW 15.7 HIGH 12.3-15.4 %
Platelets 240 150-379 x10E3/uL
Neutrophils 59 40-74 %

Comp. Metabo1ic Panel
Glucose, Serum 70 65-99 mg/dL
BUN 16 6-24 mg/dL
Creatinine, Serum 1.39 HIGH 0.76-1.27 mg/dL
eGFR 58 LOW >59 mL/min/1.73
BUN/Creatinine Ratio 12 9-20
Sodium, Serum 139 134-144 mmol/L
Potassium, Serum 4.8 3.5-5.2 mmol/L
Chloride, Serum 99 97-108 mmol/L
Carbon Dioxide, Total 26 18-29 mmol/L
Calcium, Serum 9.5 8.7-10.2 mg/dL
Protein, Total, Serum 7.6 6.0-8.5 g/dL
Albumin, Serum 4.2 3.5-5.5 g/dL
Globulin, Total 3.4 1.5-4.5 g/dL
A/G Ratio 1.2 1.1-2.5
Bilirubin, Total 2.1 HIGH 0.0-1.2 mg/dL
Alkaline Phosphatase, S 76 39-117 IU/L
AST (SGOT) 19 0-40 IU/L
ALT (SGPT) 28 0-44 IU/L

Lipid Panel
Cholesterol, Total 189 100-199 mg/dL
Triglycerides 116 0-149 mg/dL
HDL Cholesterol 33 LOW >39 mg/dL
VLDL Cholesterol Cal 23 5-40 mg/dL
LDL Cholesterol Calc 133 HIGH 0-99 mg/dL

Thyroid Panel With TSH
TSH 6.080 HIGH 0.450-4.500 uIU/mL
Thyroxine (T4) 8.6 4.5-12.0 ug/dL
T3 Uptake 31 24-39 %
Free Thyroxine Index 2.7 1.2-4.9

Testosterone, Free/Tot Equilib
Testosterone, Serum 788 348-1197 ng/dL
Testosterone,Free 42.95 HIGH 5.00-21.00 ng/dL
% Free Testosterone 5.45 HIGH 1.50-4.20 %

Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 1.2 0.0-4.0 ng/mL

IGF-1
Insulin-Like Growth Factor I 155 61-200 ng/mL

Estradiol, Sensitive
Estradiol, Sensitive 14 3-70 pg/mL

 

[lucius11]

I have had a few blood tests with similar thyroid levels ... high TSH but normal T4. I have no symptoms of low thyroid (high TSH). My doc just keeps re-testing and watching. I don't want to be on thyroid medicine (and I have resisted my docs attempts to put me on) since I have no symptoms. My LabCorp test results say:

The Endocrine Society recommends against routine treatment for patients with elevated TSH levels below 10.000 uIU/mL if free T4 or T4 are normal. Thyroid function should be monitored at 6 to 12 month intervals.

So we are just waiting to see what happens.

 

[LittleJohnny]

I forgot to mention that part of my protocol is 112mcg of synthroid every day.

 

[Megatron28]

There are a few things that don't look good.

Creatinine is high. Were you dehydrated when you gave blood? If it isn't that, you kidneys are having a hard time working. I would keep an eye on this.

TSH of 6 indicates that you may have hypothyroidism. You should speak to your doctor about this.

Don't be so quick to dismiss Hyperbilirubinemia either. This case be a sign of many potential problems going on. Again, I would definitely speak to a doctor about by this.

Your cholesterol profile could be better. You may want to consider getting a Cardiac Calcium Scan. You can usually get it done for about $100 without insurance. Regardless, most insurance doesn't cover it. But this would help you determine if you should be on station medications and/or making diet and lifestyle changes.

TT of 788 is fairly high for a trough reading on once per week injections. Have you ever tested your peak? I wouldn't be surprised if you are getting up to almost 1500.

I am surprised your E2 is that low also. Perhaps .25mg of adex once per week would be better. And again, I would like to see blood work showing what your peak levels look like. Another option is to start injecting 70mg every 3.5 days and I bet you have a decent chance of not even needing an AI. You kidneys would probably thank you for dispensing of the adex. By the way, what were your Creatinine and eGFR at prior to starting TRT?

You don't need to panic, but please do get in and talk to your doctor about these results.

 

[Mprtz]

Bilirubin is pretty high too, indicating a liver possibly under stress.

EDIT: oops, missed it adressed above.

 

[Alpin]

Your dose might need adjustment with twice weekly injects.
That will keep estradiol down and you can get rid of that low dose adex once a week. Btw adex half life is 50 hours.
After 50 hours estradiol has a huge rebound effect after adex half life is up.

 

[LittleJohnny]

There are a few things that don't look good.

Creatinine is high. Were you dehydrated when you gave blood? If it isn't that, you kidneys are having a hard time working. I would keep an eye on this. I may have been a little dehydrated due to fasting before the blood draw. But I've seen this one a little high before.

TSH of 6 indicates that you may have hypothyroidism. You should speak to your doctor about this. I do have hypothyroidism. You must have missed my 2nd post. I'm taking 112mcg of synthroid a day. I just hadn't seen the TSH high while the T3 & T4 were normal.

Don't be so quick to dismiss Hyperbilirubinemia either. This case be a sign of many potential problems going on. Again, I would definitely speak to a doctor about by this. My bilirubin always goes hand in hand with my hematocrit and hemoglobin. It always comes down with blood donations.

Your cholesterol profile could be better. You may want to consider getting a Cardiac Calcium Scan. You can usually get it done for about $100 without insurance. Regardless, most insurance doesn't cover it. But this would help you determine if you should be on station medications and/or making diet and lifestyle changes. I think a diet change is needed for the cholesterol issue. My diet over the last year has been all over the place. I'm not worried about cardiac issues. I have a very small anomaly that shows on an EKG that throws up a red flag every time I go to a new doctor. I've been poked and prodded and put through stress tests and there's nothing wrong with my heart. The last doctor that ran all the tests gave me a copy of my EKG and told me to show it to any other doctor who might run an EKG just so they don't have to run me through all the tests again. Plus, no one in my family has ever died from heart disease or a heart attack. So I'm comfortable with that part.

TT of 788 is fairly high for a trough reading on once per week injections. Have you ever tested your peak? I wouldn't be surprised if you are getting up to almost 1500. I've been on test for about 3 1/2 years. 3 years ago I was taking 200mg e5d and .5mg Adex twice a week. I usually test my blood at least every 6 months and have peaked at 1500+ once. Other than that time I've never been above normal. But I only do a male hormone panel once a year, so I rarely see my free test. That's the part that surprises me. Over the years I have lowered my protocol from 200mg e5d, to 150 e5d, to 140 e5d, and now 140 e7d. I've done this because my test levels always seem higher than necessary and I was hoping to alleviate the blood panel issues. I'm tired of the phlebotomies too since I have to pay $150 to get it done. I'm thinking about going to 100mg e7d and dropping the Adex.

I am surprised your E2 is that low also. Perhaps .25mg of adex once per week would be better. And again, I would like to see blood work showing what your peak levels look like. Another option is to start injecting 70mg every 3.5 days and I bet you have a decent chance of not even needing an AI. You kidneys would probably thank you for dispensing of the adex. By the way, what were your Creatinine and eGFR at prior to starting TRT?
I've only been taking .25mg Adex once a week for the last 2 months. That's why I was surprised my E2 was so low. I figure if I switch to 100mg of Cyp e7d I can drop the Adex completely.

You don't need to panic, but please do get in and talk to your doctor about these results. I see my doctor almost every time I have a blood panel done. I already have an appointment for next week. Good advise though.

Bilirubin is pretty high too, indicating a liver possibly under stress. This goes up and down with my hematocrit and hemoglobin. After I give a couple pints of blood it comes back down. My understanding is the bilirubin is basically dead read blood cells that have to go through the liver, causing the liver panel discrepancy.

Your dose might need adjustment with twice weekly injects.
That will keep estradiol down and you can get rid of that low dose adex once a week. Btw adex half life is 50 hours.
After 50 hours estradiol has a huge rebound effect after adex half life is up. I'm switching to 100mg Cyp e7d. I may go to 50mg e3.5d. I've read 2 trains of thought on the rebound effect of Adex. I'd like to hear more on this.

Thanks for the help guys.

 

[Megatron28]

Eat more soluble fiber. It does wonders for cholesterol.


Why do you have to pay to donate blood? Is there something that disqualifies you?

 

[LittleJohnny]

I'm disqualified to donate due to the high hematocrit I believe. Also, the TRT might be part of it. I've kind of forgotten exactly since I was disqualified 3 years ago.

I just googled soluble fiber. Here's a list I found: oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, celery, carrots, and Metamucil. Apparently it not only helps lower LDL (bad) and total cholesterol, it makes you feel fuller for a longer period of time due to slow digestion. This will supposedly help with weight control. I could stand to drop 25 lbs anyway, so I can kill 2 birds with one stone. I'm headed to the store! Thanks for the heads up on this Megatron.

 

[Megatron28]

I'm disqualified to donate due to the high hematocrit I believe. Also, the TRT might be part of it. I've kind of forgotten exactly since I was disqualified 3 years ago.

I just googled soluble fiber. Here's a list I found: oatmeal, oat cereal, lentils, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, beans, dried peas, blueberries, psyllium, cucumbers, celery, carrots, and Metamucil. Apparently it not only helps lower LDL (bad) and total cholesterol, it makes you feel fuller for a longer period of time due to slow digestion. This will supposedly help with weight control. I could stand to drop 25 lbs anyway, so I can kill 2 birds with one stone. I'm headed to the store! Thanks for the heads up on this Megatron.

I would check about donating again/ You can be on TRT and donate. And your hematocrit should be under their limit now.

It is hard to eat enough soluble fiber every day. Supplement with psylium husk. Goes well mixed with juice.

Just ease into the soluble fiber. If you consume too much right away you will be running to the bathroom. You have to build up your tolerance.

Insoluble fiber is good too, just not as good as soluble. So don't be afraid to eat some broccoli, double fiber wheat bread and so on.

 

[3J]

the easiest fix i see here is the lipid panel.. with a clean diet he can fix those points no problem

 

[LittleJohnny]

I would check about donating again/ You can be on TRT and donate. And your hematocrit should be under their limit now.

It is hard to eat enough soluble fiber every day. Supplement with psylium husk. Goes well mixed with juice.

Just ease into the soluble fiber. If you consume too much right away you will be running to the bathroom. You have to build up your tolerance.

Insoluble fiber is good too, just not as good as soluble. So don't be afraid to eat some broccoli, double fiber wheat bread and so on.

I'm already as regular as a bus schedule. Maybe I should stock up on TP and cool wipes.

I read several places that said oats are high in soluble as well as insoluble fiber, so I bought a big tub of that. I also happen to like broccoli, so that won't be a problem. What kind of juice should I mix with the psylium husk, bearing in mind I'd prefer to drop weight than gain it?

 

[LittleJohnny]

the easiest fix i see here is the lipid panel.. with a clean diet he can fix those points no problem

3J, what would you recommend for fixing the lipids as well as dropping some weight?

 

[Megatron28]

I'm already as regular as a bus schedule. Maybe I should stock up on TP and cool wipes.

I read several places that said oats are high in soluble as well as insoluble fiber, so I bought a big tub of that. I also happen to like broccoli, so that won't be a problem. What kind of juice should I mix with the psylium husk, bearing in mind I'd prefer to drop weight than gain it?

Any kind. Pick your favorite.

 

[LittleJohnny]

Thanks Megatron.

 

[Megatron28]

Changed my mind. I recommend Cranberry Juice. Get one that is not mixed with other juices. It is possibly good for your kidneys. Might as well kill two birds with one stone.

 

[LittleJohnny]

Changed my mind. I recommend Cranberry Juice. Get one that is not mixed with other juices. It is possibly good for your kidneys. Might as well kill two birds with one stone.

Perfect! That's the one I was going to use.

 

[Alpin]

Just curious were you always hypothyroid ?
Ever try just the thyroid meds to help your endogenous T ?

 

[LittleJohnny]

Just curious were you always hypothyroid ?
Ever try just the thyroid meds to help your endogenous T ?

I was hypothyroid before going on TRT. I was on synthroid for about 6 months before going on testosterone. While the synthroid put my thyroid levels back to normal, I didn't notice any change at all in how I felt. The lack of improvement was why I had my testosterone level checked. With normal T3, T4, and TSH my total test level was at 220.

 

[Alpin]

I was hypothyroid before going on TRT. I was on synthroid for about 6 months before going on testosterone. While the synthroid put my thyroid levels back to normal, I didn't notice any change at all in how I felt. The lack of improvement was why I had my testosterone level checked. With normal T3, T4, and TSH my total test level was at 220.

I see. What was TSH after being on synthroid for 6 months?
Tell me about adex rebound effect.