Blood test results, could use some input

[Mprtz]

Just got my privatemdlabs results, been on testosterone replacement therapy (TRT) for 6 months, 160-200mg Tcyp/week, .5mg Adex 2x/week, Human Chorionic Gonadotropin (HCG) 500iu 2x/week

A couple of items of concern: unfortunately I don't have any baseline from pre-TRT, so I don't know what to attribute to TRT:

Hematocrit 51.7 (37.5-51) This does not come as a surprise, donated blood once already and will do again ASAP
Glucose serum 103 (65-99) Not sure what this indicates... I fasted 11 hours before draw
Cholesterol Total 230 (100-199) This concerns me, but I have no idea if it has anything to do with TRT
Triglycerides 97 (0-149)
HDL 58 (>39)
VLDL 19 (5-40)
LDL 153 (0-99) Doesn't look good

T total is high.
IGF-1 is high 230 (59-201) (not sure what this indicates)

These are all from privatemdlabs deluxe male anti-aging panel. I have omitted all the other normal results, but can include if needed.
I'm 49 yo, 6'0", 182lbs
I would say my diet is very good, Pretty low carb, high protein, moderately fairly high fat.

Could ADEX be responsible for bad lipid results? Or does it primarily lower HDL (which is OK for me)? Thanks.

 

[Megatron28]

Just got my privatemdlabs results, been on testosterone replacement therapy (TRT) for 6 months, 160-200mg Tcyp/week, .5mg Adex 2x/week, Human Chorionic Gonadotropin (HCG) 500iu 2x/week

A couple of items of concern: unfortunately I don't have any baseline from pre-TRT, so I don't know what to attribute to TRT:

Hematocrit 51.7 (37.5-51) This does not come as a surprise, donated blood once already and will do again ASAP
Glucose serum 103 (65-99) Not sure what this indicates... I fasted 11 hours before draw
Cholesterol Total 230 (100-199) This concerns me, but I have no idea if it has anything to do with TRT
Triglycerides 97 (0-149)
HDL 58 (>39)
VLDL 19 (5-40)
LDL 153 (0-99) Doesn't look good

T total is high.
IGF-1 is high 230 (59-201) (not sure what this indicates)

These are all from privatemdlabs deluxe male anti-aging panel. I have omitted all the other normal results, but can include if needed.
I'm 49 yo, 6'0", 182lbs
I would say my diet is very good, Pretty low carb, high protein, moderately fairly high fat.

Could ADEX be responsible for bad lipid results? Or does it primarily lower HDL (which is OK for me)? Thanks.

Post all your labs. And check out the Male Hormone Panel next time instead of male anti-aging. I think it may actually be cheaper and include more.

Yes, donate blood. Soon.

Glucose:
Glucose indicates whether or not you are diabetic. I am surprised yours is that high with how high your IGF-1 is. I have always been told that high IGF-1 (Insulin Growth Factor) is good for glucose levels. Don't know the science behind that though. But what has your glucose typically come in at in the past? Have you been on diabetes watch? Does it run in your family. Diet and exercise can help lower glucose. Avoid the simple carbs. You don't want to go on insulin if you don't have too.

Cholesterol:
HDL looks great. As do triglycerides. LDL, which is the important one, is pretty high though. Have you always had a high cholesterol problem? This can't be the first time you have checked your cholesterol, right? I am guessing you either need to change your diet (even though you say it is good) to include a lot of fiber and less junk food (if that is a problem) along with more exercise or get on a cholesterol med. Be honest with yourself as to whether or not you can make those changes and sustain them. And unfortunately, with cholesterol, sometimes you can do everything right is it just comes down to your genetics. Talk to your doc about whether or not you should medicate.

As for adex causing your lipid problem, who knows. Were your lipids much better prior to beginning testosterone replacement therapy (TRT)? I am guessing you may have had this problem for a long time. But, key word is guessing there.

You didn't list your Total T. What did it come in at? And when were these labs taken relative to when you last injected? What is your injection protocol?

What was your estradiol? It included that I believe.

 

[halfwit]

1. I'd look into apheresis at the Red Cross. That will drop that pesky hematocrit faster than whole blood as you can do it every 7 days. Yes, it takes an hour plus, but you get to watch a movie while you donate.

2. Fish oil a part of your diet? I'd start if not at 4g to bring those values back into range. You might also be eating too many saturated fats, I'd look at your diet as well.

3. You my friend are close to pre-diabetic range. I'd watch those complex carbs and try to refrain from eating too many sugars for awhile. Fiber can help such as oatmeal and "brown" alternatives such as brown rice or sweet potatoes/red potatoes instead of their less nutritious cousins. Don't let the glucose get away from you, testosterone will help - but only if you watch what you eat. ESPECIALLY if you're overweight at all.

Megatron has everything else covered I believe.

 

[Austinite]

What is 160 - 200 mg ? Which one is it? Can you list your actual protocol please?

 

[Mprtz]

As I said, I have no baseline blood tests prior to TRT. No diabetic family history, I have always been relatively lean and healthy. Been exercising pretty much all my adult life.
I eat no junk food (maybe a bit of dark chocolate). Basically no bread, starches, cereals (except bran). Almost totally avoid simple carbs and sugar (maltose from whole milk being the primary exception). Eat eggs, steak, chicken, cheese, nuts. Lots of spinach salads. Protein shakes 2x a day, almond milk and some whole milk. Add optifiber to every protein shake. BCAA. 3g fish oil per day. Creatine. 1 baby aspirin per day.
Peanut butter. Basically gave up beer and all alcohol 6 months ago. I eat almost nothing that doesn't support my goals. I don't count or restrict calories - have gained about 12-14lbs since starting testosterone replacement therapy (TRT) and lost fat around the waist (the only place I really had any).
Bodyfat probably about 12%. Lift weights 5-6 days per week, etc.

Current protocol is 160mg per week (down from 200mg per week), but last injection 3 days prior to blood draw was 100mg (I inject 2x / week). Total t was >1500 (yes, I know that's higher than it's supposed to be). Sensitive estradiol was 16 (too low?).
Take .5mg Adex 24 hours after injection, 500iu hCG 48 hours after injection.

 

[Mprtz]

Complete results are below. I've calmed down a little and from my research the lipid and glucose results are described as borderline high. Is it possible that I was insufficiently fasted? I just don't see how my diet can be at fault unless it's too much saturated fat. I thought that was supposed to be kind of a non-issue if carb intake is low?


CBC With Differential/Platelet
WBC 4.6 4.0-10.5 x10E3/uL SE
RBC 5.74 4.14-5.80 x10E6/uL SE
Hemoglobin 17.2 12.6-17.7 g/dL SE
Hematocrit 51.7 HIGH 37.5-51.0 % SE
MCV 90 79-97 fL SE
MCH 30.0 26.6-33.0 pg SE
MCHC 33.3 31.5-35.7 g/dL SE
RDW 14.5 12.3-15.4 % SE
Platelets 250 140-415 x10E3/uL SE
Neutrophils 55 40-74 % SE
Lymphs 35 14-46 % SE
Monocytes 8 4-13 % SE
Eos 2 0-7 % SE
Basos 0 0-3 % SE
Neutrophils (Absolute) 2.5 1.8-7.8 x10E3/uL SE
Lymphs (Absolute) 1.6 0.7-4.5 x10E3/uL SE
Monocytes(Absolute) 0.4 0.1-1.0 x10E3/uL SE
Eos (Absolute) 0.1 0.0-0.4 x10E3/uL SE
Baso (Absolute) 0.0 0.0-0.2 x10E3/uL SE
Immature Granulocytes 0 0-2 % SE
Immature Grans (Abs) 0.0 0.0-0.1 x10E3/uL SE
Comp. Metabolic Panel (14)
Glucose, Serum 103 HIGH 65-99 mg/dL SE
BUN 24 6-24 mg/dL SE
Creatinine, Serum 1.27 0.76-1.27 mg/dL SE
eGFR If NonAfricn Am 66 >59 mL/min/1.73 SE
eGFR If Africn Am 76 >59 mL/min/1.73 SE
BUN/Creatinine Ratio 19 9-20 SE
Sodium, Serum 139 134-144 mmol/L SE
Potassium, Serum 5.2 3.5-5.2 mmol/L SE
Chloride, Serum 102 97-108 mmol/L SE
Carbon Dioxide, Total 24 19-28 mmol/L SE
Calcium, Serum 9.3 8.7-10.2 mg/dL SE
Protein, Total, Serum 6.5 6.0-8.5 g/dL SE
Albumin, Serum 4.3 3.5-5.5 g/dL SE
Globulin, Total 2.2 1.5-4.5 g/dL SE
A/G Ratio 2.0 1.1-2.5 SE
Bilirubin, Total 1.1 0.0-1.2 mg/dL SE
Alkaline Phosphatase, S 48 44-102 IU/L SE
AST (SGOT) 25 0-40 IU/L SE
ALT (SGPT) 24 0-44 IU/L SE
Lipid Panel
Cholesterol, Total 230 HIGH 100-199 mg/dL SE
Triglycerides 97 0-149 mg/dL SE
HDL Cholesterol 58 >39 mg/dL SE
According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
negative risk factor for CHD.
VLDL Cholesterol Cal 19 5-40 mg/dL SE
LDL Cholesterol Calc 153 HIGH 0-99 mg/dL SE
Thyroid Panel With TSH
1 of 2
TSH 2.850 0.450-4.500 uIU/mL SE
Thyroxine (T4) 6.3 4.5-12.0 ug/dL SE
T3 Uptake 34 24-39 % SE
Free Thyroxine Index 2.1 1.2-4.9 SE
Testosterone, Serum
Testosterone, Serum >1500 HIGH 348-1197 ng/dL SE
Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 0.8 0.0-4.0 ng/mL SE
Roche ECLIA methodology.
.
According to the American Urological Association, Serum PSA should
decrease and remain at undetectable levels after radical
prostatectomy. The AUA defines biochemical recurrence as an initial
PSA value 0.2 ng/mL or greater followed by a subsequent confirmatory
PSA value 0.2 ng/mL or greater.
Values obtained with different assay methods or kits cannot be used
interchangeably. Results cannot be interpreted as absolute evidence
of the presence or absence of malignant disease.
IGF-1
Insulin-Like Growth Factor I 230 HIGH 59-201 ng/mL BN
Estradiol, Sensitive
Estradiol, Sensitive 16 3-70 pg/mL BN

 

[Mprtz]

1. I'd look into apheresis at the Red Cross. That will drop that pesky hematocrit faster than whole blood as you can do it every 7 days. Yes, it takes an hour plus, but you get to watch a movie while you donate.

This sounds interesting... is that something different than double red cell donation? That is offered at my local blood center, but I don't know yet if I qualify because my blood type is not established.
Apheresis to lower hct only seems relevant in the context of double red cell donation, which can only be done every three months. Can you elaborate on what donation can be repeated every 7 days? Thanks.

 

[halfwit]

This sounds interesting... is that something different than double red cell donation? That is offered at my local blood center, but I don't know yet if I qualify because my blood type is not established.
Apheresis to lower hct only seems relevant in the context of double red cell donation, which can only be done every three months. Can you elaborate on what donation can be repeated every 7 days? Thanks.

Apheresis is platelet donations. They basically filter out the platelets (that's what causes high HCT and hemoglobin) and return the plasma back to your body. As your body makes them rather quickly (48 hours for most), you can donate quite often and there are even incentive programs with the Red Cross as many are deterred by the fact that each visit can last up to two hours. For us guys that are on AAS, we literally shit out platelets, so you can expect your visits to be rather quick. My last donation was under 50 minutes for example.

Oh, and 11 hours is more than enough time for fasting. You're not in the danger zone yet, but it is something to keep an eye on in the future.

 

[Mprtz]

Apheresis is platelet donations. They basically filter out the platelets (that's what causes high HCT and hemoglobin) and return the plasma back to your body. As your body makes them rather quickly (48 hours for most), you can donate quite often and there are even incentive programs with the Red Cross as many are deterred by the fact that each visit can last up to two hours. For us guys that are on AAS, we literally shit out platelets, so you can expect your visits to be rather quick. My last donation was under 50 minutes for example.

Oh, and 11 hours is more than enough time for fasting. You're not in the danger zone yet, but it is something to keep an eye on in the future.

Are you sure this will help? From my understanding apheresis is the process of filtering out some component of blood ( red blood cells or platelets ) and returning the rest to the body.

In double red cell donation, the way that I understand it 2 pints worth of blood are drawn, the red blood cells are filtered out and one pint of plasma is returned to the body.
In platelets apheresis, one pint of blood is drawn, and only the platelets are filtered out and the plasma and RBCs are returned to the body.

White blood cells and platelets only make up a very small fraction of the packed cell volume that is used to calculate hematocrit percentage. The ratio of platelets to red blood cells is about 1 to 20, and they are significantly smaller in volume. I would not expect donating platelets only to have a significant impact on hematocrit.

 

[halfwit]

Are you sure this will help? From my understanding apheresis is the process of filtering out some component of blood ( red blood cells or platelets ) and returning the rest to the body.

In double red cell donation, the way that I understand it 2 pints worth of blood are drawn, the red blood cells are filtered out and one pint of plasma is returned to the body.
In platelets apheresis, one pint of blood is drawn, and only the platelets are filtered out and the plasma and RBCs are returned to the body.

White blood cells and platelets only make up a very small fraction of the packed cell volume that is used to calculate hematocrit percentage. The ratio of platelets to red blood cells is about 1 to 20, and they are significantly smaller in volume. I would not expect donating platelets only to have a significant impact on hematocrit.

Well, I can tell you I'm sitting at 45% hematocrit and haven't donated whole blood in several months. You can even ask them what your HCT is on your second trip as they will have the data from your first donation. My hematocrit is steadily dropping even though I'm still consistently running moderately high doses of testosterone.

 

[halfwit]

Since my brain is turning off as I'm getting sleepy, here's a study for your reading pleasure:

Results
We observed that the Hb, Hct, platelet and WBC counts decreased significantly in the donors (p<0.01) after each procedure, without there being significant changes in mean platelet volume or platelet distribution width. The decreases in Hb and Hct were significantly greater with the CS 3000 and Amicus machines, while the decreases in platelet and WBC counts were significantly greater with the CS 3000 and Fresenius separators.

Pre- and post- donation haematological values in healthy donors undergoing plateletpheresis with five different systems

 

[Mprtz]

Since my brain is turning off as I'm getting sleepy, here's a study for your reading pleasure:


Pre- and post- donation haematological values in healthy donors undergoing plateletpheresis with five different systems

Thanks for the link. Apparently the solution to the mystery is that the machines don't work nearly as well as I assumed and remove or destroy a significant amount of RBCs and WBCs in the process:

"It is well established that the first generation apheresis devices caused significantly greater losses of red cells during plateletpheresis as compared to more recent versions. These losses have been attributed to several factors such as the blood loss in the void volume of the apheresis kit, the technique applied and mechanical haemolysis by the pressure pumps14"

It also appears that the allowed donation interval by the Red Cross makes the same (incorrect) assumption of a "perfect" platelet apheresis separator and lets you donate every week even though you could drop 2 percentage points hct with every visit, while making you wait 2 months to replenish the 3 percentage point drop from a whole blood donation. Effectively it's a loophole we can exploit to our advantage.

Thanks halfwit, I always learn something!

 

[halfwit]

Thanks for the link. Apparently the solution to the mystery is that the machines don't work nearly as well as I assumed and remove or destroy a significant amount of RBCs and WBCs in the process:

"It is well established that the first generation apheresis devices caused significantly greater losses of red cells during plateletpheresis as compared to more recent versions. These losses have been attributed to several factors such as the blood loss in the void volume of the apheresis kit, the technique applied and mechanical haemolysis by the pressure pumps14"

It also appears that the allowed donation interval by the Red Cross makes the same (incorrect) assumption of a "perfect" platelet apheresis separator and lets you donate every week even though you could drop 2 percentage points hct with every visit, while making you wait 2 months to replenish the 3 percentage point drop from a whole blood donation. Effectively it's a loophole we can exploit to our advantage.

Thanks halfwit, I always learn something!

My pleasure man. I'm all about exploiting the system to my advantage, so I hope you can benefit too. Getting 75 dollar gift cards every couple months doesn't hurt either as a nifty perk for lowering my hematocrit haha.

 

[Mprtz]

My pleasure man. I'm all about exploiting the system to my advantage, so I hope you can benefit too. Getting 75 dollar gift cards every couple months doesn't hurt either as a nifty perk for lowering my hematocrit haha.

Just called blood center to verify that I can donate platelets anytime. Apparently I'm AB+, so I don't qualify for double red-cell donation. They'd really like me to donate plasma, but that doesn't really work for me.

 

[halfwit]

Just called blood center to verify that I can donate platelets anytime. Apparently I'm AB+, so I don't qualify for double red-cell donation. They'd really like me to donate plasma, but that doesn't really work for me.

Yeah, definitely see how it works for you. I'd like to see your results!

 

[Mprtz]

I know I'm responding way too much to my own thread, but I just re-read the sticky on managing estrogen in the AAS forum. The following jumped out at me:

On the positive side:
* Estrogen plays a key role in immune system function and inflammatory response.
* It has a positive impact on cholesterol.
* Estrogen is essential for GH and IGF synthesis.
*It plays a role in maintaining proper '"fluid balance" within the body.
*Essential for bone density
*Assists in glucose uptake

Now, my T is >1500 and my estrogen (sensitive) is 16. Isn't that quite low? According to the above, couldn't that be the reason for both my suboptimal cholesterol values and even explain the high glucose result?

I've also noticed that my elbows and shoulders hurt while working out. Ok, I'm almost 50 and I work out a lot, but that could also be due to low estrogen, no? Maybe I need to back off the .5mg 2x/week adex. I've got caps that I can't easily divide... should I try to get .25mg and take 3x/week? 2x/week? I welcome your suggestions.

 

[halfwit]

I know I'm responding way too much to my own thread, but I just re-read the sticky on managing estrogen in the AAS forum. The following jumped out at me:

On the positive side:
* Estrogen plays a key role in immune system function and inflammatory response.
* It has a positive impact on cholesterol.
* Estrogen is essential for GH and IGF synthesis.
*It plays a role in maintaining proper '"fluid balance" within the body.
*Essential for bone density
*Assists in glucose uptake

Now, my T is >1500 and my estrogen (sensitive) is 16. Isn't that quite low? According to the above, couldn't that be the reason for both my suboptimal cholesterol values and even explain the high glucose result?

I've also noticed that my elbows and shoulders hurt while working out. Ok, I'm almost 50 and I work out a lot, but that could also be due to low estrogen, no? Maybe I need to back off the .5mg 2x/week adex. I've got caps that I can't easily divide... should I try to get .25mg and take 3x/week? 2x/week? I welcome your suggestions.

Yes, it's on the low end. I hesitate to blame your cholesterol and glucose on low estradiol as there are many other factors that come into play. Keep in mind, a blood test is just a snapshot in time; you could have had some seriously complex carbohydrates lingering in your gut which could have popped you high for that and cholesterol is finicky. I do think you may be on to something though, and it wouldn't hurt to bring that E2 back up a hair and retest. We could both learn something here.

 

[Mprtz]

Well I decided to put the platelets donation to the test and I can confirm that it works:

First visit (whole blood donation) hgb: 17.7 (not so good)
Second visit (a few weeks later, double platelets donation) hgb: 17.0
Third visit (10 days later for second double platelets donation) hgb: 15.7

Interestingly, there was apparently more drop from the apheresis (which purportedly returns RBCs to the body) than from a plain old whole blood donation.
Extrapolating, I estimate my current hgb as 14.4 ( hct 43.2% ) which is below my pre-TRT level and gives me some headroom before I need to donate again. Thanks for the excellent tip, halfwit!!

 

[Alpin]

So how was your blood donating experience?
keep an eye on those RBC's, HCT, HEMOGLOBIN...
What T dose are you on?

 

[Mprtz]

So how was your blood donating experience?
keep an eye on those RBC's, HCT, HEMOGLOBIN...
What T dose are you on?

I can't complain... was treated with courtesy and appreciation. Lots of questions in the beginning - I was grateful that I did not have to lie.
Donating whole blood is easy and quick. Platelets is another matter. Today's double platelet apheresis took 118 minutes on the machine, total time about three hours. Just keeping your arm straight starts to hurt about halfway through. Along with your filtered blood, you are infused with an anticoagulant that messes with your blood ph and can cause some tingling, etc. I can't say that it was pleasant, and I frequently had to remind myself of how much I loved my fellow man.
I'm on 200mg/week.