Bloodwork Making my TRT Decision Confusing: Advice?

[Renzo12]

Briefly: 36, 5'8", 185 lbs, with a history of fatigue, lack of motivation, ED, poor memory. Decided to get tested in May for low T, as the symptoms seem to fit. I can post the complete panel, but the standout results were:

Total T: 244 ng/dL
Free T: 6.1 pg/ml
LH: 1.4 mIU/ml

Doc recommended TRT, but I wanted to see if there were any possible HPTA issues that could be fixed. Got thyroid/cortisol/pituitary work done and saw:

TSH 0.81 miU/L (Reference Range of .5 to 5.0)
Free T3 2.9 pg/ml (2.3 to 4.2)
Free T4 1.00 ng/L (.8 to 1.8)
Reverse T3 17.3 ng/dl (9 to 27)
Prolactin 4.3 ng/ml (2.1 to 17.7)
DHEA 2 ng/ml (3-10).
Cortisol "load” is 27nM (22-46).

Salivary Cortisol test, 24 Hours:
8 AM: 20 (13-24nM)
1 PM: 3 (5-10nM)
5 PM: 3 (3-8nM)
10 PM: <1 (1-4nM)

So--thyroid levels seem low, cortisol out of whack, and DHEA low. By this point, I wanted to get a third opinion since my local endo didn't see any problem with my thyroid levels. Doc ordered updated BW, which I got last week. This is where I get confused.

Test was 244 in May, now 498.
Free T was 6.1, now 9.6.
LH doubled from 1.4 to 2.8.

Labs were taken at the same time between 10 and 11 am, fasted, at the same lab. In the four-month gap between draws, I resumed exercising with heavy compound lifts and some interval training. My question is: were my T levels really just tanked from inactivity? Why would my LH double like that?

At this point, I'll probably keep working out, cleaning up my diet more, and get another draw in a month or two. I remember my T being around 379 a few years ago when I asked my primary to check it, but I don't know if it's normal for levels to fluctuate that much. I still have symptoms of fatigue, ED, depression, etc, but I don't think 498 warrants exogenous treatment. Any thoughts?

 

[Megatron28]

First thing I want to mention is that you need to get your hormone levels checked right away in the morning. 10-11 AM is too late. It should be checked at 7-8AM. I would go back in a month and have your blood drawn at the proper time. It really does make a difference as your testosterone levels fluctuate throughout the day.

Make sure you check FSH and Estradiol as well.

I agree, thryoid looks good. So does Prolactin.

Any chance that you have sleep apnea? That could explain your symptoms. How many hours of sleep so you get per night?

Any drug or alchohol use? Any past Anabolic Steroid use or pain medications or other medications?

Have you checked iron levels, B12 and Vitamin D? How are your lipids? What did your glucose/HBa1c look like? It would actually help if you could post the full blood work results with reference ranges included.

Finally, what does your diet look like? And yes, exercising can/does increase testosterone levels as long as you don't over train.

 

[3J]

i agree.. if his diet is poor his test levels will reflect that

 

[Renzo12]

Never used AAS. Take an SSRI (Zoloft) and have for ten years. I know that can lower test. I don't drink, smoke, or use drugs and never have.

Bloodwork from May, October changes in bold.

Testosterone,Free and Total
Testosterone , Serum 244 Low ng/dL (348 - 1197) (498 in October)
Free Testosterone(Direct) 6.1 Low pg/mL (8.7 - 25.1) (9.1 in October)
LH 1.4 Low mIU/mL (1.7 - 8.6) (2.8 in October) (2.8 in October)
FSH 1.5 mIU/mL (1.5 - 12.4) (Not checked in Oct)
Estradiol 29.2 pg/mL (7.6 - 42.6)
Prostate Specific Ag, Serum 0.6 ng/mL (0.0 - 4.0)

Thyroid/Pituitary/Cortisol
TSH 0.81 miU/L (Reference Range of .5 to 5.0)
Free T3 2.9 pg/ml (2.3 to 4.2)
Free T4 1.00 ng/L (.8 to 1.8)
Reverse T3 17.3 ng/dl (9 to 27)
Prolactin 4.3 ng/ml (2.1 to 17.7)
DHEA 2 ng/ml (3-10).
Cortisol "load***8221; is 27nM (22-46).
Salivary Cortisol test, 24 Hours:
8 AM: 20 (13-24nM)
1 PM: 3 (5-10nM)
5 PM: 3 (3-8nM)
10 PM: <1 (1-4nM)


CBC With Differential/Platelet
WBC 6.0 x10E3/uL (Reference Range 3.4 - 10.8)
RBC 5.60 x10E6/uL (4.14 - 5.80)
Hemoglobin 15.5 g/dL (12.6 - 17.7)
Hematocrit 44.9% (37.5 - 51.0)
MCV 80 fL (79 - 97)
MCH 27.7 pg (26.6 - 33.0)
MCHC 34.5 g/dL (31.5 - 35.7)
RDW 14.3% (12.3 - 15.4)
Platelets 207 x10E3/uL (155 - 379)
Neutrophils 61 % (40 - 74)
Lymphs 30 % (14 - 46)
Monocytes 6 % (4 - 12)
Eos 2 % (0 - 5)
Basos 1 % (0 - 3)
Neutrophils (Absolute) 3.7 x10E3/uL (1.4 - 7.0)
Lymphs (Absolute) 1.8 x10E3/uL (0.7 - 3.1)
Monocytes(Absolute) 0.4 x10E3/uL (0.1 - 0.9)
Eos (Absolute) 0.1 x10E3/uL (0.0 - 0.4)
Baso (Absolute) 0.0 x10E3/uL (0.0 - 0.2)
Immature Granulocytes 0 % (0 - 2)
Immature Grans (Abs) 0.0 x10E3/uL (0.0 - 0.1)

Comp. ********* Panel (14)
Glucose, Serum 95 mg/dL (65 - 99)
BUN 15 mg/dL (6 - 20)
Creatinine, Serum 0.98 mg/dL (0.76 - 1.27)
eGFR If NonAfricn Am 99 mL/min/1.73 >59
eGFR If Africn Am 115 mL/min/1.73 >59
BUN/Creatinine Ratio 15 (8 - 19)
Sodium, Serum 143 mmol/L (134 - 144)
Potassium, Serum 5.9 High mmol/L (3.5 - 5.2) (5.2 in October)
Magnesium 1.8 mg/dL (1.6 - 2.6)
Chloride, Serum 104 mmol/L (97 - 108)
Carbon Dioxide, Total 26 mmol/L (19 - 28)
Calcium, Serum 10.1 mg/dL (8.7 - 10.2)
Protein, Total, Serum 7.0 g/dL (6.0 - 8.5)
Albumin, Serum 4.8 g/dL (3.5 - 5.5)
Globulin, Total 2.2 g/dL (1.5 - 4.5)
A/G Ratio 2.2 (1.1 - 2.5)
Bilirubin, Total 0.3 mg/dL (0.0 - 1.2)
Alkaline Phosphatase, S 76 IU/L (39 - 117)
AST (SGOT) 16 IU/L (0 - 40)
ALT (SGPT) 22 IU/L (0 - 44)

Lipid Panel
Cholesterol, Total 215 High mg/dL (100 - 199) (233 in October)
Triglycerides 68 mg/dL (0 - 149) (108 in October)
HDL Cholesterol 60 mg/dL >39 (52 in October)
VLDL Cholesterol Cal 14 mg/dL (5 - 40) (22 in October)
LDL Cholesterol Calc 141 High mg/dL (0 - 99) (161 in October)

Don't like my lipid profile shooting up from May. I stopped fish oil (just ran out and didn't bother to buy more) and started eating whole eggs for breakfast, but I thought they weren't supposed to raise blood cholesterol. Diet is currently eggs, whole grains (rice, whole wheat bread), chicken/tuna/turkey, protein powders and a bar before bed. Not great, but was more concerned with eating above maintenance and trying to put on some muscle.

I'm not up to 10 am or so (self-employed). Still best to check test between 7 and 8? Thanks!

 

[3J]

these were taken fasted??

 

[Megatron28]

Yes, get up in the morning to have blood work checked 7-8AM. What time do you go to bed at usually? You didn't answer my sleep related questions.

Have you tried weaning yourself off the SSRI? They are terrible for your hormones. Why are you taking Zoloft?

Any pro hormone usage?

 

[Renzo12]

these were taken fasted??

Yes. Are you asking because they're that bad, re: the lipid panel? I know it's high, but I thought it could be a lot worse. Have had higher (250 cholesterol) around 5-6 years ago.

Usually go to bed at 1 and wake up around 10. I have not tried going off the SSRI: lots of anxiety/emotional issues, and I'm better on it than off. Maybe not hormonally, but in other respects. No pro hormones.

 

[Megatron28]

Yes. Are you asking because they're that bad, re: the lipid panel? I know it's high, but I thought it could be a lot worse. Have had higher (250 cholesterol) around 5-6 years ago.

Usually go to bed at 1 and wake up around 10. I have not tried going off the SSRI: lots of anxiety/emotional issues, and I'm better on it than off. Maybe not hormonally, but in other respects. No pro hormones.

Getting your hormones squared away has allowed a lot of guys to stop using SSRI's. And have you been doing cognitive behavioral therapy with a psychologist? SSRIs are not meant to be a longterm answer.

So you normally sleep 9 hours every night? That is a lot for a 36 year old. And feeling fatigued after sleeping that much can be indicative of a sleep issue. You really should get a sleep study done to make sure that isn't the problem.

 

[Renzo12]

Getting your hormones squared away has allowed a lot of guys to stop using SSRI's. And have you been doing cognitive behavioral therapy with a psychologist? SSRIs are not meant to be a longterm answer.

So you normally sleep 9 hours every night? That is a lot for a 36 year old. And feeling fatigued after sleeping that much can be indicative of a sleep issue. You really should get a sleep study done to make sure that isn't the problem.

You're definitely on the money with this. I do see a counselor and CBT is an ongoing education. I actually may need to switch providers because I don't feel we're focusing on it enough.

Re: sleep, I had three studies done about ten years back when the fatigue was more pronounced. First test showed nothing, second showed some "mild sleep disordered breathing," and so did the third, but there were problems: for one, I slept like shit in that environment, and two, a year trial of CPAP did nothing for my fatigue. So if there's a sleep issue, I don't know I can explore it any further.

 

[Megatron28]

You're definitely on the money with this. I do see a counselor and CBT is an ongoing education. I actually may need to switch providers because I don't feel we're focusing on it enough.

Re: sleep, I had three studies done about ten years back when the fatigue was more pronounced. First test showed nothing, second showed some "mild sleep disordered breathing," and so did the third, but there were problems: for one, I slept like shit in that environment, and two, a year trial of CPAP did nothing for my fatigue. So if there's a sleep issue, I don't know I can explore it any further.

Why not give the CPAP another try for a month and then get blood work again to see if it helps your hormones?

 

[Renzo12]

Why not give the CPAP another try for a month and then get blood work again to see if it helps your hormones?

If I slept in a lab comfortably, I would. But I don't, and any titration they do probably wouldn't be right. I'd sooner go for a mouth piece, which my dentist recommends and seems to be a valid alternative without the discomfort of the PAP. I'm also waiting for a consumer-use SleepImage unit, which is a non-invasive at-home device for measuring apnea episodes and sleep quality. Doctors have them, but none in my area.

At this point, I have to hypothesize my hormonal issues are due to a mix of stress/anxiety, dubious sleep quality, SSRI use, and bouts of inactivity--though it's just strange my LH would suddenly kick in just because I've been lifting for ten weeks. Maybe correlation without causation. At any rate, I have a phone consult with a hormone doc tomorrow. Hoping to get some insight there.

 

[Megatron28]

Your LH didn't "kick in". It was low/lowish in both sets of numbers you provided. As was FSH. Given your low/lowish testosterone your LH and FSH should be much higher.

Although if your TT stays in the 500 range that isn't all that bad of a number. The average is somewhere around 600.

 

[Renzo12]

Your LH didn't "kick in". It was low/lowish in both sets of numbers you provided. As was FSH. Given your low/lowish testosterone your LH and FSH should be much higher.

Although if your TT stays in the 500 range that isn't all that bad of a number. The average is somewhere around 600.

Well, it did double, though I realize 2.8 isn't that high. I can get a pituitary MRI if I want to per my endo, but if I have a growth, it doesn't appear to be secreting excessive prolactin.

I wonder if the tests aren't indicative of my testosterone fluctuating like this all the time. It would explain why I have seem to have libido/energy some days but not others. (Probably 80/20 in favor of feeling like crap.) Not sure if TRT is indicated for that, or what the cause would be.

 

[Megatron28]

if you aren't feeling good with TT of 500 you probably won't feel better on TRT. TRT simply puts you back at normal TT levels. Once you go on TRT it is typically for life. You are doing the right thing of trying to exhaust all other possible causes of your symptoms.

 

[Renzo12]

if you aren't feeling good with TT of 500 you probably won't feel better on TRT. TRT simply puts you back at normal TT levels. Once you go on TRT it is typically for life. You are doing the right thing of trying to exhaust all other possible causes of your symptoms.

Trying to. Thanks for all of the info. I'll try to update when I learn more.

 

[Renzo12]

Update: consulted with a new doctor and explained everything. Going to try DHEA/pregnenolone for adrenal support and a 30-day trial of Clomid to see if my pituitary can be pushed into making more LH/FSH. I feel this is a good, conservative approach, as the Clomid won't shut off my HPTA. If it "holds," great; if not, doctor might consider a maintenance dose. TRT remains a last resort. He also wants me to use an AI to avoid a bump in estradiol.

I do know there are subjective reports of guys using Clomid and getting a bump in total T but not feeling the "effects" of raised libido, energy, muscle mass increase, etc. I believe Doctor Crisler mentioned that it could be due to suppression of free T because Clomid raises SHBG. I don't see why I wouldn't see improvement in my symptoms if free/total T is elevated. It should be easy to tell, as I haven't had morning erections in years. If I start, then something must be going on. I believe a company has patented a slightly revised Clomid compound that's going through FDA trials for "official" low T treatment, so I think there's some hope here.

Megatron: not that you need the endorsement, but doctor agreed SSRIs are a problem along with sleep. I don't know I can necessarily change those prompts, though--at least, not easily or right away. I'm hoping I can kick my sluggish system and work from there. I also plan to do one more T draw in a week or two around 7-8 am. Doc believes my test/LH is fluctuating due to the lifestyle factors, which would explain why I can sometimes feel okay every once in awhile. He's guessing a third draw would probably fall somewhere in the middle of the first two.

Still researching and learning. This thread really helped, so thank you to everyone who took the time to contribute. I'll keep checking in.