I posted sometime over summer about interpreting my blood results as I suspected I might be suffering from low testosterone. Since then, I have had a followup appointment with my family doc which resulted in more bloodwork and an eventual referral to an endo. My three blood tests have gone as follows:
Lab1
July 14/14 10:30 AM fasted
Free Test 26.8 (15.5-146)
LH 3.6 (1.2-8.6)
FSH 1.4 (1.3-19.3)
After being unsatisfied with the results of this test, I took the recommendation to get a second test with total testosterone included, however my doctor filled out free test and bioavailable test on the requisition form. I didn't speak up when I noticed this so it is my fault to some extent. A user also suggested I try getting tested at a different lab due to the strange reference range on the free test result.
Lab2
July 31/14 8:30 AM fasted
Free Test 18.8 (31-94)
Bioavailable Test 4.2 (2.7-19.2)
LH 3.6
FSH 1.4
TSH 1.95
My family doctor now referred me to see an endo at a large teaching hospital by where I live. When that appointment finally arrived, the endo wanted me to get another blood test done at the hospital lab with total testosterone included (but apparently not free as they didn't consider it as valid of a measure). I discussed with my endo my full history, including the fact I have been diagnosed with sleep apnea since I was around 19 or 20 years old (I am now 27). I have had UPPP surgery which was extremely painful and did nothing for me in addition two procedures that were supposed to shrink the base of my tongue (doc at the time thought it was possible it could be falling back into my airway when I sleep). I am presently and have been using CPAP with little to no abatement of my worst two symptoms which are fatigue and lethargy. Keep in mind that in my lifetime, I have had 7 studies, tried 5 different masks, had my pressure increased on two occasions with little discernible benefit. The only thing that has positively impacted symptoms in the last 7 or so years has been the 100mg of modafinil I take in the morning, and, despite this, I still feel pretty shitty.
I also went on to explain that I have a lifting background to the doctor and was concerned about physiological impacts I might be experiencing, namely the fact that I had trouble losing fat or building muscle in addition to recovering very poorly from lifting sessions.
For reference I am a decently strong dude with 6 years of a powerlifting focus under my belt but if you saw me on the street you might only give me credit for 2. Earlier this year I lost close to 25 pounds through diet and simple calorie counting (1.25 lb per week rate at greater than 25% BF) to see if weight loss would somehow improve any of my symptoms and it simply made me feel worse. At that point in time, I was not operating under any theory or suspicion I might have a testosterone related issue. I assumed that my body composition and level of strength were solely the result of how I had dieted and trained up until that point and that I must be tired because of fat or apnea. I can't be sure exactly what the breakdown in fat to muscle lost was, but I shaved a quick 30-35 pounds off my bench press (from around 380 to 350) in the first two month period where I only lost around 15 pounds. I've since stopped eating at a deficit and went to slightly above maintenance to try and grind back to where I was without success. I didn't get this specific about training with my doc because I was trying my best not to give off a certain impression or stigma.
The doctor made a point of ordering a test on my IGF-1 level as well because there was a minor concern I could have acromegaly (I don't show any of the telltale signs like gigantism) due to me getting sleep apnea at such a young age. The thought was that my jaw and esophagus might have grown a lot all at once to cause it or something along those lines. It might also be of important note that I have had apnea both 30 pounds above and 30 pounds below my current weight and it seems to make little difference. Per my last study, I seem to have a combination of obstructive and central apnea. I did my best to make them aware that while I thought apnea could be playing a factor, I have essentially exhausted what modern medicine can give me as treatment for it short of them doing mandibular advancement surgery which is painful, has risks, and isn't a sure thing much like my prior surgery. Again, I wear CPAP at a 12 pressure every night with a full face mask.
Lab3 (at hospital with endo dept)
Sep 23/14 8:30 AM fasted
Total Test 10.9 (3.5-31.6)
Bioavailable Test 3.6 (2.2-9.7)
IGF-1 119 (this was low but I don't remember what the reference range was)
LH 3
FSH 1
TSH 3.59
The doctors (one was a resident and one was not) concluded based on these results that I didn't have hypogonadism. I expressed concern based on the fact that my free testosterone was quite low in the previous test and the fact that the ranges between labs seemed to be completely subjective and unreliable. When I took the time to convert my total testosterone value into units used on US dominated forums it came out to around 319 ng/dl which, as I undersand for a 27 year old, is borderline shit. The doctors showed ZERO concern whatsoever for this result and the fact that the range allowed for as low as 101 ng/dl seemed criminal to me. My IGF-1 levels came in below range which disproved any theory of acromegaly but also left me legitimately wondering whether I actually have low IGF-1. They explained this result away by the pulsatile nature of growth hormone release which wasn't very satisfactory but I've accepted for now. I was basically shuffled out with a requisition for a final blood test to "close the door" on this.
My question is, given my medical history and the data points that I do have, should I continue with my blood work shopping around for an endo that will help me? Should I pursue this through a TRT clinic? Should I chalk it up and assume this must be my sleep apnea despite the fact CPAP doesn't do anything for me? Is there any way this could be something I am not thinking of? I am at a point where I feel completely stuck because I am running out of explanations for why I feel like shit and my body performs so poorly. Any suggestions or advice is appreciated.
Lab1
July 14/14 10:30 AM fasted
Free Test 26.8 (15.5-146)
LH 3.6 (1.2-8.6)
FSH 1.4 (1.3-19.3)
After being unsatisfied with the results of this test, I took the recommendation to get a second test with total testosterone included, however my doctor filled out free test and bioavailable test on the requisition form. I didn't speak up when I noticed this so it is my fault to some extent. A user also suggested I try getting tested at a different lab due to the strange reference range on the free test result.
Lab2
July 31/14 8:30 AM fasted
Free Test 18.8 (31-94)
Bioavailable Test 4.2 (2.7-19.2)
LH 3.6
FSH 1.4
TSH 1.95
My family doctor now referred me to see an endo at a large teaching hospital by where I live. When that appointment finally arrived, the endo wanted me to get another blood test done at the hospital lab with total testosterone included (but apparently not free as they didn't consider it as valid of a measure). I discussed with my endo my full history, including the fact I have been diagnosed with sleep apnea since I was around 19 or 20 years old (I am now 27). I have had UPPP surgery which was extremely painful and did nothing for me in addition two procedures that were supposed to shrink the base of my tongue (doc at the time thought it was possible it could be falling back into my airway when I sleep). I am presently and have been using CPAP with little to no abatement of my worst two symptoms which are fatigue and lethargy. Keep in mind that in my lifetime, I have had 7 studies, tried 5 different masks, had my pressure increased on two occasions with little discernible benefit. The only thing that has positively impacted symptoms in the last 7 or so years has been the 100mg of modafinil I take in the morning, and, despite this, I still feel pretty shitty.
I also went on to explain that I have a lifting background to the doctor and was concerned about physiological impacts I might be experiencing, namely the fact that I had trouble losing fat or building muscle in addition to recovering very poorly from lifting sessions.
For reference I am a decently strong dude with 6 years of a powerlifting focus under my belt but if you saw me on the street you might only give me credit for 2. Earlier this year I lost close to 25 pounds through diet and simple calorie counting (1.25 lb per week rate at greater than 25% BF) to see if weight loss would somehow improve any of my symptoms and it simply made me feel worse. At that point in time, I was not operating under any theory or suspicion I might have a testosterone related issue. I assumed that my body composition and level of strength were solely the result of how I had dieted and trained up until that point and that I must be tired because of fat or apnea. I can't be sure exactly what the breakdown in fat to muscle lost was, but I shaved a quick 30-35 pounds off my bench press (from around 380 to 350) in the first two month period where I only lost around 15 pounds. I've since stopped eating at a deficit and went to slightly above maintenance to try and grind back to where I was without success. I didn't get this specific about training with my doc because I was trying my best not to give off a certain impression or stigma.
The doctor made a point of ordering a test on my IGF-1 level as well because there was a minor concern I could have acromegaly (I don't show any of the telltale signs like gigantism) due to me getting sleep apnea at such a young age. The thought was that my jaw and esophagus might have grown a lot all at once to cause it or something along those lines. It might also be of important note that I have had apnea both 30 pounds above and 30 pounds below my current weight and it seems to make little difference. Per my last study, I seem to have a combination of obstructive and central apnea. I did my best to make them aware that while I thought apnea could be playing a factor, I have essentially exhausted what modern medicine can give me as treatment for it short of them doing mandibular advancement surgery which is painful, has risks, and isn't a sure thing much like my prior surgery. Again, I wear CPAP at a 12 pressure every night with a full face mask.
Lab3 (at hospital with endo dept)
Sep 23/14 8:30 AM fasted
Total Test 10.9 (3.5-31.6)
Bioavailable Test 3.6 (2.2-9.7)
IGF-1 119 (this was low but I don't remember what the reference range was)
LH 3
FSH 1
TSH 3.59
The doctors (one was a resident and one was not) concluded based on these results that I didn't have hypogonadism. I expressed concern based on the fact that my free testosterone was quite low in the previous test and the fact that the ranges between labs seemed to be completely subjective and unreliable. When I took the time to convert my total testosterone value into units used on US dominated forums it came out to around 319 ng/dl which, as I undersand for a 27 year old, is borderline shit. The doctors showed ZERO concern whatsoever for this result and the fact that the range allowed for as low as 101 ng/dl seemed criminal to me. My IGF-1 levels came in below range which disproved any theory of acromegaly but also left me legitimately wondering whether I actually have low IGF-1. They explained this result away by the pulsatile nature of growth hormone release which wasn't very satisfactory but I've accepted for now. I was basically shuffled out with a requisition for a final blood test to "close the door" on this.
My question is, given my medical history and the data points that I do have, should I continue with my blood work shopping around for an endo that will help me? Should I pursue this through a TRT clinic? Should I chalk it up and assume this must be my sleep apnea despite the fact CPAP doesn't do anything for me? Is there any way this could be something I am not thinking of? I am at a point where I feel completely stuck because I am running out of explanations for why I feel like shit and my body performs so poorly. Any suggestions or advice is appreciated.
