Planning on starting TRT next week just want to get any random thoughts on blood work

[shineroid]

I am 29 and weight about 185lbs. been lifting for 3 years.
My testosterone has measured low various times over the years. As much as I should have done something about it I simply had not. I have a suspicion it has been this way ever since losing >100lbs 5 years or so ago. End of last year I finally decided to do something about it and was taking Clomid. It raised my Test but did not seem to improve symptoms. This particular doctor was not on board with giving me injections.

Anyways I found a doctor that seemed to really be on the same page with me. Fine with injections and willing to prescribe a AI if needed.

(10/20/15)
Free 31 (35-115)
Total 276 (276-1100)
TSH 2.07(.4-4.5)

(11/19/15)
Total 384(280-1100)
FSH 4.3(1.4-18.1)
LH 1.6
Prolactin 4.7(2.1-17.7)

(12/24/15) ON CLOMID
Estradiol 35 (<41)
FSH 5 (1.2-18.1)
LH 4.8 (1.5-9.3)
Total 1092 (280-1100)

(3/25/16)
Some of my bloods:

Free .75 (.61-1.12)

Total 252 (280-1100)

TSH 4 (.34-5.6)

Cortisol 23.8 (6.7-22.6)

LH 1.3 (1.2-8.6)

FSH 2.63 (1.27-19.26)

Estradiol 16 (<41)

IGFBP 28 (0-40)

Prolactin 3.38 (4.04-15.2)

TSH and Free seem odd. Also cortisol? Having a hard time finding information on combining all of these factors.
I have all the symptoms and have had them for years now.

 

[Milton]

Welcome to the boards thanks for the info.

 

[Megatron28]

You need to either do an HPTA restart attempt or get on TRT. Staying at your current levels is unhealthy and would result in an early death.

When you lost 100 lbs was it mainly fat loss? Were you in a big caloric deficit? If so, that suppresses your thyroid and testosterone levels. But you usually bounce back from that once you start eating again. Are you eating at maintenance calories now?

It would help if you could tell us how many calories your eat daily, what your macros are and what your TDEE is.

 

[daleb]

TSH 4 (.34-5.6)

If your doctor is on board start with FREE T3 and FREE T4 labs to properly evaluate the thyroid. You need the Free labs not the Total. Start there, it might be nothing but its a good thing to rule out hypothyroidism and hyperthyroidism.

 

[shineroid]

Yes the 100lbs was mainly fat. I am more muscular now than perhaps ever. I eat between 2700-3000 calories a day and depending on day to day my tdee is right there as well. With this intake my weekly trend weight has fluctuated by less than a pound over 6months.
This is however a weight maintained by calorie counting. Hunger is always there.
Macros are always at least 200 protein. Rest is varied depending on the day. Always at least 30g of fat. most of the time quite a bit more.
updated first post with some older bloods. not much info there though.

 

[shineroid]

Second talk with this doctor was not as eventful.
Was prescribed 100 test cyp 1x a week. Wasn't comfortable with every 3 days or so but from what I have read tons of people have no problem with once a week.
An MRI of my pituitary.
25mg a day of Levothyroxine because of the TSH. Really not into this one. Said that flat out. Don't plan on filling the script.
Also did a overnight dexamethasone suppression test. Well see how that comes back. This was to help diagnose the cortisol.
Didn't want me to get any more bloods until I was injecting for 2 months.
Ugh anxiety is high.

 

[Megatron28]

Not a bad call on waiting to see if TRT improves you thyroid function. It does for a lot of guys

 

[daleb]

though sttm theres a recommended lab section that has a 7 panel thyroid screen through quest for 120 bucks. get it done. it has ferritin ft3 ft4 rt3 tpo n tbii i believe. its the best priced thyroid screen ive found.

 

[shineroid]

Got some new labs but not exactly what I was looking for. I guess its time to pay for my lab work out of pocket. Tired of doctors not ordering exactly what I ask for.

T3 Reverse 28 (8-25)
T3 Total 61 (76-181)
T4 Total 6.7 (4.5-12)
TSH 2.1 (.4-4.5)
Total Testosterone 285 (250-1100)
Free Testosterone 30.4 (35-155)
B12 626 (200-1100)
Vit D 56 (30-100)
Prolactin 3.5 (2.0-18)
FSH 3.5 (1.6-8)
LH 1 (1.5-9.3)
Estrodiol <15 (<39)
DHEA 335 (85-690)


At least have DHEA RT3 and vit d now. Also the estrodiol being so low seems interesting.

 

[Megatron28]

Got some new labs but not exactly what I was looking for. I guess its time to pay for my lab work out of pocket. Tired of doctors not ordering exactly what I ask for.

T3 Reverse 28 (8-25)
T3 Total 61 (76-181)
T4 Total 6.7 (4.5-12)
TSH 2.1 (.4-4.5)
Total Testosterone 285 (250-1100)
Free Testosterone 30.4 (35-155)
B12 626 (200-1100)
Vit D 56 (30-100)
Prolactin 3.5 (2.0-18)
FSH 3.5 (1.6-8)
LH 1 (1.5-9.3)
Estrodiol <15 (<39)
DHEA 335 (85-690)


At least have DHEA RT3 and vit d now. Also the estrodiol being so low seems interesting.

Thyroid is looking a lot better! Good news there.

TT and FT suck still. That is why your E2 is low.

 

[shineroid]

Been reading up on reverse t3 now some. Just from maintaining a weight loss for several years I have naturally swayed towards lower carb. There seems to be a rather large connection to low t3 and elevated rt3 in that situation.

 

[ShadeTree]

Im assuming the total of 1092 is total T from the lab work when you were on clomid. If you would have been on an AI and got your E in the low 20's I believe you would have felt pretty good. I'm fighting E right now and mine at 31 had me feeling just like low T. After getting fed up with incompetent doctors I've decided to basically treat myself. I started liquidex a couple weeks ago and have been seeing some really good improvement from it. My point is you can be within the lab range on E and still feel like shit. The slightest elevation out of the sweet spot for E can make you feel just like low T can. Do you know if that was a sensitive E test? That's what you need to be getting to really know where E is. If it was me, knowing what I know now about how an E of 31 affects me, I'd try clomid again with an AI and get your E around the 22 mark and see how you feel.

 

[hmcyl]

What was your clomid dose?

 

[shineroid]

Yes it was.

I was taking 25mg a day.

Saliva Cortisol was elevated even at midnight. As well as ACTH. doctor wants to do a bilateral Inferior Petrosal Sinus Sampling. Not exactly looking forward to that one.

Really am trying to just be convinced that High Cortisol, low t3, high rT3, low T is simply because of maintaing a 100lb weightloss for >5years.
If there is nothing else to it besides that then I might as well just take the TRT and feel like a person that is naturally at this bodyweight.

 

[Megatron28]

Your hormones are only suppressed while iin a caloric deficit. Not while eating at maintenance.

 

[shineroid]

Is that really necessarily true. I do believe that a maintenance level state is hormonally better. But I am not sure they would ever recover fully.
nejm.org/doi/full/10.1056/NEJMoa1105816


I suppose it's not entirely relevant if I have had tests at maintenance and surplus over the years

 

[Megatron28]

Is that really necessarily true. I do believe that a maintenance level state is hormonally better. But I am not sure they would ever recover fully.
nejm.org/doi/full/10.1056/NEJMoa1105816


I suppose it's not entirely relevant if I have had tests at maintenance and surplus over the years

I was referring to Testosterone, LH, FSH, TSH, etc levels.