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  1. #1
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    Default Conttemplating going on TRT. Need help with labwork

    Hello Dr. Nathan,
    I decided to get some blood tests done recently in April of this year:
    LH = 4.1 Ref (1.5-9.3 mIU/mL)
    FSH = 3.9 Ref (1.6-8.0 mIU/mL)
    Prolactin = 11.6 Ref (2.0-18.0 ng/mL)
    Estradiol = 23 Ref (< or = 39pg/mL)
    Testosterone , Total, Males = 290 Ref (241-827 ng/dL)

    I was very depressed to see this. I really don't know what to do. I don't have erectile problems, I want sex all the time and I'm a frequent masterbator. I do get tired later in the day sometimes, I am moody and irritable though. To be honest, I'm more of a lazy person.

    Here's a little about me:
    I'm 37 years old. 6ft tall, 213lbs and 19.5%bf. I've been weightlifting for a little over 2 years now but I've been in an out of the gym since high school. I was a runner before, did 10 years in the military and I weighed 145-155 between high school and around 27. Between 27-31 I went up to 175 and now, around 35 to present, I weigh 213. I run a typical bodybuilding split. Legs on Monday, chest and tris on Tuesday, rest on Wednesday, back on Thursday, and shoulders and biceps on Friday. I've never run a cycle of steroids before and I don't smoke or drink. My bench press is 225 for 2 sets of 5 reps, my squat is 325lbs for one rep and my deadlift is 495 for one rep.

    I went to another doctor to check my test levels again. It's still low. This doctor wants to put me on test C at 400mg every 2 weeks. I told him to give me some time to think about it. I want to do some more research before I start the lifelong TRT commitment.

    I'll post my labs in the next post.

  2. #2
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    Here are my lab results from last year:

    Collected 6/8/12
    Recieved 6/9/12

    Quest Diagnostics
    test: CS/HDL/AMY/CK/OSMOLALITY/T4/T3U/TSH/RPR/CBD/UA+ALB
    CHEM-SCREEN PNL+HDL,TIBC
    Glucose, fasting 82 REF 65-99 mg/dL
    Sodium 141 Ref 135-146mmol/L
    Potassium 4.9 Ref 3.5-5.3 mmol/L
    Chloride 104 Ref 98-110 mmol/L
    Carbon dioxide 27 ref 21-33 mmol/L
    urea nitrogen 16 ref 7-25 mg/dL
    Creatinine 1.10 ref 0.60-1.35 mg/dL
    BUN/Creatinine Ratio NOT REPORTED WHEN VALUES ARE WITHIN NORMAL LIMITS ref 6-22
    Uric Acid 5.2 Ref 4.0-8.0 mg/dL
    Phosphorus 3.5 ref 2.5-4.5 mg/dL
    Cholesterol, total 150 Ref 125/200mg/dL
    HDL Cholesterol 59 ref >=40 mg/dL
    Cholesterol/HDL Ratio 2.5 ref <= 5.0
    LDL Cholesterol, calculated 83 ref <130mg/dL
    Triglycerides 40 ref <150 mg/dL
    Protein, total 7.0 ref 6.2-8.3 g/dL
    albumin 4.6 ref 3.6-5.1g/dL
    Globulin, Calculated 2.4 ref 2.1-3.7 g/dL
    A/G ratio 1.9 ref 1.0-2.1
    Bilirubin, total 0.4 ref 0.2-1.2 mg/dL
    Bilrubin, direct 0.1 ref <=0.2 mg/dL
    Alkaline Phosphatase 50 ref 40-115 U/L
    GGT 19 ref 3-90 U/L
    AST 22 ref 10-40 U/L
    ALT 13 ref 9-60 U/L
    LD 157 ref 100-220 U/L
    Iron, total 86 ref 45-170mcg/dL
    TIBC 330 ref 250-425 mcg/dL
    Transferrin saturation 26 ref 20-50%
    EGFR NON AFR American 88 ref >60 mL/min/1.73m2
    EGFR AFR American 102 ref >60 mL/min/1.73m2
    OSMOLALITY, serum 293 ref 275-295 mOsm/kg H2O
    MICROALBUMIN, RANDOM
    MICROALBUMIN 0.4 ref NOT ESTABLISHED mg/dL
    MICROALBUMIN, RANDOM URINE 2 ref < 30 mcg/mg Creat
    CREATININE, RANDOM URINE
    Creatinine Random Urine 185 ref 20-370 mg/dL
    TSH 0.68 ref 0.40 - 4.50 mIU/L
    T4, Total 6.0 ref 4.5-12.0 mcg/dL
    T3 Uptake 31 ref 22-35 percent
    T4, free, calculated 1.9 ref 1.4-3.8 units
    CK TOTAL 315 ref 44-196 U/L OUT OF RANGE
    Amylase, Serum 70 ref 21-101 U/L
    CBC INCLUDES DIFF/PLT
    WBC 6.5 ref 3.8-10.8 Thous/mcL
    RBC 4.92 ref 4.20-5.80 Mill/mcL
    HEmoglobin 13.8 ref 13.2-17.1 g/dL
    Hematocrit 42.1 ref 38.5-50%
    MCV 85.5 ref 80.0-100.0 fL
    MCH 28.0 ref 27.0-33.0 pg
    MCHC 32.8 ref 32.0-36.0 g/dL
    RDW 13.3 ref 11.0-15.0%
    Platelet count 250 ref 140-400 Thous/mcL
    MPV 8.8 ref 7.5-11.5 fL
    Total neotrophils,% 54.1 ref 38-80%
    Total lymphocytes,% 35.5 ref 15-49%
    Moonocytes,% 9.0 ref 0-13%
    eosinophils,% 1.1 ref 0-8%
    Basophils,% 0.3 ref 0-2%
    Neutrophils, Absolute 3517 ref 1500-7800 Cell/mcL
    Lymphocytes, Absolute 2308 ref 850-3900 Cells/mcL
    Monocytes, Absolute 585 ref 200-950 Cells/mcL
    EOSINOPHILS, Absolute 72 ref 15-500 Cells/mcL
    Basophils, Absolute 20 ref 0-200 cells/mcL
    DIFFERENTIAL - An instrument differential was performed.
    Urinalysis, Complete
    Color Yellow Ref Yellow
    Appearance Clear Ref Clear
    Glucose, QL Negative ref Negative mg/dL
    Bilirubin, Urine Negative ref Negative
    Ketones Negative ref Negative mg/DL
    Specific Gravity 1.020 ref 1.001 - 1.035
    Blood Negative ref Negative
    PH 6.0 ref 5.0-8.0
    Protein, Total QL Negative ref Negative mg/dL
    Nitrite Negative ref NEgative
    Leukocyte Esterase NEgative ref negative
    Squamous Epithelial Cells None Seen ref <or =5 cells/hpf
    WBC None Seen ref <or =5 cells/hpf
    Bacteria None seen ref none seen/hpf
    RBC None seen ref <or =3 cells/hpf
    Hyaline Casts None seen ref None seen /lpf
    Cardio CRP (R) 0.5 ref <1.0 Lower relative cardiovascular risk
    RPR w/titer + Conf RFX
    RPR Screen Nonreactive ref non reactive
    Vitamin D, 25-OH,LC/MS/MS
    Vitamin D, 25-OH, TOTAL 33 ref 30-100ng/mL
    Vitamin D, 25-OH, D3: 33
    Vitamin D, 25-OH, D2: <4

  3. #3
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    THIS IS MY CURRENT BLOODWORK FROM 5/30/13

    Glucose, 74 REF 74-106 mg/dL
    BUN, 15 REF 9-23 mg/dL
    Creatinine, 1.0 REF 0.7-1.3
    BUN/Creatinine Ratio, 15 REF 8-28 Ratio
    Calcium, 9.7 REF 8.7-10.4
    Sodium Serum 144 Ref 132-146mmol/L
    Potassium 5.0 Ref 3.5-5.5 mmol/L
    Chloride 103 Ref 99-109 mmol/L
    Carbon dioxide 29 ref 20-31 mmol/L
    Protein, total 6.9 ref 5.7-8.2 g/dL
    albumin 4.4 ref 3.2-4.8g/dL
    Globulin, 2.5 ref 1.8-4.0 g/dL
    A/G ratio 1.8 ref 0.8-2.7 Ratio
    ALK.Phosphate, 77 REF 40-156 U/L
    Bilirubin, total 0.4 ref 0.2-2.0 mg/dL
    AST 22 ref <34
    ALT 21 ref 10-49 U/L
    Uric Acid 3.8 Ref 3.7-9.2 mg/dL
    Cholesterol, total 137 Ref 100-200mg/dL
    HDL Cholesterol 50 ref 40 -50mg/dL
    VLDL Cholesterol, Cacl, 13 REF 0-38 mg/dL
    LDL Cholesterol, Calc, 74 REF 70-130mgDL
    Cholesterol/HDL Ratio 2.74 ref 0-4.97
    LDL/HDL Ratio 2.74 ref 1.00-3.55
    C-Reactive Protein (CRP), <0.4 REF <1.0
    Glycohemoglobin (HbA1c), 5.2 REF <5.7
    PSA (Prostatic Antigen), 0.89 REF 0.00-4.00 nG/mL
    Estradiol, <20
    TSH, 3rd Generation, 0.72 REF 0.51-6.27uIU/mL
    Vitamin B12, 802 REF 211-911pg/ML
    Ferritin, 69 REF 22-322ng/mL
    Iron, 89 REF 65-175 ug/dL
    Complete Blood Count
    WBC, automated 5.0 ref 3.7-10.5 x10^3/uL
    RBC 5.32 ref 4.6-6.2
    HGB 14.0 ref 14.0-18.0 g/dL
    HCT 48.0 ref 42-54%
    MCV 90 ref 80.0-102.0 fL
    MCH 26.3 ref 26.0-32.0 pg
    MCHC 29.1 ref 30.0-36.0 g/dL OUT OF RANGE
    RDW 13.7 ref 11.5-18.5%
    Platelet, automated 237 ref 130-400
    MPV 8 ref 6.8-12.6 fL
    DIFFERENTIALS, AUTOMATED
    Neotrophils % 46.5 REF 40-75
    Total neotrophils # 2.33 ref 1.6-7.0
    Lymphocytes,% 43.2 ref 15-45%
    Lymphocytes # 2.16, REF 1-4.8
    Moonocytes,% 7.2 ref 3-12%
    Monocytes # 0.36 REF 0.00-1.2
    eosinophils,% 2.6 ref 0-6%
    Eosinophils # 0.13 REF 0.00-0.45
    Basophils,% 0.6 ref 0-2%
    Basophils # 0.03 REF 0.00-0.20
    Sedimentation Rate, 2 REF 0-20
    Testosterone, Total, 277 Ref 300-1000
    Testosterone, Free, 59.8 REF 90-244pg/mL
    SHBG 27 REF 13-71nmol/L
    Vitamin D, 25-Hydroxy, 99 REF 30-100ng/mL

    As you can see, the testosterone numbers have gotten lower. My vitamin D numbers improved over the past year though.

    I don't have any of the problems I see in the commercials. My libido is fine (I always want sex), my erections are fine, my memory is good, I have energy, I sleep well, my mind is sharp, I work out well and add weight to the bar. I feel great so it's kind of disappointing to see the test numbers so low. I eat well, getting in at least 200g of protein, take Orange Triad multivitamins, fish oil and 6,000iu's of Vitamin D. I work out consistently. I'm pretty bummed out over these numbers.

    Another thing, back in 2000-2003, I was in the military and I hurt my back. I also got prostatitis and epididimytis. I was treated for the prostatitis and epididymitis with ciprofloxacin, ibuprofin, and flomax. I still have a pain in my right testicle and after a few ultrasounds by different doctors, they said that I have a spermatocele but it shouldn't be a problem. Every doctor I've been too about the dull ache in my right testicle tell me that there's nothing wrong and that I should live with it.

    About the back pain, I was given tons of medication over the 2000-2002 time period. I have a list of it here. Celebrex, ibuprofin, morphine, flexeril, naorpsyn, feldene, ultram, vicodin, valium, prednisone, robaxin, pamelor and neurontin. I spoke to a friend, who's a doctor, and he said that taking all of those medications, over that period of time, probably messed up my system and over the years, my body adjusted to the low t and that's why I don't have any symptoms but I do have low T.

    I have one doc telling me the leave everything alone. I don't have symptoms and I add weight to the bar during my workout. I have another doc telling me that my numbers are low and to get on TRT to fix them. Another thing, I had a doctor check my sperm count, since I would like to have kids, and he said that my sperm count was in 100 millions so he said that I'm way above average for sperm count. He's also against getting on testosterone.

    I do'nt know what to do. Should I go on TRT? I wanted to try to raise it naturally and both doctors said that ship has sailed. I was thinking of just sitting around and waiting for ED and other symptoms to show up, then get treated. I read that I won't get Low T symptoms until I get under a 200 test level so I might have some time.

  4. #4
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    Dr. Nathan,
    Do you treat Estrogen and shrinking testicles? One of the reasons why I haven't started TRT yet is because the only DR that I found that would treat me wants to use a 400mg shot every 2 weeks and doesn't check or treat estrogen. He also doesn't worry about atrophy of the testicles.

    Also, do you take insurance?

    Thanks

  5. #5
    Hormone Replacement Therapy M.D. Dr. Joel Nathan's Avatar
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    The following is for educational purposes only. I am not recommending the regimen below for anyone. It's something that one's health care professional may want to consider.

    First a history and physical exam should be one to determine appropriate treatment for the patient.

    Testosterone cypionate 200mg IM weekly
    Human Chorionic Gonadotropin 500u sq twice a week (keeps testes working close to normal)
    adjuncntive meds:Arimidex,

    If DHT is high avoid finasteride, try to decrease testosterone dose rather than use finasteride that can cause permanent impotency.
    If estrogen become high, add arimidex as needed.

    Recheck labs in 2-3 months and adjust doses.

    Please note that finasteride can lead to permanent impotence. If DHT is high try to decrease testosterone dose before trying any DHT reducing drug.

    J. Nathan, MD

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