Help! Lab Results Are In - Need Assistance

[james2012]

So here is my regimen: 1.5tubes/day of Testim, .25mg Arimidex every third day along with 250IU HCG every third day. I am insulin resistant and have seen low SHBG even when TT was low and %freeT was high and free T was low normal. I have 25 stents. Latest lab work still indicates low cholesterol with:

LDL: 23 (0-99 range) LOW
Total: 92 (range 100-199) LOW but per cardiologist it would be high (he wants < 70)
HDL: 45 (>39 range)

Now here are my eye popping results:

TT: 1481ng/dL (range 280-800) HIGH
Free T (Direct) 52.1 ng/dL (range: 6.8-21.5) HIGH
SHBG: 15.9 nmol/L range (14.5-48.4): LOW NORMAL
Estradiol, Sensitive: 17pg/mL range (3-70) NORMAL

T4 Free, Direct: 1.63 nl/dL (range .82-1.77) HIGH NORMAL

NO MEASUREMENT for T3 which bothers me because!!!!!!: Reverse T3: 481 pl/mL (range 90-350): HIGH (Doc is checking my iron levels and does not seem to be too worried)

TSH: 1.35 uIU/ML (range .450-4.5) NORMAL

Prolactin: 5.4 ng/mL (range: 4.0-15.2) LOW NORMAL

Triiodothyronine: 3.3 pg/mL (range: 2.0-4.4) NORMAL (not sure what the heck this is)

Cortisol: 16.3 ug/dL (range: 2.3-19.4) NORMAL (blood gathered at 9:00am for all tests)

A1C: 6.0

So a couple of questions from a very nervous man that still has ED and Libido issues:

Does SHBG typically lower with TRT? If so, then if my TT lowers my SHBG should raise?

What is the significance of the Prolactin being low normal to libido and ED? What can be done to increase this level?

I am losing weight but not body mass like crazy. Doc thinks my weight loss should equate to lower A1C (it has not moved). His thinking is that A1C is being negatively impacted by high free-T. If free-T were normal then I should see a benefit to insulin resistance and SHBG should increase.

Now for this reverse T3. This is scaring the hell out of me because I have never had thyroid issues. Could this be caused by the very high TT and FT? High RT3 has been tied to MI, but I have no symptoms and am exercising at levels unseen in my entire life.

Moving forward: going down to one tube testim and no more armidex. Dropping HCG to either 150mg every three days or 50mg/day (does it matter which approach I take?)

Continuing diet and exercise with goal of 200lbs. For me this would be very thin with little adipose fat if my muscle mass remains the same. I am 22 lbs away from this. Before TRT I was 245 lbs.

My goal is to get to the upper end of the TT range and mid to upper FT range. Right now I have NO exercise induced angina and I am worried that lowering my FT and TT too much may cause angina to return. However, these high levels may actually be vasoconstrictive rather than vasodilating and being in the 700s may still be okay. I'll know as time goes on. I would love to remain on the current protocol until my weight is where I want it, but I fear that with levels this high (and that troublesome rT3 number) I am setting myself up for heart issues.

Hematocrit levels are normal and RBC is normal.

Any advice would be greatly appreciated.

 

[james2012]

By the way I have NO signs of adrenal fatigue. My energy levels are good.

 

[CubbieBlue]

So here is my regimen: 1.5tubes/day of Testim, .25mg Arimidex every third day along with 250IU HCG every third day. I am insulin resistant and have seen low SHBG even when TT was low and %freeT was high and free T was low normal. I have 25 stents. Latest lab work still indicates low cholesterol with:

LDL: 23 (0-99 range) LOW
Total: 92 (range 100-199) LOW but per cardiologist it would be high (he wants < 70)
HDL: 45 (>39 range)

Now here are my eye popping results:

TT: 1481ng/dL (range 280-800) HIGH
Free T (Direct) 52.1 ng/dL (range: 6.8-21.5) HIGH
SHBG: 15.9 nmol/L range (14.5-48.4): LOW NORMAL
Estradiol, Sensitive: 17pg/mL range (3-70) NORMAL

T4 Free, Direct: 1.63 nl/dL (range .82-1.77) HIGH NORMAL

NO MEASUREMENT for T3 which bothers me because!!!!!!: Reverse T3: 481 pl/mL (range 90-350): HIGH (Doc is checking my iron levels and does not seem to be too worried)
I wouldn't worry about it.

TSH: 1.35 uIU/ML (range .450-4.5) NORMAL

Prolactin: 5.4 ng/mL (range: 4.0-15.2) LOW NORMAL

Triiodothyronine: 3.3 pg/mL (range: 2.0-4.4) NORMAL (not sure what the heck this is)

This is your T3. Looks good.

Cortisol: 16.3 ug/dL (range: 2.3-19.4) NORMAL (blood gathered at 9:00am for all tests)

A1C: 6.0

So a couple of questions from a very nervous man that still has ED and Libido issues:

Does SHBG typically lower with TRT? If so, then if my TT lowers my SHBG should raise?

What is the significance of the Prolactin being low normal to libido and ED? What can be done to increase this level?

I am losing weight but not body mass like crazy. Doc thinks my weight loss should equate to lower A1C (it has not moved). His thinking is that A1C is being negatively impacted by high free-T. If free-T were normal then I should see a benefit to insulin resistance and SHBG should increase.

Now for this reverse T3. This is scaring the hell out of me because I have never had thyroid issues. Could this be caused by the very high TT and FT? High RT3 has been tied to MI, but I have no symptoms and am exercising at levels unseen in my entire life.

Moving forward: going down to one tube testim and no more armidex. Dropping HCG to either 150mg every three days or 50mg/day (does it matter which approach I take?)
What I was going to recommend. As far as the hCG goes do whatever causes you to have to stick yourself less.

Continuing diet and exercise with goal of 200lbs. For me this would be very thin with little adipose fat if my muscle mass remains the same. I am 22 lbs away from this. Before TRT I was 245 lbs.

My goal is to get to the upper end of the TT range and mid to upper FT range. Right now I have NO exercise induced angina and I am worried that lowering my FT and TT too much may cause angina to return. However, these high levels may actually be vasoconstrictive rather than vasodilating and being in the 700s may still be okay. I'll know as time goes on. I would love to remain on the current protocol until my weight is where I want it, but I fear that with levels this high (and that troublesome rT3 number) I am setting myself up for heart issues.

Hematocrit levels are normal and RBC is normal.

Any advice would be greatly appreciated.

All in all as long as you feel good stop obsessing over the numbers.

 

[james2012]

All in all as long as you feel good stop obsessing over the numbers.

I have no libido and sex drive is low. I feel good otherwise, but of course the real goal is to get my "maleness" back. Free-T that high cannot be good. I may feel good now and drop dead of a heart issue tomorrow because of high free-T. Remember I have 25 stents and advanced heart disease so I need to be a little obsessive.

And this reverse T3 is really bugging me. It alone can lead to erection issues. It is possibly caused by my stringent diet and could go away on its own over time - a number of sources state that often high RT3 is not permanent and does not always require thyroid supplementation to flush it out, but knowing why RT3 is high (if I am deficient in something) will allow me to assure myself that it does not return upon reversal.

 

[CubbieBlue]

I have no libido and sex drive is low. I feel good otherwise, but of course the real goal is to get my "maleness" back. Free-T that high cannot be good. I may feel good now and drop dead of a heart issue tomorrow because of high free-T. Remember I have 25 stents and advanced heart disease so I need to be a little obsessive.

And this reverse T3 is really bugging me. It alone can lead to erection issues. It is possibly caused by my stringent diet and could go away on its own over time - a number of sources state that often high RT3 is not permanent and does not always require thyroid supplementation to flush it out, but knowing why RT3 is high (if I am deficient in something) will allow me to assure myself that it does not return upon reversal.

I bet once you drop the testim and the arimidex you will be able to start finding your libido. It has something to do with your T/E ratio, not your thyroid.

 

[james2012]

All in all as long as you feel good stop obsessing over the numbers.

By the way, thanks for the feedback! My real question to you is: why would one NOT worry about high Free-T levels? High Free-T is not good, especially in my case. I am feeling more anxiety and my blood pressure is all over the map. Before it was very well controlled.

 

[mrmorris]

Well not really, just becasue someone feels good does not mean thier not doing major damgage long team. NEVER just say as long as I fell good then screw the numbers ever if some of them are out of contronl!!!!
Your TT is WAY! Too high, that's is not good, and might want to lower doses of your TRT meds, or figure out if it's not your med doses, then you and your Physician need to narrow it down and for sure get that in normal range, hell even 950-1000ng/nL would be great!
As for all the others you really want to take all of this seriously and and narrow down all the off the chart results and make a plan with you Physician I reccomend to try and get all numbers in thier normal range where they should be. Unless you have a special medical condition that is always going cause issues with any certain test result depending on what the issue is.
Other than that I'd HIGHLY reccomed getting these test result numbers closer to normal, talk with you doc if I were you ASAP!

Thanks Bud! mrmorris!

All in all as long as you feel good stop obsessing over the numbers.

 

[james2012]

Well not really, just becasue someone feels good does not mean thier not doing major damgage long team. NEVER just say as long as I fell good then screw the numbers ever if some of them are out of contronl!!!!
Your TT is WAY! Too high, that's is not good, and might want to lower doses of your TRT meds, or figure out if it's not your med doses, then you and your Physician need to narrow it down and for sure get that in normal range, hell even 950-1000ng/nL would be great!
As for all the others you really want to take all of this seriously and and narrow down all the off the chart results and make a plan with you Physician I reccomend to try and get all numbers in thier normal range where they should be. Unless you have a special medical condition that is always going cause issues with any certain test result depending on what the issue is.
Other than that I'd HIGHLY reccomed getting these test result numbers closer to normal, talk with you doc if I were you ASAP!

Thanks Bud! mrmorris!

I agree, although I believe CubbieBlue's heart to be in the right place. With me I just can't afford to mess around and my doctor is adamant I get these numbers down fast. Now I have two issues: very low cholesterol that is still very low after cutting back crestor (I may just have to remove the pill altogether) and very high T and free-T which is not good for a number of reasons.

I would like to belive CubbieBlue's suggestion that amounts to just using HCG and ridding myself of Testim altogether will work, but I don't think HCG monotherapy is a good approach. I think cutting back to one tube, cutting the arimidex out completely or using it only once per week, and then cutting the HCG back to 150IU every three days should do fine for me and I'll see numbers for TT at the high normal end and free T will probably still be high until I lose more weight and get my SHBG up. This is my next target, although anyone's opinion is certainly welcome. I think I am going to ask for a consult with the Master himself, Dr. Scally.

 

[mrmorris]

Hey what's up gmerits!

I was not trying to put down Cubbie I like him. All I was saying was the part when he said "as long as you fell good don't sweat the #'s"
I should have read the other posts above, I am sorry. Yes I do agree with you on the very high levels of Total Testosterone, and Free Testosterone. They are WAY off the chart. Also yes Dr. Scally, M.D. is the MASTER. He will for sure help you out.

Good Luck bro and hang in there, you'll get it all worked out!

Thanks Again, mrmorris!!!

I agree, although I believe CubbieBlue's heart to be in the right place. With me I just can't afford to mess around and my doctor is adamant I get these numbers down fast. Now I have two issues: very low cholesterol that is still very low after cutting back crestor (I may just have to remove the pill altogether) and very high T and free-T which is not good for a number of reasons.

I would like to belive CubbieBlue's suggestion that amounts to just using HCG and ridding myself of Testim altogether will work, but I don't think HCG monotherapy is a good approach. I think cutting back to one tube, cutting the arimidex out completely or using it only once per week, and then cutting the HCG back to 150IU every three days should do fine for me and I'll see numbers for TT at the high normal end and free T will probably still be high until I lose more weight and get my SHBG up. This is my next target, although anyone's opinion is certainly welcome. I think I am going to ask for a consult with the Master himself, Dr. Scally.

 

[CubbieBlue]

By the way, thanks for the feedback! My real question to you is: why would one NOT worry about high Free-T levels? High Free-T is not good, especially in my case. I am feeling more anxiety and my blood pressure is all over the map. Before it was very well controlled.

OK - I should clarify:

I meant after you drop the testim you should not be overly concerned with your #'s. Right now they are elevated grossly because of your dosage. Once you drop it things should normalize. I am just wanting you to not "obsess" over your numbers like many do.

 

[sade]

Mate, it's your RT3. The guys on Crislers forum reckon thats my problem too. I'm always freezing and my body temperatures always low. 34c. Do you get this?

 

[mrmorris]

Hey Cubbie!

I do agree you should not be obsessing over lab numbers. But there is a difference between obsessing and being on top of it or aware. I did read why you said to make a doseage agustment, so that was the reasoning why a few of his tests were off the charts? Taking to much that will do it!

Anyways see ya, mrmorris

OK - I should clarify:

I meant after you drop the testim you should not be overly concerned with your #'s. Right now they are elevated grossly because of your dosage. Once you drop it things should normalize. I am just wanting you to not "obsess" over your numbers like many do.

 

[james2012]

Mate, it's your RT3. The guys on Crislers forum reckon thats my problem too. I'm always freezing and my body temperatures always low. 34c. Do you get this?

No, and what's weird is my T3 is normal. Typically high RT3 equates to low T3. I'm flummoxed. it is probably the crash diet.

 

[james2012]

OK - I should clarify:

I meant after you drop the testim you should not be overly concerned with your #'s. Right now they are elevated grossly because of your dosage. Once you drop it things should normalize. I am just wanting you to not "obsess" over your numbers like many do.

Why not drop the Arimidex and lower the Testim from 1.5 tubes to 1 tube and then also lower the HCG to 150mg every third day. I would imagine that would have an impact on the Free-T and Total-T levels. Are you saying I should drop everything but the HCG?

It is interesting that I did respond to Dr. Scally's PCT therapy in the past but something shut it down again. I am not primary or secondary. Something else is shutting the axis down when I try to renormalize.

 

[sade]

My FT3 is normal, so is FT4 and I have high test and free test just like you except I'm not on trt.

No, and what's weird is my T3 is normal. Typically high RT3 equates to low T3. I'm flummoxed. it is probably the crash diet.

 

[zkt]

What does your doctor say about the A1c ?
What does your fasting glucose run?

 

[james2012]

What does your doctor say about the A1c ?
What does your fasting glucose run?

Doc thinks high A1C is due to high Free-T. Normally Free-T in the normal range assists in A1C. However, if TT and FT get too high the effect can be the opposite and it can negatively effect A1C and blood lipids but it depends on the person. I have been drinking alcohol quite a bit recently and that could be the cause. Dropping all sugars and losing more weight should drop my A1C to around 5.5-5.7 by his estimation. This is his area of expertise with TRT being something he is interested in but not extremely knowledgeable about.

 

[CubbieBlue]

Why not drop the Arimidex and lower the Testim from 1.5 tubes to 1 tube and then also lower the HCG to 150mg every third day. I would imagine that would have an impact on the Free-T and Total-T levels. Are you saying I should drop everything but the HCG?

It is interesting that I did respond to Dr. Scally's PCT therapy in the past but something shut it down again. I am not primary or secondary. Something else is shutting the axis down when I try to renormalize.

NO. I am saying you should lower the testim to 1 tube, and your FT and your TT will (likely) normalize. If not, decrease the hCG. At some point in this you can also experiment with reducing/quitting your adex.

Also you are likely suffering some form of age related hypogonadism. I honestly do not think that a PCT will hold you for the remainder of your life.

 

[james2012]

What does your doctor say about the A1c ?
What does your fasting glucose run?

Last fasting glucose was in may and measured 90.

 

[james2012]

NO. I am saying you should lower the testim to 1 tube, and your FT and your TT will (likely) normalize. If not, decrease the hCG. At some point in this you can also experiment with reducing/quitting your adex.

Also you are likely suffering some form of age related hypogonadism. I honestly do not think that a PCT will hold you for the remainder of your life.

I don't think it is age related. Numbers as low as 195 ng/dL do not seem to fit that profile. I had a collapse from an ACE inhibitor in early 2000 that knocked all my endocrine systems out of whack. Six months later I had a spontaneous recovery and everything was normal. However, the one thing they could pick on at the time was T and so the supplementation started. MRIs of adrenals and pituitary came back normal and I was labeled as idiopathic. I did respond to Dr. Scally's PCT the first time but my condition (advanced heart disease with tight cholesterol control) aided by my own stupidity concerning diet and exercise compliance dropped the top number of a TT of 600 to less than 390 and then down to 195. I believe I need to backfill due to the low cholesterol and the absence of any CHOL for preg production, thereby destroying the entire chain.

I sure could use some advice from Dr. Scally here. My E2 is 17 and if I drop 1/2 tube of testim and keep my AI regimen I won't be surprised if that number drops - which would not be good. I think I need to back of the 1/2 tube to only a single tube, space out my AI dose to every four days, and drop HCG to 150mg every three days, but that is just a guess. I really need to talk to the Doc.

Paging Dr. Scally! Your advice would be greatly appreciated at this point. .