Help Understanding Bloodwork

[sfbizercer]

Good afternoon Meso.

I got bloodwork done recently and there are some concerns I have with it, as well as some things that I don't quite understand (if I should be worried, etc). For reference, I am currently taking 12.5mg enclomiphene, 10mg ibutamoren ED as well as some other supplements that aren't relevant to the discussion at hand. I am taking enclomiphene as a "test booster", and I am taking ibutamoren to combat enclo's serum IGF-1 reduction (with the appetite and GH gains being a bonus).

I am 20 years old, hovering around 215lb in mornings recently, likely around 15-17% bodyfat. With that being said it is absolute HELL to get an accurate measurement with any method with the amount of loose skin I have, so that is just based on my eyeballs. I'm unsure as to whether or not I have any naturally high hormonal biomarkers from genetics or as a result of my childhood obesity (if even possible), but I figured the more info for you all, the better.

Recent "half-natty" bloodwork:


My main concerns / questions with these results are (in no particular order):
- Why are the reference ranges for free testosterone wildly different between the lab above and the lab below, is it due to testing methodology differing? Is this something to monitor or something that can safely go quite high (such as total test)?
- Obviously (I think), my LH is through the roof due to enclomiphene's moa, but this is both expected and fine? As with free test, is this something that can safely go quite high without worry?
- Any reason why my FSH is in range while my LH is sky high? In PMID 27337642 (see 6.2 Phase II Studies) the two seemed to have raised nearly 1-1, so I would expect FSH to be out of range at the least, but I'm not sure hence why I ask.
- Should I be taking an AI? My E2 is out of range but I'm unsure whether this is acceptable given the drugs I am taking and their dosages, or whether I should be introducing an AI and ensuring E2 is kept within range.

Older (~1yr) natty bloodwork:


Thanks in advance for any help, and apologies in advance if I asked anything retarded.

 

[mochul]

If you feel fine with e2 then there is no point in taking ai. Reduce your body fat and it will get back in range. It’s slightly out of the reference range.

 

[-Maui-]

Why are the reference ranges for free testosterone wildly different between the lab above and the lab below, is it due to testing methodology differing?

It looks like one is measured and the other is calculated.

my LH is through the roof due to enclomiphene's moa, but this is both expected and fine?

Yes, the reason is anti-estrogen and it's normal. This is the goal. Raise LH to stimulate testosterone.

As with free test, is this something that can safely go quite high without worry?

I think it's too high. Stimulating your testicles too much can fry them.

Any reason why my FSH is in range while my LH is sky high? In PMID 27337642 (see 6.2 Phase II Studies) the two seemed to have raised nearly 1-1, so I would expect FSH to be out of range at the least, but I'm not sure hence why I ask.

...rise in LH (5.3 to 11.9 mIU/mL p<0.05) and FSH (9.4 to 14.9 mIU/mL p<0.05).
LH x 2.25
FSH x 1.6
Both grow, but not 1 to 1

Should I be taking an AI?

Focus on how you feel.

 

[sfbizercer]

It looks like one is measured and the other is calculated.


Yes, the reason is anti-estrogen and it's normal. This is the goal. Raise LH to stimulate testosterone.

I think it's too high. Stimulating your testicles too much can fry them.


...rise in LH (5.3 to 11.9 mIU/mL p<0.05) and FSH (9.4 to 14.9 mIU/mL p<0.05).
LH x 2.25
FSH x 1.6
Both grow, but not 1 to 1


Focus on how you feel.

Amazing response, thank you.

I had contacted a friend of mine knowledgeable on the subject and he said the same for the AI so until my nipples feel off or I start getting emotional I'll hold off.

As for FSH, I was doing an extremely rough calculation off a glance but looked like mine didn't raise much at all compared to how far out of range my LH was; with that being said I hadn't had my FSH checked before so maybe mine just naturally low. Either way, doesn't seem too important.

I am taking what is considered a "high" dose of enclo so it would make sense that my LH might be pushing where you'd want it to be ideally, even in my situation. Is there any other information / sources you have on how much LH is "too much"? Not to insinuate you are making it up, but just so I can better know where I can ride the line between getting the most out of it and not harming myself.

 

[lift4lyfe]

I think it's too high. Stimulating your testicles too much can fry them.

How is free T correlated with stimulating testicles? Total T is correlated since your testicles produce T, but free T is unrelated to testicles, right?

 

[readalot]

How is free T correlated with stimulating testicles? Total T is correlated since your testicles produce T, but free T is unrelated to testicles, right?

Testicles produce Free T. Free T quickly (on the order of min) equilibrates with Total T serum pool via SHBG. Body makes and eliminates Free T. SHBG bound T is a reservoir in addition to any receptor activity via SHBG.

Excellent reference paper:

Chapter 12 - Hypothalamo-Pituitary Unit, Testis, and Male Accessory Organs

Read this chapter. Chapter 12 - Hypothalamo-Pituitary Unit, Testis, and Male Accessory Organs https://www.sciencedirect.com/science/article/pii/B9780323479127000123?via%3Dihub From https://www.sciencedirect.com/book/9780323479127/yen-and-jaffes-reproductive-endocrinology

www.excelmale.com

Characteristic times:

Chapter 12 - Hypothalamo-Pituitary Unit, Testis, and Male Accessory Organs

Read this chapter. Chapter 12 - Hypothalamo-Pituitary Unit, Testis, and Male Accessory Organs https://www.sciencedirect.com/science/article/pii/B9780323479127000123?via%3Dihub From https://www.sciencedirect.com/book/9780323479127/yen-and-jaffes-reproductive-endocrinology

www.excelmale.com

 

[lift4lyfe]

Testicles produce Free T. Free T quickly (on the order of min) equilibrates with Total T serum pool via SHBG. Body makes and eliminates Free T. SHBG bound T is a reservoir in addition to any receptor activity via SHBG.

Excellent reference paper:

Chapter 12 - Hypothalamo-Pituitary Unit, Testis, and Male Accessory Organs

Read this chapter. Chapter 12 - Hypothalamo-Pituitary Unit, Testis, and Male Accessory Organs https://www.sciencedirect.com/science/article/pii/B9780323479127000123?via%3Dihub From https://www.sciencedirect.com/book/9780323479127/yen-and-jaffes-reproductive-endocrinology

www.excelmale.com

Characteristic times:

Chapter 12 - Hypothalamo-Pituitary Unit, Testis, and Male Accessory Organs

Read this chapter. Chapter 12 - Hypothalamo-Pituitary Unit, Testis, and Male Accessory Organs https://www.sciencedirect.com/science/article/pii/B9780323479127000123?via%3Dihub From https://www.sciencedirect.com/book/9780323479127/yen-and-jaffes-reproductive-endocrinology

www.excelmale.com

I see. Think of SHBG as a spill over reservoir? And when/why does the body unbind T from SHBG? What’s the trigger to cause it to unbind? Does it unbind during times the testicles don’t produce free T?

 

[-Maui-]

As for FSH, I was doing an extremely rough calculation off a glance but looked like mine didn't raise much at all compared to how far out of range my LH was; with that being said I hadn't had my FSH checked before so maybe mine just naturally low. Either way, doesn't seem too important.

For good spermatogenesis, a minimum level of FSH is sufficient ;-)
Your FSH is very very good!

I am taking what is considered a "high" dose of enclo so it would make sense that my LH might be pushing where you'd want it to be ideally, even in my situation. Is there any other information / sources you have on how much LH is "too much"? Not to insinuate you are making it up, but just so I can better know where I can ride the line between getting the most out of it and not harming myself.

I came across an article about the possible harm of high doses of hCG.
I assumed that in the case of Clomid, the hypothalamus and testicles are working to hard.
I hope I'm wrong ))
If I find some information I will share with you ;-)

 

[readalot]

I see. Think of SHBG as a spill over reservoir? And when/why does the body unbind T from SHBG? What’s the trigger to cause it to unbind? Does it unbind during times the testicles don’t produce free T?

SHBG bound T and free T are interrelated by a dynamic equilibrium (look up the term equilibrium constant for more info or see math I linked above). SHBG bound T is constantly being turned over into free T and vice versa, but the equilibrium value of SHBG bound T is strongly favored (hence Free T as a % of TT is quite low).

 

[-Maui-]

SHBG bound T and free T are interrelated by a dynamic equilibrium (look up the term equilibrium constant for more info or see math I linked above). SHBG bound T is constantly being turned over into free T and vice versa, but the equilibrium value of SHBG bound T is strongly favored (hence Free T as a % of TT is quite low).

You're right, it's a continuous process. But the ratio does not change.

 

[lift4lyfe]

SHBG bound T and free T are interrelated by a dynamic equilibrium (look up the term equilibrium constant for more info or see math I linked above). SHBG bound T is constantly being turned over into free T and vice versa, but the equilibrium value of SHBG bound T is strongly favored (hence Free T as a % of TT is quite low).

Do oral AAS such as Anavar affect the equilibrium constant or only the levels of SHBG? For example, does Anavar change the equilibrium such that you can have higher Free T as a % of TT? Or does it only lower SHBG levels but the Free T as a % of TT remains the same?

 

[readalot]

Do oral AAS such as Anavar affect the equilibrium constant or only the levels of SHBG? For example, does Anavar change the equilibrium such that you can have higher Free T as a % of TT? Or does it only lower SHBG levels but the Free T as a % of TT remains the same?

1. Oxandrolone drops SHBG.

2. Lower SHBG ----> Lower TT

3. FT stays the same (same Test dosage on TRT)

4. Equilibrium constant unchanged

5. Lower TT / same FT ----> % FT = FT/TT goes up

Hence, oxandrolone increases percentage FT not FT itself.

High E2

I have never read anything about the gut detoxing estrogen. Where did you read this? Testosterone is made in the body or injected into it and never enters the gut. Once estrogen is in the blood stream how would the gut do that? The liver breaks it down and removes it from the blood stream. All...

thinksteroids.com

See here and posts below it for blow by blow. Will have another dataset soon.

 

[lift4lyfe]

1. Oxandrolone drops SHBG.

2. Lower SHBG ----> Lower TT

3. FT stays the same (same Test dosage on TRT)

4. Equilibrium constant unchanged

5. Lower TT / same FT ----> % FT = FT/TT goes up

Hence, oxandrolone increases percentage FT not FT itself.

What does the body do with the extra FT if TT is down, and FT stays the same, but endogenous T source (TRT dosage) remains constant? I'm assuming the TRT is cleaved from the ester into free T. The body excretes it? Essentially wondering why wouldn't free T go up if SHBG is lowered and endogenous T remains the same.

 

[-Maui-]

I'm assuming the TRT is cleaved from the ester into free T. The body excretes it? Essentially wondering why wouldn't free T go up if SHBG is lowered and endogenous T remains the same.

A decrease in SHBG with a constant TT (exogenous/ TRT) will rise FT.

 

[lift4lyfe]

High E2

I have never read anything about the gut detoxing estrogen. Where did you read this? Testosterone is made in the body or injected into it and never enters the gut. Once estrogen is in the blood stream how would the gut do that? The liver breaks it down and removes it from the blood stream. All...

thinksteroids.com

See here and posts below it for blow by blow. Will have another dataset soon.

Thanks, following.

 

[readalot]

What does the body do with the extra FT if TT is down, and FT stays the same, but endogenous T source (TRT dosage) remains constant? I'm assuming the TRT is cleaved from the ester into free T. The body excretes it? Essentially wondering why wouldn't free T go up if SHBG is lowered and endogenous T remains the same.

Imagine experiment where SHBG magically drops in half or just drops over the course of some time period (oxandrolone for example).

All other constraints above stay in place. Let's just make it as simple as possible by assuming TRT (aka free Test) is being introduced to the body at a constant continuous rate (like an IV drip; test ester is cleaved by the body via hydralase yielding free T). The free T fed to the body is constant. The excretion term is k×[FT] where [FT] is serum free test concentration.

Now the serum SHBG concentration magically drops (liver decreased production) but the equilibrium relationship between SHBG bound T and free T still holds.

What happens?

The free T that was bound to that SHBG (now removed) is liberated and enters the serum pool. Where does it go? It has to leave eventually by excretion via the mass balance:

Input + production = output + accumulation

Rearranged

Accumulation = input - output + production

1. Input stays the same.

2. The FT that was bound to SHBG is now liberated so that is a transient production term.

3. Output is proportional to serum [FT].

4. Hence there is a temporary accumulation of free T and with it a temporary rise in serum free T.

Remember above in link I shared the characteristic times for SHBG equilibrium.

So if SHBG was instantaneously cut in half then you'd see a temporary blip of a few minutes where serum free T would elevate above baseline then decay back to baseline.

If SHBG more slowly dropped in half over the course of a week you'd see practically no change in serum free T levels. Great question on the dynamics of the system.

For the practical question of bloodwork, the hypothetical transient detailed above would be missed unless you were measuring serum free T levels every minute after a hypothetical instanteous drop in SHBG. At steady state there is no change to free T. I'll publish my own 2nd set of experiments supporting / refuting the previous sentence. The first experiment I did supported the argument.

The closest analogy I can think of for above is what is known as the bathtub or tank filling problem in physics/math.

 

[readalot]

A decrease in SHBG with a constant TT (exogenous/ TRT) will rise FT.

Yes as stated that is correct. In practice though this never happens. See above post. Flip the problem to where SHBG drops but free T production rate (endogenous for intact HPTA) or TRT (exogenous free T input) rate is held constant.