Labwork inside - looking for help with what's wrong, please

narcolept

New Member
I've been researching Low T as it seems to fit my symptoms, and I don't think I'm making my symptoms fit low testosterone.

I'm 33 on the cusp of 34. I'm fatigued all the time, I am irritable, indifferent, can't be bothered to really do anything most of the time, and I have less than 0 libido. I don't have ED issues when it is time, but I'm starting from deep inside the hole and while the wife is pretty accepting, I don't know how long this can go on for.

I've got two kids, 2 and 4, and I'd love to feel better in general and not be "too tired" or "daddy just want to sit down when he gets home". I've experienced some brain fog. I've never done AAS, abused drugs, I drink irregularly and socially, not heavily. No testicular trauma that is noteworthy, I had a vasectomy in July of last year.

For the past two years, clearly, although I can seem to remember it going further back that . I've always been quite active, although after a half marathon about 2 years ago I was feeling run-down and chalked it up to just too many miles during training.

However, I don't feel like I've ever really recovered from that. I did have some run down feelings in the months leading up to it, and earlier in that year, but I figured it was just the miles. I was doing about 40-50/week in 2012.

I'm 5'10", 195lbs and currently about 20% body fat, up from just under 15% at the end of last year, and all of it is in my midsection. Classic spare tire just grew out of nowhere.

Since then, I've not gotten any stronger in the gym(seriously. Not in two years have any maxes really gone up), I've gotten slower on my runs, I'm lucky to maintain a 9 minute pace for 3 miles on an easy run now, where leading up to that training I was regularly doing 5-7 mile runs at less than 8min/mile. This is all when I even feel like doing anything, which isn't that often anymore. Previously, I was a 5am lifter with miles run at lunchtime or later in the day 5 days a week with long runs on weekends.

I've been searching for something that fit and although self-diagnosis is a dangerous thing, everything seemed to boil down to low testosterone or a thyroid issue. I went ahead and scheduled myself a labcorp test (Female Panel) through privatemdlabs last week to see if this was something to pursue or if I was wrong, and had that test (fasted 12 hours) last Monday, the 21st:

Test Result Range
Testosterone, Serum 347 ng/dL 348-1197
LH 3.4 mIU/mL 1.7-8.6
FSH 1.9 mIU/mL 1.5-12.4
Estradiol 14.5 pg/mL 7.6-42.6

I do have a CBC w/differential and Metabolic panel available, but I'll include my GP's lab's version below.

Now, seeing this number as something that seems low for my age I figured it was time to follow up with my GP, who, unfortunately, I've never actually seen; I've only seen his PA and she's generally disinterested. I tried to book an appointment directly with him to discuss, but couldn't get in to see him until June 2nd. I was able to get an appointment with the PA for this Friday, where I'll be discussing the blood tests I was able to order over the phone.

I knew they'd want a CBC and Metabolic panel, so I asked if I could get that ahead of the visit, and they said sure. At this point I said I thought I needed more and would like to get them if possible, I asked for Testosterone, Free and Total, Estradiol, LH, FSH, and a full Thyroid panel. They said they would ask the PA.

I called back and the PA had left them a message that I couldn't have those tests without a reason, so I said that I had symptoms which seemed to indicate those tests would be ordered when I saw her anyway and sympathetic secretary said she's talk to the doctor and leave the order for their in house lab so I could come in Thursday, the 24th and have tests done. Following are complete results:

WBC 6.40 K/UL 4.50-11.0
RBC 5.47 M/UL 4.35-5.87
HEMOGLOBIN 14.9 G/DL 13.3-17.7
HEMATOCRIT 45.6 % 39.8-52.2
MCV 83.3 FL 80.5-99.7
MCH 27.3 PG 26.6-33.8
MCHC 32.7 G/DL 31.5-35.9
RDW 16.1 % 11.0-16.0
PLATELET COUNT 157 K/UL 150-400
MFV 10.7 FL 8.0-13.0

SODIUM 139 MMOL/L 136-145
POTASSIUM 4.3 MMOL/L 3.5-5.1
CHLORIDE 102 MMOL/L 98-107
CARBON DIOXIDE 31 MMOL/L 21-31
BLOOD UREA NITROGEN 16 MG/DL 7-25
GLUCOSE 88 MG/DL 65-99
CALCIUM 9.7 MG/DL 8.6-10.3
ANION GAP 6 MMOL/L 3-11
TOTAL PROTEIN 7.5 G/DL 6.4-8.9
ALBUMIN 4.5 G/DL 3.5-5.7
BILIRUBIN TOTAL 0.71 MG/DL 0.30-1.00
ALKALINE PHOSPHATE 48 U/L 34-104
AST(SGOT) 28 U/L 13-39
ALT(SGPT) 33 U/L 7-52
EST GFR NON AFRICAN >60 ML/MIN/1.73SQ.M


CHOLESTOROL 202 MG/DL 0-200
TRIGLYCERIDE 141 MG/DL 0-150
HDL 51.8 MG/DL
NON-HDL 150.2 MG/DL
LDL 122.0 MG/DL
RISK RATIO 3.9 AVERAGE

LH 3.1 MIU/ML 1.24-8.62
FSH 2.3 MIU/ML 1.27-19.26
TESTOSTERONE 368 NG/DL 175-781

TSH 2.61 UIU/ML 0.44-4.21
T4 FREE 0.85 NG/DL 0.60-1.40
FREE T3 3.20 PG/ML 2.10-3.90

TESTOSTERONE FREE 133.3 pg/mL 35.0-155.0

Obviously they didn't order everything, notable estradioal and total t3/t4. This is what I have though. I called today asking for the results and I was told I could pick them up but everything is normal.

I tried to call Endos last week but even though my insurance doesn't require it, they all want a referral (understandably), so I'm dependent on my GP for a referral. I'm of the belief that 348-368 is low for a 34 year old active man with my history. I don't believe that on Friday when I see the PA I'll get anywhere. Is it, like they're going to tell me, all in my head?

Should I try to find another GP? Should I call the urologist who did my vasectomy? I don't believe I'd need a referral since I'm already a patient of his?

I'm a pretty determined person and although that's taken a hit with my general malaise, if I have to keep calling doctors I will. Should I beat this drum until someone helps, or should I exhaust direct options and call a clinic? That's tempting when doors get shut, but being someone with incredible insurance who could have treatments covered, it bothers me to lay out the cash for it myself if there is a problem here.

Thanks for your time, let me know if there are any questions. Unfortunately, I don't have any other bloodwork available currently and am probably not going to be able to get my current GP to order it. Anything that can be gleaned from the numbers above would be appreciated.
 
I eat a pretty textbook paleo diet, with white rice and potatoes added in for energy levels(long runs, etc), but since I'm not sensitive to gluten I don't totally abstain from some pizza every now and then, or a sandwich.

Standard day is 2-3 eggs and 2 cups of vegetables for breakfast, with sausage or bacon - all cooked in coconut oil or ghee

Lunch would be meat - stewed chicken, pulled pork, steak salad, generally leftovers of dinner the night before mixed into a salad or other vegetables.

Dinner would be meat again, with a side of a starchier vegetable, sweet potato, squash, and broccoli, cauliflower.

Following a paleo template, I don't count calories, I eat until satiated. I rarely snack, except for from the kid's easter baskets, of course. :)

Stress levels are incredibly low since switching jobs late in 2012. Previous to that I was pretty stressed at work and stuck in an on-call 24x7 situation. Now I'm able to manage my own schedule and stress is at a minimum.
 
Your free testosterone is at the high level - have you checked your SHBG?

Also - your triglycerides at 141 are high S/B <100 ideally less than that
 
I had asked for SHBG but they didn't order the test. What kind of number should I be looking for there?

The triclicerides should be lower but looking at previous bloodwork they've always been over 125 so I hadn't really noted that as an issue.

Is it possible that my cholesterol numbers are higher than optimal because of lower than normal testosterone numbers?

Is the higher level free test an indication of anything specific, and wouldn't that just be a reflection of the amount of free test as based on the total?

I.E. it's my understanding that free test is a percentage of bioavailable test used, so total test would govern this. I could have high free test but low total test and while I'm using what's available, enough isn't available?

...or am I grasping at straws here?
 
Just ordered a test for SBHG through privatemdlabs, as I'd like to have a clear picture of what I should be asking for when seeing the PA at my GP's office.

It's my understanding that this could be caused by a few things, and a few things related to a paleo diet. However, most of the reading I've done seems to be on people already undergoing TRT or with normal T levels (mid-range, over 600). Should I still be looking at TRT as something I should pursue with the rest of my bloodwork looking the way it does?
 
Why did you order shgb ? These grown men are no help to you . Your shgb is obviously low . Lab Test isn't needed . Low thyroid lowers your shgb. You need to get on thyroid replacement . That will raise your total T and lower your cholesterol . Hope I helped
 
After thinking about it, that's a very... definitive reply without any clear evidence, isn't it?

Anyone else, specifically one of the doctors on the board, care to chime in?
 
Why did you order shgb ? These grown men are no help to you . Your shgb is obviously low . Lab Test isn't needed . Low thyroid lowers your shgb. You need to get on thyroid replacement . That will raise your total T and lower your cholesterol . Hope I helped

^ Your thyroid function is your issue . Take iodine supplements . Don't do anymore test

Are you really going to try to argue that the OP has hypothyroidism when his thyroid levels are ALL WNL?

TSH 2.61 UIU/ML 0.44-4.21
T4 FREE 0.85 NG/DL 0.60-1.40
FREE T3 3.20 PG/ML 2.10-3.90

BTW, using iodine to boost thyroid function in the absence of iodine deficiency can actually result in hypothyroidism.

OP, the advice you were given might have sounded "definitive," but it is nonsense.

Just curious, is there any significance to using Narcolept for a username?


Regards

CBS
 
OP, the advice you were given might have sounded "definitive," but it is nonsense.

Just curious, is there any significance to using Narcolept for a username?


Regards

CBS

There is no significance to using it, actually. I figured someone would ask, but it's just a nickname I've been dragging around on the internet for a long time, that honestly came out of nowhere.

I didn't really dig the "definitive" advice I was getting either, especially when I was getting PMs that everyone here is in their 30s and knows nothing from the 19 year old advice giver.

Any thoughts on my original post?

Thanks
 
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Take a look at his tsh and t4. T4 is too low and tsh is to high . A tsh over 1.5 is not so good. It's clear your don't know what's wrong with him , so you trying to make me sound like an idiot , because of your lack of knowledge . Censensored board go educate yourself old man .
 
They don't need to know about me , lol you think I'm gonna sit here and private chat with men that have kids around my age . Nope it's like talking to my teacher .
 
These fools don't understand that your low shgb is either caused by high insulin or hypothyroid . Looking at your labs your thyroid doesn't look good and also you had a drastic fat gain .
 
Thanks for your replies, but you're not currently adding any value. You said your piece and I'll follow up on my thyroid, but I'm not going to start taking iodine based on your (admitted) lack of knowledge via PM.

You said yourself you're only 19 and don't know. I stated clearly in my OP that I'm in my mid-30s, and I know for sure that no one should've listened to medical advice from me when I was 19.
 
I'm providing you with better info than these guys . They keep talking about your testosterone when that's not your problem . Get your insulin checked and ask a educated thyroid doctor if your labs look good .
 
These fools don't understand that your low shgb is either caused by high insulin or hypothyroid . Looking at your labs your thyroid doesn't look good and also you had a drastic fat gain .

I don't have an SHGB number -- I'll know Thursday more than likely whether it's low or high, but please don't diagnose me based on assumption.

You're the only person that's noted my thyroid so far, the numbers seem to be in normal range. There's some things from the cleveland clinic that say it shouldn't be over 2, but by no means is it hyperthyroid indication from the research I've done.

"Drastic" is an odd word. I stated I was just under 15% in my OP, but I haven't gained anything from the 195 I've been. That's 30lbs, and 20% would be 39. So there's been some recomp, and muscle loss, but it's a 9lb fat gain, which while it isn't optimal, isn't like I packed on 40 lbs in the last few weeks.
 
Your shgb is obviously low . A normal doctor won't test your shgb . He will test your total and bio available testosterone , because that will tell you if your shgb is low or high . Yours is low
 
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