New Member here with blood work and questions. Thanks in advance.

[JRC]

I was put on trt three years ago for low t symptoms. I was not able to stay on trt very long due to doctor and insurance issues. My treatment duration was around seven months.

Five weeks now I have been back on trt. I inject 60 mgs of T cyp 1xwk.

Here is the blood work. Blood took the day of shot (before the shot).

Test name...............In Range.....Out of Range.......Units..........H / L........Ref Range

TT.........................288.................................ng/dL................... (175-781)
FT.........................37.9.........................................................No Range/Unit given?
SHBG......................26.4................................nmol/L..................(13.3-89.5)
CBC:
WBC.......................6.7.................................10^3/uL.................(4.8-10.8)
RBC........................5.4.................................10^6/uL.................(4.2-6.1)
HGB.........................................16.1..............g/dL..........H.........(12.0-16.0)
HCT.........................................48................%..............H.........(37-47)
MCV........................88..................................fL........................(80-99)
MCH........................30.................................pg........................(27-31)
MCHC......................33.9...............................g/dL.....................(33.0-37.0)
RDW........................14.7...............................%.........................(11.5-17.3)
PLT.........................199................................10^3/uL.................(150-400)
MPV.........................8.2................................fL........................(7.4-10.4)
GRAN#......................4.9...............................10^3/uL.................(1.4-6.5)
LYMPH#.....................1.4...............................10^3/uL.................(1.2-3.4)
MON#........................0.4...............................10^3/uL.................(0.1-0.6)
GRAN%......................72.6..............................%.........................(42.2-75.2)
LYMPH%.....................21.6..............................%.........................(20.5-51.1)
MON%........................5.8...............................%.........................(1.7-9.3)
CMP:
GLUCOSE....................96...............................mg/dL....................(70-105)
BUN..........................21.0.............................mg/dL....................(7.0-25.0)
Creatinine,Serum..........1.2..............................mg/dL....................(0.7-1.3)
......eGFR
... African American......82.8.............................ml/min...................>60.0
CKD STAGES:
STAGES........................................................GFR
1..............................................................90+
2..............................................................60-89
3..............................................................30-59
4..............................................................15-29
5.............................................................<15 or on dialysis
.....eGFR
non-African American...68.4..............................ml/min.....................>60.0
B/C RATIO.................18.................................calc..................NO RANGE GIVEN
SODIUM.....................141..............................mmol/L.....................(136-145)
POTASSIUM................4.2...............................mmol/L.....................(3.6-5.5)
CHLORIDE..................107.0............................mmol/L.....................(98.0-107.0)
CO2.........................27................................mmol/L.....................(21-32)
ANION GAP................7..................................Ratio..................NO RANGE GIVEN
CALCIUM...................9.7...............................mg/dL.......................(8.6-10.3)
TOTAL PROTEIN..........6.9...............................g/dL..........................(6.0-8.3)
ALBUMIN...................4.8...............................g/dL..........................(3.5-5.7)
A/G RATIO.................2.0...............................calc...........................(0.8-2.0)
GLOBULIN.................2.1................................g/dL..................NO RANGE GIVEN
ALKP.......................46.................................U/L...........................(34-104)
ALTI (SGPT)...............25.................................U/L...........................(7-52)
AST (SGOT)...............21..................................U/L...........................(13-39)
TOTAL BILIRUBIN........0.6.................................mg/dL........................(0.3-1.0)
LIPID:
CHOLESTEROL...........................243...............mg/dL..........H.............(0-200)
TRIGLYCERIDES..........................160.0............mg/dL...........H............(0.0-150.0)
HDL.......................39.0................................mg/dL.........................(23.0-92.0)
CALC LDL.................................172.0...............................H.............(0.0-140.0)
HDL RISK FACTOR......6.2
NON-HDL..................................204.0............CALC............H.............(0.0-160.0)


I know my LIPID profile is awful. I have changed my eating habits since I got these results. I am not able to do much in way of exercise due to back surgery, shoulder/knee/foot problems as well.

My back and other (physical) issues are getting better but it will be a bit before I am able to do much in the way of cardio. I am walking (very slow) for ~10 minutes 3-4x day and doing rehab stuff. For now that is all I can do.

I have been for several months and still am super depressed and also have an extreme amount of anxiety most all of the time. My sex drive is pretty much gone and has been for a long while.

I went and gave blood after I got the bloods back due to the high hgb/hct levels.

I'm not that smart on a lot of things and trt is one of them. I thought since my hgb/hct was high that my RBC should be high too. It (RBC) is in range. Is it normal to have high hgb/hct and normal RBC count?

Also, I'm in the worst shape of my entire life now. I use to never have issues with my cholesterol, triglycerides, LDL even though my HDL has never been over low 40's even when I was conditioned through strength training etc.....before accident.

I'm sure there are other things in my bloods that are not good. My doc is NOT all that great at treating low t issues. He is willing to try and that is better than the last one so I will take it. He is pretty open as for what he is willing to prescribe.

He said he would give me hcg is I wanted it. He gave me anastrozole in case I needed it. Then again, he did not test for E so I'm not sure if I do or not. The only way I can judge that is weak/infrequent erections, moody as hell and having a super hard time dropping bf. Then again, until I at least get diet under control (aside from exercise) the bf prolly will not improve.....at least that was my experience until last year or so.

I also should mention (i guess it matters) that my nuts are all but gone. They have been shrinking for a while but in the last few years they have disappeared. My doc said that was nothing to worry about but they are not his nuts either.

Like I said before, I am not up to snuff on trt issues yet. I am learning best I can but this stuff as you guys know is not easy even for most doctors so I don't feel to bad about not being educated on the subject just yet.

Anyways, I'm really trying to put this in a manner that makes some sense. Forgive my ignorance on the subject. I'm not sure exactly what to say or ask.

BTW, I'm 49 years old, 5' 10" and weigh ~198 lbs. My bf is very high. I would put me somewhere around ~25%. I carry most all of my fat in my gut. I believe I have a lot of visceral fat as well.

Any and all help/advice is much appreciated.

JRC

 

[toolman]

Your HCT wasn't horrible so no need to give blood really. I do it when I hit over 50.

You hit the nail on the head with your diet. Your lipids are not good at all. I would focus on cleaning up my diet first and becoming more physically active. I think those two changes alone will make you fell a lot better. Do not add HCG or an AI into the mix. You should also ask him to run a full sex hormone panel so you can see where your E is. I am guessing with the belly fat you describe you are on the higher side. I would wait until you know where your E is but I do not see why you couldn't titrate the test dosage up a bit to 100Mgs a week. However the diet and lack of exercise is really the root of your problems I believe and T won't improve either of those things, you have to do that. I would drop all of the simple carbs immediately, no breads, pastas, anything made from grain, including beer. No sodas or anything with sugar or high fructose corn syrup. Do you drink much?

Don't worry, you can absolutely beat this and feel much better, but it is just going to take some work and dedication on your part, not just a shot of T every week, but some real effort. Best of luck on this!

 

[JRC]

Your HCT wasn't horrible so no need to give blood really. I do it when I hit over 50.

You hit the nail on the head with your diet. Your lipids are not good at all. I would focus on cleaning up my diet first and becoming more physically active. I think those two changes alone will make you fell a lot better. Do not add HCG or an AI into the mix. You should also ask him to run a full sex hormone panel so you can see where your E is. I am guessing with the belly fat you describe you are on the higher side. I would wait until you know where your E is but I do not see why you couldn't titrate the test dosage up a bit to 100Mgs a week. However the diet and lack of exercise is really the root of your problems I believe and T won't improve either of those things, you have to do that. I would drop all of the simple carbs immediately, no breads, pastas, anything made from grain, including beer. No sodas or anything with sugar or high fructose corn syrup. Do you drink much?

Don't worry, you can absolutely beat this and feel much better, but it is just going to take some work and dedication on your part, not just a shot of T every week, but some real effort. Best of luck on this!

Hi toolman,

Good to hear my hct is not that bad. Why does the lady at blood bank tell me that they will not take my donations if my hgb gets to or above 18.4?

Also, hgb was 16.1 at doc's office but, two days later it was 17.9 at blood bank at which time she told me about the 18.4 limit.

I wish I was wrong on the diet/exercise part but there is no way around that. I am working on that. Walking a few extra steps each day and doing a couple sets of bw squats while holding on to a chair. Baby steps.

The diet part is tough for me lately especially due to my depression. For me depression always equals FOOD + (no will to move). At the same time I have extreme anxiety/panic attacks to the point to where I "feel" I cannot breath. I take meds for both. Prozac for depression and clonazapam for anxiety/panic disorders. I would love to be off both of said meds.

I have not started the anastrozole even though I was tempted to. I have a strong feeling my E is high. Without bloods I will not know for certain though.

It will be six months from now till next blood work. He will only do one blood test for trt every six months. He (my doc) is a great doctor in general but I don't think he knows anymore than I about trt issues. I was surprised that he was willing to treat in the first place even though my TT was 190 (100 - 1000) and FT 0.3 (0.7 - 1.0).

As for increasing my dose. The only thing is when I was on trt the first time ~100 mg ew would keep me to close to the upper limit and this doc's comfort zone is not that high at this point. He said he did not want me to close to the upper limit. He said he was shooting for middle ground. He did say however that he was ok with upper limits if it has to be that way to make me feel better. He did ask me to be honest about how I felt each visit and if I did so he would do what he could in the "long run" to make me "feel" better......not just go by numbers. So for now, even though I agree with you on raising the dose a tad (maybe to ~80 mg ew), I'm gonna keep my word to doc and wait and get the ok from him first.

I don't drink alcohol at all. As for the carbs, what carbs should I eat? And how much? How much protein and fat as in %'s?

I have thought about the 40/40/20 but that may be to many carbs. What macro ratio would you recommend for someone like myself?

I think my starting point for cals to lose bf slowly is ~1800 ballpark. Then adjust from there as needed depending on fat loss.

But the macro breakdown of the 1800 or so cals is where I'm not sure.

I know this will not be easy. As a matter of fact, it is going to be hard as hell. I'm giving it my all to beat my low t and all the things I face physically and mentally every day. Some days I do good.....some not so good and some are just horrible. But I'm still above ground.

Kind of off topic but relative to my exercise and hopefully motivation:

I have done one thing lately that I thought may "push" me to work harder. I went out and spent a lot of $$$ (to me) on exercise equipment.

I bought the following from a gym that closed recently:
leg extension machine
prone leg curl machine
abductor/ adductor combo machine
belt squat machine
smith machine
lat pulldoown with seated mid/low row machine
functional trainer
pro-style db's 5-80 lbs (5 lb increments) with a saddle rack
325 lbs of assorted plates
weight tree
oly bar
fid bench
an elliptical cross trainer
enough 4 x 8 rubber mats to cover my 13' x 35' home gym.

I am not able to use it yet even though it is set up and ready for use. Once I get past BW squats I will attempt to start working out.

I am however using the elliptical 3 x day. I'm adding a min or two to walking time every day. I'm up to ~10 min at a time.

 

[Raven101]

Increase the testosterone dosage to 75-80 mgs then.
You need to be disciplined with your diet, depression isnt an excuse. Thats another issue.

 

[toolman]

As far as diet goes, I was never a calorie counter. I just subscribe to what has always worked for me. Eat all the protein you want as well as complex carbs like vegetables. I snack on nuts throughout the day and eat when I am hungry. It is not really a science. Just drop grains such as bread, pasta, Rice, granola, oatmeal..You would be amazed how quickly the weight starts to come off.

The antidepressants and benzodiazepines are going to cause sides of their own. Depression and panic attacks are tough to go through but very beatable. Are you prescribed these meds by a psychiatrist or your GP.

If you are happy with your doc then fine but remember that half of all docs out there graduated in the bottom half of their class. If he is not testing for E, then he really does not know enough about TRT to be treating it. Most endocrinologists will tell you they would rather have you in the upper part of the spectrum, not the middle or lower part. That is why it is important to go to a specialist and not just your GP. The same holds true for your psychiatric issues. Some docs like to think they know more than they actually do and your docs lack of labs indicate he might be one of the many.

 

[JRC]

Increase the testosterone dosage to 75-80 mgs then.
You need to be disciplined with your diet, depression isnt an excuse. Thats another issue.

I called my doctor's office and spoke to one of his nurses. I ask her to ask the doctor if it would be o.k. if I raised my dose from 60 to 80 mgs. She is suppose to call me back.

As for the depression / anxiety issues being an "excuse", no sir. I fight it tooth and nail. I'm not saying I win every fight but I win most.

As for it being another issue......."in my case"......it has been proven for me that my depression is directly related to my hormone levels. On trt my depression gets a lot better. Off trt my depression is extremely hard to control. Same with my anxiety issues.

JRC

 

[JRC]

As far as diet goes, I was never a calorie counter. I just subscribe to what has always worked for me. Eat all the protein you want as well as complex carbs like vegetables. I snack on nuts throughout the day and eat when I am hungry. It is not really a science. Just drop grains such as bread, pasta, Rice, granola, oatmeal..You would be amazed how quickly the weight starts to come off.

The antidepressants and benzodiazepines are going to cause sides of their own. Depression and panic attacks are tough to go through but very beatable. Are you prescribed these meds by a psychiatrist or your GP.

If you are happy with your doc then fine but remember that half of all docs out there graduated in the bottom half of their class. If he is not testing for E, then he really does not know enough about TRT to be treating it. Most endocrinologists will tell you they would rather have you in the upper part of the spectrum, not the middle or lower part. That is why it is important to go to a specialist and not just your GP. The same holds true for your psychiatric issues. Some docs like to think they know more than they actually do and your docs lack of labs indicate he might be one of the many.

I have never been very successful at long term fat loss. I have always lacked will power and knowledge. I am working on both weaknesses though. In the past when trying to lose fat, I always just watched calories for the biggest part and did not pay much attention to where they came from other than the obvious such as cake, pie etc. That may have been my problem, idk. I will do as you suggest and drop bread, pasta, rice, granola and oatmeal from my diet.

As for meat, I love it and always have. The blood bank told me eating meats, certain veggies (especially green veggies) and even pinto beans would cause my hgb and hct to be even more problematic.

Yep, I have lived with depression and anxiety/panic issues most of my life. I’ve took medication for a long time with very little improvement until I started trt the first time.

The psychiatrist that I saw at the time said that low t issues were not the cause of my depression and anxiety issues. He denied the fact that I got better after starting trt. He claimed I just went into remission and it was just a coincidence and nothing more. And yes, those meds carry a large array of sides for most that take them. Like you said, it is very tough but also very beatable.

I would not say I am happy with my doc’s t treatment approach but I can only see certain docs in my area due to insurance and he is unfortunately the lesser of the evils.

Very true about ½ of doctors being in bottom half of class. On the other hand, the upper half is not much better in even for general medical treatment much less complex issues such as hormone control.

On my next doctors visit I bring up the importance of tracking E along with T. As for keeping T in upper spectrum, it will take some time to get him to see that. He said I would be allowed to be in the upper ranges after first trying mid ranges. I guess it will just be a waiting game for now when it comes to t levels.

 

[LW64]

IMHO, some of the best diet advice on the internet stressing a low carb, high fat (LCHF) approach:

LCHF for Beginners – the Low Carb, High Fat Diet

 

[JRC]

IMHO, some of the best diet advice on the internet stressing a low carb, high fat (LCHF) approach:

LCHF for Beginners – the Low Carb, High Fat Diet

Thank you for the link. The information answered a lot of questions I had but did not know how to ask (what terms..etc..).

It sounds like toolman's diet suggestion was a tweaked form of LCHF.

I did as toolman suggested and cut certain foods out starting yesterday morning. I ate nothing but meat, eggs and green veggies all day yesterday and this morning I was down 4 lbs.

I did some research on LCHF and it sounds like a magic bullet or something. I will add a bit more fat to my foods and cut even more carbs out. I did not eat very much fat yesterday as most of the meat I ate was tuna and I removed most of the yolks from the eggs. I can see I will need more fat.

I am however, still worried about all the iron rich foods and how they will effect my hgb / hct levels.

I just don't want my doctor to say I have to stop trt due to my hgb / hct levels. He is already on me about my lipid levels (for good reason).

What can I expect my hgb / hct to do while consuming high fat / moderate protein / low carbs?

 

[LW64]

It's going to be a bit of a trial-and-error process.

The MAIN idea is to cut your carbohydrate intake AND increase your fat intake. There are sources of healthy fat that are not particularly high in iron. These are olive oil, coconut oil, eggs (STOP throwing the yolk away!), and dairy. On the LCHF diet, dairy means FULL FAT yogurt and heavy cream and NOT skim milk or low-fat yogurt! The calcium in dairy is known to help block absorption of heme iron. Don't cook anything in a iron skillet and do not supplement with vitamin C as it enhances absorption of iron.

Phytic and tannic aids are two food components that can prevent the absorption of iron. Phytic acid is found in rye bread and other foods made from whole grains - but stay away; their carb content is too high. OTOH, phytic acid is also found in nonherbal teas and tannic acid is found in commercial black and pekoe teas, coffee, chocolate (LOW SUGAR means high fat and you should try 80 or 90 percent cacao chocolate bars), and DRY (low sugar) red wine.

You can also substitute legumes/beans with smaller portions of meat because they're high in protein and the iron they contain is not easily absorbed. Your body may only absorb as little as 2 percent of the iron in legumes, such as lentils and black beans. But, don't overdo it because of their carb content.

Aim for something like no more than 50 to 75 mg/carb per day and don't underestimate how difficult it can be. Look up the carb content of a typical apple and you'll see eating only one a day will use up about one-third of you daily carb limit!

Keep us posted!

FYI
Foods That Inhibit Iron Absorption | LIVESTRONG.COM

 

[JRC]

It's going to be a bit of a trial-and-error process.

The MAIN idea is to cut your carbohydrate intake AND increase your fat intake. There are sources of healthy fat that are not particularly high in iron. These are olive oil, coconut oil, eggs (STOP throwing the yolk away!), and dairy. On the LCHF diet, dairy means FULL FAT yogurt and heavy cream and NOT skim milk or low-fat yogurt! The calcium in dairy is known to help block absorption of heme iron. Don't cook anything in a iron skillet and do not supplement with vitamin C as it enhances absorption of iron.

Phytic and tannic aids are two food components that can prevent the absorption of iron. Phytic acid is found in rye bread and other foods made from whole grains - but stay away; their carb content is too high. OTOH, phytic acid is also found in nonherbal teas and tannic acid is found in commercial black and pekoe teas, coffee, chocolate (LOW SUGAR means high fat and you should try 80 or 90 percent cacao chocolate bars), and DRY (low sugar) red wine.

You can also substitute legumes/beans with smaller portions of meat because they're high in protein and the iron they contain is not easily absorbed. Your body may only absorb as little as 2 percent of the iron in legumes, such as lentils and black beans. But, don't overdo it because of their carb content.

Aim for something like no more than 50 to 75 mg/carb per day and don't underestimate how difficult it can be. Look up the carb content of a typical apple and you'll see eating only one a day will use up about one-third of you daily carb limit!

Keep us posted!

FYI
Foods That Inhibit Iron Absorption | LIVESTRONG.COM

I have been doing as you suggested about diet. Man, I have to say I was way off about it being easy.........way off.

The LCHF diet was super easy (to me) for the first three to four days. After that, well, lets just say chit hit the fan or should I say .......no chit at all......constipation from hell.

While on the LCHF diet I was eating 1200+ grams (weight grams) of string and french-cut green beans every day. I was also eating around 400+ grams (weight grams) of assorted lettuce' a day.

Even though I was eating all that ruffage and fiber my moderate constipation grew to moderately severe starting around day 6 or so on the LCHF diet.

I adjusted my meat intake down and water intake up and even upped my veggie and greens but it did not help so I had to stop the diet and take laxatives till things got better.

I was eating 4 to 6 eggs and 2 to 3 ozs of bacon and a huge bowl of greens for breakfast. I would normally have heavy cream in coffee for breakfast as well. For snacks between meals I had boiled eggs or deer jerky with a huge bowl of green beans and leafy greens with avocado. For lunch and diner I normally had either chicken or steak with a huge bowl of green beans and leafy greens.

I always drank 30 to 40 oz of water at each meal and would drink extra in between. Any food that could be eaten raw was eaten raw. I'm not sure where I went wrong.

I have since went to a diet with more carbs in it but still considered low carb by most. I am consuming 120 to 140 grams of carbs a day while keeping my protein around 175 grams a day and my fats around 60 grams a day. Still keeping water up and eating plenty of leafy greens. The constipation has mostly went away but not completely.

Is the constipation a common problem while on the LCHF diet? If not, was the foods or the amounts of them the cause? I really like the LCHF diet but the constipation was more than I could handle.

Thought?

 

[LW64]

Is the constipation a common problem while on the LCHF diet?

It can be a temporary issue as you transition to running on more fat than carbs.

When you eat less carbs, your serum insulin level drops having a diuretic effect on the kidneys and the mineral loss contributes to constipation. You are doing well on water intake, but it sounds like you need to increase your mineral intake. Drink salted bouillon once or twice a day and salt your food heavily.Take a magnesium citrate supplement: 300 to 400 mg/day; it helps with muscle cramps and is a mild laxative. Psyllium husk if/as you need it.

You will not lose and certainly not sustain weight loss at 120 to 140 gm/day carbs. You can decrease carb intake gradually to help reduce the constipation. One week at 75 gm/day, the next at 50; then stay in the 30 to 50 gm/day range for 2 weeks.

Stick with it; the first two or three weeks are the most difficult but if you get past that time and can hang in there, it will continue to work.

What has been happening to your weight?

 

[JRC]

It can be a temporary issue as you transition to running on more fat than carbs.

When you eat less carbs, your serum insulin level drops having a diuretic effect on the kidneys and the mineral loss contributes to constipation. You are doing well on water intake, but it sounds like you need to increase your mineral intake. Drink salted bouillon once or twice a day and salt your food heavily.Take a magnesium citrate supplement: 300 to 400 mg/day; it helps with muscle cramps and is a mild laxative. Psyllium husk if/as you need it.

You will not lose and certainly not sustain weight loss at 120 to 140 gm/day carbs. You can decrease carb intake gradually to help reduce the constipation. One week at 75 gm/day, the next at 50; then stay in the 30 to 50 gm/day range for 2 weeks.

Stick with it; the first two or three weeks are the most difficult but if you get past that time and can hang in there, it will continue to work.

What has been happening to your weight?

Thanks for the info about how carbs work to create higher insulin levels.

I already add salt to every thing I eat as it is. I will add a bit more. I will add the magnesium citrate to aid with constipation as well as the psyllium.

I lost 14 lbs (six days..I think) then the constipation started and I gained 5 lbs back in two days and then stalled .....and started to feel extremely bad. Doc gave me linzess to treat constipation. I lost the 5 lbs and 3 more lbs since then.

As of today I am down 17 lbs since starting. My doc told me that if I continue to lose weight at that pace for me to come back and see him. He said it was mostly water and the weight loss should slow after a couple weeks.

Currently I am still at the ~140 grams of carbs per day. It seems I am still losing weight even with the ~140 carb level. That is a lot less carbs than my body is use to getting. I will do as you suggest and drop a few more carbs each week until I get low enough.

I will add magnesium and psyllium to my intake as needed and will report back in a couple weeks with what is happening at that point.

Thanks!

 

[LW64]

Fantastic results! Keep up the good work!

You can ease up a bit and let the weight come off at a slower pace. The salted bouillon and sea-salt in (mineral) water can really help a lot.

Bouillon Options - Diet Doctor

Common Low-Carb Side Effects & How to Cure Them

As long as you're losing weight, you can gradually reduce your carb intake. Drop to the 50 to 75 gm/day range once your weight loss stalls.

Usually, the increased fat intake causes the opposite problem to constipation. In your case, it may be that the cuts of meat you're eating are too lean and you are not adding enough olive oil and butter to your diet. Think: salad dressings for the olive oil (NO commercial salad dressings or mayonnaise - they will be made from soybean oil - no good! Make your own salad dressings!) Try some coconut oil in coffee instead of milk. Put butter on white meat from poultry and eat the skin.

Keep us posted!