Blood Results - Is TRT warranted?

Hi everyone.

Would really appreciate your opinion on my blood results that were done in middle of March.
I have also had tests done in October last year (Vit D was low so started supplementing) and in beginning of Feb 2019. Except for the Vit D which has improved the rest is very much the same.

Reason for the question is that libido and general mood is not that great.
I sleep around 8 to 9 hours a day. Yet still tired / not motivated when I wake up.
I have a tendon injury in both my arms (golfers elbow) that I have been battling with for years and despite physio and biokineticist I can't get it resolved. I do all their rehab exercises, but it is as if my body just doesn't want to get stronger.
Even when I had a clean diet and was exercising regularly I didn't have amazing growth or progress.
I am 35 years of age.

In my results which I will post below my total testosterone is fairly good, but Albumin and SHBG is high and free test is still "normal" but on the low side of the spectrum and around 1.5% free.
Also concerned that my LH has been on the very low side of the spectrum on all 3 my blood tests.
Also on two of the test my Estradiol was below the minimum i.e. <36.7 and not sure if this could part of the issue with my tendons.

I guess I just need a little guidance if I am just full of nonsense and my results are normal or if it is warranted to consider HCG plus clomid to try and boost natural production or if TRT with exogenous test should be considered.
I am based in the greater Durban area, and also not sure of a good Endo / Urologist in the area.
There was a doctor in JHB who wanted to put me on TRT but after reading on the forums here I get the idea others have also been to him and that he is "trigger happy" super expensive and not the best bet.

Any advise will be appreciated.

Joefish123 wrote: Hi everyone.

Would really appreciate your opinion on my blood results that were done in middle of March.
I have also had tests done in October last year (Vit D was low so started supplementing) and in beginning of Feb 2019. Except for the Vit D which has improved the rest is very much the same.

Reason for the question is that libido and general mood is not that great.
I sleep around 8 to 9 hours a day. Yet still tired / not motivated when I wake up.
I have a tendon injury in both my arms (golfers elbow) that I have been battling with for years and despite physio and biokineticist I can't get it resolved. I do all their rehab exercises, but it is as if my body just doesn't want to get stronger.
Even when I had a clean diet and was exercising regularly I didn't have amazing growth or progress.
I am 35 years of age.

In my results which I will post below my total testosterone is fairly good, but Albumin and SHBG is high and free test is still "normal" but on the low side of the spectrum and around 1.5% free.
Also concerned that my LH has been on the very low side of the spectrum on all 3 my blood tests.
Also on two of the test my Estradiol was below the minimum i.e. <36.7 and not sure if this could part of the issue with my tendons.

I guess I just need a little guidance if I am just full of nonsense and my results are normal or if it is warranted to consider HCG plus clomid to try and boost natural production or if TRT with exogenous test should be considered.
I am based in the greater Durban area, and also not sure of a good Endo / Urologist in the area.
There was a doctor in JHB who wanted to put me on TRT but after reading on the forums here I get the idea others have also been to him and that he is "trigger happy" super expensive and not the best bet.

Any advise will be appreciated.

Please post numbers, exact numbers

BLOOD RESULTS: (Figures in brackets are the reference range)

On full blood count everything was in range except white cell count which was low – 2.55 (4-11).
Haematocrit was on 44.3 (37-45) so almost on the high side.

Cholesterol 6.3 (2.12-5.18)
Triglycerides 0.99 (0.38-1.58)
HDL 1.37(0.9-1.6)
LDL 4.55 (2.6-4.1)

Albumin 47g/L (35-52)
Ferritin 44.3 ng/mL (21.81-274.66)
Vit B12 728 pg/ml (187-883)
Insulin 3.7 uIU/ml (2-25)
Vit D(25-OH) 46.91
Creatinine (CR-S) 85 umol/L (54-110)

FSH 5.5
LH 1.72
Oestradiol 47.2 pmol/L (40-161) (On a previous test this tested as <36.7)
Prolactin 5.8 ng/ml (3.46 – 19.4)
Cortisol 302.90 nmol/L (101-535)
Testosterone 24.5 nmol/L (8.33-30.19)
SHBG 48 nmol/L (10-80)
Free Test 11.94 nd/dL
DHEA-S 9.07 umol/L (2.17-15.2)
TSH 1.57uIU/ml (0.35-4.94)

PSA Total 0.28 ng/mL (<4)
Free PSA 0.13 ng/mL
eGFR 95mls/min (>60)

It doesn't make sense that the doc wanted to put you on trt. Your total testosterone level is very good for 35 years old. Chances are your free T is fine but always best to test that as well in future.

LH does seem low at around 2 but does not matter if your testes are making that much testosterone. A healthy pituitary will only produce enough LH to maintain homeostasis, a good hormonal balance.

Besides your cholesterol everything looks good. But limited blood tests can only tell so much... Maybe you've got other life stresses getting to you?

Muscleaddict wrote: It doesn't make sense that the doc wanted to put you on trt. Your total testosterone level is very good for 35 years old. Chances are your free T is fine but always best to test that as well in future.

LH does seem low at around 2 but does not matter if your testes are making that much testosterone. A healthy pituitary will only produce enough LH to maintain homeostasis, a good hormonal balance.

Besides your cholesterol everything looks good. But limited blood tests can only tell so much... Maybe you've got other life stresses getting to you?

Blood levels should only be used as a base and to make sure you don't screw things up completely. If it was only for blood I would not have necessarily been put on TRT. Yeah sure some guys are going to take a change to get on TRT for the wrong reasons. But like in my case my numbers were not extremely low, but I had all the symptoms. Depression being the biggest reason for me looking at TRT as an option.

And I am glad I did. Going for my 4th month now and I have not felt this good since I cant even remember.

Apoc21 wrote: Blood levels should only be used as a base and to make sure you don't screw things up completely. If it was only for blood I would not have necessarily been put on TRT. Yeah sure some guys are going to take a change to get on TRT for the wrong reasons. But like in my case my numbers were not extremely low, but I had all the symptoms. Depression being the biggest reason for me looking at TRT as an option.

And I am glad I did. Going for my 4th month now and I have not felt this good since I cant even remember.

You're comparing apples with potatoes.

His testosterone levels are way ABOVE average. No doctor should suggest to put a man on TRT who has above average testosterone levels. Whether you want to do it or not is your prerogative. Doctors should be the voice of reason based on scientific data.

Based on a study of over 6000 blood samples, 10th–90th percentiles of total T in adult men was 5.20–24.2 nmol/L.

Joefish123's test result reads 24.5nmol/L. That puts him in the top 10% of men.

Thank you for your insights Muscleaddict.

1) As mentioned originally this doc is "trigger happy", my personal opinion is that he is in it for the money and not to treat patients as the treatment would have been around R3500 per month only for meds (100mg Test Cyp, Proviron, DHEAS, HCG).

2) When I did blood tests in Nov 2018 my total test was on 17.74 nmol/L and Vit D on 23.20 (according to lab this was mild to moderately deficient). I have started supplementing with 5000iu VIT D per day. Perhaps that has been the contributing factor resulting in the improvement.
My free test at this stage was 8.45ng/dl (range 4.9 - 19.04)

3) What is the view on my Estradiol levels? My understanding was that low Estradiol can also cause many of the symptoms associated with low test. Twice my result was so low that the lab only reported less than 36.7 pmol/L. In other words the lab just reported "<36.7 pmol/L".

4) In terms of stresses in my life. Think life is stressful for everyone at this stage, but yes work is stressful with not much time off in terms of leave. Also have 2 kiddies (2.5 years and 6 months) so sleep at night is interrupted.

I don't think you are a case for TRT but I suppose there may be based on how you feel. But I don't think your doc should jump right into it now though because, as MA says, your bloods are not way out of line. He definitely should not put you on DHEA, try avoid that and that level looks fine in any event.

Your estrogen is actually low, it has come up slightly now because your test has increased, increasing aromatization. Low estrogen is really not good for a number of reasons and yes, it would cause your symptoms.

In addition your LH, if the measurement is IU/L, is quite low, which says that your pituitary gland is "balanced" in terms of testosterone production. High LH and low or mid range T levels would be another indicator of a Low T situation, which this isn't.

Obviously these results look better than your first test. I would try another 6 weeks doing what you are doing and see if you can improve them even more. Vitamin D is a big part of this.

If, and I think that should be decided very cautiously with your numbers, you do go on HRT you may be a case for HCG monotherapy for a limited time period, which will increase your natural production and raise your estrogen as well (if your doc suggests this, use the lowest dose possible and monitor your estradiol levels carefully). This may get you to a point where you are feeling good and then stop to see if your system naturally takes over.

Keep us posted.

From what I can see you certainly are one of the lucky ones when it comes to natural T production - I'm pretty sure low T isn't the root cause of your symptoms.

What worries me a bit is your cholesterol, that LDL and total cholesterol is a red flag - could I suggest visiting a dietician before making your mind up on HRT? I think a small tweak in your diet could make a world of difference in both how you feel and your general wellbeing. HRT is like a tattoo, once you've got it, it's pretty much part of your life forever - and trust me, injecting yourself twice a week, every week, forever is quite a commitment.

I'm not too sure your E2 levels are all that bad actually, again, you appear to be one of the lucky ones that doesn't aromatize much - you'd be surprised how many folks, myself included, would give their left ball for that!

If I may ask, what is your weight, approximate body fat and activity level?

In most cases you take 10000iu a day for 3 months, you should land up around 70 then drop to 5000iu twice a week if it is where I expect it to be then you will know use that as maintenance. Just remember not all Vitamin D can be absorbed without the need for sun, that is why I only use Vitamin D from compounding pharma.

Heavy weight training will also burst your testosterone levels and IGF 1.

Your triglycerides are normal so that makes me think it might be hereditary your cholesterol. It might not be what you eating that is the problem, but I'm most certainly not saying that a diatician is a bad idea, I'm all for them, but I'm blown away by how good your insulin is, so I have a feeling my friend that your cholesterol might be hereditary.

Have you done a homocysteine blood test, it's very possible one of your parents might have passed down a H gene if not both of them. It will also be good to get results for AST and ALT, this will give me insight into a hunch as to why your cholesterol is high and we may have a solution here, so try get that done, remember it must be fasted.

I see your creatinine is perfect too, nice! Your cortisol looks good too, you could drop that down to around 260, that might help you with stress, there is a product by solar called 'stress damage control' take one a day not 2, you don't want to drop cortisol to low.

I think your major problem here based on what data we have is your iron bud, its VERY low, you must feel like a slug. Ferrimed, 1 a day and don't donate until your iron has at least doubled, but even higher. I can nearly bet you that you increase your ferritin you going to feel like a brand new man.

Thanks Xpornstar

I am 35 years old.
About 1.8m tall
Weight 78kg
Body Fat % - around 20%.

In terms of activity the past year I have not been active at all.
Reason being the golfers elbow which makes weight training impossible and have never been a great fan of jogging / cardio.
I realize exercise is NB, but just not that motivated to get it going.

Thanks for the insight 00pump.

Regarding the cholesterol I also think it is hereditary. About 10 years ago when I was still very active (weigh training 5 days a week), eating very healthy, not drinking alcohol etc my total cholesterol was just over 4.
I remember at that stage I had a bit of fright and was wondering what more I could be doing.

I have not done a homocysteine test. Will try and get that done next week and will post the result.

I have results for AST and ALT. Will post. Think I have figured out how to post pics now so no need to retype anymore:-)

Thank you for the comment RE cortisol. Will action.

RE Ferritin - never thought of that. Whenever I donate blood my iron tests within the range for donating. So just assumed iron is good. Clearly I need to read up a bit more on ferritin and its role. Will definitely action your suggestion here.

Below blood results.

Look into ferritin, it's very interesting. Ferrimed is a schedule 1 so you can get it over the counter. Yes your iron might be on the low level of ok if you where a female who just had her cycle.

Need the homocysteine before I can make a comment, also do you by any chance have early years / months of ALT / AST?

3 weeks on the Ferrimed you should feel like a new man. If it doesn't increase your iron you might need an infusion, but no point jumping the gun, iron supplementation works for allot of people.

Hi 00pump.

Did the blood tests on the 24th of April.




1)
Was about a week into the Ferritin supplementation before the tests were done. Nurse said it will take some time to reflect. Ferritin now borderline.
So popping 100mg Ferrimed per day.

2)Didn't pick up on this before but see on the Haematology that there is an issue with white blood cells as well.

3)Unfortunately I don't have prior period results for ALT/AST. Only the result posted on 12 of April.

4)Cholesterol keeps on climbing. So now scared of even looking at a steak or egg.

Thanks for any insights.

Joefish123 wrote: Hi 00pump.

Did the blood tests on the 24th of April.

1)
Was about a week into the Ferritin supplementation before the tests were done. Nurse said it will take some time to reflect. Ferritin now borderline.
So popping 100mg Ferrimed per day.

2)Didn't pick up on this before but see on the Haematology that there is an issue with white blood cells as well.

3)Unfortunately I don't have prior period results for ALT/AST. Only the result posted on 12 of April.

4)Cholesterol keeps on climbing. So now scared of even looking at a steak or egg.

Thanks for any insights.

Iesh bud, you might not be able to increase it with supplementation, it seems like your body is not holding onto it's iron store. You are probably going to need an iron infusion because your ferritin is going down not up and you not a woman on her period, you must be feeling like proper crap.

Your homocysteine levels are high and you need to bring them down, there is a product by Solal called Homocysteine Lowering Formula (it works properly), which you take 1 a day, give it time to work, look into homocysteine on the internet it's fascinating and there is medical articles related to the link with thyroid, cholesterol and homocysteine. The good news here is that your red blood cells is still high enough which means you are not anemic "yet", but with your iron the way it's going you may become.

You are also showing signs of non alcoholic fatty liver. You can get N-Acetylcysteine 500 mg Capsules from Compounding Pharmacy. You will wan't to consume 1500mg a day, this will lower homocysteine levels as well as bring down your cholesterol and lower your liver enzymes, these two products you may need to be on for the rest of your life, but I would start with that and check your bloods in 3 months.

HOWEVER, I am not clued up enough with low iron with low white blood cells, that immediately makes me worry and I am not a medical professional so I would really have someone clued up look at that (not a GP either), preferably with all your complications an endocrinologist. I know someone extremely clued up but he is not taking new patients. It may be nothing to worry about but like I said I don't like what I know about the two being low and if it was me I would just want to get checked out by a professional.