 07-07-2010, 11:21 PM | |||||||||||||||||
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 Labs tests in - Free T low - Need advice on what to do next I have been experiencing symptoms of low testosterone for years, low sex drive, problems maintaining an erection, lack of interest, memory problems. A year ago, I decided to have my testosterone levels tested after finding that most of my symptoms matched that of Low T. Test Results (July 2009) Free Testosterone - 27.9 pmol/L (30.9-147.5) I was out of the country then and the doctor there prescribed oral testosterone. Tried that for a couple of months with no noticeable effect (understandable due to the difficulty in absorption of oral test). Decided to stop due to concerns of liver damage. Got a second set of labs earlier this year. Test Results (Mar 2010) Total testosterone - 268 (240-950) Free Testosterone - 9.4 (9-30) Prolactin - 9 (3-13) Creatinine - 1.1 (0.6-1.3) These labs got me referred to an endocrinologist where I got further tests done. Test Results (Apr 2010) Total Testosterone - 333 (250-1100) Free Testosterone - 69.9 (46-224) Bioavailable Test - 153 (110-575) SBGH - 16 (7-49) Albumin, serum - 4.8 (3.6-5.1) Cortisol - 20.7 (4-22) FSH - 2.8 (1.6-8.0) LH - 3.0 (1.5-9.3) Endo was initially reluctant to prescribe anything since my test levels were within "reference rage" albeit at the lower extreme of the range. However, after discussing the situation, he agreed to prescribe 2.5g Androgel daily. I tried this for a month with slight improvement in symptoms but nothing significant. After realizing that such a low dose TRT would shut down natural production without providing sufficient exogenous testosterone and thus possibly lowering my testosterone levels, I decided to stop using it until I got a better doctor. I got a pituitary and brain contrast MRI. MRI showed no significant findings and results were normal. Got a more comprehensive round of labs done Lab test June 2010 Total Testosterone - 14.5 nmol/L (6.0-30.0) *Strangely elevated considering the low levels of previous tests. Lab error? Free Testosterone - 41.9 pmol/L (30.9-147.5) Cortisol - 419 (120-620) Oestradiol, serum - 90 (Male reference range <130) *Sensitive test Not Available Free T4 - 11.4 (9-25) Free T3 - 4.3 (3.5-6.5) Vitamin B12 - 263 pmol/L (>185) Prolactin - 20.4 (1.6-18.8) *Elevated and higher than previous tests FSH - 3.0 (1-12) LH - 6.0 (1-12) 25-hydroxy Vitamin D - 95.7 (60-160) Progesterone - 3.0 (0.5-5.0) Quantitative HCG (Male) - <2.0 (<2.1) Thyroglobulin antibody - <100 (<100) Copper - 11.2 (11.8-22.8) Zinc - 15.0 (9-18) Magnesium - 1.05 (.70-.95) Total Bilirubin - 14 (<21) Direct Bilirubin - 5 (<8) INdirect Bilirubin - 9 (<14) CBC - NORMAL Glucose - 4.6 (3.9-5.5) Sodium - 143 (135-145) Potassium - 4.5 (3.5-5.1) Chloride - 103 (95.110) Creatinine - 96 (50-116) Uric Acid - .49 (.18-.47) Calcium - 2.4 (2.1-2.55) Total Protein - 71 (60-82) Albumin - 43 (35-50) Globulin - 28 (35-50) GGT - 16 (<51) AST - 29 (<41) ALT - 16 (<51) Serum Iron - 21.5 (10-30) Serum Homocysteine - 45 (5-15) PSA - 0.4 (0-2.5) C-Reactive Protein - 0.5 (<1.0 Low Risk) HbA1c - 5.4% (6.0% Non-diabetic range) Thyroid Stimulating Hormone - 0.89 (0.4-4.7) Carcino Embryonic Antigen - 2.9 (<5.1) Alpha-feto protein - 3 (<11) Rheumatoid Factor - 41 (<20) Ferritin - 122 (20-300) DHEA-Sulphate - 359 ug/mL (259-596) IGF-1 - 225 (117-329) Insulin - 4 (<11) Based on the lab test results, it looks like my vitamin and mineral levels are not deficient. LH of 6 even seems to be within the optimal range? The only surprise thrown up by these results are the total testosterone levels of 14.5 nmol/L which is equivalent to 425 in regular units. Could this be from the androgel even though I had stopped using it a couple of weeks before the test? However, my Free Testerone is still very low and so if the total testosterone results are to be believed, maybe my E2 levels are elevated resulting in T being converted to E? SBGH and Albumin levels are within normal range and relatively low so those aren't the problems. Now, I have an appointment with a different endo in a couple of days and I would greatly appreciate any advice on what to do and what questions to ask. Should I try to get a sensitive E2 test, total-free-bioavailable testosterone test done just to determine what the actual levels are? Do you think that TRT along with HCG would be the best route for me? I'm 27 and would like to have kids in the future, but I'm willing to sacrifice my natural T production if it means felling better and getting out of this funk. After all, there's always deposit at the sperm bank as a matter of last resort in case I'm unable to restart my natural T. It's been a difficult year of jumping from doctor to doctor and seemingly getting nowhere. I would appreciate the expert advice of anyone here with some ideas on what I should do. | |||||||||||||||||
| 07-08-2010, 01:02 AM | |||||||||||||||||
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| Re: Labs tests in - Free T low - Need advice on what to do next My first 3 Total Test levels were 27.9 pmol/L (30.9-147.5) 268 (240-950) 333 (250-1100) It's only the latest one that came up relatively high at 14.5 nmol/L (6.0-30.0). I think it was a lab error since Free T still came up at the bottom of the range at 41.9 pmol/L (30.9-147.5) in line with earlier tests. My Free T from the past 3 tests are Free Testosterone - 41.9 pmol/L (30.9-147.5) Free Testosterone - 69.9 (46-224) Bioavailable Test - 153 (110-575) Free Testosterone - 9.4 (9-30) They all seem to consistently fall in the lower end of the range. SBHG levels look OK = SBGH - 16 (7-49) I think I would rather try the gel first and see if that works for me. Otherwise, Test Cyp it is. Most importantly, do you think that my T levels warrant treatment, given my age and symptoms?  | |||||||||||||||||
| #4 07-08-2010, 09:39 AM | |||||||||||||||||
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| Re: Labs tests in - Free T low - Need advice on what to do next It is somewhat difficult to follow your results because each doctor uses a different lab and even significantly different analysis methodologies. Not your fault. However, it is obvious that your free T is low. I have found that my free T is more important than my total T as to how good I feel and how good my erections and libido are. For your information, I am 65 and have been on TRT for a little over 2 years. My symptoms started at age 62. I started on Androgel and switched to Testim. My experience is that Testim gel absorbs better than Androgel and 2 small studies have shown that Testim has about 30% better absorption. I don't think that 2.5 gm of Androgel is nearly enough, but perhaps it is the low dose that has prevented any natural shutdown. My total T got as high as 1235 ng/dL (250-1100) and free T of 434 pg/mL (35-155) on 10 gm of Testim. That drove my E2 way over the top of the range and I didn't feel nearly as good as when my total and free T were lower and my E2 was at the lower end of the range. The method of application makes a big difference in the absorption of the gels. I have used 3 different methods. A) Shower in the evening and apply the gel in the morning. B) Shower in the morning and apply the gel right after drying off. C) Shower in either the evening or morning and then scrub the application area with a loofah pad, dry off and then apply the gel. My total T results were as follows with the 3 methods. All were done at the same lab with the range of 250-1100 and all were with using 10 gm of Testim. A) 348 B) 644 and 862 C) 1235 Dr. Crisler said in one of his presentations that a dermatologist told him that applying right after a shower and drying resulted in better absorption. My dermatologist confirmed that and explained it to me. Then someone on this board (forget who) said that he scrubs with a loofah, so I was doing that for several months before my last test at 1235. Along with free T, E2 seems to make a difference for me. A level of 25 to 35 pg/mL (<20-56) seems to be the best range. Low or high make me feel worse. I felt better when my total T was at 348 than I did when it was at 862, but my E2 was 34 vs. 57. I think that your main problem is your free T level, but you should also get your E2 tested. I have never had my SHBG tested, but back calculating from my total and free T and albumin give me a value of about 15 to 17 most of the time. When I have a free T of at least 100 and E2 in the 25 to 35 range then I feel good and sex is not a problem. At an age of 27, you are definitely low on both total T and especially free T. Your second free T test used the analog method of analysis, which gives values about 1/5 of the other methods, so you should be at least 20 using that lab method. | |||||||||||||||||
