A Cautionary Tale...

LionTamer said:

The endocrinologist I went to just told me that everything was in the reference range and therefore there was nothing to treat (which is infuriating of course...).

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I was infuriated too with similar conversations before I knew better. F around and find out.

If you are dead set on running hormones (we are back to your prior thread), why not just do it (as intelligently as possible)? You can find Docs to write you whatever Rx you want. I think many times this is a mental issue instead of a true hormonal deficiency issue. I know for me it was. Now I leverage "anabolic therapy" knowing full well the tradeoff most likely.

The quest never ends for the perfect polypharmacy cocktail to give FFMI of 30, 6% BF, Johnson that is ever hard, unlimited energy, etc, etc. Go forth and blast in peace if your mind is made up.

Share all your prior FT tests in detail (lab, assay type, correct units, etc) if you want help on your above request. Otherwise there is nothing else we can do to help on that.

LCMS+ ED FT assay by Labcorp or Quest is going to be typically 10 to 30% lower than cFTV. Yes I have a beautiful straight line for my data. cFTV works just fine to help you keep score of your FT as a f(SHBG, TT, HSA).

LionTamer said:

My sex drive issues are 1-2 years long. The only things that coincide perfectly with my libido changes are the anastrazole / clomid, the ozempic, and some of the OTCs like CoQ10, fish oil, and vitamin D.

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FISH OIL. Common libido killer masquerading as a healthful supplement. Definitely try dropping that from your regimen.

"I've never heard fish oil can neuter the human male" I hear you thinking. Search reddit for "fish oil libido".

@aloetard and @sammmy : I think you're misinterpreting my last comments. I don't want to get on TRT. It's actually the opposite. If you read my original post, here's what I wrote:

"My doctor (not a TRT clinic, but an actual doctor) put me back on clomid to see if that helps. If it doesn't I think I'll be forced to go on TRT, which is what I really was hoping to avoid. But I may not have a choice."

I came here to caution others from messing with their hormones like I did, so it can hardly be said that my preference is to further adulterate my own hormones again....

And my frustration with my endocrinologist wasn't that she wouldn't prescribe TRT, but rather that she told me there was no condition to treat. Perhaps that may have been the case with my hormones; but it was just annoying that she didn't proffer a solution.

Based on what you guys are telling me, it's not my hormonal balance that's the problem. This is good feedback. And with that, I may get back off the clomid. But then what's the actual solution? I'm certainly open to dropping any medication that may be having this effect. But I also think it's a bit dogmatic to just "drop everything". The wiser path would be to play detective, drop one at a time, and see what works.

With this in mind, I think I should see a doctor who can help with a plan to solve this problem in a concerted and nuanced manner. I'm thinking of going to Rand Mclain since he's local to Los Angeles and has good reviews here. But I'm concerned he's just another TRT clinic, a hammer to whom everything is a nail...

@aloetard A full history of my labs is attached, per your request. Thank you for the help.

LionTamer said:

A full history of my labs is attached, per your request. Thank you for the help.

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You have posted the same spreadsheet on here multiple times which contains assorted FT results that appear most likely different assays and definitely different units. Please identify assay type, units for each entry. That will require you to go back and pull that info for each result. It is clear there are results from different assays on the sheet that have differing units (pg/ml vs ng/dl). I believe this is my third time asking you for this.

For your reference:


How to compare various FT results with example:


See posts 136/137 and post 138 summary table. This is the standard required if you want to make sense of FT results from various labs. Almost no one wants to do it.

No, you can't just multiply by 10 to compare direct fT results with other methods. No, Labcorp doesn't have the wrong units on their assay.

LionTamer said:

But I also think it's a bit dogmatic to just "drop everything". The wiser path would be to play detective, drop one at a time, and see what works.

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Dropping everything would be a much faster way to determine whether one of the many things you are taking is causing your problems. If you drop everything, and things don't show signs of improvement within a few weeks, you know it doesn't have anything to do with your regimen.

However, if you are committed to removing one thing at a time, you know which one to start with:

FunkOdyssey said:

Dropping everything would be a much faster way to determine whether one of the many things you are taking is causing your problems. If you drop everything, and things don't show signs of improvement within a few weeks, you know it doesn't have anything to do with your regimen.

However, if you are committed to removing one thing at a time, you know which one to start with:

View attachment 47178

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First time I hear that about fish oil.

FunkOdyssey said:

Dropping everything would be a much faster way to determine whether one of the many things you are taking is causing your problems. If you drop everything, and things don't show signs of improvement within a few weeks, you know it doesn't have anything to do with your regimen.

However, if you are committed to removing one thing at a time, you know which one to start with:

View attachment 47178

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Where the laugh button reaction/emoji thing on here?

aloetard said:

You have posted the same spreadsheet on here multiple times which contains assorted FT results that appear most likely different assays and definitely different units. Please identify assay type, units for each entry. That will require you to go back and pull that info for each result. It is clear there are results from different assays on the sheet that have differing units (pg/ml vs ng/dl). I believe this is my third time asking you for this.

For your reference:

Public Service Announcement: "Piss Poor" Direct RIA fT measurement (HELP is on the way)

Hey Folks, thought I would update the graph for free T reference ranges based on LC-MS/MS+ED and compare with Labcorp's direct RIA fT reference range. What the hell do you do with with your direct fT measurement if you want to compare with equibrium dialysis reference ranges? Take the Labcorp...

www.excelmale.com

How to compare various FT results with example:

Calculate Free Testosterone with TruT by FPT

The idea of SHBG as a sponge that sucks up large amounts of testosterone and leaves your free T low doesn't seem to be how it really works. The way I understand it, high SHBG makes your meager production (revealed by the free T) look like it's normal or even high when it isn't. The SHBG is...

www.excelmale.com

See posts 136 and 137. This is the standard required if you want to make sense of FT results from various labs. No, you can't just multiply by 10 to compare direct fT results with other methods. No, Labcorp doesn't have the wrong units on their assay.

Response from LabCorp About Their Incorrect Unit Usages For Their Free Testosterone - Direct - Test

I've been irked for a year by the apparent incorrect unit usage for the particular Free Testosterone test mentioned above. I periodically reach out to whatever relevant executive I can find. No luck for months until the below correspondence. In brief his explanation doesn't hold up in my view...

www.excelmale.com

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I'm sorry. I'm not fully familiar with all the terminology. I'm attaching August 2022 (Labcorp) and January 2023 (Quest). As you can see, the free testosterone listed for both is in pg/mL. But that can't be the case since because of the order of magnitude difference in the numbers. This was something that confused me, but I wasn't able to get a good explanation for. Perhaps the difference is that one of them says Direct vs. the other Dialysis? Please let me know what additional clarification you need. I want to get what you're requesting; I just don't fully understand. Please forgive my ignorance.

@aloetard I just saw the rest of your post. Let me read through it. Please ignore my last post. Will read through yours first and understand it better. My bad.

LionTamer said:

This was something that confused me, but I wasn't able to get a good explanation for. Perhaps the difference is that one of them says Direct vs. the other Dialysis?

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LionTamer said:

Will read through yours first and understand it better.

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Awesome. I hope the exhaustive information I shared in post #44 above helps shine purifying daylight on this.

Seagal said:

First time I hear that about fish oil.

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FunkOdyssey said:

Dropping everything would be a much faster way to determine whether one of the many things you are taking is causing your problems. If you drop everything, and things don't show signs of improvement within a few weeks, you know it doesn't have anything to do with your regimen.

However, if you are committed to removing one thing at a time, you know which one to start with:

View attachment 47178

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Hmm you do make an interesting point here...

LionTamer said:

I'm sorry. I'm not fully familiar with all the terminology. I'm attaching August 2022 (Labcorp) and January 2023 (Quest). As you can see, the free testosterone listed for both is in pg/mL. But that can't be the case since because of the order of magnitude difference in the numbers. This was something that confused me, but I wasn't able to get a good explanation for. Perhaps the difference is that one of them says Direct vs. the other Dialysis? Please let me know what additional clarification you need. I want to get what you're requesting; I just don't fully understand. Please forgive my ignorance.

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What truly matters here is your most recent set of labs (natty) done through Quest.

In order to know what testing method was used all you would need to do is post the TEST CODE or better yet reference range for FT!

You have 3 options for testing FT through Quest and one can easily be eliminated as you never tested BAT (bioavailable testosterone).

#2 Equilibrium Dialysis is the one you want which as I stated previously if paying out of pocket your best option would be through Nelson's discounted labs





#1 (TEST CODE 18944) reference range 46.0-224.0 pg/mL



#2 (TEST CODE 36170) FT reference range 35.0-155.0 pg/mL



#3 (TEST CODE 14966) reference range 46.0-224.0 pg/mL

@aloetard and @madman please see attached. I went through and added the reference ranges and assay types. Couple things to note:​

• I double and triple checked and all the units listed across all the tests for FT was pg/mL. This is the case even with the order of magnitude difference you're seeing in some of the outputs.
• For July 2023 and March 2024, I wasn't able to get 100% confirmation of the assay type, because it's not listed on the lab and Quest archives anything older than 6 months, but I'm almost certain that it's the same as the June 2024 one (ICMA).
• For Total Testosterone, I can call Labcorp to get the assay types, but I'm assuming it's always MS? If you want me to call to get confirmation, let me know...

Thank you all for the help!

LionTamer said:

@aloetard and @madman please see attached. I went through and added the reference ranges and assay types. Couple things to note:​

• I double and triple checked and all the units listed across all the tests for FT was pg/mL. This is the case even with the order of magnitude difference you're seeing in some of the outputs.
• For July 2023 and March 2024, I wasn't able to get 100% confirmation of the assay type, because it's not listed on the lab and Quest archives anything older than 6 months, but I'm almost certain that it's the same as the June 2024 one (ICMA).
• For Total Testosterone, I can call Labcorp to get the assay types, but I'm assuming it's always MS? If you want me to call to get confirmation, let me know...

Thank you all for the help!

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No need to fret over what assay was used as the reference range tells all.

The Immunochemiluminescence Assay (ICMA) would be for SHBG.



Methodology * LABS (Jul.23, Mar.24, Jun.24)

Chromatography/Mass Spectrometry • Calculation (CALC) • Immunochemiluminescence Assay (ICMA)


Quest Diagnostics

Jan.23 - ED (Equilibrium Dialysis)
Jul.23 - Calculation (CALC)
Mar.24 - Calculation (CALC)
Jun.24 - Calculation (CALC)


Quest Diagnostics cFT (most likely a modified form of the Vermeulen equation)

*This test uses a calculation based on measurements of total testosterone, SHBG, and albumin to derive the free testosterone level. Equilibrium dialysis is considered more accurate for measuring free T [1].




As you can see if you plug in your TT, SHBG and albumin (July, March and June) using the go to calculator (cFTV) your FT would be in a healthy range and this is with highish/high SHBG to boot!

LionTamer said:

I have an eating problem.

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Then you have to eat the right things and with some discipline, you don’t need Ozempic. Ozempic or any treatment for weight loss or diabetes, is inferior to dietary/lifestyle changes.

When I started the carnivore diet, I was eating 8 pounds of steak per day and continue to lose weight.

On the carnivore diet you can eat until your full.

LionTamer said:

With this in mind, I think I should see a doctor who can help with a plan to solve this problem in a concerted and nuanced manner. I'm thinking of going to Rand Mclain since he's local to Los Angeles and has good reviews here.

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For really difficult cases, I would recommend you would be better off with Dr. Rob Kominiarek but he is pricey.

Comparisons would be the TV show House or Sherlock Holmes of doctors. This guy has people coming to see him from all over the world.

You'll need a plane ticket and a small suitcase.

I believe his yearly retainer is $5500 not including labs and medicines.

You can check him out on YouTube.

@madman thank you. so, in your opinion, my symptoms are not related to my hormones?

@aloetard do you agree?

@Systemlord thank you. i'm going reach out to him.

​

LionTamer said:

@aloetard do you agree?

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The 'tard has left the building for the foreseeable future. Tis a tale too long to unfold, yet he did wage a noble battle, with unshaken will and principles firm as stone.

My libido is generally through the roof. Your SHBG and estradiol levels on the Quest labs are what I typically see on my labs. The 53 estradiol would not lower my libido but would likely reduce penis sensitivity and make it harder to reach orgasm. Typically my estradiol is around 20-30. My SHBG is usually in the 40’s.

I have adjusted my testosterone cypionate dose up and down and my total testosterone has fallen in the same range as your Quest labs. However, my free testosterone has been in the 175-250 range.

I can’t explain why your numbers all look like mine except the free testosterone which is much lower.

After reading other comments I will add that my libido has been directly linked to my testosterone level. I fly level is high my libido is high. I have lowered my testosterone dose simply because when my testosterone level gets above a certain point my sex drive becomes almost uncontrollable.

I will also add that I don’t believe there is any problem with taking supplements. I take a lot of supplements.

I have never taken statins so I have no idea how that might affect libido