First Total and Free T Results: Help Me Understand

[AlwaysCold]

Alright, Im a noob as far as posting here but have been reading these forums, peaktest forums and t nation for a little while as I have been suspect of either my T levels or thyroid for a bit. I decided to take the plunge with discountedlabs.com and take advantage of their special at $34 for free & total test plus hematocrit last week on 3/22/2017. This is the only blood work I have ever had in regards to test levels, and the only other blood tests I have had in YEARS were a CBC/Complete Metabolic/Urinalysis/Lipid and A1C back in late December 2016.

Age 34

5'7" 125.60 lbs today, been averaging 123.90-125.60 for several weeks now (123.90 is the lightest I have been in probably 15 or so years)

NEVER any recreational drugs and have never drank alcohol. Im on the evil garbage SSRI Paxil and have been for 17.5 years now, have been trying to get off it unsuccessfully for almost as long as I have been on it, down to 5mg currently, it causes a TON of side effects.

Supplements are 500mg Vitamin C.

Other meds are occasional Viagra (Revatio) & Cialis to combat severely diminished erection quality and libido that is getting worse and worse. Havent tried these in a "live" situation yet, no confidence currently.

Results from Labcorp (using the less sensitive test, ELICA I believe) were

Total Test 429 ng/dL Range: 348-1197
Free Test 9.27 ng/dL Range: 5.00-21.00
% Free Test 2.16% Range: 1.50-4.20
Hematocrit 49.9% Range: 37.5-51.0 (this test result was 49.1% back in December)


The testing was done shortly after 11:00 am which is general if Im going to have "morning wood", between 10:00-11:00 am is gonna be the most likely time, although it doesnt happen often at all. This was also after about 4 days of not ejaculating which is alleged to increase T levels by some, although most claim you dont see a gain until day 7 of this. After around a 15 hour fast.

I KNOW I need other tests, but this test being offered at a low price at least got me to finally start looking into things more. Dr (nurse practitioner) mentioned testing levels not long ago when I was in there for a Viagra/Cialis script, but wanted me to go through their "discount" lab testing. I dont have health insurance, so Im taking this slowly, as the medical world will bleed you dry quickly without ever producing results if you let it.


I can post my other blood results from back in December 2016, but what stands out to me amongst the list

WBC 4.7 Range: 3.4-10.8
RBC 5.76 Range: 4.14-5.80
Hemoglobin 17.0 Range: 12.6-17.7
Hematocrit 49.1 Range: 37.5-51.0
Glucose 99 Range:65-99
Total Cholesterol 194 Range: 100-199
Triglycerides 149 Range: 0-149
HDL 41 Range: >39
VLDL 39 Range: 5-40
LDL 123 "HIGH" Range:0-99
A1C 5.3 Range: 4.8-5.6

 

[Vince]

I would think your low levels of testosterone, are from SSRIs, but you may need the meds.

 

[CoastWatcher]

Alright, Im a noob as far as posting here but have been reading these forums, peaktest forums and t nation for a little while as I have been suspect of either my T levels or thyroid for a bit. I decided to take the plunge with discountedlabs.com and take advantage of their special at $34 for free & total test plus hematocrit last week on 3/22/2017. This is the only blood work I have ever had in regards to test levels, and the only other blood tests I have had in YEARS were a CBC/Complete Metabolic/Urinalysis/Lipid and A1C back in late December 2016.

Age 34

5'7" 125.60 lbs today, been averaging 123.90-125.60 for several weeks now (123.90 is the lightest I have been in probably 15 or so years)

NEVER any recreational drugs and have never drank alcohol. Im on the evil garbage SSRI Paxil and have been for 17.5 years now, have been trying to get off it unsuccessfully for almost as long as I have been on it, down to 5mg currently, it causes a TON of side effects.

Supplements are 500mg Vitamin C.

Other meds are occasional Viagra (Revatio) & Cialis to combat severely diminished erection quality and libido that is getting worse and worse. Havent tried these in a "live" situation yet, no confidence currently.

Results from Labcorp (using the less sensitive test, ELICA I believe) were

Total Test 429 ng/dL Range: 348-1197
Free Test 9.27 ng/dL Range: 5.00-21.00
% Free Test 2.16% Range: 1.50-4.20
Hematocrit 49.9% Range: 37.5-51.0 (this test result was 49.1% back in December)


The testing was done shortly after 11:00 am which is general if Im going to have "morning wood", between 10:00-11:00 am is gonna be the most likely time, although it doesnt happen often at all. This was also after about 4 days of not ejaculating which is alleged to increase T levels by some, although most claim you dont see a gain until day 7 of this. After around a 15 hour fast.

I KNOW I need other tests, but this test being offered at a low price at least got me to finally start looking into things more. Dr (nurse practitioner) mentioned testing levels not long ago when I was in there for a Viagra/Cialis script, but wanted me to go through their "discount" lab testing. I dont have health insurance, so Im taking this slowly, as the medical world will bleed you dry quickly without ever producing results if you let it.


I can post my other blood results from back in December 2016, but what stands out to me amongst the list

WBC 4.7 Range: 3.4-10.8
RBC 5.76 Range: 4.14-5.80
Hemoglobin 17.0 Range: 12.6-17.7
Hematocrit 49.1 Range: 37.5-51.0
Glucose 99 Range:65-99
Total Cholesterol 194 Range: 100-199
Triglycerides 149 Range: 0-149
HDL 41 Range: >39
VLDL 39 Range: 5-40
LDL 123 "HIGH" Range:0-99
A1C 5.3 Range: 4.8-5.6

View attachment 3428

Welcome to EM. Your basic labs, testosterone and free testosterone, suggest an issue for someone not yet 35 years old. How confident are you that the practice you are consulting has the background and experience to work with you as you explore the possibility of TRT, a Clomid restart (depending on what further testing shows, this might be something to seriously consider)?

What you've presented certainly raises questions, your levels on both tests demand attention, and further testing may suggest the path to take.

 

[AlwaysCold]

Thanks for the replies!

Vince, I was put on Paxil for OCD in 1999, I was on a much higher dose but have been slowly weaning down over the years. It's one of the hardest things to get off of once you have been on it for a long period of time. I think the side effects of being on it, as well as the withdrawal side effects of missing a dose are worse than anything I was ever put on it for. I do believe there is a connection with it and low T and other issues I have, a Dr will never admit this though.

Coastwatcher, I was honestly expecting lower numbers but I guess 429 isnt exactly great for a 34 year old. Im not confident at the current discount medical place's ability to put me on TRT, so that's another can of worms completely. The first person I saw there refused my RX for cialis and generic viagra and told me to do a testosterone test, then told me "all you do is take a pill if it's low". I went in another day and spoke with a better nurse practitioner who knew the side effects of paxil, had no issues writing the RX's for the other stuff, but we didnt get into TRT or any of that crap yet. I have only been to this place a couple of times, before that I havent had a regular Dr in years, just another discount clinic I go to for my Paxil refills and the occasional oddball thing.

Both nurse practitioners at the most recent lower cost clinic (their angle is they dont accept insurance but offer medical memberships at a discounted rate) said my blood work from December looked fine. Major family history of heart issues and the thick blood as well as high cholestoral numbers are kind of alarming to me, but they didnt bat an eye.

My Dad died of a heart attack at 37, my grand dad on that side had a heart attack and later died of lung cancer, dad's sister had a heart attack and later died of lung cancer, dad's sister's daughter (my cousin obviously lol) is a little younger and had recent minor heart surgery as well as has some blood clotting issue where both times she was pregnant they considered high risk of death when giving birth.

 

[CoastWatcher]

With your family history, complex and serious as it is, you certainly need competent medical care to guide you through the ups and downs of TRT. The situation you described at the practice you're consulting is not going to work to your advantage. I realize you've no medical insurance, but it would be in your best interest to work toward a consultation with either Defy Medical or Prime Body. The good thing is that both practices will disclose the full costs of care to you, right up front, over the phone. I'd urge you to call them both and determine what the costs actually are, so as to know what such care will cost (and how long you may need to plan for it).

 

[AlwaysCold]

That actually sounds great because I prefer the idea of up front costs. The mystery and vagueness of the medical billing system has been a subject of ire for me for a long time. Im actually at the discount self pay Dr now for my Paxil RX, I'm gonna show her blood work and just see what she says while I'm here. This place is not equipped to do TRT.

 

[AlwaysCold]

She told me today that my levels were bad and recommended I go to an anti aging clinic, but she also gave me the names of a couple of Dr's in town to talk to about things. She didnt think my hematocrit was an issue though, but I cant see how it isnt?

So what should a 34 year old's levels even be? I see wildly varying numbers online, should they be 600's, 800's? Any chance of blasting these up naturally?

Current side effects (most have been ongoing for 10-15 years or so but have gotten exponentially worse in the last 1-2 years) are basically listed on the ADAM questionnaire, I checked yes on all but 2 of them, and one of those 2 was a "kind of". I get up to urinate often when in deep sleep, my stomach is a wreck (stopped up vs grumbly and urgent, never normal) and I have dark circles under my eyes that are getting worse, although Im told they may be genetic.

 

[CoastWatcher]

Before going to a local anti-aging clinic, or a doctor in your area, call Defy and Prime Body. I have no vested interest in either practice, I am not a patient, but I have an interest in seeing our members receive quality treatment. Ask Defy and Prime Body for a full breakdown of of their costs and treatment model. They will answer your questions.

Then investigate your local options with the same attitude: how much is this going to cost me and how is care delivered? Then make your decision.

As for your hematocrit, it's still below 51 on the LabCorp scale, isn't it? If so, you have some room. If you're tense, donate blood.

 

[Vince Carter]

Your HCT isn't a problem @ 49, it WILL go up if you got on TRT and we typically just donate a pint of blood periodically to lower it. That is an extremely common side effect and a highly effective (and good deed) way to deal with it.

 

[AlwaysCold]

Before going to a local anti-aging clinic, or a doctor in your area, call Defy and Prime Body. I have no vested interest in either practice, I am not a patient, but I have an interest in seeing our members receive quality treatment. Ask Defy and Prime Body for a full breakdown of of their costs and treatment model. They will answer your questions.

Then investigate your local options with the same attitude: how much is this going to cost me and how is care delivered? Then make your decision.

As for your hematocrit, it's still below 51 on the LabCorp scale, isn't it? If so, you have some room. If you're tense, donate blood.

I tried calling today but it was too late in the day and I couldnt get a human on the phone. Going to try again tomorrow.

Your HCT isn't a problem @ 49, it WILL go up if you got on TRT and we typically just donate a pint of blood periodically to lower it. That is an extremely common side effect and a highly effective (and good deed) way to deal with it.

Isnt having a high hematocrit (although in range, 49.9 is 1.1 away from the end of the scale, and my hemoglobin and RBC are close to the end of the range too) indicative of other issues? I did read about donating if I go on TRT to keep it in range, so I guess that's something I would have to look into.

If I were to order more tests now, what would be the most helpful if I didnt want to spend hundreds and hundreds yet? Esterdiol, prolactin, thyroid panel?

 

[Re-Ride]

["Any chance of blasting (serum T ) levels up naturally"]

Yep, and you need to give it a go. There are suggestions in the stickies.

There is also a chance that you can treat the OCD with aminos taken in doses implied to be effective by research studies. NALT comes to mind. Emphasis is on proper dosing. Pure powders absent of fillers can be purchased relatively inexpensively from Bulk Supplements or MyProtein. Track prices on M.P. If you are note getting 50% off "on sale" then you are paying too much. Even if clean nutrition combined with effective, not garbage supplements , does not get you 100% relief chances are you will feel much better. It's easy to over-pay on supplements, to buy ones with undesirable additives or ones that have nothing but hype behind them. Check out Examine.com and Labdoor as well as searching for scholarly articles.

 

[AlwaysCold]

I have read the sticky, just curious if anybody had before and after results with blood work, I hope it's that easy because the idea of getting a needle to the leg twice a week for the next 50 years doesnt sound appealing.

I have most of it covered, never any alcohol, I sleep as much as I want 90% of the time but I never and I mean NEVER wake up feeling great. Lower stress, well Im always stressed, even right now when I have a pretty lax living situation, it's just who I am (although I didnt used to be this way, which is one of my huge concerns). I have been doing occasional deep breathing for a little while now as well, but not as much as I should during the day. Zinc, I need to look into, I do eat a bit of beef and peanuts which have zinc in them, but I am curious about the levels. Need to find the energy to work on the exercise part, I used to be much stronger and have 10000 times the endurance.

Im all for ditching the Paxil and trying aminos and stuff as I dont want to be on it anymore, but it's one of the hardest things to quit if you are on it long term. It has taken me years to wean down to where Im at now. I was able to quit ALL caffeinated/carbonated drinks and food for almost 4 years once just because I felt like it, but I cant even come close to jumping off of this Paxil. Im curious what my numbers would do if I did though.

 

[AlwaysCold]

My cousin who's a medical assistant but thinks she's a Dr said today "429 is normal, that's a good number, it's above the limit". I asked how they would inject at their office if they treat somebody, just to see what she would say, and before she said it I already knew it, "we do it every two weeks, we start out at a month". Outdated stuff is still out there, she couldnt fathom what I said about numbers going up and and tapering off and peaks and valleys.

 

[CoastWatcher]

You aren't the first, and, sadly, won't be the last, member who is in medical limbo as you travel the hormone highway. Most of us had trouble finding a doctor who knew what they were doing. The rise of Defy Medical and Prime Body has gone a long way toward putting cutting-edge therapy within the reach of most Americans (I am a Canadian).

 

[Vince Carter]

I have read the sticky, just curious if anybody had before and after results with blood work, I hope it's that easy because the idea of getting a needle to the leg twice a week for the next 50 years doesnt sound appealing.

I have most of it covered, never any alcohol, I sleep as much as I want 90% of the time but I never and I mean NEVER wake up feeling great. Lower stress, well Im always stressed, even right now when I have a pretty lax living situation, it's just who I am (although I didnt used to be this way, which is one of my huge concerns). I have been doing occasional deep breathing for a little while now as well, but not as much as I should during the day. Zinc, I need to look into, I do eat a bit of beef and peanuts which have zinc in them, but I am curious about the levels. Need to find the energy to work on the exercise part, I used to be much stronger and have 10000 times the endurance.

Im all for ditching the Paxil and trying aminos and stuff as I dont want to be on it anymore, but it's one of the hardest things to quit if you are on it long term. It has taken me years to wean down to where Im at now. I was able to quit ALL caffeinated/carbonated drinks and food for almost 4 years once just because I felt like it, but I cant even come close to jumping off of this Paxil. Im curious what my numbers would do if I did though.

Good on you for all the effort, it will make a difference in your health but sadly none of that is going to change being Hypogonadal/Low T

 

[AlwaysCold]

You aren't the first, and, sadly, won't be the last, member who is in medical limbo as you travel the hormone highway. Most of us had trouble finding a doctor who knew what they were doing. The rise of Defy Medical and Prime Body has gone a long way toward putting cutting-edge therapy within the reach of most Americans (I am a Canadian).

Oh I wasnt asking her, but as soon as she said my numbers were normal, I knew the place she works at is outdated or just flat out shouldnt be playing with hormones.

I did call Defy today, got the forms, gonna talk to some local places, feel everything out for sure. This is a small area that's usually behind the curve though.

 

[AlwaysCold]

Does the ECLIA test read higher than the LC/MS? I read that and am curious.

 

[CoastWatcher]

Does the ECLIA test read higher than the LC/MS? I read that and am curious.

It typically does, except when it doesn't. Not being an ass, but making a point. We have had members, I beleive my good friend Vince Carter is one of them, who actually saw it work the other way, but that's very rare. The point? ECLIA, when used by men, is unreliable in the extreme. One simply can't rely on the results for diagnostic purposes.

 

[Dr Justin Saya MD]

Unless you live at high altitude, smoke cigarettes, have COPD, or have hemochromatosis (too much iron), I would be suspicious of the baseline HgB and HCT 17/49.9 despite total Testosterone only in the 400's. Specifically, I would be concerned about pre-existing sleep apnea driving that level up.

Sleep apnea combined with going on TRT is the "double whammy" as I call it which causes some patient's hematocrit to skyrocket into risky territory.

 

[AlwaysCold]

It typically does, except when it doesn't. Not being an ass, but making a point. We have had members, I beleive my good friend Vince Carter is one of them, who actually saw it work the other way, but that's very rare. The point? ECLIA, when used by men, is unreliable in the extreme. One simply can't rely on the results for diagnostic purposes.

But within my range it's probably not giving me falsely higher numbers or anything like that, right? I will do the LC/MS next time though if that's the better route.

Unless you live at high altitude, smoke cigarettes, have COPD, or have hemochromatosis (too much iron), I would be suspicious of the baseline HgB and HCT 17/49.9 despite total Testosterone only in the 400's. Specifically, I would be concerned about pre-existing sleep apnea driving that level up.

Sleep apnea combined with going on TRT is the "double whammy" as I call it which causes some patient's hematocrit to skyrocket into risky territory.

I live at sea level, have never smoked cigarettes (I did grow up in a smoking house hold and was exposed to second hand smoke for years though), and do not have COPD, no idea on iron yet, have never had it tested, should I do ferritin or TIBC, I havent seen a solid answer on which is more useful for me yet.

I have been curious about sleep apnea for awhile, I get up to urinate 3-5 times a night on average, and I always feel super sluggish upon waking up, it takes me forever to get going, and it's gotten worse and worse. I bought a new memory foam mattress last year, still having trouble, less body aches but I still do not sleep well at all.