Got my recent blood work, any thoughts?

[johndoesmith]

This was done 36 hours after every 3 day injection of 60mg testosterone. I take 500 IU hcg every 3.5 days. I should have done the lab work 60 hours after injection, but I made a mistake with the days.

This was fasted. Also after about 2-3 bottles of water. I was pretty damn dehydrated that morning, and had to wait about 2 hours due to being late for my appointment. So the water had some time to absorb I guess?

 

[PAUL-E]

looks pretty good to me vitamin D and B12 could be improved and estrogen is just out of range but I'm guessing this is around your peak so that should drop closer to your trough. how do you feel? any diabetes?

 

[johndoesmith]

looks pretty good to me vitamin D and B12 could be improved and estrogen is just out of range but I'm guessing this is around your peak so that should drop closer to your trough. how do you feel? any diabetes?

Vitamin D is kinda low, I got lazy and stopped taking my pills! Will restart!

B12 is something I've never had tested before, and I eat a ton of animal products like ground beef, pork, and eggs. I eat eggs everyday, so it's odd that it's kinda low.

Do you know if I'm at the level of B12 where I could benefit from B12 injections? I do have an appointment with Dr. Saya on Tuesday, so will definitely be asking him as well.

Yes this is about 36 hours post injection, and I really don't have any high E2 symptoms, plus with my T/E2 ratio of 33 all signs point to good E2 level(fingers crossed, no AI!!).

How do I feel?:

I've started to feel DIFFERENT. I think Testosterone is more subtle than the internet had made it seem, I was expecting almost like it "kick in" like a drug does, like your first couple of beers at 16 or something.

I can make decisions now, when something goes wrong with work or my car, all I need is facts and information and I can make a decision. I'm not taking days to decide to put rotors and pads on my car, or just pads. This was a very subtle change. Even with personal decisions, I just need to think for a little bit, and my mind is made up. This is something I did NOT expect.

I also don't stay "down" as much, like I've had a terrible past week with some just really unlucky things happening, but I bounced back quick.

I would NOT describe myself as depressed at all. Anxiety is better, not perfect, but I don't get those hot flashes of anxiety when I get embarrassed in public.

I usually have morning wood, erections are not a problem at all. It just works.

Sex drive is somewhat better, but could just be a little bit of stress holding me back.

I've gained weight, about 10 pounds I think? I haven't really lifted much weights, but I definitely added muscle, other's have said so too.

I also don't wake up super super thirsty anymore, and I don't urinate every 1.5 hours. I don't wake up with an emergency move out of my way need to urinate. This is a BIG life changer for me. I hated that.

Wow sorry that was really long.

No diabetes for me, my fasting glucose of 87 is concerning? My father was diabetic(passed away unrelated)

EDIT: What about a high anion gap? It seems as if that MAY be concerning.

 

[Vince]

high anion gap, this may help. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=anion_gap_blood

 

[johndoesmith]

high anion gap, this may help. https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=anion_gap_blood

Thank you for the link. It didn't really tell me anything new. Just kept saying "may be serious". "things can effect your results". Nothing really more. I have no idea if dehydration makes it higher or lower. Plus I was fasted, which appearently that changes it.

Does anyone notice anything else?

 

[CoastWatcher]

Just curious, what was your SHBG prior to treatment?

 

[johndoesmith]

Just curious, what was your SHBG prior to treatment?

35. Same range as this test.

That was 5 months ago. I hope it doesn't go any lower

 

[ERO]

Looks good to me. I would not adjust your TRT protocol at all based on this. Maybe just go back on the Vitamin D and up the B-12 a bit. Anion gap of 19 could mean a higher level of lactic acid present during the day of your test.

 

[johndoesmith]

Looks good to me. I would not adjust your TRT protocol at all based on this. Maybe just go back on the Vitamin D and up the B-12 a bit. Anion gap of 19 could mean a higher level of lactic acid present during the day of your test.

Thank you. I will start the vitamin d again, it was an experiment to see if I can get enough vitamin d from sunlight, guess not. Funny about b12, because I eat a lot of eggs and animal products. I will ask dr saya if I can try b12 injections, from what I've read, 200-350 levels are low enough to notice a benefit! I'm hoping I can gain a pretty noticeable difference.

I don't know much about lactic acid levels, but from what I've read a higher anion gap isn't a good thing. Are you saying a higher lactic acid level is not a big deal, just a fluctuation?

What do you guys think of my thyroid and glucose? I looked into thyroid levels before, and it seems like my levels are REALLY upper range, which I take as a good thing.

ANY input would be great.

 

[ERO]

Its just a guess, but I would think that if a person had a hard workout before a blood test one might have higher than normal lactic acid levels for a few hours. For example, I know that after a hard leg workout, one can some times show higher liver enzymes even for a couple of days. I would not worry about your anion gap score on just one test. If it was elevated on two or more tests then I would definitely ask the Doc about it. Dr. Saya visits this forum quite often and perhaps if he sees this thread he will weigh in on this.

 

[johndoesmith]

Its just a guess, but I would think that if a person had a hard workout before a blood test one might have higher than normal lactic acid levels for a few hours. For example, I know that after a hard leg workout, one can some times show higher liver enzymes even for a couple of days. I would not worry about your anion gap score on just one test. If it was elevated on two or more tests then I would definitely ask the Doc about it. Dr. Saya visits this forum quite often and perhaps if he sees this thread he will weigh in on this.

Well I can say that there was no strenuous workout the day, or even week before for me.

Fair enough. Dr saya is pretty frequent here, and if he doesn't happen to see this, I have a consult coming up soon with him anyway.

I am pretty happy with everything else!

I'm guessing it's getting sooner and sooner to donating blood time, right?

 

[Vince]

Thank you for the link. It didn't really tell me anything new. Just kept saying "may be serious". "things can effect your results". Nothing really more. I have no idea if dehydration makes it higher or lower. Plus I was fasted, which appearently that changes it.

Does anyone notice anything else?

[TABLE="class: components"]
[TR]
[TD="class: nameCol srchbl"]ANION GAP[/TD]
[TD="class: valueCol"]19 mmol/L[/TD]
[TD="class: rangeCol"]7 - 14 mmol/L[/TD]
[/TR]
[/TABLE]
That was my last one, after talking to my doctor. We came up with, overworking myself. I am very active and it has been very hot this year.

 

[johndoesmith]

[TABLE="class: components"]
[TR]
[TD="class: nameCol srchbl"]ANION GAP[/TD]
[TD="class: valueCol"]19 mmol/L[/TD]
[TD="class: rangeCol"]7 - 14 mmol/L[/TD]
[/TR]
[/TABLE]
That was my last one, after talking to my doctor. We came up with, overworking myself. I am very active and it has been very hot this year.

What do you mean by over working? Excercising, or employment work? I do work outside, not labor, but I do a lot of walking outside and it's been really hot on the east coast the past month or so. Especially hot and humid. We have dew points in the 70s most days.

Also, should I donate blood? I know I'm at 50, so still in range, and it seems like most people here recommend 51-52, so I guess that I should.

 

[Vince]

What do you mean by over working? Excercising, or employment work? I do work outside, not labor, but I do a lot of walking outside and it's been really hot on the east coast the past month or so. Especially hot and humid. We have dew points in the 70s most days.

Also, should I donate blood? I know I'm at 50, so still in range, and it seems like most people here recommend 51-52, so I guess that I should.

Personally, I would donate at 50 but like you said it's not necessary.

Very high dew point here to, for me it's both exercising and working in the heat.

 

[CoastWatcher]

While you're not at the point that a blood donation is required, you could get out ahead of things with a donation. And, as Dr. Saya has noted, blood is always needed - it's just a good thing to do.

 

[johndoesmith]

While you're not at the point that a blood donation is required, you could get out ahead of things with a donation. And, as Dr. Saya has noted, blood is always needed - it's just a good thing to do.

I just did actually. It didn't effect me as much as it used to before TRT. I would get pretty dizzy and feel the orthostatic hypotension when I'd stand up. I hate that pressure in your chest when that happens.

 

[CoastWatcher]

I just did actually. It didn't effect me as much as it used to before TRT. I would get pretty dizzy and feel the orthostatic hypotension when I'd stand up. I hate that pressure in your chest when that happens.

Glad it went well.

 

[Dr Justin Saya MD]

The anion gap is something that is typically only clinically relevant in the acute setting (very ill patients in the hospital with acidosis). In that setting, it gives clues to the cause of acidosis (decreased blood pH) - which can only be determined by an ABG (arterial blood gas, often by radial artery phlebotomy). The body has SO MANY mechanisms to control blood pH (acidic vs basic), that the normal blood pH varies only slightly under normal conditions...except in the case of severe/acute illness (sepsis, shock, severe dehydration, diabetic ketoacidosis, etc), when these mechanisms can fail or be overwhelmed, and the blood pH may be altered (acidic or basic) --- again only detectable through ABG.

In most outpatient settings, variations in the anion gap are typically just reflective of normal variations in electrolyte levels. In fact, the anion gap itself is just a CALCULATION of cations (positively charged electrolytes - Na+ and K+) minus anions (negatively charged electrolytes Cl- and HCO3-). The anion gap can (and will) fluctuate widely even throughout a given day, based on normal variation/fluctuation of cations/anions (electrolytes).

 

[johndoesmith]

The anion gap is something that is typically only clinically relevant in the acute setting (very ill patients in the hospital with acidosis). In that setting, it gives clues to the cause of acidosis (decreased blood pH) - which can only be determined by an ABG (arterial blood gas, often by radial artery phlebotomy). The body has SO MANY mechanisms to control blood pH (acidic vs basic), that the normal blood pH varies only slightly under normal conditions...except in the case of severe/acute illness (sepsis, shock, severe dehydration, diabetic ketoacidosis, etc), when these mechanisms can fail or be overwhelmed, and the blood pH may be altered (acidic or basic) --- again only detectable through ABG.

In most outpatient settings, variations in the anion gap are typically just reflective of normal variations in electrolyte levels. In fact, the anion gap itself is just a CALCULATION of cations (positively charged electrolytes - Na+ and K+) minus anions (negatively charged electrolytes Cl- and HCO3-). The anion gap can (and will) fluctuate widely even throughout a given day, based on normal variation/fluctuation of cations/anions (electrolytes).

So in other words, the human body tightly regulates pH very well. With the anion gap simply being one of 20 ways to adjust pH, there are other ways for your body to regulate it, so it's simply one measure of a highly highly complex system. Therefore just one piece of the puzzle.

I did call the office, and spoke to a patient care assistant who spoke to a nurse, and indicated the nurse said it's nothing to worry about.

Thank you for responding so quickly. I do have a consult scheduled for tomorrow with you, so we can talk about all of this in way more depth, as well as everything else.