hCG mono at 7 months | | Thyroid eval?

[Re-Ride]

Thyroid interpretation requested too. Thanks!

Hi, due to circumstances beyond my control I was OFF my hCG mono therapy for 5 full days prior to this Nov draw. This explains ( I hope) the T at 116). How does that skew the other results?

Symptoms: morning fatigue, improving since hCG.

Serum draw 11/13/15 1:30 PM

note: values prior to April were pre-hCG

Testosterone Total 240 - 871 ng/dL 116 L

T3 Free 2.3 - 4.2 pg/mL 3.04 (was 3.66 on 9/8)

TSH 0.34 - 4.82 mIU/L 1.857 (2.187 on 9/8)(2.71 on 2/10)(1.57 on 1/22)

T4 Free 0.59 - 1.61 ng/dL 0.90 (1.01 on 9/8)(.81 on 2/10)

T3 Reverse 8 - 25 ng/dL 25 (9/8/15 only)

THYROID PEROXIDASE AB (TPO) <35 IU/mL <10 ( 9/8/15)

DHEA Sulfate 25 - 95 ug/dL 158 H ref rannge for my age group= 25-95 < or=185

DHEA-S has been returning v-high since hCG 442 in june, 569 in September

Hemoglobin A1c 4.8 - 5.6 % 5.1 ( 5.0 in May )

LDL Cholesterol Direct <130 mg/dL 114 ref = <100 mg/dL Optimal; 100-129 mg/dL Near or above optimal

Ferritin 26 - 388 ng/mL 112

Glucose 70 - 99 mg/dL 89 (not fasting)

Urea Nitrogen (BUN) 6 - 25 mg/dL 23

Creatinine 0.40 - 1.30 mg/dL 1.00

GFR Est-Other >60 See Cmnt 80

Calcium 8.2 - 10.2 mg/dL 9.2 (9.7 on 9/8)

Phosphorus 2.5 - 4.9 mg/dL 3.0

Magnesium 1.8 - 2.4 mg/dL 2.3

Total Protein 6.4 - 8.2 g/dL 6.9

Albumin 3.2 - 4.7 g/dL 4.1

Vitamin B12 211 - 911 pg/mL 827 (9/8/15 and fasting on supplementation)

Progesterone 0.3 - 0.9 ng/mL 0.7 **ON 9/8

Prolactin Male: 2.1-17.7 9 (18.1H*ON 9/8)

Platelet Count 150 - 400 K/uL 179

Blood cell count normal, all values mid normal range, incl hematocrit which had been 51 in Sept. MCH and MCHV are near upper limit of normal.

Diet: A protein source switch to a diet heavy in small oily fish harvested in cold northern waters, very low in red meat, high in grass fed organic kefir, yoghurt and cheese, organic grass fed eggs has dramatically improved LDL cholesterol and glucose. Lovaza alone could not do this. I still take 1-2 caps/day. Age: 60+

 

[Vince Carter]

My opinion is that that all seems rather worthless having been off your protocol for 5 days and going ahead with the testing. I wouldn't draw any conclusions from it. I do think your Thyroid values seem to be all over the place. But again I wouldn't draw a conclusion from it, I'd rather see testing in repeatable times and conditions, everything nice and stable is the only way to make comparisons to each other. I noted this test was @ 1330 well in to the day when I'd prefer a fasting state first thing in the morning.

Just my opinions.

 

[Gene Devine]

Why did you stop HCG 5 days before your pull?

As an FYI, HCG mono-therapy is not very successful in many men and they eventually convert to Testosterone to get serum levels up to healthy levels.

DHEA is high because HCG as an LH analog is responsible for activating the P450scc enzyme that converts Cholesterol into Pregnenolone into DHEA.

 

[Re-Ride]

edit: The timely responses above were shared with the lab. They were gracious and will likely redo those tests.
__

Thanks guys. Gene, I've been looking for an explanation on the high DHEA-s since summer. None of my docs knew that. Put that gem in the hCG sticky!

Are any of the results meaningful at all? The docs and lab knew about the hCG treatment interruption. There are a lot more tests that haven't come back. Maybe I can cancel them.

Funny, the doc who ordered tot T is up in the City. He'd written "before 9 am" on that one. The lab tech when she called but said to go ahead with the draw on the rest except lipid panel. Since T is a function of hours since last injection I didn't think draw time made a difference but he does.

As far as pp saying hCG mono doesn't work, well it sure has for me with T close to 700 in the recent past.

 

[Gene Devine]

Thanks guys. Gene, I've been looking for an explanation on the high DHEA-s since summer. None of my docs knew that. Thanks. Put that gem in the hCG sticky!

Are any of the results meaningful at all? What a waste of $$$$ ! I will not be able to get any of these repeated except for the garden metobolic panel and tot T. The docs knew about the hCG treatment interruption but insisted I get tested right there in the endo's office. There are a lot more tests that haven't come back. Maybe I can cancel them.

Funny, the doc who ordered tot T is up in the City. He'd written "before 9 am" on that one. Would not release the T order to the lab tech when she called but said to go ahead with the draw on the rest except lipid panel. Since T is a function of hours since last injection I didn't think draw time made a difference but he does.

As far as pp saying hCG mono doesn't work, well it sure has for me with T close to 700 in the recent past.

All you labs are meaningful maybe with the exception of your testosterone levels. HCG has a very short half life so 5 days off will see your serum levels lowered as well.

You may want to get Total and Free T tested again but the other are all still relevant.

BTW, many don't know about HCG activating the P450scc enzyme and what it do. Pregnenolone and DHEA are the two foundational hormones from which ALL others are made by. Both need to be at optimal levels especially as we age and/or are on TRT.

 

[Re-Ride]

Gene, if the assays are valid then what do that say about my thyroid?

I often have morning fatigue and get sleepy after eating. About the only thing I haven't done is a cortisol study.

If high DHEA of 450 to 550 is a given for me and your statement that pregnenalone must be at an "optimal level" relative to DHEA then what are my serum goals f 700 is my T-target ?

 

[Vettester Chris]

Re-Ride .. Your adrenals need to be your first area to address. I think you will find this to be the culprit for some of the issues you are dealing with; primarily addressing your thyroid. Here's some markers for my talking points ...

1) Reverse T3! This lab is better served to compare ratios against its ATP producing counterpart, Free T3; more so than just reviewing serum levels. When primary issues like cortisol or iron/ferritin imbalances are evident, T4 will convert higher to higher levels of RT3, as opposed to FT3 (Free serum). This is a great regulating process in our body to yield FT3 production when it is not adequately getting into the cells of the body. Cortisol (or the glucose thereof) and iron & ferritin are two (2) of KEY items needed for this to happen. I personally call them both transport agents.

Imbalances of these items, and even to a degree with others like D3 & certain electrolytes will hinder FT3 from getting to the body. The simple method to check this is comparing FT3/RT3 ratios. You're looking for the ratio of RT3/FT3 to be 20 or higher (or even > 25 is better yet IMO). Your ratio is 14.6.

2) Real quick on the subject of FT4 and FT3 .. Ideally, you're hoping that both of these labs are hovering in similar areas of their respective reference ranges (not always, there's exceptions). On yours, your FT4 is something around 42% of Ref Range, but your FT3 is around the 73% of ref. range. Again, this variance is common in higher RT3 conversion rates, where FT3 "Pooling" is evident.

3) Your DHEA presents the possibility that your adrenals are at an early "Stress Adapted -Hyper Response" adrenal stage (Stage 1), or possible Stage 2, where Stress is adapted an ACTH divergence; keeping pace with the cortisol demand, but in later maladaptation stages this will decrease, and then the demand for pregenolone will start being problematic with the production of other hormones throughout/downstream with the endocrine system, aka Pregnenolone Steal.

The increased DHEA is your marker that you need a complete review of your adrenals, 4 x saliva kit, which at that time needs to be compared with a saliva DHEA lab to compare the current correlation. This is also the time to review the pituitary related ACTH assay. Again, DHEA will keep pace with increasing cortisol only to a point. Dr. Lam has quite a bit of information on this. To conclude, the 4x saliva kit will provide the circadian profile graph (or I can put one together for you), which might enlighten why you feel some of these "sluggish" sensations at certain times of the day.

FYI, your ferritin is where you want it, hovering a bit over 100ng/dl. Would like to see your iron serum and TIBC. TPO antibodies were covered, looks great! Just to be safe, TgAb should be covered as well to rule out both enzyme and protein autoimmune disorders. There's obviously other talking points with other labs, but that's my .02 for tonight. Will keep in touch ... Best!!

 

[Gene Devine]

Re-Ride .. Your adrenals need to be your first area to address. I think you will find this to be the culprit for some of the issues you are dealing with; primarily addressing your thyroid. Here's some markers for my talking points ...

1) Reverse T3! This lab is better served to compare ratios against its ATP producing counterpart, Free T3; more so than just reviewing serum levels. When primary issues like cortisol or iron/ferritin imbalances are evident, T4 will convert higher to higher levels of RT3, as opposed to RT3. This is a great regulating process in our body to yield FT3 production when it is not adequately getting into the cells of the body. Cortisol (or the glucose thereof) and iron & ferritin are two (2) of KEY items needed for this to happen. I personally call them both transport agents.

Imbalances of these items, and even to a degree with others like D3 & certain electrolytes will hinder FT3 from getting to the body. The simple method to check this is comparing FT3/RT3 ratios. You're looking for the ratio of RT3/FT3 to be 20 or higher (or even > 25 is better yet IMO). Your ratio is 14.6.

2) Real quick on the subject of FT4 and FT3 .. Ideally, you're hoping that both of these labs are hovering in similar areas of their respective reference ranges (not always, there's exceptions). On yours, your FT4 is something around 42% of Ref Range, but your FT3 is around the 73% of ref. range. Again, this variance is common in higher RT3 conversion rates, where FT3 "Pooling" is evident.

3) Your DHEA presents the possibility that your adrenals are at an early "Stress Adapted -Hyper Response" adrenal stage (Stage 1), or possible Stage 2, where Stress is adapted an ACTH divergence; keeping pace with the cortisol demand, but in later maladaptation stages this will decrease, and then the demand for pregenolone will start being problematic with the production of other hormones throughout/downstream with the endocrine system, aka Pregnenolone Steal.

The increased DHEA is your marker that you need a complete review of your adrenals, 4 x saliva kit, which at that time needs to be compared with a saliva DHEA lab to compare the current correlation. This is also the time to review the pituitary related ACTH assay. Again, DHEA will keep pace with increasing cortisol only to a point. Dr. Lam has quite a bit of information on this. To conclude, the 4x saliva kit will provide the circadian profile graph (or I can put one together for you), which might enlighten why you feel some of these "sluggish" sensations at certain times of the day.

FYI, your ferritin is where you want it, hovering a bit over 100ng/dl. Would like to see your iron serum and TIBC. TPO antibodies were covered, looks great! Just to be safe, TgAb should be covered as well to rule out both enzyme and protein autoimmune disorders. There's obviously other talking points with other labs, but that's my .02 for tonight. Will keep in touch ... Best!!

^^^^This is why Chris is our resident Thyroid expert!!!

 

[Vettester Chris]

^^^^This is why Chris is our resident Thyroid expert!!!

LOL, I did stay at a Holiday Inn Express the other week Thanks!!

Actually, it's just a lot of compounded information that gets digested when read over and over, and over, etc... The adrenal-thyroid correlation is actually very fascinating, and sadly I think it is immensely less understood than even TRT, which many here can attest to with their stories of GPs and endos not knowing JACK about hormones; thus the birth of the specialty providers like Defy. Back to the thyroid & adrenals ... Anyone looking to learn more, just gravitate towards Dr. Lam, Dr. James Wilson (not the House guy), Dr. Uzi Reiss, Dr. Rind, & Dr. Broda Barnes. Much of it is referenced over at STTM.com .. Plus of course, personal experiences & trials/tribulations help with the learning process!

 

[Re-Ride]

Chris, thank you again for taking the time to reply as you have. The TIBC test is in-process and should be resulted soon. reverse T3 from the same 13NV sample has been added back. It doesn't look like the doc ordered iron serum.

DHT, pregnenalone, progesterone, prolactin, IGF-1 I have standing orders for. They were all done recently but not on 11/13. IF, for some reason they need to be run on the 11/13 sample for better interpretation of the results in post #1 then I have about a day to request it from an add-on sample the lab retains. Otherwise can run at my next T in a few weeks.
Any other tests missing?

IGF-1 Somatomedin C was run pre-hCG back in feb and it was high, 316 (41-279 ng/ml)
It was 285 H on 9/8/15.

 

[Vettester Chris]

Chris, thank you again for taking the time to reply as you have. The TIBC test is in-process and should be resulted soon. reverse T3 from the same 13NV sample has been added back. It doesn't look like the doc ordered iron serum.

DHT, pregnenalone, progesterone, prolactin, IGF-1 I have standing orders for. They were all done recently but not on 11/13. IF, for some reason they need to be run on the 11/13 sample for better interpretation of the results in post #1 then I have about a day to request it from an add-on sample the lab retains. Otherwise can run at my next T in a few weeks.
Any other tests missing?

IGF-1 Somatomedin C was run pre-hCG back in feb and it was high, 316 (41-279 ng/ml)
It was 285 H on 9/8/15.

The number 1 lab IMO would be getting a 4x Saliva Cortisol Test w/DHEA Correlation. Get that, let's see the circadian profile, total burden results, DHEA/cortisol correlation analysis. Would be good to include ACTH to see how the feedback loop is performing.

Are you taking any glucocorticoid medications like Prednisone, or anything of that nature? Just add an iron-serum to the list when you can, it's good to know ...

 

[Re-Ride]

No, I am not taking any glucocorticoid Chris. My supplements are fairly limited at the moment too. My doc is willing to order cortisol 24 hour. Can I get this at Labcorp or Quest? I will tell my endo about the DHEA to HCG connection. Obviously there is a correlation to how much hCG I take and serum levels of DHEA. In my case the production doesn't seem to be part of an adrenal over-stimulation feedback loop (if I've got your drift correctly). I will get the tests you recommend, entertain the theories and sign on to a reasonable protocol with my doc's approval. Thanks again Chris!

 

[Vettester Chris]

ReRide, you can obtain the kit through Canary Club or ZRT. http://www.canaryclub.org/adrenal-stress-cortisol-dhea-hormone-profile.html

They provide some pretty good detailed feedback, including the circadian graph that I spoke about. When you get it, just scan/copy it into your thread, it will be easy to decipher from there. The DHEA-S will be beneficial to help determine a correlation analysis, which works on the Noon & 6PM Cortisol data in conjunction with the DHEA-S result. I can help you plot that on a correlation chart and provide some insight.

Keep in mind, I think this is GREAT forum conversation, and much of what we discuss here is using a lot of scientific methods that some of the best physicians in the know are using everyday. However, please consult and crosscheck anything that's mentioned here with your endo. Like TRT, adrenal issues can be primary or secondary related, so it's critical that a good physician is factoring everything in conjunction with data from your results. Sounds like you've got this covered, and maybe your doctor will get even more familiar with what some of these other physicians (like Dr. Wilson) are doing(?) ...

 

[Vettester Chris]

ZRT labs also has this combination kit .. I think Canary and ZRT are linked together on the diurnal testing, I could be wrong?

 

[Re-Ride]

Chris, lots of gratitude for your input. I'm learning about the effect of hCG on other hormones from this treatment interruption. Prolactin was done with this set and it halved. Hematocrit dropped from 51 to mid-range normal. As a side note hCG practically eliminated a painful eczema or psoriasis on my elbows. None of my docs are trained in thyroid ratio theory. They are open-minded and supportive however. I will get the cortisol study.

I've been toying with the idea of temporarily withdrawing the hCG for 6 weeks with the help of a "PCT" protocol to see where my natural T is at this point. I know "pct" has nothing to do with valid TRT but hCG mono is different in many respects. Anyone have thoughts on this? I'm still unclear as to why the high intratesticuar E2, reported to be up to 10X normal on hCG, is an issue.

 

[Re-Ride]

Delayed result from Nov 13 draw:

T3 Reverse 8-25 ng/dL 23

Iron 35 - 150 ug/dL 114

Total Iron Binding Capacity (TIBC) 250 - 450 ug/dL 348

Iron % Saturation 20 - 50 % 33

New Dec 1 draw (T not yet resulted):

Phosphorus 2.5 - 4.9 mg/dL 3.1

 

[Re-Ride]

A little over two weeks post treatment interruption and total T resulted 725 ng/dL. T-cyp still not indicated. Chris, i will proceed with the cortisol testing and report back here as soon as i am able.

 

[Re-Ride]

My primary had me consult an "eminent and highly regarded" endo in SF re the DHEA and thyroid tests. The endo began the consult by asking me why I was there. Aside from what was stated in the referral I indicated an interest in seeing how he might manage my endocrine care.

He responded: "Pt do not choose me I choose my pt's" I was informed how well off financially he had become, what a nice home he has and that he had come out of retirement "out of boredom not need".

Here are his conclusions/recommendations:

-DHEA is normal

-Thyroid normal

-serum T is "too high, exposing me to almost certain heart attack, blood clots and prostrate cancer and should be 300 - 400"

- hematocrit is dangerously high. It was well under 47 (40-52%)

- no evidence of high cortisol, all these tests have been a waste of money

- hCG is an FSH analog ( not a leutinizing hormone hormone )

[" I do not prescribe hCG. I treat major league players. I keep my prescribing history clean."]

[" hCG does not raise testosterone levels" ]

[" I will be recommending that you be removed from hCG therapy"]

["hCG does not shut down the HP axis"]

Uh doc, was it the Lovaza or the sardines that raised my T from 300 to 700 last April?

Perhaps the Eyecaps caused my T to suddenly drop to 114 last month when hCG was withdrawn while something I ate caused its return to 725 two weeks later? Merely coincidental to hCG?

I don't understand why you want to put me back on Androgel after failure. What about the bone loss, severe fatigue, mind fog, gyno, loss of muscle I've suffered in the past? What is a proper serum goal for estradiol?

["None of that is related to Androgel. I've treated at least a thousand men for TRT and never once tested for estradiol. You can have injections once a month or every two weeks but I'm not going to allow a T level anywhere near the 700 range"]

Can I have a small amount of hCG in conjunction with exogenous testosterone to preserve my testicular function?

["Absolutely not! There is no legitimate use of hCG in treating hypogonadism if you even have it which I doubt" "hCG is also far too costly to prescribe" ( but his fees are reasonable ) ]

[" I do not practice cosmetic medicine. Even if hCG could restore testicular mass while receiving T therapy that is not a legitimate medical use"]

How unfortunate that privacy issues prevented me from snapping photos of his sickly patients in the waiting room...
Yes, you too can look and feel like death warmed over for the low low price of $400 per visit.

It is high time that men unite under a national advocasy to demand sound medical treatment not charlentenism. Health insurance reform in the absence health care reform will never work.

 

[CoastWatcher]

Sad...very sad. But there are good doctors, doctors who understand how androgen replacement is simply one, key part of men's health. If such a doctor can't be found locally, I urge you to consider Defy Medical. No, I am not a patient, I have spoken to them, but have good local care (I would not hesitate to engage their services if such care was not available). Their telemed model works. Contact them and ask whatever you feel is appropriate- you deserve quality care.

 

[Nelson Vergel]

Re-ride

Wow! Your last post is full of misconceptions from that endo. I would look for another doctor who is up-to-speed in the latest data of HCG +TRT.

Here are my comments:

-serum T is "too high, exposing me to almost certain heart attack, blood clots and prostrate cancer and should be 300 - 400"

WRONG. YOUR TT IS OK AS LONG AS HEMATOCRIT AND ESTRADIOL ARE UNDER MAX ALLOWED.

- hematocrit is dangerously high

WHAT IS IT?

- no evidence of high cortisol, all these tests have been a waste of money

YES, AND NO. ADRENAL INSUFFICIENCY CAN BE TESTED FOR. HE MAY NOT BE AN ADRENAL EXPERT.

- hCG is an FSH analog ( not a leutinizing hormone hormone )

WRONG. IT IS AN LH ANALOG.

[" I do not prescribe hCG. I treat major league players. I keep my prescribing history clean."]


CLEAN? THERE IS NOTHING ILLEGAL ABOUT HCG USE IN MEN WITH HYPOGONADISM.

[" hCG does not raise testosterone levels" ]

YES, IT DOES. PROVEN BY MANY STUDIES.

[" I will be recommending that you be removed from hCG therapy"]

RUN AWAY!

["hCG does not shut down the HP axis"]

YES, IT DOES.

Uh doc, was it the Lovaza or the sardines that raised my T from 300 to 700 last April?

OMEGA 3'S ARE SUPPORTIVE BUT DO NOT INCREASE T TO THAT MAGNITUDE.

Perhaps the Eyecaps caused my T to suddenly drop to 114 last month when hCG was withdrawn while something I ate caused its return to 725 two weeks later? Merely coincidental to hCG?

NOT A COINCIDENCE

I don't understand why you want to put me back on Androgel after failure. What about the bone loss, severe fatigue, mind fog, gyno, loss of muscle I've suffered in the past? What is a proper serum goal for estradiol?

BECAUSE HE MAY HAVE A DEAL WITH ABBIE

["None of that is related to Androgel. I've treated at least a thousand men for TRT and never once tested for estradiol. You can have injections once a month or every two weeks but I'm not going to allow a T level anywhere near the 700 range"]

RUN AWAY!

Can I have a small amount of hCG in conjunction with exogenous testosterone to preserve my testicular function?

["Absolutely not! There is no legitimate use of hCG in treating hypogonadism if you even have it which I doubt" "hCG is also far too costly to prescribe" ( but his fees are reasonable ) ]

UMM...HE OBVIOUSLY DOES NOT READ PAPERS. Two Studies That Used HCG with Testosterone
[" I do not practice cosmetic medicine. Even if hCG could restore testicular mass while receiving T therapy that is not a legitimate medical use"]

BS. HCG GOES BEYOND INCREASING TESTICULAR SIZE. WHAT A MORON!