Peculiar Blood Results - any ideas?

[MunchEase]

Hey guys and thank you for your time.

I am a 23 year old who signed up for TRT a year ago. I was hovering around 320 ng/dl. I tried Clomid but it murdered my already low sex drive, so I caved and started. I know the qualms of being on TRT at such a young age, but with dealing with a whole whack of other health issues, I didn't want low T on top of everything! I do plan to (hopefully) come off when everything else is in order. Thanks to Nelson for the informative Google hangout last night!

Current protocol:

4 pumps Androgel 1% daily
250 iu HCG every 3 days
Extremely clean diet, as well as vitamin supplementation

My recent bloodwork:
(I had blood drawn 24 hours after last Androgel application, 2 days after HCG injection):

Testosterone: 20.1 nmol/L / 580 ng/dl (8.0-29.0)
Free Testosterone: 326 pmol/L (175-700)
SHBG: 52 nmol/L (10-55)
DHEA: 7.2 umol/L (2.2-13.0)
Progesterone: 2.4 nmol/L (0.0-3.0)
Estradiol: (non-sensitive, they don't have it in Canada): 49 pmol/L (0-160)
FSH: 11 IU/L (1-18)
LH: 3 IU/L (1-9)
Prolactin: 14 ug/L (0-15)
AM Cortisol: 9.2 ug/dl (10-20)


So I guess I am wondering -

A) Why is my SHBG so high? It always comes in high. I think that's what is affecting my free testosterone. My doctor said it was caused by alcohol, but I haven't drank in months.

B) My cortisol is low, as well as my DHEA (for someone of my age) - does this suggest adrenal fatigue?

C) Isn't LH/FSH supposed to be zero on TRT?

D) Anyone have any speculations?

I didn't get thyroid labs done this time, but they were always relatively normal.

THANK YOU!

 

[maxadvance]

Hcg has ZERO effect on LH

 

[MunchEase]

That's why I'm on this forum

 

[CoastWatcher]

Hey guys and thank you for your time.

I am a 23 year old who signed up for TRT a year ago. I was hovering around 320 ng/dl. I tried Clomid but it murdered my already low sex drive, so I caved and started. I know the qualms of being on TRT at such a young age, but with dealing with a whole whack of other health issues, I didn't want low T on top of everything! I do plan to (hopefully) come off when everything else is in order. Thanks to Nelson for the informative Google hangout last night!

Current protocol:

4 pumps Androgel 1% daily
250 iu HCG every 3 days
Extremely clean diet, as well as vitamin supplementation

My recent bloodwork:
(I had blood drawn 24 hours after last Androgel application, 2 days after HCG injection):

Testosterone: 20.1 nmol/L / 580 ng/dl (8.0-29.0)
Free Testosterone: 326 pmol/L (175-700)
SHBG: 52 nmol/L (10-55)
DHEA: 7.2 umol/L (2.2-13.0)
Progesterone: 2.4 nmol/L (0.0-3.0)
Estradiol: (non-sensitive, they don't have it in Canada): 49 pmol/L (0-160)
FSH: 11 IU/L (1-18)
LH: 3 IU/L (1-9)
Prolactin: 14 ug/L (0-15)
AM Cortisol: 9.2 ug/dl (10-20)


So I guess I am wondering -

A) Why is my SHBG so high? It always comes in high. I think that's what is affecting my free testosterone. My doctor said it was caused by alcohol, but I haven't drank in months.

B) My cortisol is low, as well as my DHEA (for someone of my age) - does this suggest adrenal fatigue?

C) Isn't LH/FSH supposed to be zero on TRT?

D) Anyone have any speculations?

I didn't get thyroid labs done this time, but they were always relatively normal.

THANK YOU!

How, at this point, are you feeling? I suspect you aren't absorbing the topical gel as as you and your doctor would ilke.

 

[ERO]

Very high SHBG and very low SHBG (like I happen to have) are most likely genetic in origin as the so-called causal factors often do not apply at all. (Example: guys with low SHBG are *supposed* to all be fat and diabetic) That said, topical T has a low overall success rate - many guys do not absorb it well and switch to twice weekly shots. You seem to absorb it fairly well for now, but injections are the preferred choice for most, not all, but most guys. By getting a higher dose of T via shots, you may be able to lower your SHBG and thereby get more Free T over time.

 

[MunchEase]

How, at this point, are you feeling? I suspect you aren't absorbing the topical gel as as you and your doctor would ilke.

Coast Watcher, you're always hanging out here! Overall, my gym performance is relatively normal and my muscle growth is still doing alright. I have zero libido/morning wood, but when my girlfriend is around it fires right up, so doing okay! I am 23, so less likely to TRULY suffer in that department.

I am, however, having a whole variety of symptoms, such as chronic fatigue (sleeping for 12 hours and still feeling tired), sporadic bouts of depression/anxiety (independent from life events), inability to focus, brain fog, blurred vision at times, nausea, among other things. I think the Low T is just a symptom of some other piece of the puzzle I haven't cracked! Even paid $1500 for an MRI to rule out the tumor (when my urinary cortisol came in triple the normal range). Quite certain it has something to do with my adrenals.

As for switching to injections, I am certain I would notice an improvement, but I think they would be much more difficult to eventually bounce back from (I could be wrong). With my testosterone in a sub-optimal, but functioning state, I think it's better to leave as is for now (as my LH and FSH apparently aren't fully suppressed).

 

[MunchEase]

Very high SHBG and very low SHBG (like I happen to have) are most likely genetic in origin as the so-called causal factors often do not apply at all. (Example: guys with low SHBG are *supposed* to all be fat and diabetic) That said, topical T has a low overall success rate - many guys do not absorb it well and switch to twice weekly shots. You seem to absorb it fairly well for now, but injections are the preferred choice for most, not all, but most guys. By getting a higher dose of T via shots, you may be able to lower your SHBG and thereby get more Free T over time.

Hmm, that is interesting. But I always use to hover around the 32-36 range for the first four times I drew blood. It has only been in the past five months (last three blood tests) my SHBG has made the jump to about 50 every time.

 

[Nelson Vergel]

It is interesting that you still have so much LH and FSH left even on TRT+HCG.

A higher TRT dose may decrease SHBG. I echo what ERO said about SHBG.

Have you had a sleep study or a complete thyroid panel (TSH, free T3, free T 4 and possibly antibodies) ?

One serum cortisol is not enough to diagnose adrenal insufficiency.

How are your hematocrit, body weight/height, stress/mood?


Fatigue- When Testosterone Is Not Enough

 

[MunchEase]

It is interesting that you still have so much LH and FSH left even on TRT+HCG.

A higher TRT dose may decrease SHBG. I echo what ERO said about SHBG.

Have you had a sleep study or a complete thyroid panel (TSH, free T3, free T 4 and possibly antibodies) ?

One serum cortisol is not enough to diagnose adrenal insufficiency.

How are your hematocrit, body weight/height, stress/mood?


Fatigue- When Testosterone Is Not Enough

I didn't get thyroid done this time, but have had the thyroid panels done three times and it was always relatively okay.

It is interesting you mention the sleep study - my girlfriend says I don't snore at all, but I grind the hell out of my teeth at night. Like she can hear it.

I have repeatedly done various cortisol tests, and oddly enough it is usually through the roof. The last two 24 hour urinary cortisol tests I did rang in at 430 and 560 on a scale of (100-380). Saliva test in the past reflected it was elevated. The fact that it's low now is odd.

Hematocrit is normal.

Body weight/height is normal. I am 182 lbs, 6 feet, and have a seriously unfair set of genetics - I could not workout and still have muscle definition and a six pack. I am an MMA fighter, haven't been able to compete until my medicals are sorted out, but my gym performance isn't too impacted.

Mood is all over the place. Not an angry person, but bouts of severe major depression and anxiety come completely independent of life events. I have been biohacking this issue with my DNA report, noticing a bunch of predispositions to mental illness in my genes. 23andme is definitely something everyone suffering from medical issues should look into!

 

[ERO]

High morning cortisol - first thing I would go and get a 4-tube Cortisol test as that tests your levels when you get up, around noon, around dinner and around 11-midnight. This gives a far more accurate picture of your true cortisol production. What is often found is that a person can get their healthy pattern turned backwards. For example (simplified) cortisol is supposed to be higher when you get up to get you going and then lowest at night when you are sleeping - but due to stress and other things, one can get so they have a cortisol spike at night and then be low during the day...the 4-tube test will help tell you and your Doc what is going on.