proposed tests and timing: ruling out thyroid 16 weeks in to hCG mono

[Re-Ride]

Hi, Anything missing from this proposed test lineup (below last labs)?

62 y.o. d hypoG >20 yrs, no recent TRT, past gel
hCG mono beginning April 2015. baseline TotT 200-300 went to 700 in 6 weeks
Arimidex added in July, 1/4 2xWeek
diagnoses: hyperestrogenism, gyno, hypogonadism,metabolic syndrome with improvement,

I've undergone a battery of tests over the last two years complaining of severe fatigue. Oddly Testo of 199 wasn't flagged.

current lab results:

Kidney function creatinine and eGFR are stellar, no pulmonary issues, liver enzymes normal,
PSA 0.64, see prior post for full labs.

IGF I Somatomedin C

316H

(41-279 ng/mL

H)

Z SCORE: 2.1 (H)

Hemoglobin

15.5

(13.5-18.0 g/dL)

magnesium

2.2

(1.8-2.4 mg/dL)

Total cholesterol	211	mg/dL	H
Triglyceride	173	mg/dL	H
HDL cholesterol	45	mg/dL
LDL Calculated	131	mg/dL	H
Cholesterol to HDL Ratio	4.7
VLDL (Calculated)	35	5.0-40.0 mg/dL

test dates: 12/3/14 5/21/15

[TD="class: name fixed"]Average Glucose [/TD] [TD="class: scroll"]108 [/TD] [TD="class: scroll"] 97[/TD] [TD="class: buffer scroll"][/TD]

[TD="class: name fixed"]Hemoglobin A1c4.8 - 5.6 % [/TD] [TD="class: scroll"]5.4 [/TD] [TD="class: scroll"] 5.0[/TD]

The baseline from march was missing important hormone tests. I hope to obtain a differential diagnoses for fatigue and periods of reduced cognition, espc. mornings.

Past THYROID results:

[TH="class: name fixed"][/TH] [TH="class: scroll"]1/22/15(4pm) [/TH] [TH="class: scroll"]2/10/15[/TH] [TH="class: buffer scroll"](2pm) [/TH]

[TD="class: name fixed"]TSH 0.34 - 4.82 uIU/mL [/TD] [TD="class: scroll"]1.57[/TD] [TD="class: scroll"]2.71 [/TD]

(3rd generation Siemens)

[TD="class: nameCol srchbl"]T4 Free [/TD] [TD="class: infoCol"] -- 0.59 (1.61 ng/dL [/TD] [TD="class: importantCol"]0.81) [/TD]

Past LH:

[TD="class: nameCol srchbl"]2/10/15 2pm 3.4 ( [/TD] [TD="class: infoCol"]0.8 - 7.6 uIU/mL) [/TD] [TD="class: importantCol"][/TD]

Testosterone (baseline on 2/10 )

[TD="class: nameCol srchbl"]Testosterone Free [/TD] [TD="class: infoCol"] 35.0 (155.0 pg/mL [/TD] [TD="class: importantCol"]87.8)[/TD]

[TD="class: nameCol srchbl"]Testoserone, Total 298 (250 -1100 ng/dL) [/TD] [TD="class: infoCol"] [/TD] [TD="class: importantCol"][/TD]

after six weeks hCG mono: total: 693 (240 - 871 ng/dL) free not done

O.K. I've finally got in with a new internist who has a great reputation for male health. To get the most out of the this upcoming round I need to know time of day to test, fasting and what supplements to be off.

PROPOSED TESTS:

comp metabolic panel
comp blood count
lipids (fasting)
A1C
IGF1
PSA with Rflex to free (not seen this one)

TSH, T3,T4,Free T3,fT4,reverse T3, Thyroid peroxidase antibody

estrodiol and E2 LC/MS/MS
estradiol
Vit B12

Testosterone total and free, LH, FSH, prolactin

DHEA-S

SBGH

Missing DHT but advised to ask for it. Anything else t get?

note: I'm still not sure why I have been diag secondary hypo. Take a look at the pre-treatment FSH,LH in my earlier post
.
Re-Ride

 

[Vettester Chris]

On the thyroid, get both antibodies, TPO (as you noted), and TgAb.

Do you have a link to your previous LH & FSH labs? Or, just re-post those labs and what your baseline testosterone serum was? Thanks

 

[Re-Ride]

... get both antibodies, TPO (as you noted), and TgAb.

Do you have a link to your previous LH & FSH labs?...

Chris, How far back is meaningful to you? I have labs at least 4x yearly going back decades. I only started using the on line reporting in May. Any labs past -or present- from Labcorp, which I used since the 80's , are not entered in to this online service from my the clinic which has been treating me for the past four years. Seems to be a way of strong arming to use their in-house lab.

I signed up for Labcorp's online service but they only reported the last lab.

I suppose I can request archived files from my old clinic. It won't be easy but with my current knowledge I'm curious to see those.

Thanks for clarifying that I only had one of the two AB tests down.

For the record, the doc who first diagnosed the hypoG decades ago and prescribed T treated me for 30 years primarily for a complicated underlying condition. He pulled T regularly gut as I've previously noted never discussed use, side effects or serum goals.

About 2005 I started seeing a GP who took over the scripts for A-gel for six years. I only have T labs from him because I asked for them. As I've said I never connected T serum that ranged from 199 to 800? to any of my symptoms. Gyno was blamed on one of my meds. In 2011 I moved and was under the "care" of three more docs with complaints consistent with low T / hyperestrogenism, all of whom ignored the labs they had. If anyone thinks they have a tough time getting hormonal care try throwing a serious chronic condition in to the mix.

 

[ERO]

Unless your GP happens to be an expert in TRT (and most of them are not), you would likely be better of with a doc that specializes in up-to-date TRT treatments, as they know how to treat you with your other health issues as well. Defy Medical is a great resource (I have no affiliation with them) and your don't need to travel to Florida to use them. Good prices and most importantly, they know what they are doing. Your current docs are ignoring labs...

 

[Re-Ride]

Thanks ERO. That was the backround on how I got here. Friday I saw my new internist. Living in a rural area I must travel 150 mi to the City for both HRT and specialty care. The country GP and local endo will be relegated to writing scripts, signing forms and dispensing snake oil. I have yet to determine the extent of my new internist's knowledge on TRT but it seems extensive. He pursues experimental protocols backed by studies, recommends based on his own experience but let pt's call the shots.

Talk about ignoring labs... I received a copy of a routine UA a month late from Labcorp to years ago. Showed I had an infection. Neither my ID nor my former GP contacted me. It was a Fri so I called the country GP who was at that time my "primary care". He refused to call in an Rx because he "didn't order the lab to begin with". WTF!

All docs like most folks have something to offer. We just have to figure out what that is.