Thoughts on blood work please...

[MonsterFish]

Hi guys,

Following symptoms including low libido, fatigue, anxiety, inability to build muscle etc. I recently got some bloods drawn. I have attached the results. One from about 4 weeks ago and 1 from this week.

Any thoughts/comments are greatly appreciated.

 

[CoastWatcher]

Well, you're definitely hypogonadal. What's of striking interest is your sky-high SHBG. It's clearly binding your free testosterone, which doesn't appear to have been repeated in the second test (why?). You made some general comments about how you're feeling, but can you tell us more? How long have you had the issues you presented with? Any history of steroid use? What medications and supplements are you taking?

 

[Vince Carter]

What country are you in?

 

[Vince Carter]

Well, you're definitely hypogonadal. What's of striking interest is your sky-high SHBG. It's clearly binding your free testosterone, which doesn't appear to have been repeated in the second test (why?). You made some general comments about how you're feeling, but can you tell us more? How long have you had the issues you presented with? Any history of steroid use? What medications and supplements are you taking?

Secondary, right? His LH is subterranean.

 

[MonsterFish]

What country are you in?

I'm from the UK

 

[MonsterFish]

Well, you're definitely hypogonadal. What's of striking interest is your sky-high SHBG. It's clearly binding your free testosterone, which doesn't appear to have been repeated in the second test (why?). You made some general comments about how you're feeling, but can you tell us more? How long have you had the issues you presented with? Any history of steroid use? What medications and supplements are you taking?

The two tests were taken by different labs. The first was taken via a third party private HRT company, the second was requested by myself direct from a testing company (to avoid paying a fee to the third party for the privilege). My understanding that the Free Androgen Index ratio is this labs version of a Free Test score ie. its calculated on Total Test and SHBG in some way.
I've always had a fairly meek personality, potentially never possessing high testosterone levels however what I would classify as symptoms have really been most noticeable over the past couple of years. I've been skinny and fat over the years but have never carried any muscle mass. I've been hitting the gym hard over the past 18months (weight training using progressive overload) or so and have got in reasonable shape but still have been unable to put on any noticeable muscle. About 18 months ago I also cleaned up my diet, eating more fruit & veg and getting plenty of protein etc to try and help have more energy but it hasn't solved the issues.
Generally I feel fatigued most of the time and anxious in social situations etc. I never seem to get a good nights sleep, always tired in the morning despite how long I've spent in bed. I have very little libido. I have had intercourse with my partner about once in 2017, which is causing strain as you can imagine. No morning wood to speak of.Not sure what else to add but happy to supply any other info needed.
No history of any steroid use. No medications.
Currently and for the past 18 months or so I take the following supplements daily;
Vitamin D - 7500iu
Omega 3 - 760mg
Multi Vitamin
Creatine - 5000mg
Occasionally I'll have some green tea extract and/or Turcumin.

 

[MonsterFish]

Bump.

I am meeting with an endocrinologist in 24hrs. Any further insight into what may be going on here or what I should highlight/ask about is greatly appreciated as I am unsure how knowledgeable they will be.
Here in the UK they are very reluctant to prescribe TRT so I just want to be in the best position to argue my case as possible. Thanks

 

[Vince Carter]

We have a few UK guys around here maybe they'll come around in a bit.

 

[CoastWatcher]

Where in the United Kingdom do you live? Can you pursue private care? We know of some clinics that provide first-rate care.

 

[MonsterFish]

Yes private care is an option. I am just visiting an endocronologist to see what the NHS options are and to get their view on my results. Private is an option via online methods but I am keen to speak to someone face to face also.

I am more curious as to what people think of my bloods in general...not treatment options in the UK as such.

Do people agree that secondary hypogonadism is the correct diagnosis?
Is it unusual that my LH is so low but FSH in 'normal range'?
Should I be looking to take something specifically to lower my very high SHBG? or is this likely to come down over time with standard test+hcg treatment?
Do I look like a candidate for HCG monotherapy or standard TRT?
Is there anything else unusual about my results that I should investigate?

 

[CoastWatcher]

When we speak of secondary hypogonadism we only mean the problem isn't testicular in nature; the issues lie somewhere else. The pituitary, some other axis problem, possibly rooted in a thyroid irregularity, or cortisol. That said, your labs suggest that it is secondary hypogonadism. Your LH being low and your FSH being below the midrange means your body is not signaling for those hormones in excessive amounts. Your testicles are fine.

You can't really raise or lower SHBG, you play the hand you're dealt. Injections of androgen typically lower it, and if you were to initiate TRT larger, less frequent doses of testosterone would probably be prescribed.

There are more tests needed before any therapy should start. Have you ever had a full thyroid workup? Not just TSH, but ft3, ft4, rt3, and both antibody panels? Your history suggests issues long in the making; I would certainly zero in on thyroid. Many men complain of TRT failure but never have their thyroid evaluated. I'd also look at prolactin, at a minimum.

 

[MonsterFish]

When we speak of secondary hypogonadism we only mean the problem isn't testicular in nature; the issues lie somewhere else. The pituitary, some other axis problem, possibly rooted in a thyroid irregularity, or cortisol. That said, your labs suggest that it is secondary hypogonadism. Your LH being low and your FSH being below the midrange means your body is not signaling for those hormones in excessive amounts. Your testicles are fine.

You can't really raise or lower SHBG, you play the hand you're dealt. Injections of androgen typically lower it, and if you were to initiate TRT larger, less frequent doses of testosterone would probably be prescribed.

There are more tests needed before any therapy should start. Have you ever had a full thyroid workup? Not just TSH, but ft3, ft4, rt3, and both antibody panels? Your history suggests issues long in the making; I would certainly zero in on thyroid. Many men complain of TRT failure but never have their thyroid evaluated. I'd also look at prolactin, at a minimum.

When I mentioned lowering SHBG, I meant medically via Proviron or such.
When you say larger less frequent injections would be prescribed, do you mean these would be optimal for me for some reason? or just that that is the most often prescribed protocol?

I've attached further blood work taken over the past 6 months. Didn't add it previously as I am unsure what is relevant. (

 

[MonsterFish]

Just met with the endocrinologist. Wasn't willing to accept that testosterone could be an issue. Wouldnt even look at the 2 independent tests that I provided. Only looked at an older test taken with my doctor showing a 16.1 total test score.
Advises I talk with my doctor about meds for fatigue and anxiety and viagra for sex issues.
Very disappointing.
Not sure how to move forward from here.