Week to Week Journal

[lamplight]

Hello, all.

I'm excited to finally get going with Defy medical. I'm 30 years old, but I've been off testosterone since 2011/2012(24/25) - When the issue was found by PCP.

Height: 6'3"

Weight: 220

Back then my levels were around 300ish but seem like my levels have taken a pretty steep decline. Due to an intense custody battle, I did not have the funds to continue treatment + I was a college student.

But here I am now. Once I got the results back I was not surprised to see the low level. I've always felt like crap but just dealt with it.

My question to you guys is, what other information should I have prepared so that Dr. Saya can assess the situation quickly?

Any tips?


Thank you so much! - I'm super excited about taking care of my health.


Testosterone, Free and Total
Testosterone, Serum 149 Low ng/dL 264 - 916 01

Adult male reference interval is based on a population of
healthy nonobese males (BMI <30) between 19 and 39 years old.
Travison, et.al. JCEM 2017,102;1161-1173. PMID: 28324103.

Free Testosterone(Direct) 6.6 Low pg/mL 8.7 - 25.1 02
DHEA-Sulfate 259.8 ug/dL 138.5 - 475.2 01
TSH 4.190 uIU/mL 0.450 - 4.500 01
Luteinizing Hormone(LH), S
LH 3.9 mIU/mL 1.7 - 8.6 01
Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 0.8 ng/mL 0.0 - 4.0 01

IGF-1
Insulin-Like Growth Factor I 167 ng/mL 98 - 282 02
Estradiol, Sensitive 11.3 pg/mL 8.0 - 35.0 02

 

[MarkM]

Lamplight, welcome to the forum!

Your Total, and more importantly, your Free T are well below optimal ranges and you could greatly benefit from a good TRT protocol.

Your E2 is rather low at 11.3 and will come up some when you start TRT. It appears the most important test is missing and that is SHBG (Sex Hormone Binding Globulin). There is no way to establish a proper protocol without knowing the SHBG. I find it difficult to believe that Defy did not have that test run. Are you sure you don't have it?

Your TSH looks very high at 4.19. It should be around 1.0 so I am sure Defy will want to run a full thyroid panel which would include; TSH, Free T3, Free T4, Reverse T3 and both Thyroid antibodies. his should be discussed with Defy when you have your consult.

 

[lamplight]

@MarkM,

Jesse @ Defy sent me another lab order for a Thryoid panel. Going to go do that here soon!

Forgot to add: Sex Horm Binding Glob, Serum 10.9 Low nmol/L 16.5 - 55.9 01

 

[MarkM]

Forgot to add: Sex Horm Binding Glob, Serum 10.9 Low nmol/L 16.5 - 55.9 01

I kinda figured it would be low since your E2 was so low. With SHBG so low you will best benefit with small daily or every other day (EOD) injections of testosterone.

Looks like Defy is on top of things, just as I would expect.

 

[lamplight]

Thank you for looking at it, MarkM

Back in 2011 Dr. C prescribed SubQ every day, and SHBG was still 11 or so. I'm wondering if it will need to be EOD or less.

 

[MarkM]

Yes, most likely ED or EOD with such low SHBG.

 

[lamplight]

@MarkM,

These levels were high from the lab test

Bilirubin, Total 1.4 High mg/dL 0.0 - 1.2 01
Alkaline Phosphatase 89 IU/L 39 - 117 01
AST (SGOT) 41 High IU/L 0 - 40 01
ALT (SGPT) 51 High IU/L 0 - 44 01

I'm wondering if my liver is causing low SHBG. Historically, my Bilirubin has always been high*(not low). I may need to look into a diet to help.

 

[MarkM]

Are you taking any other type of medications? How about a statin?

 

[lamplight]

Are you taking any other type of medications? How about a statin?

I was taking Wellbutrin but have since weaned my self off. The only thing I take is claritin, Everyday.

*I had to look up what a statin was.

 

[MarkM]

Wellbutrin, or bupropion, can cause infrequent and mild increase of serum liver enzymes which would explain ALP, AST, and ALT being slightly elevated. Your ALP is within range and AST and ALT just barely over range. They aren't high enough to worry about anyway but good catch and good question.

Also, if you took Tylenol or other pain medication just prior to blood work it could effect these too. I believe antihistamines, like Claritin, can also elevate liver enzymes.

 

[lamplight]

Gotcha.

That's awesome information, MarkM! I did not know that.

Thank you!

Are there any natural ways of raising SHBG? With ED SubQ I was still low in that area, and from what I read low SHBG can be hard to figure out.

What would be a reasonable level of SHBG for TRT to work effectively?

These are probably good questions for Dr. Saya! Lol

 

[MarkM]

SHBG is one of those things that "it is what it is". Low SHBG is more difficult but surely not impossible. We have many low SHBG individuals on the forum. A big part of what makes it difficult is many doctors are unsure of how to treat it and therefore the patent starts off with a bad protocol that doesn't work and the doctors sometimes don;t know what or how to address it.

The only real way for low SHBG individuals to have success on TRT is with small daily injections. Daily injections take a commitment to do them every day. Some people just won't do that. When having low SHBG your body can not handle extremely high levels of testosterone. Going for high numbers is not in the cards because with low SHBG you body will not bind to a great deal of testosterone. So,you end up with very high Free T, which sound good, but your body can only handle so much Free T because there are only so many receptors for it to bind to. So your body breaks it down into its metabolites and you pass it out of your body in your urine. With high Free T also comes high Free E2 which can wreck havoc on a male.

So you must understand that you can't let the ego get in the way and just want high testosterone numbers. Low SHBG normally do very well with Total T in the 700 range and Free T around 20 to 24 tops. If you try and chase high t numbers it will set you back.

If you understand this up front and what type of commitment is needed to inject daily, you can have great success with TRT.

 

[Vince Carter]

You can't manipulate SHBG to move up, or down, you play it as it lies. And, FTR, low SHBG isn't tied to liver issues or anything else, though your numbers are high, you should be fasted (if you were not) for your labs, I'd re-run those before making any judgement off of 1 test.

Id honestly defer the Thyroid at this time, approach it at a later date as I think trying to start TRT, AND, start treating Thyroid is a lot to undertake at one-time.

 

[Vince Carter]

@MarkM,

Jesse @ Defy sent me another lab order for a Thryoid panel. Going to go do that here soon!

Forgot to add: Sex Horm Binding Glob, Serum 10.9 Low nmol/L 16.5 - 55.9 01

Define "panel"...Thyroid is tested thru 5 tests that are run together, if it's less than these 5 it is incomplete:

TSH
Free T3
Free T4
Antibodies
Reverse T3

 

[Vince Carter]

Oh I see now you added the SHBG...10.9. I wouldn't suggest daily injections to you as they can be daunting to comply with over the long term, talk with the Doc about EOD and specifically not having your Free T over the lab range for dosing. You should ignore almost completely, Total Testosterone, doesn't matter in your case.

 

[lamplight]

Vince take a look after my first post. I added the SHBG.

Sex Horm Binding Glob, Serum 10.9 Low nmol/L 16.5 - 55.9 01

Quote

 

[lamplight]

Thank you for teaching me MarkM/Vince Carter.

I'll certainly look at it objectively without my ego & I'll put all my faith in Dr. Saya to get me right.

But I do agree that EOD would be better... I just never got to try that when I was on it due to funds. I've only done ED, but no E2 symptoms however SHBG was still around 11.

When my PCP prescribed me testosterone it was 200MG in one shot every two weeks & I was converting everything to estrogen. Talk about being miserable lol. That for sure sure was a horrible protocol

Appreciate all the help!

 

[lamplight]

Define "panel"...Thyroid is tested thru 5 tests that are run together, if it's less than these 5 it is incomplete:

TSH
Free T3
Free T4
Antibodies
Reverse T3

I looked at the lab order. TSH was on the first lab I did. Looks like it's missing antibodies on the second one. Free T3, T4 & RT3 are on the panel.

 

[Jesse-Defy]

I looked at the lab order. TSH was on the first lab I did. Looks like it's missing antibodies on the second one. Free T3, T4 & RT3 are on the panel.

We can add on antibodies, I think that one is $48. Shoot me an email if you would like to add that on and I can get you a new lab order.

 

[lamplight]

Email sent