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Started By
Message
Bloodwork results: advice on my next steps?
Posted on 4/14/24 at 5:39 pm
Posted on 4/14/24 at 5:39 pm
TL;DR - testosterone is 262. What do I do next?
Age: 39
Height: 5’7
Weight: 174
Body fat: 23% DEXA
Weight is carried primarily in love handles and midsection. Not really a belly and my legs have zero fat to them. Pronounced glutes if it matters.
Lifts:
Bench: 245 max
Squat: 275 max
Deadlift: 315 max
I lift 4 days a week. I find it very, very hard to complete my full workouts. I try to run an upper/lower split. 3 push exercises (bench, seated DB shoulder press; lat raises), 3 pull (pendlay rows, pull ups, db bicep curls) for upper. 3 leg for lower (squat or deadlift, rdls or split squats, hip thrusts)
I run twice a week. One 2-3 miler. One higher intensity day of intervals.
Again, I struggle to complete these workouts due to just wanting to quit. Like not really tired as much as I get to the point I don’t feel like it. I’ve tried to “David Goggins” it, but I don’t have it in me anymore. I ran a marathon in 2018. I get super “done” after a few miles now even though I’m not out of breath or worn out.
I get really tired the afternoons after exercising and I’m zonked the next day. After squats or deadlifts, I’ll be irritable, kind of depressed. Just want to lay around not because of soreness but because of being drained of life.
Sleep:
I get around 6 hours of sleep per night. If I practice good sleep hygiene and go to bed early, I’ll pop awake around 3am. My alarm goes off at 5:30am, so I need to be out by 10pm to get 7.5 hours.
I did get in pretty good shape a little over a year ago. More so than I’ve ever been. Dropped weight to 156 and was doing great. But it was a major struggle. I quickly went back to binge eating and am almost 20 pounds heavier.
Bloodwork:
Total Testosterone 262
Free Testosterone 4.5
TSH .7
T4 Free, Direct 1.2
Total cholesterol 205
HDL 51
LDL 129
Tri 139
HDL/LDL ratio 2.7
Vitamin D 50.5
Diet:
130g-150g of protein per day (mostly animal sources like meat, yogurt, or whey)
25g-30g of fiber daily
80g-90g of fat
I do eat carbs from fruit, vegetables, and some refined sources like pasta or tortillas.
I binge sugar almost every day. It’s a problem that probably needs a therapist to address.
Sorry for so many details, but my doctor didn’t even want to run testosterone with my blood work. She asked if I was having erectile dysfunction problems or feeling depressed. She said I’m muscular for someone who would have a testosterone issue and unless I had symptoms, she didn’t want to worry about it. I insisted.
I think I am having symptoms, more so than I probably even realize. I’m just so busy, responsible, and organized that I don’t really think much about how I feel. Like with sex - how often am I actually horny? It’s honestly pretty rare. I just mentally know I like sex, so I pursue it with my wife when I can.
Finally - and I know this is a god awful long post - I worry that my low t is what is keeping me from sleeping, making consistent food choices, and finishing workouts/staying consistent. I wish I could just get my shite together for the long term, but my history says I never will.
So is the T clinic next?
Age: 39
Height: 5’7
Weight: 174
Body fat: 23% DEXA
Weight is carried primarily in love handles and midsection. Not really a belly and my legs have zero fat to them. Pronounced glutes if it matters.
Lifts:
Bench: 245 max
Squat: 275 max
Deadlift: 315 max
I lift 4 days a week. I find it very, very hard to complete my full workouts. I try to run an upper/lower split. 3 push exercises (bench, seated DB shoulder press; lat raises), 3 pull (pendlay rows, pull ups, db bicep curls) for upper. 3 leg for lower (squat or deadlift, rdls or split squats, hip thrusts)
I run twice a week. One 2-3 miler. One higher intensity day of intervals.
Again, I struggle to complete these workouts due to just wanting to quit. Like not really tired as much as I get to the point I don’t feel like it. I’ve tried to “David Goggins” it, but I don’t have it in me anymore. I ran a marathon in 2018. I get super “done” after a few miles now even though I’m not out of breath or worn out.
I get really tired the afternoons after exercising and I’m zonked the next day. After squats or deadlifts, I’ll be irritable, kind of depressed. Just want to lay around not because of soreness but because of being drained of life.
Sleep:
I get around 6 hours of sleep per night. If I practice good sleep hygiene and go to bed early, I’ll pop awake around 3am. My alarm goes off at 5:30am, so I need to be out by 10pm to get 7.5 hours.
I did get in pretty good shape a little over a year ago. More so than I’ve ever been. Dropped weight to 156 and was doing great. But it was a major struggle. I quickly went back to binge eating and am almost 20 pounds heavier.
Bloodwork:
Total Testosterone 262
Free Testosterone 4.5
TSH .7
T4 Free, Direct 1.2
Total cholesterol 205
HDL 51
LDL 129
Tri 139
HDL/LDL ratio 2.7
Vitamin D 50.5
Diet:
130g-150g of protein per day (mostly animal sources like meat, yogurt, or whey)
25g-30g of fiber daily
80g-90g of fat
I do eat carbs from fruit, vegetables, and some refined sources like pasta or tortillas.
I binge sugar almost every day. It’s a problem that probably needs a therapist to address.
Sorry for so many details, but my doctor didn’t even want to run testosterone with my blood work. She asked if I was having erectile dysfunction problems or feeling depressed. She said I’m muscular for someone who would have a testosterone issue and unless I had symptoms, she didn’t want to worry about it. I insisted.
I think I am having symptoms, more so than I probably even realize. I’m just so busy, responsible, and organized that I don’t really think much about how I feel. Like with sex - how often am I actually horny? It’s honestly pretty rare. I just mentally know I like sex, so I pursue it with my wife when I can.
Finally - and I know this is a god awful long post - I worry that my low t is what is keeping me from sleeping, making consistent food choices, and finishing workouts/staying consistent. I wish I could just get my shite together for the long term, but my history says I never will.
So is the T clinic next?
8
Posted on 4/14/24 at 6:30 pm to StringedInstruments
Don't apologize for your "long" post, I know people bitch, but they need to stfu and just read. What needs to be said should be said. I'll never complain.
I think it's time for the T clinic as you say, or a better doctor. Sounds like you've found a "typical" pcp that does not give a shite about your goals here. Just rip that bandaid off and go find someone else.
I've only had my test checked twice, and I did so because I felt pretty much exactly like you describe. On August 2nd, 2022 mine was 339, and I wanted to re-check after 1 month just to verify and on September 8th, 2022 it was 273. I haven't gone back to get any further bloodwork done yet. I was doing this on my own, not through a doctor, but I wanted to know where I was and I found out.
The reason I'm bringing me up in a thread about you is to illustrate how stupid and meaningless your doctor's comment about your testosterone levels sound to me. As you can see, my T levels from 2022 are similar to yours now(I was 43 at that time), and I lifted about 3 days a week and (not trying to brag or flex on you) I'm stronger and probably have much more muscle than you, (but also much more fat, I'm 5'7" & 265lb, & at that time my 1RMs were 345BP, 510SQ, 420DL, 235OHP), so trust me, you can be muscular and strong and have lower T levels. You and I aren't the only ones in this boat. I got big and strong when I was young, you probably did too, doesn't mean you don't need to address your hormone levels when they are low, which they are, so you should go on a provider search as soon as possible.
Also, you're obviously already aware, but yes, there are other things like sleep, lose fat, improve diet, that should improve your T levels, but even if you did all of that you may still need something, and if not now, you eventually will...it seems.
I think it's time for the T clinic as you say, or a better doctor. Sounds like you've found a "typical" pcp that does not give a shite about your goals here. Just rip that bandaid off and go find someone else.
I've only had my test checked twice, and I did so because I felt pretty much exactly like you describe. On August 2nd, 2022 mine was 339, and I wanted to re-check after 1 month just to verify and on September 8th, 2022 it was 273. I haven't gone back to get any further bloodwork done yet. I was doing this on my own, not through a doctor, but I wanted to know where I was and I found out.
The reason I'm bringing me up in a thread about you is to illustrate how stupid and meaningless your doctor's comment about your testosterone levels sound to me. As you can see, my T levels from 2022 are similar to yours now(I was 43 at that time), and I lifted about 3 days a week and (not trying to brag or flex on you) I'm stronger and probably have much more muscle than you, (but also much more fat, I'm 5'7" & 265lb, & at that time my 1RMs were 345BP, 510SQ, 420DL, 235OHP), so trust me, you can be muscular and strong and have lower T levels. You and I aren't the only ones in this boat. I got big and strong when I was young, you probably did too, doesn't mean you don't need to address your hormone levels when they are low, which they are, so you should go on a provider search as soon as possible.
Also, you're obviously already aware, but yes, there are other things like sleep, lose fat, improve diet, that should improve your T levels, but even if you did all of that you may still need something, and if not now, you eventually will...it seems.
Posted on 4/14/24 at 7:39 pm to StringedInstruments
quote:
Pronounced glutes if it matters.
Oh, it matters to me.
Posted on 4/14/24 at 7:53 pm to StringedInstruments
quote:
Height: 5’7
Weight: 174
Losing some of the extra pounds will help. A lot of environmental chemicals are fat soluble and some mimic estrogen. So less body fat = less of those chemicals being stored in your body.
Get down to at least 155 and you should see some improvement just from that.
quote:
Bench: 245 max
Squat: 275 max
Deadlift: 315 max
This is good. You definitely aren't starting from scratch.
Posted on 4/14/24 at 8:09 pm to DrDenim
quote:
I'm 5'7" & 265lb, & at that time my 1RMs were 345BP, 510SQ, 420DL, 235OHP), so trust me, you can be muscular and strong and have lower T levels.
Stout lifts, brother.
And yeah, the numbers and physique don’t concern me. What concerns me is that I can already tell my mind isn’t really into lifting and exercising. Everything will diminish eventually if I don’t figure this out.
Posted on 4/14/24 at 8:11 pm to Bestbank Tiger
quote:
Get down to at least 155 and you should see some improvement just from that.
I definitely noticed a more positive disposition when I was in the 150s. But I also struggled with energy and irritability while in a deficit. I’ve got to figure out how to get there and find a comfortable maintenance zone for calories.
I’ve struggled with disordered eating habits and binge eating since I was 13. It’s very much an uphill battle.
Posted on 4/14/24 at 8:37 pm to StringedInstruments
I find it so funny your doctor didn't think you had symptoms. That overall feeling of "Bleh", the low energy, not being able to get dialed up for workouts, just not caring about stuff like you used to, those are all common symptoms in my book. I'm sure you've read the reports from people here to take test, having energy, feeling younger, wanting to "get after it" is what they say they feel after getting on test, and that's probably what you're looking to feel again. It's gonna be your decision obviously, but I think your first move has to be to find a healthcare provider who is on the same page as you, so you can talk about your options and then make a plan.
Posted on 4/15/24 at 7:14 am to StringedInstruments
There will be better responses than mine, but I suggest getting your T levels up. It will help a lot with your issues.
262 is low enough for insurance to cover your TRT.
262 is low enough for insurance to cover your TRT.
Posted on 4/15/24 at 7:15 am to DrDenim
quote:
I find it so funny your doctor didn't think you had symptoms. That overall feeling of "Bleh", the low energy, not being able to get dialed up for workouts, just not caring about stuff like you used to, those are all common symptoms in my book. I'm sure you've read the reports from people here to take test, having energy, feeling younger, wanting to "get after it" is what they say they feel after getting on test, and that's probably what you're looking to feel again. It's gonna be your decision obviously, but I think your first move has to be to find a healthcare provider who is on the same page as you, so you can talk about your options and then make a plan.
this.
so evne before i went on fertility treatment my numbers were about like yours. i felt exactly like you did, blah and was tired alot. like you, string, i was never really horny but i knew sex felt good so i pursued somewhat but my wife actually pursued much more at the time(opposite a decade later, big time opposite). I had zero motivation for lifting but was muscular so of course my pcp thought it was not needed and didnt even want to check numbers.
in the end i had to tell him i wanted to be referred to a specialist. thats how i ended up at baylor. i used the excuse that it was affecting fertility and we were trying at the time so worked out good. in your case, i would ask to be referred to a urologist or just do a T clinic if you are done having kids.
based off your numbers and age, you 100% have low test
if you want to hold off on the test you could do the following
- boron @15mg
-sustain alpha- as directed
go on the anabolic diet so you are eating more fat and cholesterol to provide the body more building blocks for testosterone.
do thtis for 12-16 weeks and recheck levels once bodyfat is around 15%.
if this is not appealing then go the testosterone route.
as far as the binging sugar...1/2 dose of a glp1 will break that shite with a quickness. faster and easier than a therapist and prolly way cheaper.
Posted on 4/15/24 at 7:48 am to StringedInstruments
My performance would be really terrible if I binge ate sugar every day and slept for 6 hours per night. It seems like you have some low hanging fruit you might be able to attack in the short term while you get to the bottom of the hormone issue.
I start to get what feels like CNS fatigue if my sleep falls off. I feel less sensitive to that when I’m taking creatine and beta alanine, but I ultimately have to sleep more to get out of it.
I start to get what feels like CNS fatigue if my sleep falls off. I feel less sensitive to that when I’m taking creatine and beta alanine, but I ultimately have to sleep more to get out of it.
Posted on 4/15/24 at 9:22 am to StringedInstruments
quote:
Total cholesterol 205
HDL 51
LDL 129
Tri 139
HDL/LDL ratio 2.7
Your tri/hdl ratio is 2.7 - way too high. Cutting that sugar should bring that in the preferred zone over 2.
Thanks for being so open in your description. It really helps other people speak up themselves.
Question: what should the T numbers be? I'm going for bloodwork soon but have never paid attention to anything beyond my lipid panel before.
Posted on 4/15/24 at 9:54 am to StringedInstruments
Completely cutting daily sugar external intake (meaning not from food during meals, or even an occasional dessert or cocktail but from added sugar in coffee, sugary snacks, and sugary drinks) and aiming to get at least 7 hours of sleep has really helped me in my adult years.
Posted on 4/15/24 at 9:58 am to Big Scrub TX
quote:
Question: what should the T numbers be? I'm going for bloodwork soon but have never paid attention to anything beyond my lipid panel before.
My blood work panel says 264-916 for total T is considered normal range. 8.7-25.1 for free T.
Maybe it’s due to lack of testimonials, but I don’t know of any guys under 65 saying they feel good with sub-400 total T levels. It’s supposedly an algorithm that requires all of your hormonal panel to truly understand, but I have a hard time believing anyone as low as mine at 39 is living the good life.
I should have mentioned in OP that my dad has been on testosterone therapy since his 40s. I guess it could be genetic,
Posted on 4/15/24 at 11:08 am to StringedInstruments
quote:
My blood work panel says 264-916 for total T is considered normal range.
That range is meaningless as far as whether your T is low.
Your symptoms sound textbook low T. Your doctor sounds ignorant. That doesn’t mean if I was you I’d get on TRT at 39, though, before I did everything else I could to get the number up.
Also, my T was 688 when I got checked, but I still hate my lifting workouts. My sleep is almost identical to yours, and that’s what I blame my low workout enthusiasm on.
Posted on 4/15/24 at 11:26 am to Big Scrub TX
quote:
what should the T numbers be? I'm going for bloodwork soon but have never paid attention to anything beyond my lipid panel before.
at 39, he should be at a minimum of 400 on average. the mean for his age group in the middle tier is 350-475 and 600-750 would be more optimal.
an age adjusted cutoff of 350ish would be what should be used to consider one "low testosterone" or not.
even not using the age adjustment the American urology association (AUA) would consider him to have low test as they use 300ng/dl as the cut off.
here it eh paper that was published in the journal of urology on this(its a great read btw). OP should ask to be referred to a urologist that specializes in male hormone treatment and use LOW t clinic as last resort imo.
LINK
90th percentile(optimal) is around 700
90th for free test would be in the 27.5 range
Posted on 4/15/24 at 11:30 am to lsu777
quote:
lsu777
How much variation can be expected in this stuff? Like can a guy with OPs number go and get it tested on a different day and it be 100% higher?
Posted on 4/15/24 at 11:42 am to bigbuckdj
not usually like that but i do recommend people getting 2 minimum and 3 total done before deciding on a path
different things affect it including outside temperature with peak on may-summer and valley during january
exercise, especially heavy weight lifting 2 days prior affects it
alcohol and diet affect it
so i would say his range is prolly 250-350 through the peaks and valleys more than likely. this is based simply on the research papers though where they look at like 1-2k people's blood work over a 6 month period
different things affect it including outside temperature with peak on may-summer and valley during january
exercise, especially heavy weight lifting 2 days prior affects it
alcohol and diet affect it
so i would say his range is prolly 250-350 through the peaks and valleys more than likely. this is based simply on the research papers though where they look at like 1-2k people's blood work over a 6 month period
Posted on 4/15/24 at 4:10 pm to lsu777
quote:I have some bloodwork coming up. So far, they've ordered:
lsu777
CBC w differential
Lipid Panel
comprehensive metabolic panel
reflex free T4
I've asked to add insulin serum and testosterone. What else would you advise?
Posted on 4/15/24 at 6:21 pm to StringedInstruments
quote:
TL;DR - testosterone is 262. What do I do next?
I was kind of in the same boat too. Started test last year at 44yo with a test level of 304. I was feeling run down and fatigued. My workouts never really suffered because I've been training forever and it's just a part of my life. But, my recovery was terrible. That's what I've found was the most impactful for me. I've never slept well, but on test my body just recovers so much faster. I don't feel run down anymore.
Good luck with your journey.
Posted on 4/16/24 at 7:38 am to Big Scrub TX
quote:
What else would you advise?
this is what you want
LINK
Sex Hormones:
Total Testosterone (LC/MS) [uncapped]
Free Testosterone (Equilibrium Ultrafiltration) [uncapped]
Estradiol, Sensitive / Ultrasensitive (LC/MS)
Sex Hormone Binding Globulin (SHBG)
Progesterone
Prolactin
Cortisol
Gonadotropins:
Luteinizing Hormone (LH)
Follicle-Stimulating Hormone (FSH)
Neurosteroids:
Dehydroepiandrosterone Sulfate (DHEA-S)
Prostate Health:
Prostate Specific Antigen (PSA)
Thyroid:
TSH
Free T3
Free T4
Growth Hormone/IGF-1:
Insulin-Like Growth Factor I (IGF-1)
Lipids:
Total Cholesterol
HDL-Cholesterol
LDL-Cholesterol
HDL/LDL Ratio
Triglycerides
ApoB
Lipoprotein(a)
Blood:
Complete Blood Count w/ Differential (Hematocrit; hemoglobin; mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); mean corpuscular hemoglobin concentration (MCHC); red cell distribution width (RDW); percentage and absolute differential counts; platelet count (RBC); red cell count; white blood cell count (WBC))
Metabolic:
Comprehensive Metabolic Panel (albumin:globulin (A:G) ratio; albumin, serum; alkaline phosphatase, serum; bilirubin, total; BUN:creatinine ratio; calcium, serum; carbon dioxide, total; chloride, serum; globulin, total; potassium, serum; protein, total, serum; sodium, serum)
Insulin Sensitivity:
Blood glucose
Fasting Insulin
HbA1c
Liver Function:
AST
ALT
BUN
Bilirubin, Total
?-Glutamyl Transferase (GGT)
Kidney Function:
Creatinine w/ eGFR
Vitamins:
Vitamin D, 25-OHD (25-Hydroxy)
Iron Panel:
Iron
Transferrin Saturation / Iron Saturation
TIBC
UIBC
Ferritin
Inflammatory Markers:
C-Reactive Protein, High Sensitivity (hsCRP)
Urinalysis:
Complete Urinalysis (color; appearance; specific gravity; pH; protein; glucose; occult blood; ketones; leukocyte esterase; nitrite; bilirubin; urobilinogen; microscopic examination of urine sediment)
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