Author Topic: My Bloodwork Results: What To Do Next  (Read 323 times)

zronhez

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My Bloodwork Results: What To Do Next
« on: December 13, 2017, 12:40:45 PM »
Hi Androids forum. I've recently had a male hormone profile done and I need your help in determining if I have anything to be worried about.

Age: 31

Reasons for test: Come on of anxiety in last year or so; depression as a result of. Low libido. Very modest results from consistent gym going.

The test results:


Total Testosterone 20.6 nmol/L (Range is listed as 7.60 - 31.40)

Free - Testosterone 0.325 nmol/L (Range is listed as 0.30 - 1.00)

Sex Hormone Binding Glob 54 nmol/L (Range is listed as 16.00 - 55.00)

17-Beta Oestradiol 30.8 pmol/L (Range is listed as 0.00 - 191.99)



The test company have indicated that all results are within normal range but according to other charts I知 reading against, my SHBG is in the age range of somebody in their eighties...

Looking over my results in full, every reading is comfortably away from the outer reaches of the normal ranges except the two which arguably matter the most, free T and SHBG. My free T is just within the acceptable lower end of the range and my SHBG is just within the upper end. I have concerns over the rather low E2 level too.

So I知 sure I知 not being a hypochondriac, those levels are something to be concerned about for a 31 year old, is that correct? I知 going by a 1996 study featured in this article https://www.artofmanliness.com/2013/...erone-levels/1. Are there any other charts/studies I can reference for free T/SHBG levels by age?

If the anxiety/depression isn't hormone related then I can just take fluoxetine and be done with it but I want to be sure i'm treating the problem in the right way in the first place.

Any responses are much appreciated.

Anonymous

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Re: My Bloodwork Results: What To Do Next
« Reply #1 on: December 13, 2017, 01:20:48 PM »
Hello there

Lower quartile of the range is what most experts will advise for estrogen in males as the 'sweet spot'. So 0-50 - with you at 30.8, this seems fine imo.

As you say, the issue looks like SHBG 'using up' most of your total testosterone, meaning your free testosterone for your body to use, is pretty low. That's what I'm getting from there blood results anyway.

I don't really know much about how to raise or lower SHBG, so hopefully someone more knowledgeable will come along and advise on how you can get that SHBG reading down and free up some more testosterone. :)

Stripey

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Re: My Bloodwork Results: What To Do Next
« Reply #2 on: December 13, 2017, 04:23:00 PM »
I've found this to be a good guide and explanation of SHBG. It's a few years old but probably still relevant:


http://www.lef.org/magazine/mag2011/may2011_Do-You-Know-Your-Sex-Hormone-Status_01.htm

Sham

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Re: My Bloodwork Results: What To Do Next
« Reply #3 on: December 13, 2017, 07:46:58 PM »
Briefly:

Total testoserone initially looks good but is inflated by your high SHBG.

Free testosterone is low but not a disaster. It is clearly giving you symptoms though.

E2 is low which corresponds with your low free testosterone (not much testosterone to aromatise).

We don稚 have LH and FSH to look at to judge how your pituitary is reacting to the low free testosterone.

Clearly SHBG is a problem, but there is no straightforward way to directly manipulate SHBG. It is made in the liver, so possible causes include alcohol intake, medications, toxins etc. Maybe you are just genetically predisposed to high SHBG.

Sham

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Re: My Bloodwork Results: What To Do Next
« Reply #4 on: December 13, 2017, 07:51:42 PM »
Lower quartile of the range is what most experts will advise for estrogen in males as the 'sweet spot'. So 0-50 - with you at 30.8, this seems fine

Not correct - it looks like you are getting your units mixed up. 30.8 pg/mL would be fine. 30.8 pmol/L is low and cannot be described by anyone as being near the sweet spot.
« Last Edit: December 13, 2017, 07:55:26 PM by Sham »

Olly13

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Re: My Bloodwork Results: What To Do Next
« Reply #5 on: December 14, 2017, 02:13:22 PM »
Hi Androids forum. I've recently had a male hormone profile done and I need your help in determining if I have anything to be worried about.

Age: 31

Reasons for test: Come on of anxiety in last year or so; depression as a result of. Low libido. Very modest results from consistent gym going.

The test results:


Total Testosterone 20.6 nmol/L (Range is listed as 7.60 - 31.40)

Free - Testosterone 0.325 nmol/L (Range is listed as 0.30 - 1.00)

Sex Hormone Binding Glob 54 nmol/L (Range is listed as 16.00 - 55.00)

17-Beta Oestradiol 30.8 pmol/L (Range is listed as 0.00 - 191.99)



The test company have indicated that all results are within normal range but according to other charts I知 reading against, my SHBG is in the age range of somebody in their eighties...

Looking over my results in full, every reading is comfortably away from the outer reaches of the normal ranges except the two which arguably matter the most, free T and SHBG. My free T is just within the acceptable lower end of the range and my SHBG is just within the upper end. I have concerns over the rather low E2 level too.

So I知 sure I知 not being a hypochondriac, those levels are something to be concerned about for a 31 year old, is that correct? I知 going by a 1996 study featured in this article https://www.artofmanliness.com/2013/...erone-levels/1. Are there any other charts/studies I can reference for free T/SHBG levels by age?

If the anxiety/depression isn't hormone related then I can just take fluoxetine and be done with it but I want to be sure i'm treating the problem in the right way in the first place.

Any responses are much appreciated.

Hey there,

Welcome to the forum.

At first glance its all looks alright, until I look at free testosterone and SHBG, then it starts looking odd.

It seems you have got Low Free testosterone, and also low Oestradiol, both of which are indicative of Hypogonadism, in one way or another, especially the low oestradiol, which to be suggests not enough testosterone to go around, or the fact a lot of it is bound up by the SHBG.

My next step would be to get LH and FSH tested, if these are sky high then I'd say your primary hypogonadal, on the basis of low Free testosterone, even if your total is actually at a good number.

As it turns out there isn't much which can be done to lower SHBG in my experience. There are some supplements which will lower it, but probably not enough. Vitamin D, Zinc, and magnesium are the ones to look at.

Do you take any other medications? Sometimes certain drugs can cause high SHBG. Hyperthyroidism can also cause it.

I'd hold on the fluoxetine for now, as if it is hormonal then an SSRI will likely make the issue worse.

Hope this helps. :)


Not correct - it looks like you are getting your units mixed up. 30.8 pg/mL would be fine. 30.8 pmol/L is low and cannot be described by anyone as being near the sweet spot.
Agreed. 60-100 pmol/L is where it wants to be really (roughly).

zronhez

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Re: My Bloodwork Results: What To Do Next
« Reply #6 on: December 15, 2017, 04:54:14 PM »
Many thanks for the responses so far guys.

Hey there,

Welcome to the forum.

At first glance its all looks alright, until I look at free testosterone and SHBG, then it starts looking odd.

It seems you have got Low Free testosterone, and also low Oestradiol, both of which are indicative of Hypogonadism, in one way or another, especially the low oestradiol, which to be suggests not enough testosterone to go around, or the fact a lot of it is bound up by the SHBG.

My next step would be to get LH and FSH tested, if these are sky high then I'd say your primary hypogonadal, on the basis of low Free testosterone, even if your total is actually at a good number.

As it turns out there isn't much which can be done to lower SHBG in my experience. There are some supplements which will lower it, but probably not enough. Vitamin D, Zinc, and magnesium are the ones to look at.

Do you take any other medications? Sometimes certain drugs can cause high SHBG. Hyperthyroidism can also cause it.

I'd hold on the fluoxetine for now, as if it is hormonal then an SSRI will likely make the issue worse.

Hope this helps. :)

Agreed. 60-100 pmol/L is where it wants to be really (roughly).

Thank you. I do have some LH and FSH readings from two recent blood tests. The first set of results are from an NHS direct intravenous test in early November; the second set from lancet finger prick blood tests from the company Medichecks, in late November.

NHS test:

Serum LH level 3.1 iu/L

Serum follicle stimulating hormone level 3.8 iu/L

Medichecks test:

Luteinising Hormone     6.19 IU/L     (Reference range listed as 1.70 - 8.60)

Follicle Stim. Hormone     4.7 IU/L    (Reference range listed as 1.50 - 12.40


As for other medications, only the hair loss drug minoxidil, 1ml applied topically once a day. I was considering starting finasteride as my hair loss has become very aggressive in the last year but I think it may further complicate my hormonal problems, if indeed I do have hormonal problems which appears to be the case judging by the responses here.

Clearly SHBG is a problem, but there is no straightforward way to directly manipulate SHBG. It is made in the liver, so possible causes include alcohol intake, medications, toxins etc. Maybe you are just genetically predisposed to high SHBG.

What concerns me about my free T and SHBG readings, which are just on the cusp of acceptability, is that this is me with a lifestyle pretty much as optimised as possible for the average guy. I eat fairly clean all year round, gym every other day or one on/two off, minimised work stress, 7-8 hours of sleep per night, rarely drink, never do drugs and haven稚 smoked for over 6 years now. I feel like I壇 practically start lactating and bleeding once a month if I lived like some of the slobs around me. If my free T just sits within range with good diet, gym and no drink/drugs, what on earth would it be if I was sedentary, ate takeaways weekly and drank beer in the evenings like many of the men I know?

---------------------------------------------

My problem is what to do next with these readings. When arranging the early November blood test with my GP he said that the NHS doesn't test for free testosterone, only total. I've since learned that the total testosterone number is meaningless without the SHBG and oestradiol numbers to check the ratios and determine the free T level. It seems to me very "convenient" that the NHS only test for total T levels; I suspect they'd have to devote more budgetary resources to the problem if free T were tested and many more men were revealed as having problematic readings. By comparison, my GP had very little hesitation in prescribing fluoxetine.

Are my readings that bad that they can't be solved with supplementation or do I really need to see an endocrinologist? I've seen elsewhere that the ideal is the Andrology clinic at UCLH in London (which is only a 90 minute train journey from me). I have my doubts my GP will refer me there as I physically look ok and my readings from the early November test came back as "normal". It's only because I paid 」79 for the private test that I can see my free T is low, my SHBG is high and my E2 is low. So many of the symptoms of low E2 match my experience, including sore/clicking joints around the body.





Ashto70

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Re: My Bloodwork Results: What To Do Next
« Reply #7 on: December 16, 2017, 11:33:08 AM »
Hi zronhez

Welcome aboard!

All the technical stuff's been done so I'll just give you my two-cents worth on the choices. Firstly, you're partly right that the NHS generally only tests total testosterone. However, to my understanding, very few labs in the country can perform complex free/bioavailable testosterone tests which makes them an expensive choice of test to perform when the NHS has a budget.

Secondly, if you've read some of the threads on the forum you may have come to the realisation that andrology is a complex area of medical science. The vast majority of GP's and endocrinologists have scant levels of knowledge about testosterone deficiency and the interpretation of blood test results. So in reality, I think you're basically on a hiding-to-nothing going through the NHS system to get any sort of diagnosis if you present them with the blood panel results you've shown us. I very much doubt your GP would even be interested in referring you to an endocrinologist.

If your finances and free-time allow it I'd highly consider going the private route:

You'll see someone who has time and empathy and a person who is highly knowledgeable and qualified in hypogonadism. The vital thing is he/she will offer and advise on the options available to you (if you are suffering from a deficiency) and start you on therapy almost immediately after making a diagnosis. Occasionally, some private patients are successfully able to transfer their care from the private consultant to an NHS one, thus saving you time and costs in the future.

Best regards and good luck.
Craig
 

zronhez

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Re: My Bloodwork Results: What To Do Next
« Reply #8 on: December 18, 2017, 08:25:25 PM »
Hi zronhez

Welcome aboard!

All the technical stuff's been done so I'll just give you my two-cents worth on the choices. Firstly, you're partly right that the NHS generally only tests total testosterone. However, to my understanding, very few labs in the country can perform complex free/bioavailable testosterone tests which makes them an expensive choice of test to perform when the NHS has a budget.

Secondly, if you've read some of the threads on the forum you may have come to the realisation that andrology is a complex area of medical science. The vast majority of GP's and endocrinologists have scant levels of knowledge about testosterone deficiency and the interpretation of blood test results. So in reality, I think you're basically on a hiding-to-nothing going through the NHS system to get any sort of diagnosis if you present them with the blood panel results you've shown us. I very much doubt your GP would even be interested in referring you to an endocrinologist.

If your finances and free-time allow it I'd highly consider going the private route:

You'll see someone who has time and empathy and a person who is highly knowledgeable and qualified in hypogonadism. The vital thing is he/she will offer and advise on the options available to you (if you are suffering from a deficiency) and start you on therapy almost immediately after making a diagnosis. Occasionally, some private patients are successfully able to transfer their care from the private consultant to an NHS one, thus saving you time and costs in the future.

Best regards and good luck.
Craig
 

Thanks for taking the time to post Craig.

You're right I don't think my GP will refer me but I'm going to try at least. It's a frustrating thing to deal with because according to now multiple sources, my E2 is worryingly low, as is my free test and the corresponding high SHBG.

For example, my E2 is 30.8 pmol/L, which translates to 8.39 pg/ml. According to this site: http://www.hemingways.org/GIDinfo/hrt_ref.htm the reference range for male E2 levels is 15-60 pg/ml.

This website https://www.howtoliveyounger.com/normal-estrogen-levels-in-males-2/ states "Studies in men with heart failure showed that those with normal estrogen levels had a lower incidence of dying from the illness. The fewest deaths occurred when estradiol levels were between 21.8 and 30.11 pg/ml. Death rates increased by 133% when estradiol levels were less than 12.9 pg/ml."

The symptoms for low E2 listed here https://dosagemayvary.com/high-estrogen-vs-low-estrogen-symptoms-for-men/ align with my experience, specifically:

Fatigue along the lines of sleepiness
joint pain, clicking or popping joints
loss of libido (interest in sex)
difficulty retaining water (constant urination)
anxiety, depression, irritability

Somebody else has also told me that with my E2 level, my bone health is at risk and I should get re-tested using the LC-MS/MS methodology.

So, with all that in mind, it seems ridiculous that a GP/NHS endocrinologist would simply dismiss my test results. One of the strangest things is that the medicheck reference range for E2 is "0.00 - 191.99 pmol/L". So zero is within range apparently. And even if I'm to trust the reference ranges for my free T and SHBG, being so close to the edge of the range is surely cause for a second opinion.

mt006

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Re: My Bloodwork Results: What To Do Next
« Reply #9 on: December 19, 2017, 11:32:42 PM »
Don't get hung up on the E2 just yet - the symptoms for Low T are pretty similar

There are different blood tests for E2 that return different units - the US have what they refer to as a "sensitive" test and they use much smaller units than the UK testing and a different reference range.

You can't convert the unit results from one test and line them up with ranges on the other test.





zronhez

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Re: My Bloodwork Results: What To Do Next
« Reply #10 on: January 04, 2018, 12:06:46 PM »
I presented my GP with the private medichecks results. I think he was slightly overwhelmed with the amount of "evidence" I presented to him that pointed to a possible hormonal problem. I stressed that my E2 was too low, SHBG too high and as a result my free test is restricted. He levelled with me and said that it's the arena of a specialist to interpret the results; however, he also said the wait times for a endocrinology referral on the NHS were very long. So, he pledged to write to an endo with the results, seeking advice on what I can do next. Three to four week turnaround to hear back. Better than I expected I suppose; I thought the GP would simply stick to the NHS blood test results and have me on my way.

Still, looks as though I'll need to go private with this. The E2 - bone health risk has me sufficiently concerned that I think further testing is necessary. 

Ashto70

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Re: My Bloodwork Results: What To Do Next
« Reply #11 on: January 05, 2018, 06:56:15 AM »
I'd agree with those points zronhez. Might possibly be worth holding out until you hear back from your GP with the endo's remarks and take it from there. What's for sure is that chronic levels of low oestrogen can prove as unhealthy and debilitating as high levels so it's important your doctor recognises this as acts accordingly. If not, well, yes, it looks like you'll probably be going the much-travelled private route.

Best of luck and keep us posted.
Craig

 

zronhez

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Re: My Bloodwork Results: What To Do Next
« Reply #12 on: January 15, 2018, 04:41:13 PM »
I'd agree with those points zronhez. Might possibly be worth holding out until you hear back from your GP with the endo's remarks and take it from there. What's for sure is that chronic levels of low oestrogen can prove as unhealthy and debilitating as high levels so it's important your doctor recognises this as acts accordingly. If not, well, yes, it looks like you'll probably be going the much-travelled private route.

Best of luck and keep us posted.
Craig

Thanks Craig, I'll post an update after I receive the response from my GP.

By the way, is there any way of uploading images here? I can't find how to from the reply box.


Olly13

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Re: My Bloodwork Results: What To Do Next
« Reply #13 on: January 15, 2018, 06:29:24 PM »
Thanks Craig, I'll post an update after I receive the response from my GP.

By the way, is there any way of uploading images here? I can't find how to from the reply box.

https://postimages.org

This is what I use.

:)