Help With Blood Work for Libido & ED Issues

[Advocate1]

Hi Guys,

26 year old male here with a past history of steroid use. I havent recovered from last cycle 2 1/2 years ago and I’ve been searching for the root cause every since.

My main symptoms are brain fog, fatigue, low libido & ED.

I’ve moved to functional medicine and I’m currently working with a doctor whom i hope is finally the one that helps cure my ailments.

I’ve done a sleep study for sleep apnea (i know i dont have it though) currently doing a saliva & urine cortisol test. I’ll also be getting a brain MRI and i took a boatload of blood work as well.

I dont think I’ve gotten all my bloodwork back yet but I have gotten quite a bit over the last 2 weeks.

I’ve been dealing with Euthyroid Sick Syndrome and I’ve been trying to find the cause so i can move on with my life.

Currently on 8 weeks of TRT. 100mg per week with 1000iu hcg split twice weekly along with 25mg of aromasin per week. i dont know if this is my optimal dosage yet. I was on 125mg weekly but my test came back high, this is my readjustment.

I’d appreciate the help in interpreting my latest blood work and helping me see things that I may not have been able to see myself.

06/06/2019 blood work:

TOTAL GLUTATHIONE 752 (544-1228 uM)

OMEGA 3 (EPA+DHA) 2.1 (2.2-3.2)

OMEGA 6/OMEGA 3 RATIO 12.3 (5.7-21.3)

EPA/ARACHIDONIC ACID RATIO <0.1 (0.2 OR LESS)

ARACHIDONIC ACID 11.3 (5.2-12.9 %)

EPA 0.3 (0.2-1.5 %)

DHA 1.8 (1.2-3.9 %)

OSMOLALITY,SERUM 290 (275-295 mOsm/kg H2O)

MAGNESIUM 2.0 (1.5-2.5 mg/dL)

FIBRINOGEN ACTIV,CLAUSS FIBRINOGEN 237 (175-425 mg/dL)

FSH <0.7 L (1.6-8.0 mIU/mL)

LH <0.2 L (1.5-9.3 mIU/mL)

THYROID PEROXIDASE AB <1 <9 IU/mL

THYROGLOBULIN ANTIBODIES <1 < OR = 1 IU/mL

CERULOPLASMIN 31 (18-36 mg/dL)

VITAMIN C 0.7 (0.2-2.1 mg/dL)

TNF-ALPHA,HIGHLY SENSITIVE 0.54 L (0.56-1.40 pg/mL)

ESTRADIOL, ULTRASEN,LC/MS 51 H

DIHYDROTESTOSTERON,LCMSMS 64 (16-79 ng/dL)

TESTOSTERONE,TOTAL, MS 1387 H (250-1100 ng/dL)

TESTOSTERONE,FREE 274.6 H (35.0-155.0 pg/mL)

17-HYDROXYPROGESTERONE 40 (32-307 ng/dL)

VITAMIN A (RETINOL) 46 (38-98 mcg/dL)

IMMUNOGLOBULIN A 150 (81-463 mg/dL)

SEX HORMONE BINDING GLOB 41 (10-50 nmol/L)

WBC 2.9 L (3.8-10.8 Thousand/uL)

RBC 5.95 H (4.20-5.80 Million/uL)

HEMOGLOBIN 16.3 (13.2-17.1 g/dL)

HEMATOCRIT 49.5 (38.5-50.0 %)

MCV 83.2 (80.0-100.0 fL)

MCH 27.4 (27.0-33.0 pg)

MCHC 32.9 (32.0-36.0 g/dL)

RDW 15.3 H (11.0-15.0 %)

PLATELET COUNT 231 (140-400 Thousand/uL)

MPV 9.9 (7.5-12.5 fL)

TOTAL NEUTROPHILS,% 46.8 (38-80 %)

TOTAL LYMPHOCYTES,% 42.3 (15-49 %)

MONOCYTES,% 6.8 (0-13 %)

EOSINOPHILS,% 3.4 (0-8 %)

BASOPHILS,% 0.7 (0-2 %)

NEUTROPHILS,ABSOLUTE 1357 L (1500-7800 cells/uL)

LYMPHOCYTES,ABSOLUTE 1227 (850-3900 cells/uL)

MONOCYTES,ABSOLUTE 197 L (200-950 cells/uL)

EOSINOPHILS,ABSOLUTE 99 (15-500 cells/uL)

BASOPHILS,ABSOLUTE 20 (0-200 cells/uL)

ACTH,PLASMA 33 (6-50 pg/mL)

HEMOGLOBIN A1C 5.3 (<5.7 % of total Hgb)

COPPER 124 (70-175 mcg/dL)

MAGNESIUM,RBC 4.5 (4.0-6.4 mg/dL)

SELENIUM 142 (63-160 mcg/L)

ZINC 63 (60-130 mcg/dL)

VITAMIN B6, PLASMA 38.0 H (2.1-21.7 ng/mL)

VEGF,ELISA QNI VASCULAR ENDOTHELIAL GF <31 L (31-86 pg/mL)

HUMAN TGF BETA 1 (TGF-B1) 15460 H (344-2382 pg/mL)

VITAMIN B1 (THIAMINE), B 76 L (78-185 nmol/L)

VITAMIN E (TOCOPHEROL) AMD ALPHA-TOCOPHEROL 12.9 (5.7-19.9 mg/L)

Comp Metab Panel

GLUCOSE,FASTING 91 (65-99 mg/dL)

SODIUM 139 (135-146 mmol/L)

POTASSIUM 4.3 (3.5-5.3 mmol/L)

CHLORIDE 105 (98-110 mmol/L)

CARBON DIOXIDE 30 (20-32 mmol/L)

UREA NITROGEN 17 (7-25 mg/dL)

CREATININE 1.33 (0.60-1.35 mg/dL)

CALCIUM 9.4 (8.6-10.3 mg/dL)

PROTEIN, TOTAL 6.9 (6.1-8.1 g/dL)

ALBUMIN 4.4 (3.6-5.1 g/dL)

GLOBULIN 2.5 (1.9-3.7 g/dL) (calc)

ALBUMIN/GLOBULIN RATIO 1.8 (1.0-2.5) (calc)

BILIRUBIN,TOTAL 0.6 (0.2-1.2 mg/dL)

ALKALINE PHOSPHATASE 109 (40-115 U/L)

AST 37 (10-40 U/L)

ALT 28 (9-46 U/L)

EGFR NON AFR AMERICAN 73 >=60 mL/min/1.73m2

EGFR AFRICAN AMERICAN 85 >=60 mL/min/1.73m2

LIPID PANEL

CHOLESTEROL,TOTAL 175 (<200 mg/dL)

HDL CHOLESTEROL 62 (>40 mg/dL)

CHOLESTEROL/HDL RATIO 2.8 (<5.0 calc)

LDL-CHOLESTEROL 101 H (<100 mg/dL) (calc)

TRIGLYCERIDES 41 (<150 mg/dL)

NON HDL CHOLESTEROL 113 (<130 mg/dL) (calc)

GGT 10 (3-70 U/L)

IRON,TOTAL 75 (50-195 mcg/dL)

IRON BINDING CAPACITY 298 (250-425 mcg/dL) (calc)

IRON % SATURATION 25 (15-60 %)

TSH 1.34 (0.40-4.50 mIU/L)

T4,FREE 1.1 (0.8-1.8 ng/dL)

T3,FREE 3.0 (2.3-4.2 pg/mL)

LIPASE 46 (7-60 U/L)

FERRITIN 59 SUB OPTIMAL (20-345 ng/mL)

PROGESTERONE 0.5 (<1.4 ng/mL)

VITAMIN B12 510 (200-1100 pg/mL)

FOLATE,SERUM 13.4 (> 5.4 ng/mL)

CORTISOL (AM) 11.8 (4.0-22.0 mcg/dL)

INSULIN 3.0 (2.0-19.6 uIU/mL)

DHEA SULFATE 392 (85-690 mcg/dL)

HS CRP 0.8 mg/L

HOMOCYSTEINE 7.6 (<11.4 umol/L)

VITAMIN D,25-OH,TOTAL,IA 52 (30-100 ng/mL)

INTERLEUKIN-6(IL-6),SERUM <1.40 (<5.00 pg/mL)

PREGNENOLONE,LC/MS/MS 62 (22-237 ng/dL)

T3 REVERSE, LC/MS/MS 14 (8-25 ng/dL)

VIP <50 (<75 pg/mL)

This is my latest bloodwork to date.

i swear this is a nightmare. Out of all the test and blood work done, there has been NOTHING definitive about my situation. My total t3 and free t3 have been definitive in terms of being low, but now my free t3 has bumped up a bit for whatever reason. My total t3 has always fluctuated between 60-80 without thyroid medication and i know thats far too low.

I also feel like a aromatize a lot more than i should. During past AAS cycles i NEVER needed an AI, now it feels like my estrogen is always privy to being higher. I dont know if thats a clue for my dilemma or not.

My pregnenolone levels look lowish & ferritin seems to be below optimal, any clues there?

I’m at a loss guys. I’ve either yet to find the main source of the problem or the issues in my body are quite subtle and don’t jump out right away. If theres any ideas in terms of direction i can look in, ill heavily appreciate it.

[magsyh]

The only thing that I can see that is obvious is low cortisol. Have you considered a 24hr test to see what it's doing the rest of the day? Result is much too low for morning.

[Advocate1 in reply to magsyh]

The functional medicine doctor did sign me up for a 24 hr urine/saliva cortisol test. However i'm not sure my cortisol is low otherwise I feel like that would've been picked up mooooonths ago. Nothing I've read online says that my cortisol is too low for the morning but I'll have to search around more. Hopefully you're right and it'll simplify things for me. Otherwise the things that stand out to me are Ferritin being sub optimal and mch, mchc & mcv being towards the bottom of the range. I do wonder if anything pertains to that but we shall see. Thanks for your response!

[magsyh in reply to Advocate1]

Your ferritin is low for a male. Your pregnenolone is a bit low which would give low cortisol. Your cortisol should be nearer 22 in the morning. 22 is actually low for someone under 50. 22 is usually the cut off for over 50's. Mine is 17 and on the low side for a 61 year old so 11 is much too low for someone of your age! You need a 24hour to make sure your cortisol is following the correct rhythm.

[Advocate1 in reply to magsyh]

Hmmm very interesting. I'll need to do more research that'll hopefully confirm your claims! I did take an acth stimulation test back in march and the Endo said that my results were completely normal. Let's see if the 24hr saliva cortisol test says something different. I'm currently taking pregnenolone but no change in my symptoms so it must not be the root. i also know ferritin is in relation to good thyroid function so maybe ill purchase some ferritin supplements too for the time being. In the meantime, I'll wait for my saliva/urine test to come back and hopefully it'll confirm your suspicions. If your suspicions are correct, then WOW, Doctors truly don't know shit! Thanks for your perspective. If you have any other thoughts, I'm all ears!

[magsyh in reply to Advocate1]

A result below 6 usually points to Addison's. The problem here is that most docs are not interested in cortisol being low only if it's low enough to be Addison's. Your use of steroids in the past could well be the cause of low cortisol now. Do you have low blood pressure and weight loss too?

[Advocate1 in reply to magsyh]

Never had any blood pressure problems at all, low or high. The only time I had weight loss was before TRT. Whenever I get off TRT that’s when my symptoms are at their worst. My thoughts are I could have some inflammation and or some iron deficiencies but that remains to be seen.