First post-- Do these labs make sense?

[Jack Wagon]

Hi,
I am a 44 y.o. 6'6" 260 ex-athlete who never used steroids or anything other than protein, glutamine and occasional creatine. In May of 2012 I was diagnosed with primary hypogonadism. TT was 256. Clomid got me up into the 600's while I was trying to make a baby, which is currently in the oven. The fertility doctor also works at a men's health clinic and said Clomid hasn't been proven safe for long-term use so we switched to Androgel. Eventually after getting to 3 pumps per day, my TT only made it to 300. We then switched to Testopel. 13 pellets were inserted last month.

I feel great. My one month labs just came back and per the nurse, TT is now 424 and bioavailable T is 271. She didn't read me the units used for these values, but isn't that a very high bioavailable number for such a low TT at 1 month? I am awaiting a phone call from the Dr. But I though I would seek opinions here. She had expected TT of over 900 at one month post insertion of 13 pellets. But maybe bioavailable T is more important as I am back to my old self in the wood dept. and my energy is up too.

[PeakT]

Wait - let's step back for a minute.  You really should be much higher than 424 with 13 pellets after one month.  That just does not make sense.

First of all, check out this calculator:

 http://www.issam.ch/freetesto.htm

For you to have bioavailable testosterone of 271 with total testosterone of 424 ng/dl, you'd have to have an SHBG of 18.5 nmol/l.  Is that possible?  Sure but it is low imho compared to what one normally sees on this forum.  Do you have your SHBG number?

Let me show you what I mean.  Check out these numbers from some of our more illustrious members:

Simeoni's reading was 28
https://www.peaktestosterone.com/forum/index.php?topic=528.msg4948#msg4948
and then 35 another time
https://www.peaktestosterone.com/forum/index.php?topic=528.msg4948#msg4948
Avacado's was 39
https://www.peaktestosterone.com/forum/index.php?topic=456.msg5885#msg5885
Anton was 32.8
https://www.peaktestosterone.com/forum/index.php?topic=473.msg4280#msg4280
And FightLowT was 29.6
https://www.peaktestosterone.com/forum/index.php?topic=646.msg5931#msg5931
SomeGuy was 35
https://www.peaktestosterone.com/forum/index.php?topic=354.msg3180#msg3180
Starry was 27
https://www.peaktestosterone.com/forum/index.php?topic=460.msg4212#msg4212

And if you poke around you'll see a few guys right at 25.  But this is what I'm used to:  SHBG in the 28-42 range.  Now the range for "normal" in the labs is quite large, but I'm just letting you know what we usually see here.

There have been a few guys right near 18 though:
https://www.peaktestosterone.com/forum/index.php?topic=623.msg5752#msg5752
https://www.peaktestosterone.com/forum/index.php?topic=566.msg6010#msg6010

But the bottom line is that you need to figure out if that total testosterone is right or your SHBG is lean and mean or just what is going on.

And, yes, many experts think bioavailable testosterone is what really counts.  There is less data out there for bioavailable though and so most everyone goes with total testosterone at this point in time.

[Jack Wagon]

I just got back to the house and rechecked the numbers the nurse gave me. I was off on the bioavailable-- it was 246.4. Still high considering 424 Total. The estradiol was < 11.8, but I am on half a arimidex every other day because I reported nipple sensitivity. Maybe that was in my head. I'll ask the doctor about that too since I would doubt any aromatase conversion is occurring with my other numbers. 

The doc was certain my 300 TT reading was a lab error when I was on Androgel. The repeat test gave the same figure. I wonder if she will retest my Testopel results too.

[PeakT]

I am not at all surprised you were 300 on Androgel.  Just type in Androgel in the Search and you'll see dozens of guys with low T reading on Androgel.  It is poorly absorbed by many, many men based on what I've seen.

Actually, that lower SHBG reading kind of makes sense now that I think about it.  You are primary, which is kind of rare around here.  And the body will sometimes respond to primary, or so the theory goes, by raising free testosterone levels to compensate.  HRT can also lower it:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2265.1996.tb02061.x/abstract

Wait - I just looked at your original post.  Clomid took you up to 600?!?  Then why does your doctor think you are primary if you responded so well to Clomid?

[Jack Wagon]

Another question to ask her then. I'm glad you wrote me before my call was returned. She had suggested it was from environmental damage of some sort. I'll ask why I came up higher on Clomid then. Is treatment generally different for secondary than for primary? I don't want to press her on that if its a moot point.

I'll also ask if any other tests were done last week and specifically SHBG.

[PeakT]

Yeah, ask her cuzz that does not make any sense to me.  Clomid basically works by blocking the estrogen receptors in the hypothalamus.  In other words Clomid doesn't travel to the testes directly and stimulate testosterone production.  HCG, on the other hand, mimics Leutinizing Hormone and actually stimulates the testes directly.

Clomid works by eliminating the inhibition from the hypothalamus and pituitary and thus if you see your testosterone increase substantially after a round of Clomid, this means your testes are still in good shape and can produce testosterone, i.e. they are not primary.

Let us know what she says...

[Jack Wagon]

PeakT,
Just left message 2 for my doctor this morning. The nurse confirmed that my TT got up to 689 on Clomid in July. I think I feel better at 424 on the pellets though. I seem to feel a surge after exercising, especially when it involves the legs. I'm guessing the exercise washes more blood over the pellets and I'll bet my TT goes higher after exercise than the morning lab results showed. I haven't read this anywhere, but I even felt the surge after raking and bagging leaves this weekend.

The plan up until now was to find the right dose of T for now and switch to Clomid a few months before we try for baby #2 (#1 is due in March and we've frozen sperm just in case). Does the primary verses secondary question lead you to believe I'd be better served with another plan of attack? My sperm count was actually high prior to TRT, so I think you are right about me being secondary. My question now is does it make any difference for treatment? Thanks,

Jack W

[PeakT]

I'm guessing the exercise washes more blood over the pellets and I'll bet my TT goes higher after exercise than the morning lab results showed. I haven't read this anywhere, but I even felt the surge after raking and bagging leaves this weekend.

Guys do not realize how much exercise affects mood.  The "surge you are talking" about here probably comes from several things from the exericse:

1.  An increase in dopamine
2.  An increase of testosterone in the brain
3.  An increase of blood flow to and nitric oxide in the brain.

Keep up the good work!

What you're doing makes sense to me.  I think the doc just accidently said primary instead of secondary.

[Jack Wagon]

Peak,

My doctor returned call and said she was pleased with the numbers and how I feel. She said bioavailable was high normal, TT only remained in the 400's because SHBG was low normal. She said I will probably need to increase my Arimidex at the end of the "cycle" (right now it's half a tab every other day) and she'll move up to 14 pellets in February's insertion. I didn't address the primary vs secondary question as it won't affect treatment and I probably just heard her wrong last time. She is a published expert on the subject so I'll assume it was my misunderstanding. We'll save Clomid for when I'm ready to try for a second child.

Thanks for your insight, all of your replies, and this site in general. I loved the Clomid studies posted by a member today. Why can't I find studies like that through Google?

Jack

[PeakT]

Peak,

My doctor returned call and said she was pleased with the numbers and how I feel. She said bioavailable was high normal, TT only remained in the 400's because SHBG was low normal. She said I will probably need to increase my Arimidex at the end of the "cycle" (right now it's half a tab every other day) and she'll move up to 14 pellets in February's insertion. I didn't address the primary vs secondary question as it won't affect treatment and I probably just heard her wrong last time. She is a published expert on the subject so I'll assume it was my misunderstanding. We'll save Clomid for when I'm ready to try for a second child.

Well, you're feeling a lot better, right?  If that' true, then really focus in on the lifestyle stuff and you should nice steady improvement over the coming months.  It's great to notice every week that you're feeling a little better.

Thanks for your insight, all of your replies, and this site in general. I loved the Clomid studies posted by a member today. Why can't I find studies like that through Google?

Jack

No problem.  Here is a tip:

1.  Go to scholar.google.com
2.  Usually you want to type in the generic name (clomiphene) as the researchers generally avoid the brand name.

[werd200]

My shbg ranges from 7-9.7 n/mol peak-t and probably won't change that much with weight-loss. You gain about 0.5 n/mol shbg for every 1 bmi point you lose. My shbg is extremely low, probably even at normal weight. I guess our friend here has a similar hormonal profile, low shbg, low t, but averge-high free-t and bioavailable t.

Read this study.

[PeakT]

My shbg ranges from 7-9.7 n/mol peak-t and probably won't change that much with weight-loss. You gain about 0.5 n/mol shbg for every 1 bmi point you lose. My shbg is extremely low, probably even at normal weight. I guess our friend here has a similar hormonal profile, low shbg, low t, but averge-high free-t and bioavailable t.

Read this study.

Which study?