Dr. Mariano please help 3 years of tests

[cobra]

Dr Mariano,

Please help me and give me your thoughts. I will be in your area in January and want to see you. How would I go about making an appointment how far in advance would I have to do it?

I have consistently tested low for test over this time. I have recently found a doctor that will work with me. However he wants me to see a specialist as there are “none” here locally.

Symptoms are fatigue, depression, estrogenic fat pattern, ANXIETY……………..

I want to feel normal again. Anxiety is killing me.

It all started about 3 years ago when I thought I was having a heart attack. I saw my doctor and he checked my blood pressure and did an ekg. Both were okay. He ordered a blood test.

Cholesterol 201 mg/dl <200 desirable
Triglycerides 69 mg/dl < 150
HDL Cholesterol 46 mg/dl < 40
Chol/Hdl ratio 4.4 ratio < 5.0 (noted as a problem)
Ldl Cholesterol 141 mg/dl <100optimal
T3, total 151 ng/dl 77-178
Free T4 1.0 ng/dl .60-1.70
Ultrasensitive TSH 1.15 uIU/ Ml .47-5.01

Glucose 89 mg/dl Fast: 70-99
Bun 16mg/dl 7-18
Creatinine 1.0 mg/dl .6-1.3
Sodium 138mEq/l 134-145
Potassium 4.3″ ” 3.6-5.2
Chloride 102″” 100-108
CO2 25″” 21-32
Calcium 9.4″” 8.5- 10.5
SGOT (AST) 17 IU/L 15-37
SGPT (ALT) 50″” 30-65
Alkaline Phosphate 62″” 50-136
Bilirubin, Total .02 gm/dl .00-1.00
Protein, Total 7.8″” 6.4-8.2
Albumin 4.5″” 3.4-5.0

Later I developed a gland under my left nipple and thought it was cancer,but it was gynecomastia. I saw a surgeon and he ordered this test.

Cortisol 14.8 ug/dl 6-28
Dhea 458 ng/dl 142-1410
Total testosterone 346ng/dl 190-1037
Estradiol 32pg/ml 20-75

Hepatic function profile
SGOT (AST) 21 IU/L 15-37
SGPT (ALT) 53 ” ” 30-65
ALKALINE phosphate 53″ ” 50-136
Bilirubin, total .3 mg/dl .00-1.00
Bilirubin, Direct .1 ” ” .00-.30
Protein Total 7.1 gm/dl 6.4-8.2
Albumin 4.2 gm/dl 3.4-5.0
Bilirubin, indirect .2mg/dl

I asked for a refferal to an endocrinologist and here are the test results.

FSH 5.7MIU/Ml 1.3-19.3
Lh 3.7MIU/Ml 1.2-8.6
Total testosterone 230ng/dl 190-1037
Free Testosterone 51.3 pg/ml 35-155
Prolactin 15.7ng/ml 2.6-13.1 (noted high)
SHBG 12nmol/l 7-49
% free testosteron 2.15% 1.5-2.2
Estradiol 55pg/ml <207
(changed method of testing)

Basic Metabolic Profile
Glucose 95mg/dL FAST:70-99
BUN 11mg/dL 7-18
Creatinine 1.0mg/dL 0.6-1.3
Sodium 139mEq/L 134-145
Potassium 4.1mEq/L 3.6-5.2
Chloride 104mEq/L 100-108
CO2 29mEq/L 23-31
Calcium 9.4mg/dL 8.5-10.5

A few months later

Fsh 5.1 1.3-19.3
LH 5.7 1.2-8.6
TT 253 250-1100
%free test 1.87 1.5-2.2
free test 47.4 35-155
Prolactin 15.5 2.6-13.1

and then about 2 months ago

Aldosterone………………. ……11ngdl <28ngdl
Vitamin B12……………………530 >174
Folate, Serum………………….18. 6 >5.2
Fsh……………………… ………5.1 1.3-19.3
Lh………………………. ……….3.4 1.2-8.6
Growth Hormone…………….<0.1 < or = 10
Iron total……………………. .110 45-125
Test total……………………. .240 250-1100
Free %……………………….. 2.05% 1.2-2.2%
49.2pg/ml 3.5-155
Progesterone……………… …0.6 ng/ml .3-.9
Ferritin…………………. …….161g/ml 25-371
T3 total……………………. ….146 ng/ml 77-178
anti-thyroglobulin Ab……….<20 iu/ml <20
Free T4………………………. .1 ng/dl .6-1.7
TSH ultrasentive tsh……….1.85 uiu/ml .47-5.01
IGf binding protein-3………..3 mg/l 3.4-7.8
Vitamin D(1,25 Dihydroxy)….45 pgml 15-60
Renin Activity, Plasma………2.2 ng/ml/hr .65-5
Cortisol, free, serum…………83 mcg/dl .07-.93 8:00am-10:00am
Vitamin D, 25-oh total………..25 ng/ml 20-100
(it says something about endogenous production and supplementation being indicated.)
Vitamin D, 25-Oh, D3………..20 ng/ml
Vitamin D, 25-OH, D2………..5
Magnesium………………… …1.9 1.8-2.4
Uric Acid…………………….. ..8.7 2.6-7.2

CBC
White Blood count………….7.6 3.8-10.8
Red blood cell count……….5.41 4-6.20
Hemoglobin……………….. ..15.3 14-18
Hematocrit……………….. ….44.5 42-54
MCV……………………… …82 82-101
MCH……………………… …28.2 26-34
MCHC…………………….. .34.4 32-36
RDW……………………… ..11.9 <14.5
Neutrophil……………….. ..52 40-80
Lymphocyte……………….. 34 12-44
Monocyte…………………. .9 0-12
Eosinophil……………….. .4 0-7
Basophil…………………. .1 0-2
Platelet Count……………275 140-440

Metabolic Profile
Glucose………………..85 70-99 fasting
BUN…………………….16 7-18
Creatinine…………….1.1 .6-1.3
GFR non african american..>60 Gfr< 60=chronic kidney disease
Sodium………………139 134-145
Potassium…………..4.3 3.6-5.2
Chloride………………101 100-108
CO2…………………..29 23-31
Calcium………………..9.1 8.5-10.5
SGOT(AST)……………..15 15-37
SGPT(ALT)……………..40 30-65
Akaline Phosphate……60 50-136
Bilirubin, total…………..0.5 0-1
Protein, total………………7.6 0-1
albumin………………….. …4.2 3.2-5.0

Hemoglodin A1C……………5.4 <7

Urinalysis completely normal no problems.

Semen Analysis
Volume ……………………3.5 1.5-5
Viscosity………………… ..normal
pH………………………. .8.5 7-8
Motility 30 min………..80 80-100
motility 1hr……………75 80-100
Motility 3 hr……………..70 50-100
total count………………160 million 60-150
morphology……………..70 >70 normal forms

I left one paper at the doctors office from what I remember
My cholesterol is high
Ldl………………169 <110
Total cholesterol 228 <200
Hdl ??????? normal range

total cholesterol 228 <200 triglycerides 94. <150. Hdl 47. >39. Ldl 162 <100. Ratio 4.9. <5 and dhea 324. 85-690

I am overweight and working on that right now. I don’t understand why lh is not really elevated and my sperm count is good? Either way if test will help me feel normal again so be it. I worry about thyroid and adrenals.

[leanguy]

@cobra 2074 wrote:

Total testosterone 230ng/dl 190-1037
Free Testosterone 51.3 pg/ml 35-155
Estradiol 55pg/ml <207

Your TT/E2 ratio is not good here… was this a sensitive (or ultrasensitive) E2 test? I’d talk to a Dr (Dr M if possible) about an AI (aromatase inhibitor) like arimidex to improve this ratio. You may end up needing HCG or testosterone as well.

[hardasnails1973]

@cobra 2074 wrote:

Dr Mariano,

Please help me and give me your thoughts. I will be in your area in January and want to see you. How would I go about making an appointment how far in advance would I have to do it?

I have consistently tested low for test over this time. I have recently found a doctor that will work with me. However he wants me to see a specialist as there are “none” here locally.

Symptoms are fatigue, depression, estrogenic fat pattern, ANXIETY……………..

I want to feel normal again. Anxiety is killing me.

It all started about 3 years ago when I thought I was having a heart attack. I saw my doctor and he checked my blood pressure and did an ekg. Both were okay. He ordered a blood test.

Cholesterol 201 mg/dl <200 desirable
Triglycerides 69 mg/dl < 150
HDL Cholesterol 46 mg/dl < 40
Chol/Hdl ratio 4.4 ratio < 5.0 (noted as a problem)
Ldl Cholesterol 141 mg/dl <100optimal
T3, total 151 ng/dl 77-178
Free T4 1.0 ng/dl .60-1.70
Ultrasensitive TSH 1.15 uIU/ Ml .47-5.01

Glucose 89 mg/dl Fast: 70-99
Bun 16mg/dl 7-18
Creatinine 1.0 mg/dl .6-1.3
Sodium 138mEq/l 134-145
Potassium 4.3″ ” 3.6-5.2
Chloride 102″” 100-108
CO2 25″” 21-32
Calcium 9.4″” 8.5- 10.5
SGOT (AST) 17 IU/L 15-37
SGPT (ALT) 50″” 30-65
Alkaline Phosphate 62″” 50-136
Bilirubin, Total .02 gm/dl .00-1.00
Protein, Total 7.8″” 6.4-8.2
Albumin 4.5″” 3.4-5.0

Later I developed a gland under my left nipple and thought it was cancer,but it was gynecomastia. I saw a surgeon and he ordered this test.

Cortisol 14.8 ug/dl 6-28
Dhea 458 ng/dl 142-1410
Total testosterone 346ng/dl 190-1037
Estradiol 32pg/ml 20-75

Hepatic function profile
SGOT (AST) 21 IU/L 15-37
SGPT (ALT) 53 ” ” 30-65
ALKALINE phosphate 53″ ” 50-136
Bilirubin, total .3 mg/dl .00-1.00
Bilirubin, Direct .1 ” ” .00-.30
Protein Total 7.1 gm/dl 6.4-8.2
Albumin 4.2 gm/dl 3.4-5.0
Bilirubin, indirect .2mg/dl

I asked for a refferal to an endocrinologist and here are the test results.

FSH 5.7MIU/Ml 1.3-19.3
Lh 3.7MIU/Ml 1.2-8.6
Total testosterone 230ng/dl 190-1037
Free Testosterone 51.3 pg/ml 35-155
Prolactin 15.7ng/ml 2.6-13.1 (noted high)
SHBG 12nmol/l 7-49
% free testosteron 2.15% 1.5-2.2
Estradiol 55pg/ml <207
(changed method of testing)

Basic Metabolic Profile
Glucose 95mg/dL FAST:70-99
BUN 11mg/dL 7-18
Creatinine 1.0mg/dL 0.6-1.3
Sodium 139mEq/L 134-145
Potassium 4.1mEq/L 3.6-5.2
Chloride 104mEq/L 100-108
CO2 29mEq/L 23-31
Calcium 9.4mg/dL 8.5-10.5

A few months later

Fsh 5.1 1.3-19.3
LH 5.7 1.2-8.6
TT 253 250-1100
%free test 1.87 1.5-2.2
free test 47.4 35-155
Prolactin 15.5 2.6-13.1

and then about 2 months ago

Aldosterone………………. ……11ngdl <28ngdl
Vitamin B12……………………530 >174
Folate, Serum………………….18. 6 >5.2
Fsh……………………… ………5.1 1.3-19.3
Lh………………………. ……….3.4 1.2-8.6
Growth Hormone…………….<0.1 < or = 10
Iron total……………………. .110 45-125
Test total……………………. .240 250-1100
Free %……………………….. 2.05% 1.2-2.2%
49.2pg/ml 3.5-155
Progesterone……………… …0.6 ng/ml .3-.9
Ferritin…………………. …….161g/ml 25-371
T3 total……………………. ….146 ng/ml 77-178
anti-thyroglobulin Ab……….<20 iu/ml <20
Free T4………………………. .1 ng/dl .6-1.7
TSH ultrasentive tsh……….1.85 uiu/ml .47-5.01
IGf binding protein-3………..3 mg/l 3.4-7.8
Vitamin D(1,25 Dihydroxy)….45 pgml 15-60
Renin Activity, Plasma………2.2 ng/ml/hr .65-5
Cortisol, free, serum…………83 mcg/dl .07-.93 8:00am-10:00am
Vitamin D, 25-oh total………..25 ng/ml 20-100
(it says something about endogenous production and supplementation being indicated.)
Vitamin D, 25-Oh, D3………..20 ng/ml
Vitamin D, 25-OH, D2………..5
Magnesium………………… …1.9 1.8-2.4
Uric Acid…………………….. ..8.7 2.6-7.2

CBC
White Blood count………….7.6 3.8-10.8
Red blood cell count……….5.41 4-6.20
Hemoglobin……………….. ..15.3 14-18
Hematocrit……………….. ….44.5 42-54
MCV……………………… …82 82-101
MCH……………………… …28.2 26-34
MCHC…………………….. .34.4 32-36
RDW……………………… ..11.9 <14.5
Neutrophil……………….. ..52 40-80
Lymphocyte……………….. 34 12-44
Monocyte…………………. .9 0-12
Eosinophil……………….. .4 0-7
Basophil…………………. .1 0-2
Platelet Count……………275 140-440

Metabolic Profile
Glucose………………..85 70-99 fasting
BUN…………………….16 7-18
Creatinine…………….1.1 .6-1.3
GFR non african american..>60 Gfr< 60=chronic kidney disease
Sodium………………139 134-145
Potassium…………..4.3 3.6-5.2
Chloride………………101 100-108
CO2…………………..29 23-31
Calcium………………..9.1 8.5-10.5
SGOT(AST)……………..15 15-37
SGPT(ALT)……………..40 30-65
Akaline Phosphate……60 50-136
Bilirubin, total…………..0.5 0-1
Protein, total………………7.6 0-1
albumin………………….. …4.2 3.2-5.0

Hemoglodin A1C……………5.4 <7

Urinalysis completely normal no problems.

Semen Analysis
Volume ……………………3.5 1.5-5
Viscosity………………… ..normal
pH………………………. .8.5 7-8
Motility 30 min………..80 80-100
motility 1hr……………75 80-100
Motility 3 hr……………..70 50-100
total count………………160 million 60-150
morphology……………..70 >70 normal forms

I left one paper at the doctors office from what I remember
My cholesterol is high
Ldl………………169 <110
Total cholesterol 228 <200
Hdl ??????? normal range

total cholesterol 228 <200 triglycerides 94. 39. Ldl 162 <100. Ratio 4.9. <5 and dhea 324. 85-690

I am overweight and working on that right now. I don’t understand why lh is not really elevated and my sperm count is good? Either way if test will help me feel normal again so be it. I worry about thyroid and adrenals.

I see multiple issues going
1. Vitamin D is low dangerously
2. Low zinc levels – low alkaline phosphotase
3. High uric acid which could be due to diabetic like state, blue eyes, gout, and copper excess should be ruled out
4. Vitamin b-12 deficiency at tissues.
5. Potential cortisol imbalance that need to be ruled out via ASI
6. One needs to see a complete thyroid panel including ft3 levels as well as one you have noted.
7. I would also look if this is primary or secondary hypogonadism or from other causes such as nutrient imbalances.

[cobra]

@leanguy 2079 wrote:

Your TT/E2 ratio is not good here… was this a sensitive (or ultrasensitive) E2 test? I’d talk to a Dr (Dr M if possible) about an AI (aromatase inhibitor) like arimidex to improve this ratio. You may end up needing HCG or testosterone as well.

Maybe ai and bromo plus the weight loss?

I used to not want test, but lately I don’t care I just wanna feel normal again.

I know you from the minds. I had to change my name some people at work found out I was posting there so I’ll be using this tag from now on.

[cobra]

@hardasnails1973 2081 wrote:

I see multiple issues going
1. Vitamin D is low dangerously
2. Low zinc levels – low alkaline phosphotase
3. High uric acid which could be due to diabetic like state, blue eyes, gout, and copper excess should be ruled out
4. Vitamin b-12 deficiency at tissues.
5. Potential cortisol imbalance that need to be ruled out via ASI
6. One needs to see a complete thyroid panel including ft3 levels as well as one you have noted.
7. I would also look if this is primary or secondary hypogonadism or from other causes such as nutrient imbalances.

Hi Hans,

I spoke to you on the minds and through email my wife is currently pregnant.

Anyway I changed my name cuz people at work found out my name and it’s kinda embarassing so….

I may not be able to afford to make the trip out to see you. We are barely going to be able to make it to cali with ticket, hotel, visit, tests…..

I followed your suggestion on supplementing I think it was 20,000 ius of vitamin d ( I use vitamin d3) for two weeks and currently am taking only 5,000ius a day + more sun light.

I take 50mgs chelated zinc every night with one tablespoon evo (gonna switch to coconut).

I take a mulit, hawthorne berry, celery seed extract, calcium w vitamin d & k, fish oil.

I also supplement fiber with orange sugar free metamucil 3 times daily.

I am down 10 pounds since restarting high protein low carb. Originally I thought I was 300 pounds turns out I got up to 320 now I am at 310.

Basically I eat steak, chicken, and broccoli daily. Sometimes sugar free jello. Occasional diet coke, green tea and water.

Every three days I give myself a cheat day. Reconsidering this, because I really don’t like going back into ketosis and I feel much better when I am in.

Sleep needs work.

What do you think could be causing my vitamin and mineral defficences? Diet or digestive problems?

[hardasnails1973]

@cobra 2087 wrote:

Hi Hans,

I spoke to you on the minds and through email my wife is currently pregnant.

Anyway I changed my name cuz people at work found out my name and it’s kinda embarassing so….

I may not be able to afford to make the trip out to see you. We are barely going to be able to make it to cali with ticket, hotel, visit, tests…..

I followed your suggestion on supplementing I think it was 20,000 ius of vitamin d ( I use vitamin d3) for two weeks and currently am taking only 5,000ius a day + more sun light.

I take 50mgs chelated zinc every night with one tablespoon evo (gonna switch to coconut).

I take a mulit, hawthorne berry, celery seed extract, calcium w vitamin d & k, fish oil.

I also supplement fiber with orange sugar free metamucil 3 times daily.

I am down 10 pounds since restarting high protein low carb. Originally I thought I was 300 pounds turns out I got up to 320 now I am at 310.

Basically I eat steak, chicken, and broccoli daily. Sometimes sugar free jello. Occasional diet coke, green tea and water.

Every three days I give myself a cheat day. Reconsidering this, because I really don’t like going back into ketosis and I feel much better when I am in.

Sleep needs work.

What do you think could be causing my vitamin and mineral defficences? Diet or digestive problems?

Thyroid issues and excessive body fat
The body if having high enough body fat it will recongnize fat as another organ causes nutrients to be used at a higher rate.

[JanSz]

@cobra 2087 wrote:

Cortisol, free, serum…………83 mcg/dl .07-.93 8:00am-10:00am
Uric Acid…………………….. ..8.7 2.6-7.2
Total testosterone 230ng/dl 190-1037
Prolactin 15.7ng/ml 2.6-13.1 (noted high)
SHBG 12nmol/l 7-49
Every three days I give myself a cheat day.

Work in above.

Replace cheat day with day where you just drink tap water.
.

[cobra]

@hardasnails1973 2108 wrote:

Thyroid issues and excessive body fat
The body if having high enough body fat it will recongnize fat as another organ causes nutrients to be used at a higher rate.

So do you think if I continue to lose weight and treat whatever thyroid issues and if any adrenal issues my test could normalize?

[cobra]

@JanSz 2111 wrote:

Work in above.

Replace cheat day with day where you just drink tap water.
.

Hi JanSz

What is wrong with my morning cortisol level?

Uric Acid I agree. I was told what it is caused by, but with doing low carb (around 20grms aday) high protein would this improve or get worse? I have trouble losing weight unless I’m in ketosis. I have had no other diet plan that worked as well as a keto diet. If a keto diet would make it worse is it worth it given how much weight I need to lose? I worry about my heart. You suggested a diet I should follow on the minds and I have been following one that is very close to it minus the steamer.

Testosterone is low. Do you think weight loss would raise it or fixing other issues like hans is saying?

Prolactin is high. I took bromo for a while. at first I felt a difference, but after a while it just made me feel dizzy and not much else.

Shbg is low. Is this a problem? I know it’s because I’m fat so I am already working on that. With weight loss would it raise with testosterone or by itself?

For the cheat day I meant every three weeks not three days. I set goals and if I don’t reach them I don’t take the cheat days.

[Author]

Posts