Week 48 Wrapup

At the beginning of this week, Haile Gebrselassie broke the marathon world record with a 2:03:59 time. I thought this was pretty phenomenal, but I didn't quite realize how phenomenal until I did the math. That works out to about a 4:44/mile pace. I can't run a mile in 4:44. I don't mean that I can't do it now (which I can't). I mean, if I quit my job and got a coach and trained full time, I don't think I could ever get to the point where I could run even a single mile in 4:44, much less sustain that pace across 26.2 miles. As of right now, I can't even do a 100 meter dash in a 4:44 pace.

On my mountain run last week, I rolled my left foot a couple of times on the way down. It felt okay unless I landed in a certain way, so it only hurt about once every hundred steps. As I kept going down and got more fatigued, it ended up being more like every 50 steps, then like every 20 steps. It didn't really feel that bad afterward, but when I started running again this week, it really hurt a lot. The pain's in the foot itself, sort of just to the front of the ankle and to my left. I don't know if it's a pull or sprain or stress fracture or what, so I'm just icing it until it goes away.

On Monday, my muscles were too sore from the mountain run to go running. On Tuesday, I went out and ran a mile, which hurt so much I stopped and stretched and walked another mile. After that, I tried running another mile, but I was still way too sore. On Wednesday, I skipped running again. By Thursday, I was no longer sore, so I went to the track for my speedwork. I did 6x400, but again had to stop and walk a lap between 3 & 4 to catch my breath.

After the running Thursday, my left foot hurt a lot, and continued to hurt on Friday. I weighed the idea of cutting back a little versus trying to run more and having a real injury that forces a longer cut back. In the end, I decided to skip the long run I planned for Saturday, leaving me at a total of less than 7 miles for the week. Boo-urns.

Lab Test Results

I got the lab test results back from the doctor visit a couple of weeks ago. The results are impressive, to say the least.

Here's a very lengthy recap with all of my prior test results thrown in: When I was struck by lightning in the summer of 2006, the emergency room doctor said their tests all showed me as normal except for an elevated level of ALT (a liver enzyme), and suggested I talk to my doctor about that. My doctor's tests confirmed that, and he said the most probable cause is fatty liver infiltration, basically where too many fat cells clog up the liver and keep it from working right.

At the same time, I asked my doctor to check my testosterone levels because I was suffering from some of the classic symptoms of low testosterone (fatigue, inability to concentrate, liking Coldplay). This wasn't just a "tired from working all day" fatigue. It was a "man, there's really something wrong with me" kind of thing. The worst was just not being able to focus or concentrate. I just felt like my brain didn't work right, and I couldn't snap out of it. In a surprise to no one, the lab confirmed that I indeed had low testosterone.

These first tests with my doctor were on 8/31/06, and showed my ALT at 71 IU/L. Reference range is 2-60. My total testosterone level was 268 ng/dL. The reference range is 250-1100 ng/dL. So, I was on the low end of that scale, but not completely out of range. The reference range is misleading, though, because I'm of the understanding that this particular test is not taking age into account. If the reference range is just the middle of the bell curve made by plotting all the results from all men tested, the old men whose testosterone production has naturally declined will be skewing the curve. However it's derived, and even if I wasn't technically out of range, 268 is a number more typical of a 70 year old than a 35 year old. My free testosterone was 46.8 pg/mL. Reference range is 35-155 pg/mL, so again, I was close to the low end. Percent free was 1.75%

The only other thing out of range on that test was a low BUN to creatinine ratio of 9.1 The reference range is 10-28. The doctor dismissed that as an anomaly since it was barely out of range and both my BUN and creatinine were in normal range anyway.

I followed up with the doctor a few months later (1/5/07) to find that the ALT was no longer out of range. But, he tested my cholesterol and triglycerides, and they were too high. ALT was 39 this time. Total cholesterol was 231 mg/dL. Cutoff for that is 199, and anything 200 and over apparently spells early death. Triglycerides were 179 mg/dL. Cutoff for those is 149. HDL cholesterol (the good kind) was 30 mg/dL. That should be over 39, and also should be over 20% of the total. LDL cholesterol (the bad kind) was at 165 mg/dL. That should be under 100. VLDL (another bad cholesterol) was at 36 mg/dL, which was actually within the reference range of 5-40.

One other abnormal result was that my bilirubin was at 1.3 mg/dL, but that's just barely out of the reference range of 0.1-1.2. In other words, ignore.

In the meantime, I went to the urologist seeking testosterone. Quite a few blood tests were taken to check on all of the other things that could be interfering with testosterone production. In one of them, I had a high level of prolactin, which is the hormone that makes you lactate. I've never lactated yet, but I still needed an MRI to rule out a prolactinoma, which is a kind of brain tumor (the less bad kind, from what I hear). In the end, all other causes of low testosterone were ruled out, and it was concluded that I was low in testosterone either completely idiopathically, or because I'm a lazy, fat slob.

First urologist test was 9/16/06. Prolactin was 20.9 ng/mL, out of a reference range of 2.5-17. Total testosterone on this test was 309, and this test didn't calculate free testosterone. A followup test on 9/22 measured SHBG (sex hormone binding globulin) at 15 nmol/L, out of a reference range of 5-49. Using that value for SHBG, and the 4.6 value for albumin from my 8/31 test, an online calculator figures my free testosterone on 9/16/06 as 84.6 pg/mL or 2.74%. That's almost twice as much as the 8/31 test, so either the online calculator's methodology is flawed, or the first lab's methodology for deriving the free amount is flawed, or attempting to use results from 3 different dates to get a meaningful calculation is a bad idea.

Because I wasn't yet ready to accept the possibility that my being fat and lazy was responsible for my woes, I tried some prescription testosterone gel (AndroGel, 50mg) starting 10/1/06 for about 5 weeks. After about 3 1/2 weeks, I could feel a definite difference. I wasn't so tired all the time, and I could feel a certain clarity of thought that had been missing for a long time. A blood test on 11/1/06 showed total testosterone at 325, and free testosterone at 60.3 (1.86%). That was an improvement, but I had been expecting to see something higher after taking testosterone for a month. Turns out that there's an enzyme in adipose tissue (fat) that converts testosterone to estrogen. So, even adding testosterone to my system wasn't increasing my overall level so much since I had so much fat to just swallow it up.

I was in a bit of a quandary at this point. I could feel the benefits of having more testosterone in my system, but long term use of external testosterone starts a feedback loop that eventually renders you sterile. The body sees the hormone levels increase, then cuts its own production until the testes no longer produce sperm. And, cutting off the external source doesn't bring them back on line. So, if I wanted the benefits of taking it, we were going to have to decide if we wanted more kids, plus actually bank some sperm for the future to either use to have more kids, or as a hedge against changing our minds. That wasn't a really desirable future, but it beats how crappy I had been feeling for years.

While we debated this future, I went off the testosterone, then had another test on 3/16/07 to use as a baseline of all the sex hormone levels for if I did go back on it long term. This one had total testosterone at 331, and free at 85.6 (2.59%). This didn't make any sense to me, because it was the highest level yet, but I had been off the prescription for a couple of months. It's still a low reading compared to other young males, but still, why so high relative to my previous tests? I still can't explain this one. I wasn't checking my weight during this time, so it's possible I lost a few pounds somewhere that made a difference, but other than that, I have no theories.

Before deciding on long term prescription testosterone, though, we had to explore our other option. Exercise stimulates testosterone production, and losing weight means there's less fat to convert it estrogen. It was possible that I could lick the problem through exercise alone, and even if I couldn't, less fat would mean a better ability to use the prescription stuff. I decided I just couldn't consign myself to a lifetime of medication without knowing if there was another way. So, on 11/5/07, I started a plan of exercise, and started this blog to track it.

I had originally thought I would exercise for 8 weeks, then see if my levels went up or my symptoms went away. I figured if my levels went up and I felt better, then I've found my cure. If they didn't go up, well then I needed to go back on the prescription, with the added benefit of being a few pounds lighter when I do. I did a baseline test on 11/7/07 that showed my total testosterone at a nice, low 255. Free testosterone was 52.4 (2.05%).

After 8 weeks, I was definitely feeling better, like I didn't really have the low testosterone symptoms anymore. However, I didn't want to retest until I had gone a few more weeks or made a bigger change in my weight. I was afraid that if I tested too soon, I wasn't going to get a definitive enough answer. If I was feeling a little better and my levels just went up a little, that doesn't give me clear direction about which way to go. So, instead, I kept putting off the retest. It was about 10 months later by the time I actually got into the doctor's office to test again. I had lost about 35 pounds, and any low testosterone symptoms I previously had were long gone.

The lab results I got this time are certainly definitive. These most recent tests were done 9/11/08. My total testosterone is 437, which still isn't a really high reading compared to some people, but it dwarfs any previous reading I had. Free testosterone is 84.9 (1.94%), which is right up there with the highest ones I had before.

So, it's now painfully clear to me that to remain feeling good, I need to keep myself at or below this weight, and get at least 4 hours of exercise per week. I know what the alternative is, and the way I felt before is still fresh enough in my mind to be able to know that I prefer feeling this way. If for whatever reason I couldn't exercise and stay trim, I would absolutely head back to the prescription testosterone now that I know how valuable this stuff is to me. However, being able to handle the problem solely through exercise avoids the side effects of the prescription route, and has a huge amount of other great side effects of its own.

In the category of "other great side effects" comes this: The 9/11/08 labs showed my ALT all the way down to 15, so any possible fatty liver problems I had are long gone. Triglycerides are way down, to 78. Total cholesterol is all the way down to 187. The actual breakdown of the cholesterol is still a slight concern. HDL is up to 35, but still should be over 39. LDL is down to 139, but should still be less than 130. VLDL is way down to 13. Because the HDL is low by a smidgen and the LDL is high just a tad, I'm barely missing that magic 20% minimum target ratio of HDL to total cholesterol (these numbers put me at 19%). If I could just move the LDL and HDL a bit to put them in range, I'll be golden. The only other out of range result is bilirubin, still a little high at 1.6 (and still completely ignorable at that level)

One other side effect is that I can pay a whole lot less for life insurance now. My existing policy is priced kind of high specifically because of my weight and the cholesterol. Assuming the insurance company's tests jibe with my doctor's, I can probably pay about half what I'm paying now for the same coverage. After getting these results, I went ahead and applied for a new policy, and scheduled the physical for Wednesday morning.

The only problem is that I'm going to have to make a concerted effort to eat less the next couple of days. I don't know how the insurance company breaks down their weight categories, but just in case it has anything to do with BMI, I want to make sure I weigh in inside the normal range. For a six foot height, that would be 184.2 or less. Since I normally weigh myself naked, I'll have to pick out some very light clothes to be weighed in as well. I feel like a wrestler trying to make my weight class. I would just wait a few weeks to get my weight down another couple of pounds by itself, but, I'm going to Mexico on Friday, and that's usually good for a gain of a few pounds. So, I figured I'd just get it over with now.