High levels of sex hormones and low HDL level. How to control them?

Question

Hi doctor,

Recently, I got my blood tests done without any medical advice as I was suspicious about a few endocrinological areas. Some test results have been out of the normal range, that I did not notice earlier. Please take a look at my recent report. In addition, I have also attached a spreadsheet reflecting my test results for the past few years. I have also been taking some medications like tablet Fenofibrate 145 mg, tablet Atorvastatin 20 mg, and tablet Clonazepam 1 mg for sleep. All these medications are taken at night only.

Answer 1

Hi,

Welcome to icliniq.com.

First of all, I appreciate you for taking care of your health and looking into things carefully. Based on the attached reports (attachments removed to protect the patient's identity). The following are the conclusions:

The lipid profile looks good except for the good cholesterol-HDL (high-density lipoprotein) level being low. I see that you are on the tablet Atorvastatin and the tablet Fenofibrate, and sometime in the past your triglyceride level was greater than 500 mg/dL. I would not do anything more, except suggest you increase exercise and consume a healthy diet.
The cortisol level is low but you do not have any symptoms. I further want to know if this was a morning specimen (taken before 9 AM)? If there is no symptom, then there is nothing to do or you can repeat the test.
The sex hormones show high levels of estradiol, total testosterone, and SHBG (sex hormone-binding globulin). This is confusing. Your weight is 200 pounds, so are you muscular or have belly fat? Are you on testosterone injections?
Aldosterone level is normal, but why did you send a 24-hours urine specimen?
Liver, kidney, electrolytes, and urine test results are normal.
The blood counts are also normal. I appreciate that you noticed the slightly lower side of WBC (white blood cells), but it is within the normal range.
Vitamin D is also normal. The D2 level is low whereas D3 is normal, so as per the norm the total is normal.
PSA (prostate-specific antigen) test, thyroid function tests, and blood glucose test results are normal.

Out of all the test results, the abnormal sex hormone levels are intriguing and may need more consideration.

I further want to know about your libido and erection? Is there any history of:

Prostate issues or any previous treatment is taken for it?
Head injury?
Snoring?
Sleep apnea?

If there are no symptoms or complaints then I do not think we have to do anything more. Is there anything in your medical history that you did not reveal? Are you taking any other medicines or supplements? As for lipids, it depends on your risk profile too like your family history of heart disease and stroke, your tobacco use, etc. I do not advise any change in medications. You just need to increase the exercise duration and make healthier food choices.