26, High Total Test, Low Free Test, Experiencing Fatigue, Brainfog, Anxiety

Pharma / TRT Testosterone Replacement
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Hello guys, I’ve just got bloods because since some year (and aggravating every year) I experience chronic fatigue, brain fog, anxiety, slow recovery, weakness, sometimes pre-e but my libido it’s ok only a bit swinging in some periods but that’s normal I think.

I’ll try to add all the useful information I can think of:

  • 26, healthy, no previous major problems
  • 5’8"
  • ~160lb, eating at a slight surplus from at least a year (gained ~22lb in the last 2 years)
  • ~15% bf
  • ovo lacto vegetarian from 10 years
  • doing weight lifting ~5 time a week, with some cardio
    (rest of the time I’m nearly always sitting because of work/study etc)
  • normal body temperature 36.3 (97f)
  • moderate to low stress, but always suffered form anxiety
  • these symptoms of body and brain fatigue started when I was ~21 and every year seems stronger, also since this year I’m starting to having problems with my memory
  • started to lose hair and grow body hair in the shoulders from 22, but in my family there is MPS

My diet is basically (99% home cooked)

  • Rice
  • Pasta
  • Legumes
  • Vegetables of any kind
  • cheese
  • Eggs
  • A lot of nuts as snack
  • NO soda, very rarely processed food

It’s since about two years that I take semi-regularly:

  • B12 250mcg
  • D3 5000ui
  • K2 300mcg
  • Omega3 300mg
  • Vit E 100mg
  • Curcumin 1gr (not everyday)
  • Protein powder (20~40gr protein)
  • Creatine 5gr (I miss this often)

Other

  • No smoker
  • Very rarely drink (and still not much)
  • Cannabis use hardly once a month and still not smashing dosages
  • Not under any medication, only the supplement listed above

I checked the sex hormones only now because I thought the problem was in my lifestyle (2~3 years ago I was totally sedentary) or in some micronutrients/vitamin missing, but even after fixing them I still experienced fatigue and weakness in every field, and the answer could be this.

Even if my Total T is good, in the upper side of the range, my Free T is very low, it should be ~15 compared to the normal ratio between TT and FT.

Bloodworks

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SHBG is missing because the doctor forgot to check it, but we can assume it is sky high since the TT/FT ratio.

Reverse T3 is also missing because they said they can’t test it :neutral_face:

The general blood values are all good, but I don’t have them with me, only value a bit odd is glucose that in all my exams result always a bit high, but in range like 87~89 (range 60-99)

Now which possibilities I have to fix/manage this?
TRT seems a bit excessive, and I would leave it as a last resort, but if it can fix my problems while other approaches should fail, I take it into consideration

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Low body temps reflect a balance of fT3 and rT3. fT3 is mid-range and should support good body temps, so we suspect rT3 is the problem. Please describe stress levels and past stress events including injury and illness.

Where are you located?

Good TT and low FT suggests elevated SHBG which lowers FT and inflates TT number with more SHBG+T which is not bio-available.

Describe history of using iodized salt and having low body temperatures.

Other labs:
AM cortisol - at 8AM or 1 hour after waking up
Fasting cholesterol
Fasting glucose
CBC
hematicrit

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

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Temperature

The temperature I provided is taken Under the arm, I never taken my temperature other ways (Not even on medical examination).

36.3 it’s considered a pretty normal temperature here (I’m from Italy), I think the average is 36.5

For what I get a temperature between 36.2 and 36.6 is considered the norm, while from 36.8 upward it’s fever (always talking of temperature taken under the arm)

Stress, injury and illness.

I never suffered major injury or illness, except when I was like 8 and I got a strong fever along with a strong tinnitus, dizziness. Was hospitalized and recovered after ~15 days, I got no diagnosis, and idk what medication they used.

When I was little I experienced another couple times tinnitus and dizziness episodes, but without fever and of short duration, got all kind of exams CT scan, EEG, and all was ok.

From the age of 12 till present I started to develop a very light tremor only on my hands that progressed with the years to become more evident, (but still light) it’s not disabling, but socially it’s a bit embarrassing when people don’t know about it (seems like I’m nervous while I’m fine) and it makes precision work very hard.

I got plenty of exams about this (again bloods, CT, EEG, ECG, RX even a Brain Scintigraphy to exclude Parkinson’s disease) and everything seemed ok, in fact the diagnosis was a general Essential Tremor.

I suffer from anxiety probably Generalized anxiety disorder, but never got Panic Attacks or heavy episodes.

And from years, (but every year seems worse) I suffer from fatigue, weakness, brain fog, poor memory with “Tip of the tongue”

About stress I would say normal stress the one you get with school, exams, relationships. normal life up & downs etc, nothing out of ordinary. But with anxiety even normal stress of life is heavy.

edit:
Sweat
I forgot to say that I sweat a lot, the 3~4 months of cold I’m ok, when the temperature is a little higher just a walk can cover me in sweat, in 45min of light running (like 9 minutes-per-mile) I need to drink 2 liter of water and sweat buckets

Iodine

I use Sea Salt 90% of the times (that should contain naturally iodine, even if a little less than iodized salt) cause I prefer the flavor, the other 10% of the times I use iodized salt.

I also eat Potatoes 2~3 times a week that should contain decent iodine.

Other labs

I did Fasting glucose roughly 1~2 month ago and it was 89 (range 60-99), and all the other times the result was similar, high but in range.

Also had hematocrit, cholesterol and cbc recently and they where good (middle of range), but I don’t remember the values, gonna search for the paper or repeat the test.

I don’t remember if I ever tested Cortisol, same as above.

Other missing informations:

Describe body and facial hair:
I grow thick and long hair on all my body, back and shoulder was the exception, but recently I’ve started to grow hair even there.
I’m able to grow a full thick beard.

Describe where you carry fat:
I carry most of my fat on my belly and hips

-testes ache, ever, with a fever?
No

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When making sea salt, iodine is lost during crystallization, there is no useful amount of iodine in sea salt unless the package states that it has been iodized.

Please provide oral body temperatures as requested, should not be difficult. We are concerned with small temperature differences, not determination of a fever.

Concern with cholesterol is that it can be too low.

“gained ~22lb in the last 2 years”
Thyroid function can greatly affect this if low.

Please test FT again. FT occurs in pulses with short half life and a single lab can catch a high or low value. Or see if bioavailable T can be tested which is albumin+T and FT.

Could you be exposed to toxic chemicals, heavy metals or bromine chemicals?

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I had no idea the usual thermometer could be used by mouth, however I’ve taken 3 measurement, 1st: 37.0, second 37.0, third 37.1

Also found my last analysis:

Analysis value unit usual range
Glucose in urine Negative / Negative
Urine Ph 5 ph 5~7
Blood Glucose (basal) 90 mg/dl 60~110
Creatinine 0.75 mg/dl 0.65~1.35
Serum iron 123 ug/dl 65~175
Transferrin 239 mcg/dl 200~400
Ferritin 52.51 ng/ml 25~380
ENZYMES --- --- ---
AST(GOT) 17 U/l 0~40
ALT(GPT) 14 U/l 0~45
GAMMA-GT 10 U/l 12~64
LIPIDS --- --- ---
Total Cholesterol 133 mg/dl 130~200
Triglycerides 86 mg/dl 0~175
HEMATOLOGY --- --- ---
RBC 5030000 /uL 4600000 ~ 6500000
Hemoglobin 14.6 g/dl 13~18
Hematocrit 43.2% % 38~50
MCV 85.9 fL 76~96
MCH 29 pg 27~32
MCHC 33.8 g/dl 30~35
Platelets 221000 /uL 150000~450000
WBC 6120 /uL 4000~11000
LWUKOCYTE FORMULA --- --- ---
Neutrophil granulocytes 57.1% % 45~75
Lymphocytes 33.5% % 20~45
Monocytes 5.6% % 0~10
Eosinophilic granulocytes 3.3% % 0~6
Basophilic granulocytes 0.5% % 0~1
Neutrophil granulocytes 3.50 103/uL 103/uL 2~7.5
Lymphocytes 2.05 103/uL 103/uL 1.5~4
Monocytes 0.34 103/uL 103/uL 0~0.8
Eosinophilic granulocytes 0.20 103/uL 103/uL 0~0.4
Basophilic granulocytes 0.03 103/uL 103/uL 0~0.1
REUMATOLOGY --- --- ---
VES 1h 2 mm 1~15
VES 2h 4 mm 5~30
Katz index 2 / 2~15
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Need waking and mid-afternoon body temperatures.
37C looks good so far.

This is horrible. Cholesterol is the foundation for creation of all of your steroid hormones, including Vit-D3 and cortisol. Cholesterol <160 is associated with increased all-cause mortality. May be because diet is too clean. But we do see a few young guys who simply have low cholesterol. However, DHEA-S is strong.

Did you miss any of my concerns?

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Temperature

Morning : 37.0 (~T+30min from waking up)

Late Morning: 37.1

Mid-Afternoon: 37.0

Low Cholesterol

Yes I guess my diet is very clean, I don’t have separate HDL and LDL readings, but since the 75% of the fats I eat are from nuts, olive oil, dark chocolate (85%+ cacao), while only the ~25% are from cheese and eggs, my guess is that I have a very low LDL so that’s probably why the Total is low.

I read the study about low cholesterol increased mortality, but it’s based only on elderly people and I am not fully convinced that the same would be valid for young, at least not at that range of values.

They themselves say “High serum cholesterol is known to be directly related to mortality in people younger than 65 years of age, but the results of studies in the elderly have had conflicting conclusions.”

But better not run the risk, I’ll increase a little my eggs and cheese consumption and try to establish little higher value.

About the Steroidogenesis chart you have included, even if I’m not an expert, I feel like the culprit is not cholesterol, because my DHT is sky high despite being one of the last on the steroidogenesis chain, so the “building blocks” for steroid creation should be present, it’s something in the middle or external that should cause the problem.

About iodine, since you mentioned it could be too low I started taking 2 drops of lugol’s solution stated to contain 7.62mg (iodide + iodine) per drop.

About the SHBG I also ordered the minerals and plant that it said that lowers it (boron, zinc, nettle root, muira puama) and I’m already integrating magnesium and vit D, but sincerely I don’t have much hope on these, I’ve taken muira puama and zinc in the past without major benefits, and for nettle root in some forum a person posted the before/after bloodwork showing little to no difference on SHBG.

I was also thinking about a low dose Proviron since it should lower SHBG, at 25~50mg it seems to not be suppressive but I’m still waiting a bit before trying this.

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Maybe it does not kill off young people very quickly, but may show up as hormone problems that mess with quality of life. But to pretend that you understand completely hot low cholesterol may affect you and to dismiss the negative implications is not wise.

Your DHT comes from a balance of [FT, ambumin+T]–>DHT and liver clearance. That is totally disconnected from the start of the steroid hormone cascade. Another factor is how active 5-apha reductase enzyme is in a guys body.

Your body temps are great, your thyroid function can be considered good. Sometimes this is true with some who need more iodine and their TSH and thyroid are currently managing the shortfall.

Another thing affecting energy is cortisol, I suggested “AM Cortisol” lab work.

SHBG is decreased by lower E2, your E2 does not have any room to go down. SHBG is reduced by higher FT and albumin+T, your FT is the problem and TRT makes more sense than proviron that will lower LH, FSH, T and E2.