Bioavailable T- Lab Results Not Low Enough

Pharma / TRT Testosterone Replacement
1

Hey guys, I’ve came to you before regarding this problem and because everyone was so helpful the last time I was hoping someone could help me understand the reason why my urologist says I haven’t gotten low testosterone.

Ive been suffering from anxiety, depression, low libido, poor sleeps, chronic fatigue, gyno in my right nipple and trouble sleeping in addition to no morning wood for a little over 2 years and blood tests that would seem to support my case.

My doctor claims that its anxiety/depression so at the start of May i let him try wellbutrin 2 weeks later I was so anxious I coundn’t lay down till about 4 am so he switched me to pristiq which has caused nothing but sever bouts of anger - hopefully now that I’ve played along with his game he can finally bury the depression idea.

Bloodwork is as follows

Oct 7 2011 Range:
Total Test 12.4 (7.6-31.4 nmol/L)
Prolactin 16 (<18)
Free Test 24.7 (31.0-94.0 pmol/L)

Nov 23 2011
Free Test 40.5 (31.0-94.0 pmol/L)

Feb 6 2012
Free Test 25.4 (31.0-94.0 pmol/L)

May 4 2012
Total Test 10.0 (8.4-28.7 nmol/L)
Free Test 25.4 (31.0-94.0 pmol/L)
Bioav. Test 4.8 (2.0-14.0 nmol/L)

Follitropin(FSH) 4 (2-8)
Lutropin (LH) 4 (2-6)

Sex Hormone Bind. Globulin 33.3 (10-70.0 nmol/L)

My urologist, who ordered the bioavailable testosterone test looked at the results and told me that the bioavaiable testosterone level was plenty high and dropped the subject refusing to explain any more and threw me a prescription of viagra

is he right, what should I do?

2

Anxiety, depression, low libido, poor sleep, chronic fatigue, and gyno in the right nipple aren’t necessarily symptoms of low Testosterone. I’m guessing that your doctor took note of your age and your medical background, which we don’t have. He also might have asked what you were doing with your equipment the night before those low tests. Or not. What should we do?

3

I’m just wondering how bioavailable testosterone level of 4.8 is acceptable for a 22 year old, and why how it would make 3 the out of range free testosterone levels a non-issue?

4

So, whatyagonnado? Find out what’s wrong, or go on TRT for the next sixty+ years?

5

I really want to find out whats wrong, but I also wanted a second opinion from the people here about what I should get tested - I’ve requested an appointment with an endocrinologist and have one for august… I was really hoping that someone on the boards could clarify if the urologist was right in saying “your free testosterone was out of range but your bioavaiable is just in range, so there is no way that this could be testosterone related” - if free testosterone is not important why have other doctors made such a big deal about it, and due to the large age demographic that is used as a range sample do I not have reason to be suspicious that as a 22 year old athlete I feel like I’m 70?

I lift heavy, do regular cardio, eat clean, don’t smoke, don’t do drugs, don’t drink.

I’m just trying to cover my bases before I go by asking people who are much more knowledgeable than me what their insight is on the matter

6

[quote]guysmiley wrote:
I really want to find out whats wrong, but I also wanted a second opinion from the people here about what I should get tested - I’ve requested an appointment with an endocrinologist and have one for august… I was really hoping that someone on the boards could clarify if the urologist was right in saying “your free testosterone was out of range but your bioavaiable is just in range, so there is no way that this could be testosterone related” - if free testosterone is not important why have other doctors made such a big deal about it, and due to the large age demographic that is used as a range sample do I not have reason to be suspicious that as a 22 year old athlete I feel like I’m 70?

I lift heavy, do regular cardio, eat clean, don’t smoke, don’t do drugs, don’t drink.

I’m just trying to cover my bases before I go by asking people who are much more knowledgeable than me what their insight is on the matter[/quote]

Anyway you look at it your values suck for a 22 year old. Bio-available is just in range and right at the bottom. How is that supposed to be good? Your total Test sucks 10nmol roughly equates to 280 ng/dl that level is not desired even if you were 90.

With your LH and FSH midrange and lowish test could be pointing to primary but in no way definitive just speculation. Could be entirely something else very possibly.

Yes free testosterone is what gets the job done but total test is also important.

You definitely want to investigate further why your levels are that low.

Have a read of the stickies and copy down the recommended blood tests.

You can always use a calculator online to work out your free testosterone or Bio. But you need these values:

TotalT
SHBG
Albumin

You have a lot of avenues to explore what is causing your low test. What ever you do don’t listen to that urologist who says you don’t have a testosterone issue. Find another doctor willing to listen and work with you.

You will also want to get tests for your thyroid. Get cortisol checked, also check your E2 (estradiol) all this is written in the stickies along with more tests.

Once you have more blood work post the results up!

My understanding is Bio T is Free T + T weakly bound to albumin

Chrisler says:

The T loosely bound to albumin vastly overpowers the influcence of Free T in determining androgen status–even though it’s the Free T separated from albumin we are measuring. That’s is why Bioavailable (aka “Free/Weakly Bound”) T is the gold standard for testing

7

It sounds like you’re doing the right thing, to find out what’s wrong. Low T at 22 is not normal, but just replacing it is wrong too. That’s where I feared you were headed.

We will all recommend that you read the stickies, and some PubMed too. And maybe stage a protest at your uro’s until he gives your money back.

8

Luckily I’m Canadian and the universal healthcare = no money given to the urologist in the first place, unfortunately my family doctor is still under the “well its under normal so its not an issue” and is just humoring me with this endocrinologist referral. Problem is that at least in Ontario - I need a referral to see a specialist and it seems that this is the last endo I will be getting refereed to by him. Ive read through the stickies and by the looks of it when I go to the endo I should request a E2, cortisol, TT, FT, PSA, LH/FSH, T3 and T4, DRE and prolactin. Is there anything else?

In October I had other tests done as well but nothing out of order

sTSH 1.87 (0.35-5.00 mIU/L)
Ferratin 97 (normal 80-300)
Sodium 140 (135-145)
Potassium 4.4 (3.3-5.1 nmol/L)
B12 584 (sufficiency >220pmol/L)
Urate 295 (200-440 umol/L/)

Again, I’m far from an expert at any of this and would appreciate anyone’s insight or suggestions, I’ve considered bringing the androgens and the aging male age chart for testosterone with me but I don’t want an endo to misread me a stupid or mis-educated, this is compounded by the fact that only online source I can find it at doesn’t look all that credential - so I have searched my university data base and pubmed for a chart in a published study looking at young men for data points that I can show. I’ve been looking for this information since the first blood test came back last October and as of yet have nothing to show for it. So if I’m not looking in the right place for figures on T in specific age demographics for men my age or at what T level symptoms of Andropause I’d be appreciative if someone could point me to a relevant study that might have these figures as it could go a long way into convincing them that there is at least a problem in the first place that deserves to be investigated… also the endo I’m going to specializes in diabetes (only 2 in my dostor’s referral range and they both specialize in this)

9

If you are goingto get thyroid tests don’t even bother with t3 and t4. Instead get the ft3 and ft4.

DRE is probably not needed for you since you are young. Add cortisol (8am) or the 4 daily saliva test to the list.

also

CBC
Cholesterol
Ferritin rechecked since it was pretty low in your previous test.

Here are 3 links to look at the last one has a table with age dependant levels. Print it out and take with you if you want.

www.peaktestosterone.com/Testosterone_Levels_Male.aspx

www.nap.edu/openbook.php?record_id=10852&page=121

Normal Testosterone Levels In Men: Average By Age Chart

10

Had an appointment for the doctor today he ordered all the blood tests and such - I showed him the charts for the age groups and he went off saying that their incorrect and each lab has its own range so you cant measure it to another - also told me my bioavaiable was fine since it was within range… this is frustrating.

will go in to get my blood tests in a couple days and post results once I get them - thanks guys.

11

[quote]guysmiley wrote:
Had an appointment for the doctor today he ordered all the blood tests and such - I showed him the charts for the age groups and he went off saying that their incorrect and each lab has its own range so you cant measure it to another - also told me my bioavaiable was fine since it was within range… this is frustrating.

will go in to get my blood tests in a couple days and post results once I get them - thanks guys.[/quote]

Typical bullshit from him. Sure labs have their own ranges that may differ. But if he looks at your value and the range supplied he must see that you are basically hovering just above the surface. This is what he should expect to see in 80 year olds not young dudes.

12

[quote]guysmiley wrote:
Had an appointment for the doctor today he ordered all the blood tests and such - I showed him the charts for the age groups and he went off saying that their incorrect and each lab has its own range so you cant measure it to another - also told me my bioavaiable was fine since it was within range… this is frustrating.

will go in to get my blood tests in a couple days and post results once I get them - thanks guys.[/quote]
Where are you located so we can possible give you some options ?

13

I’m located in Barrie, Ontario Canada(1 hour away from Toronto) - it seems as though I’ll be getting to see an endocrinologist soon. A full blood count was ordered, as well as Total PSA, AST, GGT, E2, Progesterone, LH, DHEA, AM Cortisol, Homocysteine and FT and TT - he wouldn’t budge with doing a free T4 or free T3 saying that its a useless test if he just gets the thyroid checked ( I wasn’t going to argue with him anymore as I could tell he was at wits end and humoring me already)

14

As an update I had a ultrasound of my chest as of a couple days ago (during high stress exam time my nipples were itching and sore and my left one was actually leaking some brown fluid at one point) - they found breast tissue growth in the right one and none in the left. So I guess I “officially” have it now… tomorrow I’ll go pickup my blood test results and hopefully there will be some answers in there.

15

Hi Guys Updating this again, I got all of your new results so here they are hopefully you can help me make sense of some of them

Glucose Fasting 4.8 (3.6-6.0)
Creatinine 104 (62-115)
eGFR 77

Sodium 140 (135-147)
Potassium 4.3 (3.5-5.5)
Total Bilirubin 11 (<22)

Alkaline Phosphase 140 U/L (45-129)
Gamma Glutamyltrynsferase 12 U/L (15-73)

Cholesterol 4.72mmol/L
LDL 2.21mmol/L
HDL 2.06mmol/L
Cholesterol/Hdl ratio 2.3
Triglycerides 0.98mmol/L

Hemoglobin 143 g/L (135-175)
Hematocrit 0.42 L/L (0.40-0.50)
WBC 4.2 xE9/L (4-11)
RBC 4.55 xE12/L (4.5-6)
MCHC 343 (305-360)
MCV 91.6 (80-100)
MCH 31.4 (27.5-33)
RDW 13.3% (11.5-14.5)
Platelet Count 163 (143-400)

Absolute: Neuts 1.4 (2-7.5)
(A) Lympho 2.3 (1-3.5)
(A) Mono 0.4 (0.2-1)
(A) EOS 0.1 (0.0-0.5)
(A) BASO 0.0 (0.0-0.2)

Homocysteine 7.0umol/L (<=15)
TOTAL PSA 0.37ug/L (0.00-4.00)

Lutropin (LH) 2 IU/L (2-6)
Progesterone 2 (<4)

Estradiol-17 BETA <70pmol/L (<150)

Total Test 11.1 nmol/L (8.4-28.7)
FREE TEST 32.8 pmol/L (31-94)
DHEA-S 7.2umol/L (7.6-17.4)

8AM Cortisol 579 nmol/L (NO STANDARD VALUE LISTED)

16

Make an an appointment at masters mens clinic in Burlington. Worth the trip and wait

17

[quote]jimbob02 wrote:
Make an an appointment at masters mens clinic in Burlington. Worth the trip and wait[/quote]

After failing with my local urologist I have an appt. with in Toronto on the 16 of August – I just need to be prepared and know what to expect and what these mean I’m still hopeful that I can be fixed rather than resort to an anti aging clinic and TRT - but thank you

18

Another update

I went to Toronto to an endocrinologist who apparently specializes in andrology, welp after an hour long meeting with him he told me that DHEA levels in men are stupid and make no difference to testosterone levels, he told me that FT levels were a useless indicator and that they notorious for showing underscored results and he told me that the last 11 months of blood work don’t mean anything.

He then told me that I have to go back to the Toronto(1.5 hrs) at least twice to get bio-avaiable testosterone done in his resident hospital’s labs – and that after he see me in 2 1/2 months (Nov 1) to discuss results.

This honestly is tearing me apart, I wanted to mediate of this problem from before going back to school as I’m not in the best state of mind to finish my 4th year of university (always tired memory fog, depressed ect dont exactly lead to great marks)

I have a urologist appointment with the doctor who prescribed me viagra earlier in the summer - what are the chances of me talking him into running a clomid treatment stacked with nolva or doing a HCG mono treatments? or is there anything else I could try that he might be more inclined to try and that would give me a temporary/bandaid solution

I should also mention I tried to get into the private mens clinic and they told me that they need a doctors referral and are currently booking appointments for next may… so after my final school year

ANY Help or insight would be much appreciated!

19

[quote]guysmiley wrote:
Another update

I went to Toronto to an endocrinologist who apparently specializes in andrology, welp after an hour long meeting with him he told me that DHEA levels in men are stupid and make no difference to testosterone levels, he told me that FT levels were a useless indicator and that they notorious for showing underscored results and he told me that the last 11 months of blood work don’t mean anything.

He then told me that I have to go back to the Toronto(1.5 hrs) at least twice to get bio-avaiable testosterone done in his resident hospital’s labs – and that after he see me in 2 1/2 months (Nov 1) to discuss results.

This honestly is tearing me apart, I wanted to mediate of this problem from before going back to school as I’m not in the best state of mind to finish my 4th year of university (always tired memory fog, depressed ect dont exactly lead to great marks)

I have a urologist appointment with the doctor who prescribed me viagra earlier in the summer - what are the chances of me talking him into running a clomid treatment stacked with nolva or doing a HCG mono treatments? or is there anything else I could try that he might be more inclined to try and that would give me a temporary/bandaid solution

I should also mention I tried to get into the private mens clinic and they told me that they need a doctors referral and are currently booking appointments for next may… so after my final school year

ANY Help or insight would be much appreciated![/quote]

This doctor sounds like a dickhead. How can he just say your 11months worth of blood work is useless. FT is bs according to him, well someone must be getting those high readings if there ranges are set-up like that. I love his explanation that FT results are awful and show underscored results, how about maybe you really do have low values.

Sounds like this doctors ego is the size of the moon.

Sounds like a pain in the ass for you to travel that far. I also have my doubts this doctor will help you, just by what has been said thus far.

Did he say anything about your values? What would he like them to be any indication that if your levels come back the same as now in his lab will he do anything?

Why blood work twice at his lab? You have blood work already, another test in his lab should suffice surely.

Hit up hardasnails for a contact.

20

[quote]iroczinoz wrote:

This doctor sounds like a dickhead. How can he just say your 11months worth of blood work is useless. FT is bs according to him, well someone must be getting those high readings if there ranges are set-up like that. I love his explanation that FT results are awful and show underscored results, how about maybe you really do have low values.

Sounds like this doctors ego is the size of the moon.

Sounds like a pain in the ass for you to travel that far. I also have my doubts this doctor will help you, just by what has been said thus far.

Did he say anything about your values? What would he like them to be any indication that if your levels come back the same as now in his lab will he do anything?

Why blood work twice at his lab? You have blood work already, another test in his lab should suffice surely.

Hit up hardasnails for a contact.
[/quote]

In his own words he said “FT is a useless value and bio-available is the only way to measure how it really is represented in your system, which just makes the last 6 labs of bloodwork meaningless to me”
he went on to say that
“you have one BioT already but I would like 2 more as it can fluctuate from day to day so make sure their at least 3 days apart,”

“Your DHEA is low but I’m not going near that because it has no effect on the male testosterone function - if you were a woman that be a different story”

–and he also mentioned I scored a 13/25 on prostate function doubting that I go piss multiple times ever hour, he said it “sounds from the test that you have the same urinary problems that occur in much older men” and needs to be checked out by a urologist, made an appointment for an ultrasound of my testicles and basically just dicked me around - I go in next Friday for the ultrasound and my first BioT, I too have little hope in this, seems Canadian doctors are real pricks - I even brought in the Age specific T tables and he brushed over that with his “BIOT or no T crusade”