Bloods - TRT or Not?

Pharma / TRT Testosterone Replacement
1

Had some low test symptoms, low libido, low energy, brain fog, fat gain etc and had some bloods taken (0930 - earliest I could get them). Certainly don’t look great to me, but wondering on others opinions on whether I should seek TRT or not?

I also had thyroid tested in case that was an issue, but I think that looks ok, have included the bloods below just in case

I’m 38, generally fit, healthy, good diet, little alcohol, no meds.

Appreciate any feedback, thanks.

TESTOSTERONE 14.6 nmol/L 7.60 - 31.40
FREE-TESTOSTERONE(CALCULATED) *0.252 nmol/L 0.30 - 1.00
17-BETA OESTRADIOL 28.5 pmol/L 0.00 - 191.99
SEX HORMONE BINDING GLOB 46.2 nmol/L 16.00 - 55.00
FOLLICLE STIM. HORMONE 4.18 IU/L 1.50 - 12.40
LUTEINISING HORMONE 4.90 IU/L 1.70 - 8.60
PROLACTIN * 381 mIU/L 86 - 324

Thyroid Function
THYROID STIMULATING HORMONE 0.721 mIU/L 0.27 - 4.20
FREE THYROXINE 13.900 pmol/L 12.00 - 22.00
TOTAL THYROXINE(T4) 67.9 nmol/L 59.00 - 154.00
FREE T3 4.88 pmol/L 3.10 - 6.80
THYROGLOBULIN ANTIBODY <10 IU/mL 0.00 - 115.00
THYROID PEROXIDASE ANTIBODIES 13.2 IU/mL 0.00 - 34.0

Vitamins
ACTIVE B12 154.000 pmol/L 25.10 - 165.00
FOLATE (SERUM) 18.17 ug/L 2.91 - 50.00
25 OH VITAMIN D 90.6 nmol/L 50.00 - 200.00

Inflammation Marker
CRP - HIGH SENSITIVITY 0.18 mg/l 0.00 - 5.00
Iron Status FERRITIN 131 ug/L 30.00 - 400.00

2

Bump, for any help I can get with the above…

3

Sorry I don’t know the conversion of your Total Test. But what is probably happening is your SHBG is choking off your free testosterone. Which is why you are having those symptoms.

E2 low also? sorry not use to these numbers.

Do you do Keto Or Intermittent Fasting?

Y

1 Like
4

14.6 nmol/l = 421 ng/dl

1 Like
5

Your FT calculated is very low.

SHBG is high.

High SHBG creates a lot of non-bioavailable SHBG+T that inflates TT so TT then overstates your T status; while reducing what FT you have.

Prolactin is high. Prolactin can be increased by recent orgasm or cuddling babies, kittens, puppies etc. Prolactin can be high from a prolactin secreting pituitary adinoma, that can reduce LH/FSH.

LH/FSH is not high, see above, but should be with your low T status. Your testes also do not seem to be working properly.

Thyroid is a bit strange. fT3 is near mid-range which is what we want, but T4 and fT4 suggest iodine deficiency. Please discuss your history of using iodized salt, or dairy consumption in UK. Provide both sets of oral body temperatures - see below.

Bottom line:
Primary hypogonadism, adinoma may be masking expected higher resultant LH/FSH. High SHBG is inflating total testosterone which will confuse almost all doctors. Thyroid is mixed signals. Need body temperatures to get the bottom line. Possible iodine deficiency suspected. You need to sort out thyroid issues your self as the lab results mean that almost all doctors will be dismissive of any concerns. Repeat prolactin labs, MRI is used to image pituitary to see what is there. Adinoma and secondary hypogonadism create opposing forces on LH/FSH levels.

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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

Maintain this one thread for your case. Multiple threads create a mess.

1 Like
6

No keto or intermittent fasting, though I did IF for the last half of 2017, haven’t this year at all. Was considering keto in the future, to be avoided then?

With SHBG choking off testosterone, can I reduce this by any means? or am I looking at TRT?

Thanks for the input.

7

Even if you lowered your SHBG, your testosterone would take a hit, since its being artificially inflated by SHBG. Its almost impossible to directly influence SHBG.

TRT can make it go lower, or give you enough test to “spill over the top” so to speak, and give you some free test.

1 Like
8

Our advice needs to take age and other factors into account, see the advice for new guys sticky.

Yes, TRT is indicated, but part of a number of issues to address.

High T levels and E2 managed near E2=22pg/ml - 80 pmol/L will reduce SHBG in some cases. But some simply have high unexplained SHBG that will not follow the rules.

1 Like
9

Thanks, very detailed and much appreciated!

So the high SHBG is the problem, again can I reduce this at all or am I looking at TRT here?

Interesting on the prolactin, I do have a nine month old at home, may have been cuddling her an hour or two before the bloods where taken, could that explain it?

i have been taking iodized salt, but only for about 3 weeks before the bloods where taken. I take some whole milk daily but not a great deal, tea/coffee or maybe in some porridge from time to time.

Will look into getting oral temperatures to see if that offers up more information.

Just quickly googled adinoma, will need to look into that further. I have ulcerative colitis but that has been in remission for years now, luckily. Not sure if that may be relevant at all, but it is a condition affecting the colon…

Again, if primary hypogonadism is the issue, I believe then I’m looking at TRT as my only option here?

The thyroid confuses me greatly and you are correct, my doctor has already dismissed it as “fine”, I suspected otherwise from my limited knowledge. I’m still confused as to whether the thyroid or the testosterone hormones are the cause of my issues, or is it both I need to fix?

And if both need fixed, does it matter which one I treat first?

Thanks again.

10

So again, even if you lowered your SHBG, your TT would tank. You have low testosterone, and your high SHBG is holding on to whatever it can.

If you lowered the SHBG, your Total test would normalize, and be even lower. Free test would go up. But your TT would be in the dirt, and free test wouldn’t be great.

You have low T regardless. You will need TRT to overcome the low t and the high SHBG.

11

Dismissive doctors could be lack of knowledge or insurance limiting coverage do to these stupid normal ranges, insurance usually starts covering things when the thyroid can get no worse.

Doctors love to follow these normal ranges that has many with hypothyroid symptoms, you complain of symptoms, doctor looks at the ranges and says you’re fine. Insurance is a scam, you pay and get nothing when you need it.