Help Interpreting Labs, Symptoms: Fatigue, Water Retention

Pharma TRT
1

Hello guys!

34 year old male. 1,88, 75kg, small frame, very narrow bideltoid width(i mention this for all the people who will say i weigh very little for my height).
Around 14-15% bodyfat according to visual and BID scale.

In the last years i went from 82 to 75kg, but slowly, it was not an overnight process

My simptoms(as of the last 4-5 years):
-fatigue(feeling tired like i could sleep at 6 PM, not waking up energized, as i did in the past)
-difficulty losing weight(which i was able to do in the past)
-difficulty gaining muscle(my lifts have stalled for the past 3 years)
-the impression that i kind of have a puffy face, and it is not my impression.

One thing to mention. I know that you can just have a puffy face because of water retention, excess sodium, too many carbs. But in my case there is a visible disconnect between my face and body. Any person who has seen me without my shirt was pretty much amazed. I am talking both girls and gym buddies.
Judging by my face they expect me to be skinny fat or even fat but i am, for normie non gym goer standards, “ripped”.
Which of course i know i am not but still goes to prove that there is something funny going on with my face.

Now i did some blood work and here it is:
TSH:2,54(0,55-4,78)
FT4: 1,05(0.89-1,8)
FT3: 2,92(2,3-4,2)
Testosterone Total: 472(197-670)
Estradiol:32(no lower limit - 39,8)

Some things to mention here:
-i know my TSH is not ideal so i went and got an ultrasound at an endo annd imagistically, my thyroid is perfect. No nodules, no cysts, no enlargement.
-I notice my FT4 and FT3 are in the lower half, i think even in the lower third of the range, which again is not ideal)
-The testosterone range in this lab is funny, i don’t understand why it is like this. But according to it i am in the upper half.
-about E2. Here is the funny part. From what i read the sweet spot is somewhere between 20-30 for most guys. This is the optimized version. However correct me if i am wrong. On the other hand according to my lab i am pretty close to the upper
range for Estradiol which is concerning for a guy with my bodyfat.
-substances: none. No weed, no coke, nothing
-caffeine: aprox 300mg per day. 1 cold brew in the morning and 1 one-shot machiatto at noon
-drugs: none(no SSRI, adderal, ritalin, modafinil, none of that shit).
-alcohol:1-2/month 2-3 glasses of wine.

My questions are:

  1. do my labs justify my simptoms?
  2. if yes to 1), what exactly is the culprit?
  3. what would you do next, in my place?

Thanks in advance for taking the time to read this freakin wall of text.

2

It’s difficult to say because your labs are incomplete and very limited. You have no Free T measurement or SHBG.

The Free T is where the rubber meets the road.

LH and FSH would be useful.

An iron problem can decrease the conversion of free thyroid hormones, and can mimic the symptoms of low-T.

Adrenal insufficiency can also mimic the symptoms of low-T.

This reference range is the population being tested, probably collected from a bunch of geriatrics.

3

Hello and thank you for your reply!

In the past i have done also free T, LH, FSH, SHBG, albumin, and every time the values were ok. Free T high, SHBG low, LH and FSH right in the middle.

Some things to mention and also some questions, in no particular order.

About the reference range. Here is where indeed i have some questions as i do not understand some things.

  1. i know the reference range is different, and i know the normal T for a man of my age is around 800-900. But i do not understand where they get the reference range. They said the reference range depends on the laboratory essay method. What i do not understand and maybe you can explain is this:
    how can a value, lets say 450 ng/mL have one reference range in Lab 1 and a different reference range in Lab 2.

  2. Why is FSH important other than sperm quality?

  3. I have no issues with libido to be honest that is why i did not investigate this further.

4

Also, forgot to add, how is adrenal insufficiency diagnosed? recently i measured 8AM cortisol and it was right in the middle of the range.

5

A low am cortisol value.

Have you ever had a sleep study done?

6

So we can exclude adrenal insufficiency.

Have never had a sleep.study done but i know for a fact that i have shit sleep.

I have a prostate problem and for the last 10+ years i wake up a minimim of 2 times per night. This is excluding the pee right after i wake up. I kind of gotten used to it.

One more thing. Do you think aspartame and stevia can dampen your T?
I drink at least 1 pepsi max every day, helps me avoid sugar cravings.

7

The mechanism of action of aspartame may also be mediated via its effect on Leydig cells, which leads to a decrease in testosterone levels.

Long-Term Effect of Aspartame on Male Reproductive System: Evidence for Testicular Histomorphometrics, Hsp70-2 Protein Expression and Biochemical Status - PMC.

Artificial sweeteners are harmful to the prostate and are bad for you health.

8

@cristiano88
A quick look at the study @systemlord links seems to show (I think) you’d need to drink a few dozen cans a day for a while to maybe get a reduction in testosterone so I’m gonna guess that 2 or 3 a day are probably not a major issue.
Not sure about prostate or the ill effects of stevia but I’m guessing moderation is key?

Caveat!
I did just skim that paper as there’s no way I can claim to have read it as way above my head so anyone please correct me if I’m wrong.

9

Your test levels aren’t that bad and these symptoms could be attributed to many issues both mental and physical. Don’t get tunnel vision. Need SHBG on labs as @systemlord pointed out. Good luck

10

Thanks!
Indeed i need SHBG but in the past it was very good. I will repeat it at my next tests.
I have some suspicions and will get back when i clear them.

11

SHBG would be nice, but the free testosterone is the one you particularly need to know.

12

I did them recently, non in this batch and they were good