Help Needed, Limited Bloodwork

Pharma / TRT Testosterone Replacement
1

So, this post will probably lack vital information (AS i dont have them), but i will post the info i have.
So, i am 36yo, 180cm and weight about 98kg.
Was diagnosed with hypothyreose about 10years ago but only do 50mcg/day.
I have been working out 4 days a weeks for probably 6-7 years and always been some what careful about what i eat buy gain weight very easy and almost impossible to lose weight.
Been wondering about low test for the last 5-6 years, done blood work but and noticed that the numbers looks low to me but doc says it is good.

Got new bloodwork done now and got results today and it doesnt look right.
Asked for e2 sensitive etc also but it was not done.

Results are as follows:
S-tsh 1,2 (0,20-4)
Free t4 17,3 (11-23)
S-testosteron 8 (8-36)
S-shbg 16 (8-60)
Free testosterone 4,8 (2,3-9,9)
B12 407 (170-650)
S-psa 0,46 (<2,6)

Anything to go on here or am i missing to much info?

Sorry about the grammar, norwegian + mobile.

All feedback greatly appreciated

2

Your free testosterone is very low for someone your age. It should be closer to almost double that. I didn’t see total T but I bet that is low as well.

A few things come to mind:

  1. check to see if your medication has any affect on testosterone and if so- there is your answer - and you need to investigate other options or it’s TRT time.

  2. check vitamin D or just start supplementing with 2-3000IUs of D3. D3 is a hormone that regulates dozens of bodily functions. I increased my natural T levels over 200 points (in ng/dl) by simply taking D3

I suspect that something metabolic is going on with your other meds affecting your T levels and energy. So if you can’t switch them you will likely need some supplemental T to feel better.

3

Hi and thank you for answering.
Been taking b12 and d3 for years 5000iu d3 and 1000mcg of b12 every day.
Only meds i take for hypothyreosis is levaxin 50mcg every day and from what i find online it should not affect T that much (if any).

4

Just thought I should add a little more info:

I always thought my problems with losing weight (and gaining weight so easy) was because of being hypo, but when I was around 30 i also noticed a drastic lack of libido, lack of energy and so on.
That’s when I started reading about low test and did my first bloodwork. Results then was pretty much the same as posted. Trusted my doc and didn’t do anything about until last year. Got new tests done and the results looked just as low but s-test even lower.
My doc just looks at reference values and by itself I am low but ok.
Then visited an american doctor and he said the opposite, that I was extremely low (he also looked at my hands and feets-they are rather small for a 180cm man and meant this also was related).
Problem is he is retiring soon and didn’t want to to injections because noone could help me after he retired. He did try androgel for 2 months but I felt worse (more tired) and bloodwork only marginally better.

After that I tried to run clomid to see if I could restart everything, first month I lost about 5kg with no changes to diet etc, energy also up, but then it felt like it stopped doing anything and weight came back on energy gone.

My biggest problem is that if I start TRT I will be my own guinea pig and will have a hard time getting the correct bloodwork done as often as I think I should.
So tracking E2 sensitive etc will be a problem.

5

Your body weight and inability to loose fat can be from low testosterone and/or thyroid problems.

TSH and fT4 look OK. But sometimes things are more complex than that.
You can check overall thyroid function bu checking oral body temperatures as described in the thyroid basics sticky.

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

  • advice for new guys
  • things that damage your hormones
  • protocol for injections

Other labs:
LH
FSH
complete blood test
hematocrit
E2 - estradiol
prolactin
AST/ALT

TT, total testosterone = S-testosterone

Your thyroid drug: Levothyroxine - Wikipedia
is T4 hormone and your body needs to convert to T3 hormone
free T3, fT3, is the active form that is used to regulate your metabolism and body temperature
Some do not convert T4–>T3 effectively
reverse T3 can block fT3 too in some cases

You need iodine and selenium in your diet.

6

Hi Ksman, was hoping you would answer this :slight_smile:
Read all the stickies and use salt with iodine + added selenium in diet.
Body temperature is stable and just around 37 celsius.

Thought I’d add the complete bloodwork I got if that helps anything.
The first one is directly after 2 months on androgel, the second is current status. t4/t3, tsh ect is out of wack because I was only told not to do androgel that day, not levaxine.

B-Hemoglobin 16 (13,4-17)
B-Hematokrit 0,48 (0,4-0,5)
S-Natrium 142 (137-145)
S-Kalium 4,5 (3,6-5)
S-Klorid 101 (97-108)
S-Magnesium 0,76 (0,71-0,94)
S-kreatinin 82 (60-105)
S-eGFR (CKD-EPI) 105 (>68)
S-Asat 25 (<45)
S-Alat 56 (<70)
B-HbA1c 5,3% (<6,1)
s-kolestrol 5,4 (3,3-6,9)
s-hdl-kolestrol 1,2 (0,8-2,1)
s-ldl-kolestrol 3,5 (1,4 -4,7)
s-tsh 0,35 (0,2- 4)
s-free t4 20,9 (11-23)
s-free t3 7,1 (3,5-6,5)
s-fsh 1 (<12)
s-lh <1 (<12)
s-prolactin 132 (<700)
s-estradiol 17 beta 0,09 (<0,18)
s-testosteron 13 (8-35)
s-shbg 16 (8-60)
free testosteron index 8,5 (2,3-9,9)

Last blood done, early morning, no meds of any kind.

B-Hemoglobin 15,6 (13,4-17)
S-crp 6 (<5)
B-leukocytter 8,5 (3,5-10)
B-trombosytter 259 (145-348)
s-ferritin 328 (20-300)
s-iron 15,7 (9-34)
B12 - 407 (170-650)
S-kalium 4,3 (3,6-5)
s-kalsium 2,32 (2,15-2,51)
s-kreatinin 88 (60-105)
s-eGRF(CDK-EPI) 96 (>68)
s-urinacid 327 (230-480)
s-bilirubin 7 (<26)
s-asat 23 (<45)
s-alat 62 (<70)
s-gamma gt 41 (<80)
s-amalyse pankrease 6 (10-65)
s-kolestrol 5,3 (3,3-6,9)
s-hdl-kolestrol 1,1 (0,8-1,1)
s-ldl-kolestrol 3,3 (1,4-4,7)
s-psa 0,46 (<2,6)
s-tsh 1,2 (0,20-4)
s-free t4 17,3 (11-23)
s-anti-tpo <34 (<100)
s-testosteron 8 (8-36)
s-shbg 16 (8-60)
free testosteron index 4,8 (2,3-9,9

Alot of norwegian words here but I hope they are similar enough to english :slight_smile:

7

You mention you are taking over the counter supplements which is good. However, some supplements have been shown inhibit Levothyroxine (Levaxin) if they are taken within hour hours of each other. A link to one of the studies is below. Please note this study lacks a control group and is neither blind nor double blind and has a sample size of 45 (n=45).

Also Coffee has been found to interfere with the absorption of Levothyroxine (Levaxin) (link below)

http://ispub.com/IJANP/6/2/11898

8

Thanks, some good info there, I knew about calcium but didn’t now coffe and other things might affect it aswell.

9

Above, you appear to be well medicated.

S-CRP=6 is indicating that there is a source of inflammation in your body.
Any idea?

Ferritin=328 may be indicating that you are getting too much iron in your diet. You can avoid vitamins that list iron and iron fortified breads etc.

B-HbA1c 5,3% (<6,1)
This range seems too high.

This could be better. Try to avoid foods that have a lot of starches and sugars.

Your thyroid meds look effective and body temperatures are good. Progress then needs to focus on fixing your testosterone levels. Increased T and proper E2 levels will help with insulin sensitivity and weight loss.

Your biggest problem will be with doctors and restrictions imposed by your health system.

10

So to conclude, continue what i am doing already and (if possible) add trt?

11

The question is whether the cause of low T can be determined and maybe fixed. You have secondary hypogonadism. Cause is not high E2 or high prolactin, so there is nothing there to fix.

Total testosterone, TT or s=testosterone is low. Because SHBG is low, FT index is OK, but I do not know what absolute free testosterone is. I think that it means that you fraction of total T is free, but then its a good ration of a small number and absolute FT is low.

At this point one can try a HPTA restart [sticky] or just do TRT. After 5-6 years in this state, a restart might not be a reasonable expectation. What do do depends on what doctors there will do for you.

12

Mayo lists absolute free testosterone as a percentage of total testosterone from LC-MS/MS.