High Total Test, Low Free Test

Pharma TRT
1

My free testosterone is low and I’m looking to increase it to the upper range of normal. I’ve got a number of abnormal indicators from a blood test.

31 yrs
5’10
180lbs 20% bf
patchy facial hair
very fine arm hair, slightly thicker leg hair, no other body hair
At high bodyfats, store fat mostly in abdomen, some in face, chest, legs. At lower bodyfats (20% currently) tend to store fat around abs and lower back
waist is 34.5"
no known health issues
Took finasteride for past 7 years which I quit weeks before blood test results posted here

Actual	Lower	Upper	Units

Out of normal range:
Vit-D 70 20 60 pg/mL
TSH 4.2 0.4 4 uIU/mL
DHEA-S 1650 1060 4640 ng/mL
E2 18 19 51 pg/mL
Total T 1140 142 923 ng/dL
Free T 10.2 7.6 23 pg/mL
SHBG 84 10 57 nmol/
Within normal range:
FT3 3.3 2.2 4.1 pg/mL
FT4 1.1 0.8 1.9 ng/mL
Prolctn 8.8 3.6 12.8 ng/mL
LH 3.4 0.8 5.7 mIU/mL
FSH 3.2 2 8.3 mIU/mL
IGF-1 194 (no range) ng/mL

Following were close to mid-range: Progesterone, Growth hormone, Liver enzymes, blood glucose, glycated hemoglobin (HbA1c).

Diet is mostly balanced (veggies, fruit, unpackaged food, the occasional fast food) and occasionally dine out. Since Nov’13 I’ve been following leangains protocol, restricting eating to 8 hours a day. Not sure how you define starvation diet. From Sept’13 to Mar’14 I reduced my calories to lose .7lb - 1.5lb / week until ~40lbs were lost. After completion I returned to maintenance or a slight calorie surplus.
Iodine history I’m not really sure of. The salt used to prepare these meals does not contain iodine, so whatever iodine I get comes from the food itself.

Training: Monday/Friday - 2 heavy sets of 5 reps each: squat, bench, weighted chinup, Friday also has 4 supplementary exercises, 2 sets for each. Wednesday: 2 sets each, overhead press, shrugs, wrist curls, lateral raises. Sleep 7-8 hours 80% of the time.

Rarely get fevers so hard to say if my testes ache.

On finasteride, morning wood maybe 5-10%. After quitting, maybe 40% of time.

2

Please provide fT3, fT4, prolactin, LH, FSH data. FSH is a better indicator of LH status than LH itself.

You have read the thyroid basics sticky?

Need your waking and mid-afternoon body temps and your long term intake history of iodized salt.

Please check body temps, this is very important and we cannot eval your situation without. Ditto iodine. *******************

SHBG is very high, so FT is low as expected and a lot of TT is non-bioavailable T+SHBG

E2 is not creating high SHBG.

So we have unexplained high SHBG and high TSH with suspect rT3. Both would be consistent with a starvation diet or perhaps other stressor.

GH labs are sort of useless, you need IGF-1 as it is better indicator of GH status than GH itself.

Provide more data about you as per the advice for new guys sticky that you should read carefully. Things like age, height, body fat patterns, weight and waist size do matter.

3

Hi KSMan. It wasn’t clear to me that the stickies were stickies as I’m used to seeing a sticky icon in most forums. Sorry about that. I’ve updated the first post with relevant info. I’ll work on getting my temperatures posted. I also have a 4 point cortisol saliva test on the way. Should be interesting.

4

Took 3 readings this morning right after wakingup:
6:00am 36c 96.8f
6:01am 36.1c 96.98f
6:20am (after shower) 36.4c 97.52f

5

I took a 4 point cortisol test. All levels were normal. I tried 6mg / day of iosol iodine for about a week with 200mg selenium, haven’t noticed any difference.

6

"You have read the thyroid basics sticky?

Need your waking and mid-afternoon body temps and your long term intake history of iodized salt.
"

Your morning temperatures indicate functional hypothyroidism.

Afternoon temperature? Please track temperatures for a few days.

Iodine intake?

From the sticky, you would know that 6mg iodine is a fraction of what is needed for iodine replenishment.

Please post cortisol labs with ranges. “Normal” not spoken here.

TSH 4.2 is a serious problem. Your fT3 is mid range and considered optimal. However your body temperature is low. This implies that your adequate serum fT3 is not getting into the cells of your body and your metabolic rate drops. Typically this is from elevated rT3 which blocks the fT3 receptors in your cell walls. Please see the advice for new guys sticky and thyroid basics, noting references to rT3, stress, infections, inflammation and Wilson’s book on adrenal fatigue.

SHBG is high and limiting your FT. “Long-term calorie restriction of more than 50 percent increases SHBG”

BTW, your posts are very nicely organized!

7

I have read the sticky, but will probably need to reread a few times.
8am temp 97, 12pm temp 98.6 Took several readings on separate days
I’ve been on 50mg/day iodoral for the past 2 weeks. Prior to that, 12mg lugols liquid iodine for a few weeks. So far hasn’t seemed to have much if any effect on my body temperature.

Historic iodine intake I would guess is on the low end, since we don’t use iodized salt in cooking.
Cortisol results (ng/mL) Morning: 6.1 (3.7-9.5), Noon: 2.1 (1.2-3), Evening: 2.0 (High 0.6-1.9), Night: 0.5 (0.4-1). I consider the evening high result to be normal, because the sample was taken after an intense workout on an empty stomach, which is part of my normal weekly routine.
DHEA-S 7.4ng/mL (2-23)

8

AM cortisol is very bad. <<<I got that wrong, see next two posts!>>>

If iodine is leading to increased T4 and T3 and you have elevated rT3, rT3 can block the increased fT3 and the increased T4 is leading to more fT4–>rT3. That might explain lower AM body temperatures and lack of temperature recovery.

You must have selenium in your diet, especially when taking large amounts if iodine !!!

AM cortisol and low AM temperatures are probably related some how.

You have taken enough iodine to address a deficiency, please go to maintenance dosing.

Time to test rT3

Repeating:
"TSH 4.2 is a serious problem. Your fT3 is mid range and considered optimal. However your body temperature is low. This implies that your adequate serum fT3 is not getting into the cells of your body and your metabolic rate drops. Typically this is from elevated rT3 which blocks the fT3 receptors in your cell walls. Please see the advice for new guys sticky and thyroid basics, noting references to rT3, stress, infections, inflammation and Wilson’s book on adrenal fatigue. "

9

Hi KSMan.

Could you elaborate on why AM cortisol is bad? According to lab it is close to the midpoint of the normal range. Are you thinking I’m chronically stressed?

My waking body temperatures have been a bit on the low side, even before I started measuring it regularly. I’m taking 200mg of selenium, vitamin d, c, zma daily so no worries. I was hoping that I was iodine deficient since I haven’t had much luck finding a doctor who can test rt3 so wanted to see if an iodine supplement had any effect on my body temperature before going in for another blood test.

I believe you meant rT3 where you said fT3, correct?

10

Fixed ft3/rt3 in both posts.

“Morning: 6.1 (3.7-9.5)”
You are correct. I was thinking of AM serum cortisol levels. I don’t have targets in mind for saliva based.

See page 22: http://www.zrtlab.com/component/docman/doc_download/145-reference-range-determination.pdf

So the only remaining concern is low temperatures with good fT3 identified early and lack of temperature recover with iodine replenishment.

My only conclusion is that fT3 is not getting into the cells. You can get rT3 tested to support or defeat that conclusion or take some rT3 to see if you feel better and if so, that supports the conclusion that then suggests rT3 as the cause. Getting a doc to do this is another matter. If a doc wants to do this “trial”, which also has diagnostic value, I would expect that they would want to Rx T4. That would be a big mistake as this would increase T4–>rT3 [if this is what is going on].

With your iodine replenishment, perhaps things are improved [but rT3 is still there] and TSH will go down as the thyroid does not need to be whipped so hard. As TSH can have some excursions with increased iodine, you would want to be on a lower maintenance level of iodine and wait for things to normalize before checking TSH or other thyroid hormones.

Did you note references to stress and stressors in the thyroid basics sticky in context with rT3 and adrenal fatigue. In that post, you can [^F. CTRL F] to search.