Interpretation of Lab Results

Pharma / TRT Testosterone Replacement
1

Hi,

I’m not on TRT but I’m posting here because this is where the expertise in labwork and endo stuff seems to lie on these forums!

I posted a while ago when I had a TT reading done which showed up as high. Although I have symptoms of Low T. I then a second T test which was just in range on the high side. On this test, I also saw that my SHBG was high. NHS Doc said “don’t worry, I interpret the results.”

So. Here are my latest results (done privately) - T/E2/SHBG is down at the bottom. Please note that the E2 test was not done on the same draw as all the other stuff. I don’t think this should make too much difference as I am not on any injections so I shouldn’t be fluctuating very wildly. Apologies for the formatting.

ME:
38
5’11
185-190lb
B/F - 18-22% (This is a guess. Mostly on the lower abs, hips, waist)

I drink more than I should. But I don’t have a bad diet and I try to train heavyish + occasional cardio but again, this is something I could improve.

Results are shown as : Test Name, Reading, Min Range, Max Range. Asterisks are used to mark out of range results.

Red Blood Cells
HAEMOGLOBIN (g/L) 137 g/L 130 - 170
HCT 0.406 0.37 - 0.50
RED CELL COUNT 4.40 x10^12/L 4.40 - 5.80
MCV 92.3 fL 80 - 99
MCH 31.1 pg 26.0 - 33.5
MCHC (g/L) 337 g/L 300 - 350
RDW 13.9 11.5 - 15.0

White Blood Cells
WHITE CELL COUNT 3.58 x10^9/L 3.0 - 10.0
Neutrophils * 1.94 x10^9/L 2.0 - 7.5
Lymphocytes * 1.02 x10^9/L 1.2 - 3.65
Monocytes 0.44 x10^9/L 0.2 - 1.0
Eosinophils 0.17 x10^9/L 0.0 - 0.4
Basophils 0.01 x10^9/L 0.0 - 0.1

Clotting Cells
PLATELET COUNT 280 x10^9/L 150 - 400
MPV 9.5 fL 7 - 13

Kidney Function
SODIUM * 134 mmol/L 135 - 145
POTASSIUM 4.5 mmol/L 3.5 - 5.1
CHLORIDE * 92 mmol/L 98 - 107
BICARBONATE 22 mmol/l 22 - 29
UREA 4.0 mmol/L 1.7 - 8.3
CREATININE 92 umol/L 66 - 112

Liver Function
BILIRUBIN 12 umol/L 0 - 20
ALKALINE PHOSPHATASE 42 IU/L 40 - 129
ASPARTATE TRANSFERASE 29 IU/L 0 - 37
ALANINE TRANSFERASE 20 IU/L 10 - 50
CK * 530 IU/L 38 - 204
GAMMA GT 22 IU/L 10 - 71

Proteins
TOTAL PROTEIN 70 g/L 63 - 83
ALBUMIN 48 g/L 34 - 50
GLOBULIN 22 g/L 19 - 35

Minerals
CALCIUM 2.37 mmol/L 2.20 - 2.60
Corrected Calcium 2.32 mmol/L 2.20 - 2.60
PHOSPHATE 1.19 mmol/L 0.87 - 1.45

Gout Test
URIC ACID 316 umol/L 266 - 474

Diabetes Test
HbA1c (mmol/mol) 35 mmol/mol 20 - 42

Iron Profile
IRON 19.7 umol/L 10.6 - 28.3
T.I.B.C 54 umol/L 41 - 77
TRANSFERRIN SATURATION 36 % 20 - 55

Lipid Profile
TRIGLYCERIDES 0.5 mmol/L < 2.3
CHOLESTEROL 4.8 mmol/L Optimum <5.0
HDL CHOLESTEROL * 2.4 mmol/L 0.9 - 1.5
LDL CHOLESTEROL 2.2 mmol/L Up to 3.0

Heart Disease Risk
HDL % of total 50 % 20 and over

Thyroid Test
FREE THYROXINE 14.5 pmol/l 12.0 - 22.0

Hormone Profile
D.H.E.A. Sulphate 13.0 umol/L 0.44 - 13.4
FOLLICLE STIM. HORMONE 3.3 IU/L 1.5 - 12.4
LUTEINISING HORMONE 3.5 IU/L 1.7 - 8.6
TESTOSTERONE 29.8 nmol/L 7.6 - 31.4
SEX HORMONE BINDING GLOB * 62 nmol/L 16 - 55
Testosterone/SHBG Ratio 48.1 24 - 104

17-Beta OESTRADIOL * 73 pmol/L 99 - 192

So anyway - Obviously my SHBG is on the high side. Also - E2 is low, I know this can cause problems of its own. I suppose I would have more E2 if I could free up T for it to be aromatised? I get the idea that there aren’t any particularly reliable ways of lowering SHBG. Anybody have any insight into what’s going on with my numbers / Low-T symptoms?

Thanks!

2

Calculated from SHBG and assuming average serum albumin, your free T would be about 35 pg/mL if measured by equilibrium dialysis, which is low and could explain your symptoms.

Low free T also could explain the low estrogen.

As you’ve surmised, a strategy to reduce SHBG isn’t realistic, and further would not actually “free up” any significant amount of testosterone and so is not a viable plan.

Unfortunately, the low E rules out that testosterone could be improved by lowering estradiol.

The free T4 is not particularly good, but I’m sure you’ve read the iodized salt advice here. Simple enough to do, or if and only if you consume plenty of seafood, baked potatos with skin, and dairy or you take an iodine-containing supplemement then you could be fine for iodine without iodized salt.

The blood test rules out iron toxicity as a possible cause for low testicular function.

As the LH is reasonable, the most likely cause is somewhat low testicular production, which does happen.

3

Thanks Bill for those insights.

Something I’ve never figured out from prowling such forums is how can I have low testicular production when I have high total T? Is it that that T has been produced over a long period of time and just been bound up and has stayed floating around in my blood?

I have read bits and pieces about iodized salt. I will do more reading on this.

Many thanks again.

4

The problem is the term “total testosterone.”

It’s no more valid than, for example, reporting how much testosterone is present in fat cells (far more testosterone is dissolved into fat than is present in the blood.) An obese person might have a huge number, but that would be meaningless.

The biological effect of testosterone is from its chemical potential, which is directly related to its free concentration in water solution. A truly accurate free testosterone measurement is the gold standard for what testosterone can do in the body. Amounts bound to other things are irrelevant to receptor binding, or to the rate at which testosterone is metabolically eliminated.

The total they refer to is not the total in your body (which would be useless) but the total measurable by them, which is the total of the free, the amount bound to SHBG, and the amount bound to serum albumin and other proteins. SHBG being high will result in a greater amount of testosterone being measured by them, but from the standpoint of your androgen receptors, that fact is irrelevant.

5

I agree, fT3 is lowish and you should consider that this might be a result of low iodine intake. Is iodizes salt available there and do you use it?

You can check overall thyroid function by checking your oral body temperature when you first wake up in the morning. 97.3F is a problem, 97.7+ is good. Also check that you get 98.6F/37C mid-afternoon. If body temperatures are low, read the thyroid basics sticky. Good thyroid labs would be TSH, fT3, fT4

You can have “Although I have symptoms of Low T” from low thyroid function!

See if you can get a direct reading of free testosterone.

What is your diet?
What Rx and OTC medications?
Where are you located?
Do you get much sun exposure on your skin? [vitamin D]

6

Bill Roberts, KSMan, thank you both very much for your replies. I apologise for not being able to get on and reply until now.

I went and got a digi thermometer from the chemists. I took a reading at around 3pm at work when I was feeling rather cold. People have often said my hands/feet are cold. This isn’t always the case, sometimes they are really warm! But on this occasion (yesterday) my oral temp was 36.1C (97.0F) - Which sounded pretty low from what you have been saying, KSMan.

My waking temp at 6am was 35.9C (96.6F) - Again, way low from what you say. I took another afternoon reading at 3pm today and it was 36.6C (97.9F) - still way below the 37C (98.6F) you mention.

So anyway- I read the thyroid/iodine sticky. I ordered me some Iodoral (12.5mg) and selenium. I’m not sure if I should start on this or do further tests. I have seen people who have had problems going straight on this high dose of iodine.

My diet : Pretty decent really. Junk 1-2 times per week, eg Burger, Indian. Mainly home cooking. Scramby eggs for breakfast most days. Quite a good amount of veg but could do better. Not low carbing. Not Paleo. My downfall is the booze, I can go out (and do most Fridays) and drink all night. Need to stop that. I have been through (significantly) less boozy periods recently though and it doesn’t seem to make too much difference to my general feeling.

Meds Rx and OTC : Nothing Rx but I dabble with Cialis 1-2 times per week. Apart from that- I have just started taking Vit D3 75mcg/day.

Located UK: Sun exposure pretty poor the vast majority of the time - but had some good weather recently so been trying to get in those rays!

Sun Exp: As above, pretty bad long term (hence D3 supp). Occasional use of sunbed and holidays. But in terms of regular full body exposure - pretty bad.

I can get Free-T test done but it is expensive. I’m pretty sure it will come in low. But if part of my problem is subclinical hypothyroid then I would like to see if I could remedy that as a more pragmatic approach.

So - Iodoral? KSMan - I know you took it and felt benefits after a few days. Should I wean myself onto it? Maybe start with kelp? Or should I just go for the 12.5mg? (Obviously with approx 400mcg selenium as well). Or - do I need to do more temperature measurements to establish thyroid issue? (I will be continuing to take temp readings anyway of course)

Thanks! - Sorry for going on at length.

PS KSMan / Bill R - You two are like angels on here- you do so much for so many people and for no personal gain. You deserve medals. I will set up a benevolent fund for you guys!!