Low Free T - Looking for Help with Bloodwork

Pharma / TRT Testosterone Replacement
1

Over the last few years I have been noticing some symptoms of low testosterone. I had 4 free testosterone readings and they were all at or below the bottom of the specified range. The age range was not specified but the news is not good either way. I have been researching these issues patiently for years now, at first hoping the wicked case of sleep deprivation of over 2 years screwed me up and I would eventually bounce back.

Although things in general are better I feel that there may be room for improvement. All of the doctors I have seen have told me that the free testosterone test is very unreliable and to not focus on the numbers. I was concerned with the higher SHBG reading from Sept 2014 which is why I asked for a referral to an endo. I was thinking it may be liver (E2) or thyroid related but the few tests that were run do not appear to show any issues that I can see.

Any ideas/help would be greatly appreciated. I am looking for some direction as to next logical steps. I am thinking upping my dose of iodine to see if it rectifies my apparent low body temperatures is worth a shot. Other than that not too sure. Thanks.

Age 36
height 5 ft 11
waist 32 inches
weight 175 lbs

describe body and facial hair
hair not thick but covering legs, arms, chest, belly, lots of hair on throat but patchy on face, have to shave every few days, can not really grow a beard due to patchiness and takes forever

describe where you carry fat and how changed
always carried on waist/love handles, pretty lean everywhere else

health conditions, symptoms [history]
no major health issues (not on any medication)
low work/life stress other than the usual being a husband/Dad stress
symptoms include:
moodiness/a few bouts of mild depression: started in early teens
lack of libido: never super high but has dropped significantly in the last 5 years
tiredness: more in last 5 years
fairly hard to gain muscle/strength (realistic about gains): since teens
erection sensitivity diminished: noticed in the last few years

Rx and OTC drugs, any hair loss drugs or prostate drugs ever
some pot use in twenties
never been on TRT or steroids

describe diet [some create substantial damage with starvation diets]
have been eating fairly clean for decades and exercising in spurts but last 5 years eating very clean and exercising regularly
have gone through bulking and cutting phases a few times in that 5 year span, heaviest weight during that time was 179 lbs (no abs), lightest 164 lbs (visible 4 pack)
focus on healthy proteins/all types of fats with some healthy carbs (oats, sweet potato, rice) and plenty of veggies, probably macro split of 30% P / 30% F / 40% C â?? have tried 8 meals a day and lately sort of using intermittent fasting with 10 hour eating window over 4 meals

describe training
was overtraining badly when I started exercising/eating clean 5 years ago, 6 days a week, 3 weights, 3 HIIT cardio. This lasted for around 8 months. At this point I started getting injured and my mental health suffered. This coincided with major sleep deprivation due to a new baby. I sleep good now - average 7 or more hours a night, have for a few years now. Current workout split is 1 upper body mostly compound movements, 1 lower body mostly compound movements, 1 cardio usually light jog 20 to 30 minutes and 1 yoga class per week.

testes ache, ever, with a fever?
Never but to note I did have a vasectomy in January 2012 and I have nerve like pain at incision site. It is less regular now but maybe once every 4 months or so it bothers me for a day or two. I have had it checked out by 3 doctors (including the guy who did vasectomy) and they all said it would probably go away, kind of seems like nerve entrapment from what I have read

how have morning wood and nocturnal erections changed
I always had strong/consistent morning wood in my teens and from what I recall in my twenties. I am not sure when it happened (probably slowly) but I rarely wake up with morning wood, maybe a half chub once or twice a week. I was consciously checking for a while there if I woke up at some point through the night and nocturnal erections were common.

lab results with ranges
Note I am in Canada, all blood tests completed at 8 am
April 2012 Tests requested by GP
TEST RESULT (RANGE) [UNITS]
Free testosterone 19.3 (31 to 94) [N/A]
NOTE no additional blood work was completed

July 2013 Tests requested by GP
TEST RESULT (RANGE) [UNITS]
Free testosterone 29 (31 to 94) [N/A]
NOTE no additional blood work was completed

January 2014 Tests requested by GP
TEST RESULT (RANGE) [UNITS]
SPECIAL CHEMISTRY II
FreeTestosterone 28.7 (LO) (31.0 to 94.0) [N/A]

July 2014 Tests requested by GP
Note I was sick when I had this testing done, should have waited until I was 100%
TEST RESULT (RANGE) [UNITS]
SPECIAL CHEMISTRY II
FreeTestosterone 16.5 (LO) (31.0 to 94.0) [N/A]
SPECIAL CHEMISTRY I
Testosterone 17.4 (8.4 to 28.8) [N/A]
SPECIAL CHEMISTRY II
TSH 1.21 (0.30 to 4.00) [N/A]
CHEMISTRY
Ferritin 51 (22 to 322) [N/A]
BIOCHEMISTRY
PSA 0.51 (less than 4.0) [N/A]

September 2014 Tests requested by Urologist and from a different lab
TEST RESULT (RANGE) [UNITS]
Testosterone, S: 24.2 (8.6 to 29.0) [nmol/L]
Sex Hormone BG 53.3 (16.5 to 55.9) [nmol/L]
Free Androgen Index 45.8 (35.0 to 92.6) [N/A]
All Reference Ranges: Male 20 yrs to 49 yrs

April 2015 Tests requested by Endocrinologist
ENDOCRINOLOGY AND TUMOUR MARKERS
TSH (3RD GEN) 1.96 (0.27 to 4.20) [mIU/L]
FREE T4 16 (12 to 22 mid 17.5) [pmol/L]
1.24 (0.93 to 1.71 mid 1.32) [ng/dL] (my conversion)
FREE T3 5.0 (3.1 to 6.8 mid 4.95) [pmol/L]
0.39 (0.24 to 0.53 mid 0.385) [ng/dL] (my conversion)
390 (240 to 530 mid 385) [pg/dL] (my conversion)
17 BETA ESTRADIOL 82 (28 to 156) [pmol/L]
22.3 (7.63 to 42.5) [pg/mL] (my conversion)
TESTOSTERONE, S 19.2 (8.6 to 29.0) [pmol/L]
SEX HORMONE BG 53.0 (16.5 to 55.9) [nmol/L]
FREE ANDROGEN INDEX 36.2 (35.0 to 92.6)
LH 2.9 (1.7 to 8.6) [IU/L]
FSH 1.8 (1.5 to 12.4) [IU/L]
PROLACTIN 6 (4 to 15) [ug/L]
IGF-1 222 (83 to 240) [ug/L]
ENZYME AND CARDIAC MARKERS
ALT 17 (less than 41) [U/L]
AST 22 (less than 40) [U/L]
INVESTIGATIONAL HEMATOLOGY
FERRITIN 87.1 (30.0 to 400.0) [ug/L]

Current Supplements: supplement regime other than the kelp has pretty much been the same for 4 years, give or take, been taking kelp for about a year
Morning:
Vit C: 1000 mg
Vit E: 400 IU
Vit D: 2000 IU
Multi Vitamin
Kelp: 375 microg iodine

Night:
Vit C: 1000 mg
Zinc 25 mg
Vit D:2000 IU
Fish oil: 1200 mg

Basal body temperature testing
Note I have avoided adding salt to food for as long as I can remember (at least back to teenage years, can not recall before that). I took my morning temperature over a 5 day span about a year ago and they readings were low (I remember the average being around 36.5 degees C). So at that time after doing some reading I decided to add in the kelp supplement and started adding iodized table salt to at least one of my meals per day. My current temperature testing as of this month is as follows:

Morn Temp at 6:00 am (deg C) 36.1, 36.4, 36.6, 35.8, 36.4
Average is 36.3

Aft Temp at 3:30 pm (deg C) 36.7, 36.8, 36.9, 36.5, 36.6
Average is 36.7

Note: readings taken using a glass thermometer underarm. The morning readings were taken as soon as I awoke and I did not get out of bed. I observed the reading after 15 minutes. My aunt and Grandma were supposedly on thyroid meds (no specifics). I have always been sensitive to cold, my extremities get cold way easier/quicker than most people. Also to note that I have always consumed fluoridated water as it is added to our water supply.

I will post full blood test results next. Thanks.

2

Please check oral body temperatures.

Does your family use iodized salt? Need to look out for them too.

Ferritin was low, now passable. Any known change to iron intake, red meat etc?
Do you have digestive or food sensitivity issues?

E2 looks good, but with your low fT, that makes you estrogen dominant, reinforcing your higher SHBG which in turn keeps fT low.

FSH is low and the better indicator of your LH status than LH itself.

Your lack of facial hair indicates that you have always been a low-T guy. So the problem that you have now may not be new, but an extension of the way things have been.

Your problem now is doctors, all the worse in Canada [and other Common Wealth Countries].

fT3 says that your body temperatures should be good, perhaps rT3 at work, but no obvious stress causes for that.

A HPTA restart seems like a reasonable thing to try, but your history of lower T levels suggests that the outcome would not be good enough.

Low dose anastrozole might help a bit, but you do not have very much room to lower E2. So that may not be viable.

If you were on TRT, higher T levels, with E2 management would reduce SHBG.

Your FT is consistently low and SHBG high. Suggest that you get forceful with docs who are looking excuses to dodge going anything.

3

KSMan - Thanks for the quick reply. Your help is greatly appreciated. Here are some follow up questions/comments. As well here is my full blood work.

Please check oral body temperatures.
[Will do and repost.]

Does your family use iodized salt? Need to look out for them too.
[I have started adding it to their food over the last month or so.]

Ferritin was low, now passable. Any known change to iron intake, red meat etc?
Do you have digestive or food sensitivity issues?
[No obvious changes. I have always eaten red meat. Since investigating these issues I have actually increased the amount of red meat in my diet. I eat it 5 to 6 times a week.
Regarding food sensitivities, yes good question. Yes I do seem to have some odd issues in that department. I am not aware of any food allergies (i.e. never been tested and do not have any obvious allergies to any foods). That being said here are some issues.
(1) My bowel movements are huge. This has been an issue since my teens. I am world renowned for plugging toilets. I am usually on the edge of constipation and have been for a while. Wiping my ass is really just a formality; there is not usually anything there (sorry for the gross factor).
(2) Another interesting issue is alcohol. I have very little tolerance for any type of alcohol. Sure I can have 1 to 2 beers and most times be ok. I will often get a headache from that amount even when I consume water with the alcohol (1 glass water per 1 alcoholic beverage). I get super cold when I used to drink (especially extremities, sometimes after only a few drinks). As well I used to throw up probably 80% of the time I took it to a level of intoxication (I am talking only in the 5 to 6 drink range per night, yeah massive lightweight).
(3) Another issue is gas. I usually smell pretty bad, I guess who does not. But often, especially when I am consuming a lot of calories, my gas is horrible. Rancid, almost smells like propane (yes weird). I was also the king at work for my gas for a while, definitely better now that my total calories are lower and probably less fibre. My wife is suggesting I go for testing regarding food allergies.
(4) Headaches/migraines. Since my teens I have had a ton of headaches which would 95% of the time turn into migraines. Up until my early twenties my only solution was sleeping them off which sucked. I read an article in my twenties regarding the benefits of caffeine and ibuprofen and especially nipping it off when the migraine was a 1 out of 10. Since then I think I have maybe had one migraine as I became so familiar with the signs that it was coming and the caffeine/ibuprofen solution was/is so effective. As for what my triggers are, number 1 is dehydration. I pretty much eat the same every day and my water intake is also very similar from a day to day basis. If for whatever reason I donâ??t drink regularly it can trigger a migraine. Eye strain is another one, as well as neck/back stiffness. I have not found any food triggers at all.
Anyone see any issues with the symptoms listed above?]

E2 looks good, but with your low fT, that makes you estrogen dominant, reinforcing your higher SHBG which in turn keeps fT low.

FSH is low and the better indicator of your LH status than LH itself.

Your lack of facial hair indicates that you have always been a low-T guy. So the problem that you have now may not be new, but an extension of the way things have been.
[I agree. I doubt I have ever been at the high end of the range or anywhere near.]

Your problem now is doctors, all the worse in Canada [and other Common Wealth Countries].

fT3 says that your body temperatures should be good, perhaps rT3 at work, but no obvious stress causes for that.
Should I get this tested in your opinion? Does it seem likely with my FT3 and FT4 being almost perfectly in the middle of their respective ranges?

A HPTA restart seems like a reasonable thing to try, but your history of lower T levels suggests that the outcome would not be good enough.

Low dose anastrozole might help a bit, but you do not have very much room to lower E2. So that may not be viable.

If you were on TRT, higher T levels, with E2 management would reduce SHBG.
[From my research I have no doubt this is true.]

Your FT is consistently low and SHBG high. Suggest that you get forceful with docs who are looking excuses to dodge going anything.
[Are you suggesting pressing them to dig deeper into the FT low / SHBG high issue for root causes or press them for TRT? If you think they should dig deeper what would be the suggested direction? More thyroid testing (RT3)? Now that I have listed some weird digestive like symptoms, any new direction in mind when it comes to testing? The Endo said there are no issues and a have a standard follow up in a year. I believe I can press him for more. He was suggesting prior to the testing that if everything came back normal it must be mental and he would prescribe me an anti depressant? Do I have mental health issues when it comes to mood? I would suggest yes to some degree but am not sure at this point if I want or need to go down that road. I realize they (antidepressants) can cause even more issues. I am the type of person who wants to do everything as naturally as possible. As for TRT my GP already has agreed to prescribe it but he admitted he will not be much help to me which is why he started the referral train. TRT is an option I have always considered but I am so conservative and would choose that as a last option.]

4

Complete blood test results

April 2012 Tests requested by GP
TEST RESULT (RANGE) [UNITS]
Free testosterone 19.3 (31-94) [N/A]
NOTE no additional blood work was completed

July 2013 Tests requested by GP
TEST RESULT (RANGE) [UNITS]
Free testosterone 29 (31-94) [N/A]
NOTE no additional blood work was completed

January 2014 Tests requested by GP
TEST RESULT (RANGE) [UNITS]
SPECIAL CHEMISTRY II
FreeTestosterone 28.7 (LO) (31.0 to 94.0) [N/A]
HEMATOLOGY
Hb 161 (135 to 175) [N/A]
Hct 0.47 (0.40 to 0.50) [N/A]
WBC 4.2 (4.0 to 11.0) [N/A]
RBC 5.31 (4.50 to 6.00) [N/A]
MCV 87.8 (80.0 to 100.0) [N/A]
MCH 30.3 (27.5 to 33.0) [N/A]
MCHC 345 (305 to 360) [N/A]
RandomDistributionWidth 13.5 (11.5 to 14.5) [N/A]
Platelets 165 (150 to 400) [N/A]
HEMATOLOGY II
Neutrophils (A) 2.1 (2.0 to 7.5) [N/A]
Lymphocytes (A) 1.6 (1.0 to 3.5) [N/A]
Monocytes (A) 0.3 (0.2 to 1.0) [N/A]
Eosinphils (A) 0.2 (0.0 to 0.5) [N/A]
Basophils (A) 0.0 (0.0 to 0.2) [N/A]
URINANYLSIS CHEMICAL
UrineColour YELLOW (NONE/YELLOW) [N/A]
UrineAppearance CLEAR (CLEAR) [N/A]
UrineSpecificGravity 1.015 (1.001 to 1.030) [N/A]
Urine pH 7.0 (5.0 to 8.0) [N/A]
UrineProtein 0.3 (HI) (NEG (less than 0.3) [N/A]
UrineGloucose NEGATIVE (NEGATIVE) [N/A]
UrineKetones NEGATIVE (NEGATIVE) [N/A]
Urine Blood NEGATIVE (NEGATIVE) [N/A]
UrineNitrite NEGATIVE (NEGATIVE) [N/A]
UrineLeukocytesEsterase NEGATIVE (NEGATIVE ) [N/A]
ROUTINE CHEMISTRY I
FBS 4.9 (3.6 to 6.0) [N/A]
Hb A1C 0.053 (LESS THAN 0.060) [N/A]
Cr 88 (62 to 115) [N/A]
eGFR 85 (60 to 89 45% of adlts) [N/A]
Na 141 (135 to 147) [N/A]
K 4.9 (3.5 to 5.5) [N/A]
Cl 102 (100 to 110) [N/A]
UA 236 (230 to 480) [N/A]
ROUTINE CHEMISTRY I
ALT 24 (12 to 49) [N/A]
ROUTINE CHEMISTRY II
CK 169 (40 to 280) [N/A]
CARDIOVASCULAR RISK ASSESSMENT
HOURS FASTING 9
CHOL 3.19
HDL 1.13
CHOL/HDL 2.8
NO (RANGE) BUT SAYS INDICATOR OF HIGH CVD RISK IF CHOL/HDL C RATIO greater than 6.0
LDL 1.8
NON HDL CHOLESTEROL 2.06
TG 0.58
LIPIDTARGET VALUES
HIGH OR INTERMEDIATE CVD RISK
PRIMARY Tx TARGET
LDL C less than OR = 2.0 mmol/L OR less than or = 50% decrease in LDL C
Alternate Tx TARGET
Non HDL C less than or = 2.6 mmol/L OR ApoB less than or = 0.8 g/L
LOW CVD RISK
PRIMARY Tx TARGET
Less than OR = 50% decrease in LDL C

July 2014 Tests requested by GP
Note I was sick when I had this testing done, should have waited until I was 100%
TEST RESULT (RANGE) [UNITS]
SPECIAL CHEMISTRY II
FreeTestosterone 16.5 (LO) (31.0 to 94.0) [N/A]
SPECIAL CHEMISTRY I
Testosterone 17.4 (8.4 to 28.8) [N/A]
Hematology
Hb 156 (135 to 175) [N/A]
Hct 0.46 (0.40 to 0.50) [N/A]
WBC 7.5 (4.0 to 11.0) [N/A]
RBC 5.25 (4.50 to 6.00) [N/A]
MCV 86.7 (80.0 to 100.0) [N/A]
MCH 29.7 (27.5 to 33.0) [N/A]
MCHC 343 (305 to 360) [N/A]
RandomDistributionWidth 13.5 (11.5 to 14.5) [N/A]
Platelets 180 (150 to 400) [N/A]
Hematology II
Neutrophils (A) 5.4 (2.0 to 7.5) [N/A]
Lymphocytes (A) 1.5 (1.0 to 3.5) [N/A]
Monocytes (A) 0.4 (0.2 to 1.0) [N/A]
Eosinphils (A) 0.2 (0.0 to 0.5) [N/A]
Basophils (A) 0.0 (0.0 to 0.2) [N/A]
HEMATOLOGY IV
B12 484 (198 to 615) [N/A]
Routine Chemistry I
RBS 3.8 (3.6 to 7.7) [N/A]
ROUTINE CHEMISTRY I
ALT 17 (12 to 49) [N/A]
Routine Chemistry I
Hb A1C 0.052 (less 0.060) [N/A]
Cr 87 (62 to 115) [N/A]
eGFR 87 (60 to 89 45% of adlts) [N/A]
Na 143 (135 to 147) [N/A]
K 4.5 (3.5 to 5.5) [N/A]
Cl 106 (100 to 110) [N/A]
UA 264 (230 to 480) [N/A]
ROUTINE CHEMISTRY II
CK 146 (40 to 280) [N/A]
CARDIOVASCULAR RISK ASSESSMENT
HOURS FASTING 1
CHOL 3.17
HDL 1.13
CHOL/HDL 2.8
NO (RANGE) BUT SAYS INDICATOR OF HIGH CVD RISK IF CHOL/HDL C RATIO greater than 6.0
LDL 1.66
NON HDL CHOLESTEROL 2.04
TG 0.83
LIPIDTARGET VALUES
HIGH OR INTERMEDIATE CVD RISK
PRIMARY Tx TARGET
LDL C less than OR = 2.0 mmol/L OR greater than or = 50% decrease in LDL C
Alternate Tx TARGET
Non HDL C less than or = 2.6 mmol/L OR ApoB less than or = 0.8 g/L
LOW CVD RISK
PRIMARY Tx TARGET
Greater than OR = 50% decrease in LDL C
SPECIAL CHEMISTRY II
TSH 1.21 (0.30 to 4.00) [N/A]
CHEMISTRY
Ferritin 51 (22 to 322) [N/A]
BIOCHEMISTRY
PSA 0.51 (less than 4.0) [N/A]

September 2014 Tests requested by Urologist and from a different lab
TEST RESULT (RANGE) [UNITS]
Testosterone, S: 24.2 (8.6 to 29.0) [nmol/L]
Reference (RANGE):
Male: 20 yrs to 49 yrs

Sex Hormone BG 53.3 (16.5 to 55.9) [nmol/L]
Reference (RANGE):
Male: 20 yrs to 49 yrs

Free Androgen Index 45.8 (35.0 to 92.6) [N/A]
Reference (RANGE):
Male: 20 yrs to 49 yrs

I used the issam calculator and with measured total T and SHBG and Albumin default of 4.3 g/dL came up with:
Free Testosterone 0.395 nmol/L or 1.63%
Bioavail Testosterone 9.26 nmol/L or 38.2%

I researched reference (RANGE)s for Bioavailable Testosterone and found a few:
2.0 to 14 nmol/L
150 to 575 ng/dL or *0.0347 = 5.2 to 19.95 nmol/L
110 to 575 ng/dL or *0.0347 = 3.8 to 19.95 nmol/L
72 to 235 ng/dL or *0.0347 = 2.5 to 8.15 nmol/L ???

CHEMISTRY
Sodium 139 (N/A) [N/A]
Potassium 3.8 (N/A) [N/A]
Chloride 104 (N/A) [N/A]
Bicarbonate (TCO2) 26 (N/A) [N/A]
Anion Gap 9 (N/A) [N/A]
Urea H 8.6 (N/A) [N/A]
Creatinine 78 (N/A) [N/A]
Bilirubin, Total 9.0 (N/A) [N/A]
Glucose, Random L 3.2 (N/A) [N/A]
HEMATOLOGY
LKC 7.6 (N/A) [N/A]
ERC 5.00 (N/A) [N/A]
Hemoglobin 157 (N/A) [N/A]
HCT 0.46 (N/A) [N/A]
MCV 91.9 (N/A) [N/A]
RDW 12.8 (N/A) [N/A]
Thrombocytes L 120 (N/A) [N/A]
Neutrophil 5.3 (N/A) [N/A]
Lymphocyte L 1.4 (N/A) [N/A]
Monocyte 0.6 (N/A) [N/A]
Eosinphil 0.2 (N/A) [N/A]
Basophil 0.0 (N/A) [N/A]
ENZYMES AND CARDIAC MARKERS
AST 28 (N/A) [N/A]
Alk Phos 68 (N/A) [N/A]
Lipase, S 27 (N/A) [N/A]

April 2015 Tests requested by Endocrinologist
HEMATOLOGY
LKC 4.5 (4.0 to 10.0) [x109/L]
ERC 5.16 (4.50 to 6.50) [x1012/L]
Hemoglobin 155 (135 to 170) [g/L]
HCT 0.46 (0.40 to 0.51) [L/L]
MCV 88.9 (79.0 to 97.0) [fL?]
RDW 13.1 (12.0 toâ?? 15.0) [%]
MPV 8.6 (7.1 to 11.1) [fL?]
Thrombocytes 150 (150 to 400) [x10*9/L]

ENDOCRINOLOGY AND TUMOUR MARKERS
TSH (3RD GEN) 1.96 (0.27 to 4.20) [mIU/L]
FREE T4 16 (12 to 22 mid 17.5) [pmol/L]
1.24 (0.93 to 1.71 mid 1.32) [ng/dL (my conversion)]
FREE T3 5.0 (3.1 to 6.8 mid 4.95) [pmol/L]
0.39 (0.24 to 0.53 mid 0.385) [ng/dL (my conversion)]
390 (240 to 530 mid 385) [pg/dL (my conversion)]
17 BETA ESTRADIOL 82 (28 to 156) [pmol/L]
22.3 (7.63 to 42.5) [pg/mL (my conversion)]
TESTOSTERONE, S 19.2 (8.6 to 29.0) [pmol/L]
SEX HORMONE BG 53.0 (16.5 to 55.9) [nmol/L]
FREE ANDROGEN INDEX 36.2 (35.0 to 92.6)
LH 2.9 (1.7 to 8.6) [IU/L]
FSH 1.8 (1.5 to 12.4) [IU/L]
PROLACTIN 6 (4 to 15) [ug/L]
IGF-1 222 (83 to 240) [ug/L]
ENZYME AND CARDIAC MARKERS
ALT 17 (less than 41) [U/L]
AST 22 (less than 40) [U/L]
INVESTIGATIONAL HEMATOLOGY
FERRITIN 87.1 (30.0 to 400.0) [ug/L]

5

Ping me with oral body temps later.

You should find a good probiotic, something with many types of bacterial and sold refrigerated in a health food shop. Take ED for a month and see if digestion changes.

With TRT and/or thyroid correction bowel movements can be more regular.

6

As requested oral temperatures:
Day 1: morn = 35.8C aft = 36.8C
Day 2: morn = 36.2C aft = 36.4C
Day 3: morn = 36.2C aft = 36.4C
Day 4: morn = 36.2C aft = 36.1C
Day 5: morn = 36.1C aft = 36.0C

Note:
Kelp supplement dose upped to 0.750mg per day
Started taking prebiotic supp

7

Most of those temperatures are low. Also need to know if you are able to hit 98.6F/37C in the afternoon.

8

Since I started checking I have never been at or above 37 C. I will continue to monitor to see if temps go up. If not I will get an iodine supp with a greater quantity than the kelp supp.

Meeting with Endo next week. The last time we met he said we have two choices after we get the blood work results (see latest blood work listed previously). If anything is out of range we will investigate further. If everything is normal he is suggesting Wellbutrin. This came out of the blue in the sense that I had met him 5 minutes ago and all I had mentioned to him was the low T symptoms, one of which is issues with mood.

I have a crazy feeling he is going to say that everything is normal and I have an issue upstairs that requires meds. To be honest maybe this is true and I haven’t eliminated it as an option. But there is a part of me that keeps going back to the lab results. I would hate to go down the medication route when in fact a potentially solveable medical issue is lowering my test levels which is resulting in mood issues.

Whether meds like Wellbutrin can in turn raise test levels is unlikely in my opinion. I frankly think there are issues with my labs. The SHBG is at the top end of the range - no idea why - E2 good, thyroid numbers OK. My total testosterone may be exaggerated as a result. My free test has always been at the low end or below. If I don’t have an intelligent conversation with this guy I’m confident he is going to move on and loose interest. It literally took me 1.5 years to see an endo after being bounced around so I’m inclined to try to do my best to get the most out if this guy. Dilemma is the above stated lack of argument or direction.

Yes he’s the Dr and that should be his job but the fact of the matter is the patients input can sometimes go a long way. Any ideas as per future testing/direction is appreciated as well as opinions on Wellbutrin. Thanks as always.

9

Wellbutrin is a good option if you need it and should be a separate issue from TRT and you should see if TRT resolves any mood issues before taking AD meds. But doc may not see it that way. Is doc or you confined by PPO or med insurance constraints.

10

No major constraints as far as medical coverage is concerned. We’ll see what he says. If he doesn’t have future plans for investigating my hormones further I figure his rational for mood meds and not TRT is the following. Although my SHBG is high and subsequently my free is low, I am reasonably fit, I have no ED issues, I’m honestly not in dire straights with regards to any of my symptoms.

This may get worse with time - probably in my opinion. He’ll probably figure we can try to address the mood issue with a seemingly more conservative approach via mood meds. From all my research i think i can safely say TRT has a lot of baggage as far as fine tuning and reversing out of it for any reason is concerned. The impact of dropping the mood meds doesn’t sound as severe.

I haven’t tried either so frankly what do I know - just going by the hundreds of hours of research. I will repost after the endo consult. I’m going to try to push him for more, hopefully challenge him to solve this hormonal puzzle with hope that he bites. Thanks again.

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Keep in mind that estrogen dominance and/or low thyroid function can make one feel down/depressed.

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Today I had my phone consult with the Endo. He didn’t mention anything about Wellbutrin. He said he doesn’t know why SHBG is at the high end. The usual suspects aren’t red flags (E2, liver, thyroid). There is certainly more testing that could be done regarding the red flags such as E1/E3 and more elaborate liver enzyme and thyroid (ex. rt3) testing but he is not recommending any more tests for these possible issues. I also asked him whether he had any suggestions regarding specialists pertaining to issues with the gut but he didn’t have anything to offer. He stated that the higher SHBG may inherently be caused by the lack of T. He is recommending injections at my doctors office once every two weeks with blood work follow. No need to comment on that suggested dosage as I’m already aware that more frequent shots seems to give more stable results. He suggested he has many patients who do well on shots every two weeks. If I decide to start injections we’ll cross that bridge when I get there. At this point I am still undecided as to the future course of action. One option is to hold off on t replacement and continue with iodine supplementation in hopes of raising overall body temperature and improving thyroid function. At the same time start looking into gut health a little closer. Maybe there is some weird mal absorption issues impacting my overall health and possibly affecting hormones. This is certainly the conservative route and maybe the way to go considering I don’t feel like I’m struggling with any major symptoms. I think I have certainly hit a road block when it comes to the high SHBG reading. Medical professionals that I’ve dealt with as well as the online community seems stumped - maybe the answer is right in front of me i.e. T replacement. If I go that route I guess I just have to muster up the balls and go for it (might as well use them before they turn to raisins!!)