Routine Eval Bloodwork, Low Free T. Typical Low T Symptoms. 23yo

Pharma / TRT Testosterone Replacement
1

Hey there,

Read a lot of knowledgeable threads on here about T replacement that stopped me from being treated some of the stupidest Endo’s i could have encountered, they were more unaware of how hormones work in males than a layman like me in some instances. I consulted my physician about low T just recently after the symptoms just upped a notch to let me not live happily. I have been training very seriously for 4 years now and after the 1st year, i have only lost lean mass and not gained any despite my work ethic and knowledge of training and dieting has increased and i have given a lot of approaches time to work me in the gym but it hasn’t even though my strength has moderately gone up on each lift very slowly. Apart from this i have typical symptoms of a hormonal disorder such as anxiety, stress, lack of energy even after good sleep, difficulty losing fat though less than gaining muscle mass and keeping fat off. I was very different 3 years back when i would never feel tired and just wanted to see the world and experience new surroundings, now i feel that i can’t be bothered to go out to meet my best mates living in the same city and it’s really bothering me. So, i’ll leave the background to that. I will happily share more if some one needs it.

My stats:

Height- 5’8
Weight- 163lbs, was standing at 170 2 weeks prior, lost 10-12 pounds when i got sick within a week(a worrying sign that my body has been giving me for the last 2 years in particular)
BF- 15-16%

I have good amount of facial and chest hair.

Blood work:

Total T- 570 ng/dl (Normal surprisingly)
Free T- 6 pg/ml (Range- 4.25-30.4) (This is the cause of concern for me)

Iron- 151.66 ug/dl (range- 70-180)
TIBC- 281.96 ug/dl (Range -225-535)

Calcium- 10.38 mg/dl (Range- 8.8-10.6)
Blood Urea Nitrogen 20 mg/dl (Range- 8-20)
Creatinine- 0.82 mg/dl (range- 0.6-1.1)

Total Cholesterol- 157 mg/dl (range- 125-200)
HDL- 60 mg/dl (Range- 35-80)
LDL- 93 mg/dl (Range- 85-130)
Triglycerides- 45 mg/dl (Range- 25-200)
TC/HDL Cholesterol ratio- 2.6 (range- 3.0-5.0)
LDL/ HDL ratio- 1.5 (range 1.5-3.5)
VLDL- 8.95 mg/dl (range- 5-40)

T3- 84 ng/dl (Range- 60-200)
T4- 8.8 ug/dl (range- 4.5-12)
TSH- 1.41 uIU/ml (range 0.30-5.50)

25-OH Vitamin D -25.75 ng/ml (range 30-100) (taking prescribed med for this)
Vitamin B-12- 613 pg/ml (range 211-911)

Diabetes screen:

HBA1c- 4%

Average blood glucose- 68 mg/dl

I also have a complete hemogram that is normal. If anymore information is required i’ll happily provide it.

So, after consulting a few very stupid endos who didn’t bother to even ask about other sex hormones such as prolactin, LH, FSH and Estradiol, i found a good urologist who’s a men’s health advocate and he seemed to be knowledgeable about his field unlike his counterparts. I am waiting on my SHBG, Albumin, E2 and repeat values of Total and Free test and should i have reports back tomorrow. At first, the doc was not convinced it was a T issue since my Total came back normal, however after my symptoms he wants to look more into my results to see what’s causing my symptoms. One way i was convinced about this doc was that he was aware of how TRT is administered in the pathological sense, and was an advocate of the pinning protocols i have gathered so much info about on here. The other docs were talking about pinning once in 2 months or so. However, i asked about TRT because i wanted to be sure about the doc and his knowledge, and i hope i don’t need it. However my Free T is concerning me and the symptoms i have been facing in the last 2-3 years make more sense to me, whereas previously i kept consoling myself about my lack of progress in the gym and my general unmotivated self, even beating myself up about how lazy and disinterested i am letting myself become.

I wanted to share these things with you guys to help me understand what might me the cause and how to go about things because it’s been becoming very hard for me to keep up with life like this. On the ending note, i have also been getting sick very often this past year and keep losing a lot of LBM. Before the other symptoms started appearing, i would never get sick.

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In addition, I forgot the two most important symptoms, I have little to no libido to the point my girlfriend is upfront with me on that and i have been so poor at remembering stuff this past 6-7 months especially. Primary Hypogonadism had been ruled out by both urologist and the endos i have consulted after performing physical examination.

3

TT is a combination of:
FT
T+albumin [lightly bound]
T+SHBG [tightly bound, not bio-available

When TT is decent and FT is very low, we can make a working assumption that SHBG is high, and TT is an exaggerated indicator that can easily be misleading. SHBG can be high from high E2 or impaired liver clearance of E2.

Many of the symptoms of low thyroid function are the same as low T. So both together …

T3- 84 ng/dl (Range- 60-200)
T4- 8.8 ug/dl (range- 4.5-12)
TSH- 1.41 uIU/ml (range 0.30-5.50)

TSH is better closer to 1.0
T3, T4, fT3, fT4 should be midrange or a bit higher.
T3 is low.
Mostly interested in fT3, fT4

What is your history of [not] using iodized salt? [If not,
Do you feel cold easier now?
Outer eyebrows sparse?
Describe history of stress and major stress events/illnesses/injuries.

Do you have ferritin, RBC, albumin, total protein, hematocrit?

Total cholesterol is best near 180.
Do you get enough fats in your diet?

Please follow these links in the 2nd post of 1st forum topic:

  • advice for new guys – any more info
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

When do you feel that your hormones started to go bad?
Any blows to the head or whiplash prior to that?

Labs: - you have some now
TT
FT
E2
LH/FSH
prolactin

  • if body temps are low, add these
    fT3
    fT4

Please describe the “getting sick very often this past year”
Anything odd with immune cell levels in your labs?

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-1)Yes, i use iodized salt, it’s been used by my family since always.
2) No in fact i feel hot most of the time
3) No sparse
4) Stress was really bad in April-July last year due to some tragedy and chronic warts on my feet which kept recurring and prevented me from training which has negative impact on my mood itself. No other long stressful times. However, i do feel emotional more than ever during the last 3 years and have sometimes severe moodswings.

-T3 as my doctor suggested could be a bit low due to large no. of small sickness that i kept having 2 months prior to testing which needed alot of Antibiotics to get rid. I will get another test shortly. I guess T4 and TSH are fine.

-As i said i’m gonna get reports of some blood work within a couple days which should help, i’ll post on here as soon as i get them for you to look at. Includes everything you list except Free T3 and T4+ ferritin.

-And for the other values you asked for:

RBC- 4.59 (Range 4.5-5.2)
Albumin- 4.46 gm/dl (Range- 3.2-4.8)
Total Protein- 7.03 gm/dl (Range- 5.7-8.2)
Hematocrit(PCV) - 47.4% (Range- 40-50%)

Don’t have ferritin though.

  • Never had any head or injuries to the testes, working totally fine according to the doc.

  • I follow a moderate to high fat diet recently in the past 1 year, before that i was eating quite low fat.

  • As i said in the post, 3 years ago, things gradually became worse with loss of LBM, Mood swings, Energy, libido etc.

5

Missed one bit out of your inquiry, The sickness i have been talking about is general infections, i also have recently developed sinusitis, which is what i mean when i say that i had been on a lot of antibiotics in the last 2-3 months, had 2-3 separate cases of sinus infections.

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Antibiotics can mess up your GI flora.

Have you asked your doc about your apparent lower immune function?

Vit-D3 and thyroid can affect immune function.

Stress can increase rT3, blocking action of fT3.

7

Yes, i asked the doc, I don’t get sick as often as i have been in the last two months and it’s the chronic sinusitis that i’m having trouble with. No other diseases and have been perfectly healthy throughout this last year till now when i started getting acute sinus attacks, maybe twice in the 3-4 months and then developed into a chronic state. I just got a CT scan to confirm it last week. Treatment slipped out of mind due to this T concern.

What do you think about Thyroid, my endo and urologist weren’t too concerned about the thyroid values at all. I am not too knowledgeable about Thyroid and would appreciate better explanation about your concerns about my thyroid values.

Thanks for your feedback.

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That link explained that low thyroid function can cause sinus congestion and lack of drainage may lead to infections.

Do you finish the antibiotics or stop when you feel better?
Worried about antibiotic resistant bacteria.

Please get your oral body temperatures. Your feeling warm may not mean what it feels like.

T3- 84 ng/dl (Range- 60-200)
T4- 8.8 ug/dl (range- 4.5-12)
TSH- 1.41 uIU/ml (range 0.30-5.50)

TSH is better closer to 1.0
T3, T4, fT3, fT4 should be midrange or a bit higher.
T3 is low.
Mostly interested in fT3, fT4

fT3 is what gets the job done. Your low T3 is worrying. fT3 may be low.
T4–>T3 may be impaired.
Low ferritin is associated with reduced T4–>T3 conversion.

9

I finish the course as my doctor recommends, in the past i have stopped when i feel better and have experienced a recurrence and the docs attribute it to not staying on the antibiotics course.

I will start recording my temperatures soon. Need to get hold of a new thermometer.

I understand that TSH is better closer to 1.0 but most of the bloods i have seen here are more closer to 2 and still have no thyroid problems so i thought i was good. Anyway, i’ll keep a closer eye on this.

Let me know if you require some new bloods, i’m getting tested in a few hours, i can get whatever tests you might need to assess further like Free T3.

Thanks again and please reply soon so that i am prepared for the blood work.

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I see you have posted in the first reply to get tested for free T3 and free T4. I’ll go ahead and get tested for those as well.

All the values i’m getting tested for tomorrow then:

Total and free Test, LH, FSH, SHBG, Progesterone, DHEA, Prolactin, Free T3 and T4, Albumin, TSH, Total T3 and T4, Cortisol, Complete Hemogram, Estradiol (E2), Hepatitis Panel.

I guess that’s all we need, will post values of the latest blood work in the coming days. Let me know in the meantime if i missed anything. Getting all these done at 9am fasted.

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I make my own kefir and use it everyday in my smoothies. Great source of probiotics IF you make your own. Really changed my life. I never have GI problems. Haven’t been sick one time since adding this to my diet. So simple. Order the kefir grains online and your good to go.

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I started a thread last week about low free T and hypogonadism.

To summarise, there was a European study that found low free T was a better predictor of hypogonadism than TT. The lower bounds of what constitutes a normal range hasn’t been determined, but it’s probably somewhere between 6 and 7 (maybe as high as 8) ng/dL.

Low free T is also associated with depression and anxiety. (I’ve been meaning to write a post about this.) It’s not certain which is the cause, and which is the symptom though.

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@KSman

I checked my body temperature on waking up and it was 97.3 F. Should i be worrying about hypothyroidism? During the day, it is around 98.6 F though.
Bloods will be coming in soon.

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Get some more temperature readings to get a better idea of trends.

Getting to 98.6 is a good sign, things are not so severe.
You could supplement iodine and see how your body responds.

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Actually it was 98.7 in the evening today. I have already ordered Iodral like you suggested to some other people, think it’ll take a week or two to arrive though since it’s gonna be shipped from the US and i stay in India.

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Okay, so this is real weird, the blood work i shared in the OP was the sample taken on 16/2/16. I was seeing another endo from then to 26/2/16, who prescribed me a T-gel called Cernos 5mg, it has 10mg of Test USP. I applied for a day, i.e, 26/2/16 and saw my current endo who seems to be more aware than the previous. He ordered new blood work that i listed above and the sample was taken on the 02/3/16 as he told me not to take any medication or such for this until we get a more clear look over the next month. I will list some significant anomalies in the latest blood work. I think it could be the one day of the gel usage but it still seems odd.

Total T- 724 ng/dl (2/3/16) and 570 (16/2/16) Range (241-910)
Free T- 14.5 pg/ml (2/2/16) and 6.4 (16/2/16) Range (4.25-30.4)

T3- 106 ng/dl (2/3/16) and 84 (16/2/16) Range (60-200)
T4- 8.8 ug/dl (2/3/16) and 8.8 (16/2/16) Range (4.5-12)
TSH- 3.75 uiu/ml (2/3/16) and 1.41 (16/2/16) Range (0.30-5.50)

RBC- 4.38 (2/3/16) and 4.59 (16/2/16) Range (4.5-5.5)
Hematocrit- 46.8% (2/3/16) and 47.4% (16/2/16) Range (40-50)
Albumin- 4.36 gm/dl (2/3/16) and 4.46 (16/2/16) Range (3.2-4.8)

And some other hemogram value changes, like 125 point decrease in Platelet count, MCV up by 5% and above max reference point. I’ll post full Hemogram values if needed.

Now other Tests that i got done for the first time :

17 OH Progesterone- 1.47 ng/ml (0.5-2.10)
A4- 1.42 ng/ml Range (0.6-3.1)
DHEA Sulphate - 316.2 ug/dl Range (211-492)
FSH- 5.09 mIU/ml Range (1.4-18.1)
LH- 6.58 mIU/ml Range (1.5-9.3)
Prolactin- 17.21 ng/ml Range (2.1-17.7)
SHBG- 64.04 nmol/L Range (14.4-48.4)
Estradiol- 36.62 pg/ml Range (0-39.8)
fT3- 3.47 pg/ml Range (1.7-4.2)
fT4- 1.24 ng/dl Range (0.70-1.80)
Cortisol- 18.28 ug/dl Range (6.2-19.4)

So i’m really curious as to why some of these are as they are, surely one time use of Cernos Gel shouldn’t make so much difference in my blood work in the matter of 4-5 days, in my estimation it should have normalised after 2-3 days which i gave for it to be tested again.

Another very weird thing is my TSH is according to @KSman should be closer 1. I was at 1.41 on 26/2 and 3.75 in 5 days. How much could Cernos gel would have affected this? T3 is also elevated, probably for the better but still odd! Some hemogram differences are also concerning.

Would love your intervention here @KSman.

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Were the labs done at different lab companies? Different ranges?

Some makes sense, some does not.

LH/FSH should be done prior to any TRT.

Please always provide lab ranges with labs.

India has a very complex politicized history of salt and iodized salt has not always been available.

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Hi @KSman,

Big thanks for your insights.

Yes, Same companies. I know i made an error of judgement really. I wasn’t convinced of the doctor and i wasn’t finding better docs than him at the time and had not learned from this platform, not to forget desperate for some of the symptoms to go away.

I did not provide ranges on the comparison bloods due to having provided in the OP for reference. I’ll just edit my post to reflect the ranges.

I was studying and working in Singapore for 4 years prior (lack of regular home cooking) to May’15 and maybe the iodine stores need replenishment and i have ordered Iodral for this and will practice your protocol. As i said in the earlier post, my family has always used iodized salt for preparation of meals and i eat atleast 3 meals at home everyday and Indian food is generally on the higher side with the salt.

I applied the Gel only once and it’s of a lower dose than American alternatives such as Androgel. I told my doc about it, he said that he would expect the blood to normalise in 2-3 days and then we draw the blood.

What according to you make sense and what does not? I am not educated enough yet to interpret the changes in some of these values, especially Thyroid values.

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I cannot make any sense in how your thyroid lab values changed.

I also point out that arsenic in well water in your part of the water is a concern.

I am confused by your description.
We labs of 2/3/16 before the Cernos?

[I am concerned that you did not need TRT and problems may be thyroid and not low-T.]

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@KSman,

2/3/16 was after Cernos that i used for only 1 day on 26/3/16. I made an error with the other lab tests dates, it was 16/2/16 instead on 26/2/16. TSH 1.41 was result of the lab taken on 16/2/16 and 3.75 was taken on 2/3/16. I talked with my doctor today about these lab results, and he confirmed that i need TRT after the calculated Free T was even lower than what my blood work suggests. ( Immunoassay is not the most accurate way of assessing Free T)

I wasn’t on any TRT prior, apart from the 5mg of cernos i applied on 26/2/16. Thyroid does not explain Mild ED though and my SHBG is extraordinarily high which explains low free T. My TSH has been closer to 1 in the two Labs that i have done prior to the latest one. fT3 and fT4 are also mid range.

I asked the Urologist about the Thyroid values today and he said that he doesn’t believe it to be a problem since 2/3 labs show it to be healthy, and he can refer to a thyroid specialist if i have further concerns regarding this. I haven’t started TRT yet so i would like to investigate further before commencing. However, does Thyroid function cause such low Free T levels and high SHBG? To my knowledge, i thought hypothyroidism can decrease SHBG levels.