Hi guys. Just joined after lurking for a while. I could do with some advice re my bloodt test results.
Few stats
Age 34
Height 5’ 6"
Weight 63kg/140Lbs (20% ish body fat)
Usual symptoms, mainly low mood, lack of sex drive extreme difficulty to make/keep gains in the gym.
If i’m reading it right, my hormones are all within range except E2 which is low. So if things are more or less where they should be, why the typical low T symptoms? What should be my next course of action?
I’m not seeing a doc yet. I need 2 blood tests showing low T before a doc will diagnose hypogonadism. I’m going through a company called optimale.co.uk who arrange the blood tests and set up a meeting with a private doctor.
TSH lab ranges are rather useless but used by doctors to define disease states. You need to be concerned with optimal.
Your thyroid status from the labs is inconclusive. TSH should be near 1.0
T3, T4, fT3, fT4 better near mid-range or a bit higher.
Please eval overall thyroid status via oral body temperatures - see below.
fT3 is the only active hormone and should be tested. There is no receptor for T4 and I suspect that few doctors are aware of that.
Many in UK are iodine deficient and the fact that only a few shops carry iodized salt is a big factor. In UK, if you do not consume dairy products you are not getting iodine that.
TT is not bad, FT is low. Low FT limits FT–>E2.
When you get T levels up, E2 will increase, but often higher than optimal E2=~80pmol/L and then guys should use anastrozole as needed get there. But a very few need higher levels to feel right.
SHBG is quite high, leading to more non-bioavailable SHBG+T that while lowering FT inflates TT that then overstates your T status.
You should test liver markers AST/ALT
SHBG is made in the liver to scavenge sex hormones and liver problems can increase SHBG some times.
FT changes a lot when measured directly, calculated FT has more confidence.
Cholesterol is good for now, TRT may reduce total cholesterol.
LH/FSH and low FT suggest that your testes are not working properly and that is untreatable unless a surgically correctable vascular abnormality is found.
FSH is very high and LH not so. In this situation you should be screened for testicular caners that typically secrete FSH. Alternatively, start TRT and LH/FSH should -->zero and then a lab later on that does not show FSH–>zero is a problem. The situation is vague because FSH levels are quite steady and LH is pulsatile with a short half-life. So the labs suggest that you need to know more but perhaps there is nothing wrong. Testicular cancer is a young man’s disease and not rare.
Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.
KSman is simply a regular member on this site. Nothing more other than highly active.
I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re Thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab numbers and ranges.
The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.
Would cold hands be an indicator of thyroid problems? I work as a railway shunter so i’m outside most of the time (day and night shifts) and never feel particularly cold but my hands are almost always cold, even at home.
Just be to clear, first thing I should do is start monitoring body temps? If body temps come back low, start supplementing iodine?
I definitely have a few of those symptoms. I’ll buy a thermometer and start monitoring temps. Thanks again @KSman, your time is much appreciated. I’ll be back when i’ve got some useful info for you!
@ksman here are my temps from the last few days. Is this enough to be diagnostic? If Iodine replenishment is required, how much per day do I need to be taking (I did read the sticky but could do with dosage clearing up)?
Wed Am 35.2c 95.4f
Wed Pm 35.7c 96.3f
Am 35.3c 95.5f
Thu Pm 35.6c 96.1f
Fri Am 35.4c 95.7f
Fri Pm 35.2c 95.4f
Am temps were taken as soon as I woke up at 0515. Pm temps were taken between 1400-1500.
Blood samples went in the post today for liver markers and 2nd lot of hormones, I should have the results back mid next week.
You really missed the target by not discussing your sources of iodine. You need to find and use iodized salt.
Large dose iodine without 200mg selenium per day creates risks of thyroid autoimmune disease triggered by inflammation caused by enzyme deficiency where the enzymes need selenium as part of the enzyme structure.
Find a high potency B-complex multi-vit with trace elements including 150mcg iodine and 150-200mcg selenium. This is your foundation.
In UK, dairy foods are considered the major source of iodine. Sea food can be to some extent. But most there will be suboptimal.
Who else in your home could be iodine deficient? Women need more iodine than men. Prenatal vitamins should have more iodine, but UK seems to have backward attitudes. Women store iodine in breast tissue with Darwinian implications. Iodine deficiency used to be considered the leading cause in metal retardation. Today insufficient iodine can lead to children having dulled intellectual capacity and behavioural problems.
In that case my iodine intake is probably pretty low. As far as dairy goes, I eat around 750g of fat free cottage cheese and 1000g of Greek yogurt a week. The rest of my diet consists of chicken or beef, potatoes, pasta and salad/vegetables.
My Mrs could well be iodine deficient too but her diet is fucking horrible, I doubt I could convince her to supplement with anything. Would being iodine deficient exasperate her depression?
I’ll try and find the right salt and a multi vit that meets the requirements above. I’ll also continue to monitor temps. I’ll report back with liver and hormone test results as I get them.
Labs say primary hypogonadism. While low thyroid function affects everything and the testes, this does not look like thyroid intervention could resolve.
LDL: What kinds and amounts of fats do you eat.
TRT could improve this.
E2 is low from low FT and low FT–>E2
Prolactin: Can be from a pituitary adinoma. Could be increased from recent orgasm, or hugging { babies | puppies | kittens} -avoid near labs. MRI to rule in or out.
Repeating:
High FSH:LH ratio can be suggestive of testicular cancer. When on TRT, test to see FSH–>0, if otherwise take action.
TSH way too high, doc thinks great!
fT4 is well above mid-range. fT3 is the only active thyroid hormone and not tested. Get fT3 tested! There is no receptor for T4, T4 is only a reservoir for fT4–>fT3.
There could be impaired T4–>T3 or FT is good, mid-range or a bit higher with rT3 blocking fT3. See the sticky re adrenal fatigue, stress etc.
Soak up selenium for 2 weeks before attempting IR. - very important.
