What is the most important to look at? My total is low but my free is within normal ranges. Im a little confused on how to proceed. Does anyone have links to any articles that can shed some light for me? Thank you.
Free or biologically active are the important figures.
What were your figures?
Total was 240ng/dl
Free was 19.78pg/ml
One can always be suspicious with labs that do not make sense. With age, SHBG and TT CAN go up while FT goes down.
Lab ranges?
First labs or prior levels?
Symptoms?
Skin changes?
Muscle loss?
Other medical issues?
Your lab units are not the expected and unfamiliar SI units.
This was the first labs ive ever had done.
Symptoms have been ongoing for probably over a decade but progressively getting worse. Mostly relating to energy levels, mood and behaviour, almost negative libido, ED, obesity.
I have lost a significant amount of weight since these labs were taken so im hoping that the next labs will show at least a slight raise in test…if not then a drop in E would be great too. but im not sure it will be enough. Ive noticed little improvement since the weight loss.
should also add that im 30 years old but posted in here because you guys have a huge knowledge base.
This pic includes the ranges. I was overseas when i went to the doc to get checked for ED issues and the doc there ran the labs, so i guess thats why the units are different.
Free testosterone has a short half life. The labs may have caught a peak level after a pulse. T is released in pulses in response to LH which is also pulsatile. But still, this does not make much sense in light of the low TT.
Based on the TT number, plus your symptoms, you should be on TRT.
Depending on your age, you should have LH/FSH tested. If younger [30], pituitary damage needs to be considered as a cause. If LH/FSH are low, you might respond to hCG if you are younger and your testes are normal. A brain scan can check for obvious pituitary problems. Another sign of pituitary problems can be reduced peripheral vision or other visual field disturbances caused by pressure on the optic nerves resulting from a growth [adinoma].
Your symptoms, and in general, many of the symptoms of hypogonadism are also consistent with hypogonadism. Get tested for TSH, FT3, FT4. If you are hypo, transdermal testosterone [gels, creams] can be expected to not work and injections will be needed.
You need a fasting CBC [complete blood count] plus lipids [cholesterol] that should also include fasting glucose. You need to be checking for insulin resistance which is a possible outcome with hypogonadism and obesity.
Another measure of your pituitary output is the size and firmness of your testes and how they hang vs staying tight to the body. It is typically not easy to evaluate some of these changes over many years.
I asked about skin changes as these can be indicative of low thyroid levels. Some skin thinning and loss of elasticity can also occur with low T. Hair and nails can be affected. Low T levels can lead to loss of hair on the lower legs.
Behaviour changes: Short tempered, social withdrawl?
At your age, one also needs to consider pituitary damage from a blow to the head or whiplash.
Some Rx and OTC drugs can repress the HPTA. Meds need to be reviewed.
Problems can involve other hormones [E2, prolactin]. If there is any sign of gyno, these other hormones be HPTA repressive. These effects can be the result of Rx or OTC drugs. Liver stress [alcohol/disease] can also cause some of this.
Where are you located now [affects treatment options]? Your lab units and ranges suggest USA and your spelling says UK.
Thats great info. Thank you very much.
I will be speaking to my doc this week.
I dont think the size of my testes has changed but as you said, its hard to tell over the years. They dont hang as low as i think they should. The big problem is that i dont know how much of this is associated with my prior obesity. How much was it down to the high blood pressure as a result of the obesity etc. I have lost a lot of weight so im hoping it will be come more clear.
Skin changes. I havent noticed anything. I started losing my hair at a young age which seems an anomaly if i have low test. Skin and nails seem to be in good condition. Loss of hair on the lower legs? My upper legs are very hairy but the sides of my lower legs are very sparse and even bald in patches.
Short tempered, irritable, anxious, depressed, lack of motivation and ambition, lack of passion.
Im British but was tested in South Korea. My neighbour is a doctor and ive mentioned this to him and he told me that UK docs are very loathe to even talk about TRT let along prescribe injections. Ive raised the issue with my own doctor while discussing my high blood pressure andthe like but he brushed it aside. I will be more forceful with him this time
Endothelial [dys]function increases with low FT and decreases with increased FT. With higher FT, more of the LDL is scavenged from [within] the arterial walls by DHL and recycled back to the liver. TRT can reduce BP.
More FT also allows the muscles in the arterial walls to relax and accommodate each surge/pulse of blood. This change in muscle tone in the arteries reduces BP which then forces less LDL into the endothelial walls. Less BP is less stress on the heart and less back pressure in the lungs [congestive heart failure]. CHF also involves hear muscle weakness. Heart muscle has a very high numbers of T receptors. Heart muscle can be damaged from CoQ10 levels, which are repressed by statin drugs. Statin drugs can reduce numbers of heart attacks when cause of death is CHF.
You can increase HDL with B vitamins.
TRT can really lower LDL numbers while leaving HDL unchanged.
TRT is probably the most important thing that you can do to increase your life span + QOL.
You need to take action.