Unexpected Lab Results

Pharma / TRT Testosterone Replacement
1

I’m just a regular guy taking 50mg of sertraline and nothing else, check out these results:

Testosterone: 1995 ng/dL (0.320-1100)
Free Testosterone: 133.7 (35.0-155.0)
SHBG: 146 nmol/L (10-50)
Prolactin: 17.4 ng/ml (Not listed)
THS: 3.871 ilU.L (0.320-5.550)
Estradoil: 50pg/ml (Not listed)
DHEA: 217 us.dL (Not listed)
FSH: 7.4miU/ml (Not listed)
LH: 8.3mIU/ml (Not listed

I have zero sex drive and no indication of high T, gyno, tall, skinny, underweight, depression, high voice, extreme difficulty building muscle mass. I eat well, get plenty of sleep, low stress, good job.

Thanks in advance from a Noob.

2

Please include ranges, edit it in.

It’s going to be difficult to diagnose you without LH and FSH. We need these if we are going to understand what’s going on with you. I suspect that Zoloft could be raising your SHBG, never seen SHBG quite that high before. These medications can wreak havoc on our hormones.

Your TSH is awful, expect clueless doctors to not be concerned for the fact that you’re in ranges. TSH only testing tells me your doctor is clueless about proper thyroid testing. No Free T3, Free T4, Reverse T3 or antibodies. You have everything but thyroid hormones tested.

Your free T percentage is .885%, 2-3 percent is considered normal. Thyroid problems which you clearly have will prevent TRT from working. Do you consume iodized salt? Thyroid requires iodine and you may be deficient which might be why your TSH is so high.

Checking oral body temperatures using a glass thermometer is the best indication of thyroid status, check oral temperatures upon waking and 2 p.m. you should reach 97.7 upon waking and 98.6 at 2 p.m.

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3

Thank you so much!

I edited the ranges and FSHLH results, and I do I salt my food with iodized salt, quite a bit actually. There was nothing abnormal about my liver except for slightly low total protein.

4

Even without the ranges I can see no way there are low. I had zero sex drive on Zoloft and these meds are known to increase SHBG. Your solution is a simply one, stop Zoloft. Most SSRIs cause problems with guys hormones and cause hormone disruption in the form of low libido and erection troubles.

SSRIs cause problems in relationships, how can a guy not be depressed with erection/libido issues? If my GF started taking an SSRI and have low libido I wouldn’t stick around for very long.

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5

Judging from the way I feel on Zoloft this doesn’t surprise me at all.

What about my thyroid though? I’ll check my temps tomorrow but my gut tells me something is very wrong with my energy levels, exercise does nothing for me physically except exhaust me.

6

You don’t actually have thyroid labs, TSH is thyroid function and usually fails at gaining any insight into the thyroid, most doctor believe TSH only testing is enough. They have no idea how wrong that is.

You need to have Free T3, Reverse T3, Free T4 and antibodies tested. Don’t expect your doctor to agree with all these tests do to cost. For the fact your doctor only tested TSH, may not have any idea how to interpret labs tests, you’ll likely need a new doctor.

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7

Well you called that one, he said my Thyroid is “Well within range”

He did however order T3 and T4 testing. He referred me to an endocrinologist and ordered an HCG as well.

His main concern is the estradoil.

8

T4 will not tell the full story, free hormones have greater diagnostic value because it’s completes the process of conversion of bound to unbound hormones.

Hope the endo gets it right, GP’s don’t usually treat the thyroid.

9

T3F 2.79 2.3-4.2
T4F 1.40 .50 -2.50

Still waiting on Reverse

10

Are you doing Keto, or IF?

11

Ranges!

fT3 is the only active thyroid hormone. There is no receptor for T4, T4 is a reservoir for fT4–>fT3.

fT3 should be mid-range or a bit higher. Midrange is probably near 3.2

TT is high because high SHBG leads to high levels of non-bioavailable SHBG+T that inflates TT so that TT overstates your T status - while lowering FT. High E2 promotes SHBG, but that is probably not sole factor.

Try to get a prescription for 0.5mg anastrozole/Arimidex twice a week. Target is near E2=22pg/ml.

Thyroid lab ranges are stupid and doctor blindly bow down to the god of normal.

hCG test is looking for cancer.

Some prolactin ranges have high limit where you are. You may have problems originating in your pituitary.

Your problems seem to have started when? Sudden change or was building for years?

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

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 number 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.

12

Edited in ranges, no keto diet and I have an appointment with an endocrinologist in a few days. She is apparently most concerned about high estradoil.

13

First concern should be SHBG levels, then estrogen.

14

The SHBG is your #1 problem. I think that’s the highest I have ever seen it.

Can you stop the sertraline?

15

Yes, went off sertraline last week and tolerating it well, I wasn’t on very much but I could tell it effected my sexual function substantially.

So what should I tell my endocrinologist when or if she says:

  1. Sertaline is not effecting anything
  2. Your thyroid is fine
16

Antidepressant-Induced Sexual Dysfunction Associated with Low Serum Free Testosterone
By Alan Cohen

Do a search and read that, has some interesting stuff about free testosterone and SHBG.

Did you ever take finasteride or Accutane?

17

Was on Sertraline at the time these labs but have since gone off successfully so far.

My primary complaint is fatigue, exhaustion and lack of desire to do anything including fun including sex.

No Keto, IF, finasteride or Accutane

Testosterone: 1995 ng/dL (0.320-1100)
Free Testosterone: 133.7 (35.0-155.0)
SHBG: 146 nmol/L (10-50)
Prolactin: 17.4 ng/ml (Not listed)
THS: 3.871 ilU.L (0.320-5.550)
Estradoil: 50pg/ml (Not listed) BUT flagged as “High”
DHEA: 217 us.dL (Not listed)
FSH: 7.4miU/ml (Not listed)
LH: 8.3mIU/ml (Not listed)

T3F 2.79 (2.3-4.2)
T4F 1.40 (.50 -2.50)
T3, reverse 22 (8 - 25)

Testicular ultrasound negative, BetaHtcgtm negative,

HERE IS MY ENDOCRINOLOGIST’S FINDINGS She had nothing to say about my thyroid or sertaline being a problem

As we reviewed today:
->your total testosterone is elevated but this is because SHBG (sex hormone binding globulin) the carrier protein for testosterone is elevated (in fact the free testosterone is normal)
_ _
->other hormone testing is also normal with the exception of estradiol being slightly elevated = which is likely the culprit for the elevated SHBG testing
_ _
->in terms of the etiology for the slightly elevated estradiol=your testicular ultrasound and HCG testing is normal so this is not coming from the testicles per se. I recommend a CT scan of the adrenal glands to verify that there is no abnormality in the adrenal glands (which is another source of estradiol precursors so can potentially cause elevated estradiol). In the end if all the additional testing is normal, then by diagnosis of exclusion the elevated estradiol is coming from increased extraglandular aromatase activity. That said, for a few years I will recommend your primary care doctor continue to assess your hormone levels periodically
_ _
->unfortunately this doesn’t explain why you are felling unwell which is why you sought medical attention in the first place, I recommend some 8-9 am fasting blood work (additional testing to rule out contributing factors that could be implicated in your fatigue symptoms)
_ _
->I recommend you have a sleep study to rule out potential sleep apnea,

She ordered cortisol, Kidney function B12 and Vit D also ordered a CT of my adrenals and brainstem.

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18

Say goodbye. Anybody would be showing symptoms of hypothyroidism at those TSH levels, those ranges are dumb and outdated. We used to have TSH ranges up to 10.0, it seems it’s been going down more and more as we learn more about the thyroid.

People can experience hypothyroidism regardless of the TSH number, because TSH only shows that the thyroid is being stimulated, it doesn’t show actual thyroid hormones being produced by the thyroid.

Only uneducated stupid doctors test TSH only and often fail to run Free T3 which is the most important test. The reason why she had nothing to say about the thyroid is because TSH is in range, it eliminates any discussions that there’s anything wrong with the thyroid. Reverse T3 is your problem and possibly antibodies, but that discussion has already been dismissed.

Reverse T3 needs to be under 15, doctor will blindly follow the ranges. I find it amazing that an SHBG of 146 nmol/L was so easily ignored, all you have to do is notice its three times higher than normal. She’s not even trying to understand it, all she needs is a little research.

19

Agreed … Say goodbye to this doctor. She doesn’t understand the role SHBG plays … meaning she doesn’t understand your true Free T percentage (calculated).

My endo said the same thing; the more you read these boards, the more you see similar comments from Endos.

By the way, I’m a high shbg guy … my highest was 120 … so congratulations! You beat me. Joking of course, these high numbers are not what we want … and not to be proud of.

Stop seeing the endo. I ran a dozen tests for my endo … all worthless in the end.

20

What did you do to bring it down?