T Nation

28, Bloodwork, Low T. Looking at TRT But Want More Info

28 years old looking into TRT. I eat clean (mostly low carb) train 3 times a week with compound lifts at high weight and low reps (would more but don’t feel like I have the energy). What brought me to check my T levels in the first place was ED, low libido, fatigue, mental fog, feeling down etc. Obviously ED being the most distressing.

Bloodwork:

Total testosterone: 279.49 range = 250 - 835 ng/dl
FSH: 5.1 IU/L range = 1.5 - 12.4 IU/L
LH: 2.8 IU/L range = 1.7 - 8.6 IU/L
Free testosterone: 31.1 range = 15.6 - 146 pmol/L
TSH (ultra sensitive): 0.75 range = 0.27 - 4.20 mIU/L
T4 FREE: 20 range = 12 - 22 pmol/L
Hemaglobin: 161 range = 130 - 180 g/L
Hematocrit 0.48 range = 0.40 - 0.52 L/L

I live in Canada (Toronto) and asked to see an endo after these bloods. At this point my family doctor just wants to put me on viagra for the ED. What a great healthcare system… My doc tells me that I am “low but within range”. Did my own research and found out I was ‘in range’ for the normal T of an elderly man. Looking for a different doctor and into just doing this all for myself (willing to pay the money if necessary to fix things). From poking around on the site I know the above bloodwork isnt enough to justify going on TRT but wanted to get a sense from any of the more experienced folks out there what other bloodwork I should get before making a decision (guessing I will need to look further into my thyroid etc.).

Any help would be greatly appreciated!

You aren’t far off the mark, these levels are seeing in 80 year old men. We typically see men in here with symptoms of low testosterone when free testosterone is below mid-range.

TSH and Free T4 are nice to see, but Free T3 is more important as it’s the only free thyroid hormone. It speeds up every cell, every organ in your body and sets the metabolic rate and no testing.

My TSH is similar to yours and I have excellent free T3, but is ruined by high RT3 which blocks free T3 and TSH is normal. TSH is unreliable in some cases.

I think there are a few parameters you’d need to assess before going for TRT

  • how is stress management
  • how is sleep / schedule+patterns
  • how much time do you spend in front of screens, especially at night
  • Write down a typical day of eating on cronometer and share it if possible
  • how is cholesterol? Insulin? Dhea-S? Prolactin? I know how it goes in Canada and unfortunately I’m not aware of a way to get bloods as fantastically thorough as the “ultimate anti-aging” panels they got in the US via LabCorp. Socialized medicine galore. I’ll try to reach out to my GFs best friend in Toronto (she’s a dermatologist) and see what can be done through her but apparently Canada Health questions extensive*expensive scripts. WTH.

With FSH being normal and LH+T on the lower end of the range you may benefit immensely from Clomid and/or Torem and/or HCG, or Triptorelin.

Really appreciate these replies. I want to get this figured out soon because my symptoms suck (brain fog, inability to concentrate, low libido, ED). I think I’m willing to go on TRT but I want the full range of information.

@systemlord will attempt to do a private clinic blood or go to a walk-in to get Free T3 and RT3.

@tontongg

  • stress management is great I moved jobs 2 years ago and generally have little stress.
  • My problem is I feel tired all the time regardless, feels like I need 10-11 hours of sleep every night. I’ve had a problem with waking in the middle of the night and not getting back to sleep, tried not drinking anything before bed etc.
  • Took some screenshots of my day today on cronometer for diet (generally low carb, high fat/protein). I am currently using many different supplements (B12, D3, Magnesium, Zinc, Fermented Cod Liver Oil, Ashwagandha).

Cholesterol total: 3.77 <5.20 mmol/L
Triglycerides 0.97 <1.70 mmol/L
HDL - Cholesterol 2.00 > 1.00 mmol/L
LDL - Cholesterol 1.33 <3.5 mmol/L
Non-HDL-Cholesterol 1.77

Dont have Dhea-S and prolactin but need to find a way to get more bloods here in Canada. I’ve been looking at the typical methods from the US (defy medical, CHEKD) but I dont know if I can mimic any of that stuff in Toronto. Any help you folks can give me to point me in the right direction re a good private clinic to run the bloods I need to run would be massively appreciated.

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One thing is sure - your thyroid WANTS carbs. What you need is low and what you don’t need is high. Try to tweak that around (plenty of fruits, tubers, low grains, lean seafood, organ meat, game) so that all you need is ashwagandha which you can benefit from. Supplements should be close to none - some plants, D3, K2.

Also make sure you’re getting high sodium (and potassium, although the foods above address that) to cool down adrenals for a better, deeper sleep. Maybe grab some mk677. If your sleep is subpar quality your T won’t go up

While you are looking into labs, get CMP, IGF-1, SHBG, E2 and VitD as well.

is a high carb diet actually bad for test? i mean i have high shbg and low test i was planning on going for lower carbs. im at 400 daily

Define “carbs”. I don’t touch grains anymore and obviously nothing industrial. Give me a bagel, Ben&Jerry’s, muffins from your favorite bakery I’ll make food donation people happy.

I have fruit, more fruit, and tubers. Dextrose in fruit juice when I’m training. Your thyroid likes carbs, both glucose AND fructose and your hormones will improve with a better thyroid function. Don’t neglect protein either which is usually not a problem with lifters but careful with tryptophan

Ok I went to an anti-aging clinic in Toronto and got some updated labs below. A few things have come out of this whole process which I have outlined below but here are my new labs (more results are incoming over the break)

@systemlord @KSman @highpull @tontongg can you please take a look? :

E2: 84 <162 pmol/L
Progesterone: 1.2 <1.7 nmol/L
Total Testosterone: 554 242-831 ng/dl
Testosterone Free: 275 196-636 pmol/L
Testosterone Bioavailable: 6.4 3.6 - 11.2 nmol/L
SHBG: 59.2 10-70 nmol/L
Vitamin B12: 465 138-652 pmol/L
Ferritin: 115 22-275 ug/L

TSH: 0.97 0.32-4.00 mIU/L
Free T4: 16 9-19 pmol/L
Free T3: 4.1 2.6-5.8 pmol/L
PSA: 0.15 <4.0 ug/L

C Reactive Protein: 0.38 <1.0 mg/L
WBC: 4.7 4-11 x E9/L
RBC: 5.46 4.5-6 x E12/L
Hemoglobin: 173 135-175 g/L
Hematocrit: 0.4999 .400-.500 L/L
MCV: 91 80-100 fL
MCH: 31.7 27.5 - 33.0 pg
MCHC: 347 305-360 g/L
RDW: 11.7 11.5 - 14.5 %
Platelet count: 206 150-400 x E9/L

Neurophilis: 2.9 2.0-7.5 xE9/L
Lymphocytes: 1.2 1.0-3.5 xE9/L
Monocytes: 0.5 0.2-1.0 xE9/L
Eosinophils: 0.1 0.0-0.5 xE9/L
Basophils: 0.0 0.0-0.2 xE9/L
Immature Granulocytes: 0.0 0.0-0.1 xE9/L
Nucleated RBC: 0 /100 WBC

Glucose Fasting: 4.7 3.6-6.0 nmol/L
Hemoglobin A1C/Total Hemoglobin: 5 <6.0%
Sodium: 145 135-145 mmol/L
Potassium: 4.0 3.5-5.2 mmol/L
Chloride: 105 98-108 mmol/L
Creatinine: 94 67-117 umol/L
eGFR: 95 90-173 m2

Urate: 456 230-480 umol/L
Albumin: 48 35-52 g/L
Bilirubin Total: 8 <20 umol/L
Alkaline Phosphatase: 66 40-129 U/L
Alanine Aminotransferase: 28 <50 U/L

Triglyceride: 0.32 mmol/L no range
Cholesterol: 3.68 mmol/L no range
HDL Cholesterol: 2.10 mmol/L no range
Non HDL Cholesterol: 1.58 mmol/L <2.6 mmol/L
LDL Cholesterol: 1.43 <2.0 mmol/L
Cholesterol/HDL Cholesterol: 1.8 no measurement given, no range given
Albumin (Urine) <5 mg/L no range given
Creatinine (urine) 16.1 3.25-24.5 mmol/L

Vitamin D: results pending
DHT: results pending
RT3 results pending

I’ll post the pending results as soon as I have them. Hopefully still waiting on LH/FSH etc as well.

I’m really surprised by my increase in total testosterone. Both blood tests I have done so far showed me in the 270-350 ng/dl range at the high end. I have been lifting very heavy (for me) in squats/deadlifts/bench press lately to try to boost T naturally though. Right now I am taking a myriad of supplements all to try to boost my T so I think this is the highest it’ll get on a natural basis. I really don’t know what to make of it.

New doctors reaction: we went through my medical history today and because I did competitive boxing for a little bit he wants to rule out head trauma as the cause of my symptoms: loss of libido, ED, brain fog, difficulty sleeping, always feeling tired, lack of motivation.

They think my thyroid may be a bit low and will likely give me some kind of supplements for that. They are wanting to put me on testosterone injections but he has to finish his report first. I think I’d rather try hCG monotherapy first or do hCG in conjunction with the testosterone (terrified of testicular atrophy). Will let everyone know how things pan out.

Also worried I still don’t have a full picture because the blood tests ordered may not be as good as the ones I can get in the US. Will update this post as soon as I have the rest of the bloodwork.

Free testosterone is at the bottom end of the ranges, just barely above rock bottom. hCG monotherapy can be problematic as AI’s can’t effect E2 inside the testicles forcing you to retreat the dosage of HCG therefore lowering testosterone.

Add to that HCG stimulates only half of the testicles. Supplements will not increase testosterone, it’s a fantasy, false hope.

I think you are going to end up needing TRT, and at age 28, you will probably want to maintain fertility, and least at some point anyway.

Thank you guys for the quick replies. I’m not sure the tests they’ve used are good enough measures. Although, I’ve now registered low on free testosterone on two separate measures:

  1. 275 196-636 pmol/L
  2. 31.1 15.6 - 146 pmol/L

My total testosterone in the second test isnt horrific though (554 ng/dl). Maybe too high for SHBG to get some of that to free testosterone? Cant tell if the E2 test I’ve done is a good one (it wasnt the sensitive assay).

Kind of worried about my hematocrit being too high as well.

Still waiting on the doctor’s full report but we will see what they recommend. I’m willing to go on TRT at this point.

Likely correct.

The ECLIA test (aka immunoassay or IA) for E2 management is commonly used for those on TRT. It is not an incorrect test or a test for women, but simply one way to check estradiol levels. The other commonly utilized test is the LC/MS/MS method (aka liquid chromatography dual mass spectrometry, sensitive or ultrasensitive). It is the more expensive of the two. There are inherent advantages and disadvantages to each of these two methods. I have been fortunate to be able to speak with professionals who work with both methods. One is a PhD researcher for Pfizer and the other is a medical doctor at Quest. I’ll summarize their comments.

The ECLIA method is the more reliable of the two in terms of consistent results. The equipment is easier to operate thus accuracy is less reliant on the skill of the operator. If the same sample were to be tested twenty times, there would be very little, if any, difference in the results.

The ECLIA method is not as “sensitive” in that it will not pick up E2 levels below 15pg/mL. If your E2 level with this test is 1-14pg/mL, the reported result will be “<15”. Because of this, it is not recommended for menopausal women, men in whom very low levels of E2 are suspected, or children. In other words, if your levels are below 15pg/mL, and it is important to know if the level is 1 or 14pg/mL, you do not want this test. For us, this is likely moot, since if you are experiencing low E2 symptoms and your test comes back at <15, you have your answer. For a woman being treated with anti-estrogen therapy for breast cancer, it may be necessary to know if the E2 level is zero or fourteen because therapeutically, they want zero estrogen.

A disadvantage to IA testing is that it may pick up other steroid metabolites, which in men would be very low levels, but still could alter the result. Another potential disadvantage is that elevated levels of C-reactive protein (CRP) may elevate the result. CRP is elevated in serious infections, cancer, auto-immune diseases, like rheumatoid arthritis and other rheumatoid diseases, cardiovascular disease and morbid obesity. Even birth control pills could increase CRP. A normal CRP level is 0-5 to 10mg/L. In the referenced illnesses, CRP can go over 100, or even over 200mg/L. Unless battling one of these serious conditions, CRP interference is unlikely.

The LC/MS/MS method will pick up lower E2 levels and would be indicated in menopausal women and some men if very low E2 levels are suspected and it is desired to know exactly how low, children and the previously mentioned women on anti-estrogen therapy. It will not be influenced by elevated CRP levels or other steroid metabolites.

On the other side of the coin, the equipment is “temperamental” (as stated by the PhD who operates both) and results are more likely to be inconsistent. Because of this, researchers will often run the same sample multiple times.

It is not clear if FDA approval is significant, but this appears on Quest’s lab reports: This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics Nichols Institute San Juan Capistrano. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. This statement is on LabCorp’s results: This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration.

It is unlikely that any difference in the same sample run through both methods will be clinically significant. Estradiol must be evaluated, and it should be checked initially and ongoing after starting TRT. It obviously makes sense to use the same method throughout. Most important are previous history and symptoms related to low or high E2. Those are correlated with before and after lab results Any estradiol management should not be utilized without symptoms confirmed by lab results.

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IA%20LC%2028-27

Good move and good luck.

This is super helpful - thank you!

Obviously keep an eye on the RBC. The only thing that bothers me is your t4 to t3 conversion. Eager to know what the rT3 is in that context. Ideal TSH ideal t4 but t3 not quite up there. Although I’ve seen some discuss high t3 as being undesirable - I think rT3 tells a better story.

Here’s one of the best reads I have on hand regarding thyroid:

SHBG is pretty high and that causes your free T to be rather low. That said if you lower your SHBG your free T might stay the same because of negative feedbacks. Can’t quite say there is much hope here. I think that focusing on thyroid can be more important and bring better results. Glad that’s what your docs wanna go for. A healthy thyroid can lead to healthy hormones and that’s a much better way to approach things than just going for T.

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UPDATE: got the rest of my bloodwork and recommendations from the Dr.

Missing Bloodwork:

25-Hydroxy Vitamin D: 282 range 75 - 250 nmol/L
Reverse T3: 20 range 8 - 25 ng/dl
DHT: 38 range 16-79 ng/dl

Turns out I was over on D3 (too much in supplements). The protocol he is looking to put me on is HCG 500 IU twice weekly until I get to free testosterone of 400-900. Said nothing about thyroid and I’m not sure he’s right. Although I asked about estrogen increase on HCG use he said “I’ve never seen a problem with estrogen but we will monitor it”. Going to try it I think but we’ll see what happens. Any advice on thyroid now that I have my RT3 value?

@tontongg @highpull @systemlord @KSman

Interesting discussion on estrogen:

Your fT3 of 4.1 makes rT3 of 20, while higher than ideal, OK.

I was able to lower my Reverse T3 22.4->17 by changing what I eat and weight lifting in only 6 weeks. Before this change I hadn’t lifted weights in almost 20 years. Also when Reverse T3 was higher, so to was estrogen and through mood problems can equal stress that can raise Reverse T3.

Insulin resistance can increase Reverse T3 as well as many other things.

Glad to see your making some progress on getting recovered! I’m in Canada also and have not had much luck with getting all the required bloodwork I need to work with. Did you need to get a referral for an anti aging clinic in Toronto? Was the blood work covered? I love just south of Calgary and I’m sure I could find a similar clinic there if I don’t need a referral.
Thanx man, best of luck!

I don’t need a referral for anti-aging clinics, my healthcare network is unaware that I’m a patient at Defy Medical, aromasin prescription and privately ordered labs.