T Nation

28 - Free Test Very Low, Total Test Good


#1

I have struggled with many of the symptoms of low T for my entire adolescence and adult hood. Low libido, mental fatigue, anxiety, depression, etc. I was a very late bloomer, and a slow bloomer, which put my me in constant stress, feeling inferior to other boys growing up at times. I always felt my hormones were out of wack, but never got my blood work done for some reason. One thing that was ironic to me, was that I put on muscle pretty well, but tend to hold fat in my thighs, butt, and lower stomach area. For the past few years I had been focusing on my head, because my anxiety and depression had become the main focal point after I had felt my body had finally developed. Well I realized that I needed to get to the root of the problem which are my hormones.

So I got my blood work done and here are the results:

Total Test : 815
Free test : 8.6
LH : 3.4
FSH: 3.2
Prostate spec ag : 0.8
Estradiol: 20.9
TSH: 2.570

I got the pre trt blood test from lab corp. What stood out to me most was the testosterone levels. I felt encouraged that my total was actually high but the free test levels were an explanation for what I had been experiencing all this tie. Maybe I don’t need TRT I thought, I just need to lower my SHBG. So I got some supplements and herbs in the past week (stinging nettle, magnesium, zinc, boron, DIM). I have to say I have definitely noticed my libido increase which is good and probably the main goal of mine.


#2

In the future, please always include lab ranges.

Thyroid!

  • TSH should be closer to 1.0, TSH=2.57 is a big problem.
  • Thyroid lab ranges are stupid.
  • This problem may be caused by not using iodized salt and then iodine supplements are also required. If is very important to have selenium in your diet at that time as a selenium deficiency can lead to thyroid autoimmune disease.

Thyroid symptoms:

  • feeling cold easily or easier
  • sparse outer eyebrows
  • dry skin
  • thyroid looks/feels large
  • almost all of the same symptoms of low-T

Please eval your thyroid function via last paragraph in this post.

SHBG is most probably elevated, which reduces FT and inflates TT with non-bioavailable SHBG+T. So TT is overstating your T status.

SHBG is made in the liver and liver problems, perhaps some medications, can increase SHBG. Liver labs are needed. AST/ALT are basic.

With low FT, FT–>E2 will be low. Your E2 might have been lower but perhaps liver clearance of E2 is reduced.

Task list:

  1. Post info re iodized salt use and body temps and symptoms
  2. Get liver tested: SHBG, AST/ALT

Please read the stickies found here: About the T Replacement Category

  • 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.


#3

Thanks for pointing the thyroid out to me. I checked my blood work and I did have the AST and ALT tested and they came in at 22 and 23, respectively.

As far as symptoms go, I definitely don’t notice any bulging to my throat area. I do have dry skin, my outer eyebrows do feel a bit sparse, and I would say I typically do get cold pretty easily. I have also had issues with excessive perspiration in the past, although it has calmed in the past year or two. I used to constantly sweat on my upper lip.

I went to the store and got some kelp which is a natural source of iodine as I’m sure you already know. I read some reviews online of people lowering their TSH levels significantly with kelp so I figured I’d give it a try. I can say that since buying the kelp yesterday, I already notice my energy is up, and I have far less irritability/brain fog/ call it what you want. There are certain things I have been procrastinating in my life and this morning I got a few of them done. I’m going to credit the kelp for that.

I will have to get a thermometer and check my oral temperature per the thyroid basics sticky. Like I said these symptoms of low T have been going on for a while now. I definitely have irritability and anxiety and ultimately I just want to get back to feeling normal. I have noticed a big difference since supplementing with boron, magnesium, zinc, nettle, and DIM, but still not quite where I want to be.

Your answer was very helpful and I really appreciate it. Is it necessary to get SHBG tested? Is there any scenario where my SHBG is not extremely high considering my Total to Free test ratio?


#4

SHBG would answer some questions.

You are in USA and iodized salt and not iodized are sold side-by-side in similar packaging. What salt have you been using, please look at the package.

If you have truly been iodine deficient, it is extremely important to not have a selenium deficiency, so you need to supplement selenium, 200mcg suggested.

Total to Free test ratio?
Please provide these with lab ranges.


#5

To be honest, I have been eating out a lot in the past 2 years since living on my own. I rarely cook, so I’m eating the salt that other restaurants use. It is likely I am iodine deficient.

Total Test 815 (348 - 1197 ng/dl)
Free Test 8.6 (9.3 - 26.5 pg/ml)

My free to total test is roughly 1%

LH : 3.4. (mIU/mL 1.7 - 8.6)
FSH: 3.2 (mIU/mL 1.5 - 12.4)
Prostate spec ag : 0.8. (0.0 - 4.0)
Estradiol: 20.9 (pg/mL 8.0 - 35.0)
TSH: 2.570 (uIU/mL 0.450 - 4.500)


#6

As stated above:
High TT and low FT strongly suggests high SHBG.
So more non-bioavailable SHBG+T which inflates TT.
E2=20.9 does not explain high SHBG.

SHBG is made in the liver and liver problems, perhaps some medications, can increase SHBG. Liver labs are needed. AST/ALT are basic.

With low FT, FT–>E2 will be low. Your E2 might have been lower but perhaps liver clearance of E2 is reduced.

Any starvation diets?


#7

I have gotten into intermittent fasting over the last two years. Also, I ingest an herbal powder called kratom 2-3 times a day. I just read online that hyperthyroidism can be a cause of high SHBG. Maybe if I can lower my TSH my SHBG will lower? Interesting how it all may originate from the thyroid. Like I said though, the symptoms of low t for me have been going on for me since I was a teenager, so I suspect its not a result of recent habits, but I could be wrong.


#8

Some natural substances are harmful, more in some people that others as our enzymes that react with these things vary a lot. The pathways of harm could easily affect hormone systems just as many pharmaceuticals do. Anything the plays with adrenal receptors as a stimulant or plays with opiate receptors is dangerous to hormone systems as well as dopamine and other neural transmitter systems.

Nice to see you reading and trying to tease out what this things may mean to you.


#9

Thanks,

These symptoms I’m feeling occurred long before I started with kratom. I also smoke marijuana daily but have stopped for months at a time and didn’t feel much different as far as libido goes.

When I was a young teen (15-16) I was concerned about my development and believed I suffered from hypogonadism. I was embarrassed to tell my parents and never addressed the issue. Around age 17 I finally got hair under my arms, started working out and putting on mass, but my body was still undeveloped. Now at age 28, I cannot say there are really any physical traits of me having hypogonadism, but the symptoms of low T are still there, and my free T came in extremely low. I’ve honestly had a very depressing life because of this and I just want to have a healthy sex life. As I mentioned I’ve been taking supplements and feel a noticeable difference, but I still don’t feel like I am quite where I want to be.

I plan to give the supplements a little more time and go in for another blood test. If I am not where I feel I want to be, do you think I would be a good candidate for TRT? Or should my main focus be on lowering TSH and SHBG?