28 Y/O Blood Results Advice

Pharma / TRT Testosterone Replacement
1

Back end of last year I got some bloods done to check out my hormones as I thought I was getting symptoms of low T. Got my first results in and thought wow I’ve low T , low free T and high SHBG for a young health guy but did some reading and found out I should of got the test done earlier not afternoon time.

Got things re-tested in the morning and T was looking good but my free T was still low end and SHBG high.
Also got another test done in the evening and my T levels had dived like 53% and free T was below range…

PSA was high as I had sex the night before hand so got that re-tested and looks fine. I do have sex with my girlfriend but have to force myself to as no drive on my end… we’ve only been going 6 months and she’s a sexy bit of stuff.

Could you guys give me your advice if I have any underlying issue here as things don’t seem normal to me but don’t want to hop onto TRT thinking I’ve an issue when I don’t?

Thanks

Temp:
27/02/18 - Morning 37.2 deg.C (98.6) Afternoon 36.6 deg.C (97.88)
28/02/18 - Morning 36.8 deg.C (98.24) Afternoon 37.1 deg.C (98.78)

Age: 28
Height: 6ft.
Waist: 33”
Weight: 88kg
Describe hair: Going thin on top, have decent facial hair but parts of it is thin, pubes for chest hair.
Fat: All my fat goes to my belly, seem to be lean everywhere else.
Health: Low sex drive, weak erections, mind fog.
Rx and OTC: Viagra, Cialis
Diet: Pretty good health diet… wholegrain rice, chicken, Weetabix, oats, egg whites, protein shakes, vitamins, D3, drink mainly water, started using iodised salt, fruit.
Training: Training roughly 3 times a week just now, lost motivation really.
Testes: No pain as such.
Morning wood: Don’t seem to have much morning wood now, haven’t had any in a while that I can remember.

Lab Results:-

28th Feb 2018, 0900

Hormones
FOLLICLE STIM. HORMONE 3.79 IU/L 1.50 - 12.40
LUTEINISING HORMONE 5.62 IU/L 1.70 - 8.60

Kidney Function
CREATININE 93 umol/L 66.00 - 112.00

4th Jan 2018, 1600

Testosterone 9.6 nmol/L 8.0 - 27.8
SHBG re-std. 35 nmol/L 10 - 70
Free Testosterone 181* pmol/L 200 – 600
Oestradiol 100mol/L (< 150)

Total Protein 69 g/L 60 - 82
Albumin 43 g/L 35 - 50
Alkaline Phosphatase 66 U/L 30 - 110
Total Bilirubin 7 μmol/L < 21
Gamma GT 10 U/L 5 - 50
AST 32 U/L 5 - 35
ALT 34 U/L 5 - 40
Globulin 26 g/L 23 - 39

2nd Jan 2018, 0930

Testosterone 20.4 nmol/L 8.0 - 27.8
SHBG re-std. 41 nmol/L 10 - 70
Free Testosterone 385 pmol/L 200 – 600
Oestradiol 104mol/L (< 150)

Total PSA 0.95 μg/L < 2.51

Total Protein 70 g/L 60 - 82
Albumin 44 g/L 35 - 50
Alkaline Phosphatase 66 U/L 30 - 110
Total Bilirubin 8 μmol/L < 21
Gamma GT 10 U/L 5 - 50
AST 30 U/L 5 - 35
ALT 40 U/L 5 - 40
Globulin 26 g/L 23 – 39

26th Nov 2017, 1200

Red Blood Cells
HAEMOGLOBIN (G/L) 158 g/L 130.00 -170.00
HCT 0.462 L/L 0.37 -0.50
RED CELL COUNT 5.23 x10^12/L 4.40 -5.80
MCV 88 fl 80.00 -99.00
MCH 30.1 pg 26.00 -33.50
MCHC (G/L) 341 g/L 300.00 -350.00
RDW 12.0 % 11.50 -15.00

Clotting Status
PLATELET COUNT
196 x10^9/L 150.00 -400.00
MPV 9.7 fl 7.00 -13.00

Liver Function
ALKALINE PHOSPHATASE 68 IU/L 40.00 -129.00
ALANINE TRANSFERASE 33 IU/L 10.00 -50.00
CK 127 IU/L 38.00 -204.00
GAMMA GT 14 IU/L 10.00 -71.00

Proteins
TOTAL PROTEIN 70.6 g/L 63.00 -83.00
ALBUMIN 42.9 g/L 34.00 -50.00
GLOBULIN 27.7 g/L 19.00 -35.00

Iron Status
FERRITIN 79.3 ug/L 30.00 -400.00

Cholesterol Status
TRIGLYCERIDES 2.19 mmol/L 0.00 -2.30
CHOLESTEROL 4.99 mmol/L 0.00 -4.99
HDL CHOLESTEROL 1.
1 mmol/L 0.90 -1.50
LDL CHOLESTEROL 2.89 mmol/L 0.00 -3.00
NON-HDL CHOLESTEROL 3.89 mmol/L 0.00 -3.89

Heart Disease Risk
HDL % OF TOTAL 22.04 % 20.00 -100.00

Thyroid Function
THYROID STIMULATING HORMONE 2.35 mIU/L 0.27 -4.20
FREE THYROXINE 17.9 pmol/L 12.00 -22.00
FREE T3 5.56 pmol/L 3.10 -6.80

Hormones
TESTOSTERONE 14.4 nmol/L 7.60 -31.40
FREE-TESTOSTERONE(CALCULATED)*0.254 nmol/L 0.30 -1.00
17-BETA OESTRADIOL 52.5 pmol/L 0.00 -191.99
SEX HORMONE BINDING GLOB 42 nmol/L 16.00 -55.00
PROLACTIN 247 mIU/L 86.00 -324.00

Prostate
PROSTATE SPECIFIC AG(TOTAL) *1.46 ug/L 0.00 -1.40

Edit: -

Take 160ug of Selenium per day which is in my multi-vitamins. (If this isn’t enough let me know)

2

Your test levels are really low for your age, your likely dipping below ranges some days as your highest score is 20 nmol/L which 576 ng/dL. Way low for your age group and your SHBG is above midrange affecting FT, go by FT calculated. Your E2 levels are also below ranges.

There’s no way in hell your getting TRT from state healthcare with your numbers, forget it. State healthcare is already underfunded and will only treat worse cases. You must go private or bust.

3

I’m already approved for private TRT and got these delivered but want more opinions if this is the right way to go… any idea why my SHBG is high and causing low FT?

4

SHBG isn’t overly high, your problem is low T. Once you start TRT SHBG will drop which will free up your free hormones.

5

Ok doctor prescribed sustanon 250 0.5ml E5D and anastrozle 0.5mg E5D with bloods 6 weeks to check levels. Will give this a go.

Is it normal for TT to plunge roughly 53% over the course of a day? I’ve read its usually 25%.

Thanks for advise!

6

Any more opinions of my situation?

@KSman
If you have time your opinion would be appreciated.

Thanks everyone!

7

I didn’t have a lot of time to dig into this, but I would repeat the 9am testing. The later tests don’t tell the most accurate picture. This study found that T levels declined in the afternoon by a significant margin in younger men. PURLs: It’s time to reconsider early-morning testosterone tests - PMC

I would try to get a diagnosis and try to figure out what is going on. Personally, if my testosterone was 20nmol/L naturally, I would have not been so quick to jump on TRT. The best I could get was less than half that. I would just hate to see you on TRT when it may not be necessary. If you decide to come off of TRT, you run the risk of not returning to level you’re currently at.

8

What would you recommend to get tested again at around 9am so i can get a clear picture?

Good read thanks, a bit worried my levels are 20% more than the average on there. Don’t know if this is something i should be worried about dipping below the ranges in the afternoon?

Getting any help through the NHS is pointless hence why i’m funding this myself and asking for advice.

9

I’m just some guy on the internet bud, only been reading and learning for about 5 months or so. I’m far from a professional, so I’m hoping more of the experienced members will chime in soon. Excelmale is a pretty active forum as well with knowledgeable people.

I would test after a good nights sleep of 7-8 hours minimum.

Total Testosterone
Free Testosterone
LH
FSH
DHT
DHEA-S
Estradiol (sensitive if even possible over there)
Chemistries, specifically liver
SHBG
Vit D
If you do another thryroid panel, I would test reverse T3 as well.

Your liver enzymes look borderline, not sure if that’s typical for some people or an indication of something. Liver problems can be associated with elevations in SHBG according to some light reading I’ve done. Any sleep problems? Sleep apnea a possibility at all? Ask your GF if you snore. Do you or have you taken any Rx or OTC medication that you haven’t already indicated? Any digestive problems? Do you get cold easily? Have you been checked for a varicocele?

10

No problem its appreciated.
All my previous tests have been on a good sleep and not close to any alcohol consumption if that matters.

Never noticed that about my liver, will do some reading into that! No sleeping problems, usually sleep fine… might wake up once or twice during night but fall back asleep easy. Usually get 8hrs sleep a day. No sleep apnea as far as i know, girlfriend says i randomly do a deep snore but its not consistent.

No prescription medicines, take supplements like multi-vit and D3. No digestive problems, don’t feel cold but sometimes body can be cold to touch? Like i could touch my girlfriend after being in same room for a while and go wow your warm…

Never had a varicocele but i did a sperm test this past week and i’ve good fertlity so would that mean i’m ok there?

11

I did some more light reading, there are plenty of studies out there thankfully. It sounds like you’re doing a lot of things right and nothing stands out as an absolute indication.

Sleep apnea is a possibility, does the random deep snore happen every night, or just here and there throughout the night? It could be evidence of an apnea event. A sleep study would be the only way to know for sure if you think it’s a possibility and worth exploring. It does not just affect obese people. My father used to snore terribly and started having all sorts of problems. After he was diagnosed with sleep apnea and got a CPAP machine he is doing much better. I know several people with the same story.

A semen analysis does not necessarily rule out a varicocele. There are studies linking varicoceles to low T, and the only way to know is to get your testicles examined. What was your sperm count? For what it’s worth I have been on TRT for 4-5 months now, and I had a semen analysis a couple of week ago and it came back at 0. I need to get on HCG and am fighting that battle right now, but if fertility is a concern it needs to be considered.

It seems like most hypogonadal males have maximum T levels of less than 300ng/dL, which you have demonstrated. Usually the diagnosis is for secondary(pituitary problem), or primary(testicular problem), but you have also demonstrated the ability to reach debatably normal levels of Testosterone with mid-range LH and low-normal FSH. You really need to run all of the necessary labs at the same time as you did not run Testosterone when you tested your LH/FSH. This to me, makes things confusing and I feel like other possibilities should be explored. The symptoms for sleep apnea, hypothyroid, varicocele, ect, medication side effects, ect. can overlap.

TRT is not a miracle, some have a hard time getting dialed and it all takes time with small changes every couple months after labs. There are a lot of ups and downs, especially initially when your HPTA axis crashes shortly after starting TRT. I felt worse than I ever did pre-TRT for a couple of months until I reached a steady state and made some adjustments based on labs. Even when dialed in, a lot of guys still rely on the use of Pde5 inhibitors for sex.

I’m 26, and can relate with the ED, brain fog, fatigue ect. It sucks when doctors are not willing to help, and you have to pay out of pocket to get proper testing done. The highest reading I got was 280ng/dL(9.7nmol/l), and I have a clear diagnosis of secondary hypogonadism because of a 3mm pituitary adenoma, and low-normal LH/FSH. I’m not trying to talk you out of TRT, but there are a lot of things to consider before starting something that is a life-long commitment.

12

After reading a few studies, i don’t think my borderline ranges are anything to worried about. Seems like it has to be 2-3 times the ranges to be mildly elevated!

The girlfriend says its happens maybe once or twice during the night that she notices. I don’t think i have sleep apnea and either does she but will keep this in mind!

It was greater than 20million/ml. I will have a varicocele done next time at docs. I do want to have children in the future but not right now and HCG is expensive private! Was thinking starting HCG when the time comes and if that doesn’t work i would come off TRT until it worked out.

I’ve emailed the people i usually get blood tests from for the below, if there is anything i missed let me know thanks.

Total Testosterone
Free Testosterone
LH
FSH
DHT
DHEA-S
Estradiol
SHBG
Albumin
Vitamin D
TSH
FT4
FT3
rT3
Liver function
Prolactin

I’ve already got Viagra and Cialis due to ED but hope TRT would solve that problem.
Your circumstances is a lot worse than mine and would jump straight onto TRT in your boots. Currently i’m thinking of giving TRT a shot for 3 months and if i don’t feel any different to the way i do now i would come off it.

Appreciate your time and help here!

13

Some temperatures below, seems to drop rather than go up during the day. (These are 3 different days in past week)

Morning - 98.96 / 98.24 / 98.24 °F
Afternoon - 97.88 / 98.78 / 97.52 °F

14

No, your supposed to use a regular thermometer, not a digital one. Results are rather useless.

15

Could you link to what a regular thermometer is so i could see about getting one of those?

What i’m using : -
Braun Age Precision Stick Digital Thermometer

16

It’s made of glass, not electronics. Those link are against forum rules.

17

Please post forum rule where this is not allowed. Website are fine. Just no personal emails and such.

18

Read up on accuracy of glass v digital and everywhere seems to say there isn’t much difference between the two?

Also reason why your seeing 2 decimal places is because i’m converting from C to F due to most people being American here… should maybe round it to one!