T Nation

35 Y/O Investigating TRT - Blood Results In


Had bloodwork at about 23 that showed low T, did not want to start TRT at that point as I had very few symptoms. 35 now and the low T symptoms are hitting me so had some new bloodwork done.

35 YO
180 lbs
VERY low bf
waist 31-32

normal body and facial hair
Full head of hair

Problems: fatigue, cuts heal very slow, trouble gaining muscle, starting to frequently get injured playing sports

I seem to be getting slight glucose intolerance (fasting glucose is still good due to diet/workouts), have been eating high protein, medium fat, low carb diet

here are my results:

LH 3.1 mIU/mL REF RANGE 1.7 - 8.6
TSH 3.750 uIU/mL REF RANGE .450-4.50
FT 6.2 pg/mL REF RANGE 8.7ng/dL - 25.1ng/dL (thus sub min.)
TT 529 ng/dL REF RANGE 264 ng/dL - 916 ng/dL
Estradiol sensitive 13 pg/mL REF RANGE 8 - 35
SHBG 82 nmol/L REF RANGE 16.5 - 55.9
PSA 0.4 ng/mL REF RANGE 0 - 4

fasting glucose- 91
BUN/Creatinine 27 REF RANGE 9 - 20
hematocrit 45.5 REF RANGE 37.5 - 51

Total Chol 151 mg/dL REF RANGE 100 - 199
Triglyc. 74 mg/dL REF RANGE 0 - 149
HDL 54 mg/dL REF RANGE >39
VLDL 15 mg/dL REF RANGE 5 - 40
LDL 82 mg/dL REF RANGE 0 - 99
T. chol/HDL ratio 2.8 REF RANGE 0 - 5

just took an afternoon temp, 97.7, according to sticky that doesn’t sound good, I will take more temps. Started used iodized salt/brazil nuts

Any input? TT looks okay I guess but SHBG and free T look horrible… I read somewhere on the internet that a low carb diet can raise SHBG, could that be part of the problem?

The TSH looks pretty bad as well… Although the reference range is still 0.45 - 4.50 there are a number of endocrinologists who have been lobbying to reduce the range from 0.45 - 3.0 - meaning anything over 3.0 would be considered hypothyroid.

Would be worth getting a repeat of that one along with Free T4, Free T3, Reverse T3, and both Thyroid antibody tests.

What are your main symptoms??

Low FT increases SHBG which is very high.
SHBG reduces FT by creating non-bioavailable SHBG+T
SHBG can also be increased by liver pathologies.

So you were not using any iodized salt.
Others in your household suffering from that too?

Why are you so lean?
Diet also taking cholesterol too low.

Larger dose iodine increases TSH making TSH lab results useless.


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.

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.

Thanks for the reply. I just looked up symptoms of hypothyroid, included was weight gain. I eat like a pig, when i go out to dinner i typically order 2 apps and 2 entrees (although i do workout and play alot of sports) but find it VERY hard to gain weight, fat or muscle. Part of that I’m sure is from eating low carb though.

But to your question, my symptoms are mood swings, depression, easily get injured playing sports, cuts take a long time to heal and lately even tiny cuts leave little scars that never used to. Libido is fine. The mood lows are brutal though.

The sensitive estrogen test, thats on the lower end surprisingly, I thought that would be higher.

Thanks for the reply, I was not using iodized salt at the time of this blood test. I just switched after reading the stickies. I am so lean because I started getting glucose intolerance and did not want it to turn into prediabetes, so I started a low carb diet. I play a lot of sports as well. I eat a ton of protein but have found it very difficult to gain significant weight on a low carb diet. I suspect low T is causing the glucose intolerance because I have always ate clean, worked out alot, and have no family history of diabetes.

EFAs, I eat salmon 2-3x per week and take a fish oil supplement.
Vit D3 - I am in Florida and am out in the sun all the time, probably too much. Perhaps I should take a D3 supplement as well?

I have a consult next week at a TRT clinic. But I wonder if TRT is even something that would help me. I suspect that my problems stem from my low free-T/high SHBG, not so much my total T. So lets say TRT brings my total T from 529 to around 800 (the top of the range, REF RANGE 264-916). With my free T being so low can I expect TRT to bring that to the top of the range as well? These blood tests seem very confusing, I’m having trouble searching through old threads trying to find someone with a similar blood test. It seems like usually people on TRT mostly had lowish total T and low free T and TRT brings them into the upper ranges of both.

Your case is very much not typical. The main issues are unexplained high SHBG, thyroid, injury/healing, low FT and expected SHBG+T inflating TT that overstates your T status.

As for injury and healing, this can be from your low-T, but IGF-1 should be tested to see if GH status is OK. Do not test GH directly. Also test AM cortisol and do labs at 8AM or 1 hour after waking up.

With thyroid issues and low-T, your levels of activity might be adrenalin driven which creates risk of adrenal fatigue and elevated rT3. We see that pattern quite often.

You leanness and activity is unexpected.

Your Vit-D3 and EFAs should be good.

Both FSH and LH should be tested.

Starvation diets and stress can increase SHBG. So what would your body think that starvation might be?

TRT with high T numbers would decrease SHBG and you do need higher E2 to be healthy.

There are many hormone clinics in your area. If outdoors a lot, transdermals would be a poor choice getting sweated off. And with thyroid issues you may not be able to absorb. Please read the first two suggested stickies to get familiar with injecting T.

Your input is appreciate, some great insight. Not sure on what my body would think the starvation might be, except perhaps that I eat low carbs (50-100 grams of carbs per day). I eat a ton of calories, loads of protein and a good amount of fats.

I looked up hypothyroidism and I certainly have some of the symptoms (irritability, depression, fatigue in the morning -although I have lots of energy once I’m up). Those all could be from lowish TT and VERY low FT though. There are a number of hypo symptoms I am not even close to experiencing, I do not get cold easy, in fact I turn the a/c down so low my wife starts complaining and puts on a sweater and long pants. I do not gain weight or fat easily, despite eating many more calories than I burn.
Hopefully I am a candidate for TRT, I have read that some doctors will not offer TRT for low FT, but really even my TT looks low-normal as well.

I forgot to mention, I did get LH tested:

3.1 mIU/mL ref range 1.7 - 8.6

I did not have FSH tested yet.

Should I continue with the iodized salt/brazil nuts or stop until I have had further thyroid bloodwork completed?

In regards to food only and not blood test.

If you aren’t eating enough carbs your body will selectively use protein as energy therefore your muscles will not be obtaining enough protein to grow, it will store the fat and use muscle/and or protein for energy due to low body fat. you must make sure that your body is getting plenty of calories to suffice the activities you do in the day.

BMR + Activity calories + Surplus of 500+ Calories to earn 1lb in weight per week which naturally would occur 1/4lb of muscle which wouldn’t give you a great amount of mass to notice change. over 12 weeks you may notice.

Find calculators to work out your daily allowance and make sure you stick to a 40/40/20 for a lean minimum fat growth.

I agree with shaunuk26 in regards to your not eating enough carbs. Since we are about the same dimentions ( I’m 6’2’’ was 185 lbs before TRT) and have similar symptoms and activities I will tell my story. 3 tears ago was doing crossfit 4 x week (outside in the Florida heat and humidity, lots of running/sweating ) plus lifting 2x week. 46 years old. Couldn’t gain weight, lifting the same weight over and over…no increase in strength. Definitely not drinking enough water and not taking any vitamins. Just felt depleted. Energy was good enough to workout in the morning and after eating lunch I was like a zombie for the rest of the day. I was eating healthy, watching carbs, BMI was around 12-13. Felt like crap. All the symptoms of low T with severe brain fog. Went to my Primary after deciding I can’t live like this anymore and was put on 100mg Test Cyp per week after T was low. Gained 10 lbs in two weeks without changing any eating or exercise habits. Did that for 2 years with bloodwork every 3 months, T was averaging mid range with increases in strength and mood. Looked better, felt better. Still dealing with brain fog though. Being that he was a general practitioner there were blood tests that were not done and estradiol was never monitored. Decided to go to a specialist and now I’m pretty much dialed in but with TRT there are alot of moving parts. This site has been a wealth of information for me and I have learned a lot in the last 6 months so keep reading (especially those stickies) and I will leave the blood work interpretation to KSMAN and the others. My advise to you would be to take B-Complex vitamins and D3 10,000iu per day at least. These are not expensive ( I like Life Extesion brand on Amazon 5000iu bottle) and will most likely give you an increase in energy. Being in the sun prob isn’t enough when you factor in hats, clothing and sunblock. And don’t be afraid of carbs,sounds like you are burning them off anyway.

Just started TRT, had a couple of beginner questions:

1- after I drew the testosterone from the vial I flicked the syringe to move the air bubbles to the top and slowly pushed until a drop or two of test come out. It looked like there was a TINY air bubble at the top (not in the actual syringe but in the plastic piece that is attached to the needle). I tried to get rid of it by pushing a few more drops of test out but I just ended up wasting a bunch and the tiny air bubble remained there. Is this normal?

2- I drew the testosterone with a large needle then switched to a smaller needle to inject. It was very quick and easy to draw the testosterone from the vial. I see lots of people comment about how it takes a long time to draw the test out. Is that because they are using a smaller needle?

3- When I drew the test from the vial there was about a decent sized air bubble which made it kind if difficult to get the dose right on. Any tips on this?

4- HCG, I forgot to draw the air out of the powder vial before putting the water in, did I ruin the HCG? I had 2 HCG bottles so I did it properly on the second vial and noticed the time I did it incorrectly it fizzed WAY more. Did I ruin one of my vials of HCG?

5- I put the water in both bottles then put them in the fridge and noticed each bottle says they are only good for 28 days, is that accurate?

Thanks for your help guys, I’m not off to a great start on this >:

  1. Yes that is normal.

  2. I’m using 23g needles for IM and its fairly easy. Many on here are using smaller guage for sub q which would take longer.

  3. Try this…if you are drawing 1ml out of the vial pull the syringe to the 2 ml mark and when the medication reaches the 1 ml mark stop. Pull needle out of vial and pull on syringe to get all medication out of the needle before switching to smaller needle.

4 and 5. Not sure about HCG reconstitution but you probably should have waited to mix the second one until the first one was gone.

I had a full thyroid panel done due to my pre TRT bloodwork showing a high TSH. Does anyone have any input? rT3 is a little high and T3 is a little below mid range, I don’t think this warrants medication though, or am I wrong? Luckily all the antibody tests look good.

free T4 1.34 ng/dL 0.82 - 1.77
TSH 3.54 uIU/mL 0.450 - 4.5
reverse T3 18.1 ng/dL 9.2 - 24.1
Thyroglobulin antibody <1 IU/mL 0.0 - 0.9
Thyroid Peroxidase (TPO) Ab 12 IU/mL 0 - 34
Triidothyronine, free, serum 3.0 pg/mL 2.0 - 4.4

In terms of hypo symptoms, skin on my body is a little dry (altho skin on my face quite oily since starting TRT), and my joints are a little sore. Energy is good and stay lean/muscular very easily. I don’t really gain much fat no matter what I eat, especially since starting TRT and pigging out lately lol. I’ve been monitoring temps everyday for the past few weeks. Morning temps are decent, hovering around 97.3, but afternoon temps don’t go up too much, usually around 97.8, never reaching 98.

My skin after starting TRT was very oily and and my fingernail were super shiny, it’s taken almost 6 months to stabilize and now my skin seems to be leveling out to where it’s most without being oily. Low T and thyroid problems can cause skin to be dry. My joints became sore after about 3 months and are still somewhat sore after 6 months, I spent over a year with low estrogen which is hell on joints. You are slightly iodine deficient, supplementing iodine should restore normal body temps.


I have been on TRT for about 6 months so far and it has been great. My TSH since being on TRT has dropped from 3.7 to 1.69 which is great (I am not taking an idione supplement or anything). My only concern is my estrogen, my latest blood test came in at:
Total T: range: 264-916 - result: 1241
free T: 8.7-25.1 - result 20.7
estradiol sensitive- 8-35 result 47.9

my doctor does prescribe arimidex to patients but doesn’t think I need it. I don;t think I have a ton of high e2 symptoms but I def have a fair bit of water retention (can tell by my face and ring finger).

Any input on my E2 lvls? I feel really good since starting TRT by the way, no complaints really.

(by the way my protocol is 70mg test 2x per week and HCG 40 units 2x per week)

What you describe sounds like high E2, you’re puffing out is a sign of high E2.

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