T Nation

37 y/o Low T. Initial Blood Test, Looking for Advice/Feedback

A little background. I’m 37 and around 18% bodyfat. I work out 4 days a week weight training. I eat pretty healthy throughout the week and keep track of my macros. I take creatine, multi vitamin, fish oil, claritin, and one prescription of buspar for general anxiety. Only started this about 1.5 months ago. Only real bad habit I have is drink about 6-8 beers a week. I get about 7 hours of sleep a night, getting up at 4:00 am to work out.

I’ve been trying to shed about 15 pounds and having trouble losing fat (and gaining muscle when in a calorie surplus). The past year or so I’ve had the blah’s, no motivation, hard to focus, low energy, increasing anxiety, brain fog. I have a desk job, but I’ve always had one and used to have tons of energy when I would get home. Went to the doctor to just get a physical and do some blood work to see if anything would stand out. Doctor didn’t notice anything, but I thought my test was low.

Checked online and found this place for my symptoms. Decided to get some more blood work based on Defy Medical. I’ve attached both my initial test from about 1.5 months ago and the other test from a week ago. I was hoping you guys could take a look and see if anything stands out. My 2nd test had my total test come in a little higher so not sure what to think about that. Any help would be appreciated. I have a phone call with Defy Medical later in the week.


You are in a tough position. You have lowish T but not truly low T. If you find a doc willing to put you on a good protocol and you’re willing to deal with a lifetime of injections, you might want to do it. But think long and hard before jumping in.

Yeah, I’m fine with lifetime injections if it will improve my quality of life and alleviate my symptoms. I just want to make sure that it isn’t something else before I jump in. I know there are people on this forum that can look at my blood work and tell if something else looks off so hoping they chime in. Thanks for the reply.

Why didn’t they test your FSH? Your LH is low but in the absence of FSH or repeated tests, that doesn’t mean much as it changes often. Nash pretty much nailed it. You are not low T. Many people seem to think it a cure all. You will feel good for awhile following the 3-6 week primer phase but it wears off. You just become the new you with more T. If you are having mental health issues, test typically won’t solve those. Remember as Nash said, its for life so you should be hesitant to start it. I would repeat with FSH to see if you are low and could possibly try an HPTA restart.

I’m really not sure why FSH wasn’t ordered. Looking back at the order from Defy it never mentioned that as part of the initial blood work needed.

You don’t think 320 and 400 test for a 37 y/o is low T?

Neither are ideal, you will do better in every respect if you were in the 800’s. Most of the diseases are associated below 440 ng/dL.

If you had high SHBG then yes. But your free T levels are also in range. Point being you are definitely on the low side but not clinically in either test. I would test for FSH and see if you can diagnose the cause before starting any regimen. If you start TRT then your FSH/LH will drop to 0 and you can’t test anymore to know the root cause.

TSH is too high and should be close to 1.0
Thyroid lab ranges are mostly useless.
TSH might be elevated from not using iodized salt.
Please check and post oral body temps to eval overall thyroid function as suggested later in this post.

Training on low energy from low thyroid function and low T is fueled with adrenalin and the adrenals can suffer and rT3 can elevate blocking some effects of the active thyroid hormone fT3. This falls into adrenal fatigue, stress etc. Look for these terms in the thyroid basics sticky. People need iodine and selenium for thyroid health.

Anxiety may be from low thyroid function, low T and adrenal fatigue.

See what in the stickies that you identify with.

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.

age - 37

-height - 6’0"

-waist - 33 inches

-weight - 200 lbs

-describe body and facial hair - average facial hair, can’t grow a full beard. Body hair is thin to average. Mainly hair in center of chest and around nipples.

-describe where you carry fat and how changed - Mainly around waist and thighs/butt

-health conditions, symptoms [history] - Consider myself pretty healthy. I weight train 3-4 days a week. Stay active on weekends, but have a desk job. Never really go to the doctor because I’ve been healthy. Started feeling down and tired last couple of years and seems to be getting worse. Lack of motivation to do anything. Have memory blanks and fogginess. Lost about 20 pounds last year, but it’s come back and I can’t seem to lose it like I did before. Unable to make strength/muscle gains. Libido gone down. Get muscle aches after lifting that take a couple days to subside. These symptoms have come on in the last year or two. Never had a head injury that I know of. Only testicle trauma was getting kicked in the balls in elementary school once. It was painful, but didn’t require any medical treatment.

-Rx and OTC drugs - did take topical rogaine about 15 years ago, but only very short term. Taking buspar now for 1.5 months, but never been on any other medication. OTC take creatine, fish oil, multi vitamin, claritin. Take a preworkout with caffeine along with 4-5 cups of coffee during the day and 1-2 diet drinks per day.

-lab results with ranges - attached

-describe diet - Track my macros and try to eat mainly unprocessed foods. Pretty much eat the same things week to week. Fruit/veggie smoothie in the morning with eggs (with iodized salt) and milk, protein bar, nuts, deli sandwich on whole wheat, chicken, low fat beef, protein shakes, avocado. I do drink beer. Probably 6-8 a week. We do use iodized salt at home, but my vitamin didn’t have what you recommended. I switched to a vitamin that has multiple pills and includes the amounts you recommended for iodine and selenium about 2 weeks ago. I’ve been trying to lose weight pretty much this entire year. I eat about 1,900 calories per day, but I’m a little more lenient on the weekends. This is about a 500 calorie reduction per day on my maintenance weight/calories.

-describe training - weight training about 45 min a day/ 3-4 days a week. No cardio

-testes ache, ever, with a fever? Nope

-how have morning wood and nocturnal erections changed - decreased a little. Still get both about everyday. Get about 7 hours of sleep during the week. Tired on the weekends and get a little more and usually an afternoon nap.

Body temp - this morning at waking up 97.4, middle of the morning 98.1, middle afternoon 98.3

Based on everything should I look at taking Clomid to do a restart? Should I go on T injections? I have no future plans to have children if that makes a difference. Or should I do something else before either one of those options? Thanks again for taking the time to provide your feedback.

Retest LH/FSH. Clomid is easier to deal with than the big 3 you’ll most likely need on TRT (HCG an AI), but clomid can make you feel bad (some guys feel good on it though).

Clomid/nolvadex usually step 1 in your case and TRT if that doesn’t produce desired results.

Anything to report from IR efforts?

Thyroid labs: - if body temps still low
fT3 - the only active thyroid hormone
rT3 - interferes with fT3

Note that IR does increase TSH and then TSH results are not actionable.

KSman, thanks for the follow up. I didn’t check my temp again after what I posted earlier. I’m still on the vita pack that includes the iodine and selenium.

I started TRT at the beginning of October and had my first follow up labs done this past Monday so about 9 weeks on. I’ve attached the labs and wanted to see what you guys thought of it. Since starting I do feel much better, especially with the brain fog and concentration. My energy levels are up most days, but I also feel some fatigue at times like before TRT. Much of the anxiety is also gone. It appears my total T is much better, but not quite at the top of the range. My free T on the other hand is much higher. Any thoughts or see anything that I should bring up with the doctor when I have my follow up phone call this week? I know you aren’t supposed to shoot for a number, but more how you feel. Like I said, I do feel better and hope as time goes on the positive aspects will continue.

One thing is I’ve kind of gone back and forth with subq and IM. I’ve tried subq with the test in my stomach, but it will always leave a bump so I’ve pretty much gone with outer thigh for the most part. It will sometimes leave a bump, but it doesn’t seem to bother me as much as the bump on my stomach.

Here is my protocol:
test cyp 50 mg MWF
HCG 300iu MWF
Anastrozole 0.15 mg Monday & Friday

i may be injecting soon. Do you inject the HCG right after? do you do it near where you injected the T? Thank you.

Yes, I inject at the same time. I’ve always injected the HCG in the stomach, but go back and forth with test in thigh and stomach.