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39, Low Total T but Normal BioAvailable (Advice)

I’m looking for a little advice as I’m at a loss and think I’m getting the run-around through GP and Urologists. My biggest issues (regarding quality of life) is fatigue, anxiety, brain fog, and reduced libido. These symptoms have been dragging me down for years and I just recently got turned on to the possibility of it being Low T. The latest I heard (4th opinion) was “go in for depression since the Bioavailable T is normal and the Total T is normal too.” Any push on the placement within the ranges and what’s behind those ranges just puts up a wall in the conversation. I’m looking for some insight as to whether Low T is still worth pursuing or start looking at other possible causes for my symptoms. Thanks in advance for any insight.

Age: 39
Height: 6’2"
Waist: 34"
Weight: 166lbs
Body Hair: legs. thin on arms
Facial Hair: never shaved jawline. patchy mustache after 2 weeks.
Carry Fat: mainly midsection
Health conditions: typical low T symptoms (fatigue, libido, brain fog, weakness, anxiety), neurological disorder akin to light-MS.
Diet: consistent. morning (no-salt black beans + 3 eggs), lunch (12oz chicken breast + 1 cup rice), dinner (bag of steamed veggies + fish/beef/etc.). Often miss snacks.
Rx drugs: n/a
OTC drugs: Zinc (15mg), Vitamin D (3000ui)

  • had three sets of blood work done (~2 weeks apart). below represents latest and most comprehensive test. anything with ‘/’ shows progression through the tests. latest in bold*

Testosterone, BioAvailable 117 (72-235ng/dL)
Testosterone, Total 267/235/270 (240-950 ng/dL)
T4 Free 1.24 (0.76-1.70 ng/dL)
Luteinizing Horomone 2.4 (2-12 mIU/mL)
Estradiol Level 24 (6-44pg/mL)

Hemoglobin A1c 5.1 (4.2-5.6%)
TSH 1.5 (0.3-5.5 mIU/L)
Follicle Stimulating Hormone 2.7 (1.5-10.0 mIU/mL)

Cholesterol 137 (<200 mg/dL)
Triglycerides 95 (<150 mg/dL)
HDL 42 (>40 mg/dL)
LDL, Calculated 76 (<130 mg/dL)
Chol/HDL Ratio 3.3 (<4.5)

Iron Level 106 (33-150 ug/dL)
Iron Binding Capacity 253 (220-440 ug/dL)
% Iron Transferrin Sat. 42 (20-50%)
Prolactin 11 (3-23 ng/mL)
Transferrin 200 (168-348mg/dL)
Ferritin 295.7 (18-320 ng/mL)

Protein 7.0/7.3 (6-8.3 g/dL)
Sodium 142 (136-146 mmol/L)
Potassium 4.3 (3.5-5.0 mmol/L)
Chloride 106 (98-108 mmol/L)
CO2 27 (22-34 mmol/L)
Creatine 0.79 (0.7-1.3 mg/dL)
Glucose 94 (73-100 mg/dL)
Albumin 4.3/4.3 (3.5-4.9 g/dL)
AST 24/25 (8-30 IU/L)
ALT 25/31 (<=35 IU/L)
Alkaline Phosphatase 85/86 (30-116 IU/L)
Bilirubin, Direct 0.2 (0.0-0.3 mg/dL)
Bilirubin, Total 0.7/0.7 (0.2-1.2 mg/dL)

WBC 7.3 (4-10 K/uL)
HGB 14.7 (13.5-17.0 g/dL)
HCT 44.5 (40-50%)
PLT 243 (150-400 K/mL)
RBC 5.08 (4.4-5.7 M/uL)
MCV 87.6 (79-99 fl)
MCH 28.9 (27-32 pg)
MCHC 33.0 (32-35 g/dL)
RDW 12 (11.5-15.0 %)
MPV 11.1 (9.0-12.2 fl)

How long has this been going on?
Where are you located? Affects diagnostic and treatment options.

Are you avoiding salt and also not using iodized salt, making you iodine deficient? Please eval overall thyroid function via last paragraph in this post.

What healthy fats do you consume?
Fish oil or other essential fatty acids [EFAs]?

Please confirm LH=24
**LH=24 indicated major degree of primary hypogonadism. FSH is often a better indicator of LH status than LH itself as LH has a short half-life and is released in pulses. LH lab can catch a high, low or in between.

FSH=2.7 VS LH=24 does not make any sense. LH=2.4?

Primary hypogonadism cannot be fixed unless cause is a bilateral case of vascular abnormalities that can be surgically repaired.

Your diet is driving cholesterol way to low, ideal is 180. Cholesterol is the foundation for the whole steroid hormone cascade.

Avoid iron fortified foods or vitamins that list iron. Rice can be fortified with iron, and some B vitamins etc. Washing fortified foods looses a lot of the vitamins, but iron may stick to the rice. Cereals and flour can be fortified foods. Men are very good at hording iron and you are a good example.

You appear dehydrated for this blood work. For fasting blood work, remember to drink water.

As you are starting to understand, you need to know more than the doctors.

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.

Thank you for the great feedback!

How long has this been going on: There have been traces of these symptoms for the last 10+ years, but they have increased to the point of significantly interfering with daily life for ~2-3 years.

Location: Michigan, United States

Salt Intake: Didn’t realize it until you pointed it out, but I’ve been using non-iodized kosher salt for several years as my primary salt source (many home-cooked meals). Outside of that I try to limit salt to <3000mg/day.

Healthy Fats: I typically eat 2-3 avocados a week, 3-4 tbsp of extra virgin olive oil a day, 3 eggs a day. No fish oil supplements at this time.

LH: It should be 2.4. I missed the decimal. Sorry

Iron Intake: Is your recommendation just for fortified foods like cereals/rices/etc. or does it include other iron rich foods like red meat, seafood, …?

Update (5/8/17):
I recently took oral body temperatures and recorded: 97.0 (9am), 97.4 (1pm), 97.1 (5pm), and 96.9 (9pm). Temperatures were the average of three readings. Checking my medical records my temperatures have been around 97.5 for the past 4 years with my earliest record coming in at 98.3 (7 years ago). I purchased iodine supplements and will provide an update once that test runs its course.

Thanks again, this is a big help.

You must be getting selenium. A high potency B-complex multi-vit with trace elements including 150mcg iodine + 150-200mcg selenium is a good option. Should not list iron which most “male” targeted products would be. Males do not need added iron unless there is a GI bleed or some other pathology.

Note that serum iron levels are very changeable. You should not be making changes based on that alone.

Others in your home are also iodine deficient.

Avoiding iron fortified foods is good. Not asking you to avoid foods that you like!

Thyroid function has a large influence on fat gain or ability to loose fat.

In future, you can test TSH, fT3, fT4 [please not T3, T4]. Need direct fT3, fT4 labs. When taking larger amounts of iodine, TSH will be increased and that is expected, making TSH lab results of no value at that time.

Do read the finding a TRT doc sticky.

Thanks for the info and heads up regarding selenium. Just got my supply in and will start dosing with iodine tomorrow (+ few dietary changes). Thanks again and I’ll report back after the iodine process.