T Nation

42 Y/O Male. Test Results and Doc Appt Next Week. Advice?


I have the following symptoms.

  • Tired all the damn time
  • No what I call “GO!” factor for anything
  • Weight Gain around midsection (6’6’’ 230 in USMC, 330 now)
  • Sex Drive is ok but Dick is seldom always cooperative. The opinion of ok maybe an excuse for a not always cooperative Dick. Practice safe sex always, last three years sex with condom almost impossible. Gen Prac gave me low dose V to help.
  • Never wake with morning wood
  • I am by no means “weak” which seems odd and delayed myself getting checked. But I have found or realize that I have adapted to longer rest days and low rep workouts. I call this the old man workout. I definitely cant handle “volume” workouts.
  • Depression? yes… I been telling myself don’t be a pussy and sometimes shake it off.
  • Sleep sucks
  • I have an unfamiliar sit on the couch IDGAF about anything, that I am not comfortable with and often fake or go through the motions to get out of it. But when I get somewhere where there are ladies around, I am immediately exhausted with the event of being out and want to go home.

Here are my test results. I value any opinions about them. I want to be somewhat prepared when I visit the Doc. Also, please provide any questions I should ask and what are typical responses of a Doc who knows WTF they are doing.

Thanks in advance for your help. I been putting this off because of the societal shaming of possibly being on Test, etc. I am 42. I figure I have maybe 30 years left, why suffer anymore.

Hemoglobin A1c 5.7

T4,Free(Direct) 1.21

Tsh 5.440 0.450-4.500 uIU/mL

Estradiol 15.7 7.6-42.6 pg/mL

Hematocrit 45.2 37.5-51.0 %

C-Reactive Protein, Quant 5.5 0.0-4.9 mg/L

Thyroid Peroxidase (Tpo) Ab <6 0-34

Comp. Metabolic Panel (14)

Test Low Normal High Reference Range Units
Alt (Sgpt) 26 0-44 IU/L
Ast (Sgot) 21 0-40 IU/L
Alkaline Phosphatase, S 89 39-117 IU/L
Bilirubin, Total 0.4 0.0-1.2 mg/dL
A/G Ratio 2.0 1.1-2.5
Globulin, Total 2.3 1.5-4.5 g/dL
Albumin, Serum 4.5 3.5-5.5 g/dL
Protein, Total, Serum 6.8 6.0-8.5 g/dL
Calcium, Serum 9.4 8.7-10.2 mg/dL
Carbon Dioxide, Total 22 18-29 mmol/L
Chloride, Serum 100 96-106 mmol/L
Potassium, Serum 4.5 3.5-5.2 mmol/L
Sodium, Serum 140 134-144 mmol/L
Bun/Creatinine Ratio 18 9-20
Egfr If Africn Am 79 >59 mL/min/1.73
Egfr If Nonafricn Am 69 >59 mL/min/1.73
Creatinine, Serum 1.28 0.76-1.27 mg/dL
Bun 23 6-24 mg/dL
Glucose, Serum 98 65-99 mg/dL

Lipid Panel

Test Low Normal High Reference Range Units
Cholesterol, Total 178 100-199 mg/dL
Triglycerides 143 0-149 mg/dL
Hdl Cholesterol 43 >39 mg/dL
Vldl Cholesterol Cal 29 5-40 mg/dL
Ldl Cholesterol Calc 106 0-99 mg/dL

Testosterone,Free And Total

Testosterone, Serum 315 348-1197 ng/dL

Free Testosterone(Direct) 11.2 6.8-21.5 pg/mL

Lh 4.1 1.7-8.6 mIU/mL
Fsh 3.3 1.5-12.4 mIU/mL

Prostate Specific Ag, Serum 2.4 0.0-4.0 ng/mL

Insulin-Like Growth Factor I 223 75-216 ng/mL
(Why is this high, can it be this way because everyone in my family is 6’2’’ or taller? I am 6’6’’ Do I have a natural “high.”

Reverse T3, Serum 21.8 9.2-24.1 ng/dL

Vitamin D, 25-Hydroxy 37.1 30.0-100.0 ng/mL

Homocyst(E)Ine, Plasma 7.7 0.0-15.0 umol/L

Thyroglobulin Antibody

Thyroglobulin Antibody <1.0 0.0-0.9

Triiodothyronine,Free,Serum 3.6 2.0-4.4 pg/mL

Sex Horm Binding Glob, Serum 32.6 16.5-55.9 nmol/L


I’m sure our resident expert KSMan will offer some advice, Hopefully you have read all the stickies for the TRT forum.

What jumps out at me is your TSH is WAY too high, should be closer to 1, and your Total Test is way too low, should be over 500 at least, preferably around 800.

You get those 2 things where they should be and you will feel a world of difference!

P.S. Dont let your Dr put you on TRT without a solid AI to prevent E2 increases. Also, ask to pin yourself so you can dose every 4 days or so.

Good luck


Thanks for the response. Looking forward to hearing from KSMan. I am reading as much as I can here and hope to hear from some experts here so I can have an intelligent conversation with the Doc. Ask the right questions and know what a good doc should be recommending with current treatments and methods.

Thoughts on Planning PCT

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

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc
  • thyroid basics

You have a major thyroid issue.
TSH should be closer to 1.0
T3, T4, fT3, fT4 should be mid-range or better
rT3 is too high and blocking fT3 to some extent - more later

Please eval overall thyroid function by checking oral body temps as per the thyroid basics sticky. fT3 regulates mitochondrial activity as part of the body’s temperature control loop, so the two are connected. In your case with fT3 above midrange, TSH is increased trying to overcome the problem. If you are exposed to bromines, that also makes things worse as bromines displace iodine in the body.

The best outcome would be that your thyroid function is low because you are iodine deficient from not using iodized salt. If using iodized salt, check the label. Sea salt and mineral salts do not have useful amounts of iodine.

rT3 can be elevated by different factors. See references to these terms in the thyroid basics sticky:
stress, ongoing life stress or major stress events
infections/inflamation acute or chronic
Note inflammatory marker C-Reactive Protein [CRP] is high.
IDNGAF attitude?
adrenal fatigue
cortisol and Wilson’s book
over training, which includes training when your body is compromised with things like you have now.

Low-T can make you flabby. Low thyroid can make you fatter and slower.

Mitochondrial make ATP, the universal currency of cellular energy. That all slows down if:

  • fT3 is low
  • fT3 is impeded by rT3
  • CoQ10 is low, which can be effect, for some, of a statin drug to lower cholesterol

Note that low-T can result from blows to the head - pituitary damage.

Please list medications, Rx and OTC.
Please list medical issues.
Problem is longer than 3 years?

Back to Thyroid: ?

  • history of [not] using iodized salt or vitamins listing iodine+selenium
  • feeling cold easier
  • outer eyebrows sparse
  • generalized hair thinning
  • brittle nails
  • thyroid enlarged, sore, asymmetrical, lumpy

What is your diet like?
How much food do you cook yourself?
Living alone?

Back to inflammation:
labs did not list white blood cells and other immune cell counts.
inflamed gums
aches and pains
digestive issues
cough, chronic cough
battle wounds
leg or foot cramps

There is nothing wrong with been on testosterone. There is something wrong with not dealing with these issues.

If you are expecting the VA to be helpful with these issues, you may not like the result.

More on rT3 and adrenal fatigue. You have too much fT4–>rT3. I doc puts you on T4 medication, more T4 means more T4–>rT3. See the sticky re T3 only medication. Most docs are going to screw this up. A desiccated thyroid product [T3+T4] is better but ignored by most doctors.


I use Armour Thyroid in case you’re interested. Its desiccated Porcine (Pig) thyroid gland. Insurance covers it too.


Stud: Was Armour offered up front or did you have to ask for it?


I had been on it from a awesome Dr who was also a bodybuilder. Back then there were manufacturing issues and it was very hard to get so I had to switch back to synthroid. When I moved to a new town and got a new Dr, I asked if she was willing to put me on it and she was. So far its been great. My wife tried it too but she didnt like the feeling.


Many docs are Rx’ing Nature Thyroid, similar to Armour.