T Nation

Advice on Blood Tests

TL:DR: I was on T, got good results, came off, got hormone levels balanced well naturally but now feeling symptoms and considering trying TRT again. Looking for advice on what blood tests to ask from the doc.

To cut a VERY long story short, around 4 years ago, despite leading a pretty healthy lifestyle I was suffering a lot of the symptoms of low T which included:

  • Low sex drive

  • Depression

  • Fatigue/Poor Sleep

I went to the doc and both my levels were low (9nmol/l). After an MRI of my pituitary, he put me on SERMS (clomiphene) which worked great for a while before my estrogen went sky high and I had to come off.

Eventually I ended up on a combination of Sustanon 250 (I’m in the UK), HCG and anastrazole and got my numbers up to the mid 20s.

Then I panicked.

I didn’t like the idea of being on a medication for the rest of my life and being in my late 20s and wanting a family some day I was worried about fertility - so I came off it all cold turkey.

Didn’t actually experience any bad repercussions or anything and after getting really strict about my sleep, workouts and diet I had my T tested a few years later, and I was at 19 nmnol/l

Fast-forward to now.

I have gradually noticed the symptoms of low T coming back into my life, particularly poor sleep, anxiety and low sex drive so I want to get my levels tested by the doc again to see what’s going on.

Being in the UK I can’t just request any tests I like, so I have to have a good reason for having each test done.

I’m going to ask for the following tests: Testosterone (total and free), E2 (estrogen), SHBG, TSH, FSH, LH, GH, Prolactin, ACTH (to see where the issue is exactly), Liver function (am I clearing E2 properly?), Cortisol (are levels too high and blocking T receptors?)

My question is this - Can you guys think of any more tests that might be useful to help me work out what’s going on?

The tests you laid out should be sufficient for your goal.

This post never got much traction, but for anyone who was interested, my tests came back and my results are actually pretty good I would say:

Cortisol: 362 nmol/L (140 - 620)
Oestradiol: 114 pmol/L (0 - 145)
FSH: 3.2 iu/L (1.4 - 18.1)
LH: 3.1 iu/L (1.5 - 9.3)
Total T: 23.1 nmol/L (8.0 - 23.2)
SHBG: 35.3 nmol/L (11.5 - 54.5)
Serum Albumin: 47 g/L (35 - 50)
Calc Free T: 0.466 nmol/L (0.174 - 0.729)

Can you see any reason for the other symptoms? Particularly the low sex drive, I feel like I have no motivation to do anything.

This says it all, you went on TRT and got good results, then got off and now symptoms have returned. If your hormones testing reveals good results, remember if hormones are only good on certain days and not consistently, then your average hormone levels is lower.

You are likely one of those men that require higher hormone levels as there are a percentage of men above the reference ranges naturally which are excluded from the reference ranges.

There are no tests for testosterone resistance, but known chemicals in the environment that block hormones action on target tissue.