T Nation

Age 37, 423 TT, 3.5 FT. Why Is Free T So Low? Feedback?

Age 37, Height 5’11, weight 205, waist 34.5", ~15% BF

I have most all off the low T symptoms:
No morning wood, no sex drive,
tired, lack off motivation, lack of progress in the gym.

I am a disabled military veteran but would rather
not deal with the VA in this matter. I choose to test
for low T on my own and was very surprised by
just how low my Free T is. I want to know if this is
something to be concerned about and if I can do
anything about it.

My history: I used anabolics for 3 years ending 13 years ago. I did do pct but I figure I never fully recovered. Things have gotten worse with time. I am now being treated for PTSD/Bipolar I am on 600mg of Lithium and 300mg of Wellbutrin ED going on 1 1/2 years. My Lab results indicate primary hypogonadism high LH and FSH but low T.

My thyroid and kidney function are regularly monitored by my doctor due to my use of lithium carbonate.

Last TSH was 2.1 up from 0.9 when I started lithium. This test was taken when I was following a cyclic ketogenic diet, and may be elevated due to very low carb intake (30g day). My morning temp was 97.8, mid day 98.7
I use Iodized salt and have Lodoral on hand.

Any feedback is greatly appreciated,


Testosterone, Total, LC/MS 423.0 264.0-916.0 ng/dL

Free Testosterone(Direct) 3.5 LOW 8.7-25.1 pg/mL 0

LH 7.9 1.7-8.6 mIU/mL 01

FSH 8.0 1.5-12.4 mIU/mL 01

Estradiol 20.3 7.6-42.6 pg/mL 01
Roche ECLIA methodology

Full Labs


Lithium can cause hypothyroidism, Lithium induces a decrease in production of thyroxine (T4) from the thyroid gland. You just might be able to turn things around once you talk to your doctor about withdrawing or reducing the dosage of Lithium. I’m willing to bet if you had a full thyroid panel done you would have found out you are hypothyroidism, induced by Lithium.


Thank you for the reply. I will get a full thyroid panel done. I was planning on retesting my results before starting trt. I will also test for prolactin and SHBG. Is it possible that hypothyroidism could be causing extremely high SHBG and thus very low free T?

Absolutely hypothyroidism, diabetes, certain medications and basically unhealthy liver can cause high SHBG. I’ve never seen a borderline low-normal TT with FT so low compared to your TT. High SHBG can decrease FT, once you’re able to lower SHBG your FT might improve which I believe is caused by the lithium induced hypothyroidism.


Thanks for the feedback. In your link above it says hypothyroidism causes low SHBG. Using this calculator SHBG is 109 nmol/L normal range for men is 6-50 nmol/L. The only things I have heard that work to lower SHBG are taking testosterone injections or taking DHT base steroids (winstrol, masterone and proviron).
I am going to retest everything and if things are still very out of wack I will have to see a doctor. I do wonder if it is possible that the result was a lab error.
I do feel terrible but I have for a long time. My energy has been low since my early 20s and I have had depression most of that time. I do have a healthy lifestyle, I don’t drink, don’t smoke, exercise and eat a mostly healthy diet. I just want to feel better and having the free T of a 95 year old cant help

A large dose of T will decrease a lot of guys SHBG to levels lower than before they began TRT and if their SHBG is already low it will decrease it even further. That’s why a lot of guys feel no benefit from TRT no matter how often then inject per week. I believe your condition is unique because your lifestyle seems to be in order except the lithium is clearly interfering with all the positive lifestyle choices you’ve made that would otherwise make you feel healthy.

I’ve been on medications my whole life up until a year ago and these medications can cause your hormones to be out of whack, the entire time (30 years) on meds I always felt fatigued, low energy and sluggish. My levels were so low my doctor diagnosed every muscle in my body was atrophied, it seems like I have more energy all the time, muscles are still coming back from the dead though. TRT has done more for me in the first 5 months than all the medication I have ever taken.