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Att KSman: Current Labs, Low T and Thyroid

Lately I’ve been feeling run down an exhausted. In addition to very irritable, very forgetful and hard time concentrating. So I went to my GP and got blood drawn. The following is the best I could get out of him;

E2 22
Total T 202 ref 160-684
Free T 3.2 ref 7.2-24
FSH 11.70 ref 1.27-19.26
LH 6 ref 1.24-8.62
TSH 5 ref .450-5.330
Total T3 88 ref 70-180
Free T4 .86 ref .60-1.77
LDL 87 (on Crestor)
HDL 43
Temps are roughly 96.8 in the morning and never get above 97.8 all day and night
These symptoms with similar labs have been going on for a few years and have gotten worse along with the worse symptoms.

I’ve done the IR protocol twice.
I supplement with CoQ10 and selenium.
I know all of these issues are interrelated just not sure if it’s the chicken or the egg causing the issues.
Thoughts and advice please? I feel terrible. Where do I start or go from here? Thanks

Your TSH is a problem, missing fT3, rT3 and antibodies. Doctors cut corners on thyroid labs often missing the big picture, if antibodies is high means immune systems is attacking the thyroid. GP’s often fail at anything hormone related, you need to request an endocrinologist. Most endocrinologists get hormones wrong, it is what it is. Be prepared.

TRT won’t do much of anything for you until you address your thyroid issues, TRT attempts to restore metabolic rates, a low function thyroid will hinder TRT. You are hypothyroid and many with hypothyroidism are prescribed SSRIs and labeled with depression and anxiety.

Your low body temps are connected to fT3 thyroid hormone, sometimes rT3 can block fT3 from entering your cells and make you hypothyroid. Good fT3 = 98.6 degrees at midday. If in the US you can order these labs yourself so your next doctor’s appointment can be more productive, rather than going to appointment, ordering labs and waiting for another appointment all while you suffer.

Your also missing SHBG results, SHBG scavenges sex hormones and regulates your free T. If elevated, SHBG can shrink your free T.

Is that E2 lab the LS/MS/MS method, if not then it’s a female E2 test and is invalid.

I thought you could calculate SHBG from Free and Total T?

The problem with this is the very short half life of free T, it’s released in short micro pulses throughout the day and results wouldn’t be accurate. It would show SHBG changing rapidly throughout the day.

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I’m not so sure immunoassay is invalid. Last time I had blood work I got both, IA was 21 and LC/MS/MS was 23. Next time I get labs, I’m going to get both again.

Wrong test, ELISA or immunoassay method is for non-pregnant females. This isn’t an opinion, it’s a fact. We see doctors get this wrong so often we almost expect it to be the wrong test for the fact that GP’s don’t specialise in hormones, they are likely unaware that there is even separate labs for men and women. When I see your god awful super duper low free T, it’s hard to imagine you would have normal E2 levels unless your liver is a complete mess.

Immunoassay is 100 percent invalid, it’s designed for a women’s biology. If you had both tests come close, it was an unlikely chance occurrence. We convert a small portion of our free T into estrogen, you don’t have much free T to convert.

You want more accurate free T, calculate SHBG and TT = free T.


If? Do you think I am lying? Why would I do that? Anyway, we’ll see if it is chance as I’m going to do it over again. I became interested in labs from reading this forum, and I’m just trying to figure this out. I’ve talked to a researcher (PhD) who uses both methods in her work. She said that unless the level doesn’t register with the IA (<15) it’s OK. I’m going to see if I can speak to a lab doctor that works for Quest regarding this.

I really don’t care what anyone does, I’ve been doing TRT for four years and E2 has been coming back in the 20-27 range with the IA test. I do well, so seeing that my doctor (all he does is this and he seems pretty damn good at it) is an idiot for ordering this test made me want to look into it further. My doctor is aware of the LC/MS test and just laughs when I talk to him about the “ultrasensitive” test. He says it is a waste of money. If patients come back <15 on the IA, he cuts the anastrozole dose to get them back over 20. He likes E2 in the 20-22 range but will let it go higher (probably not over 30) depending on how the patient feels.

Regardless, if anyone is interested, I’ll report my next lab results. I hope others will get both tests as well. I’d be interested to see what they find.

Hold on here, I was originally responding to the original poster and you came in here claiming that ELISA wasn’t invalid for which I informed you it was invalid.

Why don’t you do a little research before getting all bent out of shape. When I get home from work I’ll be glad to provide some links for you showing what I’m saying is a fact.

Some doctors feel insulted when the patient is more informed than they are, that’s why he is laughing when you mention the ultra sensitive test.

Ok Thanks. So basically in a nutshell I need to find a knowledgable HRT Dr who knows about the thyroid too. I’m thinking an endocrinologist might not be too good with addressing the low T.
Do you think the hypothyroidism is making me low on test, or is that an issue separately on its own?
If anyone knows a good endo or HRT Dr in Jersey let me know thanks. Or even someone that does online consults and can order labs and do everything online.

Hypothyroidism does not cause hypogonadism, they are two separate issues. Honestly a lot of endocrinologist get TRT horribly wrong, I’ve had to figure out my TRT protocol on my own as the past three endocrinologist have just been pretty much useless, all they’re good for is prescribing me testosterone cypionate.

It sounds like what you need is Defy Medical, an online service and your hundred percent guaranteed to get a hormone specialist that knows what the hell they’re doing. They treat thyroid, low testosterone and they even treat women’s hormones.

Otherwise you could spend the next couple of years go in the clueless doctor route and having to figure everything out on your own. If everyone found a knowledgeable doctor the first time this forum would be a very lonely place.


Hold on here, I was originally responding to the original poster and you came in here claiming that ELISA wasn’t invalid for which I informed you it was invalid.
Why don’t you do a little research before getting all bent out of shape. When I get home from work I’ll be glad to provide some links for you showing what I’m saying is a fact.
Some doctors feel insulted when the patient is more informed than they are, that’s why he is laughing when you mention the ultra sensitive test.

As I mentioned, I’m not sure IA is invalid. I understand your position. I am questioning it. Nothing personal.

I am doing research. I mentioned some of it. However, I would be very happy to read anything you have. Thank you for offering. Again, I am just trying to figure this out, which is why I had both tests ordered. When you say “if you had both tests come close” it implies you are at least entertaining he possibility I am lying. That’s fine, you do not know me, but I simply asked why you think I would do that. I’m not bent out of shape.

I don’t think my doctor is insulted at all. He told me he reads the internet discussion boards at times and he is familiar with this forum. He encourages me to do research and loves getting questions. He will order any test I want.

By the way, as you can see above, I was off on the numbers, 18 IA and 21 LC/MS, not 21 and 23.

Thanks again for your help.

I did the same. Eclia was 34 sensitive was 30.

From Lab Corp site
Adult Men. The use of a sensitive, LC/MS assay for serum E2 measurement in males is preferred over direct immunoassays because of its greater sensitivity and lesser interference by other steroids.28 In males, estradiol is present at low concentrations in blood, but it is extraordinarily high in semen.4 Estradiol plays an important role in epididymal function and sperm maturation and is essential for normal spermatogenesis and sperm motility.4

  1. Handelsman DJ, Newman JD, Jiménez M, McLachlan R, Sartorius G, Jones GR. Performance of direct estradiol immunoassays with human male serum samples. Clin Chem. 2014 Mar; 60(3):510-517. PubMed 24334824

Thanks for the advice guys. One last question. I notice you guys are debating the accuracy of different estrogen tests. I have no clue about the specifics or accuracy of either but I do have an important question relating to my estrogen result.

I noticed that on the edge of both ariolas I’ve developed very small tender lumps, one on each side maybe the size of a lentil pea. I would"ve guessed high estrogen but as you can see my results show otherwise.

I’m not sure what test they used but it was Lab Corp and there was a reference range below it for females and males.


Thanks, I downloaded the publication and as well as a couple of the citations.

Interesting your immunoassay was higher than the LC/MS, while mine was the other way around. Still fairly close though. Thanks.

I did read that as long as you use the same assay you can still track changes. But if you can get the sensitive that’s the assay preferred.

This the reason why the the LC/MS/MS test is used over the immunoassays, because the immunoassays gives inconsistent results as by now you are aware of. It was by pure chance your immunoassays came so close to your LC/MS/MS test do to the inaccuracies of the immunoassays test.

I read through the paper Charlie referenced. Your point is taken, and if it helps, reading posts here motivated me to look into this further. This is what I posted earlier after speaking with someone who uses both immunoassay and LC/MS/MS in her job:

“She uses both immunoassay and LC/MS in her work, and from the sound of it, daily. Overall, she was much higher on the immunoassay procedure. She said it was more reliable and repeatable. She said the LC/MS equipment was much more temper mental and more difficult to use, with the skill of the operator critical and results more likely to be impacted by user error.”

Regardless, I’m going to get both tests for a while. I’m interested to see if the results will be consistently close. I’m going to see if I can talk to a doctor with Quest. Some, like my doctor, really like to talk about what they do.

If you are still willing to provide the links you mentioned previously, I’d like to read them. Thanks again.

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Glad that you are using CoQ10 with crestor. One sign of a problem is a chronic low level cough if CoQ10 is low. Ubiquinol absorbs a lot better than ubiquinone.

What is total cholesterol? Should not be deeply low.

Primary hypogonadism. Perhaps your age is in another thread.

When FSH is a lot higher than LH there can be concern about a FSH secreting testicular cancer. When you get on TRT, if FSH does not -->~zero that is a red flag.

Low body temps and low T3 seem to fit each other. You probably need thyroid meds and better labs including fT3, rT3 and thyroid immune markers.

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.