Blood Test Results - What is Going On?

Hello all,

I’m looking for some thoughts on some recent blood tests as the numbers perplex me a bit. Seeing my endo in a couple weeks- numbers below…
Symptoms low energy, low(ish) libido, weight gain and difficulty in losing weight.

Started on nebido a few weeks ago

Total Testosterone : 20.2 nmol/L (10.0-35.0)
Sensitive Oestradiol : < 55 pmol/L * (55-150 pmol/L)
IGF1: 37 nmol/L (11-32)
A.C.T.H : 17.6 pmol/L (1.6 - 13.9 pmol/L)
Cortisol: 597 nmol/L (145-619)
Serum Prolactin : 220 mIU/L (45-375)
Thyroid Stimulating Hormone (TSH) : 3.61 mIU/L (0.50-4.00)
FSH: 2 IU/L (1-10)
LH: <1 IU/L (1-10)

Maybe low E2 combined with low LH, high ACTH? Not on any AIs… Any ideas?


Looks like thyroid and adrenal issues. The high ACTH means you have some form of adrenal fatigue. The 20nmol/l total test is also too low for many people to feel good

The low estrogen isn’t good, it could mean your Free T isn’t high enough, your Free T converts to other hormones which is where you get estrogen via aromatization. You might have high SHBG and if so you may need more androgens to compensate. If you can’t get E2 to increase on TRT in isolation, you may need to add HCG to your TRT protocol.

Your E2 is the the ranges where I’ve seen people get diagnosed with osteoporosis. You might also have some subclinical hypothyroidism going on if TSH has anything to say about it. I recommend checking Free T4, Free T3 and Reverse T3.

You might as well get Thyroglobulin Antibodies (TgAb) and Peroxidase (TPO) antibodies while you are at it.

Interesting. My TSH was 2.1 about 2 months ago prior to TRT so not sure why that would be. I haven’t seen much talk about ACTH here but definitely concerning it and cortisol are both high.

Before TRT my fT4 was 12.7 pmol/L (9-19)
Also prolactin jumped from 140 to 220
TSH 2.1 to 3.6

Although both of these could be explained as had to have the pre TRT bloods in the afternoon not morning.

I will try to get SHBG tested in the next lab

I expected as much because TRT restores higher metabolic rates which places greater demands on the thyroid gland and if already struggling TRT can take it a step further.

My TSH increased 0.6->1.01 on TRT.

This is totally normal. TRT can put greater stress on thyroid and adrenals. If they are ok most likely the values will come back to normal, otherwise and if you feel symptoms thyroid and adrenals will need to be optimized as well.

Also TRT increases prolactin for most people me included

Doing labs 2 weeks after starting TRT is pointless. It’ll take a month or more before your levels reach a steady state. Do labs after 6 weeks on a consistent protocol. If you’re levels are still the same then take more testosterone.

  • How much Testosterone is in each injection and how often are you injecting?

  • When did you start TRT exactly?

  • How long after your previous shot did you get the labs done?

Worrying about TSH is pointless this early. See how your body responds after months before messing with anything else.

Thanks for the replies.

First injection was 3 weeks prior to bloods. I actually elected to get additional bloods after 3 weeks just out of interest, but I get your point. I won’t be changing anything, it’s a standard 1000mg dose of test undecanoate, only the frequency will change if required under approval from endo (every 10-14 weeks). I have another lab after 6 weeks from injection.

The low E2 is worrying, as if systemlord is right and it’s high SHBG with low free T, there’s no easy way to fix that is there? I’m not in the US and things are much stricter here, so upping the dose or adding HCG if total T is normal is probably not gonna happen…

If I’m not mistaken it’s going to take longer than 6 weeks for Nebido to reach a steady state do to the longer half-life. It will likely take months.

You’re probably right.

Yet again, another absurd piece of reasoning from SystemFiction. Since when do we use E2 to predict free T?

Really, you should be banned. You paint this whole forum with your nonsense and newbs and lukers alike read it as fact from your high post count and consistent spamming of every thread.

Free T converts to estrogen, it’s not that hard to understand. I said low E2 “could” mean his Free T isn’t high enough, I see it often in men with very high SHBG, low Free T and low E2. I don’t understand why you are having a problem with it.

You know what they say, first impressions are very telling, it’s a predictor of future behavior. I’m talking about when someone joins T-Nation and uses their first post to repeatedly attack other members without offering any advice whatsoever to the thread creator.

If I remember correctly, it irritated other members as well. What I said is a real possibility and if anyone should be banned, it’s you.

Real quick: I literally have no idea how you have the nerve to say this to anyone. Watch yourself. Final warning.

Are you saying e2 gets aromatized by free t?

Is this correct? All the info I looked at said it comes from testosterone.

That’s exactly what I’m saying, Free T converts to E2 via aromatization. Naturally you get your estrogen from two sources, within the testicles and aromatization where on TRT in isolation you only get it from aromatization.

Free T → free testosterone, it’s the active portion, the Total T is inactive.

Can you entertain me and provide a resource that free t converts to e2?

Again all the pathways I see is that free t gets covered to dht or used directly in tissues.

The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men.

Still don’t see where it says e2 comes from free t. It looks like once testosterone becomes free t - FREE T does not convert to e2

Total T can’t convert to anything because it’s inactive, the only active portion of testosterone is Free T. You are not going to find it saying “Free T” converts to E2 because they assume you have done your homework have a grasp of the basics.

You act as if free testosterone isn’t testosterone, there is total testosterone and free testosterone in the body. When you inject testosterone, some of it gets bound to SHBG and some is active, but both are testosterone just in different forms. The free testosterone is the only one that interacts with tissue and is converted to E2 and DHT.