T Nation

Considering TRT, Seeking Labwork Opinions

Hey y’all, hoping to get some opinions on my lab work. I’m close to pulling the trigger on TRT, but I get the impression that I’m on the outer edge of needing it. I’m also puzzled by my thyroid numbers, I’m in range but my TSH is all over the place and my T3 seemed to be borderline when my TSH was good earlier this year.


24y/o, 6’3, 185lbs. Dx history of adult mild-moderate depression and pediatric/adult ADHD. Current symptoms in no particular order include low sex drive, hit-and-miss erections, fatigue (some remains even on ADHD stimulants), brain fog/poor memory, low motivation, aches/pains and slow physical recovery from exertion.

My sister has Hashimoto’s, so thyroid problems are a thing in my family.

July 2019 pre-TRT labs

LabCorp, fyi. Done through a telemedicine TRT clinic (yes, that one in Florida).

  • Total T: 379 ng/dL, range 264 - 916
  • Free T: 13.6 pg/mL, range 9.3 - 26.5
  • SHBG: 33.8 nmol/L, range 16.5 - 55.9
  • Estradiol (sensitive): 11.4 pg/mL, range 8.0 - 35.0
  • LH: 6.1 mIU/mL, range 1.7 - 8.6
  • IGF-1: 380 ng/mL, range 115 - 355 High
    • I was on biotin supplements a few days before the test, so this is probably interference.
  • TSH: 3.760 uIU/mL, range 0.45 - 4.5

April 2019 thyroid labs

LabCorp. Done through my GP.

  • TSH: 1.7 uIU/mL, range 0.45 - 4.5
  • T3: 143 ng/dL, range 71 - 180
  • T3 Free: 4.2 pg/mL, range 2.0 - 4.4
  • T4 8.6 ug/dL, range 4.5 - 12.0
  • T4 Direct Free 1.58 ng/dL, range 0.82 - 1.77
  • Hemoglobin A1c: 5.2%, range 4.8 - 5.6

October 2014 labs

LabCorp. Just some old labs I had laying around, for further context. No idea why the MD decided on T4 Free of all things to focus on.

  • Total T: 450 ng/dL, no range provided
  • TSH: 4.09 uIU/mL, range 0.45 - 4.5
  • T4 Direct Free: 1.32 ng/dL, range 0.93 - 1.6
  • Vitamin D 25-Hyd: 30.7 ng/mL, range 30 - 100

Your Total T levels are very low given your age, Free T is no good either, Dr. Abraham Morgentaler and expert at Harvard and TRT expert says men at or below Free T 15 pg/mL (6.8-26.5) are expected to show benefit on TRT. Your best testosterone panel isn’t even close to being acceptable.

Most doctors were taught a certain way in medical school, it has handicapped them from truly helping people, Free T4 is less useful and Free T3 shows how much thyroid hormone is making it into the cells. Testing Free T4 leaves more questions unanswered and you are basically guessing about thyroid status.

TSH bouncing around suggest a problem, unless supplementing iodine, the pituitary gland is hinting at a problem. T3 is (obsolete) more useful in diagnosing hyperthyroidism, Free T3 is best for diagnosing hypothyroidism.

LH is good and testosterone isn’t, testicles are not performing well. Thyroid increases metabolism, this includes metabolizing and absorbing minerals from eating food.

Thanks, appreciate the reply.

Any thoughts on me starting TRT now, doing another thyroid panel (perhaps adding rT3 and Hashimoto’s antibodies) at the end of the year once TRT is stabilized, and going from there?

You’ll know fairly soon if your thyroid is causing problems, you will not be able to dial-in your TRT protocol because no matter what protocol you’re on, if thyroid is causing problems you’ll never feel good for very long.

If you are having thyroid problems, then TRT will likely increase TSH and you’ll see it in lab testing.

No doubt TRT would be good for you. Both TT and E2 are very suboptimal.