T Nation

Feeling Resigned. Normal TT, Very Low Free T and FSH (2 Years Later)

Original post for context and more symptoms detail: Very Low Free T (Otherwise Normal Labs) + Small Testes + Symptoms

I kinda feel resigned and have been living in a bit of a haze recently, trying to ignore my symptoms and focus on work. I’m 32 and I think subconsciously I’m avoiding relationships because of my issues.

You guys are awesome and I’m very thankful this forum exists.

The Free T figures shown below were provided by legit online blood panel companies, so I presume they’re accurate. If my Free T is indeed this low, it might explain my symptoms. Doctor is hesitant to refer me to endocrinologist - and wouldn’t even test for SHBG - because my total T is within normal range.

What I’d like opinions on is why I have low Free T despite normal TT. SHBG and albumin seem to be at the higher end of the ‘normal range’, but is this enough to explain it? Anything I can do to raise Free T? I’ve been taking boron capsules sporadically over the past few years but they don’t seem to have helped much.

Symptoms:

  • Poor erection quality for some time, diminished libido.
  • ‘Tight’ balls - aren’t your balls supposed to sag more as you get older? Not sure if it’s related, but my balls just don’t sag at all anymore. Also it sometimes feels like the tubes are twisted up
  • On a related note, I was diagnosed with testicular microlithiasis a couple of years ago. I should go back to the urologist to check on this; may be the cause of low FSH?
  • I have been constantly mildly dizzy recently, which I attribute to an ear problem but may be linked.
  • Fatigue/brain fog issues

Recent labs:
Total T: 19.7 nmol/L
SHBG: 43 nmol/L
Serum albumin: 48 g/L
Free T (calculated): 0.359 nmol/L (previously 0.228)
Free Androgen Index: 38.82
FSH: 1.6 IU/L
LH: 5 IU/L
TSH: 3.18 mIU/L
Oaestradiol: 94 pmol/L

Thanks again, any comments welcome

Total T doesn’t show the complete picture and is bound to SHBG therefore not bioavailable and your body can’t use any it, so your GP is fixating on Total T and is a mistake, free testosterone is the free hormone circulating in the blood responsible for muscle, libido and erectile strength. If free testosterone is on the bottom end, then you may very well experience low T symptoms.

There is a variability in the stickiness of SHBG from person to person, yours is grabbing on hardnose to your testosterone choking your free testosterone. You have all the classic symptoms of low T and you listed all of mine as well when I was diagnosed.

I am almost certain your GP doesn’t know anything about sex hormones, otherwise he would have sent you to see an endo who most likely is TRT ignorant himself as these types of doctors don’t specialize in TRT. There really is no doctor inside traditional medicine that specializes in TRT, it has exists outside of traditional medicine for decades in anti-aging and sports medicine. the type of treatment you pay for out of pocket.

A urologist isn’t any better of a choice, typically is you want proper care, you will be going private as the state healthcare is not trained or taught how to do TRT.

TSH is high, TSH >2.5 likely indicates a problem in the making. TSH increases when the pituitary gland detects low levels of Free T3 or high Reverse T3, if nothing is done to address elevated TSH, it will continue to increase as well as the symptoms of hypothyroidism. Most mainstream medicine will not be concerned of a TSH of 3.0, this is a mistake.

These TSH ranges are flawed and most experts agree ranges need to be narrowed to .5-2.5 as there are many in the population experiencing hypothyroid symptoms in the TSH ranges between >2.5-4.5.

Google “OPTIMAL VS NORMAL THYROID LEVELS FOR ALL LAB TESTS ALL AGES”.

A number of studies show a relationship between testicular microlithiasis and testicular cancer.

Please provide lab ranges.

Thanks very much for the time you took to respond systemlord.

Yea, as far as I’m aware Testosterone can get bound up by SHBG and to a lesser extent, albumin. My albumin is right at the top of the “normal” range and SHBG somewhat near the top (ranges below).

You’re right about the GP but I’m equally pessimistic about the endo. When I had bloods taken, they didn’t take SHBG because it’s “not normally helpful with testosterone in the middle of the range” (so SHBG is from online lab tests beforehand). GP told me he’d contact the endo but that they probably wouldn’t refer me because of my total T. I will fight harder for that appointment.

I’m really not keen to start TRT and see it as a last resort, if I can’t fix my problems any other way. I may be misguided, but isn’t TRT primarily to increase Total T? So if my T availability problem persists then perhaps it won’t help. I wonder if there are treatments available to reduce/reduce the effects of SHBG/albumin, thus increasing Free T and relieving symptoms?

I will google that after this post.

I should also note that my red/white blood cell counts are right at the bottom of the ranges, and that my GP noted I have “quite” low blood pressure. Not sure if relevant

Recent labs:
Total T: 19.7 nmol/L (range 9.9 - 27.8 nmol/L)
SHBG: 43 nmol/L (range 16 - 55 nmol/L)
Serum albumin: 48 g/L (35 - 50 g/L)
Free T (calculated): 0.359 nmol/L (previously 0.228) (0.3 - 1 nmol/L)
Free Androgen Index: 38.82
FSH: 1.6 IU/L (1.5 - 12.4 IU/L)
LH: 5 IU/L (1.7 - 8.6 IU/L)
TSH: 3.18 mIU/L (0.35 - 4.5 mIU/L)
Oaestradiol: 94 pmol/L (41 - 159 pmol/L)
Total white cell count 4.5 109/L (4 - 10 109/L)
Red blood cell count 4.85 1012/L (4.5 - 6 1012/L)

ps. If I do decide to go TRT, I’m happy to pay out of pocket and go private - I know a practitioner in the UK who is knowledgeable/understanding of these issues. I just need to decide whether there is anything else I can do to lift my levels, first

Your welcome,

Manipulating SHBG is difficult as the liver finds its own sweat spot, increasing Total T increases Free T and is the standard method of raising T in high SHBG men. While your SHBG isn’t officially high, I have seen higher SHBG level in men with more Free T than you as you present a Free T level of someone with higher SHBG.

Thyroid should also be more closely looked at, Free T3, Reverse T3 and antibodies is a good idea. A lot of people are walking around with hashimoto’s thyroiditis and don’t even know it until decades later when the thyroid gland is all but destroyed.

Balancemyhormone in Dorset is popular and reputable.