T Nation

Finally! My "Thorough" Pre-TRT Lab Results. Plz Advise


Testosterone, total
216 (286 - 802) ng/dL

Testosterone, free
34.17 (34.51 - 107.78) pg/mL

Testosterone, bioavailable
138 (138 - 430) ng/dL

16.0 (14.5 - 48.4) nmol/L

E2 (Estrogen)
32.6 (7.6 - 43.0) pg/mL

4.0 (1.7 - 8.6) mIU/mL

3.5 (1.5 - 12.4) mIU/mL

16.7 (3.46 - 19.4) ng/mL

Cortisol (AM) (had sex a little less than 48 hours prior to testing)
8.30 (3.7 - 19.4) ug/dL

160.3 (150 - 350) ng/mL

Thyroid Panel
4.54 (0.27 - 4.20) uIU/mL

T3, free
3.6 (2.0 - 4.4) pg/mL

T4, free
1.24 (0.93 - 1.70) ng/dL

Lipid panel
216.1 mg/dL

Desirable: <200
Borderline: 200 - 239
High risk: >240

32.7 mg/dL

Low: <130
High: >60

139.5 (<130) mg/dL

27.90 (<40.0) mg/dL

Tg (Triglyceride)
219.5 (<200) mg/dL

HB (Hemoglobin)
12.5 (14 - 18) g/dL

45.1 (42 - 50) %

4.79 (4.5 - 6.2) x10*6/uL

5.60 (5.0 - 10.0) x10*3/uL

WBC & diff / Lymphocyte
40.6 (20 - 40) %

26.0 (27 - 31) pg

29.5 (32 - 36) g/dL

94.2 (80 - 95) fL

10.1 (2 - 20) %

Platelet count
250.0 (150 - 400) x10_3/uL

(up to 10) mm/hr

Clotting time
(2 - 6) mins

Bleeding time
(1 - 6) mins


Glucose (fasting)
98 (65 - 99) mg/dL

8.60 (8.40 - 10.2) mg/dL


82.0 (40 - 130) U/L

40.2 (Up to 41) U/L

24.9 (Up to 40) U/L

Bilirubin, total
0.80 (up to 1.1) mg/dL

Bilirubin, direct
0.20 (up to 0.25) mg/dL

Bilirubin, indirect
0.60 (0.1 - 0.75) mg/dL


Urea Nitrogen (BUN)
43.5 (<50) mg/dL

0.862 (<1.1) mg/dL


4.60 (3.60 - 5.5) mmol/L

141.0 (135.0 - 152.0) mmol/L

99.0 (98.0 - 110.0) mmol/L


4.40 (3.6 - 4.6) g/dL

Protein, total
7.30 (6.4 - 8.3) g/dL


Why I’m here:
Interested in starting TRT due to very low testosterone. Looking for advice.

Age: 33
Height: 6’5
Weight: 264 lb
Body fat: %27
Waist: 44"
Body temp before sleep: 96.98 F
Body temp after wake up: 96.98 F
Body temp mid afternoon: 98 F (this was taken right after climbing a flight of stairs)

Iodine intake:
I would say normal, but that’s solely based on how much iodized salt I eat. I put more salt on my food than the average person. Always been like that since I was a kid. My food can be too salty for most people.

All the salt I eat is iodized, been that way since childhood so definitely had had long term use of iodized salt. Never seen any other salt around here anyway. Restaurants and pretty much everyone around here uses iodized table salt.

And yes I know… The amount of iodine in iodized salt, is really only enough to tread water.

Body and facial hair:
Got a full on beard and mustache. If i shave now, 3 weeks later i would have a thick, combable beard and mustache.

Body hair I would say is “normal”. I got hair on legs and arms and chest but nothing major, just fair amount I guess.

Where I carry fat and how changed:
Hips, thighs, buttocks and then belly.
Got a gut, now that I’m out of the gym. Something I never had when I was working out and dieting. The hips, thighs and buttocks fat have always been there though, although to a much lesser degree when I was working out…which was most of my life prior to 4 years ago (more on that in a little bit).

I was never able to “lean out” in those areas even at single digit body fat. That was extremely frustrating. Whenever I tried to shed fat, I would reach skeleton proportions everywhere else but those areas would still be far from lean.

Health conditions, symptoms [history]:

Past 3 years…don’t drink. Don’t smoke.
Before that…smoked for 17 years. Drank for about 14 years or so but just during weekends and socially.

And yeah, no history of head trauma or whiplash as far as I recall.

Rx and OTC drugs, any hair loss drugs or prostate drugs ever:
Yes! Propecia about 4 years ago.

Quit a few weeks in due to feeling completely lifeless downstairs. Things got back to normal shortly after I quit.

Used to be 6 meals a day, well thought out, strict, daily diet plans for most of my life until about 4 years ago when I started eating like the average American.

About %60 of my food is now fried. Every meal has white carbs. Drinking fruit juice all day.

Past sample diet plan:

Above is something I strictly followed for at least 10 years. Switched macros up every couple of months or so.

Now, zero.
4 years ago…a well though out, strict weight lifting regiment for 17 years.

Bodybuilding was my passion so I made sure I did everything correctly. I knew the harms of over training so I was sure not to over trained.

Testes ache, ever, with a fever?:

How have morning wood and nocturnal erections changed?:
Well, they aren’t like when I was in my teens, that’s for sure.
I get them “sometimes” but can’t tell if it’s because I want to pee (which is always the case waking up) or if its a genuine “morning wood”. But they are definitely not like they used to be. Come to think of it, they are much less.

What got me to suspect low testosterone (before getting blood work done):

  • Difficulty / inability to gain muscle.
  • Easily gain fat.
  • Almost all gained fat goes straight to hips, buttocks and thighs.
  • Almost %100 of IMS symptoms.
  • Loss of libido
  • Jewels shrinkage

Since my TSH is high and FT3 is in mid-range but body temp is low, I’m guessing my rt3 might be high…correct me if I’m wrong.

A little history:
I started bodybuilding when i was 13. Seriously when I was 15. So as far as I can remember, I’d been bodybuilding my entire life.

For 15 years, I religiously followed a bodybuilding and nutrition regiment. I knew so much about the two, I honestly felt almost all trainers, bodybuilders and nutritionists were idiots. So in a way, I felt similar to how KSman feels about urologists and endocrinologist . And similarly still, even though it wasn’t my profession, bodybuilding and nutrition was my passion…although KSman uses the word hobby.

But unfortunately, no matter how much effort and dedication I put in…it never really paid off. People that barely knew anything about bodybuilding, almost zilch about nutrition and were half assing their workouts, were making gains in less than a year what took me 15 years. And I’m not talking about your genetic freaks. I’m talking about your average Joe.

With clothes on, ppl couldn’t even tell I worked out. What’s more frustrating was when I told people about that, they said “you must be doing something wrong” “you gotta change your diet” “change your training” “you have to hit your muscles slower, faster”…etc. And all I could think was “Really dude? You really think in 15 years I haven’t tried every single variable? You think the reason I haven’t packed on slabs of muscle is because I didn’t go slower on the weights or that I didn’t eat an extra spoon of peanut butter?”

About 12 years into bodybuilding natty, I decided to start cycling. Unfortunately, I never done blood work beforehand.

I made nice gains, nothing spectacular, just satisfactory. But for the first time in my life, people were coming at me with “wow!” while checking out my physique. The compliments meant that results weren’t bad at all.

Cycle ended. Ran PCT. Went back to my natty regiment.
Unfortunately, I lost most of the gains I’d made in about 6 months even though I tried all I could to maintain and add to the gains.

2 years after my first cycle, I started another one. 6 months after ending it, like the first time, I was left with nothing to brag about.

Typical stats off-cycle:
Weigh: 214
Body fat: %16

1st cycle:
Week 1 - 4: D bol 35mg ED
Week 1 - 12: Test E 500mg EW (250mg x 2)

PCT (1st cycle):
HCG @ 1000 IU ED for 10 days, 4 days after last pin of Test E, then…


2nd cycle:
Week 1-2: Anadrol @ 50mg ED
Week 3-4: Anadrol @ 100mg ED
Week 1-12: Deca @ 500mg EW
Week 1-15: Test C @ 600mg EW
Week 1-16: Eq @ 600mg EW

PCT (2nd cycle):
HCG @ 1000 IU ED for 10 days, 4 days after last pin of Test E, then…

Nolvadex: 20/20/20/10/10
Clomid: 50/50/50/25/25

Yes I realize I might have been a victim of broscience.

About a year after my 2nd cycle, I moved, started traveling a lot, hence I wasn’t able to maintain my bodybuilding and nutrition regiment. I stopped going to the gym. And since I wasn’t working out, I felt dieting and 6 healthy meals a day was useless. So for the first time in my life (well, sorta), I started eating junk food. Plan was to get back on track soon as I settled down.

Settling down didn’t come till 3 months later. But by then, I’d already broken my habit. I was too lazy and too demotivated to get back to my healthy lifestyle.

4 years later, today, I’m yet to get back to working out and eating healthy. I’ve been leading a pretty sedentary lifestyle and my diet consists of a lot of fried food and white carbs. Needless to say, 15 years of gains went down the drain. I now stand at the above stats. Used to hover at around %15-18 body fat.

So now I’m looking into TRT and getting back on track with training and nutrition. I’m hoping TRT will enable me to see gains that I should have seen at the gym a long time ago. As well as fix all the other issues in “what got me to suspect low testosterone”

As you can see from the lab results, my testosterone is too low. Cause is something I’m yet to determine. I’m hoping you guys can chime in. Judging by the difficulty in gaining muscle, I really think I’ve always had below average testosterone levels, but then I can’t be sure since I’d never done blood test until now.

Thank you for taking the time to read my post and for any point in the right direction!


OK, this is best opening post seen here:

  • very comprehensive
  • great grasp of interlocking variables
  • very well composed and structured

Are you a writer?

As you noted, TSH is very high. I agree that rT3 is a possibility to pursue.
Cold easily?
Outer eyebrows sparse?
I am wondering if above applies as a result of rT3
Have to consider adrenal fatigue and stress issues as well.
Labs for this issue:

  • rT3
  • DHEA-S
    We know that there is some adrenal problem as 10 is the lower limit for AM cortisol that allows for normal functioning.
    Your stress includes struggling along with low T and impaired thyroid function.
    Any history of starvation diets?

Also consider thyroid antibody panel.

If you did a SERM challenge and LH/FSH did not get decent, its a pituitary problem.
If LH/FSH gets good and T is poor, its the testes.
Combo is possible.
If LH/FSH and T are decent, see the HPTA restart thread for further guidance.

IGF-1 is low for your age. Might be influenced by T and thyroid function.

If you started TRT now, your low thyroid function and low cortisol might not support the metabolic demands of youthful T levels.

ALT seems high for someone not training.

Calcium seems low. Low T can also lead to bone weakening. You could get scanned.

HTC seems strong relative to T levels. Watch HTC carefully when starting TRT.

Prolactin is interesting, but probably does not warrant a MRI.
Any loss of width of peripheral vision?

You are very estrogen dominant. E2=32.6 with your low T is simply wrong. Some will blame body fat, but I also suspect reduced estrogen clearance. Take Ultimate Flora probiotic in case gut flora are recycling estrogen metabolites back to active forms.

SHBG is low VS E2.

HDL is usually shown as target, not < target.
See your

Attachment shows that HDL is low.
You have LDL data for HDL.

Total protein is oddly quite strong VS low T.

high potency B-complex multi-vits with trace elements and iodine+selenium
EFA’s: fish oil, flax seed oil/meal, nuts
5,000iu vit-D3, then test Vit-D25 later

Summary: Good need for TRT, but thyroid function and adrenals might not be ready. Could do TRT now, but be aware that you might have problems.

When do you think hormone levels started to slip?


Thank you for your input and compliment KSman.

Not a writer. I just write the way I like to read I guess.

Lets see…

-Cold easily?
Not at all. On the contrary. I’m noticing that I get hot pretty easily. I’m always fighting at the office with the thermostat. They turn it up, I turn it down…10 times a day. The temperature is comfortable to me when the average person has to wear a jacket. I noticed this is something recent. I was pretty normal before or at least I wasn’t like this

-Outer eyebrows sparse?
Not at all. I got thick well-formed eyebrows

Am I stressed?
That’s a tough one. Not sure what stress means. Physically or mentally? Situationally or just in general.

Worried? Not at all. I’m pretty laid back. So I guess I’m not stressed in that sense. But I get pissed pretty easily. It doesn’t take much to irritate me. It’s what got me to look into my test levels in the first place.
Does stress kick in when one is angry or irritated? If yes then I guess I am situationally stressed.

Any loss of width of peripheral vision?

SHBG is low VS E2.
Any ideas what that means?

What exactly is the above a remedy for?

Several questions here if you don’t mind:

  • What problems could I have if I started TRT now?

  • How exactly can I fix my thyroid / adrenals issue? What plan of attack do you suggest? Is there in fact an adrenals issue? Can we conclude that that’s the case solely based on low cortisol…or is the high THS, normal fT3 an indication of adrenals fatigue as well?

  • We know what the problem is (high THS, normal fT3 / Low cortisol / Low test / High E2…is there more?)…but what exactly is causing the problem of high TSH, low fT3? (Adrenal fatigue?) How to find out / make sure?

  • Where should I start?

When do you think hormone levels started to slip?
I think they’ve always been bad. They just got worse now that I stopped training and eating regular food.

I’ve always felt there was something off in regards to building muscle. Didn’t know that it could have been due to low test levels. Just wrote it off as bad genetics.

However, I really started to notice now that I am out of the gym and not dieting.

Thanks again KSman.


I normally don’t comment in this section, but I would like to urge you to see your primary-care physician about these labs (assuming you haven’t already), because several are concerning. I don’t mean to alarm you–by no means am I trying to imply you’re about to drop dead or something; I’m simply telling you these lab values need to be reviewed with/by your physician. Also, when you see your physician, it’s important to be upfront and honest about your history of PED use. Best of luck.


I recommended supplements that support vitality and HDL.

Higher E2 typically increase SHBG levels. Your pattern seems odd with SHBG low relative to E2.

Low body temps would point to rT3 blocking your adequate rT3. Stress can weaken adrenals and increase rT3. TSH is really a problem. So thyroid function is am important consideration. You could look at the thyroid basics link/sticky for more info. With low body temps and feeling warm when others are cold is another abnormality. In that sticky, find references to rT3, Wilson’s book, rT3, stress.

I think that you should go for TRT, if you do not seen anything in the HPTA restart thread that appeals to you. But TRT can be a problem if thyroid function and adrenals can take the load.


Could the issue with my thyroid be due to high E2 since TBG binds to E2 hence there not being enough T3 since its transport is being held…or is it that E2 increases TGB?


You really need to be concerned with free thyroid hormones.

Found this at Wikipedia: “since TBG production can be modified by other factors such as estrogen levels, corticosteroid levels, or liver failure. If, for example, the TBG level is high, which can occur when estrogen levels are high, the TBG will bind more thyroid hormone, decreasing the free hormone
available in the blood, which leads to stimulation of TSH, and the production of more thyroid hormone”

In any case, we see above mid-range fT3. This can be indicating that your system is compensating for fT3 not been visible which could be from rT3. Body temperatures can resolve some of this. But to some degree rT3 can be overcome with higher hormone outputs. Thyroid is more complicated than male HPTA.

Your E2 is not ideal, but not really high enough that we should be focusing on secondary effects like TBG.