T Nation

First Bloodwork, Low Total T. Didn't Check FSH, LH and DHT

Hi Guys,

Great forum, lots of good information.


I’m 48 years old in decent shape, good diet, don’t smoke, don’t drink too much, lift weights and exercise regularly.
In my twenty’s I cycled steroids on and off for about three years, I never had any adverse side effect at the time and my testicles never shrunk.
When I decided to stop I continued to train naturally and have remained natural for over twenty years.
I had no problem starting a family and have no intentions of having any more children.
All was fine until about two years ago when I noticed my self-getting extremely exhausted from what should have been relatively easy workouts.
I wasn’t recovering from training as I use to and injuries were becoming commonplace. I now have chronic lower back and shoulder pain.
Physio helped a little and I’m off the anti-inflammatory drugs for now. I was becoming more and more depressed and I realized I had pretty much all the symptoms for low testosterone.
So I finally made an appointment with a urologist. He assessed me and ordered blood work.

WBC 5.37 10^9/1 3.5 – 11
RBC 5.1 10^12/L 4.5 – 5.9
Haemoglobin 14.8 g/dl 14 – 17.5
HCT/PCV 45% 41 – 53
MCV 90 fl 80 – 100
MCH 30 pq 27.5 – 34
RDW 12.5% 11.8 – 14.5
MCHC 32 g/dl 33 – 35

Platelet Count 230 10^9/IL 150 – 450
Neutrophils 44.7% 34 – 75
Lymphocytes 41.5% 12 - 50
Monocytes 11% 3 – 15
Eosinophils 2.7% < 5
Basophils 0.2% < 3

Vit-D25 22 ng/ml 30 – 100
DHEA-S 74 ug/dL 70 – 500
TSH 2.48 uIU/ml 0.3 – 4.2
FT4 11.27 pmol/L 7.86 – 15.96
PSA 0.35 ng/ml < 2
Test Free 55.4 pg/ml 30.3 - 183.2
Test Bio 145 ng/dL 40 - 250
Test Total 280 ng/dL 279 - 815
Prolactin 11.5 ng/ml 2.65 – 13.15
SHBG 24.5 nmol/L 13 – 89.5
E2 23 pg/ml 20 – 47

As you can see my Total Test is low as well as my DHEA-S and Vit-D25.


Testosterone undecanoate 4 ml 1000 mg 2nd shot in 6 weeks.
Vit D 50,000 iu weekly for 12 weeks.
DHEA 30mg a day for 12 weeks.

Unfortunately FSH, LH and DHT were not tested.
Without the FSH and LH levels is it still possible to know if I have primary or secondary hypogonadism or Is it even important to know?
The Doctor said my treatment would be the same either way.

Is there any point requesting FSH, LH and DHT levels in the next blood test?

No, you can’t get a proper diagnosis without these tests. Once you inject testosterone, LH and FSH will be suppressed and therefore not able to get a diagnosis unless you stopped TRT at a later date.

A lot of men feel unwell on Nebido which is probably do to metabolizing testosterone quickly and Nebido has slow acting long esters meaning it doesn’t release the testosterone quickly enough.

It could take several months to balance out on Nebido where it would only take 6 weeks on Sustanon or enanthate.

Is it worth stopping treatment to find out if it is primary or secondary hypogonadism and if I knew would the treatment be any different?

No, treatment would be the same, expect if primary, HCG would do little to stimulate the testicles or allow testicles to become full. Your TRT dosing would be no different than anyone else.

Thank you for your input systemlord.

My next round of bloodwork is at three months in, that should be enough time to tell if the Nebido is working for me or not.

What protocol base on my bloodwork do think would work best for me?

Nebido is tricky devil, almost impossible to dose correctly. It’s unpopular for a reason. I do know of a guy on Nebido 20mg daily with similar levels to you, but I doubt you would inject daily.