T Nation

Free T is Fine, but Total T is Low


#1

If my serum testosterone ranges from 250 to 420 (335 average) but my free testosterone is always around 70 to 100 (on a scale from 35 to 155), then should I consider TRT or not?

-age 39
-height 5�¢?? 10�¢??
-waist 35 (at belly button)
-weight 160
-describe body and facial hair �¢?? takes me like 5 days before I have to shave my face. No hair on my back. Lots of hair on my stomach arms and legs.
-describe where you carry fat and how changed - Midsection and back.
-health conditions, symptoms [history] - No sex drive, don�¢??t want to socialize or do anything. Tired. Brain fog.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever - No drugs.
-lab results with ranges:

Testosterone, Serum: 357 (normal range 348-1197)
Sometimes as high as 420, as low as 180. Average around 320.

Free testosterone: 97 (normal range 35-155). Has ranged from 40 to 110.

TSH: 1.021 (0.450 to 4.5)
FT3: 3.5 (2.3 - 4.2
AM Cortisol: 16.3 (3.1-22.4)
PM Cortisol: 9.2 (3.1-22.4)
Estradiol: 31 (0 to 53)
Dihydrotestosterone (DHT): 29 (no reference range provided)
Ferritin, Serum: 235: (22-322)
Vit D, 25-Hydroxy: 83 (32-100)
Copper: 97 (70-155)
Zinc: 107 (70-150)
Magnesium, RBC 6.2 (4.2-6.8)
I have much more.

-describe diet: 160g protein, 200g carbs, 30g fat. Mostly: 3 egg whites and oatmeal with a protein drink for breakfast, large turkey or grilled chicken sandwich for lunch, steak for dinner, or salmon, or chicken. Another protein drink. Once in a while some almond butter, avocados on the turkey sandwich, and whatnot for fat.

-describe training: Currently lifting weights about 4 to 5 days a week for about 30 minutes to 45 minutes each day, split in two. No cardio other than riding my mountain bike once a week.

-testes ache, ever, with a fever? �¢?? Yes. I have a vericocele that hurts. Urologist didn�¢??t recommend surgery. Neither did the family doctor.

-how have morning wood and nocturnal erections changed �¢?? Morning wood is random, maybe two or three times a week and it�¢??s always when I�¢??m asleep �¢?? goes away when I wake up.


Original whiny post:

I'm tired, taking naps every day, my stomach and ass are fat and arms are skinny, and I don't have any energy or drive. My doctor says it is all in my head because my free T is perfectly in the middle range. Is he right?

I can't gain muscle without gaining way too much fat and all the fat goes to my back and lower abdomen. For example using a caliper my stomach has 30mm of fat while my upper arm, chest, etc. has 5mm. The calipers won't even fit on the big giant fat roll on my lower back. Maybe TRT is not a shortcut to fat loss, but doesn't low T cause fat to migrate downwards? My estrogen levels are normal.

I'm pale and appear to be sick to others, everyone always asks if I'm tired, and my skin is very thin compared to how it used to be. Low T? My doctor says I just need to go outside more and sleep more. For fucks sake I sleep 10 hours a day.

I'm always exhausted and I have no sex drive and no ambition. I want to stay home and not go out. Always tired and groggy. I'm just depressed and lazy according to my doctor, because my free T is �???�??�?�¢�????�????perfectly fine".

So what is with Free T being normal and serum T low, and why is my SHBG so low (12 out of 10 �???�??�?�¢�????�???? 57)?

DHT is low (29)

My thyroid is normal (TSH 1, FT3 3.2, FT4 1.5, RT3 in range).
Blood chemistry all normal. Liver, cholesterol, etc. all fine.
Estrogens normal.

I work out 30 minutes a day, eating lean meats and drinking LeanBody �???�??�?�¢�????�???? getting 150g protein a day (I weigh just 160 at 25% body fat), otherwise I barely eat, I don't do any cardio because I will lose the small gains I have made. I'm always tired and have to take a nap at least once a day. As soon as I lay down I'm out and snoring within 5 seconds. My sleep at night is fine. When I don't exercise for the 30 minute a day I'm fine.

I could be wrong but it sounds like Low T to me. But the doc says ALL IS FINE BECAUSE FREE T is "PERFECT". Is he right?

Maybe it is all in my head and I just need to step up my workouts. But judging by the way I feel, I'd have an adrenal crisis. Which by the way, my AM and PM cortisol are always perfect.


#2

Probably not, please post labs with ranges:
My thyroid is normal (TSH 1, FT3 3.2, FT4 1.5, RT3 in range).

Have you always used iodized salt?

Get cold easily?
Dry skin?
Brittle nails?
Thirsty and pissing a lot?
You crave salt?
Drink sports beverages with bromated vege oil?

Please read these stickies:

  • advice for new guys
    – need more info about you
  • thyroid basics
    – check your body temperatures when you wake up and mid-afternoon
    – history of high stress events? - adrenals

These labs are useful:
LH/FSH
TT
FT
E2
Prolactin
CBC
Hematocrit [should be in CBC]
fasting cholesterol
fasting glucose
maybe A1C

Don’t pronounce your labs as normal of perfect, post labs in list form with ranges.


SHBG levels are decreased by androgens, administration of anabolic steroids,[19] polycystic ovary syndrome, hypothyroidism, obesity, Cushing’s syndrome, and acromegaly. Low SHBG levels increase the probability of Type 2 Diabetes.[20]

Your doctor has a point. We need to look at what else is making you feel like crap and maybe your low T is a symptom of something.

Please post cortisol labs

*** How old are you*** and when did this problem seem to start. Was that subsequent to an illness or accident?

Pulse and blood pressure too.

Are you or have you been exposed to fumes, chemicals, toxins?
List all medications, Rx and OTC.


#3

[quote]KSman wrote:
Probably not, please post labs with ranges:
My thyroid is normal (TSH 1, FT3 3.2, FT4 1.5, RT3 in range).

Have you always used iodized salt?

Get cold easily?
Dry skin?
Brittle nails?
Thirsty and pissing a lot?
You crave salt?
Drink sports beverages with bromated vege oil?

Please read these stickies:

  • advice for new guys
    – need more info about you
  • thyroid basics
    – check your body temperatures when you wake up and mid-afternoon
    – history of high stress events? - adrenals

These labs are useful:
LH/FSH
TT
FT
E2
Prolactin
CBC
Hematocrit [should be in CBC]
fasting cholesterol
fasting glucose
maybe A1C

Don’t pronounce your labs as normal of perfect, post labs in list form with ranges.


SHBG levels are decreased by androgens, administration of anabolic steroids,[19] polycystic ovary syndrome, hypothyroidism, obesity, Cushing’s syndrome, and acromegaly. Low SHBG levels increase the probability of Type 2 Diabetes.[20]

Your doctor has a point. We need to look at what else is making you feel like crap and maybe your low T is a symptom of something.

Please post cortisol labs

*** How old are you*** and when did this problem seem to start. Was that subsequent to an illness or accident?

Pulse and blood pressure too.

Are you or have you been exposed to fumes, chemicals, toxins?
List all medications, Rx and OTC.

[/quote]

Thanks for the reply. I just updated my original post with some of this info you requested.

TSH: 1.021 (0.450 to 4.5)
FT3: 3.5 (2.3 - 4.2
FT4: 1.5 (0.8 - 1.7)
RT3: 0.15 (0.11 - 0.32)

I have used iodized salt in the past but a few years ago I switched to non iodized salt. But I take a multi vitamin with 80mcg of iodine in it.

Get cold easily? Not really, but I get hot very easily. I cannot sweat as much as I used to.

Dry skin? Not really, also not too oily.

Brittle nails? No, they’re pretty good.

Thirsty and pissing a lot? No. Also my blood sugar is pretty good. 99 usually.

You crave salt? No, I sort of don’t like salt.

Drink sports beverages with bromated vege oil? No. I’m pretty much just drinking water, sometimes with a lemon and honestly I don’t go for sports drinks or sodas.

I will read the stickies some more.

Additional labs:

AM Cortisol: 16.3 (3.1-22.4)
PM Cortisol: 9.2 (3.1-22.4)
Estradiol: 31 (0 to 53)
Dihydrotestosterone (DHT): 29 (no reference range provided)
Ferritin, Serum: 235: (22-322)
Vit D, 25-Hydroxy: 83 (32-100)
Copper: 97 (70-155)
Zinc: 107 (70-150)
Magnesium, RBC 6.2 (4.2-6.8)

A1C: 5.2 (4.8-5.6)
LH: 5.2 (1.5-9.3)
FSH: 11.3 (1.4-18.1)
Androstenedione: 80 (57-265)
DHEA: 753 (146-850)
Pregnenolone: 34 (20-150)
IGF-1: 276 (115-307)
Renin: 1.85 (1.31-3.95)
Aldosterone: 13.4 (4-31)
ACTH: 27 (6-48)
Prolactin: 9.1 (2.1-17.1)

CBC:
WBC 5.4 (4-10.5)
RBC 4.8 (4.1-5.6)
Hemoglobin: 13.2 (12.5-17)
Platelets: 215 (140-415)

Cholesterol:
HDL 49 (40-59)
LDL: 87 (0-99)
Trig: 93 (0-149)

Glucose: 86
Uric acid: 5.4 (2.4-8.2)
BUN: 12 (5-26)
Creatine (1.1 (0.5-1.5)
Sodium: 141 (135-145)
Potassium: 4.1 (3.5-5.2)
Chloride: 101 (97-108)
Carbon Dioxide: 29 (20-32)
Calcium: 10.3 (8.5-10.6)
Phosphorus: 3.5 (2.5-4.5)
Protein: 7.2 (6-8.5)
Albumin: 4.3 (3.5-5.5)
Globulin: 3 (1.5-4.5)
LDH: 133 (100-250)
AST (SGOT) 22 (0-40)
ALT (SGPT) 29 (0-55)
GGT 20 (0-65)

Urinalysis:
SG: 1.025 (1.005-10.030)
pH: 6.8 (5-7.5)
WBC Esterase: Neg
Protein: Neg
Glucose: Neg
Ketones: Neg
Occult Blood: Neg
Bilirubin: Neg
Nitrite: Neg

I’m 39. My blood pressure is 95/65 usually. Pulse is around 65 to 70.

Have never been exposed to fumes, chemicals or toxins as far as I know. Currently not on any meds, just taking about 50mg zinc, 500mg magnesium, 1g vitamin C, 75mg rosehips, 200mg CoQ10, a multi-vitamin, 5000IU vitamin D3.

Thanks.


#4

LH: 5.2 (1.5-9.3)
FSH: 11.3 (1.4-18.1)
DHEA: 753 (146-850)
Estradiol: 31 (0 to 53)

With your low T levels, E2=31 makes you quite estrogen dominant. 0.5mg anastrozole in divided doses might be beneficial, lowering E2 which should increase LH/FSH.

LH is moderate, FSH is higher than we typically see. LH levels are not steady so a single lab number is not very useful most of the time. FSH is a better indicator of average LH than LH itself. So you appear to have a degree of secondary hypogonadism and you have one known bad testes and surgery might be beneficial.

Your DHEA is high. DHEA is released in pulses, so a single lab is not useful. DHEA-S levels are steadier and one should test DHEA-S, not DHEA. We know that some guys convert DHEA–>E2 for some reason and that issue comes up with supplementation. Perhaps naturally high DHEA levels can do the same for some guys. DHEA is made in the adrenals and it is in the adrenals that DHEA–>E2 can occur. Cortisol levels do not indicate adrenal issues, but high DHEA might. DHEA-S might clarify.

Your higher LH/FSH might be driving T–>E2 inside your testes.

Suggestions:
DHEA-S labwork

Why so much CoQ10?

What sources of EFA’s do you have? [essential fatty acids]

When did this problem seem to start Was that subsequent to an illness or accident?
10 years?
What was going on in your life then and prior?

Please report body temperatures.

Total cholesterol? [might be too low]

How old is rT3 lab work and any change to your condition since then?

Hematocrit?

Low T can cause thin and frail skin, you are catabolic. Your lower body is much more androgen receptive and your upper body not. Suspect that skin on lower body is healthier.

Describe “adrenal crisis” and when.

Your efforts to just get by plus gym work are probably adding to your state of stress/crisis given your current state of low metabolism and low T catabolic state. You may be pushing your body onwards with adrenals.

You might not be getting enough iodine. But your thyroid labs do not indicate that in any way.


#5

I had DHEA,s checked about 6 months ago:
DHEA-Sulfate 407.4 - (88.9-427.0)

Why so much CoQ10: I feel much better at this dose. Been using that for about 5 years.

I get Carlson’s Fish oil and a little flax seed oil (about a teaspoon).

This problem started about 10 years ago, when I started working at a desk job. Some stress but no more than average.

I have a temperature chart because I was checking my thyroid for a while. It averaged between 97.7 and 98. But that was under my arm.

I can’t find my total cholesterol. Will have to call the doctor’s office.

rT3 test is only about 6 months old.

Hematocrit: 41.5 (36-50)

Yes my skin on my upper body and face is incredibly thin and pale. It causes under my eyes to appear red especially when I get overheated. That’s when people ask if I’m sick. Used to not be this way. Doctor says I’m just aging.

Adrenal crisis… it’s just the more I exercise, the more run down I get and the more naps I need. I have never had a real adrenal crisis but feel weak as hell.

I’m going to get fresh blood work done in about one or two weeks and will report back the numbers.


#6

Hematocrit: 41.5 (36-50)

  • seems a bit low, beyond what I would expect for your T levels
    Have you ever had an occults blood test that looks for blood in your poop?
    Any digestive issues?

I agree with your adrenal suspicion.

If CoQ10 makes you feel better, that suggests that you otherwise have a deficiency. CoQ10 is made in the liver. Statin drugs can decrease CoQ10 levels. You could try Ubiquinol form of CoQ10, much more bioavailable.

Look at “magazine” articles here: http://search.lef.org/?q=ubiquinol

Your cells all work with ATP as an energy source. ATP is made by the mitochondrial bodies in your cells. These are almost separate symbiotic life forms. The mitochondrial require CoQ10 to function and your “deficiency” is really all about ATP production issues. Your CoQ10 was low or you need more to compensate for reduced mitochondrial activity.

See magazine articles here: http://search.lef.org/?q=Mitochondrial
You can experiment with lipoic acid and other things to see what your body’s response is.


and https://en.wikipedia.org/wiki/Mitochondrion#Dysfunction_and_disease


#7

Thanks, I will check out those links and try the lipoic acid.

Last year I tried pantethine for a month and that seemed to help. A lot actually.

Fecal occult was clean.

Not sure what might have caused my mitochondria to be damaged if so. Also going to retest my free testosterone. Labcorp says I’m low, Sonora Quest says I’m normal. not sure which to believe. I read that low T causes mitochondrial damage. Hypothyroidism too. Will check FT3 and TSH again.


#8

Is this too much blood to have drawn at once and should I add anything else?

fT3
fT4
rT3
TSH
TPO antibodies
tgab
ferritin
SHBG
TT -total testosterone
bio-T
cortisol am and free
DHEA-S
vitamin D 25 oh
progesterone
DHT
prolactin
estradiol sensitive assay (what?s this?)
E2
CBC
CMP
B-12/folate serum
IGF-1


#9

There are some labs that I would not repeat. How old are your prior labs?

Would still like to see oral waking and mid-afternoon body temperatures.


#10

[quote]KSman wrote:
There are some labs that I would not repeat. How old are your prior labs?

Would still like to see oral waking and mid-afternoon body temperatures.[/quote]

Here are the temps (if my Walgreens thermometer is any good):

Morning oral temp: 97.4 (my wife was 98.3)
Under the arm: 96.3 (my wife was 97.1)

Evening oral temp was 96.1.

Day two (today) oral temp was 96.9 waking.

Shit.

Thinking I might just re-check my TSH and fT3 before doing all the other blood work and wasting it all, if I’m hypo. Because if I have to take synthroid, that will effect most everything else once I get adjusted. Thoughts?

Update: Getting the following drawn tomorrow 2 hours after waking, not fasting:

CBC
E2
SHBG
fT4, fT3, TSH
Serum and Free T
TPO
Cortisol
ACTH


#11

noted


#12

Shitty results here.

First the lab called and said they couldn’t get my FREE T results and offered a refund or to redraw.

Just posting what is out of range for now. I will post the CBC and the rest tonight.

TSH 6.670 (0.45-4.5)
Testosterone, Serum 243 (348-1197)
Cortisol 19.9 (2.3-19.4)
ACTH 97.1 (7.2-63.3)

Everything else is fine but will post tonight.
E2 16.5 (7.6-42.6)
SHBG 25.4 (16.5-55.9)

I have been overtraining like crazy.

I feel just a little run down.

I’m thinking that if my Testosterone and Thyroid were up a little, the ACTH and Cortisol would go down. Or if I stopped training completely.


#13

[quote]DronePilot wrote:
Shitty results here.

First the lab called and said they couldn’t get my FREE T results and offered a refund or to redraw.

Just posting what is out of range for now. I will post the CBC and the rest tonight.

TSH 6.670 (0.45-4.5)
Testosterone, Serum 243 (348-1197)
Cortisol 19.9 (2.3-19.4)
ACTH 97.1 (7.2-63.3)

Everything else is fine but will post tonight.
E2 16.5 (7.6-42.6)
SHBG 25.4 (16.5-55.9)

I have been overtraining like crazy.

I feel just a little run down.

I’m thinking that if my Testosterone and Thyroid were up a little, the ACTH and Cortisol would go down. Or if I stopped training completely.[/quote]

You can calculate free/bioavailable T from total T and SHBG. Google free testosterone calculator. This is sometimes considered more reliable than direct tests of free testosterone, which are sometimes not accurate.

Since your SHBG is normal and total T is low, I am quite sure your calculated free- and bioavailable T will be low.


#14

Hematology
WBC 6.4 x10E3/uL 3.4-10.8
RBC 4.77 x10E6/uL 4.14-5.80
Hemoglobin 14.0 g/dL 12.6-17.7
Hematocrit 41.9 % 37.5-51.0
MCV 88 fL 79-97
MCH 29.4 pg 26.6-33.0
MCHC 33.4 g/dL 31.5-35.7
RDW 13.7 % 12.3-15.4
Platelets 234 x10E3/uL 150-379
Neutrophils 55 %
Lymphs 28 %
Monocytes 12 %
Eos 4 %
Basos 1 %
Neutrophils (Absolute) 3.6 x10E3/uL 1.4-7.0
Lymphs (Absolute) 1.8 x10E3/uL 0.7-3.1
Monocytes(Absolute) 0.7 x10E3/uL 0.1-0.9
Eos (Absolute) 0.3 x10E3/uL 0.0-0.4
Baso (Absolute) 0.1 x10E3/uL 0.0-0.2
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 x10E3/uL 0.0-0.1

Thyroid
TSH 6.670 HIGH uIU/mL 0.450-4.500
Thyroxine (T4) 6.3 ug/dL 4.5-12.0
T3 Uptake 29 % 24-39
Free Thyroxine Index 1.8 1.2-4.9
T4,Free(Direct) 1.18 ng/dL 0.82-1.77
Roche ECLIA methodology Thyroid Peroxidase (TPO) Ab 2 IU/mL 0-34
Triiodothyronine,Free,Serum 3.4 pg/mL 2.0-4.4

Hormones
Testosterone, Serum 243 LOW ng/dL 348-1197
Free Testosterone(Direct) XQNS pg/mL 02 LabCorp was unable to collect sufficient specimen to perform the test(s), and is providing the patient with re-collection instructions.
Cortisol 19.9 HIGH ug/dL 2.3-19.4
ACTH, Plasma 97.1 HIGH pg/mL 7.2-63.3
Estradiol 16.5 pg/mL 7.6-42.6
Sex Horm Binding Glob, Serum 25.4 nmol/L 16.5-55.9

My doctor called me in some Synthroid. I’m hoping that is all that is required to bring the cortisol down to at least high-norm range. Apparently my adrenals are falling behind, judging by my ACTH being far more elevated than my cortisol. Gas peddle is through the floorboard but I’m just barely breaking the cortisol speed limit.

The weird thing is that I used to only do 30 minutes a day. I’ve only been overtraining for about two or three weeks (since I started this thread). I’m going to cut down weight lifting from two hours a day to one hour, or a half hour again. This is terrible because I was starting to get good gains. I put on about eight or ten pounds of what I think is mostly muscle in the past month, according to the fat calipers. It’s easy to gain muscle when hypothyroid. I guess I need more thyroid and more testosterone and only do an hour.

I also know that testosterone can reduce cortisol.

I’ve also heard that the thyroid has to be fixed before attempting TRT. Why is that so?


#15

[quote]DronePilot wrote:

I’ve also heard that the thyroid has to be fixed before attempting TRT. Why is that so?[/quote]

Because thyroid hormones affect all other organs in the body. Thus if you are lucky fixing thyroid may cause testosterone levels to normalize and eliminate the need for TRT.


#16

IGF-1? - can affect cortisol

Triiodothyronine,Free,Serum 3.4 pg/mL 2.0-4.4
and
low body temps suggest elevated rT3 as does over training and stress. See rT3 and stress items in the thyroid basics sticky.

Labs:
IGF-1
rT3


#17

[quote]KSman wrote:
IGF-1? - can affect cortisol

Triiodothyronine,Free,Serum 3.4 pg/mL 2.0-4.4
and
low body temps suggest elevated rT3 as does over training and stress. See rT3 and stress items in the thyroid basics sticky.

Labs:
IGF-1
rT3[/quote]

Will do. Getting those two done next week and will read that sticky.


#18

Test results just came in:

IGF-I, LC/MS 220 (53-331) 60%

Testosterone, Total (LC/MS/MS) 212 L (250-1100) -0.04%
Testosterone, Free 43.6 (35-155) 0.07%

ACTH, Plasma 42 (6-50) 81%
Cortisol, AM 13 (4-22) 50%

RT3 211 (90-350) 47%
TSH, High Sensitivity 5.26 (0.45 - 4.5) 118%
(this TSH is on 50mcg Synthroid - increasing dose).

#1 My testosterone is going lower on Synthroid and I am feeling worse. I slept half the day yesterday.

#2 My ACTH is higher than I’d like. Probably from being hypo and stressing my adrenals.

#3 My IGF-I is nice.

#4 My testosterone is terrible. Yes?

I feel like complete crap and starting to get anxiety.

I waited a few extra weeks to get this test because I had some stress [details deleted]. Something tells me I should be on TRT and more Synthroid but I could be wrong. I read that TRT lowers ACTH.


#19

I guess I should change the subject to “Free T sucks, and now Total T sucks, too”.

Should I go off Synthroid to see if my testosterone returns to “normal” ? Should I increase Synthroid?

The doctor just says “recheck in 6 weeks” but I can’t feel like this for 6 more weeks.


#20

When hypothyroid guys go on TRT, they can feel worse. With TSH=5.26, you were very hypo. So it looks like you are simply under-medicated. Are you missing doses?

Check your body temps as per the thyroid basics sticky and let body temps be your dosing guide.

You are taking T4 medication, but some need T3 as they are poor converters of T4–>T3.

This post needs thyroid panel labs.

I also noted:ACTH, Plasma 42 (6-50) 81%
Cortisol, AM 13 (4-22) 50%

ATCH can be up if the needle in your arm stressed you out and cortisol response to that can lag. That cortisol level is a bit low. Your thyroid function state might be part of this. Get good thyroid labs and body temperatures and see where adrenals go. You could try some KAL brand progesterone cream [which is 2%], amazon has it, also good for your ?wife? perhaps.

You need to be checking fT3, it is what gets the job done inside your cells, regulating body temps via mitochondrial metabolic rate.