T Nation

FT vs TT, and Low FSH

Hello everyone,

about three years ago, I went to a urologist who had published a press/web about low TT (12 nmol/l was his limit) and the importance of TRT (especially for +middle aged men), and told him I’ve low T symptoms, after some tests, he showed me the door and told me … IT’S IN YOUR HEAD!

THREE YEARS OLD Results (not sure if it matters, but it shows that my TT has been low since then):
Total T. 12.29 nmol/L (Reference range 9.9 - 27.8)
Free T. 44.60 pmol/L (Reference range Adult men “20 to 39 years: 31.0 - 94.0”)
DHT 2.27 nmol/L (Reference range 1.13 - 4.13)

Glucose FBS:
5.70 mmol/L (Reference range 4.22 - 6.11)
102.71 mg/dL (Reference range 76.04 - 110.1)

Prolactin:
230 mIU/L (Reference range 86 - 390)
10.81 ng/ml (Reference range 4 - 18)

TSH:
1.05 mIU/mL (Reference range 0.27 - 4.2)

Triglycerides:
1.18 mmol/L (Reference range < 2.31)
103.25 mg/dL (Reference range < 202.12)

Cholesterol:
4.65 mmol/L (Reference range < 5.21)
179.77 mg/dL (Reference range < 201.42)

LDL Cholesterol:
3.1 mmol/L (Reference range < 4)
118.30 mg/dL (Reference range < 154.6)

HDL Cholesterol:
1.16 mmol/L (Reference range 0.9 - 1.56)
44.85 mg/dL (Reference range 34.79 - 60.31)

Lately, one of my symptoms became worrisome, and I got more abdominal fat, also, I’m planning to take Accutane, so I took some tests:

Total T: 3.82 (Reference range: Male 20-49yrs : 2.49 - 8.38 ng/ml)
Free T: 22.5 (Reference range: 4.5 - 42 pg/ml)
FSH: 1.02 (Reference range: 1.5 - 12.4)
LH: 3.73 (Reference range: 1.7 - 8.6)
E2: 37.25 (Reference range: 7.63 - 42.6)
TSH: 1.76 (Reference range: Euthyroid: 0.25 - 5.0)
Zinc: 84.30 (Reference range: 70 - 120)
Vitamin D3: 13.21 (Reference range: Sufficiency 29 - 100)
Vitamin B12: 376.7 (Reference range: 191 - 663)

I should get the results for DHT and SHBG in a few days.

Info/Life style:
I’m 27 years old, 5’10" 164lbs, I’m not sure how much fat % I’ve, but I think it safe to assume it’s about 20%.
I don’t workout, and pretty much set on my ass all day long, sleep hours/schedule is fucked up (sleep disorder)

Symptoms:
It’s hard to determine my low T related symptoms (thanks to my life style), but I think the most apparent symptoms I’ve is:

  • Moodiness/Depression:
    The problem is I’m not sure it’s caused by my T level, life is not going too well, nor do I see a light at the end of the tunnel, also my sleep disorder can cause this.
  • Libido/ED:
    Naturally, this is somewhat based on the state of the first symptom (which fluctuate wildly), but lately, I think it became more obvious (can’t keep an erection without constant stimulation).
  • Rare spontaneous erections.

Questions:

  • Is my FT low? or just lowish and will improve once E2 is under control?

  • Why is my FSH low, and my TSH and LH normal?

  • Will Losing fat be enough to lower my E2? or do I need to take supplements/medication?
    Should I consider taking AI, along with Vitamin D? and maybe try to push my Zinc closer to upper limit (how much AI/Zinc should I take?)

  • Will lowering my E2 increase my TT significantly, or at all?
    I’m wondering because, even if I were to convert all the E2 to T, it’s still a very small percentage of the TT.

  • Does bound T matters? if not, then why does TT matters IF FT and E2 are within acceptable range?

  • Do I need TRT for my low TT? or would lowering my fat/E2 and working out should be enough for me?
    I dread the idea of depending on TRT for the rest of my life, especially in this god forsaken place, where a decent doctor will be very hard (and very expensive) to come by, BUT, I’ll do what I must/can …

Thanks for taking the time to read my lengthy post, your advice is much appreciated.

yes, you should lower E2, suggest 0.5mg anastrozole per week in divided doses, you are very estrogen dominant and E2 is reducing your T production.

We need ALT/AST liver marker lab data if you have that. Your liver removes E2 from your body and liver health/function is very much part of the game.

Your TSH should be near 1.0, ignore “normal”. TSH has increased. Did you switch to sea salt? If so, you are iodine deficient. Read the thyroid basics sticky and check your body temperatures. Any symptoms in the sticky fit? Like feeling cold?

Next labs: TSH, fT3, fT4

Take 5,000iu vit-D3, find tiny oil based capsules. Take one per day, but take 5 per day for one week to get started.

Thyroid problems and low-T have same symptoms.

Blood pressure?

EFA’s: fish oil, flax seed oil/meal, nuts

  • About the AI, I only found Arimidex 1mg, should I try to split them in half (if I can, small pills) and take a half each week?

Do you have any idea why do I have high E2? I know I’m not fit and my life style is a bad one, but I’m not overweight/obese by any means.

Does this mean that E2 have a higher negative feedback and thus lowering my TT substantially? or I just naturally have low TT and Thyroid problem.

I should post my ALT/AST labs later today (did them for Accutane).

  • The salt is iodized, and has 70-100mg iodin per 1Kg, my meals are mostly home cooked, is this not enough?

I take it that Thyroid tests has no requirements?

about the cold, I actually prefer winter (our summer is hell), and my family/coworkers often complain about the AC being set too cold, but, I get cold hands, feet and joints, even while sweating from exercising. and sometimes I get hot flashes, especially after drinking a hot beverage.

Symptoms in sticky:
-Social withdrawal - “I would rather not go out”
-Why do really (or some minor ones) stressful situations leave me feeling physically beat up. Adrenal fatigue.

AST 24 u/l (Reference range 15 - 64)
ALT 25 u/l (Reference range 13 - 69)

Glucose 95 mg/dl (Reference range 70 - 140)
Creatinine .8 mg/dl (Reference range .7 - 1.5)
Cholesterol 199 mg/dl (Reference range 100 - 220)
Triglycerides 107 mg/dl (Reference range 40 - 160)
Direct HDLC 46 mg/dl (Reference range 29 - 86)
LDL 131 mg/dl (Reference range 65 - 160)
VLDL 21 mg/dl (Reference range 2 - 32)
CHOL/dHDL 4.29

My CBC was normal, except a slight elevation in WBC 11.6 REF 3.5-9.

SHBG:
23.7 nmol/L (Reference range 14.5 - 48.4)
DHT:
0.60 ng/ml (Reference range 0.33 - 1.20)
2.07 nmol/L (Reference range 1.13 - 4.13)

TSH: 1.02 (Reference range: Euthyroid: 0.25 - 5.0)
FT4: 18.28 pmol/l (Reference range 12 - 22)
FT3: 5.24 pmol/l (Reference range 3.10 - 6.80)

My Temp for the past few days has been the same, it’s 97.3 when I wake up, 98.6 midday, and late in the day/before I sleep it’s 96.3.

Mid range fT4 is 17, you are 18.28
Midrange fT3 is 4.95, you are 5.25

Temperatures are low, so one suspects rT3 is blocking fT3
If rT3 is blocking fT3, we can expect to sometimes see higher TSH and fT3, fT4
TSH =1.76 is consistent with iodine deficiency and/or elevated rT3

In any case, you have functional hypothyroidism as indicated by body temperatures.

Are you iodine deficient? Hard to say, might be a factor.

If rT3 is elevated because of:

  • stress
  • accidents
  • acute infections
  • chronic infections or inflamation
  • starvation diets

Then we would also expect to see the rest if the ‘adrenal fatigue’ spectrum, including low levels of cortisol. ‘AM cortisol’ lab work should be done. Also test DHEA-S, as low DHEA can also indicate adrenal issues.

How old are the ALT/AST results?
Yes, higher E2 reduces LH/FSH which lowers T levels.
And vice-versa
Thyroid problems can reduce LH/FSH.
I think that it is best to deal with the thyroid issues first as all body systems are been affected.

How old is this data?
TSH: 1.02 (Reference range: Euthyroid: 0.25 - 5.0)
FT4: 18.28 pmol/l (Reference range 12 - 22)
FT3: 5.24 pmol/l (Reference range 3.10 - 6.80)
Because TSH increased, we probably cannot be using the above data
So get TSH, fT3, fT4, rT3, DHEA-S, AM cortisol [do labs at 8AM!]

When thyroid status is fixed, then you might respond to a HPTA restart.

about the TEMP, I’m not sure about the accuracy of these off the shelf digital thermometer, if I keep it in my mouth after it beebs, the temp will rise.

  • The ALT/AST results are about 10 days old.

  • The NEW thyroid tests results (the one you quoted) are done today at 8AM (I was up around 6AM) and fasting.

  • Do I need to redo ALL the thyroid tests? or just rT3? or just DHEA-S and cortisol?

  • If I need rT3, can I get my it by subtracting my Free T3 from Total T3?

  • Should I fast and/or rest the day before the tests?

BTW, how long should I keep using Arimidex before I retest TT and FT?

fT3 is not fT3

labs: rT3, DHEA-S, AM cortisol

Don’t mean to derail anything, but I’m curious about this exact thing. My FSH is low, while LH and T are mid range (FT is on the lower side). Does anyone have any idea what isolated low FSH would indicate (besides low sperm count) like could it cause other side effects or hint at a hypopituitary, etc.

My labs

Testosterone, Serum 620 348-1197 ng/dL CB
Free T 14.6 (ref range 8.9-26.9)
LH 3.6 1.7-8.6 mIU/mL CB
FSH 1.2 LOW 1.5-12.4 mIU/mL CB
Estradiol 26.9 7.6-42.6 pg/mL CB
Sex Horm Binding Glob, Serum 43.4 16.5-55.9 nmol/L CB

I’ve been taking my temp for the past days, and It seems that my sleep hours/schedule affect’s it, I get lower wake-up temp (96.7 ~ 97.1), never reach’s 98.6, and fluctuate more throughout the day.

I’ve also been reading about Adrenal Fatigue, and I’ve many of it symptoms, it MIGHT even explain my sleep disorder, but my Cortisol level suggests otherwise?

to get accurate Cortisol readings, I’ve tried to be in a good physical/mental state and choose a time where I sleep/wake like a normal person.

Blood drawn at 8:45AM (6~7h of sleep) and fasting:

Cortisol: 592.3 (Morning 7-10 AM: 171 - 536 nmol/l)
DHES-S: 2.03 (1.0 - 4.2 ug/ml)

Free T3: 5.66 pmol/l (3.10 - 6.80) - (redone for fT3/rT3 ratio)
Not sure if these results alone can help. rT3 result might take 3-4 weeks, I’ll post it once I get it.

According the readings/questionnaire I done, I’ve a mild/moderate Adrenal Fatigue, and my highish cortisol suggests it’s in the early stages. and that adrenal fatigue is … not a recognized/proven medical condition.

anyone have any input/info/advice (other than avoid stress and get as much sleep as possible) about it? perhaps from experience?

if this thing is real, and/or the cause of my sleep disorder, then it has been ruining my life for a very long time …

Cortisol is on the high side but not that bad. Might want to do the 4x24 saliva test to make sure it’s falling in the evening.

Getting E2 down into the 20s and getting DHEA-s into the upper part of the range should be easy to do. That might provide a modest improvement.

Why are you planning on taking accutane?

I’ve taken it for 6 months as a teenager and suffered with low T problems a couple years later. There is an accutane/roaccutane action group (google that) that discusses all the nasty side effets of accutane. One of the biggest would be sides related to low DHT (libido, wood, etc.)…even after eliminating that drug from your system.

I’d be very careful.

rT3: 0.39 ug/L (0.09 - 0.35)

@dhickey
I thought that “High side” is when it’s on the upper part of the range (and even that is not a good sign), not over it? especially considering I was in a good state …
Unfortunately the 4x24 saliva test it not available nor possible in here.

Lowering E2 should be easy to do using AI, and it shouldn’t have risks, (although I’ve been on Adex for over a month and I haven’t seen a big change)

but How do I increase my DHEA? supplementation? If yes, won’t that cause cortisol to rise some more as well?

My Cortisol/rT3 levels seems to be the source of all my problems, I’ve more of their symptoms than low T (low T might be one of them)

@Atn
I’ve read about Accutane, and that is why I’ve been delaying it for a very long time now, but my cystic acne has messed up my face, and as far as I know, it is the only cure for oily skin.

I’ve read/known people who took it (in a high doses too), and got no problems, so I was thinking maybe I should take it in a low dose 20/30 and keep checking my T and DHT levels.

I won’t take it until I fix my other hormones, hopefully, by that time, I won’t need it, thanks to hormonal balance, dieting and some skin care.

Thank you for taking the time to warn me about it.

Couple of options for raising DHEA. You can try magnesium oil. Using magnesium transdermally is supposed to raise DHEA. It seems to have worked for me. You could also just supplement DHEA directly. 25mg of micronized DHEA raised mine quite a bit.