T Nation

Guidance on Low T, Obesity, Etc

I had an appointment with my Primary Care Physician, and discussed all the the issues that KSMan addressed in his responses to my post.

He was impressed with how thoroughly all of the relevant issues were touched on by KSMan, and ordered all the different blood tests which were suggested.

I was most impressed by my Doctor’s humility, in saying that if I do end up starting on HCG, and then TRT with AIs, etc he will refer me to a specialist in my area that has a lot of experience with these treatments.

I will report back with my blood test results in a few days.

You could offer to the doc that these issues are relatively easy to deal with and that you are willing to work through these things with him and then he will be able to offer services to other males in this situation, You can tag me in the KSman is here thread for faster response. After a thread gets older, I let it drift on its own, considering that I gave it a good launch.

Your doc may not know of a “specialist” and referrals to endos and urologists typically fail and the doc is just getting you out of his office.

NEW LAB RESULTS - 12/31/2015.

TESTOSTERONE TOTAL 309 ng/dL 302 - 903 ng/dL

TESTOSTERONE FREE 35 pg/mL 47 - 244 pg/mL

Testosterone, Free Pct 1.1 % 1.6 - 2.9 %

Sex Hormone Binding Globulin 72 nmol/L 13 - 110 nmol/L

FSH 7.7 mIU/mL 1.5 - 33.4 mIU/mL

LH 6.8 mIU/mL 0.5 - 76.3 mIU/mL

Estradiol 45 pg/mL 0 - 357 pg/mL
MALE: 0-40 pg/mL

Homocysteine, Plasma 11.8 umol/L 4.3 - 11.4 umol/L

Hemoglobin A1c 5.5 % 4.0 - 6.0 %

TSH 2.15 uIU/ 0.33 - 4.70 uIU/mL

Free T4 0.97 ng/dL 0.89 - 1.76 ng/dL

INSULIN LIKE GF 1LC/MSMS 147 ng/mL 94 - 163 ng/mL

Vitamin B12 552 pg/mL 211 - 911 pg/mL

Vitamin D, 25 Hydroxy 37.4 ng/mL 30.0 - 100.0 ng/mL

DHEA SO4 26 ug/dL 80 - 560 ug/dL

Cholesterol 142 mg/dL <=199 mg/dL
HDL Cholesterol 47 mg/dL 40 - 59 mg/dL
Triglycerides 113 mg/dL <=149 mg/dL
LDL Cholesterol 72 mg/dL <=99 mg/dL
Chol/HDL Ratio 3.0
VLDL 23 mg/dL


The DHEA-S is low, but with all else the way it looks I do not believe this is a problem other than the weight affecting the steroid hormone levels adversely and the low normal total testosterone is also consistent with weight being the driver.
The free testosterone is not as reliable a measure as the total.
The testicles and the brain seem to have appropriate responses
Repeat total Testosterone on another day may give more context as there is some day to day variation.
The homocysteine level is high, please start folic acid 1 mg daily.

Please review my earlier posts.
Body temps?

Homocysteine is too high. You have arterial inflammatory processes going on, aka heart disease.
Take the supplements that I suggested.

TSH should be closer to 1.0

You need to take DHEA!!!

Cholesterol is too low, better near 180. 160 and below are associated with increased all-cause mortality.

Did you read those stickies?

You need TRT and E2 management to enable weight loss and restore health.
You ability to loose weight is been negatively affected by low thyroid function.

You may need to find an age management doc. Your doc does not have any sense of urgency.


Thanks Again, it is appreciated.

My body temperature (checked daily) has varied from 98.2 F to 98.6 F.

I am gathering the supplements to start ASAP.


There are two different situations:

  • morning/waking temps are low, afternoon is good
  • both morning and afternoon temps are low

I will record a week’s worth of waking and afternoon body temperature readings and report back then.

Thanks Again.

Recorded Body Temperature Readings:

Mornings were 97.1/ 97.8/ 97.6/ 96.9/ 97.1 / 97.3

Afternoons were 98.3/ 98.7/ 98.3/ 98.4/ 98.1/ 98.3

KSman I will tag you in to this posting.

Your PM temperatures are not so bad. So the problem is not so deep.

Our reference articles can be found linked in the 2nd post of the one sticky in this forum.
Please read/review the thyroid basics sticky.

And your total cholesterol is too low. 180 is deal.
<160 is associated with increased all-cause mortality and hormone problems.

Are you taking DHEA?
Your DHEA levels are a big problem.
DHEA may be rate limiting DHEA–>T inside your testes!
Your doctor is saying insane things about DHEA, you need a doctor who in not ignorant and guessing.

Pregnenolone could be low, reducing pregnenolone–>DHEA in the adrenals, or adrenals are not right. You should also check AM Cortisol and do that at 8AM.


I am now taking recommended supplements:

DHEA (25mg x1 per day)

Ubiquinol (50mg x 1 per day)

Vitamin D-3 (5,000 iu x 2 per day)

Chromium Picolinate (200mcg x 1 per day)

Folic Acid (800mcg x 1 per day)

Will start on Vitamins C, E, B Complex & EFAs when they arrive by Mail.

Start going back to gym in 2 weeks (using Jim Wendler’s 5/3/1 Program)

Looking for a good practitioner concerning TRT and related issues. Search continues…

Starting to clean up diet, eat more regularly, plan out the week’s meals.

Thanks again to KSman for all he does here on the Forum!!

The stickies are no longer stickies, but are linked from the 2nd post in the 1st thread in the forum.

Any change in diet to try to increase total cholesterol?


I am reviewing the “former stickies.”

One of my main issues is eating, period.

I am a morbidly obese bugger, but I eat infrequently.

That does not jive with the simplistic “calories in, calories out” mantra that allopathic medicine is wedded to.

At least I have started what will be a very long process and journey.



Your metabolism is slow and efficient.

T, cortisol, thyroid and growth hormone are all critical hormone factors. Mitochondria are on the front line.

This may sound far fetched, but I feel better already on these supplements.

I suppose it is more likely a placebo effect, but I feel less “stress” (for want of a better term)

on my system, like I am breathing easier or something?

Is that even possible?

yes, but hard to know which are the heavy contributors.


So I continue to struggle with the same issues.

TRT Doc turned out to be a waste of time (“let’s observe things for 4-6 months and come in again”)…

Had a bad health scare a few months ago, Deep Vein Thrombosis, still on coumadin, exhausted all time.

Not on any Testosterone, haven’t been in about 2 years. Still my hair is falling out, it used to be super thick and grow fast.

I will see my primary care doctor in a couple of weeks, and get a bunch of new blood work.

KSMan, any advice or encouragement would be greatly appreciated.

Thanks Again.

Your body temperatures were low. Please see where they are now.
You may be iodine deficient. TSH too high, fT4 too low.
What has been your history of using iodized salt?

General hair thinning can be from low thyroid function.
Do you feel cold easily?
Are your outer eyebrows sparse?
Dry skin?

New labs?

What supplements are you [still] taking?

Here is the new boiler plate:

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


Thanks for the reply.

Over the last 3-4 months, my sensitivity to cold has increased a lot.
I don’t know if it is related to being on Coumadin anti-coagulant since January 2017
from the deep vein thrombosis (blood clots) I developed suddenly at that time.

Skin and eyebrows seem ok.
I have noticed that my fingernails are more brittle with ridges on them.

I do not think I have ever used iodized salt that I can remember.

The only supplements I take currently are Vitamin D and Folic Acid.

I will record a week’s worth of body temperatures asap.

I will get a full set of new labs next week, and report back.

Thank You


  1. I am now off Coumadin/Warfarin.

  2. Still tracking morning and evening body temperature. From what I have already taken, they still run low.

  3. NEW LABS (from June 9, 2017):


Hemoglobin A1C 5.8% UNDER < 6.4%

INSULIN LIKE GF 1LC/MSMS 144 ng/mL 77 - 224 ng/mL

FSH 6.0 mIU/mL 1.4 - 18.1 mIU/mL

TESTOSTERONE TOTAL 321 ng/dL 302 - 903 ng/dL

TESTOSTERONE FREE 32 pg/mL 47 - 244 pg/mL

Testosterone, Free Pct 1.0 % 1.6 - 2.9 %


DHEA SO4 18 ug/dL 80 - 560 ug/dL

T3, Free 3.0 pg/mL 2.3 - 4.2 pg/mL

TSH 2.20 uIU/mL 0.33 - 4.70 uIU/mL

FREE T4 (REF) 1.22 ng/dL 0.89 - 1.76 ng/dL

Vitamin D, 25 Hydroxy 33.4 ng/mL 30.0 - 100.0 ng/mL

FOLATE 15.0 ng/mL >=5.4 ng/mL

Ferritin 200 ng/mL 22 - 322 ng/mL

CHOLESTEROL 123 mg/dL <=199 mg/dL
HDL 35 mg/dL 40 - 59 mg/dL
Triglycerides 132 mg/dL <=149 mg/dL
LDL Cholesterol 62 mg/dL <=99 mg/dL

NA 137 mmol/L 135 - 144 mmol/L
K 4.3 mmol/L 3.7 - 5.5 mmol/L
CL 101 mmol/L 99 - 110 mmol/L
CO2 27 mmol/L 20 - 31 mmol/L
ANION GAP 9 4 - 13
GLUCOSE 84 mg/dL 70 - 100 mg/dL
Due to the ambiguity of the fasting status, it is recommended not to use this result for the determination of Diabetes.
BUN 12 mg/dL 6 - 23 mg/dL
Creatinine, Serum/Plasma 0.95 mg/dL 0.60 - 1.30 mg/dL
Bun/Creatinine 12.6
CALCIUM 9.2 mg/dL 8.3 - 10.4 mg/dL
ALK PHOS 98 IU/L 32 - 110 IU/L
BILIRUBIN TOTAL 0.7 mg/dL 0.2 - 1.2 mg/dL
AST 18 IU/L 11 - 39 IU/L
ALT 20 IU/L 6 - 42 IU/L
Total protein 7.2 g/dL 6.1 - 8.0 g/dL
ALBUMIN 4.3 g/dL 3.2 - 4.9 g/dL
GLOBULIN 2.9 g/dL 1.6 - 4.0 g/dL
Albumin/Globulin Ratio 1.5 0.6 - 2.8

WBC 5.8 10^9/L 3.9 - 10.6 10^9/L
RBC 5.31 10^12/L 4.50 - 6.00 10^12/L
Hgb 15.4 g/dL 13.5 - 17.5 g/dL
Hct 45.2 % 41.0 - 53.0 %
MCV 85.1 fL 80.0 - 100.0 fL
MCH 29.0 pg 25.0 - 35.0 pg
MCHC 34.1 g/dL 31.0 - 37.0 g/dL
Platelet Count 272 10^9/L 140 - 444 10^9/L
MPV 10.1 fL 6.5 - 12.3 fL
NEUTROPHILS % 61.4 % 40.0 - 81.0 %
LYMPHOCYTES % 28.5 % 18.0 - 42.0 %
Monocytes % 7.5 % 1.0 - 12.5 %
EOSINOPHILS % 1.6 % 0.0 - 7.0 %
BASOPHILS % 0.7 % 0.0 - 2.0 %
% Immature granulocytes 0.3 % 0.0 - 1.0 %
NEUTROPHILS ABS 3.5 10^9/L 1.8 - 8.0 10^9/L
LYMPHOCYTES ABS 1.6 10^9/L 1.0 - 4.8 10^9/L
MONOCYTES ABSOLUTE 0.4 10^9/L 0.0 - 0.9 10^9/L
EOSINOPHILS ABSOLUTE 0.1 10^9/L 0.0 - 0.5 10^9/L
BASOPHILS ABS 0.0 10^9/L 0.0 - 0.2 10^9/L
Absolute Imm. Granulocytes 0.02 10^9/L 0.00 - 0.03 10^9/L
RDW-CV 12.9 % 11.5 - 14.5 %
RDW-SD 39.8 fL 35.1 - 46.3 fL

** Looks like they did not run/report ESTRADIOL test.

Thanks Again!

Please try to get on TRT. Study the stickies. There is one for finding a TRT doc.

Were you fasting for labs?

Fat loss requires good TT, FT, E2, cortisol and thyroid function.

Prostate can have problems with high E2 on TRT or estrogen dominance with low-T. How have prostate symptoms changes with TRT stopped?

What has your history been with PSA and why not tested now.

What meds have you used for arthritis pain. Some Rx or OTC can affect kidneys and increase homocysteine, indicating endothelial side effects.

How much iodized salt? Only your cooking and salt shaker count.

Not taking an statin drugs to lower cholesterol?

Depression can be driven wholly or partly by low T, elevated E2 and estrogen dominance and low thyroid function. Low cortisol could certainly be a factor, but not tested in this lab set.

High BP can also be contributed to by a magnesium deficiency. Leg or foot cramps or the ability to contract a muscle and make it lock up is a sure sign of magnesium deficiency.

Ridges in fingernails and folds in earlobes are associated with increased risk of a cardio vascular event. You should be concerned with endothelial dysfunction, the mechanism of ‘heart disease’. There is a lab test for an inflammatory marker for this" homocysteine". The endothelium is a one cell thick layer that isolates the blood from the arterial wall. Blood pressure is partly a marker of these process. You can protect endothelium with high potency B-complex multi-vits, adequate DHEA levels, fish oils, natural source Vit-E, Vit-C and other antioxidants, good T levels and optimal E2 levels avoiding estrogen dominance. Insulin sensitivity is also important and that also requires optimal thyroid function.

DHEA-S=18 is extremely low, never have seen this. DHEA is made in the adrenal glands pregnenolone–>DHEA. So some concern for other adrenal hormones. Take 25mg DHEA and test DHEA-S again next lab set.

Get AM cortisol blood work, and do this at 8AM or 1 hour after waking up. Please no coffee and try to have a relaxed drive to the lab blood draw station. At doc’s office may involve unreasonable wait times.

Total cholesterol 123 is really too low. Some just are that way as there livers do not produce enough. 180 is optimal and <160 is associated with increased all-cause mortality. Cholesterol is needed for many things including the foundation for making all of your steroid hormones, including Vit-D25, DHEA and cortisol etc.

Vit-D25 would be better if increased please take or increase by 5000iu Vit-D3 per day.

Take DHEA, fish oils, Vit-D3, Vit-E with low fiber meals with more fats. With oatmeal would be the worst.

If taking a statin drug, does seems too high. If so and you have muscle soreness or a persistent low level cough, that is a statin drug induced CoQ10 deficiency.

IGF-1: You may need hGH in the future, check IGF-1 once a year.

TT is low. FT is very low, FSH is strong. Your have primary hypogonadism, your testes are not working well. SHBG is high creating a lot of non-bio-available SHBG+T that reduces FT and free % FT while increasing TT that then over-states your T status that is lower than TT alone implies.

CBC looks very good.

fT3 is slightly low and TSH=2.20 should be closer to 1.0
Thyroid rages are useless and stupid.
Have you not been using iodized salt?

Please post your waking and mid-afternoon “normal” body temperatures.
TSH does not seem right.

#See last paragraph to evaluate overall thyroid function. This is important, more useful than most thyroid lab sets.

You will need to read this post multiple times.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.