T Nation

Help Interpreting Blood Results?

Hello everyone.

So I am a 41 yr old male suffering from alot of the popular symptoms of low testosterone. No libido, anger, anxiety, severe tiredness. So decided to get some blood work done and annoyingly the results came back in the normal range all bar SHBG which was slightly elevated. Got thyroid tested as a result of the elevated SHBG and they came back normal. I must admit I was slightly disappointed to see everything coming back in normal ranges. My question is should I go back for another test? What is causing these symptoms other than low test. Been to docs so many times and no one can explain. Any help would be greatly appreciated.
I keep reading that doctors are not truly up to date with male hormone so I just wanted to check first of all that these levels are not problematic. I understand that we will see a slow decline in test as we get older but this decline happened far too quickly. I was happy, high sex drive, good energy ,could control weight gain only 18 months or so ago. Now nothing

Test 21.5 nmol range 10-35
Free test 331 pmol range 225-725
Shbg 58 nmol range10-50
Sense oestridiol 62 pmol range 55-150
Fsh 6 u/l range 1-9
Lh 3u/l range 1-8
Progesterone 1 nmol high range 3.9
Prolactin 260 mu/l high range 330
Cortisol 389 nmol range 150-600
Dhea 6 umol range 2.4-11.6
Thyroid
Tsh 2.18 m u/l range 0.4-4
Ft4 15 pmol range 10-20
Ft3 4.7 pmol range 3.5-6.5

If possible, post the ranges for those lab tests.

Add ranges.

Your symptoms are from low testosterone and your high SHBG is part of the reason, a sluggish pituitary is the other reason if your LH has anything to say about it.

Directly measure free testosterone isn’t very accurate, total test has a lot better accuracy as well as SHBG and LH being what it is on these tests, you can easily deduce your symptoms are from low testosterone.

I’ve seen a lot of men will very high total testosterone, very low free testosterone, equally low estrogen and very high LH because SHBG is astronomically high.

In this case the pituitary gland is functioning optimally and yours isn’t responding appropriately. If you were able to increase testosterone by any degree, a large portion of it will be converted to the inactive total testosterone and free testosterone won’t increase by much.

Your SHBG isn’t really something easy to manipulate and increases with age. This can happen sooner if you starve yourself, certain medications can elevate SHBG and diet (vegetarian) can certainly contribute to increasing SHBG.

Ranges added

Thanks very much for your response systemlord. Very much appreciated. What is the best way forward to get the pituitary gland working optimally?

I hate to be the one to give you the bad news, but there isnt’ much you can do to increase testosterone to a degree where you are going to feel optimal.

Your recovery naturally is somewhere between low testosterone and suboptimal testosterone neither of which will all of your symptoms be resolved.

I’ve seen men with pituitary glands that perform like champs, but it doesn’t matter because natural increases in testosterone will be futile. Testosterone cypionate and the unnatural spikes in produces is what supresses SHBG like no other treatment.

Clomid increases LH but also increases SHBG, so any attempt at clomid will be futile. HCG might work, but shutsdown the HPTA while keeping the testicles function and producing testosterone, but guys usually report feeling much better when switching over to TRT.

Would TRT help alleviate some of these symptoms or should I forget about TRT?

TRT will alleviate all your symptoms because SHBG will be lower and free testosterone higher. Your SHBG will decrease to around 30 which is good.

If your doctor isn’t up to speed on TRT, you will be told levels are normal. It’s not every day you see a 41 year old with free testosterone hovering at the bottom of the ranges. That’s not average or normal either.

Why is everyone being told to hop on TRT these days? He can try a more natural route, there’s no harm in doing so… and with his labs it’s probably what I’d recommend. Sure, symptomatology is individualistic, but if OP can get up to 7-800ng/dl (very possible with lifestyle adaptations, dietary modification and supplementation of potentially deficient minerals/vitamins) then he will be fine…

It’s getting irritating that everyone is being told to go straight to TRT, esp when coming in with a TT of 500+ng/dl, low range free T… This can be improved within most circumstances. It’d be more interesting to see his vit D, magnesium, zinc, vit C, boron etc

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These are symptoms of many things, low testosterone being only one of them.
I don’t mean to be flip, but from an evolutionary/teleologic standpoint, do you think an animal would have a sex drive in a total environment that was producing severe tiredness, anxiety, and anger? Would this be a good environment to bring an offspring into?
There’s a chicken vs egg question here. If you have a logical reason to be sleep deprived, stressed, anxious, then your body naturally would reduce your ability to reproduce. Will TRT help? Sure, it could help your symptoms, but from a holistic standpoint, it’s not the right answer if other things are going on. Changing the environment is the answer (moving environments, historically, or changing one’s place in it). This is where the tire meets the pavement when it comes to TRT for average docs. Should a person work on fixing their environment, or should the doc “juice him” and help him succeed in a “competitive” environment. This is a philosophical question, not a mainstream medicine question.
There is no “up to speed” on this question. If I was your loved-one, I’d encourage you to do the natural approach as much as possible, support you as best I could. TRT isn’t a one-way street, but it is a huge treatment consideration in life.

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Exactly, too many times on here I’ve seen TRT touted as the be all end all holy grail… it’s not magic, improvements can be dramatic in those with a severe deficiency (such as myself prior to TRT)… TT of low/mid 200s, one test at like 140, FT low/sub 200pmol

and even then, it wasn’t as if it was impossible for me to function… I was just tired and cranky all the time, couldn’t get an erection etc

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Considering his symptoms aren’t mild, extreme actually the extra 200 ng/dL will not net him hardly any extra free testosterone. He will need to move those numbers a great deal more than 200 ng/dL.

Uhhhh, yes it will… and his symptoms aren’t entirely related to low T, there are many reasons as to why he could be feeling this way, neurological imbalance for one…

Sometimes the advice we can give on here can harm more than it does help. I’m not saying this guy DOESN’T need TRT, however it’s possible his symptomatology could be fixed absent of hopping on. TRT is lifelong treatment, it’s not something to take callously… his TT is 619ng/dl, his SHBG is too high, however getting that TT to say 1000ng/dl could make a big difference

And yes, that’s certainly possible with lifestyle modifications, dietary adjustments, adequate mineral/vitamin supplementation (of which deficiencies in themselves can be a sole cause of hypogonadism)

Perhaps he will require TRT, but why jump straight to the most extreme scenario right off the bat. Yes, his free T is currently too low, but it’s not through the floor (granted one can’t judge simply based on numbers, you have to go by how one feels) but his TT/FT according to literature isn’t associated with an increased risk for CVD/ long term ailment as far as I’m informed

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A 41 year old guy at 1000 naturally, I just don’t see it happening. No harm in trying, compliance will be better on TRT.

Also, perhaps a more comprehensive set of bloods would be preferable

Not saying this guy shouldn’t go on TRT, however it needs to be thought through carefully, it’s lifelong treatment as I’ve specified before and that is a big decision to make.

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Thank you to everyone for these great responses. For the 18 months or so I have tried numerous changes , mainly diet. I tried intermittent fasting, eating less at meal times. My diet is generally pretty good but there is always room for improvement. I still get very tired far too easily I have even resorted to pre workouts just to get myself in the gym. As the day goes on the brain fog symptom seems to get worse.
I try to get as much sleep as possible and although I do generally get 8 hrs it’s normally broken with a wide awake hour or so throughout the night. Libido is terrible , can’t remember the last time I woke with morning wood. My wife would agree 100% with this :joy:. I recently passed an exam which was very demanding and in a normal world would have been super proud of myself but the reality was I didn’t feel anything , maybe relief if anything but certainly no pride or excitement. Thanks again everyone I really appreciate the help

Thanks unreal 24278.
What further tests would you recommend I do. I am happy to try anything to get to the bottom of this.

Couldnt agree more.

Its terrible to see that basically everybody joining this forum and posting symptoms which COULD be coming from low T is automatically advised to go on TRT by non qualified persons. And frequently men are also adviced to buy into a T dosage which brings them way over the physiological range.

Not saying that he couldnt potentially benefit from TRT. But dishing out this advice
prematurely on the basis of a single lab measurement without taking into account (and with no qualification) other relevant factors is just quack and doing more harm than good.

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This guys estrogen is 16, his free testosterone is low (FT->E2) and you think it’s something else, please! This guys SHBG is high and we all know what this means for free t.

Free t isn’t to be trusted, the total t, SHBG and the LH are better indicators of T status. His symptoms are also painting a clear picture, when you consider the labs and the symptoms.