T Nation

Help Interpreting Bloodwork (updated results)

Hey guys,

Recently turned 30 so I decided to get my test levels checked in order to establish a baseline and to determine if it might explain the way I’ve been feeling for the last year or so.

Have been experiencing a number of low T symptoms, which include; irritability, fatigue, cognitive impairment, lack of interest, low mood… although I don’t seem to be affected in terms of sex drive or erectile problems.

Blood was drawn fasted at 8:00 am.

Testosterone: 503.47 ng/dL (range: 229.00 - 902.00)
Albumin: 4.4 g/dL (range: 3.5 - 5.3)
SHBG: 48.1 nmol/L (range: 14.5 - 48.4)
Free Test (calc): 8.24 ng/dL (range: 2.62 - 16.7)
Bioavailable Test: 197.0 ng/dL (range: 51.7 - 392.0)

***** Additional Results Following Advice ******

blood again drawn fasted at 8:00 am

Serum Iron 63 ug/dL (45-182)
Ferritin 79.30 ng/mL (23.9 - 336.2)
TSH 6.062 uIU/mL (0.38 - 5.33)
Free T4 0.80 ng/dL (0.54 - 1.4)
Free T3 2.68 pg/mL (2.5 - 3.9)
FSH 2.63 mIU/mL (1.27 - 19.26)
LH 3.13 mIU/mL (1.24 - 8.62)
E2 45 pg/mL (<20 - 47)
PSA 2.610 ng/mL (0 - 4)

Seem to have a number of different issues cooccuring. Not sure if I should target one at a time and work through them methodically or to try and address all at the same time? Is it generally best to try and get your thyroid sorted first before going down the TRT route or could addressing both simultaneously be beneficial?

High TSH would indicate hypothyroidism. Will get my antibodies tested, but still trying to find a lab that can test rT3 or iodine. Is blood iodine generally the way to go?

Could I also be borderline anaemic?

Lowish FSH and LH would suggest secondary hypogonadism?

E2 also looks a little high?

Your Total T and SHBG when plugged into the Tru-T calculator Free T is 15.12 ng/dL, while not the lowest could still be a problem for you. Usually most men scoring Total T mid-range with SHBG 30> are experiencing symptoms which we see a lot around here.

There is usually a type of guy that would be optimal at a Total T of 500, that would be me because I have low SHBG which allows the majority of my hormones to be free rather than bound to SHBG.

There is no way to lower SHBG, it is either genetic and/or do to starvation diets/lifestyle. Remember your Free T is calculated, directly measured Free T is tricky animal and usually inaccurate. SHBG will only increase as you get older binding up more and more testosterone.

The average healthy 30 year old has seen almost no decline in testosterone and typically score 650> ng/dL closer to the top of the ranges and by 40 would start seeing the decline. There is no way you would get TRT in the NHS if you chose to return home, there standards are purposely low.

Low thyroid function can share some of the same symptoms as low testosterone, in fact without enough Free T3, testosterone can not go to work. You should at least investigate your thyroid, we see a lot of guys having both low testosterone and low thyroid hormones.

Checking TSH, Free T4, Free T3, Reverse T3 and antibodies is a good idea if TRT should not show good results. You definitely have all of the classic symptoms of low testosterone.

Most men are right around 100mg weekly, I recommend 50-60mg twice weekly shots, redo labs in 6-8 weeks. Please note men’s HPTA is shutdown 1-3 weeks into TRT, so you may go back to feeling unwell for a short amount of time as your body adapts to TRT.

Thank you for explaining all of that.

Yea my SHBG has been a problem of mine for some time. I just had a search through my inbox and found some blood work from three years ago that I had forgotten about while looking for any thyroid tests I may have had in the past.

Back then my SHBG, measured in the UK, was even higher at 51.1 nmol/L! I was very unwell at the time that measurement was taken though and was extremely sedentary as a result. I was offered TRT by an NHS endo back then actually, but regrettably didn’t opt to do it as a second opinion I got told from a different endo told me that TRT would likely just cause further upregulation of SHBG?

Okay I’ll look into getting a thyroid panel done to see if this helps explain anything better. Are there any other tests I should get while I’m at it?

Your endo has it backwards, endo’s are typically very bad at TRT. TRT lowers SHBG in just about everyone except those with suppressed SHBG do to insulin resistance and/or obesity. There is no literature that shows testosterone upregulates SHBG, often endo’s make up stores because they want nothing to do with TRT.

If you were taught in medical school TRT causes prostate cancer, you would probably do the same. As far as other tests, an iron and ferritin panel would be a good idea as your thyroid would need sufficient iron to properly convert T4 to T3. Another is cortisol.

You’ll notice another thread on here near this one, “Problem Finally Solved” or something like that, it’s an old thread someone resurrected. In that one they are discussing DHEA-s and that guys anxiety. Give it a read.

Interesting. Yea I typically have very little trust of NHS doctors in general.

Okay great I’ll get those done. Luckily private medical testing is really cheap and quick here in Taiwan.

Thanks for the suggestion. I read that thread, and while anxiety has also always been a problem for me, my BP tends to be a little low if anything, unlike the poster of that thread.

Added additional test results to original post.

I would definitely worry about the thyroid first, it could easily be causing the other issue.