T Nation

Help Interpreting Lab Results. Low T? Thyroid? Adrenal Fatigue? All Three?

Would love some help with an interpretation of these results and symptoms. I recently engaged with a local APRN who has experience with male hormone therapy and go back in mid-March to discuss results. Looking to be prepared in the follow-up.

Height – 6 ft
Weight – 225 lbs
Waist – 38 in
Age – 40 y/o
Body hair – little on chest. None on back. Light on arms. Moderate on legs (mostly below knee). Would have a lot of difficulty growing a beard. Head is full.
Weight gain is usually stomach and chest.

Medications: metoprolol, Flecanaide Acetate (both for atrial fibrillation).
Other medically-related issues. Suffer from a rare non-Hodgkin’s lymphoma. Incurable, but slow acting.
Mild depression for over 10 years. Have seen several therapists consistently over this time. Was on fairly high doses of Lexapro and Welbutrin to no effect so stopped cold turkey (without any withdrawal effects) probably about 7-8 years ago.
Used to exercise pretty consistently (4-5 times/week). Now exercise very rarely.
Played football through college. Only once did I have what I would consider a concussion (never diagnosed).
Alcohol consumption – probably more than I should.
Diet – pretty bad. Long days at work/out of house (about 11-12 hrs a day). Inadequate vegetables/quality food. Usually grab what’s fast and ready. Sleep approximately 6 hrs a night
-Brain fog – some would say lifelong if you count really bad short term memory. Concentration/focus is easy in short bursts, difficulty with sustained focus.
-Social withdrawal (lifelong)
-Consistently moody, worse in last couple of years
-Erection used to be OK, but quality and frequency have fallen off a cliff in last 12 months

  • Intermittent testes ache started within last 1-2 months, but not all the time
    -Nocturnal erections – none that I know of
    -“morning wood” – not really, more like occasional half-mast

Always cold. In summer, I occasionally wear a light jacket. In winter, I sleep with knit hat, sweatshirt and sweatpants on, under one or two comforters. Hands pretty consistently cold to the touch regardless of season.
Only tested thyroid once about a decade ago and got the dreaded “tests are normal” which I took at face value at the time. Body temperature has never consistently measured above 97.4 on any thermometer at any point in my life, regardless of time of day. If it is above, then I am sick.
Have hormone saliva test on order. Recently started Iodarol for iodine while waiting for results.

Adrenal fatigue.
Moderately stressful job (in-house lawyer to company). Moderately stressful marriage situation. Incurable lymphoma. Depression. Read Wilson’s book and just about only symptom I don’t have is difficulty falling asleep.

Lab results.
I have more, but I think these are what are needed.
TESTOSTERONE, TOTAL, LC/MS/MS – 687 (Range: 250-1100 ng/dL)
TESTOSTERONE, FREE - 98.8 (Range: 46.0-224.0 pg/mL)
TESTOSTERONE, BIOAVAILABLE - 216.1 (Range: 110.0-575.0 ng/dL)
SEX HORMONE BINDING GLOBULIN – 32 (Range: 10-50 nmol/L)
ALBUMIN, SERUM – 4.8 (Range: 3.6-5.1 g/dL)
DIHYDROTESTOSTERONE, LC/MS/MS – 24 (Range: 16-79 ng/dL)
TSH - 1.94 (Range: 0.40-4.50 mIU/L)
T4, FREE – 1.3 (Range: 0.8-1.8 ng/dL)
T3, FREE – 3.6 (Range: 2.3-4.2 pg/mL)
DHEA SULFATE – 223 (Range: 106-464 mcg/dL)
ESTRADIOL - 32 (Range: < OR = 39 pg/mL)
PSA, TOTAL – 0.5 (Range: < OR = 4.0 ng/mL)
Vit D total - 42 ng/mL
Vit D, D3 - 42 ng/mL
Vit D, D2 - <4

Any thoughts are welcome. I will update once the saliva hormone tests are received. Thanks in advance.

Edit: edited to add Vit D levels and add that I have been off certain meds for a long time.

All your levels look great scoring pretty good across the board, not at all used to seeing these numbers here. Forget about your FT score, we use TT and SHBG to get our FT numbers as it’s more accurate. FT measured directly is pointless do to the short 30 minute to 1 hour half life of FT.

If anything warrants closer examination is your thyroid, suggest get rT3 tested as this has a pooling effect that prevents fT3 from entering your cells do to rising rT3 therefore raising TSH. Also get pregnenolone tested as well, this important hormone improves cognition, memory and also provides deep sleep quality.

DHT is near bottom of ranges, DHT is important to libido in the brain.

You really want fT3 75% of the ranges, middle isn’t optimal. Please see thyroid sticky and check body temps using glass thermometer, 97.7 upon waking and 98.6 between 12pm - 2pm.

We don’t really put much stock in saliva hormone tests.

Thanks. I thought they looked generally average across the board. Unfortunately, it doesn’t explain the problems (fatigue, depression, lack of joy) I have had the last 15-20 years, but I guess there is some benefit in knowing what it likely isn’t.

Will focus on thyroid now.

Incidentally, my libido is least of my concerns. What i consider a low libido, my wife considers supercharged (because hers is virtually nonexistent).