T Nation

Help with Blood Test Results for a Newbie

Hi Guys,

I’m a newbie here and to the world of TRT. I recently had my bloodwork done and I’m looking for some peer advice/interpretations of the results prior to going back to see my doctor. This is only because I’m in the UK and TRT is considered some sort of witchcraft by medical professionals here. Basically I want to go in well armed with knowledge and advice and learn as much as I can as well.

I’m 30 and always been in good health, but the last couple of years I’ve had lower sex drive, bad lethargy (which seriously intensifies after the gym) and have struggled to focus at work, which is very unusual for me. What’s also strange is that after going to the gym these days, I can just feel incredibly down the day after which is strange as it only happens after heavy weights etc.

My interpretation is that I have low free test and even my total is on the lower end based on some studies I’ve been reading. The high prolactin is a concern to me, but is likely stress related in my opinion, but could be contributing to the low free test.

I’m wondering whether I should be considering TRT here (obviously pending another confirmatory test)?

Here are my results…

Thanks in advance.

Tom

You’ll find doctors not overly concerned with bottom on the range levels, it’s party do to no one really knows at which point symptoms start to develop, everyone will experience symptoms at different ranges and that makes it difficult to determine if low-T numbers are causing your systems because so many other medical conditions could be responsible.

Your prolactin is high and may be a link to low thyroid hormone (Free T3) levels, but you don’t have any active thyroid hormones tested, the Free T4 is not the main active hormone, the Free T3 is where the rubber meets the road.

There is no doubt, your Free T is low and is more than likely what’s causing your systems. The question becomes is the prolactin responsible. The thing you have to ask yourself, what came first, the stress increasing prolactin then lowering testosterone, or the low-T causing the stress and which caused the high prolactin…?

Low-T men are less equipped mentally to deal with everyday normal stress levels.

BSSM guidelines also state:

  • a FT level lower than 225 pmol/l (0.225 nmol/l) provides supportive evidence for testosterone therapy in the presence of appropriate symptoms.

According to the British Society Of Sexual Medicine, your Free T levels (under 225 nmol/L) qualify you for a 6 month trial of TRT.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men: A Locally Weighted Regression Analysis.

The locally weighted regression showed that total testosterone levels of 440 and 480 ng/dL were associated with increased Framingham CVD risk and an increased probability of increased hsCRP, respectively. Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk.

If we go by this locally weighted regression analysis, levels below 480 are associated with CVD risk, your levels are 345 ng/dL, well below the threshold. There is Balance My Hormones in Dorset which is a private hormone clinic.

Your prolactin is not high. There all kinds of shit that can make it spike including having an orgasm sometime before the test, stress etc. Your best bet is to find someone here in the forum that resides in the UK, has a doc that knows TRT and is willing to treat you.

Hi Guys,

Thank you very much for your insight here, its very interesting and very helpful.

One other question I have is, what is your opinion on the predictive reliability of low free test vs total test for having testosterone deficiency? EG. my total test is within normal range (albeit at the lower end), but my free test is low. The white papers and opinions on free test seem to be mixed.

Ive read a lot of studies and it seems to be 50/50 on whether they find free test to be a useful indicator of test deficiency. I’m wondering what the opinion/consensus is on this forum with people who have actually experienced low free test / normal total test.

In terms of my next test, i want to include a full thyroid test (eg. free T3), but is there any other tests that could be useful? Eg. estrogen variants etc…?

Thanks,
Tom

Thanks,
Tom

With what we know today, the focus should be on FREE T, not total. The idea is total T includes a lot of T that is bound to shbg and is unusable, where free T is actually what is available.

I have read alternatives to the “free hormone theory” but right now free T seems to most closely follow symptoms for most people, so I’d focus on that piece.

Thanks for the reply on free T, that reassures me.

In regards to thyroid function, Ive been reading the threads on the forum (and the reply above from @systemlord) and I am now acutely aware that if my thyroid function is diminished, then TRT could be a bad idea. As a result, id like to know what tests/markers people recommend for Thyroid function? The 2 main markers I know of are free T3 and rT3. Are there any other critical ones?

Thanks,
Tom

Don’t be confused, you should base TRT decisions on Free T. At least in my opinion, Total T is only slightly better than worthless.

Looking at your labs and your age, a couple of things stand out.

  • You seemed worried about your prolactin levels. They are slightly out of range, but I would not describe them as excessively high. Keep in mind that prolactin is a hormone that is released in episodic bursts, granted less episodic than LH, but still episodic. You may have simply hit on a spike. I suggest retesting a couple more times. I’ve been following my prolactin levels for about the last 3 years and have 6 labs. Two of those labs are slightly high (similarly to yours in magnitude) and the other 4 are within range.

  • Your Total T and Free T are definitely on the low side. I would particularly be concerned with the Free T which is almost out of range. What is interesting is that your gonadotropins (LH and FSH) are on the low side too (but still in range). One would expect that gonadotropins would increase in response to low T. This tells me that the root of your problem is probably with pituitary rather than testicular function.

  • TSH is on the high side of normal and T4 is on the low side of normal. I’m thinking there may be some hypothyroidism going on here. You may want to consider treatment. It would be interesting to know your rT3 to T3 ratio too. If that is under 20, I’d also consider thyroid treatment.

  • Given what i see, I’d suggest you retest to see if these labs are repeatable or if you just happened on a bad day. I’m particularly interested to see if the high prolactin and low gonadotropins are repeated. If so, you may want to pursue a pituitary MRI to rule out a tumor. If the high prolactin is not repeated but the low gonadotropins is repeated, then the problem probably is within the brain (i.e., GnRH sectretion) or the connection between the hypothalamus and the pituitary which is sometimes damages when there is neck injury. Is there a history of this?

Thanks for the reply @youthful55guy, you bring up some interesting points.

I have another testing kit on the way, which will include free T3 and rT3 this time, as well as its etc…I will post the results up as soon as I get them back.

What’s your opinion on TRT if it turns out I have secondary hypogonadism as a result of either pituitary or hypothyroidism? Will TRT help or should I look at pituitary/thyroid treatment first and then assess my free Test levels after treatment? I’m trying to play devils advocate here as there are very few doctors in the UK that are knowledgeable or competent when it comes to hormone therapies.

Thanks,
Tom

Testing kit? Are these results from a saliva test or the newer prick your finger tests? I’ve never seen an at home blood draw test. If saliva, I’d certainly want to double check them for accuracy. Can you post a link to the at home test site. I don’t need them, just always wanting to do more research on available resources for guys on TRT. Most states in the USA allow for patients to use internet based companies where patients can purchase tests A la carta as long as a certified doctor orders them. There are at least 2 companies that I know of (1 that I use) and they offer reasonable prices.

Regarding the thyroid/low T connection. It’s a gray area that I don’t know a lot about. I suppose I should do more research in the area to understand it better. A word of caution is that there is very good research that treatment with thyroid hormones can increase SHBG. This may be why some of the earlier research indicates that thyroid hormone treatment increases testosterone. The paradox is that the early research is not wrong if you only test for total T. This is because SHBG binds and protects T from liver metabolism, so Total T will increase if SHBG increases. However, SHBG also sequesters T and lowers Free T. Only Free T can cross the blood-brain barrier where it is need to for guys to feel right.

So, yes, thyroid treatment may increase Total T, but it can also lower Free T at the same time and make you feel worse than before. My experience is that you have to balance thyroid treatment with concomitant TRT so that both the thyroid hormones and Free T are within range.

@youthful55guy Im based in the uk and it was a home finger prick test. My latest result are from a venus return kit.

So I have my latest results (see attached). My free testosterone is 0.380 now. My doc says he will not treat me with TRT as my levels are normal. My question is…is this accurate? Reading these forums it seems my levels are still low? What level should I be aiming for if I do go with TRT?

My lipids are messed up at the moment, but my diet has not been in check for a few months. I can square that away easily and get that back on track.

Do you guys have any other comments on my results?

I’m still waiting on my free T3 and rT3.

Thanks,
Tom

It’s worth mentioning that the blood was drawn as soon as I woke up in the morning (6am), so should be at its highest (in theory).

You need to find out why mean cell volume is low. The causes could be gastrointestinal bleeding and iron deficiency. Normally low red cell distribution is seen in people with microcytic anemia, something I have personally experienced.

In fact my labs mirrored yours with some barely in range (bottomed out) with others below range. An iron panel is recommended checking iron, ferritin, iron saturation and total iron binding capacity. If you are wondering if iron deficiency can be a cause for your lethargy and low sex drive, absolutely.