T Nation

Help with Blood Test Results

I was on TRT through my doctor (UK based) about five years ago. Long story short, I came off to have kids, ran a successful PCT, knocked the Mrs up a few times and monitored my bloods for a few years after coming off. All was good - I was never properly diagnosed primary/secondary but that’s another story. Im now 37, fairly fit/healthy, diet not too bad and drink little. No meds currently, no steriod use or anything.

However, recently I had some of the usual low Test symptoms again and had some AM bloods taken. Results are below and interested in any feedback on these? Although test is in range, my symptoms are similar to those I had when test was 1 nmol/L way back when I started TRT (not as bad but similar).

Concerned about my SHBG being so high and my FAI seems pretty low? wondering if these factors could be an issue and causing my symptoms and any advice? Thanks.

D.H.E.A. SULPHATE 7.200 umol/L 0.44 - 13.40
FOLLICLE STIM. HORMONE 4.17 IU/L 1.50 - 12.40
LUTEINISING HORMONE 4.91 IU/L 1.70 - 8.60
TESTOSTERONE 13.8 nmol/L 7.60 - 31.40
SEX HORMONE BINDING GLOB 54.9 nmol/L 16.00 - 55.00
FREE ANDROGEN INDEX 25.14 Ratio 24.00 - 104.00

Two weeks after this, I had some more bloods done, as below…

testosterone. 13.5 nmol/L 7.60 - 31.40
17-BETA OESTRADIOL <18.4 pmol/L 0.00- 191.99

Is this oestradiol number a concern? Symptoms still persist and I’d prefer not to go back on TRT but I think I will have to if this continues. Can anyone offer more advice or suggest what they would do in my position?

Thanks a lot

Its your SHBG. Its choking off your free testosterone.

SHBG can be overcome by using large injections of test. Usually once a week. This will put pressure on the SHBG come down (from large amounts of androgen) and also spill over the top and give you some extra free test, that would normally have been bound up.

Low estrogen is a concern, it’s needed for joints, bone health and an important for sleep quality. Sometimes when estrogen is low, free T is also low, we convert estrogen from free T so consider the source.

SHBG is lowering your free T, therefore as mentioned earlier low estrogen is expected. LH is better than midrange and T is low suggesting primary hypogonadism in the beginning stages, would like to see prolactin tested.

Do you consume iodized salts? Many in UK are iodine deficient, milk (dairy) has some iodine. Do this, check oral body temperatures per thyroid sticky, if body temperatures are spot on this would indicate good fT3 hormone levels and thyroid labs may not be unnecessary.

If body temperatures are slightly low, iodine and selenium could bring your temperatures to normal. If not suggest full thyroid panel, it will be a struggle to get a full thyroid panel in the UK, doctors like to cut corners.

When TRT is needed usually it is for life unless the cause was not looked into thoroughly (high prolactin) or misdiagnosed. Most UK doctors (NHS) will not make the SHBG connection, SHBG is causing problems shrinking your free T.

In any case you require TRT to bring high SHBG down to free up some T, even if prolactin is elevated. You finely need proper diagnosis before you begin TRT and second time around.

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Funny you should say that, sleep quality is very poor, and joint pain in the elbows at the minute. But I’ve also had a joint replace so bone health is
a real concern!
I take Himalayan salt but not iodised, I’ll look into that and the thyroid and try to get prolactin levels too, so thanks for that info.
What would high prolactin indicate?

I’d love to get a proper diagnosis but this has proved difficult in the U.K., I waited months for an appointment with a specialist the last time and all he tested was my testosterone levels before putting me on TRT. I really don’t want to wait all that time just to be told less information than I can get here, especially with my joint replacement, I don’t want to risk compromising that as well as all the other symptoms that just make life miserable at the minute. I still have my TRT prescription, so can go back on anytime, the question is should I, based on these bloods? Or try something else first like clomid etc?

I will get the other bloods first tho, if I can. Thanks.

Low FT or low Bio-T is leading to low T–>E2.

Low E2 speaks to how low FT is.

With high SHBG, there is more non-bioavailable SHBG+T that inflates TT. So your T status is worse than TT implies.

You need TRT, end of debate.

Please post all other available labwork.

Some shops there do carry iodized salt. Do not keep using pink salts routinely.

Post your oral body temperatures to eval thyroid status - see below.


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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.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

So, I’ve taken on the advice posted above…

Have started taking iodized salt.

Have been checking my temperatures in the AM and at lunchtime. Under the tongue, mouth closed.

However, we had what I thought was a pretty good thermometer but I have been a little frustrated when taking the temperatures as the reading seem to fluctuate quite a bit even when I take two readings within a few minutes of each other. Anyway, Temperatures have been averaging out as follows

AM 96.3
Lunchtime 98.1

I also had some more bloods taken for prolactin and thyroid (have included all of the bloods taken over the last few weeks below for clarity).

PROLACTIN * 381 mIU/L 86 - 324

THYROID STIMULATING HORMONE 1.2 mIU/L 0.27 - 4.20
FREE THYROXINE 12.3 pmol/L 12.00 - 22.00
FREE T3 4.18 pmol/L 3.10 - 6.80

D.H.E.A. SULPHATE 7.200 umol/L 0.44 - 13.40
FOLLICLE STIM. HORMONE 4.17 IU/L 1.50 - 12.40
LUTEINISING HORMONE 4.91 IU/L 1.70 - 8.60
TESTOSTERONE 13.8 nmol/L 7.60 - 31.40
SEX HORMONE BINDING GLOB 54.9 nmol/L 16.00 - 55.00
FREE ANDROGEN INDEX 25.14 Ratio 24.00 - 104.00

Two weeks after this, I had some more bloods done, as below…

testosterone. 13.5 nmol/L 7.60 - 31.40
17-BETA OESTRADIOL <18.4 pmol/L 0.00- 191.99

The general thoughts above had been that I should be on TRT. Based on the above (with the temperatures/prolactin/thyroid bloods) is there anything else I should be looking at first or is TRT still the best option for me? Does thyroid look ok? Symptoms persist… Thanks.

You can get thyroid (and just about any other labs you’d want) at medichecks if you don’t want to jump through the NHS hoops mate. It does mean putting your hand in your pocket though, which kinda sucks considering we’ve already paid into the NHS.

As stated before your have super low estrogen, I converted to US measurements and it comes out to 5 pg/ml which is 15 point below the minimum. This is bad for bone health, joint health and can only assume your joints are painful. Low estrogen is dangerous and can only imagine that free T is also very low and is most likely do to your SHBG level.

SHBG holds onto most of your testosterone and releases 2-3% in the form of free T which then converts into estrogen, so both are low so you clearly need TRT, no doubt. You want fT3 to be midrange or better and fT4 you also want midrange, yours is near the bottom.

TRT or BUST.

TRT or BUST, I get that. But should I be looking to do anything about the thyroid first before I begin TRT again? Or is it a separate issue that can be investigated further whether I am on TRT or not?

Also is the high PROLACTIN a separate issue and needs looked at further or is that something TRT will perhaps fix also?

Thanks.

I don’t think the prolactin is an issue, but keeping an eye on it is a good idea. It isn’t the first time someone had prolactin slight over the ranges, thyroid is seperate from testosterone production but if thyroid function is low expect TRT not to work.

I see guys trying to fix things naturally all the time, the majority fail and eventually end up on TRT. They waste years fighting it and it’s common to hear them say I wish I went on TRT sooner. Life is short and most believe they will make it to retirement and live to old age.

Thanks for all your help, I might do one more run of bloods but TRT it will be. I suffered and waited too long before getting help the first time, I’ll not be making that mistake again.