T Nation

Help With Labs and What To Do?

Backstory: I’m a 20 year old male and I’ve had low libido and other symptoms for a few years, and I thought lifting would help with my testosterone levels and general mood. I’ve been lifting and tracking macros properly for about a year and a half and seen great results while cutting (probably genetic or something) but recently got my labs checked because the symptoms had been getting worse (and I’ve been trying to lean gain for the first time). Turns out, I have low test and a few other labs out of the normal range (labs below). I was hoping someone here might have had similar experience or something I guess.

Obviously it’s a lot to go through while still trying to believe I am making progress. How much has this been holding me back (if at all, I would assume at least somewhat) and assuming I get it fixed with my endocrinologist what should I expect in the future? I’m not looking for a diagnosis, I just wanted to hear from anyone who has experience with something like this. Thanks!

Labs: Testosterone Serum: 278 (348-1197) LOW
T4: 0.95 (0.82-1.77) NORMAL
TSH: 1.17 (0.45-4.5) NORMAL
Thyroid Peroxidase TPO ab: 36(0-34) HIGH
LH: 1.3 (1.7-8.6) LOW
FSH: 2.6 (1.5-12.4) NORMAL
Free Testosterone: 13.5 (9.3-26.5) NORMAL
Thyroid Stim Immunoglobulin: 32 (0-139%) NORMAL
Complete metabolic panel: all normal range
Estradiol serum ms: 9.4 (8.0-35) NORMAL
Androstenedione LCMS: 73 (44-186) NORMAL
DHEA-Sulfate: 244 (38-523) NORMAL
17-ALPHA-Hydroxyprogesterone: 45 (27-199) NORMAL
Prolactin serum: 7.5 (no range given)
Testosterone, Bioavailable with SHBG: 302
SHBG: 53.6 (16.5-55.9)
Bioavailable Testosterone S: 78 (128-430) LOW
Bioavailable Test %: 25% (no range)

SHBG is high when E2 is low, should be opposite. High SHBG is creating more non-bioavailable SHBG+T that lowers FT and inflated TT so TT overstates your T status.

Thyroid is a problem, the lab ranges are not helpful.
TSH should be close to 1.0, 1.17 is OK/
T4, T3, fT4, fT3 should be mid-range or a bit higher.
fT3 is the active hormone and not tested.
TPO is high, this may be from a selenium deficiency, you should find a high potency B-complex multi-vit with trace elements including 150mcg iodine and 200mcg selenium.

Please provide history of using iodized salt. Yes this is important.

Eval overall thyroid function, see a paragraph further down.

You have secondary hypogonadism with low T and low LH/FSH. The cause is not from elevated E2 or prolactin. Any blows to the head?

Training with low-T and thyroid problems with young guys often involves low natural energy and adrenalin compensating for this. That can cause problems with the adrenals then elevated rT3 that interferes with fT3.

You may need TRT and please note that you will need to take steps to protect your testes and fertility. Many times we see doctors fucking this up. You need to be proactive in your hormone health care, passive fails most of the time.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

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.

Thanks for all the help. My body temperature is typically pretty low but when I got a full thyroid panel done a month or so ago all of the ranges were normal. I’m not sure what you mean by iodized salt intake? I would categorize my salt intake as relatively normal I guess. I’m just concerned with how I should approach treatment, and basically Clomid vs TRT vs other options I suppose

What’s the best course of action if I previously had had a low-calorie diet and low-ish fat intake and trained a lot? I still train 6 days a week intensely but I’m trying to lean gain now. In other words, what would indicate it’s actual hormonal/health problems or if I just need to recover more?

Had more labs done, but have been feeling better (morning erections returning, feeling better again in the gym every day).

LH: 2.8 (1.7-8.6)
FSH: 3.2 (1.5-12.4)
Testosterone Serum: 557 (264-916)
Free Testosterone (Direct): >50 (9.3-26.5) High
Test Free MS/Dialysis Serum Total: 567 (264-916)
%Free Test Dialysis: 0.9 (1.5-3.2) Low
Free Testosterone Serum: 51 (52-280) Low
SHBG: 80.2 (16-100 Pubertal, 16.5-55.9 for 20-49 year olds) High

I’m 20 so I’m not really sure where I fit in with the SHBG, but these numbers are all over the place except for the total which I’m glad to see is still climbing up. Currently supplementing zinc, Vit D, fish oils and a multi daily if that matters. Plenty of protein, carbs, fats, fiber in my diet and 6 days of lifting per week. 3-4 months ago I went on a super low calorie diet for 6-8 weeks because I didn’t know how to maintain proper nutrition while cutting, have heard this can affect hormones and SHBG for a while after. I also took Accutane for about a year when I was 17, and it worked (for the acne), idk if that could be something. Please respond when you have the time, thanks.

There are lots of people who suffer from low thyroid function and have normal thyroid labs because thyroid lab ranges are mostly useless.

Post thyroid lab numbers with ranges.

The question is whether you are getting iodine from iodized salt.
Is the salt that you used iodized? Examine the package.

If you oral body temperatures, BOTH, are low, there is a real problem. Get an oral thermometer and post temperatures.