T Nation

Help with Reading Bloodwork?

Hello, this is my first post. I have just received my blood test results and the doctor has told me that everything is good and nothing is required, however I have a lot of symptoms that would indicate low testosterone.
I will post my results and request some feedback.
I had these tests done in Germany so I hope I translate them correctly.
I am 50yo, weigh 94kg and am 189cm. I’m not sure if that information is necessary or not?

TSH(TSH Basal), 1.21 ÂuU/ml
TEST-1(Testosterone total), 5.13 ng/ml
Albumin-2_S, 45.2 g/l
SHBG_R, 36.3 nmol/l
FAI_R(Free Androgen Index), 49 kA
PROL_R(Prolactin), 7.7 Âug/l
FSH_R, 5.7 mIU/ml
LH_R, 6.3 mIU/ml
E2_R(Estrodial) 18 pg/ml

It’s difficult to read labs without labs ranges. Guys with high SHBG need more TT otherwise free T suffers, Your TT and SHBG puts your free T at 10.3 ng/dL which is 2 %. Typically 2-3% is considered normal.

Your estrogen test is designed for female E2 levels, you do not have access to the correct test in your country. E2 is probably even lower which is causing your symptoms, joint pain and joints popping and clicking.

The state of healthcare in your country will not understand any of this, you can’t put every man into the same range and consider it normal, there’s far too much diversity on our planet for that to be the case. You face significant challenges in your medical community.

What symptoms were you referring to?

I don’t actually live in Germany, I contacted a TRT clinic in the UK before I left on holiday to Germany so decided to get some tests done here as I work 7 days a week and finding time is difficult.
The main symptoms I have are low energy, almost no interest in sex(although I don’t presently have a girlfriend), unable to gain muscle mass, cloudy mind most of the time, not too much fat but what I have is stored on the chest and stomach, problems sleeping(always waking in the middle of then night), a kind of flatline emotionally.
I can post their ranges if that will help?

Here are their ranges;

Albumin 35.0-52.0
TSH 0.30-4.20
Test Total. 2.30-7.40
SBHG. 20.0-77.0
FAI 22.0-77.0
Prolactin. 4.0-15.0
FSH. 1.5-12
LH 1.7-8.6
E2 11-43

I hope this helps? And thank you for your time.

The flatline emotionally is a result of low estrogen, it makes men a unic or the effect of neutering a man. If you think about women their estrogen is high so they tend to be overly emotional so you can imagine if estrogen was low it would have the opposite effects. I does no good to even list E2 ranges as I said it’s the wrong test designed for females.

Are you taking any medications?

No medications, I don’t drink or smoke either.

The reason I am confused is that the doctor told me all is ok, however when I sent the results to the clinic I contacted in the UK, he told me that he calculated my free testosterone on Nebido.com and it was 0.345 which is borderline for low T symptoms? Thus I’m looking for a unbiased opinion.

FSH and LH are relatively high indicating that your testes are not functioning very well.

Low FT as I suspected, but FT should be tested directly when possible. NHS does not typically test FT.

While your TSH looks nice and TSH=1.0 often seems ideal, you can evaluate your overall thyroid function via oral body temperatures - see below.

AM cortisol, at 8AM or 1 hour after waking
CBC - complete blood work
Hematocrit - may be part of the above
fasting cholesterol
fasting glucose
A1C - best indication of glucose/diabetes status
PSA - should have this known before TRT

Your lower E2 is typical of lower FT leading to lower FT–>E2. With your assumed higher body fat, I think that your potential for FT–>E2 would be high, as the aromatase enzyme is found in fat tissue.

“doctor has told me that everything is good and nothing is required” simply means that doc will not do anything. Doc is probably tied to the criteria of the NHS or German criteria. But there are private doctor$… Doctors and national health systems create barriers, party to avoid costs of treatment and partly because of ignorance or stupidity.

Are you snoring as well? Ask GF.

Libido is a state of health for males and many things can contribute to low libido. Sleep, T status and thyroid are major influences. Any other heath or vitality concerns?

Do you get leg cramps? That is a sign of magnesium deficiency and magnesium supplements can resolve that. Then nerves may be calmer and sleep may be improved, but that will not resolve sleep problems.

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.

Thank you for the thorough response, I’ll read the stickies you have suggested.
In response to your questions;

I am a side sleeper and fairly certain I don’t snore. No gf so can’t confirm that unfortunately.

I rarely get muscle cramps… and not in the legs(feet only).

The clinic I am in contact with have requested a second blood test comprising; PSA, biochemistry(iron, ferritin, transferrin saturation, TIBC, hba1c), cortisol, full blood count, lipids, kidney and liver function.

I should have stated leg/foot cramps. Try the magnesium before you go to bed, can be part of the routine of brushing your teeth etc. If foot cramps resolve, you have the diagnosis and the cure.

If you can tighten muscles and have them lock up, perhaps your foot, that is also a sign.

Ok KSman I have read all the stickies you have suggested and will now update my details that could be relevant, they are not in any particular order.
As a child I recall two occasions of receiving very strong blows to the head, these were strong enough that the misalignment of my neck that I have now may be due to those blows. Also for a short period of time I boxed at an amateur level, I was never knocked unconscious but of course I received blows to the head.
For around 7-8 years I was on and off a drug addict, mainly amphetamines but during that period I took pretty much everything. While I was not involved in drugs I was a high level athlete.
At around the age of 26-29 I did a few months of steroids, there was around 3-4 of them, I can remember 2 being Sustanon and Dianabol, I’m not 100% certain if Decca was one also?
One of the sports that I competed in was road cycling, sometimes I would spend 5-10 hours on the bike training, during these times the pressure of the seat would trap the nerves and my genitals would be completely numb. It’s actually well known that many Pro cyclists end up impotent. I thankfully don’t have that problem but perhaps some damage has been done?
Well that’s about all I can think of for now that may relevant.
I would like to ask you what will happen if I start down the road of TRT, is this a one way road, will I be able to recover if they don’t work or I don’t like what is happening?


All of those events have potential for some harm.

At some point get semen checked for sperm quality etc.

TRT with hCG prevents harm to the testes.

How do the the activities you just describe fit the timeline of when you think your T started to decline?

Did you look at the HPTA restart sticky?

Your high LH/FSH suggest that your hypothalamus and pituitary are working well and that the problem is your testes. That is primary hypogonadism and we only see potential for recovery if there is a vascular abnormality that is surgically repairable. This means that HPTA restart would be futile with testes as they are now.

My apologies, I just realised I haven’t read all the stickies. I’ll get back to reading again.
Because I came off drugs of all kinds at around 30yo it is difficult to say what was what as everything was upside down. I was in a state of exhaustion for a very long time, maybe years before I really started functioning in any way normally, so I can’t really give you any useful information regarding my thoughts on T decline.
I have noticed in the last 6 months a definite decline in attraction to woman, sleep problems have returned that I suffered maybe 5-6 years ago. I did have over the last few years short periods of time where my testicles would really ache, quite painful and for no external reason.
I will be getting another blood test done tomorrow and will post the results as soon as I have them. Until then I won’t waste any more of your time. Thank you for your help so far.