T Nation

Help with Reviewing My Test Results

I’m 45 years old and scheduled for my yearly physical in a couple weeks. I requested my blood test to include a view into my testosterone, free, bio, total, etc. The last time I had this done was 2017 and my doctor felt the results were “normal” – pasted below for reference. As I head in for an updated view, I’d love perspective from the group on my 2017 results. As a side, I’ve been feeling run down and had vitamin D levels checked (among other things) and my vitamin D clocked in low at 24 ng/mL (normal range: 30 - 100 ng/mL) and doc recommended supplementing with 800 IUs of Vitamin D3. From my untrained eye, my free test (62.4) and my bioavailable test (114.8) both sit at the bottom of the standard range. Does this provide reason to have a conversation and explore options?

Thanks in advance for your feedback!

2017 Results
Testosterone, Total, LC/MS/MS - my value: 433 ng/dL (Standard range: 250 - 1100 ng/dL)

Testosterone, Free - my value: 62.4 pg/mL (Standard range: 46.0 - 224.0 pg/mL)

Testosterone, Bioavailable: my value: 114.8 ng/dL (Standard range: 110.0 - 575.0 ng/dL)

Sex Hormone Binding Globulin: my value: 31 nmol/L (Standard range: 10 - 50 nmol/L)

Albumin,Serum: my value: 4.0 g/dL (Standard range: 3.6 - 5.1 g/dL)

Your hormones aren’t perfect and when compared with other healthy men your age, your levels are very low. Your doctor believes your levels are normal because they are in the normal ranges, simple as that, but if you look at other men your age they are much higher.

Doctors are taught in range is normal in medical school, but in range is normal when age is accounted for and according to the statistics, you are lower than other healthy men in your age group. The Total T is irreverent and is not the active portion of T, your Free T is very low and you are hovering on the bottom of the ranges, the problem is there aren’t a lot of doctors that are educated enough to make the assessment of normal status.

This is the state of our medical system, TRT is a new field of medicine that is slowly being accepted and there are still doctors terrified of prescribing steroids to men because of all the older studies showing prostate cancer, heart attacks and blood clots which happens in a very small percentage of men.

By the way TRT doesn’t cause prostate cancer or heart attacks, a bad defective hearts when mixed with TRT can have consequences. People with clotting disorders are at risk for blood clots. The truth is TRT gets high marks for safety and effectiveness.

You didn’t get all the necessary testing done, LH is a stimulating hormone secreted by the pituitary gland which then stimulates the testicles to produce testosterone. If LH is low than this would explain why Free T is so low. The leydig cells in the testicles become less responsive as we age and therefore less testosterone is produced even though LH is plenty high enough.

What’s a “Normal” Testosterone Level

Testosterone

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.

Why is it this low? Is there a reason, or simply a direction to supplement? Do you ever go outside without sunscreen? What is your calcium level? Phosphorous? Magnesium?

Word of caution - I would ignore systemlord based on post history in the “Uncontrolled Diabetes” thread in the supplements and nutrition category.

Read the posts there and decide for yourself.

So because I have diabetes and am struggling with my health I don’t have anything to offer?

How short sighted of you and thanks for the flame.

I am sure you do have something to contribute, it may not be in the realm of endocronology though.

It will be interesting to see where you are now, three years later.

What about other symptoms, libido, weight gain, strength and muscle loss?

Given your lab results, unless you were feeling good or happy with the way you were functioning, you should have been on TRT then. Get your total testosterone up to 900 and triple your free test, you’ll be happier and wishing you had done it sooner.

You will, however, have to find a TRT doctor to treat you. Even if you are low out of the range, it is doubtful your GP will treat you with a high enough dose to make a difference.

As mentioned, it would be nice to get a complete workup, thyroid, LH, FSH, E2, DHEA-S, IGF-1, etc. Good luck going forward. You look like a good TRT candidate.

Take 10,000IU Vitamin D3 for 3 months and retest.
Make sure you get Thyroid and Cortisol tested before you attempt TRT.
-Free T3
-Free T4
-Reverse T3
24-Hour Saliva Cortisol Panel

Not sure and was surprised myself. I definitely get sun – too much in my younger years – as I’m now a regular at the dermatologist to remove basal cells. My calcium was 8.6 mg/dL (normal range is 8.5 - 10.5 mg/dL). The doctor just recommended that I supplement with vitamin d3. I didn’t get my phosphorous or magnesium levels tested. I take creatine, ZMA and BCAAs on a daily basis. Should I be asking follow up questions and not just blindly supplementing? Is this a sign of possibly something else?

You should be asking follow up questions, that is not normal at all. You should find out why. They should be doing a PTH (frozen preferrably) test on you, and you should not take anything - especially D3 - until you know more.

Test results are back on my updated TESTOSTERONE, FREE,BIO AND TOTAL, LC/MS/MS. Not much different from two years ago, but would be interested in any additional thoughts beyond what’s been said.

My concern is that most numbers fall within the “range” (bioavailable Test was slightly under range) and my doctor has typically been a “range guy” and I doubt highly that’s he’s going to prescribe TRT. So, I guess my question is – If he balks on TRT, I need a new doctor, but in your experience, how did you find the right one who understands your goals (improved fitness/performance) and healthy lifestyle? Thanks in advance – everyone has been super helpful!

Testosterone, Total, LC/MS/MS 469 ng/dL (Range - 250 - 1100 ng/dL)
Testosterone, Free 58.4 pg/mL (Range - 46.0 - 224.0 pg/mL)
Testosterone, Bioavailable 109.9 ng/dL (Range - 110.0 - 575.0 ng/dL)
Sex Hormone Binding Globulin 37 nmol/L (Range - 10 - 50 nmol/L)
Albumin, Serum 4.1 g/dL (Range - 3.6 - 5.1 g/dL)

Did he test anything else? Your test level is likely linked directly to your borderline hypocalcemia. There are some studies coming out on it, and it’s linked to Vitamin D and phosphate levels as well.

Yeah, he did a basic metabolic panel and my calcium was: 8.7 mg/dL (range: 8.5 - 10.5 mg/dL).

If that number didn’t spark some interest from him, go see someone else. That is not an okay number.