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High Total Testosterone, Low Free Testosterone


#1

LAB RESULTS

I recently had some blood work done and my results came back with high total testosterone levels while having low free testosterone levels. Estradiol and Estrone were also tested. Here are the results:

TOTAL TESTOSTERONE: 9.54ng/ml (Lab range: 2.8 - 8.0ng/ml)
FREE TESTOSTERONE: 13.0pg/ml (Lab range: 5 - 30pg/ml)
ESTRADIOL: 20.76pg/ml (Lab range: 0 - 53pg/ml)
ESTRONE: 2.21pg/ml (Lab range: 42.28 - 127.15pg/ml)

Note that I currently live in Mexico, and so the tests were administered by http://www.olab.com.mx/.

If I did the conversions and math correctly, my free testosterone is only 0.14% of my total testosterone ( 13pg/ml / 9540pg/ml). At a normal ratio of 2%, my free testosterone numbers would be 191pg/ml.

However, it appears that their test uses the direct method of testing free testosterone, and from what I understand, you can't get the free testosterone percentage by dividing free direct testosterone by total testosterone. You can only get free testosterone percentage by using calculated free testosterone. So it’s possible that my free T is not low, although that would be quite odd given that I’m out of the upper range for Total T in their tests, while simultaneously in the lower 33% of their free T range.

I also do not understand why my estrone could be so ridiculously low and out of their range, and if it’s a potential cause for concern

ABOUT ME

33 years old
6’2"
32.5” waist
162lbs.
~15% body fat

I tend to carry most body fat fairly even, although there's a bit more around my waist and hips. This has always been the case.

I have a fairly thick beard and a receded hairline. I have body hair on my chest that extends down to my belly in a T like shape.

Symptoms: The major symptoms to note are that I have had issues with weak-ish erections and lack of morning word. My sex drive is variable and is probably on the lower end of average.

I do have issues with fatigue, joint pain, insomnia, and peripheral neuropathy. However, I do have chronic Lyme disease, which causes all of these symptoms, so it’s hard to say to what extent hormonal issues could potentially be contributing to any of these symptoms.

Note that in people with chronic Lyme disease, as in my case, they can often develop hormonal irregularities. From what I’ve read, when it affects testosterone, it only seems to lower total testosterone. I have not read of any cases where only free testosterone was affected.

In addition, people with chronic Lyme disease can often develop adrenal fatigue, since the whole body is under such high stress from the disease. I do not know if I have adrenal fatigue (I have ordered a 24-hour cortisol saliva test though). I mention since from what I understand, there is a strong relationship between the adrenals, cortisol and testosterone.

Medications: Currently taking a few different herbs for Lyme disease and 200mg Doxycycline daily. I will be adding more antibiotics in the coming weeks. I also take various vitamins. The ones of note are 60mg Zinc, 2.5g fish oil, 15g L-Glutamine, and a men’s multi-vitamin. I can provide info on all supplements I take if needed.

I have taken Propecia in the past. This was about 7 years ago and I took it for about a year.

Diet: I follow a ketogenic diet and have been primarily in ketosis for the past 5 months or so (I have come out of ketosis at times). As such, my diet is very low in carbs, medium in protein and high in fat. I follow a ketogenic diet so as to help my Lyme disease. Whenever I eat a lot of carbs, my Lyme symptoms tend to get much worse, so I would like to remain low-carb.

I do not consume dairy or gluten.

In general, I do 16/8 intermittent fasting. I am not religious about it so some days, I will fast for less or some days I may fast a bit longer.

Training: Currently not training at all as I simply do not have the energy to do any sort of serious lifting due to Lyme disease. Once a week or so, I may do a Bikram Yoga session.

Testes: My testes will ache whenever I have a fever or flu. Typically, they will ache a day or so prior to getting sick and so in many ways, they sort of act as a canary in the coal mine.

Morning Wood: I get morning wood 15-20% of the time. This has been fairly consistent over the years.

Other Things of Note: In the past, my body temperature typically runs low. Often, when I get sick, I do not run fevers unless deathly ill. I have started to record my body temperature during the past 3 days to get some more data on this. Here are the results (note that I go to bed and wake up late):

DAY 1

12pm (waking): 97.5
4:15pm (post-meal): 97.7
7:15pm: 97.9
10:40pm (post-meal): 98.3
3:15am (before bed): 97.2

DAY 2

11:15am (waking): 97.4
4:45pm (post-meal): 97.9
8:45pm: 97.2
12:00am: 98.2
2:15am (before bed): 97.0

DAY 3

11:15am (waking): 97.0
4:15pm (post-meal): 98.2
8:45pm: 97.6
10:45pm (post-meal): 98.2
2:30am (pre-bed): 97.3

DAY 4

1:15pm (waking): 98.0
5:45pm (post-meal): 97.9
10:30pm: 97.8
1:45am: 97.9

Finally, I use sea salt with my food and do not typically use iodized salt. I do not supplement with iodine.

I also tend to get sore throats often and do not tolerate the cold well.

TESTING AND DIAGNOSIS

I’d like to come to a clearer understanding of what’s going on, so I can then take any steps or treatment remedies to correct it. To that end, I’d like to figure out what tests I should take, etc.

Firstly, do you think it’s worth it to seek out another lab to have my total and free testosterone levels tested? I could go to various labs to get different results and see what their reference ranges are and then select the one that has the most reasonable reference ranges. Would this be worth it? I’d be okay with paying for several different tests just so I can know that the results are reliable.

Secondly, what are all the blood tests that I should order? This is the list I have come up with so far:

All tests in Chemistry Panel & Complete Blood Count

Sex Hormones
Follicle Stimulating Hormone (FSH)
Luteinizing Hormone (LH)
Total Testosterone
Free Testosterone
Free Testosterone %
Sex Hormone Binding Globulin (SHBG)
Dihydrotestosterone (DHT)
Dehydroepiandrosterone sulfate (DHEA-S)
Androstenedione
Progesterone
Pregnenolone
IGF-1
Prolactin
Estradiol (E2)
Estrone (E1)

Thyroid
Thyroid Stimulating Hormone (TSH), Ultrasensitive
Free T4
Free T3
Reverse T3
Free T3: Reverse T3 Ratio
Thyroid Peroxidase (TPO)

Other
Prostate Specific Antigen (PSA)
Homocysteine
C-reactive protein
Hemoglobin A1C (HbA1C)
Vitamin D, 25-Hydroxy
B-12/folate serum
Ferritin
Iron, Total Binding Capacity
Iron, Binding Capacity
Magnesium, RBC

Is there anything that I should add? Should I remove any of these tests?

Also are the following helpful as well??

  • Thyroglobulin Antibodies (TGAB)

Thanks for any and all help. It's very much appreciated.


#2

With your diet, %BF and diet, you really do not seem to be candidate for diabetes, A1C seems unwarranted. Add CBC, hematocrit [HTC], fasting cholesterol and fasting glucose.

With lower T, DHT will be lower and DHT lab results do not provide any useful information.

You are iodine deficient and need to take higher dose iodine for replenishment. But make sure that there is selenium listed in your vitamins, and how much iodine is in the vitamins.

You seem to have thyroid hypo symptoms. Taking higher dose iodine will exaggerate TSH and the TSH labs are then not very useful.

Thyroid does impact immune system. So does Vit-D. Take 5000iu Vit-D3 per day and then test Vit-D25 to see where you are.

Typically thyroid antibody tests are done as a follow up to other thyroid lab results. Thyroid auto immune problems can be from high TSH, from iodine deficiency with a lack of selenium needed to support critical enzyme processes. Without selenium, inflammation triggers immune processes to clean up damaged cells and immune system can interpret the cellular debris as foreign and then its an autoimmune disease.

Are your outer eyebrows sparse?
Thyroid is sore, enlarged, asymmetric or lumpy?

Please read the stickies found here: https://forums.t-nation.com/t/about-the-t-replacement-category/38/2?u=ksman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • thyroid basics
  • finding a TRT doc

Stop using sea salt. Others in your home are affected too!
Get more iodine, selenium is very important.


#3

Hey @KSman, thanks for your help and for responding to my post. Here are my responses to some of the things you said/asked.

I'm going to hold off on supplementing Iodine until I complete my Thyroid labs. I should be getting them done next week, at which point, I'll start on Iodine.

Currently, I take 100mcg of Iodine daily and 130mcg of Selenium as part of my multi-vitamin. What would be a target daily Selenium dose would: 400-600mcg?

I had my vitamin D tested back in April 2016 and it was at 95ng/mL (range 30 - 100). Since then, I've continued to take Vitamin D but have lowered my dose to around 1500IU daily. I will retest vitamin D as part of the blood test panel, and then see if I need to up my Vitamin D again.

No, they seem fairly normal to me.

Not totally sure if I'm doing it right, but I tried to feel the thyroid gland, and it didn't seem enlarged, asymmetric or lumpy. When I applied pressure on it, it did hurt a bit, although again I'm not totally sure if I was feeling the thyroid gland correctly.


I read all the stickies.

@ksman, I will update my blood tests with your recommendations.

I have one other question. Are my estrone results a potential cause for concern? Should I re-test they're valid? For reference, here are my results:

ESTRONE: 2.21pg/ml (Lab range: 42.28 - 127.15pg/ml)


#4

There are very few posts here re estrone, E1. So we really do not have any insight or experience to react to this. So retesting will not help here. You do have enough E2 to active estrogen receptors.

E1 estrONE
E2 estrDIol
E3 esTRIol

I do not see a male E1 range that has a minimum. http://www.questdiagnostics.com/hcp/intguide/EndoMetab/EndoManual_AtoZ_PDFs/Estrone_Serum.pdf

100mg iodine is not adequate. I do not know what amount of selenium is required for proper thyroid support. I assume that what one finds in vitamins is adequate.

April 2016 Vit-D25 lab results could be shifted by sun exposure or a spring vacation?


#5

Thanks @KSman

I had been on vacation about 10 days before, so I was in the sun a bit more than normal, but nothing too extreme. Also leading up to this test, I think I was taking 4000IU of Vit-D per day.

I will re-test Vitamin D next week and then calibrate how much I should be taking.

Also, I updated the original post with more results from my daily temperature readings.


#6

Good sun exposure can lead to creation of 10,000iu Vit-D3 in your skin.


#7

Just got results to the tests that are part of my thyroid panel:

TSH: 1.74 (Range: 0.3 - 5.2 µUI / mL)
T3 TOTAL: 91.26 (Range: 64.0 - 181.0 ng/dL)
FREE T3: 3.05 (Range: 2.08 - 4.3 pg/mL)
T4 TOTAL: 5.78 (Range: 5.91 - 12.56 µg/dL)
FREE T4: 1.19 (Range: 0.63 - 1.34 ng/dL)

They forgot to include Reverse T3 so I'll have to go back for that.

I'll also be going in the next 1-2 weeks for the rest of the blood tests. Hard to find a lab here in Mexico that does all of them, which is why I'll be doing it in batches with different labs.