Interpreting Blood Results Before TRT

Can anyone help me decipher those results? Especially thyroid?

Total T: 442
Free T: 12.5 (8.68-25.09)
SHBG: 9.2 (10.0-57.0)
E2 sensitive: 45.77 (>39,8)
Prolactin: 146.78 (45-375)
FSH: 1.38 (1.4-18.1)
LH: 3.65 (1.5-9.3)
Ferritin: 85.4 (18-360)
FT3: 4.63 (2.3-4.2)
FT4: 1.16 (0.89-1.76)
TSH3UL: 1.469 (0.55-4.78)
FolateBA: 2.98 (>5.4)

Thanks!

On paper fT3 is over range and is in hyperthyroid tertiary, the question is are you experiencing hyperthyroidism. TSH usually would need to be very low, testing T3 is best for diagnosing hyperthyroidism.

I doubt there are thyroid problems, good fT3 supports the ability to lose body fat.

You have a strange T-FT ratio given your SHBG, with these T-FT ratios if I knew nothing about your SHBG, I would assume its a lot higher and usually I’d be correct, but in your case your SHBG binds androgen very strongly with is working in your favor and isn’t working against you.

You do seem to aromatase quite a bit which could cause symptoms, E2 is high in relation to your testosterone creating some degree of estrogen dominance and dictates your TRT protocol to include very frequent dosing, preferably daily injections of enanthate, 2-3x weekly sustanon.

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subacute thyroiditis or toxic adenoma/multinodular goiter

Symptomatic? if yes for how long have your symptoms been ongoing? If acute did you have a recent viral infection?

Only hyperthyroidism symptoms I am experiencing are irritability, anxiety, mood swings, nervousness, agitation, emotional, decreased concentration. Apart from that nothing. Physically I feel fine. So I also doubt thyroid problems.

I started with 50mg M/W/F protocol 2 weeks ago. So far I got higher libido and finally morning wood back.

In that case should I be happy about low SHBG or?
And should I do another blood test after 6 or 8 weeks?

Only hyperthyroidism symptoms I am experiencing are irritability, anxiety, mood swings, nervousness, agitation, emotional, decreased concentration . Apart from that nothing. Physically I feel fine.

I had no infection at all. Atleast that I know.

For how long do you have these symptoms? Any signs of a goiter? Anti thyroid antibody titer known? An ultrasound scan of your thyroid would be a good idea.

I would get this checked out.

I had those symptoms my whole life. Was able to reduce them with diet and regular exercise.

But for the past 3 months symptoms are getting much worse.

Do I simply say to a doc “I want thyroid ultrasound”?

It’s common for low SHBG men to have emotional problems, I see it a lot on these forums and these low SHBG men seem to struggle the most of TRT. Your chosen protocol may very well suppress SHBG, moderately large injections always lowered my SHBG, but daily protocol actually allowed an increase in SHBG.

On rare occasions I will see a guys increase in SHBG after starting TRT, most of the time I see a decrease in SHBG. I’m one of those rare cases which see an increase, not decrease in SHBG after starting TRT.

The obesity and insulin resistance will suppress SHBG, improving the insulin resistance allowed for an increase in SHBG since it was the cause of suppression of SHBG.

You can do labs at 6 weeks, but know it may take longer to actually feel the effects of said protocol. Your levels become stable st 6 weeks, but takes longer for your body to use those increase in hormones.

Weird that you have low FT despite injecting 50mg 3x a week with extremely low SHGB.

Not an expert of any kind, but I usually see people with low SHGB having overshot FT even at low doses of Test, which causes high E2 in return and negates any benefits of TRT.

This is why I always recommend daily injections, the smaller doses tend to convert less FT->E2 and you end up needing less testosterone to achieve healthy FT levels which in turn lowers estrogen. When I was on my 20mg EOD protocol (80mg weekly), estrogen was 53, the daily protocol (7mg daily, 49mg weekly) had about the same TT and FT levels, except estrogen was 26.

High estrogen will make it seem like you are not benefiting from TRT, you may even feel fatigued, have brain fog and be irritable. You cannot have a healthy strong libido and good erections if you are emotionally compromised.

I would recommend 12-14mg daily for a low SHBG guy using 27-29 Easy Touch insulin syringes and inject in the shoulders and quads.

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Yeah I’m emotional. I tried things as reading books, going to workshops, etc and it definitely helped. But as always I feel like I’m suddenly back at the beginning.
Emotional rollercoaster, passive, mood swings, etc…

The thing is I’m not obese nor have any problem with insulin resistance. Blood sugar is fine.

I guess I will do another blood tests in 4 weeks. And I really don’t mind waiting for seeing TRT benefits. I’m happy that I have better libido and morning wood.

So you need much lower T dose?

Should I rather just continue with M/W/F protocol instead switching to ED now?

Is that lab now preTRT or after starting TRT?

Anyways google ‘Syndrome of isolated FT3 toxicosis: A pilot study’ and you will find a pdf to read. Talk to your physician and try to get a scan of your thyroid. With the fT3 elevated she/he should do it anyways.

I wouldnt do TRT before you havent sorted out that thyroid problem.

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If I were you, I would switch to a daily protocol on the basis of your pre-TRT SHBG levels. Unless you hyper metabolize T and/or excrete it faster than average, the 150mg weekly might very well be too high a starting dosage.

I would keep the total weekly dosage around 100mg and inject 12-14mg daily and make adjustments as needed at 6 weeks if levels are suboptimal.

I’ll ask for thyroid ultrasound

What happens if I excrete T too fast? Apart from conversion to E2?

No you will just see levels drop more quickly, men excrete T through the kidneys and estrogen
through the liver. You deal with this metabolism of T and/or excretion by inject very frequently.

E2 conversion should be less injecting frequently.

I see. Thanks for the info and help. Appreciate it

T is not excreted through the kidneys, simply because its a hydrophobic (not water soluble) substance. Only a very small fraction of about 1 to 2% is excreted unmodified in urine, its about the solubility of T in water.

Some 50% of T which is not metabolized to active metabolites such as DHT or estrogens is conjugated in the liver to make them hydrophilic (soluble in water) and only then excreted via urine and stool.

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