T Nation

Just Got Bloodwork Back. Help?


I just got my blood work in and have these results…
F Total TESTOSTERONE ADULT MALE 256 300-1080 (ng/dL)
F FREE T4 1.23 0.61-2.00 (ng/dL)

a bit about me…i’m a 24yo male 6ft tall, broad shoulders, Thin face and extremeties, but have very high body fat around mid section especially for my weight of 220. Had this body fat since i was around 10yo. My doctor wants to order another round of blood work around 2 weeks after the first, but is testing for the same things. What should i ask him to test for and what do my results mean? Any information will be greatly appreciated.

thanks again,


You need sensitive estradiol, SHBG, free testosterone, free T3, Reverse T3 and antibodies. There are lots of people walking around with Hashimoto’s disease and don’t know it because doctors aren’t testing for thyroid antibodies.

Free T3 is the only active thyroid hormone, it’s the end result and is where the rubber meets the road. Testing the chain of events before it (Free T4) is of less value, because Free T4 could be lower and Free T3 high or low normal.

A man can experience low testosterone with total testosterone very high, then SHBG would be the culprit as its scavenges sex hormones and when elevated reduces bioavailable testosterone.

If for some reason you do end up needing TRT, I don’t think this doctor is going to be able to help you. He’s missing some of the most important tests for being able to diagnose and androgen deficiency, something we see quite a lot here on the forums.

Your doctor probably wants to keep the insurance company’s happy and not get in trouble for running extensive testing.


Thank you so much for your feedback. I will notify my doctor that i need a full test done.
My only symptoms are the high body fat, the fact the i may be infertile and have lower muscle mass. I am currently on a weight loss route folllowing a ketogenic low carb diet, would that coupled with a bit of drinking the night before the blood work impact my score that much?
ps how are my Free T score and TSH score? what do they imply?
thanks again,


It’s difficult to judge Free T based off a number, Free T scored can’t be considered good for the fact that you are here. I need Free T to be at the top of the ranges to feel good, even midrange and I feel like death. TSH score isn’t the best, but isn’t the worst either. TSH closer to 1.0 is optimal, when thyroid hormones aren’t optimal TSH will increase past 1.0.

I believe through diet and exercise you may be able to improve thyroid numbers, not testosterone though. You don’t bounce back scoring as low as you are.


That right there is some cold hard truth. I always knew something was up. Is it possible that i have high estrogen thus resulting in lower T? Are there estrogen blockers out there that will decrease it? The only problem i have with TRT is that its indefinite and that it may cause heart problems…my doctor was so confused that he thought he could just prescribe TRT to me without the follow up bloodwork or the specialist. I had to inform him of both. I will be going back for another round of bloodwork at the end of the month. Any advise on what my eating and work out habits should be leading up to it?


TRT doesn’t cause heart problems, any doctor who says so is confused. Testosterone is a natural hormone so I don’t see how it could cause heart problems. Estrogen doesn’t lower testosterone, low LH causes low testosterone.

You better seek a specialist’s not some garden variety doctor, you will likely need to go private. Your doctors comments should be cause for concern. I can tell you what is known, you will get heart disease if you remain Low T long enough.

Old men are expected to have low testosterone, next time you see an old man struggling do fo low muscle mass, think low hormones. You’ve got one foot in the grave and your concerned about raising testosterone back to youthful levels?

Men with low testosterone have a higher mortality rate than someone with normal testosterone levels.

You’re wasting your time with this doctor, it’s time to move on.


It appears that is not true.



so what are some side effects of TRT and how does impact fertility?


There are no side effects to TRT when done right, this isn’t like taking prescription medication and experiencing side effects, these are natural hormones your body evolve to process.

TRT can effect fertility and there are several way to correct this, adding HCG and even FSH to your TRT protocol.


ok, let’s say i take TRT for years then decide to get off of it, will that have any effects? will my T levels just go back to pre TRT levels or will my body not be able to produce them at all?


If you stop TRT you will crash hard, testosterone will go to zero, why would you want to go back to your baseline of 256 ng/dL? As you get older natural testosterone will decrease even further, so if you came off TRT a decade later, your new baseline will likely be lower than it is now.

Look your natural production is finished, you will never produced enough testosterone to feel good again. End game is TRT unless you enjoy feeling like a 90 year old man.

If I had to choose between feeling like a 18 year old, high sex drive, lots of muscles and energy v.s feeling like a 90 year old man just to remain fertile and risk heart disease, cardiovascular disease, I’ll choose the former.



my results are as follows
Total T: 256
Fsh 7.4 normal 1.3-19.3
Lh 7.3 normal: 1.2-8.6
Test free 46 47-244

does this give me any insight?

thanks again,


Are those the only tests completed? It really helps to have a full picture. Lipid panel? SHBG? Any other deficiencies? Liver and Kidneys?
What kind of Dr are you seeing? Is it an Endo? Private Clinic? Primary Care Physician?
Did Dr mention anything about an MRI of the pituitary gland?


That’s primary failure of the testicles, testosterone should be high given LH is high which indicates the pituitary gland is pumping out loads of LH to stimulate the testicles into producing more testosterone, the testicles are struggling as it is.

Please tell me your doctor is running more tests than this.


I am getting more done this weekend.


He stated its a secondary hypogonadism. Which is a problem in the Pituitary gland. Do you know anything about this?


Your doctor is wrong, the pituitary is secreting enough LH for the testicles to produce youthful testosterone. It’s the job of the pituitary gland to secrete LH, it’s doing just that in spades, it’s the job of the testicles to respond to the LH stimulation and produce testosterone.

That’s not happening, that’s a testicle failure.

I’m dumbfounded that your doctor could be so clueless, mark my words, any treatment that this doctor puts forth won’t be successful because his basic understanding is showing a large gap of knowledge that is hinting at disaster to come.

There aren’t that many doctors that truly know how to properly diagnose hormonal issues, let alone treat.

Clomid, HCG will not work.



" Primary hypothyroidism (Gonad problem) is usually diagnosed based on an elevated TSH level. In this situation, the failure of the thyroid gland to secrete sufficient thyroid hormone results in decreased levels of T3 and T4. In turn, there is less negative feedback inhibition at the hypothalamus and pituitary, causing TSH levels to increase (Figure 1). Increased TSH levels are therefore indicative of the diagnosis, and normalization is seen during adequate treatment."

In contrast, owing to hypothalamic or pituitary failure, TSH levels might not increase in response to low T3 and T4 levels.6 Thyroid-stimulating hormone levels can, in fact, be in the low, normal, or elevated range.3This is because TSH pulse frequency and amplitude might be maintained, and additionally, its biologic activity might be reduced with its immunoactivity still retained.2 Furthermore, other hormone deficiencies can affect its measure.7 Therefore, for the diagnosis of central hypothyroidism, one needs findings of low free T3 and T4 levels together with low or “inappropriately” normal TSH concentration in the context of hypothalamic-pituitary disease.3les/PMC3114669/figure/f1-0570677/)). Increased TSH levels are therefore indicative of the diagnosis, and normalization is seen during adequate treatment.
(test= low-normal TSH LH and T3 and T4)

for It to be a gonad problem their must be elevated levels of TSH LH and elevated as in much beyond the normal range. Usually around double.


please look at above reply.


Hypothyroidism is not a gonad problem it is a thyroid problem. Hypogonadism is a gonad problem. You are confusing two different issues.