T Nation

Lab Interpretation Help

Background: 24 year-old male, lean, muscular. I took an SSRI (fluoxetine/prozac) for a period of time, and after discontinuing it (over a year ago), I now suffer from low libido and ED (to a degree). I’ve been lifting heavy and eating well. Before starting the drug, I was hypersexual.

I would greatly appreciate it if anyone could help me interpret the following results, as well as give me some guidance with regard to how to improve my numbers (and consequently my sexual function).

Test taken at noon while somewhat stressed/anxious (probably high cortisol/adrenaline - hate doctors)

Testosterone, Serum 532 ng/dL 264 - 916
Free Testosterone(Direct) 8.8 Low pg/mL 9.3 - 26.5
Dihydrotestosterone 49 ng/dL [ Reference Range: Adult Male: 30 - 85]
Prolactin 6.1 ng/mL 4.0 - 15.2 (on low end of spectrum)
Estradiol 7.8 pg/mL 7.6 - 42.6 (on low end of spectrum)
Estrone, Serum 78 High pg/mL 15 - 65

Adult male reference interval is based on a population of
healthy nonobese males (BMI <30) between 19 and 39 years old.
Travison, et.al. JCEM 2017,102;1161-1173. PMID: 28324103.

EDIT: Took a testosterone test earlier in the week, but I was stressed and it was taken in the late afternoon (4pm), so I don’t think the results were reflective of my normal levels. As such, I had it redone (and the results are above).

1st test results:

Testosterone 3.7 ng/mL|2.2 - 7.8 ng/mL
Sex Hormone Binding Globulin 51 nmol/L 13 - 90 nmol/L
Testosterone Free 52 pg/mL 30 - 140 pg/mL

Thanks again!

Your doctor skipped SHBG testing which would explain decent Total T, low Free T and low estrogen, Free T converts to estrogen. Do not expect managed healthcare doctors to understand hormonal problems related to sex hormones or TRT, most do not know how to diagnose or prescribe appropriate TRT protocols do to dated guidelines.

Your high SHBG is not reversible, the liver is overproducing SHBG and pretty much TRT is the only solution to this problem. I was hypersexual as well before tapering off Klonopin, not so 10 months after tapering. These drugs mess with brain hormones and rewire the brain to function is an unnatural way.

Your LH which is a stimulating hormone for the testicles to produce testosterone is most likely on the lower end. Your problem is your age, most managed healthcare doctors will refuse prescribing TRT to young men. If your doctor recommends clomid to increase LH/testosterone, this is not advisable because clomid increases SHBG further lowering your Free T into oblivion.

You may need to seek private care for TRT.

This is strange, Labcorps ranges top out at 55 for SHBG, you’re right up there at the top. This is where we see the majority of high SHBG men with low Free T and better than mid-normal Total T.

Someone like me would be optimal at 500 ng/dL because my SHBG is usually mid to high teens, on TRT my SHBG increases which is not the norm, most see a decrease. It would be advisable to get a thyroid panel, recommended for those considering TRT.

What about privoron/mesterolone for lowering SBHG? I’ve heard it won’t shutdown T production at lower doses (25 - 75 mg/day)?

Thanks for the reply. I was also on klonopin/clonazepam at one point, discontinued it, and now I’m back on it. I couldn’t handle the withdrawal symptoms, which were still present after some 6 months.

Also, my SBHG doesn’t look terrible. This is one other lab test from the SAME WEEK. Only, I was stressed and they measured my T late in the day (4 pm), so I wanted it redone. The second test was done at 12 noon, and I was somewhat more calm (though I have a phobia of the doc to begin with :/).

First Lab:

Testosterone 3.7 ng/mL 2.2 - 7.8 ng/mL
Sex Hormone Binding Globulin 51 nmol/L 13 - 90 nmol/L
Testosterone Free 52 pg/mL 30 - 140 pg/mL

Benzos are not joke, it took 10 months of hell to get off this horrible medicine! I had to cut up the pills into ridiculously small pieces. I was on 2mg per day for 30 years to control Tourette Syndrome.

These benzos will destroy memory and cognitive function and cause alzheimer like problems, you need to consider a slow, slow taper. Use a pill cutter if you have to, I even heard one guy got his pills reconstituted for a slow years long taper.

I found Vyvanse to help during withdrawal, it kept my mind together. Withdrawing off Vyvanse was a picnic by comparison.

The reason why I had higher testosterone was do to the Klonopin, withdrawal off it decreased my testosterone. I had genetically low SHBG and it only helped in this regard.

Effect of anticonvulsants on plasma testosterone and sex hormone binding globulin levels.

They definitely aren’t good drugs to take long term. The only reason I’m currently taking them is because my anxiety is out of control and I can’t dare touch another antidepressant, since it is the cause of this mess in the first place.

From the first week of SSRI use onward, my libido dropped, numbness increased, morning wood disappeared, and it was harder to cum. However, I was told all these effects would go away after discontinuing the drug…yeah right. I don’t know what it did to my hormones (and neurological state, but that’s another matter), but it’s an absolute mess to resolve.

All thyroid numbers are completely normal (TSH, T4, T3).

The other (SBHG) test was not done through LabCorp. It was done through a hospital with a lab.

Well you would know that the current normal reference ranges are not normal at all, so saying your thyroid numbers are normal doesn’t really say much.

95% of the population has a TSH <1.5, this is normal. As for normal Free T4 and Free T3, this is still under debate. T3 is best for diagnosing hyperthyroidism, Free T3 indicates how much hormone is in your cells.

It would be nice to see a complete hormone panel. Post it if you can.

You’re going to need to run your testosterone up pretty high to get your free testosterone to high normal levels. For your age, those levels are not good.

Hopefully, your doctor will start you at 150mg a week. I would avoid an aromatase inhibitor.

It would be nice to see a complete hormone panel. Post it if you can.

These are the only numbers I have available right now. What other numbers should I have run? LH and FSH?

I haven’t decided on TRT yet. I’m wondering if there is anything else I can do. I would prefer to somehow lower SBHG instead.

It’s not going to happen, let’s say you were able to decrease as SHBG by 50%, you still will have to deal with low testosterone. Your high SHBG is fooling you into thinking testosterone is good, but it is not.

If SHBG were lower Total T would decrease below 300 and Free T would increase a little and your situation is unchanged. There is now way Free T will get to a level where symptoms are completely gone if SHBG is halved.

I’ve seen guys waste years of their lives trying to lower SHBG, they have no chance because SHBG is only going to increase with age.

Excess testosterone is how you deal with high SHBG.

I see. I wasn’t aware that lowering SHBG also lowered total T.

So low dose mesterolone/proviron would lower my total T, even if it increased my free T?

Testosterone bound to SHBG is Total T, it’s the inactive portion of testosterone, Free T is the stuff in circulation.

SHBG is the balance between Total T and Free T. My SHBG is low (14) and I have high Free T at 500 ng/dL.

Right. I understand. But by lowering SHBG, you then “unbind” the bound testosterone, thus freeing it up, correct? This should result in higher free T while not lowering total T?

Am I missing something here? Sorry - I’m new to this hormone stuff. That’s why I’m asking the experts here.

Lipids
CBC
CMP
IGF-1
LH
FSH
prolactin
TSH
free T4
free T3
DHEA-S
E2
total test
free test
SHBG
PSA
VitD

If your pituitary gland was working the way that it should, you would see Total T very high, the reason is the pituitary gland should notice Free T is low and increase LH to get more testosterone out of the testicles.

This isn’t happening and I expect your LH to be below mid-range. Your pituitary gland is sluggish, this is secondary hypogonadism.

A properly functioning pituitary gland would see Total T 1200> and LH above range, most of the time this is not even enough to get Free T to move to where it needs to be.

Most doctors don’t know everything they need know about hormones, sex hormones is an area of medicine only a select few are truly considered experts.

This is everything I have. I have thyroid numbers, CBC, and metabolic panel. I don’t know if this is at all helpful.

Vitamin D is probably high (supplement it daily). Unsure about the others.

WBC|5.91 103/uL|4.3 - 10.0 103/uL|
RBC|5.21 106/uL|4.40 - 5.60 106/uL|
Hemoglobin|15.6 g/dL|13.0 - 18.0 g/dL|
Hematocrit|46 %|38 - 50 %|
MCV|89 fL|81 - 98 fL|
MCH|29.9 pg|27.3 - 33.6 pg|
MCHC|33.8 g/dL|32.2 - 36.5 g/dL|
Platelet Count|157 103/uL|150 - 400 103/uL|
RDW-CV|12.2 %|11.6 - 14.4 %|
% Neutrophils|72 %|%|
% Lymphocytes|21 %|%|
% Monocytes|6 %|%|
% Eosinophils|1 %|%|
% Basophils|0 %|%|
% Immature Granulocytes|0 %|%|
Neutrophils|4.25 103/uL|1.80 - 7.00 103/uL|
Absolute Lymphocyte Count|1.23 103/uL|1.00 - 4.80 103/uL|
Monocytes|0.36 103/uL|0.00 - 0.80 103/uL|
Absolute Eosinophil Count|0.04 103/uL|0.00 - 0.50 103/uL|
Basophils|0.02 103/uL|0.00 - 0.20 103/uL|
Immature Granulocytes|0.01 103/uL|0.00 - 0.05 103/uL|
Nucleated RBC|0.00 103/uL|0.00 103/uL|
% Nucleated RBC|0 %|%|

TSH with Reflexive Free T4 2.162 u[IU]/mL 0.400 - 5.000 u[IU]/mL
Reverse T3, Serum A 16.6 ng/dL 9.2 - 24.1
Thyroxine (T4) Free, Direct, S 1.20 ng/dL 0.82 - 1.77 0

Sodium|141 meq/L|135 - 145 meq/L|
Potassium|4.7 meq/L|3.6 - 5.2 meq/L|
Chloride|104 meq/L|98 - 108 meq/L|
Carbon Dioxide, Total|29 meq/L|22 - 32 meq/L|
Anion Gap|8|4 - 12|
Glucose|102 mg/dL|62 - 125 mg/dL|
Urea Nitrogen|12 mg/dL|8 - 21 mg/dL|
Creatinine|0.86 mg/dL|0.51 - 1.18 mg/dL|
Protein (Total)|7.0 g/dL|6.0 - 8.2 g/dL|
Albumin|4.7 g/dL|3.5 - 5.2 g/dL|
Bilirubin (Total)|0.5 mg/dL|0.2 - 1.3 mg/dL|
Calcium|9.8 mg/dL|8.9 - 10.2 mg/dL|
AST (GOT)|17 U/L|9 - 38 U/L|
Alkaline Phosphatase (Total)|100 U/L|42 - 136 U/L|
ALT (GPT)|15 U/L|10 - 64 U/L|
GFR, Calc, European American|>60 mL/min/{1.73_m2}|>59 mL/min/{1.73_m2}|
GFR, Calc, African American|>60 mL/min/{1.73_m2}|>59 mL/min/{1.73_m2}|

Very interesting and informative. Thank you. I will definitely look into getting LH and FSH tested as well (although I am hemorrhaging money right now).

What could cause a sluggish pituitary?

I should mention I also believe I have HPA axis dysfunction. I haven’t had my cortisol levels checked (yet), but they’re likely high. I feel stressed and uneasy almost constantly :confused:

TSH isn’t bad, <2.5 is usually fine, but seen some guys hit hypo at 2.7-3.0. Free T3 increases metabolism and is the star performer, you never run Reverse T3 without Free T3, these two must be balanced.

You want Reverse T3 <15 ng/dL, yours is fine, but if Free T3 is on the lower end, then the ratio of ReverseT3- Free T3 is off. Your free T3 is most likely fine.

TRT may very well increase demand on the thyroid, TSH will likely increase a little. My TSH went from 0.6–>1.01 on TRT.