Low Free T & Low Estradiol & Very High IGF-1

Pharma / TRT Testosterone Replacement
1

For the past year, I’ve had ups and downs with energy levels and after being bombarded with low T ads on TV, I decided to have blood work done. My info and blood work details are below. Here are some questions I am hoping I can get some answers to - or pointed in the right direction on.

  1. Any idea what causes low estradiol levels in men? Understood that E follows T and my T is on the low side, but my E seems way low relative to my T level. The only thing I have found related to low E causes was for women that may apply to men are low body fat and pituitary disease. I have low body fat and a very high IGF-1 level (over the range - see below blood work).

  2. How consistent are blood tests? I’ve been told conflicting information from different doctors that hormones can vary significantly from test to test and also been told it’s typically consistent. I’m questioning some of my results that seem a bit odd - see following questions.

  3. Given my low free T and low estradiol, should I be concerned even though I do not show symptoms (or at least the severity of symptoms) that are typical of these low levels? On the whole, I don’t feel that poorly so it is strange to me given what I have researched (not complaining or wanting more symptoms, but just curious if I’m an oddball).

  4. Is having low free T and very high IGF-1 out of the norm? I would expect these two to be somewhat correlated to each other, but Google has not helped me out much on finding info.

Age: 39
Height: 6’3"
Waist: 33"
Weight: 195lb
Body/facial hair: Medium hairy body (no significant back hair), full beard

Fat carry areas and changes: Carry most fat on rear end (20mm skin fold) and thighs (12mm skin fold). No real changes in fat carry areas since hitting puberty. Minimal fat on stomach/hip (4-5mm skin fold).

Health condition/symptoms: Some minor exhaustion even with adequate rest, increased irritability over last year+
Rx and OTC drugs: No drugs being taken or hair loss/prostate meds ever.

Diet: Typically 40/30/30 with high quality foods. 2k-3k calories/day depending on activity level. Supplement with Metabolic Drive shakes (~40-80g/day) and multi, b-complex, vit C, iron, selenium, ZMA, Carbolin 19. Eat a lot of greek yogurt and protein bars for convenience.
Training: Hockey 2-3x/week and 2x/week weight sessions
Testes Ache w/ fever?: No
Morning Wood Changes: Rarely have them anymore, can’t recall when they stopped.

Bloodwork (report range):
Chemistries
Glucose, Serum 99 mg/dL (65 - 99)
BUN 20 mg/dL (6-20)
Creatinine, Serum 1.19 mg/dL (0.76 - 1.27)
eGFR If NonAfricn Am 76 mL/min/1.73 (>59)
eGFR If Africn Am 88 mL/min/1.73 (>59)
BUN/Creatinine Ratio 17 (8 - 19)
Sodium, Serum 143 mmol/L (134 - 144)
Potassium, Serum 5.2 mmol/L (3.5 - 5.2)
Chloride, Serum 102 mmol/L (97 - 108)
Carbon Dioxide, Total 27 mmol/L (18 - 29)
Calcium, Serum 9.5 mg/dL (8.7 - 10.2)
Protein, Total, Serum 6.8 g/dL (6.0 - 8.5)
Albumin, Serum 4.5 g/dL (3.5 - 5.5)
Globulin, Total 2.3 g/dL (1.5 - 4.5)
A/G Ratio 2.0 (1.1 - 2.5)
Bilirubin, Total 0.5 mg/dL (0.0 - 1.2)
Alkaline Phosphatase, S 67 IU/L (39 - 117)
AST (SGOT) 36 IU/L (0 - 40)
ALT (SGPT) 38 IU/L (0 - 44)

Lipids
Cholesterol, Total 174 mg/dL (100 - 199)
Triglycerides 52 mg/dL (0 - 149)
HDL Cholesterol 70 mg/dL (>39)
VLDL Cholesterol Cal 10 mg/dL (5 - 40)
LDL Cholesterol Calc 94 mg/dL (0 - 99)
LDL/HDL Ratio 1.3 ratio units (0.0 - 3.6)

Thyroid
TSH 1.880 uIU/mL (0.450 - 4.500)
Triiodothyronine,Free,Serum 2.8 pg/mL (2.0 - 4.4)

Immunoassay
Prostate Specific Ag, Serum 1.1 ng/mL (0.0 - 4.0)
Insulin-Like Growth Factor I 258 ng/mL (83 - 233)
Testosterone, Serum 467 ng/dL (348 - 1197)
Free Testosterone(Direct) 7.4 pg/mL (8.7 - 25.1)
LH 3.7 mIU/mL (1.7 - 8.6)
FSH 2.1 mIU/mL (1.5 - 12.4)
Sex Horm Binding Glob, Serum 53.8 nmol/L (16.5 - 55.9)
Estradiol 6.9 pg/mL (7.6 - 42.6)
Roche ECLIA methodology

CBC, Platelet Ct, and Diff
WBC 3.6 x10E3/uL (3.4 - 10.8)
RBC 4.67 x10E6/uL (4.14 - 5.80)
Hemoglobin 13.1 g/dL (12.6 - 17.7)
Hematocrit 40.4 % (37.5 - 51.0)
MCV 87 fL (79 - 97)
MCH 28.1 pg (26.6 - 33.0)
MCHC 32.4 g/dL (31.5 - 35.7)
RDW 13.5 % (12.3 - 15.4)
Platelets 200 x10E3/uL (150 - 379)
Neutrophils 54 % (40 - 74)
Lymphs 37 % (14 - 46)
Monocytes 7 % (4 - 12)
Eos 2 % (0 - 5)
Basos 0 % (0 - 3)
Neutrophils (Absolute) 1.9 x10E3/uL (1.4 - 7.0)
Lymphs (Absolute) 1.3 x10E3/uL (0.7 - 3.1)
Monocytes(Absolute) 0.3 x10E3/uL (0.1 - 0.9)
Eos (Absolute) 0.1 x10E3/uL (0.0 - 0.4)
Baso (Absolute) 0.0 x10E3/uL (0.0 - 0.2)
Immature Granulocytes 0 % (0 - 2)
Immature Grans (Abs) 0.0 x10E3/uL (0.0 - 0.1)
Vitamin D, 25-Hydroxy 21.3 ng/mL (30.0 - 100.0)

2

You’re IGF1 is just barely out of range, but you might want to get an MRI. My IGF1 was ~500ng/mL, and it was caused by an 8mm pituitary adenoma, which I just had removed a month and a half ago. My other symptoms probably caused by elevated HGH/IGF1 are height (6’4", taller than everyone in my family), big hands and feet, slight acromegaly visible in facial features.

The first doc I went to didn’t think I needed an MRI, just prescribed TRT for a year before I saw another better doc who had IGF1 tested and then had the MRI done. You also might want to get prolactin tested, because the most common type of secreting pituitary tumor does produce prolactin. In my case prolactin was in normal range, it was just IGF1/HGH that were elevated. I haven’t tried coming off of TRT yet, but hopefully I’ll be able to.

3

Thyroid not right. Please read the thyroid basics sticky, eval your iodine intake and check your body temperatures. TSH is too high and fT3 is too low.

Blood is a bit thin. Do you have any digestive problems or food sensitivities. These can cause low grade GI bleeds that can affect CBC. You can get a poop smear test kit from your doc that you take home. That detects occult blood in your stool.

If ferritin is low, that blocks efficient fT4–>fT3 generation, which can compound other weaknesses in your thyroid system.

SHBG is really high relative to E2. Quite abnormal. This creates larger TT numbers, but most of your TT is T+SHBG which is not bio-available. Your FT is the measure of your T status.

note *acromegaly *
"SHBG levels are decreased by androgens, administration of anabolic steroids,[19] polycystic ovary syndrome, hypothyroidism, obesity, Cushing’s syndrome, and acromegaly. "
So this weighs against acromegaly.

Also test DHEA-S, prolactin, AM cortisol - at 8AM

FSH is more of an indicator of LH status than LH itself.

Your E2 is low and makes sense relative to your low FT. We see two camps in TRT guys, low E2 and elevated. In your case, your E2 would not appear to be responsible for depressed LH/FSH. So we look for prolactin which can do that.

Why is your liver not clearing T+SHBG normally? Good question. Your liver indicators AST/ALT are up a bit. But that is also a natural result of any training that makes muscles sore. So we can’t make any conclusions.

Hockey: Read about blows to the head in the advice for new guys sticky.

4

KSMan - Thanks for the detailed response.

I had another blood test done to confirm my low T. Pretty much the same:

Total T 558 (250-1100)
Free T 55.4 (46-224) [Don’t understand these values on the range as these are the same units (pg/ml) as my last test, but the values are way higher]
Bioavailable T 111.5 (110-575)
SHBG 48 (10-50)
Vit D 24.3 (>30)
Estradiol <24 (7.63-42.6) [No idea why they give a “normal” range, but didn’t give a specific reading. I’m assuming it is still low given no real changes to T, etc.]

I didn’t get the DHEA-S, prolactin, AM cortisol as I didn’t see your response until after I had my GP do the second T test. I’ll probably follow up to have these done shortly. My GP said, “Well, you are in the normal range for T, so there must be something else causing your lack of energy.” Yeah, normal T levels for a 70 year old man. And the conversation was revolving around Total T, which is wrong obviously.

I started the iodine several weeks ago after I read the stickies. Average AM body temp for 7 days was 97.1. Started at 6.25 mg/day to be conservative and did it for 2 weeks. No significant AM body temp change, so I bumped to 12.5 mg/day last week. I’ve eliminated all known bromine and flouride sources - diet Mt Dew, flouride toothpaste, etc. I’ll keep tracking temps and see what happens.

I can have T/HCG/anastrozole tomorrow if I want it, but I decided to hold off on going this route until I can get a better handle on the root cause. I believe a significant factor is that I am over-stressing my body in several ways - work stress, physical exercise and possibly suboptimal intake of key nutritional items related to T (Vitamin D, zinc/mag, saturated fat, cholesterol, EFAs, etc.). I’m going to give a shot at some lifestyle/nutritional changes over the next month or so to see if I can see a positive change in my T, etc.

5

They changed the labs and different labs can vastly different lag ranges. Seems really bogus, but that is what it is. See if you can do labs with labcorp so your E2 is useful. Ask doc to repeat E2 with labcorp or first lab out of his pocket as the result it totally unusable. Based on where you were with first labs, the outcome is very stupid.

So not much change since first labs. SHBG does not make any sense, read my prior post again.

Get 5,000iu tiny oil based Vit-D3 gel caps and take one a day. Take 20,000iu per day for first week. You need to build up your body’s stores.