T Nation

Low Free Testosterone. Advice Needed


#1

Hi,

I’m new to this forum. I recently had two sets of blood work done which showed low normal total testosterone (294ng/dl) and below normal free testosterone (8.1ng/dl). I was just wondering if anyone had any idea what could be wrong? Would these levels warrant TRT?

When I spoke to my GP he said he had absolutely no clue about any of this.

I’m an otherwise healthy 35 yo male. Very clean diet and regular exercise consistently for the last 10 years.

Symptoms

Brain fog
No libido at all
No morning erections (can’t even remember when I had these)
Smaller / shrinking testes
Noticeable drop in physical strength
Generally tired
Thinning hair
Lack of drive (I used to be extremely motivated)

First blood test

D.H.E.A. SULPHATE 6.970 umol/L (0.44 - 13.40)
FOLLICLE STIM. HORMONE 5.26IU/L (1.50 - 12.40)
LUTEINISING HORMONE 6.15IU/L (1.70 - 8.60)
TESTOSTERONE 14.2nmol/L (7.60 - 31.40)
FREE-TESTOSTERONE *0.283nmol/L (0.30 - 1.00)
SEX HORMONE BINDING GLOB 35.8nmol/L (16.00 - 55.00)
FREE ANDROGEN INDEX 39.66 Ratio (24.00 - 104.00)
17-BETA OESTRADIOL 98.4pmol/L (0.00 - 191.99)

Second blood test

TESTOSTERONE 10.3 nmol/L (7.60 - 31.40) 294ng/dl
FREE-TESTOSTERONE(CALCULATED) *0.282nmol/L (0.30 - 1.00)
17-BETA OESTRADIOL 103pmol/L (0.00 - 191.99)
SEX HORMONE BINDING GLOB 17.9nmol/L (16.00 - 55.00)

Third blood test

TESTOSTERONE 9.2 nmol/l or 265ng/dl

Any help or advice would be appreciated. Especially in understanding why my free testosterone is so low and if I should pursue TRT as a treatment option.


#2

Usually when someone has a low free test number, they have high SHBG, your first SHBG was a little elevated, 35, but still good. Then your second one was 17, which is on the lower end. Your total test numbers warrant TRT. Do you take medication?


#3

I don’t understand how your SHBG could drop from 35.8 to 17.9 between 2 blood tests. You do need TRT but with your SHBG bouncing around makes recommending a protocol difficult. Wonder if it could be a lab error. I always recommend two injections per week unless your SHBG is crazy high.


#4

Thanks for the reply. I don’t take medication. I was equally confused as I thought low free t would be caused by high SHBG also.


#5

@systemlord thanks. I’m waiting on a third set of bloods from my GP. Hopefully that will clarify whether it’s a lab error. They’re also checking thyroid which I’ve been told can affect test levels. Confused.


#6

Maybe @KSman has some insight into what might cause low free testosterone when SHBG is low or normal?


#7

How long between the labs?

Repeat labs need LH, FSH, prolactin
If body temps low, TSH, fT3, fT4 [not T3, T4]
CBC with hematocrit
fasting cholesterol and glucose
AST, ALT

Were testes small for 2nd labs but not for 1st? [indicates low LH]

Are testes hanging or up tight [indicating very low LH].

Please eval overall thyroid function, see body temperature below…

Do you now feel cold easily?
Are you getting iodine from iodized salt?


Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#8

Thanks @KSman labs we’re about 2 weeks apart. Testes are up tight generally and feeling smaller. LH appeared normal in first bloods.

Getting more bloods next week and will be getting thyroid checked. My mother has hypothyroid so I’ll definitely investigate that first. I don’t generally feel the cold to be honest and not aware of any changes recently in that area.

Regarding iodine I don’t know to be honest. I live in the UK and have a generally low salt intake I’d say.

Thank you for the pointers. I’ll investigate all of this and based on my next bloods decide if I need to pursue TRT.


#9

The first bloods were taken a few weeks ago and had LH at high normal with FSH fairly normal also.


#10

Testes pulling and shrinking up is indicative of very low LH while lower LH can reduce size of testes.

Many in UK are not getting enough iodine. It is assumed that you will get that from dairy food, even as many do not consume much of that. A few shops there have iodized salt and you can get 150mcg iodine and 150-200mcg selenium in some multi-vits. Selenium is very important when introducing iodine after when deficient.

You need to eval with oral body temperatures.

Low iodine intake often affects whole households, check body temps of others too.


#11

Some further bloodwork has indicated an autoimmune thyroid disorder (likely Hashimotos). There is a history of hypothyroidism in my family. My TSH is up at 6.7 mIU/l (0.27-4.20) and I have elevated TPO antibodies at 137 IU/ml (0-34). I’m unsure if this is the cause of the low testosterone. My latest total testosterone was 265ng/dl so I am going to see a TRT specialist in January. The NHS have been useless but did do a few blood tests for free. I had to get the antibodies tested via a third party.


#13

What’s surprising is your LH and FSH look more than decent which don’t correspond to your T levels at all, with good LH and FSH I expect to see higher T numbers. Aren’t you glad you didn’t take the NHS diagnosis that you are fine?


#14

Yeah I was also confused by this. I’m getting further tests done again which include LH and FSH. The NHS doctor has ordered some more tests which will come back soon. My SHBG is also a bit all over the place.

The NHS doctor basically said he wouldn’t help with TRT and suggested I go to see an endo. I’m certain now that I’m not fine. Likely I need both TRT and thyroid treatment.


#15

There are lots of interesting studies linking thyroid and testosterone levels so it’s possible there is some interaction there causing the problem.

What is interesting from my point of view is that almost every patient I treat who has high thyroid peroxidase antibodies also has a corresponding low testosterone level.

Some of this may be due to thyroid hormone and its effects on testosterone levels, but I have also noted improvement in autoimmune diseases with testosterone replacement.


#16

Most GP’s here in the states would attempt to give TRT to a patient without any clue or training in administering it, it always ends up with a referral to an endo. More often than not we end up with a clueless doctor, TRT has to be the most misunderstood treatment on earth who the only person that knows much of anything is the patient after visiting a couple of forums and doing a little bit of research.

Hopefully you many not even need TRT.