T Nation

Low T But High Free T?


I have some basic questions.

I had a testicle removed when diagnosed with testicular cancer about 13 years ago.
I am now in my mid 50s. I have been proscribed testosterone (androgel then testim) all this time except the first few months maybe. 50 mg tubes.

I was never tested for E2.
I did have one Dr say well try upping your dose probably 12 ye240-ars ago, but I not only felt randy all the time but I felt aggressive, so I dropped back down.

I had a Dr test my Free T (first one that ever did this) about a year ago.
Numbers at that time:
T 350 (240-950 normal range)
T bio avail 242 (50-190).
Again no E2 tested, no other meds given except T.
My T when tested (every year or few) from 206 on, was always about 300 give or take some. I don't have the earlier numbers handy but will be tracking them down.

Last week I went to a Dr that specializes in hormones. I know they push pellet (not going to get any) and so far the nurse practitioner/physician assistant has said some really stupid things - like testosterone is not created in testicles, it is created in the prostate (yup, she was talking about testosterone, not after it was changed to something else) but she was only ordering tests so I blew it off.

I am seeing the Dr in the morning and I am not sure I will hear anything better from her.
Latest test results: NOTE: This was with no testim for 3 days, I wanted to clear it out some.
thermometer test was fine 1st thing in morning (high 97) and mid day (got up to 98.6)
TSH - 2.72 (.45-4.5)
T4, free .82 (.82-1.77)
T3, free 2.7 (2.0-4.4)
Reverse T3, serum 13.5 (9.2-24.1)
I think my thyroid fine, I have no symptoms and the only really off number is T4. I know that low T can create low Thyroid (and that low thyroid can mean T can't be maintained at the right level). I want to try and get T up and then recheck thyroid to see if T4 came up some.

Estradial 20.3 (7.6-42.6) - not horrible but could be better
Testosterone serum 114 (348-1197) yup real low especially with no T added in
Free T 5.3 (7.2-24) hmmm, only 2nd time taken and this one is very low.
DHEA 54 (31-701)
DHEA-Sulfate 106 (51.7-295)
Are these numbers ok? I read on the forum ignore DHEA, that DHEA-S is the important one.

Prolactin 22.9 HIGH (4.0-15.2) - ok, I don't know what this being high means.

PSA .8 (0-4), always been "normal"
DRE always been "normal"

I did some playing and I feel bad with no T in me for 3 days, but I can't tell the difference if I have 50mg T (testium) in me vs 75 mg T (testium) - done for a few days in a row).

Vit D is low 23.2 (30-100), I used to do supplements, guess I should again.
They didn't test Vit B, but it was tested about 1 1/2 years ago and was great (little higher than range)

Age 57, Male, about 220 lbs (190 would be ideal), waist about 43 inches.
Lean in teens and 20s, I was a runner and then got into biking in my 30s (over mountains as well as rode bikes).
I have what I call tree trunk legs (muscular).
I have been doing more weight lifting just the last few years (girlfriend got me into kettlebells then with a trainer that does cross fit type exercises, barbells, dumbbells, pullups, push ups, etc. with some rowing and other cardio mingled in). 45 min a day 4-5 times a week and weekends I do some elliptical or biking with a little weight lifting.
I muscle up quickly and I now have very defined arms.
But I have a big gut - I struggled with this on and off since my 30s, but it just seems bigger and bigger the last 5-10 years, and I have small man boobs.
Oh, and my butt is small and flat but not fat (don't know why my arms and legs bulk but not my gluts especially with my barbell work). And I do have some small love handles.
I am not V shaped naturally, I am more barrel chested.
Hair has always been medium, enough to see and run some fingers thru in all the important areas including chest and legs, but thick or matted. Hair is more fine (including on head).

Since 2010 I was diagnosed with high blood pressure & high cholesterol. I want to get T into a good balance and then see where these are (I know T effects these).
No hair loss or prostate drugs ever.
Diet - fish daily during the week for lunch with veggies and oatmeal for breakfast of, veggies - 3-5 servings a day, fruit 1-2 servings a day. Lean meats, beans sometimes, cottage cheese. I do bread or rice or pasta sometimes, but not regularly. At home no processed foods and no breads/pastas/only brown rice or quinoa and not regularly, most of my eating out is the same.

I do take some low doses of meds - statin & for high blood pressure. I take some suppliments like vitamins, fish oil, etc.

I am playing with testium some right now to see what level feels like too much or too little, and then I will get it to a place that feels good and get another blood test. I am considering moving to shots especially if I have to really increase the gel to get the level I feel good at.

So questions:
From what I read, I NEED to be on an AI. But not a SERM? Or at least try the AI first?
What AIs are better ones these days? Sounds like a Type II might be better to play with in the beginning (effects wear off quicker)?

Free T - ok, I read in the forums you guys want this and don't think it is a problem, but mayo clinic is who tested for it (yeah, a regular doc, an internist). When should I be concerned about Free T and when shouldn't I be concerned about free T?

Thanks for the help,


Please read these stickies:

  • advice for new guys
    -- need more lab data, CBC, cholesterol
    -- list all medications, OTC and Rx
    -- note info re statin drubs and CoQ10 - Ubiquinol
    --- do you have a chronic minor cough or muscle pains

-thyroid basics
-- your fT3 should be near 3.3, you are almost 20% below mid range.
-- post waking and mid afternoon oral body temps
-- post history of use for iodized salt and vitamins that list iodine

- fish oil caps, flax seed oil or meal, nuts
- high potency B complex multi-vits with trace elements/minerals and iodine
- Antioxidants: vit-C, natural source vit-E
- 25mg DHEA
- 50-100 mg CoQ10 in Ubiquinol form, not cheap
- 5000iu vit-D, find as tiny oil caps, [Walmart has these]

Need these lags, you can skip the ones done already:
- cholesterol
- ALT/AST liver markers
- fasting cholesterol
- TT
- FT
- E2
- FT
- fT3
- fT4

At your age, assuming age related decline and not pursuing causes of any secondary hypogonadism that might be fixed as fixed is not very promising at your age.

Weight gain can be from poor thyroid function and hypogonadism. Do not get T tunnel vision.

Free T, FT, gets the job done. Most of your TT is T+SHBG and the T in that is non-bioavailable. There is also albumin+T. That and FT are bioavailable T [Bio-T]. FT levels are vary variable during the day, so the numbers are very definitive. Your Bio-T looks good, but your range will be age adjusted. I do not know what a youthful range would be and you cannot compare FT of bio-T across different laboratories.


KS covered almost everything for you, listen to him.

High prolactin means you need an MRI to rule out prolactinoma.
LH and FSH data would be nice to have to corroborate.

At your age and with your medical history T+HCG+AI is the best approach.

Well done TRT once turned in should have some nice benefits for you.


Your numbers off the gel don't mean much, since your own T production has been shut down for so long.

Your numbers on the gel (lowish T but high free T) mean that your SHBG (which binds T) is very low.

Very low SHBG is a classic indicator of insulin resistance, metabolic syndrome, or diabetes. This could also explain your weight gain. Have you been evaluated for diabetes?


With the transdermal T products, FT can spike and then drop. So those numbers are not very useful. If you get a good TT and good E2, that would be a good indicator. With injections that are done frequently, FT can be quite steady and then FT is a good indicator.

Yes, high prolactin would be expected to lower LH and FSH.