T Nation

Low T, Help Interpreting Blood Test

Hi guys.
So a little background about myself. I am 25 years old, 150lb, 5’'8, in solid physical shape at about 10% bodyfat, lift 5 days a week + 3 cardio sessions, and have a well balanced diet eating 2800-3000 cals a day. I have never taken steroids. Decided to request to have my T levels checked from my GP in 2018 after doing research on low libido. My T levels came back at 380 ng/dl and my testosterone free came back at 50 pg/mL. After doing more research, once I got my results, I realized that i always had most of low testosterone symptoms ranging from low energy, no erections and no libido whatsoever, brain fog, memory lapses, no motivation, lack of appetite, and weak in the gym. Prior to getting my T levels checked I had always though that this was “just me” and didn’t attribute it to low testosterone. So i recently went to an endocrinologist and was definitely suspect because a lot of endos are not well acquainted with Low T and that they’d say that my T levels of 380 fall within the “normal range”. Anyways, she was concerned with my low LH levels (1.2 mIU/mL) and subsequently had me go in for blood work. I got bloodwork done early in the morning (810 AM). I’m currently trying to look for an endocrinolgist that is well versed in TRT in Brooklyn or Manhattan, NY if anyone here can reccomened anyone? If you guys can please help me in interpetting my blood results(attached below) I would be so appreciative. Thank you guys. Ray

Your Total T is low compared to your SHBG levels, testosterone binds to SHBG and when SHBG is elevated, it handcuffs your Free T, so guys with SHBG towards the higher end need more Total T to equal the same Free T as a guy with lower SHBG.

Free T can be affected by as much as 50% having SHBG go from the lower end to the higher end of the ranges.

Total T isn’t bioavailable, only Free T is bioavailable and it’s on the lower end. LH confirms you have a T deficiency. TSH is elevated because your pituitary gland isn’t happy with Free T3 levels, Reverse T3 needs to be tested because if elevated, it may also help explain why TSH is elevated.

A lot of doctors don’t bother testing Reverse T3 do to costs, it’s the most expensive thyroid test.

Most endocrinologist fail to properly diagnose T deficiencies as you already are aware.

with his low lh is he considered secundary? If lh is low it also means his t is low? so basically if you increase t lh increases?

Thank you so much for your response. Is my SHBG ridiculously high to the point where I can’t lower it with some natural remedy. Just read a few posts here with guys in the 55-70 levels of SHBG where TRT was the only protocol to reduce it, but I’m at 42. Also worth noting that my AST levels are still high but I had a liver ultrasound done a year ago, due to elevated liver enzymes, and results were okay. Did research and apparently weight training can increase AST levels so I wasn’t to concerned but now I’m thinking that it can be related to my high SHBG…? If anyone can refer an endo or urologist in NYC area please lmk! Even willing to travel out to see someone that is well informed in this. Thanks guys

Ray Sofer

It just so happens I got a liver function test the very week I stopped TRT and liver enzymes skyrocketed, I look at past levels of AST while on TRT, quite a dramatic difference! My AST levels weren’t that high since before going on TRT.

I went with a telemedicine clinic Defy Medical because I got tired of shopping around for knowledgeable doctors.

He is secondary.

Wow interesting. I know that there are age clinics here in Brooklyn but I’m hesitant due to snake oil business so would be a last resort for me. Did the clinic also prescribe you HCG and AI? Because remaining fertile is crucial for me. Thank you.

Ray Sofer

I was asked if fertility was a concern and I state it wasn’t, then Dr. Saya then recommended against HCG, but I did need an AI and one was prescribed.

Defy can prescribe FSH injections for fertility as well.

Defy is located in Florida correct? Do you have to go in for injections or is everything sent to you for self-injections?

Ray Sofer

Yes, Tampa FL.

I inject at home 20mg every 2 days, Defy doesn’t treat you like an invalid.

My test numbers were just under yours when I started TRT almost six years ago, at age 59.

As for hCG, you can hold off on that until ready to conceive. There is some concern with long term use. Any idea as to when that might be?

Regarding thyroid, you need it regardless of where your reverse T3 level is. I think I’d start with test and see how your respond, recheck thyroid later. With those numbers, you’re going to need it anyway, but I would want to see what testosterone does before adding thyroid. My guess is you’ll like test, but will still feel as though you could be better.

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hey rayray,
some questions:
Did you check your D vitamin lvls ?
What about your fat intake, what source ? how many / day?
Eat regular sea foot ? how often ? (iodoine/omega3)
C vitamin foods?

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Hi highpull,

Thank you for your response.

Wow. I’m definitely showing my next endocrinologist this post for comparison if they say that my numbers are “normal”. I want to a have kids within the next 5 years. Really? How long are we talking? Had no idea that there was some concern with long term HCG use. Regarding thyroid, so in other words my T3 and T4 numbers are a concern? That’s super unnerving to think that TRT won’t produce optimal results if my thyroid is compromised…

Hi Straff,

Thank you for the response.

It was checked in August 2018: Vitamin D 25 hydroxy total 51.9 ng/mL. I’ve been consistently eating in between 70-90 grams of fat a day. Seafoods I eat are salmon and tuna fish. My fat sources consist of avocado, almonds, walnuts, salmon, dark chocolate. As for vitamin C, I eat a bag of frozen broccoli almost every night.

If you have to explain to your doctor what normal levels are in health people suffering no symptoms, it’s time to start looking for another doctor. In reality endocrinologist only care about lab ranges as they are taught to treat the reference ranges and ignore symptoms.

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Yes. Which is exactly why I’m not going back to the endocrinologist I most recently went to as I felt she was unqualified. I have high hopes for the endo I’m seeing in NYC in 2 weeks. If it doesn’t work out then I’m going to resort to looking into working with a men’s clinic. Found one in Brooklyn, Royal men’s medical center.

It is possible. However, your TSH is well into the upper end of “normal” range, while fT3 is close to the bottom. Your brain is trying to get more thyroid hormone out of your thyroid gland. There may be a conversion problem (reverse T3 would bear that out) or simply poor receptor site sensitivity. T3/T4 would fix it, get your TSH down to nothing and your fT3 up to 4.0, you’ll feel better.

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Any natural/effective ways you suggest in increasing FT3 and lowering TSH? Thank you.

I’ve never known anyone to decrease TSH and increase fT3 without thyroid treatment. Unless you are really bad off, a sick care doctor (endocrinologist) is going to tell you you’re fine.

A sick care system instead of a health care system. … We have a medical (that is, sick) care system—a system that waits until we become ill before it kicks into action—instead of a health care system focused on helping us stay healthy.

You are sick when you drop below ranges, however if you want to optimize health, a sick care doctor will not listen. They will tell you that you’re fine or within normal ranges.

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Gotcha. Are my LH and FSH numbers so low where it would be advised to get an MRI for my pituitary?

Ray Sofer