T Nation

Low T, High LH, Low-Normal FSH, High Albumin

Hi everyone

I was hoping I could get some advice on my most recent bloodwork. Some background about me: I am 25m, done three blood tests till now and always tested low on T. Typical symptoms: low energy, libido, ED, slow gains

Latest bloodwork

Albumin: 54 9/L (Reference level: 34-50)
FSH: 1.9 IU/L (Reference level: 1.5-12.4)
LH: 9.6 IU/L (Reference level: 1.7-8.6)
Total Testosterone: 12.9 nmol/L (Reference level: 7.6 (lol) - 31.4)


I am in UK and NHS would not help me as my t levels are “in range”. So I approached a private clinic and they wanted me to get two blood tests done to detect if it is primary or secondary hypogonadism. I am due to talk to them in next few weeks but wanted to get your view on my bloodwork.

My understanding is it is primary hypogonadism as pituitary gland is working fine (high LH) but I am confused as to why my FSH is low. I have read that LH and FSH gone up or down together. Would love to know what you guys think.

Guys in 20s who went on TRT, what are your experiences? Did it help with your symptoms?

Thank you

You are primary hypogonadism, LH is high so you should have high levels of testosterone, testicles are damaged. I’m not at all surprised an NHS doctor miss that one? You are on your way to becoming infertile with low FSH which is needed for sperm production. If kids are important freeze sperm now before TRT.

You’re missing complete set of labs for thyroid, if thyroid is subpar so to will TRT. TRT only works if other system are function properly. Your SHBG level is excellent, you should respond well to TRT only if your thyroid is optimal. NHS is useless, good riddance.

Thyroid labs needed:
Free T4,
Free T3
Total T3,
Thyroid Antibodies,
Calcitonin, Thyroglobulin

Thank you for your response. Bummed about the fertility thing as I do want to have kids in the future. Can I not start using hCG to up my LH/FSH when I want kids?

I am not aware of how Thyroid interferes with SHBG, will look it up.

This test from medichecks looks like what you are recommending on Thyroid: https://www.medichecks.com/thyroid-function-tests/thyroid-check-plus

If you are primary then hcg will have little to no effect on your over all TT levels.

Thanks for your message. Agreed, I was referring to my LH/FSH levels in a future date when I might want kids.

LH is released by the pituitary gland, it tells the testicles to produce testosterone, your testicles are struggling to produce testosterone. HCG is used on guys who’s LH is low and testicles that are function properly to raise LH and keep a guy fertile provided his FSH isn’t terribly low. It would be in your favor if LH was low and FSH higher, than when you start TRT LH will drop to near zero and then you would add HCG to your protocol to raise LH provided FSH isn’t bottomed out.

You want the Thyroid Check UltraVit rT3.

The future doesn’t look to bright for kids, now is the time to freeze what little sperm (if any) you have left. Once you start TRT it will shut down your pituitary gland, this will drive LH into the floor and FSH will be affected. There’s no guarantee once you stop TRT in the future that FSH will recover, but by then you could have complete testicle failure and by then it’s too late.

You are 25m. It looks like you are primary. I suggest a testicular ultra sound. You are 25! your balls should be working.
Even if you are primary, you can take HCG with TRT. With primary mono-therapy with HCG may be useless. Still good at your age to add HCG to TRT to keep your balls alive.

Edit - as others have said. get the thyroid labs before you start any therapy. While doing your thyroid labs try to retake LH/FSH labs.

Thank you, this has been very helpful. I will get the Thyroid labs and ultra sound per you suggestions and report back.

Edit: Are you suggesting ultra sound to detect possible testicular cancer? I do have high WBC which is concerning.

To check for varicocele, and hopefully they use Doppler to to check blood flow in and out. Any inflammation. Testicular tumors (unlikely but the age you would get them you are in).

How high was your WBC count?

12.3 10^9/L (Reference range: 3-10)