T Nation

Low Total T and E2, Normal Free T?

Can someone please help me make sense of my lab results?

Testosterone Serum (ECLIA) - 320 (250-900)

Estradiol Serum (ECLIA) - 16 pg/ml (25-60)

Free Testosterone (ELISA) - 13 pg/ml (1-28)

TSH, FT4 are mid range

I am 20 years old and I suffer from anxiety, irritalitability, no morning wood, low energy, brainfog.

Also excessice urination, thirst and low BP whi h may be caused by low E2

So how is it possible to have low Test and Estradiol and at the same time have normal free testosterone? And what would be the solution for this?

Its not normal; ideally you’d probably feel better at double that amount. Just cos it’s in range doesn’t mean you’ll feel good.

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Ok , but how can I go about fixing this? No doc will put me on TRT with these numbers and I already workout and eat healthy.

I was put on TRT with 305ng TT. I started at a clinic first then found a doc to continue treatment. You probably wouldn’t get a normal doc to start you, but a place like Defy or a local clinic probably would start you. They know that it’s more about symptoms.

I don’t know a natural way to increase FT unfortunately :frowning:

Probably low SHBG, or you’d would feel worse than you do. TRT likely solution.

If you go by the sick care reference ranges you’ll always be in a disease state, the reference ranges include old men with diabetes and young men with HPTA’s that function like champs.

Young men are normally at the top of the ranges and old men closer to the bottom while middle aged men are well somewhere in the middle.

The reference ranges for growth hormone/IGF-1 are based on age, the problem is the reference ranges for testosterone do not account for age because there is a huge bias against TRT within the medical community.

I’m not seeing LH or FSH, these would hint at secondary hypogonadism a pituitary failure or primary hypogonadism a testicular failure.

So your levels are normal for a elderly man and the last time I visited my old man he was acting the part, irritable, grumpy, low energy and his memory isn’t as clear as it used to be and he hasn’t seen a morning wood in ages.

TSH and Free T4 do not speed up every cell in your body, Free T3 is the active thyroid hormone that increases energy and metabolism within all cells. There are no T4 receptors in the body, in fact there are more T3 receptors in the brain than in the entire body.

TSH is a poor biomarker for checking thyroid status, I’ve seen men with a TSH of 2.7 and full blown hypothyroid and a guy with a TSH of 3.3 and no symptoms. If you wish to see how the thyroid is performing, you’ve got to check the active thyroid hormone.

You are using the Direct Immunoassay which have been shown to be inaccurate and overestimate Free T levels by up to 40%, the Equilibrium Dialysis or Ultrafiltration are the gold standard for lab testing. So you are not even using a reliable lab testing.

I would trust the Total T and estrogen before relying on the Free T results. SHBG affects the balance between Total T and Free T, testosterone bound to Total T is not bioavailable and your body will see none of it, the Free T is what truly matters.

If SHBG is lower, then this would help explain why Free T levels are higher, but testing methods are also another factor.

You need TRT, but you’ll never get it within sick care 300>, forget it it’s not happening. You need to seek private care because sick care will refuse levels 300>.

Also it will be almost impossible for you to get TRT based solely on your age, it is frowned upon doctors prescribing TRT to young men with immature HPTA’s, another reason why most doctors would send you packing and would refuse to even talk about TRT.

If you were 40-50 years old, HPTA by then is fully mature, TRT is no problem as long as you are <300, an arbitrary number not based on clinical research, but an attempt to restrict what is demonized in western medicine. Some insurance companies deny TRT until <200.

The actual research shows a strong association with cardiovascular disease <480.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

The locally weighted regression showed that total testosterone levels of 440 and 480 ng/dL were associated with increased Framingham CVD risk and an increased probability of increased hsCRP, respectively. Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk.

T is definitly too low for your age. But i would strongly recommend to try to find the root cause of this at your are. At your age low T is typically a consequence of an underlying disease

For how long is this ongoing? Did you undergo normal puberty in the sense of body hair growth, muscle gain, libido etc? LH, FSH and Prolactin?
Kidneys ok? Blood sugar ok (reg freq urunation)? Extra mass in your pituitary?
.

Thanks for the reply. I am gonna get some more tests now including SHBG. But if free testosterone is what trully matters and mine is actually mid range maybe my problems are from something else and TRT won’t help?
My TSH is 1.56 (0.3-4.5)
FT4 1.5 (0.5-2)
If anything I might be a little hyperthyroid with these results I think lol

I think what you need is a thorough medical checkup. We are all not MDs and you will get feedback based mostly on personal experience and/or literature, this cannot substitute for consulting an expert (although the expertize for TRT is very high here).

As mentionet your T levels are too low for your age, total T and free are typically interpreted together. Many of your symptoms can be explained by the low T level, but the main question is why the level is so low.

You could have primary hypodonadism caused by an injury or by disease like mumps. You could have Kallmans disease or an adenoma in your pituitary. You could also have lowT caused secondary to diabetes or other disease state which causes a high degree of systemic inflammation.

If you post more info about you and your history we might be able to point into a direction but your situation considering your age requires more attention then just exogenous T.

Dont give up and keep looking for a cause.

I am thinking probably primary hypogandism. I had one undescneded testicle which was brought down when I was 2 yrs old but it didn’t really develop properly and is noticably “softer” than the other one. I also had a couple hard hits on my testicles as a child. I have always had most of these symptoms but in the last few years it has been getting worse.

I am visiting an endo on Monday

Not necessarily, I see men complaining of low testosterone when scoring midrange all the time, in fact recently there was a guy with Free T closer towards the top and notice improvements on TRT.

You are failing to considering another factor, androgen receptor sensitivity. It is known that some people has what is thought to be T3 resistance at the cellular levels because they don’t respond to normal thyroid hormones, they require much higher levels to feel normal.

If someone has less sensitive receptors, they will need more Free T v.s the next guy. I need hardly anything, my Total T has been hovering between 97 and 119 ng/dL and I feel alright and do have morning erections and some throughout the day, but muscle mass is low.

I do plan on restarting TRT, hopely soon.

Man you’re lucky I haven’t had a morning erection in probably 5 months… I hope I can find an understanding doctor because here in Eastern Europe they are very conservative

I went to an endo and he did an ultrasound of my testicles which showed nothing abnormal and also made me do other tests. Here are the results today (from a different lab)
Testosterone Serum (ECLIA) - 460 (300-1000)
Estradiol Serum (ECLIA) - 26 pg/ml (11.6-41.2)
Free Testosterone (calculated) - 10 ng/dl (5-21)
SHBG - 26 nmol/l (18 - 76)
Albumin - 4.7
LH - 3.6 mu (1.8-9.6)
FSH - 2.8 mu (1.4-18)
Prolactin - 246 (45-375)
DHEA-S - 568 (70-492) HIGH

So this test shows my T 140 points higher than the other one and Estradiol in range too(but this may be because I took hops extract every day to raise e2). Free T is midrange in both tests. What do you think is low T responsible for my symptoms or it’s something else? Also is mri justified with lowish LH and FSH? Thanks

Personally I think you should look at lifestyle changes. You mentioned you’re young. Are you partying? Not getting great sleep?

Your numbers from this last test are low, but not super low. My TT, prior to TRT, was in the high 100s.

Maybe search on google why your DHEA is so high compared to the rest of your numbers.

says high DHEA can mean an adrenal tumor or other scary stuff… I will ask the endo but next appointment is in 2 weeks. I already workout 3x a week, eat clean and sleep around 7 hours a night. But I feel like complete sh*t

Any thoughts on my new results bro?

Yes it is more than likely responsible for your symptoms, you are scoring in the range of President Trump and need I remind you of his age. Young men are build for high testosterone right out of the gate and as we men get older our receptors become less sensitive and levels lower.

Your levels didn’t necessary improve because of lifestyle improvements on your more recent testing, it’s just a natural daily fluctuation, nothing more. Your levels are maybe better on that particular day and lower on other days and so on.

The problem is a lot of doctors out there are participating in managed healthcare where insurance companies dictate when you get treatment, in range is normal and your levels are in range therefore insurance companies send you packing and the doctors full well know this and turn around and say your levels are normal, they are within range.

Even if your doctors wanted to prescribe TRT, he can’t because the insurance companies say no and we will not cover treatment. If we compare you to the rest of the population, these levels are seen in very healthy 60-70 year olds like the US president.

The averages for men <25 years old is 669 ng/dL, 25-34 it was 617 ng/dL 30-34 the result 621 ng/dL, 35-39 is 597 ng/dL.

You should be here -->669 ng/dL.

I’m unable to provide links, Google “Testosterone Week: What’s a “Normal” Testosterone Level and How to Measure Your T”

Yeah I will test for a thrid time and if it comes <400 again and the endo refuses to treat me I am just gonna self prescribe I think. I can’t stand living like a zombie anymore