T Nation

Need Advice, Bloodwork Attached

Hey Guys, I just stumbled across this forum and thought maybe someone can give me some advice. I’ll try to keep this post as concise as possible. Thanks in advance!

Starting from the beginning - I’ve had problems concentrating and maintaining focus, putting on muscle, night sweats, low energy levels, remembering things, etc since high school/college. My GP gave me a blood test back in 2015, and determined that I have low testosterone levels as well as elevated prolactin levels. Not sure what caused this - I did take accutane for acne when I was 15, 17 and 22 (6 months each course) and it eliminated my acne. I also partied a lot in college.

Ever since my initial labs, I’ve been trying to figure this out on my own. I have seen an endocrinologist that prescribed me cabergoline. The medication worked a bit initially but soon gave me headaches. I’d figured that the cabergoline was depleting my prolactin levels so I started to take a lower dosage - .25MG every 3 weeks instead of .5MG every week. My headaches were gone but my total testosterone stayed low…(all of this is reflected on my attached file) I also went in for a MRI to see if my pituitary gland has a tumor/abnormalities but the result came out negative. Since then, I have stopped taking cabergoline in 2018 and haven’t done much to follow up with the endo.

I’ve recently been lurking the forums and completed some bloodwork referencing a lot of what other members test for. Please see below for summary:
Total Testosterone, Serum - 463.7 (264-916 ng/dL)
Testosterone, Free, Direct - 25 (9.3-26.5 pg/mL)
Vitamin D, 25-Hydroxy - 36.5 (30- 100ng/mL)
Prolactin - 27.8 (4-15.2 ng/mL)
LH - 3.6 (1.7 ‐ 8.6 mIU/mL)
FSH - 2.9 (1.5 ‐ 12.4 mIU/mL)
TSH - 3 (0.450 ‐ 4.500 uIU/mL)
SHBG - 15.8 (16.5 ‐ 55.9 nmol/L)
Dihydrotestosterone - 25 (30 - 85 ng/dL)
% Free Testosterone (Dialysis) - 2.9 (1.5 - 3.2%)
Free Testosterone, Serum - 132 (52 - 280 pg/mL)
Bioavailable Testosterone, % - 63.6%
Bioavailable Testosterone, S - 289 (128 - 430 ng/dL)
(More results on the attached file)

Since my last follow up with my endo, I’ve been taking 4500IUs of Vitamin D3 and 15mg Zinc w/ 2mg Copper for the past 2 years and have felt a little better. My recent labs surprised me with my total t levels going up a bit to 463ng/dL(not nearly at optimal levels), but also my free testosterone is at 25pg/mL?? Not sure how that works, maybe because of the low SHBG? But I also have low DHT??

Not sure if this can be fixed with just supplements/nutrition, I’ve been thinking about starting TRT/HCG. I’ve attached a spreadsheet with my lab results that I’ve been tracking since 2015. Hopefully you guys can give me some input. Thanks again!

Personal Stats:
27 y/o male, roughly 165lbs, 20-25% BF according to InBody 270 (US Navy Method - 17% BF), 58 - 59" // Lift weights 3 times weekly, still hard to lose bodyfat…

Nutrition - mostly low carb/high protein diet. Lately, I’ve been eating more like a pescatarian, substituting fish for chicken/beef.

Supplements (everyday) - 4500IU Vitamin D3, 15mg Zinc Orotate w/ 2mg Copper Orotate, 500mg Chelated Magnesium Lysinate

(With these latest lab results: I will be increasing my intake of Vitamin D3 to 6000IU’s, Zinc to 30mg/4 mg Copper and will be intaking more fiber to lower LDL Cholesterol.)

Your Free T levels are optimal, Total T is inactive and you don’t have low testosterone. The elevated prolactin levels can be linked to low thyroid hormones and might have been affecting your testosterone production.

Your TSH is a little suspect though and is a poor marker for thyroid status, median values are 1.-1.5, you would need to check thyroid hormones to see why TSH is elevated.

Thyroid levels needed:

  • Free T3
  • Free T4
  • Reverse T3
  • Thyroglobulin Antibodies (TgAb)
  • Peroxidase (TPO) antibodies

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I wanted to add accutane/finasteride (5α-reductase inhibitors) has been linked to some serious side effects that last long after these drugs are stopped. The 5α-reductase inhibitors have been known to cause a loss of androgen actions on target tissues which remains highly resistant to hormonal treatments.

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@systemlord Thanks for the quick reply! I’ll definitely circle back with those results on my next labs.

I did find a couple of the items you requested for on my latest labs. Not sure if it provides any additional info for you guys. Let me know thanks!
Please see below:

  • Triiodothyronine (T3), Free - 3.5 (2.0-4.4 pg/mL)
  • Thyroid Peroxidase (TPO) Ab - 8 (0-34 IU/mL)
  • Thyroxine (T4) - 5.8 (4.5 - 12.0 ug/dL)

These levels are good, but no Reverse T3. The only other thing that stands out is the previous low cortisol value (7.7), I know it looks better now, but I wonder what your cortisol looks like over a 24 hour period. A single blood test isn’t going to show where your cortisol levels are throughout the day, it’s just not very informative.

I have seen guys with normal cortisol on these TRT boards, then once more through testing is done, cortisol can dramatically decrease suddenly and is now is low at certain times of the day. If cortisol is low at other times, you can’t get thyroid hormone into your cells with low cortisol.

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Interesting, I totally overlooked that point! I’ve seen another member reference doing a 24 Hr Saliva Cortisol test. Would that be the appropriate one? Would Labcorp perform a test like that?

DHT is low, adequate concentrations of DHT are pivotally important for erectile function, maintenance and development of secondary sexual characteristics etc…

@unreal24278 -

I noticed this as well. Do you think its due to having elevated prolactin levels for a prolonged period of time? Or could it be due to accutane being a 5α-reductase inhibitor as @systemlord mentioned and still having effect on my body?

Discount Labs offers such a test, it’s a 4-tube cortisol salivary, which you would drop off at LabCorp once completed.

@systemlord his free T is optimal for who? I wasn’t aware that there was a universal optimal number. 25 eh? That’s the optimal number for everyone?

That’s funny.

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The saliva cortisol tests aren’t that accurate.

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Got it, thanks for the help!

Is there a more accurate test from Labcorp I can take? Let me know, thanks!

I appreciate all the help this community has given me so far. I hope to have the new lab results up in a couple weeks time. If there’s anything else I need to test for, please let me know.

@drip420

Total Loss of Libido. Help?

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Agreed. If we are going to play the numbers game here, we can calculate free T with total T and SHBG. The calculated value comes back with free T = 13.6 ng/dL (9.0-30.0 ng/dL) which is arguably crap and also an accepted method of determining free T.

What does this mean? Is the Testosterone, Free, Direct lab result not accurate? I came across something called a Tru-T calculator and got a similar result as you. Does this mean my Total-T has to be increased? I would love to hear your guys’ take on this. Thanks! @galgenstrick @dbossa

Testosterone labs are not perfectly accurate. There are also wildly varying reference ranges depending on who you ask.

It is important to weigh symptoms with labs to get the best picture of your situation.

For example, these two sources have quite different reference ranges for free T

https://www.mayocliniclabs.com/test-catalog/Clinical+and+Interpretive/83686

There are a lot of cases that are not cut and dry (like mine). So the bottom line is you need to look at both the data and the symptoms. If you suspect low T, then rule out any treatable medical conditions that might be causing it. Decide for yourself if TRT is right for you. And if it is, then get on a protocol that is going to give you the best chance at success (do your research).

Hey Guys - as promised, attached are follow up labs that include a full thyroid panel recommended by @systemlord. Do I have hypothyroidism due to my body not converting enough T4 to T3? DHT value is lower than before… (19 vs 25ng/dL) I would love to hear your thoughts. Thanks!

24 Hour Cortisol Saliva Test to follow.

Disclaimer - I did take .25mg of cabergoline 3 weeks prior to this blood draw and it has definitely skewed my prolactin levels. Did not feel good for about 1 1/2 weeks after taking the dose.




I think your thyroid looks fine, your testosterone and estrogen labs look good as well, but I don’t put much stock in Free T testing. The Total T is going to be more accurate.

I’m surprised your getting these Total T numbers with LH around 3 and in some cases less.

I like to add I took my body temps this morning. They are as follows:

  • 9AM - 96.3 Degrees
  • 12:30PM - 97.9 Degrees
  • 1:30PM - 97.4 Degrees

Seems like it would make sense because I always feel cold in the morning. Any additional thoughts guys? Thanks!

Youre chasing your tail mate. Time for TRT or more useless testing.

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