T Nation

Need Help Interpreting Blood Tests

Hi guys, first time poster, but long time lurker here.
I’m a 30 year old male and I’ve been feeling little down lately, low energy, low libido, no morning erections, and also my nipples started to get sensitive so I decided to get myself checked by endocrinologist who told me to do some blood tests. I’ve got the results back today and my values are below.

FSH 5,2 IU/L (ref. 1,5 - 12,4)

LH 6,7 IU/L (ref. 1,7 - 8,6)

Prolactin 150 mIU/L (ref. 86 - 324)

Estradiol (E2) - 11 pg/ml (ref. 11,3 -43,2)

Testosterone 4,59 ng/ml (ref. 2,49 - 8,36)

So I realize my T levels aren’t the best, but I’ve been pretty sedentary lately so that could’ve contributed. I started hitting the gym again today so that will hopefully help with raising my T to more respectable levels. Also, I thought my issue with sensitive nipples is caused by either high prolactin or high E2 but both values are in range, with E2 even being a little bit below it. So my question for you guys is can sensitive nipples be caused by some other random reason or could it be a mistake from the lab? Also, in case my T levels don’t increase after few months of healthy and active lifestyle should I consider TRT?

You need to test free testosterone and SHBG. A thyroid panel is also advised before starting TRT.

Life style changes are a very good step forward.

Regarding T. It’s a single measurement. As T varies widely I recommended to repeat the testing before making any moves towards TRT.

Hey, man, thanks for replying. This time I didn’t test for free T and SHBG since my doctor didn’t ask for it, but I have those numbers from a blood test I did few months ago so I’ll write values below.

SHBG 41,2 nmol/L (ref. 16,5 - 55,9)
Testosterone 4,79 ng/ml (2,49 - 8,36)
Testosterone, free 1,82% (ref. 1,53 - 2,88)

TSH 0,78 mIU/L (ref. 0,35 - 4,94)
fT3 4,2 pmol/L (ref. 2,6 - 5,7)
fT4 13,4 pmol/L (ref. 9,0 - 19,1)

That’s the plan. I’ll try my best to keep up with the gym and healthy eating, and then retest in 3 months. Thanks for feedback!

Your T levels are low enough I don’t think anyone here would be upset if you started TRT. Obviously, always try lifestyle changes first.

When did the sensitivity start? I know for me, I can get it and it last a few days then goes away. It’s rare though. I’m not sure if it’s possibly the lower E2 that causes it. Mine was also on the low side like yours before I started TRT.

I will for sure, even though I doubt it will increase my T levels significantly. I’m 30, but I look much younger, I was a late bloomer, my facial hair is not fully there, same with body hair, so I think my T was on the low side for my entire life. The thing is, I’m from Europe, and in my country doctors are very conservative about TRT, and they religiously hold on to reference ranges, so if you’re not below the lower end they are never going to get you on TRT. They’ll tell you you’re stressed out or depressed, then give you antidepressants or whatever. My plan is to make sure there’s nothing else that is causing my low energy levels and libido, and if that’s the case I’ll see what I can do on my own.

As for sensitivity, it started like a year ago, but it was intermittent like yours. Last few months it’s been an every day thing. Everything I read about it always mentioned either high prolactin or high E2 as a cause. Since you had the same experience, I really think it might be caused by either low E2 as well, or some other thing we are not aware of.

Your free testosterone isn’t expected to be steller with SHBG in the 40’s, normal free T percentage is 2-3 percent, but closer to 3% is best. free testosterone is converted over to estrogen, so your E2 is low because your free testosterone is low.

It’s imperative your get free testosterone elevated because at these E2 levels you are staring down the barrel of osteoporosis and cardiovascular problems with low free testosterone. The problem with most healthcare providers is they only care about normal ranges, but these levels aren’t normal at 30 years old.

The average 47 year old (85%) has a total testosterone of at least 550 ng/dL, so there is no way these levels are normal. You should compare your levels to other healthy men in your age group.

Yes low estrogen is more than likely why you’re experiencing sensitive nipples. I stopped TRT several months ago and soon started experiencing sensitive nipples because my total testosterone was 91 ng/dl and my estrogen was low. The ranges go down to 11, but that doesn’t mean it’s healthy.

No. The average T level of 40 - 50 year old men is 481 ng/dL.
It’s based on the latest ref range using the FDA calibrated assay, which is now the standard assay for most labs worldwide.

Okay, I didn’t know that. Is there any way to raise my free T besides TRT?

I see. I guess low E2 can really do that then. Why did you stop TRT? And how long did it take you to get your hormone levels back to baseline?

People like to think we have control over our hormones and while we do, we don’t have a great degree of control like going from 300 ->800. Any increases you to get will most likely immediately bind to your moderately high SHBG which increases as you age.

You can fight to hold onto your testosterone, but age and our environment is working against you. You’re going to need TRT at some point in your life, this is inescapable.

TRT seems to affect my urination, I go from urinating 12 times a day off TRT to not being able to emty my bladder within a few days and my bladder starts filling up and I’m unable to urinate much at all. I’m known as a hyper T responder, my dose is ridiculously low (7mg daily, 49mg weekly) and you’ll never see other members at this dosage.

That first 7mg injection produces crazy energy and benefits are immediate. After two and a half years, stopping TRT cold turkey, four and a half weeks later my HPTA restarted and I could feel it and for a day I felt perfectly normal, then it was back to feeling low testosterone.

I think something is suppressing my testosterone and don’t know what is causing it. Whatever is causing my low testosterone seems to be causing problems on TRT as well.

The data I was referring to isn’t recent data, I’ll bet if we revisit this in 10 more years, the averages will be lower.

This is getting old. I already tried to explain previously why T levels and their ref ranges are lower now then 5 years ago. It’s the method and not the decline in T on a population level.

I know about the methods used have changed and that why there is a difference, but the issue with declining testosterone and sperm mobility is a separate issue.

Yeah, you’re probably right. The bad thing is I’ll probably need to do it myself since no doctor here will prescribe TRT unless T goes below the reference range.

That’s a pretty strange reaction. Could it have something to do with prostate? Anyways, I really hope you figure out what’s causing it.
Also, what T level does 49 mg a week get you to? Four and a half weeks to reset your natural production after two and a half years on TRT sounds really good.

You will probably have to take matters into your hands, a lot of doctors are just not very well educated on normal testosterone and so it’s difficult get treatment. The studies show cardiovascular risk well above the bottom of the reference ranges (<480 ng/dL), just because levels are in the normal range doesn’t mean it’s healthy or there won’t be any symptoms.

I have tried a social experiment on my doctors, I tried to get them to see everyone is truly biochemically unique and everyone is different, they just kept repeating the same line, levels are within range. I feel like I’m talking to a robot, not a human being with critical thinking.

PSA has never been lower (.8), I think it’s TRT affecting the bladder and urethra which then do to not urinating I start getting hardness and swelling on both sides of torso. My kidneys have no place to send this waste product, so it goes into my tissues.

I’m seeing a urologist tomorrow.

The 7mg daily protocol for total testosterone to 417 ng/dL and free testosterone 14.9 pg/mL (6.8-21.5) in only three and a half weeks. My levels would have been higher in two and a half weeks because enanthate was still building up in my system, so everytime you change the dosage, 6 weeks till levels reach the highest levels achieved on the protocol.

I felt like a teenager only two and a half weeks into this protocol and had significant body comp changes, I was thinning out and even my watch band was loose.