T Nation

Need Help Interpreting First Labs

I’m a 33 y.o. male. 2 years ago I began having all the symptoms of low T - suddenly, no morning erections, weaker erectile quality, weaker ejaculation, low libido, sleep became fitful, lack of motivation, etc. When I went to the doctor, he insisted it was grief and offered antidepressants. I didn’t take them.

I returned to the doc 1.5 years later with the same symptoms - he still said it was grief, and offered me Viagra. I went to another doc, asked for all the requisite tests - which he performed, reluctantly. He also offered Viagra and said “Hmm! Weird” when I enumerated my symptoms. Upon reviewing my bloods, his only commentary was that my iron was low.

Anyway, I went doctor shopping, and I found a urologist who (I hope) takes these things seriously. I’d like to know what to question and push him on when I go in, based on my labs. I don’t know what’s wrong with me beyond that I feel 33 going on 70.

Results (with ranges on the right):

T3, free 2.97 pg/mL 2.52-4.34
TSH with Reflex 3.396 uIU/mL .270-4.200
Reverse T3 20.0 ng/dL 9.0-27.0
Cortisol 15.8 ug/dL .4-22.6
Iron 49 ug/dL 50-212
Ferritin 66 ng/mL 24-336
Prolactin 5.6 ng/mL 2.64-13.13
FSH 5.18 mIU/mL 1.27-19.26
LH 6.52 mIU/mL 1.24-8.62
SHBG 68.48 nmol/l 13.3-89.5
Total T 455.3 ng/dL 175-781
Free T 23.07 35-92.6
Estradiol 12.6 pg/mL 10-42.0
Estrogens, total 32.4 pg/mL 19-69.0
Estradiol, Sensitive 16.86 pg/mL 0-31.5
Vit D, Total 31.1 ng/mL 30-100

Current supplementation: fish oil, Vit D3 5,000 IU, ZMA, Niacin.

You need to prepare yourself for the fact a lot of doctors don’t know much about sex hormones because it’s not taught in medical school.

Your doctor clearly doesn’t understand anything about SHBG and how it can affect the balance of the active T and bound T.

The Free T is where the rubber meets the road, yours is abysmally low! Your estrogen is also low enough to cause osteoporosis.

You’re probably going to need a Total T above 1000 to be able to get your Free T high enough to benefit from TRT.

Those reference ranges for estrogen include children and adults, so an E2 of 12 is low for an adult male.

Lower your SHBG and raise FT, that’ll likely help raise e2 as well, and at least put you in the path of feeling better.

Failing that, go with a clinic for TRT. But you can try this without that first

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I’m sorry, I’m new to this. How would I lower SHBG and raise FT? Other than the obvious of training, eating well, and remaining lean, all of which I already do regularly.

This is a difficult thing to do naturally, TRT will decrease SHBG is most cases. Things than can increase SHBG is cutting what amounts to starvation. Of the high SHBG cases I have seen over the years on these forums, the majority have failed to lower SHBG to a meaningful degree.

The problem with a lot of high SHBG cases is they will need Total T above 1000 in order to benefit, problem is there’s not many doctors allowing levels above the normal ranges.

TRT clinics to the rescue.

Woof. That’s grim, but I think I understand.

Is there a way to find doctors who are educated on male hormones outside of the clinic? I’m fairly certain insurance will deny treatment anyway - my total T isn’t low enough, and in other recent tests it’s come back in the 800s - but I’d like to search for the rare “with it” doctor who will at least try and advocate for me. If it matters, I live in Illinois.

The only way is by word of mouth and online reviews.

Yes it is, you just need to find a doctor that isn’t clueless that can recognize your situation. The doctor that ordered these labs isn’t able to interpret much of what he ordered and was just trying to help.

Don’t hold your breath.

Doctors are not clueless and they do not “struggle” with hormones. Like most everyone, they rely on their education. What is below is part of that education.

If you were a PCP, and you read this information, published by the DEA, would you prescribe testosterone to anyone not fitting into the exact clinical definition of hypogonadism? Even if they do, is it any wonder why the PCP might be very reluctant to proceed with TRT?

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I didn’t say “doctors are clueless”, I said this one is, big difference. I have said doctors in general struggle with hormones in other threads because it’s true, not just in the US but worldwide.

The patient had to ask for these tests instead of the doctor taking the initiative, that looks bad. This case isn’t even in the gray area, it’s a clear case of low-T (low E2) and this doctor completely failed to recognize the situation.

A single sheet of paper doesn’t amount to a proper education and even with an extensive education, experience prescribing TRT is a whole other ball game.

Geez, once again, you misunderstood something meant to be an explanation regarding the utilization of TRT by PCPs and instead took it as an attack on you. Not about you.

If you would, please go back and read my last two sentences. I am making no claim whatsoever that a one page memorandum from the DEA amounts to proper education. However, can you bring yourself to understand why the average PCP would be adverse to prescribing testosterone after reading that? The one who gave it to me thought enough of it to determine he wants no part of TRT. He has referred some patients though, but has zero interest in learning anything about what we do. Does this make any sense at all to you?

For the others here, consider the fact that your own PCP, or urologist, or endocrinologist for that matter, at least have access to this kind of information (misinformation), possibly read it and probably give it credibility if they do read it.

My hope is some will avoid the waste of time expense going this route. If you have a primary doc that helps you with TRT, good for you. Just saying that is not typical.

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@highpull , do you think docs have a tendency to swing the other way - that is, working overtime to avoid prescribing testosterone therapy? I got in with a urologist, who immediately insisted I go on clomid 50mg ED, and mentioned that TRT “isn’t worth it until you’re about 50.”

Based on the old data TRT being contraindicated for those with prostate cancer and that high testosterone causes, fuels prostate cancer, if this urologist gave TRT to a 20-30 year old and those men got a prostate cancer diagnoses long before age 50, which is the typical age at which the disease is diagnosed, the TRT could be blamed and the doctor could get in trouble, only now we know better and with the newer data that TRT or high testosterone doesn’t cause, fuel prostate cancer as once believed.

This urologist’s head in the sand and is covering his own ass, he can’t help you and you are wasting your time with him.

TRT is worth it for anyone suffering the symptoms of low-T. TRT is the most natural medication you can take which can’t be said of clomid, a drug which takes the body it outside of a natural state.

It’s difficult to say, but yes, I think some simply do not want to take what they perceive to be a risk. Everyone bases their decision making on what they have been taught and their own individual clinical experience. Also, they base clinical decision making in part on what they read, which may include items like the DEA memorandum I posted.

Generally, it’s older doctors that seem to have an anti testosterone bias. I have even seen patients (dx with prostate cancer) treated very differently by doctors within the same group. Interestingly, I know a few TRT/HRT doctors who will not give testosterone to a man under 40.

As for his statement that testosterone is not worth it until you’re about 50, I do not understand why he thinks increasing testosterone with a drug that essentially screws with your brain chemistry is worth it, but increasing testosterone by giving you the real thing is not.

Your E2 is low-ish. I didn’t see that kind of reference range for Free T before, is it pgmL?

Maybe, try HCG 250iu 3x a week and see how that goes. Or Tamoxifen.

What about that grief part though? I hope you are not on anti depressants or any other medication, if so, that’s it. That’s the cause of your problems.

Got it, thank you. This doc was about 60. When I asked, “clomid acts on your pituitary, right? Based on my numbers it seems like the issue isn’t my pituitary, so why would we treat that?” he got angry and yelled. I eventually got out of him that he thinks TRT is so rough that “some people have to inject every week - even twice a week!”

Not going back to that guy.

Now that you mention it, there aren’t units listed for the Free T. The only marker is “Free T Index,” so I’m not sure how they calculated. Hopefully it wasn’t based on my total T.

What about that grief part though?

Actually, that was my first clue that my PCP was off his rocker. I laid out my timeline of symptoms - started January 2019, parent got sick with cancer in May 2019. This man jumped on that like a dog on a bone - “Sounds like grief! Do you want antidepressants to help you sleep?” (fucking LOL) Of course I didn’t take them. Nearly 18 months later, on my return visit to the same doc, his notes read, “I still think he’s depressed over [Parent’s} death. Will try Viagra.”

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