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Testosterone Free Blood Results Question

I have a question about some blood work I had done, particularly about the free testosterone test. The only reason why it confuses me is that there is a whole buttload of different tables and inconstant data floating around the internet. I am 22 years old. 6’1 in height and 135 pounds with clothes on and can’t gain an ounce of muscle no matter how hard I try. I have crappy erection quality and occasional lose erection during intercourse. ANYWHO my general practitioner had my “TESTOSTERONE FREE” levels checked, and my results were 12.3 pg/mL (pico grams per mililiter). The range of the lab I had tested (Providence Sacred Heart Medical Center in Spokane WA) was 5.0- 40 pg/ml. I’m within the range, granted in the low 30% but within the range none the less.

Where I get confused is that there are no other studies I can find where FREE TESTOSTERONE was tested in pg/ml where the range matches the range on my blood chart. For example the http://www.mens-hormonal-health.com/normal-testosterone-levels.html has free testosterone levels by age and in pg/ml but it seems like their ranges must be completely different of I would have the testosterone of a 150 year old dead woman. Perhaps I was tested in a different manner or I am comparing two different testosterone levels yet both labeled free testosterone and measured in pg/ml. Thanks for your time.

Age: 22
Height 6’1
Weight 135 lb
-Little chest hair, normal leg hair, 0 back hair, facial hair present but not very full. Hair likes to fall out a lot along the sides of my head, I can grab a patch in the shower between my forefinger and thumb and sometimes get 5-10 or more hairs. Hair stylist says I have some “cowlicks”
-I get shaky if I don’t eat or use medium burst of energy, almost like a hypoglycemic would
-I have frequent urination problems
-low libido
-poor erection quality and lose erection during intercourse but doc tested me on cialis to see if my “pipes” are working, seems to be effective. Also seem to be kinda “numb”
-0 morning erections apart from the “cialis test”
-sometimes I get achy testicles
-Low energy / chronic fatigue
-sleep a lot more than 10 hours a day
-lack of interest yet not full on depressed, maybe a middle zone
-Foggy mind and trouble concentrating, doc put me on aderol because he thinks I have ADD. Never really had concentration issues until the last couple years. But add runs in the family.
I have difficulty communicating with other people, like i can’t understand their words.
-Have been using protein, creatine, and l-arginine supplements and working out 4 times a week for an hour. Trying to eat many calories (at least 3k on a bad day) with oats, fruits, some veggies, meats, complex carbs, some fats. I will occasionally eat a hamburger from time to time. Despite this I don’t gain weight or muscle mass
-Only real fat deposits I posses are on my abdomen. Never used to have fat on abdomen, only for the least few years.
-If “mobile joints” means flexibility then I have tons of it. They used to call me gumby in my BJJ class. But all my joints work to the best of my knowledge if not more so than they should.

  • I have noticed very little gains at all in either cardio, muscle mass, strength, or energy in my diet and exercise attempts.

Recent generic blood work done at 8:30 AM: Body temp usually around 97

Doctor Results and Prescriptions:
Low Vitamin D ~ 50,000 IU capsules once a week for 4 weeks
ADD ~ Amphetamine Salts 5mg twice daily then increase to 5mg 3 times daily after 1 week.

You cannot compare lab results from different labs. This problem is definitely worse when dealing with FT. So you can compare your position within your range relative to the position of other numbers in different labs.

Important: T is released as FT in pulses, then most of it, ~98% is then tightly bound to SHBG. FT levels change a lot and a lab sample is a snap shot of a moving target and that tells you very little. TT is the best indicator of T status for a guy who is not on TRT.

Read the “advice for new guys” sticky, carefully. Note issues with iodine and body temperature as well.

Get proper lab work:
TT
FT
E2
LH/FSH <-- very important
CBC
TSH, fT3, fT4
ALT
AST
fasting cholesterol [the concern is that it could be too low]
DHEA-S
AM cortisol

If LH/FSH is low, then test prolactin to see if that is a cause. If prolactin is elevated, you should have a MRI to study your pituitary.

At your age, low-T is not aging, it is a symptom of another problem. So you need to be looking for possible causes. Also note that there are conditions that create many of the same symptoms as hypogonadism.

Are your joints extremely mobile?

This also needs to be considered: http://en.wikipedia.org/wiki/Klinefelter_syndrome#Physical

Describe your diet and how much you eat. Do you have an eating disorder? Do you carry any fat? Where?

How has your condition progressed? Always been the way that you are now?

Provide more data as per the sticky.

I did the best I could to provide the most information possible. However I don’t have “proper” testosterone blood work at this time. These results were done by a general practitioner. I am getting a second testosterone test done by urologist who kinda helped me out with my frequent urination. How much of testosterone knowledge he posses is unbeknownst to me but I hope I get more testosterone information rather than just “your free T looks great, your a healthy young man now go get some tiger” quote as he slaps me on the back in a reassuring manner.

Just got back from my urologist and he had a total testosterone test ran and on a scale of 241-827 I registered at 232. He said that at my age I should be at or above 500 on this scale which equates to roughly 45% of maximum. With my current symptoms he suggested that we start TRT gel.

It was nice to see the relation of my two blood tests. I scored low on WBC and platelets for both tests which is kinda cool but whatever. General physician had my TSH(thyroid) tested and I was close to the center of the range which he said was perfect.

We talked a lot about whether my low T was the cause of all my symptoms or if it could be a symptom of a much larger issue. He suggested TRT without getting LH and FSH tested since he believes in my current physical and mental state that I probably don’t have any pituitary tumors or testicular cancer or have testicular failure.

[quote]jaggar wrote:
We talked a lot about whether my low T was the cause of all my symptoms or if it could be a symptom of a much larger issue. He suggested TRT without getting LH and FSH tested since he believes in my current physical and mental state that I probably don’t have any pituitary tumors or testicular cancer or have testicular failure.[/quote]

Post the labs. Your TSH was at 2.0 in the first one that is not optimal.

He doesn’t want to test LH and FSH and prefers to assume?

That doesn’t sound right.

The general physician TSH results I was referring too in the last post was from my first blood test in my first post. Sorry I did not explain that better. I only mentioned it because I was trying to infer that according my medical professional my thyroid was fine and therefore probably not a contributing factor to my symptoms. I have done 0 research on the matter however and don’t really know what a decent thyroid rating is supposed to be.

This is the blood test result I just received from urologist. http://i.imgur.com/UGTkpgf.png

He did not flat out say he did not want to test my LH and FSH. He said that there are no red flags that my pituitary has any issues but it is possible that something is wrong up there but not showing any obvious symptoms. I don’t carry a lot of fat or have chronic headaches or trouble seeing…there were a few more symptoms he rambled off that I didn’t have that would have suggested my T was getting converted to E. Another thing is those tests are unusual for someone my age and we might run into some issues with my insurance. He explained that by prescribing me testosterone, there is a chance that my insurance will want to cover a single LH and FSH rather than cover their share of a copay for testosterone. At least that how I perceived what he was telling me if it makes any sense. My thought process doesn’t work at soundly as it used to.

At my next follow up they are going to do a blood sample anyway. I can re inquire about the LH and FSH testing and whether or not I can get those tested. In the mean time he wants me to take the 30MG gel. If anything I can at least raise my T levels a little bit and take the edge off all the shitty symptoms. I am however not happy that he did not order a thyroid test himself since low testosterone risk is increased for bitches with thyroid problems. Same with cholesterol.

Doc is an idiot you don’t need to have the symptoms he described to have a pituitary problem or an adenoma.

Find a doc who will listen to you.

You need the labs KS suggested and also prolactin.

Hey guys. I thought I’d do an update and ask for some advice here. I got referred to an endo, and I’m sure you’re probably just shaking your head now that you’ve read that. It’s hard for me to think that this man doesn’t know what the fuck he is doing because of his credentials and I get my info from the internet, but man I am so disappointed at how this is turning out.

To sum up what’s been happening,

  • Problems with erection, energy, concentration, and happiness levels
  • Diagnosed with hypogonadism from Urologist with a total T level of 232 in a range of 241-827
  • Put on 2 pumps of 30mg Axiron and it boosts my free T to about 600 in the same range
  • Feel slightly better after 6 weeks but as months go by I start feeling shitty again
  • Get referred to Endo from Uro because I was asking about HGC
  • Endo gets blood work done, total T levels are 478 in a range of 332-896

Appointment just ended not 30 minutes ago, basically he said that he was not convinced that I ever had a low T problem to begin with, and would like me to stop completely. He then wanted me to schedule a super expensive in-depth adrenal gland procedure (cortisol ACTH) test. I was expecting to get HGC since my testes have shrunk quite a bit and ache. He even commented on my first appointment about how my testes were below average in size… Made me feel all warm and fuzzy inside. I feel like trying to raise my T levels is the correct thing to do, but after 3 medical dudes telling me that it is super unlikely that T has anything to do with my mood, sex drive, and poor erection quality, it makes me feel like I am an idiot and it’s super discouraging.

Is it wise to just keep looking for someone who will allow me to raise my T levels to 800-1000 with HGC and anatrozole, or take this adrenal test…

Here is the most recent blood work. Blood work was taken while on Axiron so some things may be skewed.

ACTH 15 pg/mL (0-46)
Estradiol 28 pg/mL (0-56)
T total 478 ng/dL (332-896)
FSH 4.0 mIU/mL (1.4-11.2)
LH 2.1 mIU/mL (1.7-8.6)
TSH 1.43 uIU/mL (0.4-5.0)
T4 Free 1.15 ng/dL (0.7-1.5)
Cortisol 7.7 ug/dL (6.0-30.0)

Adrenals look like they are stressed

What test?

Do a 4 point cortisol test. Go see a naturopath or a homeopath

What time were these labs taken?

What is going on here?

You are either not absorbing the cream at all or you have testicular cancer and I don’t think this is the case??

Why is lh and fsh being tested while on trt and why are they in range???

My endo wants me to go to a lab, test my cortisol and ACTH levels and then get a Cortrosyn injection. I then get my blood drawn 30 minutes after the injection, and then again at 1 hour. This is supposed to give him a better idea about my adrenal function. At least thats how he explained that to me.

I cannot explain the lh and fsh scenario. Hope I dont have cancer…Labs were taken 14:27.

[quote]KSman wrote:
You cannot compare lab results from different labs. This problem is definitely worse when dealing with FT. So you can compare your position within your range relative to the position of other numbers in different labs.

Important: T is released as FT in pulses, then most of it, ~98% is then tightly bound to SHBG. FT levels change a lot and a lab sample is a snap shot of a moving target and that tells you very little. TT is the best indicator of T status for a guy who is not on TRT. <~~~~~ Wrong
^^^
This is wrong 98 percent is not tightly bound to shbg

50-68% is tightly shbg bound ( slow dissociated half time)

0.5-3% is free T

30-44% is albumin bound and is loosely bound

Free T + albumin bound= bioavailible testosterone (gold standard for testing)

Ok well cortisol should be tested at 8 am and fasting…

Your doc shod be retesting morning cortisol and properly

As stated 4 point cortisol test and screw the endo lol

I believe if you had cancer levels would be more elevated.

I don’t believe you are absorbing the cream.

What were ur levels pre trt

I had some errors in my last post i corrected. My latest T results were total testosterone tests where i stated free testosterone.

At first my total T was 232 in a range of 241-827 when tested by my URO. After gel, the same doctor retested and i boosted up to 600 in a range of 241-827. Then I got referred to endo and he tested me at 478 in a range of 332-896 while on gel.

I know you cannot compare lab reults directly, but you can compare them proportionally within their range.
First test : below 0% of max range
After 4 weeks of gel : 61% of max range
After 6 months of gel : 25% of max range

Ok well I have no idea, this is not making sense to me…

Lh and fsh should not be on the map… Why is an endo not questioning this??

And I wasn’t saying you can’t compare them, ofcourse you can compare them to a degree…

What he said sounds like a bunch of malarkey…

Labs may be different but If free T always shows up low them it is prolly low… Common sence tells me this

Im going to stick with gel isn’t working…

Can you tell, what was the eventual diagnosis and what treatment are you taking these days?

You stopped absorbing the gel after 6 months, it happens to a lot of guys after a while. You require injections, our bodies didn’t evolve to absorb medicine through the skin, your doctors should think about an retirement as they are failing as doctors!