T Nation

Trying to Decipher Old Test Results

T Replacement
#1

Recently switched to my 4th TRT doc went though my GP>Endo>GP>Telemedic practice now. Just getting everything set up with them long story short started with issues of low energy, libido, mood in general. Fast forward 3 years I’ve still got the same issues as pre trt. I’ll have new test results hopefully within the week. I’m currently trying to think of things I need to ask the new DR in regards to treatment and things I can personally look at in the new labs being done.

TESTOSTERONE, TOTAL, LC/MS/MS 690 ng/dL 250-1100
TESTOSTERONE, FREE 221.2 pg/mL 46.0-224.0 TESTOSTERONE,BIOAVAILABLE 464.5 ng/dL 110.0-575.0
SEX HORMONE BINDING GLOBULIN 9 nmol/L
ALBUMIN,SERUM 4.6 g/dL
ESTRADIOL 33 pg/mL
TSH 1.30 mIU/L

Previous doctor didn’t do labs often and often did not check the correct labs it was kind of a here try this let see if you feel better in 3 months, or hey lets try some anti-depressants and see what happens.

TLDR: What addition questions should I be asking as to why energy,libido, and general mood hasn’t changed with trt and if other hormones are at play.

#2

cb750 what are you asking? Your thread is very confusing.
Are these old before TRT tests if so you never should have been put on TRT.
Your low energy, libido, mood in general issues lie some where else. Did your doc check your thyroid?

#3

Sorry, its been a long week these are results post TRT @ 50mg E3.5D during the trough. Pre diag test and after stopping TRT for an extended period of time were 250~ Total 60~ free, E2 was lower. Mainly I’m after what questions to ask to narrow down what the hell is going on.
I’ve done an a ton of reading but I haven’t seen anybodys numbers quite like mine where Total is mid range and Free/Bio test are top of the range and if that could potentially be part of my issue.

#4

Your SHBG is very low. Do your symptoms change relative to your injections?

Have you had any additional thyroid tests, fT4, fT3 and rT3?

#5

Your estrogen may be too high for you, free estrogen even higher. You can mitigate this by injecting more frequent doses. When a low SHBG guy has normal estrogen (20-35) free hormones tend to be very high, so if free T is high, free estrogen may also be very high and this will kill erections and libido.

The takeaway is an estrogen score of 33 may be normal, I bet if you were to test free estrogen, it would be near the top of the ranges much like free testosterone.

Definitely have a thyroid panel done, testosterone will only work if thyroid hormones are sufficient. If you do have thyroid problems it would explain why you feel no improvement.

When I went from twice weekly to EOD injections SHBG increased 16->22.

#6

oK that helps. I like your numbers. Free T is right at the top.
E2 is well with in range. My clinic doesn’t get worried until E2 is over 45.
I know when my E2 gets too high I ball(cry) over nothing like a woman on her period.
30-35 is my happy place and my SHGB runs between 22-29

If low T was your issue this protocol should have fixed it.
You should be on top of the world with these numbers.

As others have said here do all the thyroid tests.
Do you have a lot of stress in our life? If so look into cortisol. The 4 mouth swaps not the blood test.
Google stress and cortisol see if those symptoms don’t match yours.
How about your quality of sleep? Ever been tested for sleep apnea?

So questions for the Dr. Thyroid, cortisol, and sleep study for apnea.

hope that helps? I think your 100mg/wk is perfect.

#7

I’ve got a thyroid panel and a bunch of other blood work coming in later next week so I should see something on there. As far as sleep apnea I sleep like a rock I actually sleep less since starting TRT then i did pre. As far as the cortisol thats kinda hit or miss the only thing that really fits is the fatigue. But i’ll bring it up if labs come back looking good.

#8

People with apnea, or even heavy snorers, don’t always know that they have it. You could start with a sleep app that records you and give you a sleep score and recordings to review. I use one called SnoreLab. It gives you a score and records all the snoring. I was amazed at how unrestful my sleep was based on the amount of snoring I was doing. My wife is a heavy sleeper so it never wakes her so I wasn’t fully aware at how bad it was. It was a huge positive change to get this taken care of with a mouth guard.
If you aren’t snoring or having gasping episodes (apnea) then move on but this is important. Testosterone won’t fix the problems that lack of sleep cause.

1 Like