T Nation

Variable TT levels - Understanding Bloodwork


#1

I started having a bunch of strange symptoms which started about a year ago, and have undergone a huge battery of tests including things like MRI’s, Echos, Stress Tests, and lots of autoimmune blood work to try and figure out what was going on. Then my GP tested me for Testosterone a couple months ago and it came back at 204. A couple months later and I finally got in to see an Endocrinologist who tested me again and this time my TT came back at 344 so now he’s saying he doesn’t want to prescribe me TRT. My FSH was at the very bottom of the normal range (1.3 vs range 1.3-19.3), and my vitamin D was in the “deficient” range (18 compared to 30-100). I’ve been so miserable over the past year and I was excited I might have finally found what had been making me feel bad, but now I’m not sure what to think or where to go next. Do my symptoms and test results (both below) indicate testosterone as a possible issue? What avenues can I take if my endocrinologist doesn’t feel like I should be treated?

I’m a 40 year old man, about 6’2" and 175-180 lbs, 34 in waist.

image Result Range
TT (Sept) 202.0 300-800
TT (Nov) 344.0 250-800
Free T 60.0 35-155
LH 2.0 1.2-8.6
FSH 1.3 1.3-19.3
TSH 1.4 0.3-5
T3 Free 3.4
T4 Free 0.9 0.6-1.6
Vit D 18.0 30-100
Prolactin 3.1 2-18
Cortisol 12.2 4-22
Aldolase 3.7 <8.1
ALT 17.0 7-52
AST 17.0 13-39
B12 800.0 200-1100

Symptoms

  • Low Back Pain - Started 18 months ago. No obvious cause, MRI was clean
  • Exercise Intolerance - Starting Fall 2017 I started feeling extremely fatigued and weak AFTER exercise, and my breathing muscles would hurt for a day or two after the exercise. Up until this point I ran about 30 miles a week, played basketball, and was very active.
  • General Fatigue - Slowly over the past year my exercise intolerance morphed into fatigue with normal activities, like mowing lawn or doing dishes.
  • Dizziness & Nausea - Started about a year ago, aggravated by computer use and driving
  • Low Sex Drive - up until the past year I was very interested in sex every day, but slowly it’s gotten to the point where my wife is always the one initiating and I’m fine with once every couple of weeks. My erections have taken longer and aren’t as strong. I can’t remember any morning erections for a long time.
  • Anxiety - Started feeling a lot of anxiety over past year for no real reason. Anti anxiety medications actually made me feel worse. Never had an issue with anxiety before. I’m usually the calmest person around.
  • Weight Gain - 10 lbs in past year, but likely from the decreasing amount of exercise
  • Insomnia - I can usually fall asleep fine but almost always wake up at some point during the night, often for an hour or two before I can fall back asleep. Not a problem before.
  • Hot Flashes - Although rare I get occasional times where I suddenly get very hot and feel flushed for a minute or so.
  • Itchiness - In the past couple months started having a ton of itching in the lower half of my body, no obvious rashes

Health History

  • Varicocele - Repaired twice over the past 20 years, still bothers me some
  • Muscle Pains/Stiffness for years - diagnosed fibromyalgia, but I think that’s just a lazy diagnosis
  • Don’t smoke, very rarely drink (none in past year)
  • I’ve NEVER been able to gain muscle, despite being very active. Over the years I’ve played lots of sports, done rock climbing, lifted weights, did various exercise programs, etc and never built up any mass.
  • Family History: potentially relevant stuff is Lupus, Graves, Hashimoto’s
  • BP normally about 120/80
  • Slowly balding for past 10 years, but I started with a really dense amount of hair so it’s just getting to the very obvious point

Current Medications

  • Gabbapentin: For tension headaches - only 100MG
  • Zoloft: Doctor wanted me to try this for fibromyalgia pains, just started a couple months ago 25MG. Hasn’t made a difference.
  • Occasionally take ibuprofen and prilosec OTC, no supplements

#2

What your doctor fails to understand is that a blood test is only capturing a very small part (snapshot) of a much bigger picture, the fact that you tested well below the range once in the early morning is troubling. Most guys will experience symptoms in the 400 range as this seems to be where wellbeing, libido and erection trouble begin. The issue you’re facing is a doctor who is poor at understanding how to properly diagnose low T, this is the reason why you are not on TRT already. To a knowledgeable doctor your LH and FSH are both low enough to suggest you are indeed suffering from (low T) hypogonadism, your doctor has failed you.

This seems to be a trend amongst endo’s everywhere, it doesn’t matter what country you’re in, TRT is the most poorly understood field of medicine among endo’s as they are all under trained. The reason for this is simple, there’s little money in TRT, all the money for an endo is thyroid disorders and diabetes. So a guy comes into the office complaining of low T symptoms and this lack of training prevents a guy even from receiving treatment because this is not what the doctor treats people for all day.

TRT is like a hobby for endo or a side business, you need a hormone specialist. Unfortunately most are cash only because they realize there’s a huge market for such a business with all the clueless endo’s out there that their certain guys will flock their way.

Zoloft made me 100% asexual, destroyed my erections and libido, all SSRI’s do it! These SSRI’s meds destroy your hormones. When I had low T I also had muscle pains.