T Nation

What Protocol Would You Recommend with These Labs?


New to the forum.
Male, 6’1", overweight at 295lbs, 245 lbs would look pretty good on me for reference of my frame. 32 yrs old, Weight training for 14 years.

Previously (2) T only cycles 7-8 years ago with AI and PCT.

Symptoms which prompted a visit to the Dr. and bloodwork included:

Fatigue - particularly early evening and during workouts
Increased anxiety, irritability, and generally a depressed mood. Relationships were suffering as a result.
Lack of ambition in both career and personal life
Strength is waning and body fat rising. Muscular endurance has reduced significantly adding to the frustration of an already mediocre existence.

Feb 25
Initial blood panel taken at 8 AM (checking triglycerides, A1C, Thyroid, Free Test, etc) came back generally good with the exception that Test Serum came back “Low” at 296ng/dl (reference 348-1197). Free Test (Direct) came back at 10.4 pg/ml (reference 8.7-25.1) .

It was recommended that I improve my diet to lose weight, supplement with 50mg of DHEA sulfate daily, and check the levels again in 5 months. I couldn’t wait (because I don’t want to commit to feeling like ****) for another 5 months, so I went to an Endo. My visit was met with a lot of skepticism (due in part to my age) and the Endo did not seem concerned with my symptoms but was somewhat dismissive until more testing was performed. It was recommended I stop taking DHEA sulfate. I did and within 2 weeks had an additional panel (11 am) with more comprehensive tests. Results are as follows:

April 15
Test Serum - 332ng/dl (348-1197 reference)
Free Test Direct - 12.3 pg/ml (8.7-25.1 reference)
LH - 2.6 mIU/ml (1.7-8.6 reference)
FSH - 6.5 mIU/ml (1.5-12.4 reference)
Prostate specific Ag Serum - 0.9 ng/ml (0.0-4.0 reference)
Hemoglobin A1c -5.4& (4.8-5.6 reference)
Prolactin - 7.3 ng/ml (4.0-15.2 reference)
TSH - 1.260 uIU/ml (0.450-4.500 reference)
T4 Thyroxine Free Direct -1.18ng/dl (0.82-1.77 reference)
DHEA Sulfate - 237.8 ug/dl (138.5-475.2 reference)
T4 Thyroxine - 7.1 ug/dl (4.5-12.0 reference)
Ferritin, serum - 151 ng/mL (30-400 reference)
Estrogens, Total - 61 pg/mL (40-115 reference)

As most of the levels seem with “normal” range with the exception of Test Serum, how can I get my symptoms to improve and test to increase without causing more issues and throwing everything else out of balance? Did I miss anything that is a concern level? I would like an optimal level to support an active, high energy lifestyle, and demeanor. I’m reluctant to lose weight at the expense of hard earned muscle and I feel like a low test level will make this increasingly difficult. Do you think at my age a physician will help in this endeavor?


Please get through suggested reading.

Do eval your overall thyroid function via last paragraph in this post.

Thyroid labs might be suggesting that you need more iodine. Using iodized salt? Iodine+selenium in your vitamins?

Thyroid has a big influence on energy levels, mood, libido and fat gain/loss/patterns.

FSH is typically similar to LH. But FSH is often a better indicator of LH status than LH itself which is released in pulses with a short half-life. So LH is variable. But notably lower than FSH. Were your testes physically examined? Are they sore or achy? Feel normal?

FT is also pulsatile with a short half-life. So any given lab does not have a absolute meaning. Your low total estrogens suggest that T–>E2 rate is low from low FT and that liver clearance of estrogens is good.

If you cannot find a correctable cause of your low-T, you need TRT. That is way more than T. Not sure if your problem is primary [weak testes] or secondary [low LH]. Your low T needs to be considered a symptom at this point, not the disease.

If as a trial you self-injected 250iu hCG SC EOD for a month and did labs with strong TT and FT, you are secondary. If T levels are not good, you are primary. We do see some mixed cases often.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


@KSman - Thank you I was hoping I would get your response. I’ll start to monitor thyroid

By saying TRT is way more than T, you’re referring to the on-going management, continued lab analysis, adjustments, and treatment of sides correct; not just a band-aid?

If it’s worthwhile to post some additional data from my Feb. lab results (metabolic panel, CBC, Lipids, TSH (1.97 mIU/mL (0.450-4.50 reference range) please let me know.

I do have some dull pain occasionally in testes, during physical activity, or sitting at work but this subsides pretty quickly or after sleep. Sometimes I just think my yams are in a twist or sit on one of the little guys. :disappointed:

Would my next best step be to see a primary care doctor, endocrinologist, or urologist, optimum health clinic? I would like to understand and correct the root-cause as you suggest.