T Nation

What the Hell Is Going on?!

Hi Guys -

Can someone offer some advise? I am 33, father of twins. I sleep 5-6 hours a night and work 50+ hour a week at a desk job. I do about 60 min of solid state cardio 3-5 times a week. I am carrying about 35 lbs of fat. I am an ex-athlete, but have gained some weight due to health issues and kids. I have Hashimotos (low thyroid), I take meds for this and I am often at or slightly below normal levels. Recently, I had blood work and my total test came back at Free Test 57.9 pg/ml … total test 407. My main issues are- no energy, brain fog, body ache, hard time losing weight. FSH - 2.3.

Any advise?

Thanks boys.

Twins, 50+ hour work week, you’ve got your hands full.

If thyroid levels are below normal, please explain why treatment is failing or maybe it’s not the treatment that is failing, maybe it’s the… Free T3 should be midrange or higher and Reverse T3 <15 ng/dL or else Free T3 will pool and Reverse T3 will block Free T3 from getting into your cells. Please include reference ranges, I have no way to measure your free testosterone value against the top and bottom value.

Total testosterone is low, low enough to put you at high risk for cardiovascular disease.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction. Further study is required to evaluate the validity of these testosterone thresholds for CVD risk.

Sick care doctors unfortunately do not know how to help, uneducated in sex hormones and they often prescribe outdated protocols do to old guidelines in need of updating. Most are clueless and useless and only good for getting the prescription filled, you will have to figure out everything, dosage and injection frequency which should be two or more times per week depending on SHBG levels.

TRT will not work when there are low thyroid hormones, optimal levels are needed to metabolize testosterone in the liver. TRT will not do much for you with suboptimal thyroid hormones, more symptoms are expected. It’s common for thyroid doctors to underdose their patients, perhaps what you need is a specialists who care about a state of optimal health.

FSH is related to sperm production and is the ultimate predictor of health status, you wouldn’t expect older men to have high testosterone or healthy sperm count, you would expect low testosterone and low sperm count.

If LH is low and testosterone low, the diagnosis would be secondary hypogonadism. High LH and and testosterone low, the diagnosis would be primary hypogonadism ~ testicular failure. We live in a world filled with chemicals, poor sleep, excessive work hours, processed foods and it’s degrading our quality of health.

The medical community turned it’s back of steroids 70 years ago, there is a lot of stigmata surrounding TRT in the medical community and is why few doctors are good at TRT and there is no TRT specialists in medicine.

There are those who have learned a few tricks, those private doctors who treatment with hormonal issues and unfortunately do not take insurance. If looking to go on TRT, it is home to anti-aging and sports medicine.

Thank you for the response. I recently switched to Armor Thyroid vs Synthroid for my thyroid medication. I am increasing my dose by 1 pill as per the Dr. I’ve been to a million Endo’s in the past, but found a doctor like you said who likes to take a different approach. I just fear even he is not even considering the testosterone levels.

Below are my ranges:

T4, Free: 0.7 (0.8-1.8ng/dl) Low
T3, Free: 3.1 (2.3-4.2 pg/mL)
T3 Reverse, LC/MS/MS: 7 (8-25 ng/dl) Low
TSH: 3.44 (0.40-4.50 mIU/L)

TESTOSTERONE, FREE: 57.9 (46.0-224.0 pg/mL)
TESTOSTERONE, TOTAL, MALES : 407 (250-827 ng/dL)

LH: 4.6 (1.5-9.3 mIU/mL)
FSH: 2.3 (1.6-8.0 mlU/ml)
ESTRADIOL: 15 (< OR = 39 pg/mL)

Does this help? Thank you for the support.

You’re going to want to see fT4 at 1.3 or higher, fT3 every bit of 4.0, or higher.

On thyroid meds, this should be no higher than 1.0.

Nope, you want to at least triple your free test and double your total test.


Most doctors take action when total testosterone drops below 300 ng/dL, it would be fraud if your doctor prescribe TRT and the insurance company would deny treatment. At 301 congratulations you’re normal, but if you are 299, you are approved for TRT.

It’s a game the insurance companies utilize to deny medical coverage because there is so much stigma surrounding TRT within the medical community, the people incharge has a huge bias against TRT.

You will have to seek private care and pay out of pocket.

This in no way mean you are normal, normal is whatever the insurance company says is normal.

The clinic studies show normal is north of 500 ng/dL, actually the average 30 year old is north of 600 ng/dL.

Hi - ok, but despite who will treat me, are these test levels way off? I am not familiar with the difference between 407 vs. 600 ng/dl. Is that 407 low enough for me to notice issues?

is the free test that low? what level is this comparable too in regards to age? thank you.

Where are you located? We can guide you to find a legit doc. You can consult my doc but you have to fly out to see him. Or in Cali telemedicine.

He’s a legit doc and can sort you out. He did for me and many others.

Guys are coming here all the time with symptoms of low testosterone when they’re free testosterone is mid range, yours a scraping along the bottom of the ranges. Healthy young men will see free testosterone in the high normal ranges or higher.

President Trump has higher levels than you do (446 ng/dL), he’s 72 years old. Your test is low because you aren’t getting enough sleep and working to hard. It takes a couple of hours to hit stage 4 REM sleep, so you are only getting a couple hours of sleep.

Sleep replenishes your testosterone, cutting out a few hours per night of deep restful sleep and over time lowers testosterone.

We were engineered as hunter gathers, we conserve energy for the hunt. Your expend too much energy and getting too little sleep, this will lead to other health problems down the road. Researchers are stating that low hormones can lead to alzheimers disease in older people with insufficient hormones.

It is that low. Get it to 150 and you will know what I mean.

All the previous responders here have way more insights on the medical aspects of your question but the one suggestion I would make from what you’ve said is to try to get more sleep (based on the age of your kids though I understand that that might be easier said than done) and instead of doing an hour of steady state cardio I would instead do sprints and/or sled pushes/pulls, which will give you more time for your hectic schedule and way more bang for your buck in terms of results


Circuit training will kick anyone’s ass and get fit quick.

Ok. This makes sense. In your experience, is the free test so low that it signifies an issue? Should weight loss be my first plan of attack (other than thyroid)?

I wish I could man. I’m an ex wrestler / and lifter. Tore my rotator cuffs at CrossFit 3 years ago. Destroyed my body.

Expanding somewhat on what @mwdsolof202 said, long distance/time periods of steady state cardio is not conducive to great testosterone numbers. From what I understand it can be quite the opposite.

TRT and thyroid, don’t prolong recovery, you testosterone is not going to increase naturally. Your numbers signifies low testosterone being masked by what may be elevated SHBG or at least it’s binding up androgens strongly.

We normally see men in here with similar Total T and Free T ratios, the common denominator is SHBG is binding androgens and testosterone production is low, but elevated SHBG is causing Total T to be elevated and Free T bottomed out.

I’m a low SHBG guy (16-22) and would see Free T at midrange with a Total T in the low 400’s.