Where to Start, Bloodtest-wise?


35 year old male here with some libido/sexual issues over the last year to 1.5 years. 150lbs, 6’ tall, no change in weight ever really. I’m curious what I should start with blood test wise to try to get some direction on whether T or thyroid hormones would help me–I’ve done a few basic tests over the last year or so due to several symptoms (more on those later) but I’m wanting to get one comprehensive set of tests done to post here to see what you guys think is going on.

Sorry my results are going to be kind of all over the place Here are the results I’ve had, though these were from several months ago:

TSH was nearly 3.0
Free test was very low, 4.1 [8.7-22.5]
I did not have SHBG tested, though I’m assuming it’s quite high
Total test was in the mid range, 448
Prolactin was high normal, 23
Estradiol was, I think, kind of low at 12 [8-35]

And that’s all the results I have. I have a previous total test results from about 6 months earlier where my total test was nearly 1000 (totally natural)

My symptoms for the last year+ have been lower than normal libido, difficulty achieving orgasm (sensation does not feel normal, I just don’t feel the “oh my god this feels good” feeling lately) + long refractory period. I used to be always good for once a day and by the time it’d been 3-4 days I would be more worried about being “done” in 3 minutes than not being able to at all. Now even when it’s been 4-5 days I’m lucky if it doesn’t turn into a long session (too long) to get the job done. Very frustrating for me and my partner.

Any thoughts/questions/direction would be much appreciated.

I have not been to a doctor about this. I have no confidence they will be able to do anything other than run a bunch of tests and tell me my total test is in range so I’m fine

Your TSH is high. Do you have any other thyroid numbers? Your free T sucks, but it may not be that thyroid or something else is causing your problem, TRT might fix the symptoms, but you should know the problem first before you decide what to do.

I don’t have any other thyroid numbers from when I had those tests done… I do have some results from about 6 months earlier than the results I originally posted, those are:

“Thyroxine (T4) Free, Direct” - 1.51 [0.82 - 1.77]
“Triiodothyronine (T3), Free” - 3.2 [2.0 - 4.4]

I don’t know that that will do any good given they were 6 months prior to the results I originally posted, or that they are even what you’d want to see anyways.

Unfortunately I didn’t know what to test so I didn’t get everything I really needed all at once. Live and learn I guess.

So in 6 months your total test dropped by more than half. That is an issue, could be serious. Could be a faulty lab test, but that’s a pretty massive drop.

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Yeah, it is concerning. I guess the only other piece of info is the original test was first thing in the morning, the second (lower) one was afternoon, but I don’t know that it accounts for that much of a drop

Free test also went from 7.2 to 4.1 over that timeframe

I’m undecided on whether I should go ahead and do another round of tests on my own or try to visit a doc. I just expect the process at the doc to be very slow and frustrating if they will listen at all. But it would be cheaper if a dr. orders the tests as my insurance is very good. But I can pay out of pocket if I need to, so it’s not a 100% deciding factor.

They are highest first thing in the morning, but that’s a big drop. Have the doc run them. You can go to someone else out of pocket for treatment if you don’t like how he handles it, but you can go with labs in hand.

Sounds like a plan to me

Your SHBG must be elevated, it’s the only way T could be almost mid normal and free testosterone low. Do not expect your doctor to understand any of these labs you have ordered, the doctor will see total testosterone in range and that will be the end of that, then your time would will have been wasted.

TSH is a problem, anything >2.5 is not normal, of note TSH isn’t a thyroid hormone. Free T3 will show how much thyroid hormone is at the cellular level, sometimes Reverse T3 can block Free T3 at the receptor if elevated above 15 ng/dL.

Your best bet is to seek a private doctor who specializes in TRT and not an ordinary endocrinologists or sick care doctor who doesn’t specialize in this area of medicine.

Thanks. Yeah, SHBG has to be high, there’s no way around it.

Free T3 was 3.2 pg/mL. I’m not sure how that converts to the units you mentioned. From the way the range is written by the lab, I’m right in the middle of their “range”, but I have no idea if that’s good or not.

I’ll look into a private doctor. I’m assuming there are some suggestions on the forum for ones to go to? I’ll do some reading

It would help to know your location, if no good doctors are in your area, you could always go with a telemedicine clinic.

I am in North Carolina

wow. what a drop! did you have a significant life style / stress change on that period?
like night shift job, divorce, diet restriction/ changes.

Nope, nothing that I can think of. I always chalked it up to testing in the morning vs afternoon but I don’t know how big those differences usually are

Which end of NC?


I think that fact alone is killing part of your T count, LOL. Less stress in the mountains.

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Haha, I did start having issues about the time I started coming to Raleigh a lot and ultimately moved back. I was towards high point before that

All joking aside, the life there is probably greatly to blame. I’m sure you work in an office and don’t have time to cook much. Sitting in traffic is a killer and the lack of activity that goes with it hurts too. Keep in mind also that sun doesn’t count if you are behind glass, you won’t generate any vitamin D from it if you are behind glass.

All true. I commute about an hour each way, almost every day to an office job…

I’m trying to get better about the diet part but I still eat my fair share of fast food unfortunately.