T Nation

Worried About Low T. Blood Test Results, Too Low?

Hi all,

I’m a 31 year old male suffering bad from symptoms such as:

  • Constant Fatigue
  • No energy
  • No motivation
  • Anxious/depressed

Things started to get really bad a few months ago to the point where I would just lie in bed on my laptop most of the day and it definitely didn’t feel normal.

Decided to get my testosterone levels checked online from a reputable source and here are the results (bloods taken at 9am):

TESTOSTERONE: 7.53 nmol/L (7.60 - 31.40)
FREE-TESTOSTERONE(CALCULATED): 0.225 nmol/L (0.30 - 1.00)
BETA OESTRADIOL: 33.4 pmol/L (0.00 - 191.99)
SEX HORMONE BINDING GLOB: 12.5 nmol/L (16.00 - 55.00)
PROLACTIN: 362 mIU/L (86.00 - 324.00)

Everything else came back normal.

The doctor left a note saying that my test levels were low, but more importantly my prolactin levels were quite high and I should see a doctor (which I have booked in for next week).

I am taking no other medication, my bodyfat % is around 20%. I have always had pretty poor body composition (skinny fat with an emphasis on the man boobs), and I’ve always had a hard time putting on a lot of muscle and holding on to it.

Is TRT my only and best option at this point and would lowering my prolactin levels make a big difference to my overall test levels?
All I really care about is feeling normal again and having good energy levels back.

What are your lab ranges. I don’t believe your prolactin is all that high. I thought males ranged from 2-18 in ng/dl but could be wrong. You need to test FSH/LH at the same time as your other tests.

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Please directly edit your post above and add lab ranges to the data. Lab ranges are not universal and vary from one laboratory to another.

Please evaluate the width of peripheral vision. Should be around 180 degrees. Stare straight ahead and move index finger or hands off to the side and note where you detect. A pituitary tumor can press on optic nerves and reduce peripheral vision. If there is a prolactin secreting pituitary tumor, it can be easily managed with 0.5mg Dostinex/cabergoline per week which is a light burden.

Now that you have these results you need followup labs to better understand the problem.

Please get LH AND FSH both tested.

You need some treatment for sure, these are the lowest T levels I have seen reported.

Also post other labs with ranges as available: - get labs for these if need
fT3 - the only active thyroid hormone
fT4 - please not T3, T4 or indexes etc
fasting glucose
fasting cholesterol
IGF-1 for hGH status [GH should not be tested at this point]
AM cortisol - at 8AM or 1hour after waking up

What is the time-line of these problems?
Any blows to the head leading up to that?

What has happened to your testes?
Do they hang normally or pulled up tight? If up tight, LH/FSH are probably very low.

Loss of hair on lower legs is from long term low T.

Thyroid can also be part of this and it a common problem with guys who come here with low-T.

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

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Do this!

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 is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

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Full bloods (also updated the OP with the lab ranges)

Peripheral vision seems fine, can pretty much detect full range.

Will do many thanks for the in-depth information!

Mild symptoms for maybe 5-6 years I would guess. Not much energy, no motivation, depressed, hard time putting on muscle and a harder time fixing my skinny fat body composition.
Could never lose my moobs no matter how much weight I dropped, and they are always the first thing to get huge during a clean controlled bulk.
My levels 1.5 years ago came back at 10.5 (compared to 7.5 today) for what it’s worth.

Extreme symptoms started around 4-5 months I guess where I just haven’t been able to get up out of bed most days and live a normal life. Feel sluggish beyond belief and no energy.

No blows to the head.

It’s funny you say that because I was wondering why they weren’t hanging loose lately, they are extremely tight and shriveled as of late, pulled up extremely tight.

Again, funny you say this because I used to have the hairiest legs out of anyone I knew (even the older kids) and now they don’t feel anywhere near as hairy… never understood it but never thought about it much either.

Regarding salt, I only never take pink himalayan salt just because there is a tonne of it lying around the house! I eat fairly clean and rarely have much processed food.

I will do everything else you said, I am going to see the doctor early next week so I’ll bring up a lot of the points with him.

I did some reading on high prolactin levels and read that it could interfere with LH/FSH.
I feel like that could be the root cause, but at the same time my T levels just seem way too low in general.

Would it be a good idea for me to go on TRT or is there a chance this could resolve itself by fixing out the prolactin issue (if it’s even an issue at all that is)?

Your levels are pretty low. 7.6 nmol is about 200 ng/dl on the American scale.

Lowering prolactin wont do anything to test levels if your fsh and lh are normal.

You will definitely neee treatment. What country are you in? That range for a 31 year old is nonsense too. Dont let them fool you into thinking you are within range if your numbers slightly go up and get to 10 or 11.

My lowest is 4.4 nmol so I know how shit you feel.

Hey TJ.

I am in the UK! I got a letter out from my doctor today and he wants to see me regarding my T levels (never happened before) so I guess he agrees it’s low.

Few questions for the more experienced guys on here:

  1. Is my prolactin really that high that it’s something I have to worry about?
  2. Could high prolactin cause FSH/LH to be low in the first place?
  3. Are my oestradiol levels too low at 17 ng/dl - or is it fine because of the low T?
  4. SHBG is at 12.5 nmol/L - some folk have said that TRT might not even help me if that number is low - how do I go about increasing this?

I understand improving insulin sensitivity can improve SHBG, so I guess I could increase this number by leaning out as I have put on a lot of weight in the past 4-5 months and got out of shape but still not 100% sure. Problem is the energy levels trying to do so…

  1. Hypothetically, what would happen if I went on TRT right now, starting today? Would it do way more harm than good, or is there a chance it could potentially fix a lot of the problems?

I think your Prolactin is fine and a MRI of pituitary would come up negative for a prolactinoma… we’re talking serious levels if that was the case.

Mine for example is only 7 mm wide by 6 mm which is tiny and my prolactin was 1400 on the same scale as yours and I wouldnt even say it lowered fsh and lh because they were both middle of the range too.

Your oestradiol is fine for where your test level is. If you were to boost T to a reasonable level you would probably find yourself at a good level for e2 which is about 80-100 pmol

I think you will need to go on some form of treatment it wont resolve it self. You can talk to your doctor about trying hcg or a SERM but check your fsh and lh before in my opinion so you know what you’re dealing with.

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Hi guys,

Got my LH / FSH results in:

FSH: (1.50 - 12.40) 1.39 IU/L
LH: (1.70 - 8.60) 7.62 IU/L

Where do I go from here?

I went to my doctor (before I got these test results today) and he already referred me to an endocrinologist but said I could be waiting 3 months, and on top of that there is absolutely no one private around here.

Does anyone have any suggestions on what I can do?

If going through the NHS forget about it as they will likely deny you. I’ve seen others denied that were at the bottom of what’s considered low! You need a protocol of either every day or EOD do to you low SHBG.

Of TRT or something else?

Typically FSH and LH are similar. But LH is pulsatile with a short half-life making results variable. But this quite high LH VS FSH is a pattern that I am seeing more and more often and I do not know what to make of it. Cannot determine if problem is testes or pituitary or both, FSH says pituitary. Testes pulling up tight indicated a lack of LH receptor stimulation and this then is also contradictory with LH=7.62. It is almost like your LH receptors changed.

Your self-induced iodine deficiency needs to stop for you and others in your household. TSH=1.8 is the result, fT3 is the active hormone and is a bit below mid-range. Please post the two requested oral body temperatures. fT4=20.4 is oddly above mid-range, suggesting some impaired T4–>T3 conversion. Ferritin is strong and that then is not a factor in T4–>T3.

Get and use iodized salt or use multi-vits that list 150mcg iodine and 150-200mcg selenium. You should get a product that does not list iron.

Have you read the first two stickies?

Thanks for the info as always, it’s greatly appreciated.

I have to apologise to you, my testicles aren’t pulling up as tight as I first thought (unless they have dropped a bit). They are hanging a little more normal now after a proper inspection since reading your response - I am not sure why that is but they are definitely hanging looser.

I’ve still no idea what this means in terms of my LS / FSH levels.

Iodine Deficiency
Morning temp in bed (averaged over 3 readings): 96.8 f
Afternoon temps: 97.8 f

I have ordered a 150mcg iodine / 200mcg selenium supplement - should be here tomorrow.

Treatment Options
I have read the stickies, but I am still quite confused on the best route to take:

Option 1: Supplement Cabergoline to reduce prolactin levels.

Issues: My prolactin levels don’t seem that high to begin with. Would I really expect to see a massive increase from my current 7.53 nmol/L (217 ng/dl) level? I am going to assume it would still be quite low and further treatment would still be needed.

Option 2: Do a restart using the protocols listed in the sticky and re-evaluate after 4 weeks.

Issues: Im in the UK so getting a hold of HCG is going to be difficult/expensive.
I could try clomid and see how it goes - but this is something I do NOT want to take long term so I am reluctant to take this route.
Given my low FSH levels, this could work - but as my LH is already high wouldn’t clomid raise it even higher?

If I understand correctly, the best case scenario is that the restart will kick-start my T production back into gear, meaning no TRT or long-term SERM/HCG because it fixed itself.
However if T levels drop back down, then TRT is most likely the best option?

Option 3: TRT
I could go straight on TRT and supplement 100mg/week to start with (split 2-3x a week) and re-evaluate my blood work after 4 weeks.

Issues: This could get my T and therefore my E2 levels back up to normal range (as both are dangerously low). A raise in E2 could also raise my SHBG higher which would be great, or the high T could plummet the SHBG even more - I don’t know enough about how it works to really make that assumption though.
I am also not really sure going on TRT would find and address the root cause.

Option 4: Wait 3-4 months to see an Endo
Issues: Have to feel like shit and do nothing for another 1/4 of a year… I would rather self-treat myself in the mean time - I honestly can’t wait that long and from what I’ve read, UK endos probably won’t be much of a help anyway.

@KSman: what would you recommend, as it’s the option I will most likely try first.

Thanks again

Been thinking about it a lot recently, but what are peoples thoughts on starting a Clomid restart? 25mg EOD for 4 weeks to rule out testicular problems? I can’t get hold of nova as per the sticky but not sure what else I can do while I wait 2-3 months for an official endo appointment.

1 week on 25mg Clomid eod and haven’t felt any type of change at all. I know it’s only a week but I thought I would have seen or felt some type of change.

Can anyone tell me if my blood results show if I’m primary or secondary?