New Member is Canada w/ pre-TRT bloodwork

Thread starter #1
Hi guys,

I’m a 24 y/o male from Canada. I exercise 6xx/week (3 lifting, 3 sports) and have been doing this for over 8 years. I’m 6’0 and 200lbs (prob about 20% BF).

My problems all started about 7 years ago. I developed an eating disorder while trying to “cut” and lose some body fat. I had body image dysmorphia and frequently fasted for >20 hour periods in order to justify binge eating. I was eating not nearly enough dietary fat and ate certain points in my journey carbs as well. I went from about 220 pounds to 175 pounds in about 6 months. I got quite lean but at the cost of my health and my hormonal balance. I wasn’t mature enough to recognize it at the time but I had clear symptoms of low thyroid and low testosterone in addition to my mental health problems. I have since fixed my mental health problems (no medications) and no longer have body image issues. I exercise for health now, not for the way that i look.

Unfortunately my improved mental strategy towards a healthy lifestyle did not improve my symptoms of low thyroid and low testosterone. I visited a doctor to have blood tests done and to my surprise my TSH was >5. The doctor mentioned my testosterone was “low normal” and that I would be fine if I just fixed the thyroid. I was prescribed synthroid and have over the last 3 years worked my way up to 100mcg/day. It works great. I no longer feel cold all the time and have more energy. TSH is about 1.

In the last year I have increasingly felt my symptoms of low T worsen. I feel like I have no drive, no motivation, I feel “emotionless”. Erections are possible but I have almost no desire to have sex. I have feel that I can never get those last few reps to really plush myself in the gym. I have lost muscle and all my lifts have dropped (slowly). I have increasingly larger “love handles” despite my weight being stable at 200lbs. I sleep at least 8 hours every night but feel groggy and foggy brained all the time. I eat more vegetables than I ever have, drink less than I ever have (2-3 per week), sleep more and control stress better but still I feel awful. I finally decided no more and chose to go annoy doctor after doctor until someone would give me a blood req. Here are my results:

Ferritin: 80ug/L (range: 20-250)
Sodium: 137mmol/L (range: 135-146)
Potassium: 4.3 (range: 3.5-5.1)
Chloride: 98 (range: 100-110)
Carbon Dioxide: 24 (range: 22-31)
Anion Gap: 15 (range: 8-16)
Leukocytes 5.27 (range: 4-11)
Erythrocytes 5.03 (range: 4.6-6.2)
Hemoglobin: 150 (range: 135-180):
Hematocrit: 0.433L/L (range: 0.405-0.546) LOW NORMAL
Platelets: 200 (range: 150-400)

DHEA-S: 9.44umol/L (range: 4.34-13.4)
SHBG: 34.1nmol/L (range:13-71)

Cholesterol: 5.39mmol/L (range: 3.2-4.6) HIGH
Triglycerides: 0.52mmol/L (range: 0.6-2.3) LOW
HDL: 1.87mmol/L (range: 0.9-1.6) HIGH
LDL (calculated): 3.28mmol/L (range: 1.7-3) HIGH
Cholesterol/HDL: 2.9mmol/L (average risk) = <3.5)

PSA: 0.47ug/L (range: 0-4)

FSH: 7.7IU/L (range: 1.4-18.1)
LH: 7.8IU/L (range: 1.5-9.3) HIGH NORMAL

IGF-1: 254ug/L (range: 105-298)

TSH: 1.2 (range: 0.27-4.2)

Glucose: 5.6mmol/L (range: 3.6-10)

Labcorp values
Estradiol sensitive: 11.0pg/mL (range: 8-35) LOW NORMAL
Testosterone serum: 557ng/dL (range: 264-916)
Free testosterone: 15.9pg/mL (range: 93-26.5)

Canadian lab test values
Testosterone: 9.51nmol/L (range: 5.8-28) LOW NORMAL
Free Androgen Index: 29.4 (range: 35-92.6) LOW
Estradiol: 41pmol/L (range: 28-156)

Testosterone: 16 (range: 5.8-28)
Free Androgen Index: 41.6 (range: 35-92.6) LOW NORMAL


Discussion:
- Hematocrit is borderline low, due (in part) to low T?
- lipids are not as concerning as they look IMO. High HDL and low TG (depending on who you talk to ) is a good thing. LDL calculated also tends to overestimate LDL in pits w/ low TG (reference)
- LH high (ish)
- estradiol sensitive is low (makes sense as i feel emotionless) and estradiol normal assay tends to overestimate
- serum and FT numbers from labcorp are higher (in comparison to reference ranges) than the ones from the lab in Canada are. Free androgen index is often not sensitive enough to accurately capture highs and lows near end of normal range (reference)

Plans:
- I have an appt w/ A doctor in Canada next week to discuss TRT (he was recommended as a good doc for “mens health”). Small chance he knows how to do TRT effectively but I can always hope.
- if he ends up not panning out. I have a consult booked w/ Defy for the week after and will proceed w/ treatment plan from them.

Any questions/advice would be greatly appreciated. I’m here to learn and would be happy to learn from (and hopefully at some point contribute to) this great community.

Thanks

EDIT: couldn’t post references b/c post count too low
 
#3
Your testosterone is not really low. Your FT is ~ 16. Did you measure it fasted early in the morning? Your hematocrit is not low and most likely has nothing to do with your testosterone levels. It probably is related to your diet.
At these TT and FT levels I would not consider TRT. You mention eating disorder. The key here might be your nutrition. I know little about thyroid but like Vince said it is worth investigating further.
 
Thread starter #4
You mentioned that you had hypothyroidism, can you post your thyroid labs. TSH, FT4, FT3, reverse T3 and antibodies.
Never have reverse T3 tested. Antibodies were high positive for hashimotos. Back when i was new to synthroid i had FT4 and FT3 were in range, as well as TSH
 
Thread starter #5
Your testosterone is not really low. Your FT is ~ 16. Did you measure it fasted early in the morning? Your hematocrit is not low and most likely has nothing to do with your testosterone levels. It probably is related to your diet.
At these TT and FT levels I would not consider TRT. You mention eating disorder. The key here might be your nutrition. I know little about thyroid but like Vince said it is worth investigating further.
Fair enough, maybe i am reaching with the hematocrit comment. FT was measured fasted in the morning. I would agree that my nutrition had something to do with my health problems starting. Essentially i starved myself and lost a ton of weight very quickly. It’s very common (at least from what i read) to have young men who get to absurd levels of leanness have their hormone levels affected (testosterone and thyroid specifically). That was 7 years ago. Since then i have not tried to lose weight, i’ve eaten well, slept well and in general taken much better care of myself. Over those 7 years my low t symptoms have improved only marginally. In my opinion I have run out of “lifestyle” changes to make in hopes of making myself feel better and thus am seeking the advice of a physician.

I appreciate your advice though!
 
Thread starter #7
Tested positive for Hashimoto's, Synthroid is not the way to treat it. You really need your reverse T3 checked
Hmmm. Thanks for the link. I gotta say that (about 3 years ago when i started synthroid). I responded immediately and quite well to it. I was amazed at the fact that i was not freezing cold anymore, felt less fatigued, started sweating again during exercise. Thats part of the reason i let me low t numbers slide. I felt better. Not 100% better but when you go from feeling terrible to feeling okay its easy to listen to a doc that doesnt want to treat your low t levels and just go with the little improvement that you have. Are my FT3 numbers perfecr now? Dunno havent had FT3 tested in a few years. I would find it hard to believe that even IF those numbers are low that they would contribute so greatly to low libido, loss of muscle mass, lack of emotion, etc. Especially given the bloodwork numbers that suggest low testosterone and low estrogen.

Appreciate the link tho. I’ll be sure to bring it up at my appt next week. Thanks
 
#8
I would find it hard to believe that even IF those numbers are low that they would contribute so greatly to low libido, loss of muscle mass, lack of emotion, etc. Especially given the bloodwork numbers that suggest low testosterone and low estrogen.
Well believe it because hypothyroidism has very similar symptoms to Low T, we all know this here. Now we know you are hypothyroid and being treated with only T4. It is possible your Ok on this treatment but it's also possible you are still hypothyroid but don't know it. Without knowing what these labs are (FT3, FT4, RT3, TSH, Both Antibodies and ferritin) it's only a guess.
 
Thread starter #9
Well believe it because hypothyroidism has very similar symptoms to Low T, we all know this here. Now we know you are hypothyroid and being treated with only T4. It is possible your Ok on this treatment but it's also possible you are still hypothyroid but don't know it. Without knowing what these labs are (FT3, FT4, RT3, TSH, Both Antibodies and ferritin) it's only a guess.
Is it fair to say that both thyroid levels and/or test levels might be contributing to the symptoms? And the only way to know for sure would be to have those thyroid numbers ran?

What would you do if rT3 was highish and FT3 was lowish? Treat that with T3/T4 combo and wait to see if that solves all symptoms?

What if they come back normal? Then would TRT seem a more favourable option?

Just looking for others opinions. Thanks
 
#12
Fair enough. Thank you
Many men start trt and never feel right, I believe the thyroid should be treated before someone is treated for low testosterone. Men who have hypothyroidism use high levels of testosterone to feel good, and some just never feel good.
 
Thread starter #13
Many men start trt and never feel right, I believe the thyroid should be treated before someone is treated for low testosterone. Men who have hypothyroidism use high levels of testosterone to feel good, and some just never feel good.
Fair. I’ll try to get the full thyroid panel tested next week. Hopefully it shows that it’s all good cause i’d rather try to solve one problem than two.
 
#15
Note that a full thyroid panel doesn't necessarily include the lab tests we posted above. Just so you know before hand and of course RT3 probably isn't available... but it is in some private labs.
 
Thread starter #16
Note that a full thyroid panel doesn't necessarily include the lab tests we posted above. Just so you know before hand and of course RT3 probably isn't available... but it is in some private labs.
Of course. I’ll do my best to make sure it includes FT3 FT4 TSH and RT3.

I assumed since I had such a dramatic improvement in specific symptoms after starting synthroid that it had solved my thyroid problems completely. That could certainly not be true. Hopefully i can get those labs (might be difficult in Canada). I’m still very concerned about my T levels (see the Free Androgen Index numbers above) but I need both my thyroid and my T in line to feel great. Thanks guys.
 
Thread starter #17
#20
I thought I posted my ferritin numbers

Ferritin: 80ug/L (range 20-250)
You did include ferritin in the original post. 80 ug/l is not bad and they say it needs to be a minimum of 80 ug/l for the thyroid to work properly. Optimally you probably want your ferritin between 130 and 150 so a good iron supplement will help. TRT seems to lower ferritin so you should supplement anyway since you are going on TRT.
 
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