Recent Labs - are they normal?

[drgnv]

Hey guys,


Would appreciate some input on this pattern.


I’ve been experiencing ongoing low energy for the past few years — mainly a lack of morning drive and waking up feeling flat or unmotivated. I wouldn’t describe it as depression, but my baseline motivation definitely feels lower than it should be.


My libido is around 4/10. I don’t have erectile dysfunction, and I still get morning erections.


I’m 32 years old, lean, around 82 kg. I don’t drink or smoke. My diet is quite strict, and I’ve never been overweight or had any metabolic health issues.


Current labs:

• Total T: 4.30 ng/mL (~430 ng/dL) (previous tests around the 500 mark)
• FREE T: Pending ....
• SHBG: 16.3 nmol/L (consistently low on last 4 labs over ~1 year)
• LH: 3.87
• FSH: 4.93
• Estradiol (E2): 47 pg/mL
• Prolactin: 12.96 ng/mL
• eGFR: 82
• Lipids & liver enzymes normal
• TSH: 1.854 uIU/ml
• FT3: 2.580 pg/ml
• FT4: 0.0900 ng/dl
  

Does this look more like aromatization/inflammation-driven imbalance vs true androgen deficiency?


Curious how you’d approach this pattern before considering any intervention.


Thanks.

 

[Cataceous]

No androgen deficiency. The lowish SHBG means free testosterone is respectable, around 12.4 ng/dL by the Vermeulen calculation. Elevated estradiol is potentially an issue, but you need to confirm that the result is accurate. If the test is immunoassay-based then it could reflect significant cross-reactivity with other substances. In particular, if your C-reactive protein is elevated then this can "bleed" into the estradiol result. A mass spectrometry-based estradiol test is capable of much better discrimination, though historically these tests have been finicky. In either case a confirmation of the 47 pg/mL value would be appropriate.

Although the prolactin result is in-range, some men can experience problems at this level. It's worth looking at if other issues are ruled out. Higher prolactin is also linked to elevated estradiol. If the estradiol result is accurate then experimenting with extremely small AI doses could be interesting.

Your FT4 result seems unusual. What is the reference range for that test?

 

[drgnv]

No androgen deficiency. The lowish SHBG means free testosterone is respectable, around 12.4 ng/dL by the Vermeulen calculation. Elevated estradiol is potentially an issue, but you need to confirm that the result is accurate. If the test is immunoassay-based then it could reflect significant cross-reactivity with other substances. In particular, if your C-reactive protein is elevated then this can "bleed" into the estradiol result. A mass spectrometry-based estradiol test is capable of much better discrimination, though historically these tests have been finicky. In either case a confirmation of the 47 pg/mL value would be appropriate.

Although the prolactin result is in-range, some men can experience problems at this level. It's worth looking at if other issues are ruled out. Higher prolactin is also linked to elevated estradiol. If the estradiol result is accurate then experimenting with extremely small AI doses could be interesting.

Your FT4 result seems unusual. What is the reference range for that test?

FT4( free Т4)

ng/dl

0.730 - 1.700

[td]

​

[/td]​

[td]

0.900​

[/td]​

That’s the FT4 results, my mistake earlier.


I recently completed a second course of treatment for Helicobacter pylori, as the first one failed. The initial treatment was about three months ago. I finished the second treatment a week ago, which included levofloxacin, amoxicillin, a proton pump inhibitor (PPI), and bismuth. Given that, it’s possible the elevated estradiol is related to recent infection, inflammation, or antibiotic treatment.

As I mentioned before, I’ve often had elevated prolactin levels. However, I want to clarify something important. In most cases, blood samples were taken immediately after I arrived at the lab, without resting for 20–30 minutes beforehand. Only twice was I allowed to rest before the blood draw, and on those occasions prolactin came back in the high-normal range. When samples were taken immediately, prolactin was frequently elevated, sometimes even reaching around 800 ng/ml.

 

[drgnv]

Those are the final results with FREE T sitting at: 17,50 pg/ml (1.75 ng/dl) (0.061 nmol/L)