Thoughts/Opinions on my bloodwork/saliva test

Hi,

30 year old here with past AAS use (years ago). Since the AAS I had never felt that my libido had returned to normal. Dealing with lack of desire, weaker erections, etc.. In addition I have many of the typical symptoms for low T. (Depressed, lack of motivation, brain fog, grumpy..)

Recently I had my family doctor run some labs. The first time around bloods were done in the evening and results are as follows:

TSH: 2.26 mIU/L (0.35-4.30)
T4 Free: 13.3 pmol/L (9.0-19.0)
Testosterone (Total): 9.44 nmol/L (8.00-32.00) = 272 ng/dl for you American folks


Roughly 2 months later he did some bloodwork for me again which was drawn early in the morning this time around. The results are as follows:

LH: 3.2 IU/L (0.6 - 12.0)
FSH: 7.2 IU/L (1.0 - 12.0)
Testosterone (Total): 9.95 nmol/L (8.00-32.00) = 287 ng/dl

The total testosterone the second time around was actually supposed to be for free testosterone but there was either a screw up or someone in our healthcare system decided not to do free..

My family doctor didn't seem concerned at all despite my symptoms. From there I sought out an anti-aging clinic here (the only option I could find that deals with TRT). The doctor(A4M trained) at this clinic had me do a saliva test upon waking. The results were as follows:

Estradiol: 2.5 pg/mL (0.80 - 6.6)
Testosterone: 100 pg/mL (43 - 150)
DHEAS: 4.9 ng/mL (3.0 - 11)
Cortisol AM: 4.9 ng/mL (0.90 - 9.5)

He doesn't think my T is the problem and I was fairly shocked to find it sitting in the range where it is. He leaned towards adrenal fatigue and suggested 25 mg DHEA daily + an adrenal support supplement.

I'm hoping that some knowledgeable folks can chime in on my situation here. Is it normal to have such low total test and have free test look much better? Do other folks tend to agree that this looks more like an adrenal issue?

Some other background:
-I eat healthy
-183 lbs ~18% bodyfat currently
-I lift weights 3 days a week (full body focused on compound exercises)


My apologies if I've left out any important information. I really appreciate any input/advice.

Thanks,

-A

Welcome to EM. As a fellow Canadian I understand it can be frustrating to find capable medical care if you're dealing with hypogonadal issues. That said, no doctor who understands his or her way around hormones trusts saliva-derived testosterone or estradiol values. Why? They are utterly inaccurate. Simple as that.

Your blood work suggests you are hypogonadal. Your doctor made the all too common error of assuming that because you are "in range" that you're "normal." Not necessarily true. Of course, there is a lot more testing that wasn't done...so that means your first step is finding a capable doctor in the Halifax-Dartmouth region.

We've had some luck finding referrals for members in Ontario and Quebec, and I will see if that good fortune can be extended to the Atlantic provinces. It may well mean stepping outside the health care system for private care.

I second what CoastWatcher says but in addition to that, salivary testing for cortisol is usually done at 4 time intervals per day. (search ZRT labs) I've done it and was then diagnosed. To suggest with just the morning cortisol that you have problems is on the thin side. You won't know your cortisol rhythm or stage you are in until you test the 4 different periods of the day. Also salivary testing is quite good for DHEA and that's pretty much it. TT of 287 ng/dl sure looks low to me..

Thank you both for your replies.

CoastWatcher said:

your first step is finding a capable doctor in the Halifax-Dartmouth region.

We've had some luck finding referrals for members in Ontario and Quebec, and I will see if that good fortune can be extended to the Atlantic provinces. It may well mean stepping outside the health care system for private care.

Click to expand...

Unfortunately finding GPs in Nova Scotia is pretty bad at the moment. Many people are on a wait list just to get a family doctor. Not sure what my options are in terms of finding someone new.

That would be amazing if a referral could be obtained. I certainly don't mind going for private care - the anti-aging clinic was not covered. I don't even mind a bit of a road trip if it means getting proper care.

Update:

Pushed my family doctor a bit around my T levels. He ended up running a bioavailable/total/SHBG/Albumin and prolactin for me.

Results:

Albumin: 45 g/L (35-50)
Prolactin: 2.9 ug/L (3.5-19.4)
Total Testosterone: 8.82 nmol/L (8.00-32.00)
Bioavailable Testosterone: 1.90 nmol/L (2.50-10.00)
SHBG: 29.9 nmol/L (13.5-71.0)


Thoughts on the bloodwork?

He's now open to going down the TRT road by the sounds of it including self-injections. He's also referred me to an endo here that has an interest/specializes in male hypogonadism. Things could be looking better regarding treatment.

akirez said:

Update:

Pushed my family doctor a bit around my T levels. He ended up running a bioavailable/total/SHBG/Albumin and prolactin for me.

Results:

Albumin: 45 g/L (35-50)
Prolactin: 2.9 ug/L (3.5-19.4)
Total Testosterone: 8.82 nmol/L (8.00-32.00)
Bioavailable Testosterone: 1.90 nmol/L (2.50-10.00)
SHBG: 29.9 nmol/L (13.5-71.0)


Thoughts on the bloodwork?

He's now open to going down the TRT road by the sounds of it including self-injections. He's also referred me to an endo here that has an interest/specializes in male hypogonadism. Things could be looking better regarding treatment.

Click to expand...

You are certainly hypogonadal. In fact, your bioavailable-t level is one of the lowest ever posted here. It's no wonder you're feeling as you are. You have more tests to run, a more in depth thyroid panel and a psa to cite the most obvious, but you're moving toward treatment. How much experience does your primary care physician have with TRT?

As noted above, your provided labs are a bit inadequate. On thyroid, TSH & FT4 is just a small picture of what's going on. T4 will be your reserves, but the real truth lies in Free T3 and Reverse T3, along with TPO & TgAb antibodies. Rat also tapped on the 24hour Cortisol w/DHEA correlation panel, which is the double gold dipped in chocolate standard for the adrenal profile, along with drawing a standard ACTH serum assay. See what you can do, we will be able to provide you with feedback on those results.

It's also important that you raise the question of monitoring estradiol with both your family doctor and the endocrinologist you are going to see. Living in Canada, you will not have access to the sensitive, LC, MS/MS, e2 test, that's just a fact. The best you can hope for is that they are skilled in assessing patient response and will work to match your subjective report of symptoms to the results of a standard estradiol test. There are two extremes to avoid: the idea that e2 levels are unimportant (still an attitude a lot of guys encounter), or the tendency to rush in with an AI when symptoms may not call for it.

Thanks for the input everyone.

I will see what I can get my GP to run for me. He's been pretty open to my requests so hopefully there won't be much challenge there.

What is the reasoning behind a more in depth thyroid panel? Can that effect T or is it more a matter of symptoms/other potential issues going on?

Also I am 30 - is a PSA usually recommended at my age as well? No issues asking for it and I'm sure he'll run it.. Just curious.

As for my GP's experience with TRT, he has seen some men for TRT in the past but he is young. He admitted that he wanted to go do some research before jumping into things.

Having said all of this, he mentioned starting TRT prior to seeing the endo if I wanted. (and assuming the addition bloodwork indicates this that direction) I wasn't sure what to think of doing that as I'm scared that the endo may want to take me off. (Perhaps attempting a restart?) The last thing I want is a hormonal roller coaster but I'm obviously eager to find relief of my symptoms.

Thanks again for all the replies.

akirez said:

Thanks for the input everyone.

I will see what I can get my GP to run for me. He's been pretty open to my requests so hopefully there won't be much challenge there.

What is the reasoning behind a more in depth thyroid panel? Can that effect T or is it more a matter of symptoms/other potential issues going on?

Also I am 30 - is a PSA usually recommended at my age as well? No issues asking for it and I'm sure he'll run it.. Just curious.

As for my GP's experience with TRT, he has seen some men for TRT in the past but he is young. He admitted that he wanted to go do some research before jumping into things.

Having said all of this, he mentioned starting TRT prior to seeing the endo if I wanted. (and assuming the addition bloodwork indicates this that direction) I wasn't sure what to think of doing that as I'm scared that the endo may want to take me off. (Perhaps attempting a restart?) The last thing I want is a hormonal roller coaster but I'm obviously eager to find relief of my symptoms.

Thanks again for all the replies.

Click to expand...

It doesn't matter how old you are, a psa is a mandatory test prior to starting TRT and needs to be monitored on an annual basis. The old notion that exogenous testosterone causes prostate cancer has largely been discredited, but psa values can, and do, increase while a patient is on TRT. A value above 4.0 means urological evaluation must be sought.

There is a reason that the thyroid is called the master gland. A bit of research will show you that if thyroid issues are present, androgen replacement therapy can be frustrated.

Finally, you are very young to be hypogonadal. What discussion has there been in regard to your age and the possible trial of a Clomid restart protocol?

CoastWatcher said:

It doesn't matter how old you are, a psa is a mandatory test prior to starting TRT and needs to be monitored on an annual basis. The old notion that exogenous testosterone causes prostate cancer has largely been discredited, but psa values can, and do, increase while a patient is on TRT. A value above 4.0 means urological evaluation must be sought.

There is a reason that the thyroid is called the master gland. A bit of research will show you that if thyroid issues are present, androgen replacement therapy can be frustrated.

Finally, you are very young to be hypogonadal. What discussion has there been in regard to your age and the possible trial of a Clomid restart protocol?

Click to expand...

There has been no discussion of an attempt to restart. Given that my GP doesn't seem to be experienced with TRT, I doubt he's familiar with any restart protocols. It may be best just to hold out for the endo who is more likely to have experience with restart attempts.

akirez said:

There has been no discussion of an attempt to restart. Given that my GP doesn't seem to be experienced with TRT, I doubt he's familiar with any restart protocols. It may be best just to hold out for the endo who is more likely to have experience with restart attempts.

Click to expand...

I hope that's the case. It would seem that the keys to managing a Clomid protocol are patience, on the part of the patient, and experience, on the part of the doctor. Being 30 years old it's worth serious consideration before you embark on TRT for life.

Youre going to have to be your own advocate if your family doctor is also learning the ins and outs of TRT. It can be done, and there is plenty of material in the sticky posts here at EM to help you. Please let us know how this unfolds.