Low TT/FT, 31 Years Old - Next Steps?

Just got setup with a local PCP and my main concern was being tired all the time, thus he drew labs, and I had actually requested he check TT and FT. I've always considered myself reasonably healthy but I've had typical hypothyroid symptoms (fatigue, cold all the time, low body temps, constipation), and it runs in the family on my mother's side. I have no sexual issues (2-4 days a week morning wood, average libido, no erectile dysfunction) but my strength in the gym is pathetic and I haven't made much progress with physique. I'm 6'2 190 and probably 20% bf with 34in waist

Total Test: 406 ng/uL (348-1197)
Free Test: 8.2 pg/mL (8.7-25.1)
** Would you treat this if no sexual side effects were present?

Vitamin D: 15 (30-100)
*** super low and I've since mega dosed vitamin D3 and plan to take it for life at this point; I avoid the sun because of right risk of skin cancer
TSH: 3.370 uIU/mL (0.5-5)
**everything I read suggests that the range should be reduced from 5 to 3, and aside from that.... there's no doubt I suffer from Hypothyroidism.

I have an early appointment with my PCP re: these labs. I already know he does TRT (not sure on his methods) but that's my last ditch effort. I want to add ZMA and clean up my diet for a re-check before considering TRT. What labs would you consider absolutely essential to ask for in case he wants to do labs tomorrow (for both Thyroid and Hypogonadism).

Your pretty low as far as total but doing terrible for Free T and many of your symptoms could be found there and some of the better Drs will treat your lack of Free T and not just the total.

As far as Thyroid see if you can get an more complete panel, 3.3 isn't great should be closer to 1.5 and having more values to examine could get more discussion going, see if you can get: T3, T4, Free T4, Reverse T3, and antibodies.

For you labs make sure that they are fasted 8-10hrs (water only) and first thing in the morning.

For Vit D3 I use 10000iu daily bit that has been shown thru testing what I need to use, up from 5000iu.

Based on your symptoms and those numbers I agree with Vince the full thyroid panel (FT3/FT4, etc.) would definitely be a good diagnostic tool at this point. Definitely rule out thyroid issues before going downstream the TRT route because low thyroid output can absolutely be the driver of the symptoms you are describing.

If my thyroid numbers aren't in the upper 25% of the range of FT3/FT4, I typically get tired, have a hard time keeping myself lean and in shape, etc.

I agree, with TSH: 3.370 uIU/mL (0.5-5) and hypothyroidism runs in your family, I would be concerned. I would definitely have a complete thyroid panel.

So I spoke with my PCP today and he kind of downplayed the TSH and Low Testosterone..... but he did listen to what I had to say and was sympathetic. He said he personally wouldn't feel comfortable treating my TSH without it being out of range, and I can understand that from his point-of-view. I'd rather him admit he's not comfortable with subclinical hypothyroidism, than throw a pill at it. He didn't advise TRT but said that it can be done if it's something I want. I told him I'd make some lifestyle modifications and get a full thyroid panel (TSH,ft3,ft4,anti-bodies) and Testosterone panel (TT/FT/LH/FSH) in 3 months. I'm cleaning up my diet to go with less processed stuff.... I've been doing the whole IIFYM and I think that's a great approach if you don't have medical issues.... but I feel better on a "cleaner" higher fat diet. I plan to take fish oil, ZMA, Vitamin D3 (my level was vey low), and a Multivitamin that has some iodine and selenium. Any other suggestions on an underachieve thyroid?