2 blood tests - low free T - fatigued, considering TRT

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binkybonky

New Member
Hi bloods below and attached pic

I seem to have low end normal total t and below range free t, I think because of my high end SHBG.

My main symptoms are lack of drive (including sex), fatigue, brain fog, forgetfulness, lack of confidence, and mild anxiety.

I spend the week at work (doing just about ok), and most of my weekend and time off in bed or on the sofa because I'm exhausted and don't feel like doing anything at all. I've also been going to the gym 6 days a week and watching calories and macros very carefully on bulk cut cycles, but gaining little muscle mass.

Should I be looking into TRT or something else?

Thoughts, input much appreciated.

Thanks

Labs
Haematology
Result Name Result Value Result Units Reference Range Status
Haemoglobin 150 g/L ( 130-170 ) N


Haematocrit 0.426 L/L (0.400-0.500) N


RBC 4.7 x10e12/L ( 4.5-5.5 ) N


MCV 91.1 fL ( 80-100 ) N


MCH 32.0 pg ( 27-32 ) N


MCHC 351 g/L ( 315-345 ) H


RDW 12.5 % ( 12.0-16.0 ) N


Platelets 194 x10e9/L ( 150-410 ) N


MPV 7.5 fL ( 7.0-11.0 ) N


WBC 9.4 x10e9/L ( 4.0-10.0 ) N


Neutrophils 6.5 x10e9/L ( 2.0-7.0 ) N


Lymphocytes 2.1 x10x9/L ( 1.0-3.0 ) N


Monocytes 0.8 x10e9/L ( 0.2-1.0 ) N


Eosinophils 0.07 x10e9/L ( 0.02-0.5 ) N


Basophils 0.03 x10e9/L ( 0-0.1 ) N


ESR 2 mm/Hour ( 0-10 ) -
Biochemistry
Result Name Result Value Result Units Reference Range Status
Sodium 139 mmol/L ( 133-146 ) N


Potassium 4.0 mmol/L ( 3.5-5.3 ) N


Urea 9.6 mmol/l ( 2.5-7.8 ) H


Creatinine 87 umol/L ( 62-106 ) N


eGFR 85 - - -
Units are mL/min/1.73 m2.Multiply eGFR by 1.2 for African/Caribbean subjects.Interpret with regard to UK CKD Guidelines.
Glucose (Non-Fasting) 4.1 mmol/L - -
Calcium 2.32 mmol/L ( 2.10-2.55 ) N


Calcium (Corrected) 2.22 mmol/L ( 2.10-2.55 ) N


Inorganic Phosphate 1.31 mmol/L ( 0.80-1.50 ) N


Uric Acid 330 umol/L (200 - 430) N


Total Protein 73 g/L ( 60-80 ) N


Albumin 48 g/L ( 35-50 ) N


Globulin 25 g/L ( 20-40 ) N


Total Bilirubin 7 umol/L ( < 21 ) -
Alkaline Phosphatase 74 IU/L ( 30-130 ) N


AST 48 IU/L ( < 41 ) H


ALT 47 IU/L ( < 41 ) H


Gamma GT 16 IU/L ( 8-61 ) N


Serum Iron 10.0 umol/L ( 5.8-34.5 ) N


Cholesterol 3.4 mmol/l ( <5.0 ) -
Triglycerides 0.82 mmol/L ( < 1.70 ) -
HDL Cholesterol 1.5 mmol/L ( 0.9-1.5 ) N


LDL (Calculation) 1.6 mmol/L ( < 3.0 ) -
HDL/Cholesterol Ratio 0.44 - ( > 0.25 ) -
Cholesterol/HDL Ratio 2.27 Ratio - -
Non-HDL Cholesterol 1.9 mmol/L - -
TSH 2.75 mU/L ( 0.27-4.20 ) N


Testosterone 6.27 nmol/L ( 8.64-29.0 ) L


Sex Hormone Binding Globulin 51 nmol/L ( 18.3-54.1 ) N


Free Androgen Index 12.2 - ( 22-104 ) LL


Hormones
Cortisol (8-10am) 312.0 166 - 507 nmol/L
Markers
PSA (Prostate) 0.772 <4 ug/L
 

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ratbag

Member
Yes you would benefit from TRT. Your very low FT isn't helping you and yes it's related to your high SHBG . Also anytime the TSH is over 2 there is very likely an underlying problem. You would need these following labs in order to ascertain the problem. Although you're androgen deficient, symptoms from a thyroid problem are quite similar. I believe you are suffering from symptoms from both low T and thyroid issues... it's a double whammy! I also wonder whats up with your liver enzymes? Do you have Hep C?

TSH
FT3
FT4
RT3
TPO
TGAb
Ferritin
 

CoastWatcher

Moderator
Welcome to Excelmale. May I ask how old you are? What are your sleeping patterns like? Medications you're taking (prescribed, over the counter, and supplements)? History of steroid or prolonged opiate use?
 

binkybonky

New Member
thanks for quick response. I'll look into getting these tests. The attached pic in my original post (taken a couple of weeks after the text in the shows slightly better results which confused me). I don't have Hep C or any other illness as far as I'm aware. I read a little about thyroid treatment and was a bit concerned that often the treatment involves removing it, and sometimes it seems the end result if prescprition of TRT regardless. Any thoughts on this?
 

binkybonky

New Member
Coastwatcher, thanks also for quick response. I'm 46. I don't sleep well. I get to bed early, but either take a while to get to sleep or wake early. I usually get 5-6 hours a night, rarely sleep more than 6. I take lots of vitamins (multi, 3x1g vit c, d3 300iu) and fish oil, glucosamine, creatine, beta alanine, citrulline malate, and whey protein. No medications per se. No steroid or opiate use.
 

Vince

Super Moderator
I agree with ratbag, before you considered TRT. Get a complete thyroid panel, and if you need to make sure you get the proper treatment for it.
 

CoastWatcher

Moderator
Coastwatcher, thanks also for quick response. I'm 46. I don't sleep well. I get to bed early, but either take a while to get to sleep or wake early. I usually get 5-6 hours a night, rarely sleep more than 6. I take lots of vitamins (multi, 3x1g vit c, d3 300iu) and fish oil, glucosamine, creatine, beta alanine, citrulline malate, and whey protein. No medications per se. No steroid or opiate use.

You must have your sleep evaluated. There is an "undiagnosed epidemic " of sleep apnea in men (Dr. Justin Saya's words). Lack of solid, continuous sleep can - and almost always does - hammer your hormones. Prior to any TRT protocol it is imperative that apnea be addressed/ruled out.

Ratbag and Vince raise excellent points in regard to your thyroid - these are not "nice to have" tests. They are critical studies.
 

binkybonky

New Member
Thanks CoastWatcher. I'll definitely get the thyroid panel done. Will also find out about what can be done to diagnose sleep apnea. I'm not overwieight (quite slim), don't have any choking or breathing issues, and my wife hasn't noticed any signs of breathing difficulties. So it may not be that.

I'm seeing a specialist in TRT tomorrow, I'll also ask him what can be done about thyroid panel and sleep apnea investigation (I'm in the uk by the way).
 

CoastWatcher

Moderator
Thanks CoastWatcher. I'll definitely get the thyroid panel done. Will also find out about what can be done to diagnose sleep apnea. I'm not overwieight (quite slim), don't have any choking or breathing issues, and my wife hasn't noticed any signs of breathing difficulties. So it may not be that.

I'm seeing a specialist in TRT tomorrow, I'll also ask him what can be done about thyroid panel and sleep apnea investigation (I'm in the uk by the way).
Are you seeking private care, or through the NHS?
 

Saul

Member
Binky, your situation has many similarities to mine. Others are giving good advice, and i think you may benefit from TRT as i did. Your lack of sleep may also be an issue. I slept better once I went on TRT and when I started propping up to breath better. I noticed your AST and ALT are elevated. Did the Dr. comment on that? Also, do you feel depressed? Are there things you want to go do but don't have the energy or is more that you don't care about anything so you don't do much on the weekends?
 

binkybonky

New Member
Thanks for your reply Saul. I used to feel more depressed, but nowadays, its almost a bit more "detached". I care less, but also the fatigue means I don't have the motivation to get up off the couch, I'd rather go to bed. I don't have any problems with my breathing and don't wake up in the night, except maybe once to go for a pee. I just don't sleep long enough, its almost like my body clock only wants me to have 4 hours, but yet I'm always exhausted.
I too was concerned about high ast and alt, but my gp told me its nothing to worry about. My opinion of GPs is rapidly diminishing, however so I will look into it some more. A quick google for mildly elevated ast and alt doesn't seem to suggest much that might be causing it for me. I don't eat any sugar (I do use erythritol and stevia as substitute), my body fat is in check, I'm probably around 12-14% , 6'2", 187lbs. I had just finished a 6m bulk when the readings were taken so I had previously been on circa 4300 calories per day. I'm currently in a mild deficit - 2700 cals per day, and losing circa 1lb a week. Could it be supplements and vitamins causing high ast and alt, or possibly the high calorie intake (all healthy whole foods, with most of my calories coming from carbs)?
 

ratbag

Member
A buddy of mine is an alcoholic and he says his MD tells him no alcohol for 3 days before his labs or he risks raising his ALT. I had the same problem (not from alcohol) with my ALT it was between 42 and 49 for 10 years but my FT4 was only 50% so when I raised it to a higher level my ALT went down to 25.
 
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