Blood work questions: Decently high Free T but Low Total T?

[halj77]

31 year old male. Have been having low T symptoms for the past 8 months or so (gaining body fat easily despite working out and eating clean, harder to put on muscle, lack of libido, fatigue, motivation issues). I am 5'10" 190 lbs, pretty athletic, not fat but decently muscular. Diet is good, sleep is good. Still have low T symptoms. Got blood work done three times in July, a week apart from each other.

First bloodwork (3pm):

Total T: 233 ng/dL (range 264 - 916)

Second bloodwork (8am):

Total T: 309 ng/dL (range 264 - 916)

Third bloodwork (8am):

Total T: 365 ng/dL (range 264 - 916)
Free T: 18.8 pg/mL (range 8.7 - 25.1)
TSH: 3.041 uIU/mL (range 0.450 - 4.50)
IGF-1: 174 ng/mL (range 98 - 292)
Estradiol, Sensitive: 13.4 pg/mL (range 8.0 - 35.0)
SHBG: 17.6 nmol/L (range 16.5 - 55.9)

Unfortunately the first and second blood tests only tested total T.

Questions: All three tests had lowish total T, but my third test showed my free T looking pretty decent. What should I make of this? Are my low T symptoms actual not related to T? Do I need additional tests? What path forward do you recommend?

Thanks

 

[Systemlord]

I recently score similar numbers, Total T 376, FT 15.1 and E2 29.6 and didn't feel to well, no erections, no libido either with decent FT numbers. I believe genetically low SHBG men have high free testosterone for a reason and some need to be at the top of the ranges to feel good.

If you look at the picture as a whole, your testosterone is low. Your testosterone is that of an elderly man, that's a fact. Any TRT protocol will need to be one where you inject testosterone EOD or every day. Low SHBG men excrete testosterone into our urine within 1-2 days so weekly, twice weekly injections will not work. I may be difficult to align this idea with a garden variety endo or urologists.

We convert our Free T into estrogen, estrogen is low. Raise Free T and raise estrogen.

You should target no higher than 600 ng/dL do to low SHBG.

 

[madman]

31 year old male. Have been having low T symptoms for the past 8 months or so (gaining body fat easily despite working out and eating clean, harder to put on muscle, lack of libido, fatigue, motivation issues). I am 5'10" 190 lbs, pretty athletic, not fat but decently muscular. Diet is good, sleep is good. Still have low T symptoms. Got blood work done three times in July, a week apart from each other.

First bloodwork (3pm):

Total T: 233 ng/dL (range 264 - 916)

Second bloodwork (8am):

Total T: 309 ng/dL (range 264 - 916)

Third bloodwork (8am):

Total T: 365 ng/dL (range 264 - 916)
Free T: 18.8 pg/mL (range 8.7 - 25.1)
TSH: 3.041 uIU/mL (range 0.450 - 4.50)
IGF-1: 174 ng/mL (range 98 - 292)
Estradiol, Sensitive: 13.4 pg/mL (range 8.0 - 35.0)
SHBG: 17.6 nmol/L (range 16.5 - 55.9)

Unfortunately the first and second blood tests only tested total T.

Questions: All three tests had lowish total T, but my third test showed my free T looking pretty decent. What should I make of this? Are my low T symptoms actual not related to T? Do I need additional tests? What path forward do you recommend?

Thanks

Your TT levels are low and even though your FT is descent (mid-range) due to your low SHBG.....you may very well need your FT in the higher end of the range to see improvements.

You also need to look into your thyroid as you definitely have some dysfunction going on!

 

[Vince]

Low shbg guy need more frequent injections of testosterone. With TSH of 3.041 I would get a complete thyroid panel TSH, FT4, FT3, reverse T3, and antibodies.

 

[halj77]

Low shbg guy need more frequent injections of testosterone. With TSH of 3.041 I would get a complete thyroid panel TSH, FT4, FT3, reverse T3, and antibodies.

Thanks. Full thyroid panel coming soon. Will update once I get it.

 

[Vince]

Thanks. Full thyroid panel coming soon. Will update once I get it.

That's great I think anyone with low testosterone should always get a complete thyroid panel.

 

[halj77]

That's great I think anyone with low testosterone should always get a complete thyroid panel.

Cool. Any other tests I should get while im at it? Prolactin, cortisol, etc?

 

[Systemlord]

Thanks. Full thyroid panel coming soon. Will update once I get it.

If you're going to do a full thyroid panel there just isn't any reason not to do ferritin and cortisol, both are needed for thyroid hormone production.

My personal list.

Total T
Free T
SHBG
Estradiol Sensitive (E2)
LH-Luteneizing Hormone
FSH-Folicle stimulating hormone
Prolactin
Cortisol
Ferritin
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel