Lifetime Low-T symptomatic, but seemingly solid numbers. Is it in my head?

[HankTankerous]

Hello,

33 year old male who, frankly, should have taken a closer look at this a long time ago. I've always had low ambition, energy and libido. Socially awkward, anxious and feelings of inadequacy. Puberty for me was uneventful. I certainly went through a growth spurt but any other masculinization effects were, IMO, minimal. Probably didn't help that I was an overweight, soda drinking, lethargic teenager... it wouldn't shock me if I was at least pre-diabetic. I was a fat 240lbs through high school, then went up to a high of 270lbs at 20yo before losing 100lbs through diet, cardio and the occasional now-since-banned fatburner. Currently sitting at 6'3" 205lbs and contemplating a DEXA scan to get a better idea about body composition

The decision to finally get tested came back in May. I had been going through a longer-than-usual lull in weight training (stopped mid-October and picked it back up on July 10) I have a basement gym and it's not uncommon for me to drop lifting through the winter but this time I was really having a hard time convincing myself to make the journey downstairs. Eventually I had this thought of "you've been lifting for 12 years and have made piss-poor progress in terms of strength and muscle gains. What's the point?" which finally made me reflect on all the shit in the opening paragraph that has followed me throughout my life. So back in May, I went to a Quest Diagnostic for their basic health profile (CBC, CMP, cholesterol Panel and urinalysis) and a testosterone test, which is attached. They only checked total test which came in at 648ng/dL and nothing else in the health profile seemed out of the ordinary to me. I looked online if there was anything about low T symptoms with normal total T levels, which is how I ultimately found excelmale and discountedlabs.com.

Last week I went back to Quest with a discountedlabs male elite panel (full results attached). Total test was up to 883 ng/dL*. LH and FIH were two hormones that weren't measured that seem to be recommended as part of a panel. Other numbers of interest:

DHEA SULFATE

280

93-415 mcg/dL NL1

PROLACTIN

7.1

2.0-18.0 ng/mL NL1

SHBG

58 H

10-50 nmol/L

ESTRADIOL,ULTRASENSITIVE, LC/MS

33 H

< OR = 29 pg/mL

TESTOSTERONE, FREE:

112.1

35.0-155.0 pg/mL

DHT,LC/MS/MS:	76 H	12-65 ng/dL
IGF 1, LC/MS	132	53-331 ng/mL

I threw the * in there because I have read that biotin can have an effect on testosterone measurement. I started taking a multi-vitamin again earlier that week (Irwin Naturals Men's Living Green Liquid-Gel Multi) which has 15mcg of biotin per serving size. I don't know how much and for how long it needs to be supplemented to make a difference.

So that's where I'm at... Turns out I have my yearly physical exam tomorrow with my PCP so I'm going to bring these reports down with me. Is there anything else I could ask to check, whether it be from her or a specialist? Or should my focus be more on the mental side of things?

 

[sammmy]

On May 20: your free testosterone was low normal; you had some suspicious elevation in platelets and neutrophils indicating immune activation.

On July 15: your free testosterone is completely normal i.e. it doesn't seem that low free testosterone is your problem despite the slightly high SHBG. Your platelets and neutrophils are less elevated than May 20, so whatever it was, it seems resolving. Your AST liver enzyme is high - this is not normal and should be monitored. If you started taking some "magical" supplement or "testosterone booster", it may be harming your liver.

 

[HankTankerous]

Thanks for taking a look, Sammmy. How did you figure out free test for May 20? Did you use the SHBG from the July 15 report?

The AST was a shock to me too, especially since it was at 18 on the 20th. I've never taken a test booster but if I had to guess, it would've been the Beverly International Ultra 40 which are desiccated liver pills; not just magical, but old school magical. They tout the heme iron as a benefit and looks like too much iron can raise AST. I had added that back in sometime in July... timeline seems to match up if that's the cause. I think I'll keep that shelved.

 

[sammmy]

I used the SHBG from July 15 and the Vermeluen free testosterone calculator:

Free & Bioavailable Testosterone calculator

The normal range for calculated free testosterone is 5-25 ng/dL = 50 - 250 pg/mL:

Template:Testosterone levels in males and females - Wikipedia

en.wikipedia.org

 

[sammmy]

Are you on some kind of keto diet? Your cholesterol is excellent with high HDL and very low Triglycerides.

Your blood calcium is running high normal, higher on May 20. Are you taking calcium supplements or eating a lot of milk products?

Your creatinine is a little bit elevated, but that could be due to taking creatine supplements, eating a lot of meat, or some drugs can elevate it too. I usually like to see it closer to 1.0 mg/dL.

 

[HankTankerous]

No, not on a keto or low carb diet. I was back in 2011 but that was just to get down to 170 so I could say I lost the 100lbs.

I don't eat that much dairy. Little splash of half & half for my coffee, shredded cheese + half & half in scrambled eggs which are cooked in butter. No whey protein, not a regular eater of ice cream and I haven't had milk in months and it was years since the last time before that. No calcium supplements

Creatine, I haven't taken in over a year. Not on any drugs; prescription, illicit or otherwise. Meat consumption probably clocks in at around 1 - 1.25 lbs a day

 

[Cataceous]

...
I threw the * in there because I have read that biotin can have an effect on testosterone measurement. I started taking a multi-vitamin again earlier that week (Irwin Naturals Men's Living Green Liquid-Gel Multi) which has 15mcg of biotin per serving size. I don't know how much and for how long it needs to be supplemented to make a difference.
...

Not an issue in your case. The biotin dose is low, but more importantly your testosterone test is based on LC/MS—not an immunoassay—and therefore is not susceptible to this interference.

 

[jadenfox]

You might want to explore with adding Dopamine supplements...

I've seen guys who have decent testosterone levels, but their body still isn't producing enough energy. Adding L-Tyrosine & L-Phenylalanine activates the energy receptors in the brain and "turns on" your natural energy levels.

This did the trick for me.
I take it 3 times a day or so... (every 3 hours)

 

[bixt]

You might want to explore with adding Dopamine supplements...

I've seen guys who have decent testosterone levels, but their body still isn't producing enough energy. Adding L-Tyrosine & L-Phenylalanine activates the energy receptors in the brain and "turns on" your natural energy levels.

This did the trick for me.
I take it 3 times a day or so... (every 3 hours) Have you tried Whey protein and eggs which contain good amounts of those two aminos?

Have you tried whey protein and eggs which contain more than decent amounts of those two aminos?

 

[jadenfox]

I have, it's totally not the same.
Not everyone's body converts protein properly... so providing it already converted makes it directly usable.

 

[sammmy]

Another supplement that might increase the feeling of natural body energy and endurance is DMG (N-Dimethyl Glycine).

 

[HankTankerous]

Any thoughts on the IGF-1, hemoglobin, hematocrit and RBC levels? IGF seems like it's on the lower end of normal. The blood numbers strike me as weird... depending on which reference ranges I look at, it's borderline anemia and that's with good test levels.

 

[sammmy]

Hemoglobin is a bit low. You mentioned you eat a lot of meat daily, what kind?

 

[HankTankerous]

Mainly ground beef. Chicken less frequently and, when I do, I typically go with chicken thighs over chicken breast.

 

[sammmy]

With that much beef you must be getting sufficient amount of iron.

I would do another CBC with differential test to see if your platelets and immune system are still elevated, and blood tests for vitamin B12 and Folate to see if you have deficiency.

Do you have any digestive symptoms: fullness after meal, indigestion, stomach pain, gastritis, GERD, IBD, diarrhea, constipation etc?

 

[Nelson Vergel]

The biotin dose is low, but more importantly your testosterone test is based on LC/MS—not an immunoassay—and therefore is not susceptible to this interference.

I agree 100%