I have always had low energy for a number of years. I've had blood tests done before, and the results were normal, although the tests were carried out through the NHS, so I didn't see the actual figures. I also completed a home sleep apnea test a few years ago, which I believe came back at 3.5, and it needed to be 5 or higher for a diagnosis.
During the past year especially, I have felt much more tired. My libido is now quite low, or even very low. I have brain fog, and most days it feels as though I haven't had much sleep. It's worse on weekends when I don't have work, as I feel a lot more tired and struggle to motivate myself to do anything. I also tend to eat more, as it feels like I'm constantly searching for energy.
I decided to get a finger-prick
testosterone test a few weeks ago, which showed a total testosterone level of 9.4 nmol/L. I then proceeded with a full blood test and received the results last week. My total testosterone is a little higher at 10.8 nmol/L, but my free testosterone is barely within range at 0.2052 nmol/L.
What do you think? I am considering TRT, but I have ordered another home sleep apnea test to rule out sleep apnea first. I don't want to start TRT if the issue is being caused by something else. I am 43, with a BMI of 22 and approximately 17% body fat. I'm fairly lean and try to keep fit with cardio on an exercise bike four times a week, along with weighted press-ups, planks, crunches, and ab rollouts on the days in between.
During the week, I tend to function better, but I never wake up feeling refreshed. My blood results are below, a couple of markers are low, and my prolactin is slightly elevated.
| Test | Reference Range | Result |
|---|
| HbA1c | <42 mmol/mol | 29 mmol/mol |
| Total Cholesterol | <5.00 mmol/L | 4.2 |
| Triglycerides | <2.30 mmol/L | 0.83 |
| HDL Cholesterol | 0.90–1.70 mmol/L | 1.56 |
| LDL Cholesterol | <3.00 mmol/L | 2.27 |
| Non-HDL Cholesterol | <4.00 mmol/L | 2.64 |
| HDL % of Total | >20% | 37% |
| Ferritin | 30–518 µg/L | 91 |
| TSH | 0.270–4.200 mIU/L | 2.29 |
| Free T3 | 3.1–6.8 pmol/L | 4.2 |
| Free T4 | 12.0–22.0 pmol/L | 18.3 |
| Cortisol (Serum) | 133–537 nmol/L | 418 |
| PSA (Total) | 0.00–2.50 µg/L | 0.94 |
| Total Protein | 60–80 g/L | 70 |
| Albumin | 35–50 g/L | 47 |
| Globulin | 19–35 g/L | 24 |
| ALT | <45 U/L | 30 |
| Alkaline Phosphatase | 30–130 U/L | 66 |
| AST | <45 U/L | 30 |
| Gamma GT | <55 U/L | 14 |
| Bilirubin | <22 µmol/L | 10 |
| Urea | 2.5–7.8 mmol/L | 9.3 ↑ |
| Creatinine | 60–120 µmol/L | 108 |
| eGFR | >90 mL/min/1.73m² | 75 ↓ |
Hormones
| Test | Reference Range | Result |
|---|
| Testosterone (Total) | 8.64–29.0 nmol/L | 10.8 |
| SHBG | 18.3–54.1 nmol/L | 32.8 |
| LH | 1.7–8.6 IU/L | 3.9 |
| FSH | 1.5–12.4 IU/L | 4.4 |
| 17-Beta Oestradiol | 41.4–159.0 pmol/L | 18.4 ↓ |
| Prolactin | 86.0–324.0 mIU/L | 433 ↑ |
| Free Testosterone | 0.1980–0.6190 nmol/L | 0.2052 |
Full Blood Count
| Test | Reference Range | Result |
|---|
| Haemoglobin | 130–180 g/L | 148 |
| Red Cell Count | 4.40–6.50 x10¹²/L | 4.95 |
| Haematocrit (Hct) | 0.400–0.520 L/L | 0.439 |
| MCV | 80.0–100.0 fL | 88.6 |
| MCH | 27.0–32.0 pg | 29.9 |
| MCHC | 320–360 g/L | 338 |
| RDW | 11.5–15.0 % | 13.2 |
| Platelets | 150–450 x10⁹/L | 212 |
| MPV | 7.0–13.0 fL | 9.1 |
| White Cell Count | 3.0–11.0 x10⁹/L | 4.5 |
| Neutrophils | 2.0–7.5 x10⁹/L | 2.6 |
| Lymphocytes | 1.5–4.5 x10⁹/L | 1.56 |
| Monocytes | 0.20–0.80 x10⁹/L | 0.29 |
| Eosinophils | 0.00–0.40 x10⁹/L | 0.07 |
| Basophils | 0.00–0.10 x10⁹/L | 0.02 |
| Neutrophils % | — | 57.1% |
| Lymphocytes % | — | 34.5% |
| Monocytes % | — | 6.4% |
| Eosinophils % | — | 1.6% |
| Basophils % | — | 0.4% |
Welcome to Nelson's house!
Clear as day the most critical fraction free testosterone is sitting at the bottom end.
The finger prick testing method is not going to cut it here and should never be used/relied on.
Luckily you had went and had your blood work done at the lab.
Even then did you test at the peak (early am) in a fasted state?
If not then your results would be skewed and I would retest.
Keep in mind that TT is important to know but the most critical fraction FT is what truly matters here as it is the active unbound fraction responsible for the positive effects.
Just to be clear here the only way to know where your FT truly sits is testing it using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.
Unfortunately if you live outside of the US you would not have access to such in most countries.
Luckily the next best testing method the go to calculated linear law-of-mass action Vermeulen (cFTV) will give a good approximation and is the most commonly used/relied on testing method by those in the know if the gold standard ED is not an option.
Unfortunately many of those clueless doctors especially many of those run of the mill dime a dozen T-clinics still use/rely on the known to be inaccurate direct immunoassay (RIA/CLIA) which no one should be using.
Seeing as you mentioned the NHS then chances are your FT was tested using the calculated method.
We can easily calculate your FT using the go to linear law-of-mass action Vermeulen (cFTV) which is available online for free to the general public.
All you need to do is plug in your TT, SHBG and Albumin.
If we take your dismal TT 311.5 ng/dL (10.8 nmol/L), normal SHBG 32.8 nmol/L and Albumin 4.7 g/dL then your cFTV 5.92 ng/dL would be low as in sitting in the gutter!
cFTV 5.92 ng/dL (refernce range 6.5-25 ng/dL)
FT <5 ng/dL would be considerd low.
FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.
FT 10-15 ng/dL would be healthy.
FT 20-25 ng/dL would be high-end/high.
Just to put this in perspective here a healthy young natty male would be hitting a peak cFTV 13-15 ng/dL or peak FT 10-12 ng/dL tested using the gold standard Equilibrium Dialysis.
Your cFTV 5.92 ng/dL is well below this!
Definitely suffering from low T and you need to address this.
There are numerous options here such as Serms (clomid/enclomiphene), solo hCG before jumping on full blow exogenous T (oral, pellets, transdermal, injectable).
Definitely need to address your elevated prolactin which can also hammer down the libido.
