New member and Lab Advice

[20Bluey20]

I have been reading this forum for 6 months because I was tired of feeling not myself and because of less than stellar free T level. Anyways I just got retested and my level and quite a bit different.

I'm 37 years old and have low energy, Inability to maintain a hard erection, loss of confidence, anxiety, low libido, lack of motivation, mental fog, irritability, etc. I had my labs done when I consulted with a trt DR. Below are the lab results:

Height: 6'-1"
Weight: 160 lbs
Total T: 847 (641 a year ago)
Free T: 14 (5.6 a year ago)
Estradiol: 22.1 (wasnt tested a year ago)
LH:3.4 (about same year ago)
TSH: 1.02 (about same year ago)
Albumin: 4.6
Vitamin D: 75 (25 a year ago)

I lift weights 3 days a week, do cardio/bodyweight exercises 2 times a week. I eat a fairly clean diet, sleep 8 hours a night, don't smoke, drink a glass or 2 on the weekends. Also I'm seeing a counselor to help with any psychological hang-ups.

Why did my free T and total T number change so much? What if anything would you guys recommend?

 

[BrooklynJerry]

It looks like your routine is,working well

 

[Golfboy307]

You need SHBG from both tests to better understand your Free T levels.

 

[Vince]

Good job and congratulations on your efforts. It really paid off for you. I'm sure the 8 hours of sleep helps a lot and working out with weights.

 

[Rhino 2.0]

I have been reading this forum for 6 months because I was tired of feeling not myself and because of less than stellar free T level. Anyways I just got retested and my level and quite a bit different.

I'm 37 years old and have low energy, Inability to maintain a hard erection, loss of confidence, anxiety, low libido, lack of motivation, mental fog, irritability, etc. I had my labs done when I consulted with a trt DR. Below are the lab results:

Height: 6'-1"
Weight: 160 lbs
Total T: 847 (641 a year ago)
Free T: 14 (5.6 a year ago)
Estradiol: 22.1 (wasnt tested a year ago)
LH:3.4 (about same year ago)
TSH: 1.02 (about same year ago)
Albumin: 4.6
Vitamin D: 75 (25 a year ago)

I lift weights 3 days a week, do cardio/bodyweight exercises 2 times a week. I eat a fairly clean diet, sleep 8 hours a night, don't smoke, drink a glass or 2 on the weekends. Also I'm seeing a counselor to help with any psychological hang-ups.

Why did my free T and total T number change so much? What if anything would you guys recommend?

My guess is that you have high SHBG which is lowering your free T levels.

 

[Vince]

If I were you, I would consider using a good zinc copper supplement. I like zinc balance from Jarrow.

 

[Vince]

How to decrease SHBG and increase free testosterone

As shown in the figure above, about 2 percent of the testosterone in the body is active. This “free testosterone” is not attached to binding proteins that would prevent it from interacting with its receptor. About 40 percent of the body's testosterone is attached to albumin. This is a protein...

www.excelmale.com

 

[20Bluey20]

Thank you all for the information. I have added a zinc copper supplement (see below). But due to feeling more off than usual for the last month I decided to take a blood test and see what was going on and below is the results:

Quest Diagnostics:
Total T (MS): 173 ng/dL (Low)
Free T (Dialysis): 15.9 pg/mL (Low)
Estradiol (Ultra): 6 pg/mL
Albumin: 4.5
Vitamin D: 123 ng/mL (High)
SHBG: 52 nmol/L (High)
DHEA Sulfate: 516 mcg/dL (High)
ABSOLUTE LYMPHOCYTES: 563 cells/uL (Low)
ABSOLUTE EOSINOPHILS: 9 Cells/uL (Low)

Current Supplements:
-Now brand Cal-Mag Caps (Calcium 250mg, Magnesium 125mg, Zinc 3.75mg, Copper 0.25mg, D3 250IU, Manganese 1.25mg)
-Dr. Martins L-Carnitine 1000 mg
-Metagenics D3 10,000 IU + Vitamin K 20mcg & MK-7 90 mcg
-Zhou DHEA - 50 mg

This is the third blood test this year (July 22, 2020) and the numbers are quite different than from before (April 3, 2020 & May 1, 2020). Anyone have insight on what is going on? How long should I wait to take another test to get a handle on what is going on?

FYI: I'm planning on stopping the dhea supplement and cut back to every other day for vitamin D.

 

[Golfboy307]

Those are some pretty horrible hormone levels. If you have the ability I would repeat those tests in a week or two just to confirm they are that low. If they are, you need to seriously consider TRT or Clomid. You must be feeling pretty lousy. Going on TRT will usually bring your SHBG down as well. Mine dropped from around 50 to the high 20's.

 

[20Bluey20]

Thank you all for the comments and wanted to follow up with additional blood work and recommendation from PCP (Primary Care Physician) and TRT specialist. Any advice or guidance would be greatly appreciated with the blood work results and the recommended courses of action.

PCP - Not sure if this is in house or Labcorp (September 2, 2020)

Total T (Serum): 617 ng/dL
Albumin: 4.6

PCP has recommended:

• Anti-Depressants

TRT Specialist - LabCorp (October 9, 2020):
Total T (Serum): 840 ng/dL
Free T (Direct): 9.6 pg/mL
Estradiol (Sensitive): 13.6 pg/mL
Albumin: 4.4
IGF-1: 193 ng/mL
SHBG: 58.1 nmol/L (High)
DHEA Sulfate: 220 ug/dL


Current Supplements:
-Now brand Cal-Mag Caps (Calcium 250mg, Magnesium 125mg, Zinc 3.75mg, Copper 0.25mg, D3 250IU, Manganese 1.25mg)
-Metagenics D3 10,000 IU + Vitamin K 20mcg & MK-7 90 mcg

This is the fourth & fifth blood test this year and the numbers are all over the place when compared between them all.

TRT Specialist has recommended:

• BEGIN T Cyp 200 mg/ml – 0.40 ml IM/SQ twice a week
• BEGIN HCG 500 iu SQ twice a week to reverse/prevent testicular atrophy
• BEGIN Anastrozole 0.125 mg twice a week as needed per E2 symptoms (reviewed with Pt.) only start if high e2 symptoms occur
• BEGIN Fish Oil 2grams daily for HDL support
• Begin Vitamin B12 500mg one daily

 

[madman]

I have been reading this forum for 6 months because I was tired of feeling not myself and because of less than stellar free T level. Anyways I just got retested and my level and quite a bit different.

I'm 37 years old and have low energy, Inability to maintain a hard erection, loss of confidence, anxiety, low libido, lack of motivation, mental fog, irritability, etc. I had my labs done when I consulted with a trt DR. Below are the lab results:

Height: 6'-1"
Weight: 160 lbs
Total T: 847 (641 a year ago)
Free T: 14 (5.6 a year ago)
Estradiol: 22.1 (wasnt tested a year ago)
LH:3.4 (about same year ago)
TSH: 1.02 (about same year ago)
Albumin: 4.6
Vitamin D: 75 (25 a year ago)

I lift weights 3 days a week, do cardio/bodyweight exercises 2 times a week. I eat a fairly clean diet, sleep 8 hours a night, don't smoke, drink a glass or 2 on the weekends. Also I'm seeing a counselor to help with any psychological hang-ups.

Why did my free T and total T number change so much? What if anything would you guys recommend?

Post reference ranges and if you did not have your FT levels tested using the most accurate assays such as Equilibrium Dialysis or Ultrafiltration then you have no idea where your FT level truly sits.

What is your SHBG as it is critical to know and will have a big impact on your FT level?

When having blood work done for testosterone it should always be done in a fasted state and first thing in the morning 7-9 am as natural T levels follow a diurnal 24 hr circadian rhythm and will start to rise gradually around 3 am reaching peak levels around 8 am.

It is also wise to have your T levels tested twice a few weeks apart on a different day and it is critical to always have your blood work done using the same lab, the same assay (accurate), same time 7-9 am when comparing blood work.

You should have TT/FT/e2/DHT/prolactin, LH, FSH, DHEA-s, CBC, CMP, Lipids, TSH (full thyroid panel), cortisol (4 tube-salivary), Vit D, PSA.

Testing Thyroid and Adrenal health is critical as dysfunction can mimick low-t symptoms.

 

[madman]

I have been reading this forum for 6 months because I was tired of feeling not myself and because of less than stellar free T level. Anyways I just got retested and my level and quite a bit different.

I'm 37 years old and have low energy, Inability to maintain a hard erection, loss of confidence, anxiety, low libido, lack of motivation, mental fog, irritability, etc. I had my labs done when I consulted with a trt DR. Below are the lab results:

Height: 6'-1"
Weight: 160 lbs
Total T: 847 (641 a year ago)
Free T: 14 (5.6 a year ago)
Estradiol: 22.1 (wasnt tested a year ago)
LH:3.4 (about same year ago)
TSH: 1.02 (about same year ago)
Albumin: 4.6
Vitamin D: 75 (25 a year ago)

I lift weights 3 days a week, do cardio/bodyweight exercises 2 times a week. I eat a fairly clean diet, sleep 8 hours a night, don't smoke, drink a glass or 2 on the weekends. Also I'm seeing a counselor to help with any psychological hang-ups.

Why did my free T and total T number change so much? What if anything would you guys recommend?

Missed the last half of the posts was cut off on my end so that would have been my response to your original post!

 

[madman]

Thank you all for the comments and wanted to follow up with additional blood work and recommendation from PCP (Primary Care Physician) and Defy. Any advice or guidance would be greatly appreciated with the blood work results and the recommended courses of action.

PCP - Not sure if this is in house or Labcorp (September 2, 2020)

Total T (Serum): 617 ng/dL
Albumin: 4.6

PCP has recommended:

• Anti-Depressants

TRT Specialist - LabCorp (October 9, 2020):
Total T (Serum): 840 ng/dL
Free T (Direct): 9.6 pg/mL
Estradiol (Sensitive): 13.6 pg/mL
Albumin: 4.4
IGF-1: 193 ng/mL
SHBG: 58.1 nmol/L (High)
DHEA Sulfate: 220 ug/dL


Current Supplements:
-Now brand Cal-Mag Caps (Calcium 250mg, Magnesium 125mg, Zinc 3.75mg, Copper 0.25mg, D3 250IU, Manganese 1.25mg)
-Metagenics D3 10,000 IU + Vitamin K 20mcg & MK-7 90 mcg

This is the fourth & fifth blood test this year and the numbers are all over the place when compared between them all.

TRT Specialist has recommended:

• BEGIN T Cyp 200 mg/ml – 0.40 ml IM/SQ twice a week
• BEGIN HCG 500 iu SQ twice a week to reverse/prevent testicular atrophy
• BEGIN Anastrozole 0.125 mg twice a week as needed per E2 symptoms (reviewed with Pt.) only start if high e2 symptoms occur
• BEGIN Fish Oil 2grams daily for HDL support
• Begin Vitamin B12 500mg one daily

Total T (Serum): 840 ng/dL
Free T (Direct): 9.6 pg/mL
Estradiol (Sensitive): 13.6 pg/mL
Albumin: 4.4
IGF-1: 193 ng/mL
SHBG: 58.1 nmol/L (High)
DHEA Sulfate: 220 ug/dL

This is a big no when it comes to testing FT especially in cases of altered SHBG (high/low) and I would not rely on the FT direct immunoassay.

If anything you should be getting your FT tested as I sated above using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration if you want to know where your FT level truly sits.



This is the fourth & fifth blood test this year and the numbers are all over the place when compared between them all.

As I stated in an earlier post.....It is also wise to have your T levels tested twice a few weeks apart on a different day and it is critical to always have your blood work done using the same lab, the same assay (accurate), same time 7-9 am when comparing blood work.

 

[madman]

The FT assay done with this set of labs is the one you should be getting.



Thank you all for the information. I have added a zinc copper supplement (see below). But due to feeling more off than usual for the last month I decided to take a blood test and see what was going on and below is the results:

Quest Diagnostics:
Total T (MS): 173 ng/dL (Low)
Free T (Dialysis): 15.9 pg/mL (Low)
Estradiol (Ultra): 6 pg/mL
Albumin: 4.5
Vitamin D: 123 ng/mL (High)
SHBG: 52 nmol/L (High)
DHEA Sulfate: 516 mcg/dL (High)
ABSOLUTE LYMPHOCYTES: 563 cells/uL (Low)
ABSOLUTE EOSINOPHILS: 9 Cells/uL (Low

 

[madman]

Thank you all for the comments and wanted to follow up with additional blood work and recommendation from PCP (Primary Care Physician) and Defy. Any advice or guidance would be greatly appreciated with the blood work results and the recommended courses of action.

PCP - Not sure if this is in house or Labcorp (September 2, 2020)

Total T (Serum): 617 ng/dL
Albumin: 4.6

PCP has recommended:

• Anti-Depressants

Defy - LabCorp (October 9, 2020):
Total T (Serum): 840 ng/dL
Free T (Direct): 9.6 pg/mL
Estradiol (Sensitive): 13.6 pg/mL
Albumin: 4.4
IGF-1: 193 ng/mL
SHBG: 58.1 nmol/L (High)
DHEA Sulfate: 220 ug/dL

First set labs your TT was 617 ng/dL using the most accurate assay LC-MS/MS but you did not show what your FT (using an accurate assay) or SHBG level was?

In the second set of labs, your TT is robust 840 ng/dL (not sure what assay was used), and your FT was done using an inaccurate assay so although your SHBG level is high which will have a big impact on your FT level (depending on how high SHBG is and where your TT levels sit) you have no idea where your FT level truly sits and it may not be as low as you think!

Again I would retest using an accurate assay for FT and always have testing done at the same lab, same time (early am) using the same assays (accurate) otherwise you are just wasting your time.

 

[madman]

Any of these 4 assays when testing FT will suffice!

Total and Free Testosterone Test Panel plus Hematocrit

Lowest Cost Hematocrit, Total and Free Testosterone Test Panel for Men on TRT

www.discountedlabs.com

Testosterone, Free (Equilibrium Dialysis) and Total, MS - Most Affordable and Accurate Test

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

www.discountedlabs.com

500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences) | Labcorp

Labcorp test details for Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences)

www.labcorp.com

081786: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone | Labcorp

Labcorp test details for Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone

www.labcorp.com

 

[madman]

This is the fourth & fifth blood test this year and the numbers are all over the place when compared between them all.


If I were in your shoes then I would be doing this before jumping on trt!

Post reference ranges and if you did not have your FT levels tested using the most accurate assays such as Equilibrium Dialysis or Ultrafiltration then you have no idea where your FT level truly sits.

What is your SHBG as it is critical to know and will have a big impact on your FT level?

When having blood work done for testosterone it should always be done in a fasted state and first thing in the morning 7-9 am as natural T levels follow a diurnal 24 hr circadian rhythm and will start to rise gradually around 3 am reaching peak levels around 8 am.

It is also wise to have your T levels tested twice a few weeks apart on a different day and it is critical to always have your blood work done using the same lab, the same assay (accurate), same time 7-9 am when comparing blood work.

You should have TT/FT/e2/DHT/prolactin, LH, FSH, DHEA-s, CBC, CMP, Lipids, TSH (full thyroid panel), cortisol (4 tube-salivary), Vit D, PSA.

Testing Thyroid and Adrenal health is critical as dysfunction can mimick low-t symptoms.




This is critical and should be a given when testing for low-t!

*It is also wise to have your T levels tested twice a few weeks apart on a different day and it is critical to always have your blood work done using the same lab, the same assay (accurate), same time 7-9 am when comparing blood work.

 

[20Bluey20]

Madman thank you for all that information!

I'll proceed with your advice and get additional testing at the same facility and with the best testing method(s). I am cash strapped at the moment; due to having the basics test (CBC, CMP, Lipds, TSH, LH, etc...) completed several times this year would it be acceptable to order just the [Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration)] labs?

If not then I will have to wait till the beginning of the year.

I should have done this from the beginning and just attached all my labs. All labs were drawn early morning (~8-9 am) and fasting (8+ hours). The LabCorp labs were all done at the same facility and about the same time of day (early morning). I used discountlab for one of the labs and that is why I have a quest diagnostic lab. And the other lab from pcp was done in house by them.

 

[madman]

Madman thank you for all that information!

I'll proceed with your advice and get additional testing at the same facility and with the best testing method(s). I am cash strapped at the moment; due to having the basics test (CBC, CMP, Lipds, TSH, LH, etc...) completed several times this year would it be acceptable to order just the [Testosterone, Total, LC/MS and Free (Equilibrium Ultrafiltration)] labs?

If not then I will have to wait till the beginning of the year.

I should have done this from the beginning and just attached all my labs. All labs were drawn early morning (~8-9 am) and fasting (8+ hours). The LabCorp labs were all done at the same facility and about the same time of day (early morning). I used discountlab for one of the labs and that is why I have a quest diagnostic lab. And the other lab from pcp was done in house by them.

Yes just retest TT (LC-MS/MS) and FT (Equilibrium Dialysis or Ultrafiltration) and get SHBG done again.

That way you will know where your FT level truly sits.



Lab 1 TT is robust, SHBG not tested, and FT lower end (FT tested using an inaccurate assay).

Lab 2 TT is robust, SHBG not tested, and FT just under the mean (mid-range) FT tested using an inaccurate assay.

Lab 3 TT is absurdly low, SHBG high, and FT absurdly low (FT tested using an accurate assay).

Something wrong with lab 3 as your TT and FT is absurdly low compared to the previous 2 labs and makes no sense that TT would be that low compared to the 2 previous labs.

Lab 4 TT is decent but FT and SHBG not tested.

Lab 5 TT is robust, SHBG high, and FT bottom end but again it was tested using an inaccurate assay.