Recent Labs - are they normal?

[drgnv]

Hey guys,


Would appreciate some input on this pattern.


I’ve been experiencing ongoing low energy for the past few years — mainly a lack of morning drive and waking up feeling flat or unmotivated. I wouldn’t describe it as depression, but my baseline motivation definitely feels lower than it should be.


My libido is around 4/10. I don’t have erectile dysfunction, and I still get morning erections.


I’m 32 years old, lean, around 82 kg. I don’t drink or smoke. My diet is quite strict, and I’ve never been overweight or had any metabolic health issues.


Current labs:

• Total T: 4.30 ng/mL (~430 ng/dL) (previous tests around the 500 mark)
• FREE T: Pending ....
• SHBG: 16.3 nmol/L (consistently low on last 4 labs over ~1 year)
• LH: 3.87
• FSH: 4.93
• Estradiol (E2): 47 pg/mL
• Prolactin: 12.96 ng/mL
• eGFR: 82
• Lipids & liver enzymes normal
• TSH: 1.854 uIU/ml
• FT3: 2.580 pg/ml
• FT4: 0.0900 ng/dl
  

Does this look more like aromatization/inflammation-driven imbalance vs true androgen deficiency?


Curious how you’d approach this pattern before considering any intervention.


Thanks.

 

[Cataceous]

No androgen deficiency. The lowish SHBG means free testosterone is respectable, around 12.4 ng/dL by the Vermeulen calculation. Elevated estradiol is potentially an issue, but you need to confirm that the result is accurate. If the test is immunoassay-based then it could reflect significant cross-reactivity with other substances. In particular, if your C-reactive protein is elevated then this can "bleed" into the estradiol result. A mass spectrometry-based estradiol test is capable of much better discrimination, though historically these tests have been finicky. In either case a confirmation of the 47 pg/mL value would be appropriate.

Although the prolactin result is in-range, some men can experience problems at this level. It's worth looking at if other issues are ruled out. Higher prolactin is also linked to elevated estradiol. If the estradiol result is accurate then experimenting with extremely small AI doses could be interesting.

Your FT4 result seems unusual. What is the reference range for that test?

 

[drgnv]

No androgen deficiency. The lowish SHBG means free testosterone is respectable, around 12.4 ng/dL by the Vermeulen calculation. Elevated estradiol is potentially an issue, but you need to confirm that the result is accurate. If the test is immunoassay-based then it could reflect significant cross-reactivity with other substances. In particular, if your C-reactive protein is elevated then this can "bleed" into the estradiol result. A mass spectrometry-based estradiol test is capable of much better discrimination, though historically these tests have been finicky. In either case a confirmation of the 47 pg/mL value would be appropriate.

Although the prolactin result is in-range, some men can experience problems at this level. It's worth looking at if other issues are ruled out. Higher prolactin is also linked to elevated estradiol. If the estradiol result is accurate then experimenting with extremely small AI doses could be interesting.

Your FT4 result seems unusual. What is the reference range for that test?

FT4( free Т4)

ng/dl

0.730 - 1.700

[td]

​

[/td]​

[td]

0.900​

[/td]​

That’s the FT4 results, my mistake earlier.


I recently completed a second course of treatment for Helicobacter pylori, as the first one failed. The initial treatment was about three months ago. I finished the second treatment a week ago, which included levofloxacin, amoxicillin, a proton pump inhibitor (PPI), and bismuth. Given that, it’s possible the elevated estradiol is related to recent infection, inflammation, or antibiotic treatment.

As I mentioned before, I’ve often had elevated prolactin levels. However, I want to clarify something important. In most cases, blood samples were taken immediately after I arrived at the lab, without resting for 20–30 minutes beforehand. Only twice was I allowed to rest before the blood draw, and on those occasions prolactin came back in the high-normal range. When samples were taken immediately, prolactin was frequently elevated, sometimes even reaching around 800 ng/ml.

 

[drgnv]

Those are the final results with FREE T sitting at: 17,50 pg/ml (1.75 ng/dl) (0.061 nmol/L)

 

[Seagal]

Maybe your diet is too strict, not enough calories in the long term. Overtraining or not enough recovery time could also play a role

 

[Belekas]

Maybe your diet is too strict, not enough calories in the long term. Overtraining or not enough recovery time could also play a role

Yup, seen this a lot in the folks I've trained and mentored. Overworked and underfed is a real thing. Not enough rest is another. Not enough time to "smell the roses" is there as well. For me getting into single % BF naturally requires real struggle and willpower on very low calories(for me). That impacts all this a lot. Getting up in the morning is hard, doing anything is hard af. But we all different and everyone has to experiment and find what their sweetspots. Fuck being very lean and feeling like trash. It's just not worth it, at least for me. Gotta implement strategic refeeds or cheat days which do work or just be very, very strict which spoils the principle of life for me. TRT helps as well. On low calories my libido dips significantly. Up the carbs. Boom. Waking up with the "antenna" again lol

 

[drgnv]

Yup, seen this a lot in the folks I've trained and mentored. Overworked and underfed is a real thing. Not enough rest is another. Not enough time to "smell the roses" is there as well. For me getting into single % BF naturally requires real struggle and willpower on very low calories(for me). That impacts all this a lot. Getting up in the morning is hard, doing anything is hard af. But we all different and everyone has to experiment and find what their sweetspots. Fuck being very lean and feeling like trash. It's just not worth it, at least for me. Gotta implement strategic refeeds or cheat days which do work or just be very, very strict which spoils the principle of life for me. TRT helps as well. On low calories my libido dips significantly. Up the carbs. Boom. Waking up with the "antenna" again lol

Yeah I get it mate. Currently I'm sitting on about 3,500 calories, the activity is not that high about 10k steps per day with some weightlifting. Even when I had surgery 6 months ago and not training, to maintain my weight I was eating about 2,800 calories.
Don't get me wrong, I'm not here to "push" myself into TRT. I just want to find out, what might be wrong to feel that way.

 

[Belekas]

Those are the final results with FREE T sitting at: 17,50 pg/ml (1.75 ng/dl) (0.061 nmol/L)

These numbers look off. Are you sure they are correct? If 0.061 nmol/L that would be absolutely crushed and tanked FT way below UK reference range of 0.2-0.6 nmol/L fwiw.

 

[Belekas]

Yeah I get it mate. Currently I'm sitting on about 3,500 calories, the activity is not that high about 10k steps per day with some weightlifting. Even when I had surgery 6 months ago and not training, to maintain my weight I was eating about 2,800 calories.
Don't get me wrong, I'm not here to "push" myself into TRT. I just want to find out, what might be wrong to feel that way.

It's all good I don't judge. Have you tried reverse engineering your diet into Chronometer app for example and checking if you get all the required micros per day? Also before all this happened, were you feeling good and everything was alright? It's the context that matters and the devil is in the details, as I like to say. Diet, sleep, training, recovery, other drugs or supps, etc. Also environment matters a lot. Toxic people, etc. Its a complicated and multifactorial issue FWIW as your bloods look ok to me from the first quick glance.

 

[Cataceous]

These numbers look off. Are you sure they are correct? If 0.061 nmol/L that would be absolutely crushed and tanked FT way below UK reference range of 0.2-0.6 nmol/L fwiw.

It points to using an immunoassay-based FT test, aka "direct" method, which is hopelessly inaccurate even when scaled. Use the Vermeulen result.

 

[Belekas]

It points to using an immunoassay-based FT test, aka "direct" method, which is hopelessly inaccurate even when scaled. Use the Vermeulen result.

Thanks for clarification Cataceous. I just ran his numbers with a standart albumin 4.3 and got FreeT sitting at 12ng/dL which is more then 2x higher then my natural cFT at 5.7684ng/dL fwiw lol. So yeah, I would start looking for an issue somewhere else and not in the androgen department. And mine 5.7ng/dL came in only once I fed myself really good and upped the carbs properly. Before that I clocked even lower while being lower carb and in calorie deficit as was leaning out.

p.s. sorry didn't see you already made a post with exact same calculations.

 

[Phil Goodman]

@drgnv have you had vitamin d tested?

 

[drgnv]

It's all good I don't judge. Have you tried reverse engineering your diet into Chronometer app for example and checking if you get all the required micros per day? Also before all this happened, were you feeling good and everything was alright? It's the context that matters and the devil is in the details, as I like to say. Diet, sleep, training, recovery, other drugs or supps, etc. Also environment matters a lot. Toxic people, etc. Its a complicated and multifactorial issue FWIW as your bloods look ok to me from the first quick glance.

Will try that, I haven’t really thought much about my micronutrients.

I’ve actually been feeling like this for more than 5 years. It affected my previous relationship quite a lot. The most annoying part is that even when I get good sleep, after waking up it still feels like it’s not enough.
I do track my sleep, and in most cases it’s between 7–8 hours with around 1h30 of deep sleep, but my REM isn’t great. Even on my best days, I barely get 1 hour of REM sleep.

My digestion has also been pretty bad, mainly because of the Helicobacter I mentioned. I finished the second-line treatment 8 days ago since the first one didn’t work.
I still don’t know if this round worked either, but I’ll do a test in about a month and see where I’m at.

Training-wise, I’m satisfied with my visual progress in the gym, but when it comes to strength, it’s been quite poor.


Psychologically, I also feel like something is missing when it comes to taking risks and being assertive.

 

[drgnv]

@drgnv have you had vitamin d tested?

Yes mate, 3 months ago. It was in the low range, so I'm supplementing 10000 IU since then. Forgot to check it, but next time I'll definitely will.

 

[Belekas]

Will try that, I haven’t really thought much about my micronutrients.

I’ve actually been feeling like this for more than 5 years. It affected my previous relationship quite a lot. The most annoying part is that even when I get good sleep, after waking up it still feels like it’s not enough.
I do track my sleep, and in most cases it’s between 7–8 hours with around 1h30 of deep sleep, but my REM isn’t great. Even on my best days, I barely get 1 hour of REM sleep.

My digestion has also been pretty bad, mainly because of the Helicobacter I mentioned. I finished the second-line treatment 8 days ago since the first one didn’t work.
I still don’t know if this round worked either, but I’ll do a test in about a month and see where I’m at.

Training-wise, I’m satisfied with my visual progress in the gym, but when it comes to strength, it’s been quite poor.


Psychologically, I also feel like something is missing when it comes to taking risks and being assertive.

There you go mate. Fix your micronutrients and fix your gut/digestion and you will feel 100x better. Been there done that. I also battled HP a lot with many useless rounds till I composed my own protocol with more then 120g of antibiotics ( lol) and nuked the fucker. Then started rebuilding my gut and things are 10x better now. I have an old thread here if it still hasnt been deleted where I shared my journey back then and all the findings, etc. Take a read if you can find it. I'm sure you will become better, hang in there! Diet, digestion, micros effect how we feel and handle stress big time as well and looking good but feeling like trash aint something to take home as well, thats for sure.

 

[drgnv]

There you go mate. Fix your micronutrients and fix your gut/digestion and you will feel 100x better. Been there done that. I also battled HP a lot with many useless rounds till I composed my own protocol with more then 120g of antibiotics ( lol) and nuked the fucker. Then started rebuilding my gut and things are 10x better now. I have an old thread here if it still hasnt been deleted where I shared my journey back then and all the findings, etc. Take a read if you can find it. I'm sure you will become better, hang in there! Diet, digestion, micros effect how we feel and handle stress big time as well and looking good but feeling like trash aint something to take home as well, thats for sure.

First treatment was with Metronidazole, Tetracycline, a PPI, and Bismuth. Some of the bacteria was eradicated, but when I did a test after 3 months, it was still positive.
The second treatment was with Amoxicillin, Levofloxacin, a PPI, and Bismuth. It doesn’t look great yet, but it’s only been 8 days since I finished it.
The gut plays a big role in how we feel, since about 90% of serotonin is produced there. I’m not sure how much of that is actually used by the brain. Also, if digestion and nutrient absorption are compromised, I imagine the body will struggle with micronutrient status regardless of intake.

I'll see if I can find your thread, in the meantime would you share what antibiotics you took, because 120grams sounds like a lot?

 

[Belekas]

First treatment was with Metronidazole, Tetracycline, a PPI, and Bismuth. Some of the bacteria was eradicated, but when I did a test after 3 months, it was still positive.
The second treatment was with Amoxicillin, Levofloxacin, a PPI, and Bismuth. It doesn’t look great yet, but it’s only been 8 days since I finished it.
The gut plays a big role in how we feel, since about 90% of serotonin is produced there. I’m not sure how much of that is actually used by the brain. Also, if digestion and nutrient absorption are compromised, I imagine the body will struggle with micronutrient status regardless of intake.

I'll see if I can find your thread, in the meantime would you share what antibiotics you took, because 120grams sounds like a lot?

It is a lot but there was no other way to kill it in my case. Simple protocols didnt even touch it. I dont remember what I took just remember the massive amounts. And it did worked. I researched it well and also got help from other smart men in this forum who were dealing with it or dealt with it in the past. For some- a simple generic protocol works for others its a nightmare. And seratonin is also a double edged sword and a lot of issues are from too much of it in the gut IIRC. Plenty of research and data about that. I have forgotten most of the stuff as been busy with bussines and with other self improvement as my gut and pain issues got way way better after working my ass off trying to find the root cause of the issues I was dealing with back then. I have everything documented in the thread if its still there somewhere. Also you will see that HP protocols are needed far longer then basic docs suggest. A week does absolutely fuck all at least in my case. So you gotta be smart and do proper research and thinking how to attack that mofo Agree re compromised nutrient absorbtion issues but it doesnt really matter as you have to always eat properly and collect all the required micros for optimal function. Reverse engineer the diet and see what youre lacking