What should I ask the doctor in my visit tomorrow? Resuts attached

[sn17adv]

Hi all, I am 30, 5'11 and 150lbs. Ever since my early 20s, I have not had strong erections, lacked energy and typical skinny fat with manboobs. But the lethargy and lack of ability to work and feeling sleepy has become too much in recent years. Three years ago, I ate junk and didn't exercise and did desk job. So, was like 20lbs more. I did a test panel and it showed results below:
Total test 287 Low ng/dL 348 - 1197
Free test 8.3 Low pg/mL 9.3 - 26.5
I also had very low Vit D:
8.9 Low ng/mL 30.0 - 100.0
Also, Hemoglobin A1c 5.9 High % 4.8 - 5.6
TSH 2.620 uIU/mL 0.450 - 4.500
Thyroxine (T4) 8.6 ug/dL 4.5 - 12.0
T3 Uptake 23 Low % 24 - 39
Free Thyroxine Index 2.0 1.2 - 4.9
The general physician then told me that it was due to improper diet and lack of exercise. He also told to take Vit D and said no need to worry about T.
My symptoms continued and due to personal stuff never went back to doc. Early this year, I started eating healthy and did keto to lose 20lbs. I also started weight training 6 months ago. I still felt like shit and didn't see significant muscle gains either. Add to this, in a rare relationship I had, even though the girl was very hot, I could hardly get hard and premature ejaculation like always. Taking cialis didn't help either. I seriously gave another thought..took zinc, ashwagandha, nettle, vit D etc for couple months and then 3 months ago, finally tested again. The results came as below:
TESTOSTERONE, SERUM 373 264-916
FREE TESTOSTERONE(DIRECT) 12.2 8.7-25.1
TSH 3.52 0.450 - 4.500
H1ac 5.8
Doctor again told..oh you testosterone is all fine within normal range. Just exercise more and improve diet to reduce H1ac.
Then past few weeks, I thought enough is enough, wanted to see how low it could go. So, ate like shit for couple weeks, no proper sleep, didn't take any supplements, masturbated many times (i did keep doing my weight training though). I got tested again, to get the below numbers:
TESTOSTERONE, SERUM 375 264-916
FREE TESTOSTERONE(DIRECT) 12.3 8.7-25.1
So, literally nothing changed! All my tests were done around 8:30AM and last two in the same lab.
I have now scheduled an appointment with a urologist. How do I convince him to at least do the additional tests to find where the problem is? (And not just say oh you are in the normal range). Also, what are the tests I should specifically ask out for? btw, I am not eager to have TRT but at least to find what the issue is.

Thank you for your time!

I have attached the complete results in the files.

 

[Systemlord]

Doctor again told..oh you testosterone is all fine within normal range. Just exercise more and improve diet to reduce H1ac.

I'm afraid you are dealing with a medical system that is ignorant in what constitutes normal testosterone, if you want insurance to cover TRT you will need levels below 300 ng/dL, or the levels of an 80 year old man.

Doctors participating in managed healthcare go base off reference ranges, in range and you are normal. The is true for everything except testosterone, testosterone peaks at about 30 years old at the top of the ranges and begins a gradual decline and by the time you are elderly, levels are low, except EDCs in the environment interfere with the body’s hormones and are causing this decline happen more quickly and it's happening everywhere.

If you look at the averages in your age group, 667 ng/dL is the average, twice what they are now. The insurance companies are installing barriers to medical treatment, which is not surprising considering insurance companies are always looking for ways to deny medical treatment.

If your urologist was to prescribe you TRT with levels above 300 ng/dL, the levels of old men, it would be insurance fraud. There are options, there are private clinics available which have doctors that know about what constitutes normal testosterone. You can't gain muscle at these testosterone levels, you would need to be a level based on the average men you age which is 667 ng/dL to stand any chance of building muscle.

Your TSH is another problem, the reference ranges for TSH included people with hypothyroidism and unfortunately doctors are still using these reference ranges that are not normal. You need a full thyroid panel checking TSH, fT4, fT3, rT3 and antibodies.

Your T3 uptake is below range which means you are unable to use the majority of your thyroid hormones, I'm shocked that your doctor isn't treating you thyroid! The care you are receiving is abysmal!

Optimal vs Normal Thyroid Levels for All Lab Tests & Ages

What’s a “Normal” Testosterone Level and How to Measure Your T

Cost of hormone-disrupting chemical exposure in Europe in billions

 

[sn17adv]

I'm afraid you are dealing with a medical system that is ignorant in what constitutes normal testosterone, if you want insurance to cover TRT you will need levels below 300 ng/dL, or the levels of an 80 year old man.

Doctors participating in managed healthcare go base off reference ranges, in range and you are normal. The is true for everything except testosterone, testosterone peaks at about 30 years old at the top of the ranges and begins a gradual decline and by the time you are elderly, levels are low, except EDCs in the environment interfere with the body’s hormones and are causing this decline happen more quickly and it's happening everywhere.

If you look at the averages in your age group, 667 ng/dL is the average, twice what they are now. The insurance companies are installing barriers to medical treatment, which is not surprising considering insurance companies are always looking for ways to deny medical treatment.

If your urologist was to prescribe you TRT with levels above 300 ng/dL, the levels of old men, it would be insurance fraud. There are options, there are private clinics available which have doctors that know about what constitutes normal testosterone. You can't gain muscle at these testosterone levels, you would need to be a level based on the average men you age which is 667 ng/dL to stand any chance of building muscle.

Your TSH is another problem, the reference ranges for TSH included people with hypothyroidism and unfortunately doctors are still using these reference ranges that are not normal. You need a full thyroid panel checking TSH, fT4, fT3, rT3 and antibodies.

Your T3 uptake is below range which means you are unable to use the majority of your thyroid hormones, I'm shocked that your doctor isn't treating you thyroid! The care you are receiving is abysmal!

Optimal vs Normal Thyroid Levels for All Lab Tests & Ages

What’s a “Normal” Testosterone Level and How to Measure Your T

Cost of hormone-disrupting chemical exposure in Europe in billions

Thank you so much for the

I'm afraid you are dealing with a medical system that is ignorant in what constitutes normal testosterone, if you want insurance to cover TRT you will need levels below 300 ng/dL, or the levels of an 80 year old man.

Doctors participating in managed healthcare go base off reference ranges, in range and you are normal. The is true for everything except testosterone, testosterone peaks at about 30 years old at the top of the ranges and begins a gradual decline and by the time you are elderly, levels are low, except EDCs in the environment interfere with the body’s hormones and are causing this decline happen more quickly and it's happening everywhere.

If you look at the averages in your age group, 667 ng/dL is the average, twice what they are now. The insurance companies are installing barriers to medical treatment, which is not surprising considering insurance companies are always looking for ways to deny medical treatment.

If your urologist was to prescribe you TRT with levels above 300 ng/dL, the levels of old men, it would be insurance fraud. There are options, there are private clinics available which have doctors that know about what constitutes normal testosterone. You can't gain muscle at these testosterone levels, you would need to be a level based on the average men you age which is 667 ng/dL to stand any chance of building muscle.

Your TSH is another problem, the reference ranges for TSH included people with hypothyroidism and unfortunately doctors are still using these reference ranges that are not normal. You need a full thyroid panel checking TSH, fT4, fT3, rT3 and antibodies.

Your T3 uptake is below range which means you are unable to use the majority of your thyroid hormones, I'm shocked that your doctor isn't treating you thyroid! The care you are receiving is abysmal!

Optimal vs Normal Thyroid Levels for All Lab Tests & Ages

What’s a “Normal” Testosterone Level and How to Measure Your T

Cost of hormone-disrupting chemical exposure in Europe in billions

Thank you so much for the reply. So, the TSH in the test 3 years ago was 3.5 but the recent one is 2.5. does that seem acceptable? Also, is there possibility of treating the thyroid improving the testosterone? Sorry, I'll go read up this stuff.i just found this forum. Lots to study

 

[blinkyvx]

at the very least new primary doctor, yours seems terrible. Should of pushed to get T therapy when your levels were low... Can wait month and try to re test with new doc and hope for low levels, re test on your own and try to see when your levels are lowest [they fluctuate throughout the day from things i've seen]

 

[mooseman109]

If you can not find a dr that will actually help you, you can try defy medical in flordia, they do tele medicine. Many of us here use them including myself

 

[Systemlord]

Thank you so much for the reply. So, the TSH in the test 3 years ago was 3.5 but the recent one is 2.5. does that seem acceptable? Also, is there possibility of treating the thyroid improving the testosterone? Sorry, I'll go read up this stuff.i just found this forum. Lots to study

Both of those TSH values are abnormal, anying 2.5 or higher is indicating a thyroid problem, together with your low T3 uptake and your situation is worse. Depending on which day you run the testing, your TSH could be 2.5 today and 3.5 tomorrow, this is unacceptable. Your TSH fluctuates every day, so you see it higher 3 years ago when in fact it's probably always been between 2.5-3.5 depending on when you are testing and you are just catching where TSH lands on that particular day and it could be higher when not testing.

TSH is as very poor marker for thyroid status, it colorates poorly with symptoms, if one wants to see how the thyroid is performing, one must test actual thyroid hormones and it doesn't seem like you doctor is testing free thyroid hormones. fT3 is the only active thyroid hormone which increase metabolism and provides energy to every function within your body, rT3 can deactivate some of your fT3 if they are out of balance.

The cliff note here is you cannot rely on TSH alone when checking thyroid status, this is the old school way of doing things and any doctor not researching and staying up to date will become irrelevant and unable to provide good healthcare to their patients. Medicine is constantly evolving and some doctors fall behind in knowledge and the patients coming in seeking treatment are forever lost.

It sounds like you've had these problems most of your adult life and your doctors are treating the numbers and not paying any attention to the symptoms, this is unacceptable. The reference ranges was never meant to be the ultimate deciding factor in getting treatment, it is a guide or a suggestion and together with a clinical picture of the patient, treatment is initiated if the symptoms match the low hormone value.

TRT will not work when there are thyroid problems and to date have never seen anyone respond well to TRT scoring a TSH of 3.5, in fact TSH will likely increase once TRT is initiated because as TRT increases metabolic rates, it will place a greater demand on your thyroid increasing TSH even higher.

Reference ranges for TSH and thyroid hormones

Though TSH remains the most commonly used endocrine test in clinical practice, the issue of an appropriate TSH, and to a lesser extent, free T4 and free T3 reference ranges is still under debate. First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L.

On the other hand, upper TSH reference limit is (assay-dependent) usually around 4.2-4.5 mU/L. There is also an argument that significant number of patients (up to 30%) with TSH above 3.0 mU/L have an occult autoimmune thyroid disease.

The evidence for a narrower thyrotropin reference range

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group.

 

[blinkyvx]

would the increase in metabolic rate relate at all to getting cold around 1AM ? [ work midnights 7pm to 7am]

 

[Systemlord]

If thyroid hormones are low in the day, at 1 a.m your metabolism have got to be lower than normal. Having a low T3uptake mean what hormones you do have and not getting used.

 

[blinkyvx]

my TSH was like 1.5