Please have a look at my bloodwork and advise. Possible Low T or Thyroid?

[narc0lept]

I posted this elsewhere, so it may look familiar to some, but I'm looking for the largest amount of opinions I can get.

I've been researching Low T as it seems to fit my symptoms, and I don't think I'm making my symptoms fit low testosterone .

I'm 33 on the cusp of 34. I'm fatigued all the time, I am irritable, indifferent, can't be bothered to really do anything most of the time, and I have less than 0 libido. I don't have ED issues when it is time, but I'm starting from deep inside the hole and while the wife is pretty accepting, I don't know how long this can go on for. No morning erections, no spontaneous erections.

I've got two kids, 2 and 4, and I'd love to feel better in general and not be "too tired" or "daddy just want to sit down when he gets home". I've experienced some brain fog. I've never done AAS, abused anything illicit, I drink irregularly and socially, not heavily. No testicular trauma that is noteworthy, I had a vasectomy in July of last year.

For the past two years, clearly, although I can seem to remember it going further back that . I've always been quite active, although after a half marathon about 2 years ago I was feeling run-down and chalked it up to just too many miles during training.

However, I don't feel like I've ever really recovered from that. I did have some run down feelings in the months leading up to it, and earlier in that year, but I figured it was just the miles. I was doing about 40-50/week in 2012.

I'm 5'10", 195lbs and currently about 20% body fat, up from just under 15% at the end of last year, and all of it is in my midsection. Classic spare tire just grew out of nowhere.

Since then, I've not gotten any stronger in the gym(seriously. Not in two years have any maxes really gone up), I've gotten slower on my runs, I'm lucky to maintain a 9 minute pace for 3 miles on an easy run now, where leading up to that training I was regularly doing 5-7 mile runs at less than 8min/mile. This is all when I even feel like doing anything, which isn't that often anymore. Previously, I was a 5am lifter with miles run at lunchtime or later in the day 5 days a week with long runs on weekends.

I've been searching for something that fit and although self-diagnosis is a dangerous thing, everything seemed to boil down to low testosterone or a thyroid issue. I went ahead and scheduled myself a labcorp test (Female Panel) through ************* last week to see if this was something to pursue or if I was wrong, and had that test (fasted 12 hours) last Monday, the 21st:

Test Result Range
Testosterone, Serum 347 ng/dL 348-1197
LH 3.4 mIU/mL 1.7-8.6
FSH 1.9 mIU/mL 1.5-12.4
Estradiol 14.5 pg/mL 7.6-42.6

I do have a CBC w/differential and Metabolic panel available, but I'll include my GP's lab's version below.

Now, seeing this number as something that seems low for my age I figured it was time to follow up with my GP, who, unfortunately, I've never actually seen; I've only seen his PA and she's generally disinterested. I tried to book an appointment directly with him to discuss, but couldn't get in to see him until June 2nd. I was able to get an appointment with the PA for this Friday, where I'll be discussing the blood tests I was able to order over the phone.

I knew they'd want a CBC and Metabolic panel, so I asked if I could get that ahead of the visit, and they said sure. At this point I said I thought I needed more and would like to get them if possible, I asked for Testosterone, Free and Total, Estradiol, LH, FSH, and a full Thyroid panel. They said they would ask the PA.

I called back and the PA had left them a message that I couldn't have those tests without a reason, so I said that I had symptoms which seemed to indicate those tests would be ordered when I saw her anyway and sympathetic secretary said she's talk to the doctor and leave the order for their in house lab so I could come in Thursday, the 24th and have tests done. Following are complete results:

WBC 6.40 K/UL 4.50-11.0
RBC 5.47 M/UL 4.35-5.87
HEMOGLOBIN 14.9 G/DL 13.3-17.7
HEMATOCRIT 45.6 % 39.8-52.2
MCV 83.3 FL 80.5-99.7
MCH 27.3 PG 26.6-33.8
MCHC 32.7 G/DL 31.5-35.9
RDW 16.1 % 11.0-16.0
PLATELET COUNT 157 K/UL 150-400
MFV 10.7 FL 8.0-13.0

SODIUM 139 MMOL/L 136-145
POTASSIUM 4.3 MMOL/L 3.5-5.1
CHLORIDE 102 MMOL/L 98-107
CARBON DIOXIDE 31 MMOL/L 21-31
BLOOD UREA NITROGEN 16 MG/DL 7-25
GLUCOSE 88 MG/DL 65-99
CALCIUM 9.7 MG/DL 8.6-10.3
ANION GAP 6 MMOL/L 3-11
TOTAL PROTEIN 7.5 G/DL 6.4-8.9
ALBUMIN 4.5 G/DL 3.5-5.7
BILIRUBIN TOTAL 0.71 MG/DL 0.30-1.00
ALKALINE PHOSPHATE 48 U/L 34-104
AST(SGOT) 28 U/L 13-39
ALT(SGPT) 33 U/L 7-52
EST GFR NON AFRICAN >60 ML/MIN/1.73SQ.M


CHOLESTOROL 202 MG/DL 0-200
TRIGLYCERIDE 141 MG/DL 0-150
HDL 51.8 MG/DL
NON-HDL 150.2 MG/DL
LDL 122.0 MG/DL
RISK RATIO 3.9 AVERAGE

LH 3.1 MIU/ML 1.24-8.62
FSH 2.3 MIU/ML 1.27-19.26
TESTOSTERONE 368 NG/DL 175-781

TSH 2.61 UIU/ML 0.44-4.21
T4 FREE 0.85 NG/DL 0.60-1.40
FREE T3 3.20 PG/ML 2.10-3.90

TESTOSTERONE FREE 133.3 pg/mL 35.0-155.0

Obviously they didn't order everything, notable estradioal and total t3/t4. This is what I have though. I called today asking for the results and I was told I could pick them up but everything is normal.

I tried to call Endos last week but even though my insurance doesn't require it, they all want a referral (understandably), so I'm dependent on my GP for a referral. I'm of the belief that 348-368 is low for a 34 year old active man with my history. I don't believe that on Friday when I see the PA I'll get anywhere. Is it, like they're going to tell me, all in my head?

Should I try to find another GP? Should I call the urologist who did my vasectomy? I don't believe I'd need a referral since I'm already a patient of his?

I'm a pretty determined person and although that's taken a hit with my general malaise, if I have to keep calling doctors I will. Should I beat this drum until someone helps, or should I exhaust direct options and call a clinic? That's tempting when doors get shut, but being someone with incredible insurance who could have treatments covered, it bothers me to lay out the cash for it myself if there is a problem here.

Thanks for your time, let me know if there are any questions. Unfortunately, I don't have any other bloodwork available currently and am probably not going to be able to get my current GP to order it. Anything that can be gleaned from the numbers above would be appreciated. I have an SHBG test scheduled for tomorrow as well.

[kelkel]

Wow. Very thorough first post Narco. Welcome to the forum.

LH & FSH are low, thus low T.
Estradiol is not the correct test. It needs to be an Estrogen Sensitive Assay. If you use Labcorp I can provide the correct codes. On the first numbers it appears to be Labcorp. With low estrogen comes low libido and I guarantee you are much lower than your Estradiol number given.
TSH is high as well. Yes, it's within that labs range but a more modern range is .3 - 3.0. Further testing should probably be done here to include T4, T3, FT3, FT4, RT3 and Antibodies. Prolactin and cortisol would also be good to know. Any of the three can suppress T levels.

To me you appear to be on the right track. Exhaust all avenues to find the causative factor. Far too many do not do this and end up on TRT years before they need to be. Whether you need to find another doc is up to you. Your doc should be a partner to you, not a supervisor and should treat you based on symptoms and how you feel, not by numbers.

[BallSak]

Could your free testosterone possibly be a typo? Because it is near the top of the range...

[narc0lept]

Could your free testosterone possibly be a typo? Because it is near the top of the range...

That's what the bloodwork said, but I'm thinking it has to be a lab error, right?

[narc0lept]

Wow. Very thorough first post Narco. Welcome to the forum.

LH & FSH are low, thus low T.
Estradiol is not the correct test. It needs to be an Estrogen Sensitive Assay. If you use Labcorp I can provide the correct codes. On the first numbers it appears to be Labcorp. With low estrogen comes low libido and I guarantee you are much lower than your Estradiol number given.
TSH is high as well. Yes, it's within that labs range but a more modern range is .3 - 3.0. Further testing should probably be done here to include T4, T3, FT3, FT4, RT3 and Antibodies. Prolactin and cortisol would also be good to know. Any of the three can suppress T levels.

To me you appear to be on the right track. Exhaust all avenues to find the causative factor. Far too many do not do this and end up on TRT years before they need to be. Whether you need to find another doc is up to you. Your doc should be a partner to you, not a supervisor and should treat you based on symptoms and how you feel, not by numbers.

Thanks for the reply. Yes, it's not the sensitive assay. I got the female panel from *************, as I said, because I wanted to see if I was on the right track with research. That is from labcorp. I figured that it was better to get the less expensive one to "check" before calling the GP, since all my doctor ordered work is covered 100% and I could ask for more. Their testing is done through Quest, I believe.

Unfortunately, they didn't order the sensitive estradiol, or any estradiol test even though I asked.

I'm going to discuss all this with my GP's PA (I've never actually seen my GP, don't even know what he looks like), and see where I can get presenting that the test is low, and likely because of a thyroid issue, or that's at least my gut feeling.

Now, where I get confused is like this -- If the test is low, and it's because of the thyroid, if I treat the thyroid will the test improve, or does that depend on other factors?

It seems when researching that you tend to read a lot of forum posts and everyone who is taking synthroid or armour is also on TRT. Shouldn't resolving the thyroid issue resolve the testosterone issue, or is this not always the case?

[kelkel]

Hypothyroidism causes hypogonadism. Fix the first and you can rectify the latter, assuming there are no other issues. A good list of blood work is in the Finding A Doc sticky thread at the top of this forum. Take a look at stopthethyroidmadness.com. Good site to learn from.

[narc0lept]

Thanks a lot. I posted this on a few boards and this is the only place that I got an answer that wasn't from a TRT clinic telling me TRT would change my life, or someone telling me to take iodine supplements and I'll be fine.

I really appreciate it

[kelkel]

Glad to help. It's a good place here. Stick around narco.

[narc0lept]

SHBG results:

Sex Horm Binding Glob, Serum 14.6 16.5-55.9 nmol/L

[kelkel]

And that's why your FT % is high even with lower Serum T.

[narc0lept]

So I should be focusing on the thyroid then, I believe.

Based on research that if I use the new range of .3-3 for TSH I'm somewhat high, and that with low free T4 seems to point towards primary hypothyroidism.

I'm gathering references on hypothyroidism and the revised ranges for my doctor visit tomorrow, along with references to show my TT is not in range and ask that we investigate the thyroid in an attempt to resolve the TT issue. I had thought low T initially, because, well, my TT number is low. With symptom overlap, and the way bloodwork seems to be taking it, I'd lean more towards hypothyroid now.

Self diagnosis is something my GP's office will love, I'm sure. I personally just want to feel better. Any references you can provide that might help me out with my doctor would be appreciated.

[kelkel]

It's possible, or maybe sub-clinical hypothyroidism.
No doubt they'll love your self diagnosing. But it's your health and sell it to them that you want to be proactive with this and not just jump on testosterone supplementation. You want to find the actual problem. Challenge him. Your attitude is important.
I think we spoke of stopthethyroidmadness.com. Other than that, google is your friend. Ton's of sites.

Don't give up.

[narc0lept]

Just an update. Dr's office doesn't feel the thyroid is anywhere in a range for treatment but said something to keep an eye on (my mother has hypothyroid). They did offer to treat the low T directly, but I declined at this point in lieu of a referral to an endo to ask more about the thyroid.

Depending on the outcome of that either we'll treat the thyroid/T with the endo, or it'll be back to the GP to look at the T again.

[kelkel]

I think to make that assessment they'd also need to see RT3 and Antibodies.

Subclinical Hypothyroidism: An Update for Primary Care Physicians

Glad you're fighting this fight. You very well may end up on TRT but at least you'll have the piece of mind to know that you ruled everything out first. So many do not do this.

[narc0lept]

That's why I figured I'd get the referral and check with an endo first. Like I said, I'm dealing with the PA at my GP, so as she said she can't really make split second decisions on what's acceptable and not, she just operates under his guidelines.

She said his comments were thyroid shouldn't be anything to worry about AT THIS POINT, so he did seem in agreement that it's something to keep an eye on, and that test is low and they'd treat that.

So, if I strike out with the endo (they actually said they'll refer me to 4 different ones in total if the first one declines to see me, etc.), then I have the GP to circle back to. They did refer me as Low T with both my total numbers marked - 368 and 347, so they said there is a good chance that the first endo will take the referral and schedule a visit with me at least.

Sanity check, though. I figure that everything points to secondary hypogonadism, in that the lower TT is being caused by something else, could be the thyroid, cortisol, whatever.

If I do strike out with the endo at this point and just accept TRT, the secondary cause will still be there and I could continue to seek out help for finding that cause and possibly be able to go for a restart if that problem is resolved in any kind of short-to-regular term, or am I mistaken?

[kelkel]

T
If I do strike out with the endo at this point and just accept TRT, the secondary cause will still be there and I could continue to seek out help for finding that cause and possibly be able to go for a restart if that problem is resolved in any kind of short-to-regular term, or am I mistaken?

You are correct.

[narc0lept]

Thanks.

[narc0lept]

Had an appointment with endo this morning, supposedly best in area.

He said 348 was normal for a 34 y/o man, and dismissed all my symptoms but for libido. He said he'd order a bioavalable T test and prolactin, but he doesn't plan on seeing me again unless the bloodwork shows something really out of whack.

I'll get that bloodwork on Monday morning, and he's ordering it to be sent out to quest rather than the hospital's lab. He told me to call in a week if I don't hear anything from them.

At this point, either the prolactin and bioavailable test shows something that changes his mind, or I my next steps are:

1. Go back to GP to see if they'll treat test and work on finding the cause of it being low
2. See if they'll treat test and refer me to a different endo or another specialist to look for the root cause while I'm under treatment
3. Find a clinic and start treatment on my own while searching for a new GP.

Endo left me disappointed. He was all about the numbers from the lab, but when I showed him the labcorp tests I had which had it being below their range, he said that didn't matter because I was 25th percentile on the lab they use's range. I said to him that still leaves me at half of normal, and he said that maybe I was a little low to start, but I'm just seeing normal age related decline.

I then asked him why not treat and/or fix this now instead of saying "Oh, well if you come back in 5 years I'll probably treat it". He said there's no reason to in his opinion. I then reiterated my symptoms and he again dismissed everything but libido. He then said he didn't really know, and asked the PA student that was with him this morning if he had any ideas. I asked him why it's acceptable to just say I'm going to feel like crap in general.

I didn't exactly leave feeling warm and fuzzy. Anyone want to make any suggestions based on my options as I see them, as laid out above?

I assume that if I go the clinic route now, it would improve the symptoms and get me "normal", or I'd hope. At that point I could just search for a new GP/endo and just inform them I'm on TRT when I see them and find one that might be willing to take that over and have my insurance cover it. Might be worth the initial outlay of the clinic route?

BTW, this endo does most of the thyroid treatment in the area, and is my mom's endo for her thyroid issues -- He said he sees nothing indicative of thyroid issues and wouldn't even pursue that as a cause of my low(er) T. He did make a comment that someone would probably treat me for the T, but it wouldn't be him.

[narc0lept]

Update!

Endo has declined to treat me for anything, has judged everything as normal.

He had ordered Bioavailable Test and Prolactin, and had the Test sent out to Quest's lab in Virginia rather than at the local hospital.

Anyway, on to the results:

Albumin Serum 4.4 g/dL 3.6-5.1
Testosterone Bioavailable 188.3 ng/dL 110.0-575
Testosterone Free 93.6 pg/mL 46.0-224.0
Testosterone Total 372 ng/dL 250-1100
Sex Hormone Binging Glob 13 nmol/L 10-50
Prolactin 5.27 NG/ML 2.64-13.13

Not sure what to make of it. Got results back from Endo Friday around lunchtime, placed a call to my GP's office and didn't get a call back, but it was later in the day.

I'm going to follow up with GP tomorrow. Anyone want to chime in on these results, and still experiencing the same symptoms as earlier?

I'm assuming the prolactin means nothing other than there's no indication of a pituitary tumor, as that's what all the literature I've read seems to point to a reason for testing.

Thanks for reading!

[BallSak]

Unless I missed it, you really need cortisol labs done. As I am now finding out, cortisol makes a huge difference in how you feel.

Your free T3 looks good but you still need to check RT3 to fully gauge your thyroid function.

The doc is treating your numbers instead of your symptoms. This is a sign of a crappy doc.

[narc0lept]

I don't have them handy, but I've had recent cortisol labs done, since I've been feeling off and they were pretty much spot on normal. I'll see if I can dig the numbers up tomorrow but I've been eating paleo for a while, so based on how much the paleo community focuses on cortisol levels it was one of the first things I asked to have checked.

[narc0lept]

Spoke to GP's office -- They are declining to treat based on the endo's note that based on my history(!?) he doesn't feel my testosterone is low. I asked what they suspect to be the cause of my symptoms that seem to fit low T, and the numbers being low in the range, they said, "I don't know."

I asked for a referral to a second endo, and I'm going to call the urologist who did my vasectomy to see if they will see me, at the very least. Other than that I guess I need to find a new GP who would be willing to treat my symptoms in some way, shape, or form.

EDIT: Called urologist, his receptionist said they get these calls all the time after people in the area see "certain" endos. Have an appointment July 3rd, if they can get me in sooner they will.

[narc0lept]

Just going to update this to keep a running log, thanks of reading, anyone who is still checking in.

Got a call from GP's office today, they got me another endo appointment, for OCTOBER 8th.

I'm actively searching for a new GP currently, and hoping my urologist appointment on the 3rd goes better than my previous Dr. visits have

[narc0lept]

Update: Saw Urologist this morning. Said all my numbers are in the range, there's no problem, and he can't treat me because that would be "doping".

Sigh.

[kelkel]

Damn narco this is getting depressing. I didn't read the trail but did you ever get a full thyroid panel?

[narc0lept]

Endo wouldn't do it, said there's 100% nothing wrong with my thyroid and sent me on my way.

[kelkel]

Endo wouldn't do it, said there's 100% nothing wrong with my thyroid and sent me on my way.

Was than based on a full panel or simply TSH?

[thisAngelBites]

Endo wouldn't do it, said there's 100% nothing wrong with my thyroid and sent me on my way.

You have got to find a better physician. Try looking for a clued-up one: Thyroid Disease Top Doctors Directory

It's so heartbreaking that so few doctors know so little about thyroid problems.

[narc0lept]

Just based on the tests listed above. Felt my thyroid, looked at my numbers, said he won't even order more tests.

Not that I know anything, but anyone think if none of these doctors are helping me, if before I go the clinic route I try a clomid or nolva restart on my own? All the literature is out there on it so it wouldn't be hard to put one together and test after certain intervals to see if it works, and if it does boost the T levels if I feel better again?

[Flatus78]

Dear Narco.
It must be very frustrated not knowing why you are feeling so tired and fatigued, and not getting any more help from your GP.
I recommend checking vitamin-status, and maybe also bloodtest for coeliac disease, and mabye also fecalprotectintest regarding IBD(esp. mb Crohn). I am not sure if you could have been exposed to tick-borne disease like borreliosis and other co-infections like babesia, mycoplasma and bartonella and many more(maybe this is far out, but it seems like a desperate situation, so maybe worth investigating?). Sleep apnea can also cause general fatigue symptoms. Hope you manage to figure it out, best of luck

[narc0lept]

Another endo took the referral from my PCP -- Appointment August 1st. Getting pretty run down on seeing these doctors and I'm not really hopeful at this point.

[dirkmcgirk]

God damn these doctors and their traditional//orthodox approaches to male issues disgust me. Further, you really would expect more from a male endo or uro. I say Efff the doctors and go a reputable TRT clinic with your blood work results.

[jwh7699]

Like the previous poster mentioned. Getting a sleep study test is a good idea.

Any dramatic weight loss or gain? Dramatic weight loss can also be an indicator of Celiac disease which Flatus78 mentioned.

You should get a complete thryoid panel done. If your Dr. will only order certain ones, pay out of pocket and get it done yourself. Saves the constant run around.

Good Luck!!

[narc0lept]

Update, finally.

Saw second endo today. He disagrees with the first, and said he would send a note to him explaining things.

Started on synthroid , will redo full thyroid labs and test labs in 5 weeks, follow up with him in 6 weeks.

He also recommended that at the same time I try to go keto for a bit to see if that helps jumpstart energy, etc.

He told me he will find the cause, whether it's the thyroid or I end up on TRT. Mentioned some stuff about aromatase and the thyroid + retained body fat issue, so I'll give his recommendations a shot and follow up with him at next appointment.

Feeling a lot better about things than before.

[thisAngelBites]

Keto, meaning ketotic/in ketosis? People who eat such little carbs that they are in ketosis have lower levels of T3 and higher levels of reverse T3 (this is a fairly new observation, as far as I know, google around and you will find lots of read about this area of interest). So there is increasing evidence that carbs are important for people who are hypothryoid. Energy levels might well improve if you get rid of processed food which has a lot of rubbish carbs in and stabilise blood sugar in this way. Instead eat lots of veg, including some sweet potatoes, potatoes etc (but don't overdo it because you don't need loads) and a bit of less sweet fruit (berries are best, avoiding really sugary things like mango and banana) and cut processed food and grain as much as possible (there is lots of investigation that is pointing to links between gluten consumption and hashimoto's, which is an autoimmune hypothyroidism). Glad to hear someone is trying thyroid meds and look forward to hearing how you are doing in a few weeks.