Free T - low percentage

[pkp382]

Hello,

My most recent blood work over the last year or so has showed my total T in the "normal" range, usually 450-500. However, the 4-5 times I've had blood work done over this time period, the free T has always been low, ranging from 1.1% - 1.5%. Everything I've read online, and the tests themselves say free T should be 2-3%. This would likely explain why I've been feeling poorly this time, even though my results have been midrange for total (250-827).

My question is - does anybody know of a way to retain more of the total T I am producing, ideally to get to the 2-3%? Any supplements, workouts, anything at all? I'm 37, 200 lbs, 34-35 inch waiste, and eat a healthy diet due to my celiac disease (no sweets) and take multivitamins, fish oil, etc. there is nothing remarkable about me physically one way or the other.

Side note, I was on TRT fora few years because I was low (200s) for some reason, but decided to take a break because I wasn't seeing any benefits. With my levels in the normal range (admittedly, low normal) I decided to stay off.

Now I just need to find a way to increase the free T. Does anybody have any suggestions?

Many thanks to anybody who can provide some insight.

[kelkel]

Hi pkp. Several things:

Was there ever a diagnosis by your initial doc who prescribed TRT? Meaning what was causing it?
If you have blood work from just before TRT post it up as well as current BW. Maybe we can find something suppression endogenous T production.
If you don't and can obtain it, use the list in the Finding A Doc sticky at the top of this forum.

Know that as we age our SHBG levels rise causing more T to be bound, resulting in less free T. Test it next time. Solid Vit D levels can help here a bit as it will help to suppress SHBG resulting in more FT. You need to know your D level before you supplement, imho. Most in North America are low and need to take it. It's a fat soluble hormone so take it with a large meal and monitor your levels. Many other things can suppress T production as well, such as thyroid, prolactin, cortisol, elevated estrogen, etc.

When you say you weren't seeing any benefits from prior T can you explain further please? Usually when that's the case there's an issue with the protocol or monitoring (BW) of it.

[pkp382]

Kel,

Thank you for the reply. As for my prior TRT use - I tried various treatments (testing, axiron) at various levels, and it never seemed to improve libido or help with weight loss. I finally realized that I needed to monitor e2 also, but couldn't find a doc that would prescribe anything for that. So I stopped taking it altogether, and pretty much feel the same now as I did then. This was a couple years ago - then I noticed I wasn't keeping enough free t, which came after additional blood tests because I was feeling lousy. I'm not saying all that was the best way to go about this, but I'm content with where my total t is, but it's low enough to where when I'm not keeping the 2% free, I can feel it.

And there was no cause determined - it was secondary of some nature. I don't have the blood work from then. The only thing I offered to the different docs Back then I saw (I got 4 separate opinions) was that a year or so prior to feeling lousy, I had been taking Vicodin and drinking 1-2x per week, and I read opiates can cause harm. That was ruled out by all 4 (and by myself, from what I read online) as a cause because 1) it was not chronic use - there was 5-6 days between this moronic behavior, allowing my system to reset, whereas OPIAD is caused by chronic, near daily use for an extended period of time, continuously, where your system can't reset. Also, because it had been over a year that I had quit, and felt fine, before this began. I was 30 years old with free t in the 200s, and stupid as it was, mild dabbling with recreation in my late 20s wouldn't cause that, from what I was told and read.

As for blood work, here is the most recent;

LH 2.6 (1.5-9.3) - this dropped from 4.0 in a month, FYI
FSH 3.2 (1.6-8)
Total t 448 (250-827)
Free t 64 (46-227)
TSH 1.91 (0.5-5.2)
FT4 1.5 (0.8-1.8)
Ferritin 104 (14-338)
Cortisol 18.7 (4-27)
SHBG 28 (10-50)
Prolactin 7.2 (2-18) - rose from 5.8 in 1 month
Vit d 53 (30-100)
E2 24 (10-39)

So this recent round dropped my LH considerably, but total test remained about the same, but free dropped from 82-64 in a month. Historically, my LH and FSH since quitting TRT have been mid-range so this drop was a surprise. Other than that and the free t being at least 0.5% what my retention should be, things appear to line up ok (not great).

Thank you again, and apologies for the long post - want to make sure I covered everything. See anything that advice can be given on?

[kelkel]

Nothing jumps out as suppressing your LH. Thyroid is a main culprit but what you show here does not give rise to immediate concern. When TSH gets over 2 it should be looked into though. I would assume your SHBG rose when your FT dropped.

Have you had any head trauma in your life? Anything that can impact pituitary function? If not, it simply may be time to get back on TRT, but with a competent doctor this time.

[pkp382]

No, no head trauma. And frankly the drop in LH surprised me - it had always been between 4.0 and 5.6 since I quit TRT, but as I mentioned the total t has stayed consistent regardless of the LH output, so that's less a concern than the drop in free t.

I just found it bizarre that for a year, free t was between 80-100 (off TRT), now with no different lifestyle changes, less than 1 year later it had been between 49-72, all while total t has stayed somewhat constant. I felt fine (not great, but fine) with the former, and kinda crappy with the latter.

Thanks again for your help. I'll add more vitamin D to the diet for starters.