Blood Work Results - Low Free Test - What do you think?

[eiff]

The first figure is my result and the second figure is the "Standard Range". I asked to be checked because I've felt a loss of energy, lack of progress in workouts, and lowered libido.

I'm 29, 5'9", 205lbs, 18-20ish%BF.

Do you think I should consider HRT?

Any insight is hugely appreciated.

Thanks,

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# TESTOSTERONE, TOTAL AND FREE

Total Testosterone 2.8 2.5 - 11.5 ng/mL
Free Testosterone 4.22 9.00 - 47.00 pg/mL L

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# TSH

TSH 2.290 0.358 - 3.740 uIU/mL

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# COMPREHENSIVE METABOLIC PANEL

Sodium 140 136 - 148 mmol/L
Potassium 4.5 3.5 - 5.1 mmol/L
Chloride 105 98 - 108 mmol/L
CO2 27 21 - 32 mmol/L
Anion Gap 8 6 - 16
Glucose 81 60 - 100 mg/dL
BUN 24 3 - 21 mg/dL H
Creatinine 1.20 0.80 - 1.30 mg/dL
eGFR non-African American >60
Calcium 9.3 8.5 - 10.1 mg/dL
Total Protein 8.2 6.4 - 8.2 gm/dL
Albumin 4.8 3.4 - 5.0 gm/dL
Globulin 3.4 2.0 - 3.9 gm/dL
Bilirubin, Total 1.4 0.2 - 1.0 mg/dL H
Alk Phos 100 50 - 136 U/L
AST(SGOT) 33 10 - 37 U/L
ALT(SGPT) 58 12 - 78 U/L

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# CBC

WBC 5.7 4.0 - 10.6 x10E3
RBC 5.49 4.64 - 6.00 x10E6
Hemoglobin 16.4 14.5 - 17.7 gm/dL
Hct 49 42 - 53 %
MCV 88 81 - 98 fL
MCHC 33.8 31.2 - 35.2 gm/dL
RDW 13.1 11.0 - 14.5 %
Platelets 190 150 - 400 x10E3

[HRTstudent]

Well, you are low for your age, but how long have you felt lowered libido and lack of energy?

What's your diet and lifestyle look like?

Alcohol or other drugs you are on (legal or otherwise)?

Slower workout results can be so many things.

HRT is pretty serious and usually it's done indefinitely. It is in your interest to find out if you have some transient problem before stepping into a "permanent" solution.

[kelkel]

^^Well said hrt. Op, do you have LH/FSH by chance? SHBG.

And welcome to the forum.

[eiff]

Well, you are low for your age, but how long have you felt lowered libido and lack of energy?

What's your diet and lifestyle look like?

A lcohol or other d rugs you are on (legal or otherwise)?

Slower workout results can be so many things.

Thanks so much for the reply. There's clearly wisdom in your response.

A lcohol: I'd say I drink 1 glass of wine a week.
D rugs: None at all, past or present, except for Flonase for allergies. Never taken any sort of testosterone, hormone, etc.

I'd say my energy and libido have been slowly decreasing over the period of a few years. Nothing really drastic or anything, my wife of 3 years wants sex more than I do, which seems weird for 29. I used to be a project oriented kinda guy, but lately I have a hard time getting motivated.

I have a desk job and workout 4 times a week (currently doing a starting strength type linear progression (stalling like crazy, frustrated) & cardio, count my calories everyday - 3000 with 300g protein daily (trying to build strength). I take a multivitamin, greens supplement, vitamin D, fish oil daily.

[eiff]

^^Well said hrt. Op, do you have LH/FSH by chance? SHBG.

And welcome to the forum.

Thanks so much! I've been a long time lurker, but never registered.

I wish I had more thorough tests, but the ones posted are all my doc ordered.

Maybe smart to request some more tests.

[zaggahamma]

Well, you are low for your age, but how long have you felt lowered libido and lack of energy?

What's your diet and lifestyle look like?

Alcohol or other drugs you are on (legal or otherwise)?

Slower workout results can be so many things.

HRT is pretty serious and usually it's done indefinitely. It is in your interest to find out if you have some transient problem before stepping into a "permanent" solution.

agree with kel, well said..especially if transient means fixable/temporary

eiff, youre already considering TRT as would I...follow the guys advice, post up the lh/fsh....usually the doc will have you test low again before they offer test repla***ent

[eiff]

Thanks for responses everybody. I so appreciate your time.

I'm waiting to hear back from my doctor on what our next steps should be. Seems like what I need to request is to retest the Testosterone and also LH/FSH and SHBG. Does that seem smart?

[kelkel]

eiff read the Finding a TRT Physician Sticky at the top and see if that works for you. While there, read all the stickies and study up to prepare for your next visit. Educate yourself and your questions will not be dismissed by your doc.

[eiff]

I'll re-read the stickies. I figured my first step was to see if low test was even an issue or not. Now that I THINK it is, I'll discuss getting the additional lab work tests listed in the stickies. I guess I was curious if it seemed like the levels that my tests showed warranted entertaining the idea of TRT. Seems like I need to ask my doctor about getting the additional tests and go from there.

Thanks again everyone!

[eiff]

Ok,
Got some additional blood work done. I get them online- MyChart. I'm still expecting Estradiol to pop up any time now. But I think this is the rest of em.

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Testosterone Bioavailable 194
Reference range: 131 to 682
Unit: ng/dL
(NOTE)
INTERPRETIVE INFORMATION: Testosterone, Bioavailable
Tanner Stage IV 40 - 485 ng/dL
Tanner Stage V 124 - 596 ng/dL
The concentrations of free and bioavailable
testosterone are derived from mathematical expressions
based on constants for the binding of testosterone to
albumin and/or sex hormone binding globulin.

Testosterone Free 65
Reference range: 47 to 244
Unit: pg/mL
(NOTE)
INTERPRETIVE INFORMATION: Testosterone, Free
Tanner Stage IV 35 - 169 pg/mL
Tanner Stage V 41 - 239 pg/mL
To convert to pmol/L, multiply pg/mL by 3.47.
The concentration of Free Testosterone is derived from
a mathematical expression based on the constant for
the binding of testosterone to sex hormone binding
globulin.

Testosterone % Free 1.7
Reference range: 1.6 to 2.9
Unit: %
(NOTE)
Performed by ARUP Laboratories,
500 Chipeta Way, SLC,UT 84108 800-522-2787
www.aruplab.com, Sherrie L. Perkins, MD, Lab. Director

Testosterone Total 380
Reference range: 300 to 1080
Unit: ng/dL
(NOTE)
INTERPRETIVE INFORMATION: Testosterone, Adult Male
To convert to nmol/L, multiply ng/dL by 0.0347.

Sex Horm Bind Glob 35
Reference range: 11 to 80


# LUTEINIZING HORMONE, BASELINE

Baseline 2.2 mIU/mL

# FSH

FSH 5.1 mIU/mL

Male Reference Range:
Males: 13-70 years: 1.4 - 18.1 mIU/mL

# THYROID SCREEN

FT4 1.0 0.8 - 1.5 ng/dL
TSH 1.820 0.358 - 3.740 uIU/mL
All TSH values represent 3rd generation TSH.

# PROLACTIN

Prolactin 5.2 2.1 - 17.7 ng/mL

# CORTISOL

Cortisol 11.3 ug/dL

Cortisol Reference Range:
a.m. serum (7 - 9 a.m.): 4.30 - 22.40 ug/dL
p.m. serum (3 - 5 p.m.): 3.09 - 16.66 ug/dL
Circulating cortisol results from patients receiving
Prednisolone or Prednisone (which is converted to
Prednisolone in vivo) therapy may be falsely
elevated.
Exercise caution with cortisol determinations for
patients undergoing therapy with these and
structurally related synthetic corticosteroids.

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There's no reference range on the LH. Weird. Also, the endocrinologist that I went to to get these additional tests worked to try and downplay my previous low 'Free T' result that was flagged as low. Something about it just being a calculation and not actually reflecting my free T. Didn't quite get what he meant.

Refresher: I asked to be checked because I've felt a loss of energy, lack of progress in workouts, and lowered libido. I'm 29, 5'9", 205lbs, 18-20ish%BF.

Any insight?

[eiff]

Hmmm... There we go, just did it in a few smaller chunks.

It's strange to me that there's a 'Free Testosterone' and a 'Testosterone Free' and one is flagged as low and the other isn't. When I had my appointment with the Endo before this 2nd set of tests, he was downplaying the importance of the 'Free Testosterone' from the previous test, saying it's just a calculation off the total T. It was strange.

Also there's no reference range for the LH for some reason. (I access these online using MyChart)

Any insight is hugely appreciated.

Thanks,

[eiff]

Here's the last 2:

# TESTOSTERONE, TOTAL AND FREE (this is the same test I took a couple weeks ago, at top of thread, taken a second time)

Total Testosterone 3.8 2.5 - 11.5 ng/mL
Free Testosterone 7.25 9.00 - 47.00 pg/mL L

# ESTRADIOL

Estradiol 7.6 pg/mL
Male Reference Range
3-70 pg/mL
This estradiol assay uses DPC-RIA reagents and detects
endogenous as well as exogenous estradiol (natural or synthetic).

[HRTstudent]

Your numbers are low for the age you are. But you could try something relatively simple like clomid therapy to see if it gives you the boost. Also, it's probably very reasonable to think that some lifestyle and diet changes could get you into a more mid-level range.

Given your age and not-super-low levels I would look at all my options before TRT.

[eiff]

Thanks for the response hrt.

I hadn't even heard of Clomid therarpy. I've now heard a few papers on it and it definitely seems like there's some good options for me to consider before TRT. I have an appointment with my Endo (who ordered the tests) on monday, so I'll see what he thinks we should do.

As far as diet / lifestyle, I'm pretty strict with getting 8 hours of sleep a night, 2800 calories, 300 g protein, fish oil, vit D, multi, etc.

Thanks again for everything!

[ecdysone]

Given your age and not-super-low levels I would look at all my options before TRT.

What hrt said, otherwise you are good to go.

[eiff]

Sorry to bug, just one more question.

Is there anything in this BW that would indicate a primary vs. secondary problem? I'd think you'd use the LH to determine this? The LH of 2.2 with no range doesn't mean anything to me. There's no range on the MyChart website.

I'm still trying to decipher the numbers, and there's a lot to learn.

Thanks again,

[HRTstudent]

A LH of 2.2 mIU/mL is most likely low normal. This could mean you are secondary hypogonadism so therefore you may get positive results from something like clomid therapy, diet/lifestyle changes etc.

I would very likely not opt to testosterone therapy to be frank. If you wanted to try something that could effect you perhaps quicker than living a healthier lifestyle then I would, in your shoes, probably do clomid therapy and try to bring my natural T production up. It's worth looking into, I think they also use AI to raise natural T, but clomid has definitely been studied in the field of HRT quite a bit.

[eiff]

Thanks for the reply hrt. That's very helpful. I'm definitely not in any rush to get on TRT and would turn it down right now if it was offered to me. I'm hoping to find the root cause.

As far as lifestyle changes go, I'd love any suggestions. I'm happily married, I get a firm 8 hours of sleep, count my calories and macronutrients, take a multi vitamin, fish oil, vitamin D, strength training, cardio, don't drink, don't smoke, never taken any AAS. I'm kind of a health nut.