Guidance with Initial Labs (very low Free-T)

[Reason]

Help Reading Initial Labs?

Hey all,

New here, first post!

I just got my initial labs en route to a Defy consultation (2-3 weeks out). I'm somewhat new to this so I would really appreciate some guidance reading the results.

Background:

37 / 5'11" / 190lbs / ~18-20% body fat

Gyno as a teenager that stuck around until my mid-20s when I got plastic surgery for it. Pretty sedentary job (college professor). Strength training 4x/week consistently for the past 2+ years. Knowledgeable about nutrition + implementing it, was on low card and then keto until a few months ago (hence the high LDL levels). Supplementing strategically (zinc, D3, magnesium, Omega 3s, etc.). I consider myself to be actively pursuing better health and constantly running up against an invisible wall.

The usual list of awful low-T symptoms: constant fatigue, depression, low libido, inability to gain muscle, insomnia, etc. Most have been a constant for most of my life, though some (low libido/fatigue) are severe right now. I feel mostly useless in life and at the gym.

Labs Summary:

• Total T: 366 ng/dL (264-916)
• Free T: 7.5 pg/mL (8.7-25.1) Low
• LH: 3.3 mIU/mL (1.7-8.6)
• Estradiol, sensitive 16 pg/mL (8-35)
• SHBG: 34.3 nmol/L (16.5-55.9)
• DHEA-S and TSH smack dab in the middle of the range

Obviously, Total-T is on the lower end and Free-T is awful. I'm most confused as to why Free-T is so low given my SHBG and Albumin being within range. Just a factor of low total?

E2 seems low, but I'm guessing this is also a factor of low total T?

Is there anything else that jumps out? I checked these against the forum's guidelines and don't notice anything out of the ordinary other than the above.

Also wondering what you recommend I ask my Dr. at the time of consult given these results.

Thank you in advance!

 

[Reason]

I'm wondering why I've received no replies yet. Did I make a mistake I'm not aware of?

 

[Vince Carter]

Well there's not much point in trying to digest labs when they're basically a throw away because it's all going to change when you start therapy so honestly its only good for your Dr, what's the point of picking these apart at this stage? Wouldn't be much to gain if I said do this and change that only to start therapy and have it all "reset", as it were.

 

[CoastWatcher]

Both your free testosterone and your estradiol wwill respond, that is, increase, once your therapy is initiated. You had full-blown, glandular gynecomastia when you were young? Bilateral? Were your hormones evaluated when that presented?

 

[Vince]

You may want a full thyroid panel, just to check your numbers.

 

[Reason]

@Vince: You're right, but I am looking to get better informed before my consultation, so besides reading all the info here, I was wondering if your (EM's members') trained eyes could spot something besides the low test I could look into. Not necessarily recommend care, which is why I sought Defy.

@CoastWacher: Full-blown, glandular, bilateral gyno. No hormone evals were done and none were recommended. Even PCPs later in life never thought to look into hormones even when the gyno was disclosed along with persistent psychological symptoms. I had a thyroid test done once ~4 years ago, probably just TSH, which the doctor said was normal but I know now how meaningless that is.

 

[CoastWatcher]

@Vince: You're right, but I am looking to get better informed before my consultation, so besides reading all the info here, I was wondering if your (EM's members') trained eyes could spot something besides the low test I could look into. Not necessarily recommend care, which is why I sought Defy.

@CoastWacher: Full-blown, glandular, bilateral gyno. No hormone evals were done and none were recommended. Even PCPs later in life never thought to look into hormones even when the gyno was disclosed along with persistent psychological symptoms. I had a thyroid test done once ~4 years ago, probably just TSH, which the doctor said was normal but I know now how meaningless that is.

Younwere probably just happy to have the Gyno resolved, having dealt with it that long. Your primary care doctor, and the surgeon, none of them engaged in speculation as to WHY this somewhat rare situation presented itself? Was your puberty otherwise unremarkable?

 

[Reason]

I was VERY happy to get rid of it. I was never very overweight so there was no hiding the gyno. None of my doctors ever mentioned there could be a possible non-random non-genetic cause worth looking into.

Puberty was late but I was active and healthy. Never an athlete and scrawny but nothing that caused alarm. I’ve always had small testicles (grape) but thought they were fine because libido was great up until 2-3 years ago. Still unclear if that’s an issue?

I had good libido even during my worst depressive phases and when I was severely out of shape. The usual story, few look into testosterone issues until sexual symptoms start showing up...

 

[CoastWatcher]

I was VERY happy to get rid of it. I was never very overweight so there was no hiding the gyno. None of my doctors ever mentioned there could be a possible non-random non-genetic cause worth looking into.

Puberty was late but I was active and healthy. Never an athlete and scrawny but nothing that caused alarm. I’ve always had small testicles (grape) but thought they were fine because libido was great up until 2-3 years ago. Still unclear if that’s an issue?

I had good libido even during my worst depressive phases and when I was severely out of shape. The usual story, few look into testosterone issues until sexual symptoms start showing up...

Do you have prolactin levels?

 

[Reason]

No, not one of the tests in the Defy initial battery.

 

[johndoesmith]

Honestly, these are pretty standard labs for low testosterone, nothing really sticks out except for low Test and low E2. They're boring, which is good. I'd say you've found your problem.

Be happy with boring.

 

[Reason]

Honestly, these are pretty standard labs for low testosterone, nothing really sticks out except for low Test and low E2. They're boring, which is good. I'd say you've found your problem.

Be happy with boring.

Thank you, I hope you're right.