I'm a 24 y/o male from Canada. I exercise 6xx/week (3 lifting, 3 sports) and have been doing this for over 8 years. I'm 6'0 and 200lbs (prob about 20% BF).
My problems all started about 7 years ago. I developed an eating disorder while trying to “cut” and lose some body fat. I had body image dysmorphia and frequently fasted for >20 hour periods in order to justify binge eating. I was eating not nearly enough dietary fat and ate certain points in my journey carbs as well. I went from about 220 pounds to 175 pounds in about 6 months. I got quite lean but at the cost of my health and my hormonal balance. I wasn't mature enough to recognize it at the time but I had clear symptoms of low thyroid and low testosterone in addition to my mental health problems. I have since fixed my mental health problems (no medications) and no longer have body image issues. I exercise for health now, not for the way that i look.
Any questions/advice would be greatly appreciated. I'm here to learn and would be happy to learn from (and hopefully at some point contribute to) this great community.
You are concerned with your free testosterone results which is understandable as even though it is good to know ones TT level, FT is what really matters as it is the unbound active fraction of testosterone.
First thing that stands out is looking at your lab results from Labcorp your TT levels are descent 557 ng/dl (range 264-916) and your FT 15.9 pg/ml is just below mid-normal of the reference range (range 9.3-26.5) as 17.6 would be the mean (mid-normal) of the reference range so your FT is average but not low by any means.
Even when one converts Canadian units for TT or free t to the US units and wants to compare Canadian vs US labs it is not accurate as the testing methods used by different labs for TT and free t are usually different and depending on the testing methods for TT and free t certain assays are more accurate than others.
Regarding Total Testosterone at most labs in Canada they use the automated immunoassay which is not as accurate as the liquid chromatography tandem-mass spectrometry (LC-MS/MS) which is used at certain labs in the US and Labcorp offers it which you may have had done when your TT was tested and more than likely your FT was the direct assay.
Regarding free testosterone at most labs in Canada they use the calculated free t as oppose to the direct or equilibrium dialysis which is offered at most US labs mind you calculated free t is also used.
Than to top it off lab reference ranges are different in Canada and the US and there is also variance in reference ranges between labs.
Two of the biggest labs in Ontario are Lifelabs and Dynacare and there is a difference between reference ranges for TT,FT,SHBG,E2 and so on.
Two of the biggest labs in the US are Labcorp and Quest and there is also a difference in reference ranges.
Not sure which province you are located but when looking over your Canadian labs (1st set) your TT is definitely on the lower end at 9.51 nmol/L (range 5.8-28) but the more important aspect is your FT and the testing method FIA (free androgen index) used is unreliable and it is surprising that the calculated free T method was not used as it is the one to be used when testing FT in Canada as most labs do not use equliibrium dialysis considered the (gold standard and reference method against which other methods are compared) or ultracentrifugation which is (comparable to equilibrium dialysis).
If anything you should have your labs done again for FT using the calculated method to get a more accurate picture of where your FT truly sits and even than also retest TT as you were 9.51 nmol/L the first test and 16 nmol/L the second test.....did you have your blood work done fasted and in the morning (7-10 am) as it is critical due to the natural circadian rhythm of a health young males testosterone levels which peak in the early am and than slowly decline throughout the afternoon/evening.
You can easily find out your FT (calculated method) as long as you know your TT and SHBG levels using the Free & Bioavailable Testosterone Calculator online.
Most men ideally need their FT to be in the 2-3% range.
Regarding Total Testosterone at most labs in Canada they use the automated immunoassay which is not as accurate as the liquid chromatography tandem-mass spectrometry (LC-MS/MS) which is used at certain labs in the US and Labcorp offers it which was used when you had your blood work done.
If anything you should have your labs done again for FT using the calculated method to get a more accurate picture of where your FT truly sits and even than also retest TT as you were 9.51 nmol/L the first test and 16 nmol/L the second test.....did you have your blood work done fasted and in the morning (7-10 am) as it is critical due to the natural circadian rhythm of a health young males testosterone levels which peak in the early am and than and than slowly decline throughout the afternoon/evening.
Thank you very much for the detailed reply. I’m in Saskatchewan (Lifelabs). I’ve used that calculator before but wasnt sure of it’s accuracy.
If 2-3% is ideal it appears im at about 2%. Hmmm. I FEEL like I definetly need help from medication. I know when i was 16 (before the extreme dieting) i had ZERO libido problems, zero fatigue, zero depression or loss of enjoyment and all this while i slept 6-7 hours per night, didnt eat well etc. So i definetly feel worse now. But the problem is with numbers like that (borderline low) how do I convince others to believe that I need help? Its been challenging for sure.
I tried for years now to fix it w/ lifestyle. Its become clear that route is not working.
Again. Thanks for the detailed reply.
Thank you very much for the detailed reply. I'm in Saskatchewan (Lifelabs). I've used that calculator before but wasnt sure of it's accuracy.
I understand your frustration as doctors that specialize in trt are far and few in Canada let alone the accuracy of certain assays used in Canada when testing TT, FT and of course estradiol (mind you the sensitive assay is available in Ontario at Dynacare) and as of a month ago Health Canada licensed Beckman Coulter's Access Sensitive Estradiol Assay which is great news for us!
I agree with others that you should look into your thyroid deeper.
You are only 24 and it would be wise to make sure your thyroid is functioning optimally before jumping into trt.
Also your Labcorp labs are useless in Canada as doctors would require labs to be done at a Canadian laboratory.
I would definitely retest your TT and FT again but make sure the lab uses calculated method not the FIA and even though your FT looks to be around 2% using the calculator you may very well need it to be higher to be optimal.....mind you most men that have issues with low FT usually have high SHBG and your SHBG of 34.1 nmol/L is not high and actually under the mid-range (range 13-71) as the mean (mid-range) is 42 nmol/L.
For sure thyroid should be looked into more. I’ll try to get TT and FT tested again but “calculated” rather than FAI. We’ll see how that goes. I’ve only ever had FAI done here in Canada.
I got FT and Estradiol sensitive at Labcorp in order to schedule a consult w/ Defy.
Regarding the Canadian Testosterone Deficiency Guidelines if a male is experiencing low t symptoms and lab work shows a TT level between 8-12 nmol/L (considered the grey zone) along with a low/low-normal free t than under the guidelines a 6 month trial of trt is recommended.
The sad fact of the matter is that most doctors would consider a low-normal TT/FT as in range and tell you everything is ok when in fact you are truly suffering from a testosterone deficiency.
Even if one has borderline TT/FT it is rare for doctors to even check ones SHBG and of course there are many cases where a male may have normal TT but low/low-normal FT due to high SHBG!
It comes down to finding a doctor who has experience with treating men for low T which can be very difficult to say the least.
Thanks for reply. I’ll have to find those guidelines and use them as ammo in my appt with the Canadian doctor next week. It is a shame that most docs consider numbers in the normal range with symptoms as okay. If symptoms are present that is a good indication that everything is probably not okay. Thanks again.
Had a meeting w/ a doc today (never seen him before). After describing my situation he ordered some lab tests and told me to rebook for a week or two from now to review + full physical. Of the lab tests he ordered, included is TSH, FT4 and FT3.
This will be good so I can see my FT3 number and hopefully have some measure of whether i am converting enough of the synthroid to T3 (and thus whether my symptoms are at all related to thyroid or not). My question to you more experienced guys is, what is the point of testing RT3? I mean if someone is taking enough synthroid to make their TSH < 1 but they still have low thyroid symptoms coupled w/ a low FT3 reading (and an adequate FT4) then what difference does high RT3 make compared to normal RT3? Wouldn’t the treatment include some kind of T3 prescription either way? Just trying to learn the reasons why so I can better understand what my own blood test results mean.
Canada, most of the talking points have been covered ... KEY emphasis by many is the labs. Without them there isn't all that much to contribute, but just speculation.
On the antibodies, do you recall which set was positive (TPO or TgAb)? Either way, it will be good to see everything current, along with the other thyroid assays.
The other critical area that needs to be added is iron serum and TIBC (or UIBC can calculate the total). As stated, ferritin needs to come up a bit, but the iron serum also needs to be factored.
i’ve got iron serum and TIBC on the way. Unfortunately i do not remeber which antibody was elevated. I can try to find out.
After iron serum, TIBC and RT3 do I need any other labs? I assume I need to get iron/ferritin in order to ensure that T3 is making it into my cells. That assumes FT3 comes back in range. If it comes back low then would I add cytomel to my synthroid to get T3 up (and again optimize iron so its getting into the cells).
of those symptoms (need stimulants to wake me up in the morning, low energy, low resting heart rate).
Sorry I’m kind of bouncing all over the place here. Up until I started reading this forum about a week ago I really thought that I had it all figured out. The more I read the more I realize how muh there is that I dont know.
i have been diving deeper into the forums here. Reading more about thyroid, iron and cortisol and i remembered something very important from my days of extreme dieting that I completely forgot about. At the time I was dieting and exercising very frequently and intensely i also took some “bodybuilding” supplements. I went back and looked through and found something that is disturbing me. It might (you all would know much better than me) explain some of my symptoms and how they might be related to low cortsol.
I took a supplement that was marked as “cortisol reducer” which contained 7-alpha-hydroxy-dhea and 7-beta-hydroxy-dhea. Could this (combined with chronic stress, malnutrition and overtraining) contribute to long term low cortisol? Like I said before, i have some of the symptoms that STTM describe as adrenal fatigue. I am very embarrassed that I would put something like that into my body while at the time knowing so little about it and what effect it might have. I’m just so desperate to get better and I hope you all understand that I was a dumb kid.
- currently trying to learn more about interpreting iron labs. What I do know is since the lab draw I have started taking an iron supplement 28mg/day along w/ 200mcg selenium and 1000mg vit C and my resting heart rate has increased from 45bpm to 52bpm.
- i assume that to a certain extent low iron has contributed to T3 not getting into cells. Initial iron supplementation i believe has helped bc of improvement in resting HR and a more alert feeling throughout the day.
- should i alter my iron supplementation at all? How long till i should get labs again? Any recommendations?
- 100mcg of synthroid per day is putting my T4 high enough for sure. Appears to be converting to T3 at an okay rate? My symptoms tho (including body temps) show that i’m still hypo. Leads me to believe that my rt3 is indeed high (although the docs here refuse to test for it) and that is likely contributing to T3 not getting into cells and hypo symptoms.
- low? Should i supplement?
- i essentially say I respect his opinion but what if my reverse T3 is high and therefore blah blah blah.
- he basically responds that the thyroid is good and try some antidepressants for a month and see how you do. Says he never prescribes T3 and only specialists do that rarely.
- have consult w/ defy the week after and talk to them about fixing the thyroid first before looking at TRT. If rt3 is high maybe try to reduce the t4 dose and add some t3. See if we can get rt3 to drop and hypo symptoms to improve.
- continue w/ iron and selenium supplementation and track body temps and resting heart rate throughout.
Any recommendations would be much appreciated. Thanks guys!
I fee very good. I can tell that i’m not dialed yet but i’m definetly feeing better already. It’s funny. The first few days of NDT i eased into it with one grain per day and felt absolutely nothing. Upped it to 2 grains and felt slightly better but still kinda meh. Around this time I got the results ofy 4x diurinal cortisol test back. They were all low except right before bed. I started looking into what I might be able to do to up my cortisol numbers (apart from hydrocortisone) and I read somewhere that taking melatonin before bed lowers your morning cortisol. Still not sure how true that statement is or isnt but I decided to ditch the 5mg of melatonin i had been taking before bed for over a year and boom. Within a few days I was feeling really really good, kinda like the NDT really kicked in all of the sudden. The start with TRT had been rocky for the first week. Had 2 or 3 days after my first injection where I felt pretty darn good. Whether it was in my head or not is anyone’s guess but then within a week I started having low estrogen symptoms similar to what I had before TRT (maybe even slightly more severe). My heart beat pounded in my ears while I was in beed trying to sleep for a few nights in row. But i stuck with the plan and slowly but surely for a few weeks after that i felt better and better with regards to energy in the gym. Dare I say that the low estrogen symptoms are almost completely gone. I feel slightly more emotional than before, still probably a little less than I should. No sore joints at all, libido has improved slightly but still not there yet. Overall happy with how its going so far. I understand that it is still very early and it will be a while before I have it dialed. I’m still not there yet and I’m guessing low cortisol might have something to do with it. We’ll see come 3 weeks from now when I get my blood tested again as well as the 4x salivary cortisol again. I’m in Canada so getting the proper tests (ie. estradiol sensitive) has been tough. Last time I flew down to the states just to get it done. Now I’ve found a way of getting the proper tests done here at home, although I still do have to pay for them. I’d be willing to share if anyone else from Canada is interested (or if it’s in accordance with the forum’s rules). Anyway. I’ll attach some cool charts of my restin heart rate showing big spikes when I start supplementing iron (July) and when I started NDT (Sept). Cool to look at.
Hope everyone else is well. I’ll post my bloodwork results in about a month or so.
The estradiol sensitive (LC/MS-MS) has been available in Canada since early this year through Dynacare!
As far as I knew you still had to have it prescribed by a doc. My doc wouldnt prescribe the sensitive assay.
I certainly have some concerns and am open (and would very much appreciate) anyone’s advice.
1) thyroid antibodies. Both sky high! I was diagnosed with hashimotos back at the beginning of all this but i believe this is the first time since then that the antibodies were tested. Any advice?
2) lipids need to improve but they are stable from before TRT. I can definetly afford to lose 10 or 20 pounds slowly over time.
3) iron numbers are worse than before!! I did give quite a bit of blood in order to have multiple rounds of bloodwork done but is this drop in those numbers from TRT? I dont know. Still supplementing iron w/ vit C. Maybe bump it to twice per day?
4) free t3 could afford to come down a bit? I havent been sleeping great lately. Maybe this is why? Also this is my first time having rt3 done. Thoughts?
5) still waiting on the estradiol sens result but i feel like the estrogen has gone up. Less low estrogen symptoms for sure. Test level looks good? Free test the same as before trt but thats cause SHBG went from 30 to 50 almost. I read this is normal but any way to bring it down a bit? Rather than inject more T? Hematocrit is a bit high. Will talk to my doc about donating but i really need to get those iron numbers up!
By the way i’ve felt a TON better since starting TRT. Not 100% for sure but a big improvement in energy, mood, strength (a little bit) and libido (a little bit). Sleep has been bad the last 3 weeks and i’m thinking if i go down to 1.5 grains it will improve? Also still waiting on second round of 4x salivary cortisol testing results. Previous one showed evidence of adrenal fatigue. Recently started taking a cortisol supplement that seems to be helping. Waiting on these results to see if hydrocortisone is indicated or not.
Edit: felt kind of itchy lately. Onset of symptoms kinnnda line up with starting the cortisol supp. Could that be to blame for high antibodies? I dont know.
Those are my thoughts. Please if you can spare a moment to make some recommendations i’d greatly appreciate it.
Probably the number one recommendation for hashimoto's is to give up grains. I don't have hashimoto's but I have gave up grains since I have hypothyroidism. Also I would supplement with low dose iodine and selenium.