Big Les shares blood test results but skips key details

What did @bigwiseone actually say?

He shared a private blood test from Numan, walking through results live on camera. His testosterone came back at 4.99 nmol/L against a reference range requiring over 12. He called this "in the floor" and linked it directly to fatigue, low mood, and poor strength. He also flagged slightly elevated total cholesterol at 5.6 mmol/L, low folate, and elevated creatinine, which he attributed to creatine supplementation and insufficient water intake. His plan: dietary tweaks for cholesterol, iron supplements for folate, more water for creatinine, and a GP referral for testosterone confirmation.

To his credit, he was transparent, didn't dramatise wildly, and recommended seeing a doctor rather than self-medicating. That matters.

Does the science back this up?

On testosterone: yes, largely. A reading of 4.99 nmol/L is below the European Association of Urology threshold of 12 nmol/L for suspected hypogonadism, and symptoms like fatigue, low mood, and reduced strength are textbook presentations. Bhasin et al. (2010, New England Journal of Medicine) established that symptomatic men with consistently low testosterone are candidates for evaluation. One test is not a diagnosis, which he correctly acknowledged by arranging a confirmatory test.

On creatinine: his reasoning is biologically plausible. Oral creatine supplementation is well-documented to raise serum creatinine without reflecting true kidney dysfunction. Pline and Smith (2005, Annals of Pharmacotherapy) confirmed this effect in healthy adults taking creatine. His "drink more water" solution is oversimplified though. Hydration affects eGFR transiently but doesn't neutralise creatine's effect on creatinine readings. A cystatin-C test or stopping supplementation before retesting would be more informative.

What did they get wrong (or right)?

The folate-anaemia link is where he gets muddled. He said "if I start taking an iron supplement" that will fix his low folate. Iron and folate are different nutrients addressing different types of anaemia. Folate deficiency causes megaloblastic anaemia; iron deficiency causes microcytic anaemia. Taking iron won't correct low folate. He needs folate supplementation, typically folic acid, not iron. This is a genuine clinical error that could lead someone to take the wrong supplement while their actual deficiency goes untreated.

His cholesterol read is reasonable. A total cholesterol of 5.6 mmol/L is mildly elevated, and his HDL ratio being favourable does reduce cardiovascular risk meaningfully. Emerging evidence from Ference et al. (2017, European Heart Journal) supports non-HDL cholesterol and LDL as stronger predictors than total cholesterol alone. Dietary modification is a legitimate first-line approach for mild elevation.

What should you actually know?

Low testosterone at a single time point is not a diagnosis of hypogonadism. NICE guidelines in the UK and Endocrine Society guidance both require two early-morning fasting samples showing low testosterone alongside clinical symptoms before treatment is considered. Stress, illness, poor sleep, and recent exercise all suppress testosterone temporarily. His plan to get a GP retest is exactly right, and anyone watching who identifies with his symptoms should follow the same path rather than jumping to TRT.

On TRT itself: if confirmed hypogonadism is diagnosed, treatment decisions should involve assessment of luteinising hormone and FSH to distinguish primary from secondary hypogonadism, as the causes and treatment pathways differ. Self-diagnosing from a single private panel and self-treating is not recommended.

• Low testosterone symptoms overlap heavily with depression, sleep apnoea, obesity, and thyroid dysfunction, all of which appeared partly normal in his results but warrant proper clinical review.
• Folate deficiency has independent associations with mood and fatigue, separate from anaemia, which makes his result clinically relevant beyond just tiredness.