33 years old with Total T of 14.2 nmol/L and Free T of 213 pmol/L

[spencer]

Hello, I just had my blood tested for levels of T and Estradiol. Results are as follows:

Testosterone: 14.2 nmol/L
Free T: 213 pmol/L
Estradiol: <73 pmol/L

I have known that I'm low for a couple years now. These results are better than my last tests, but are still low. I eat a very healthy diet focused on good fats and proteins and minimizing carbs, hitting around 2,500 kcal per day. I have been working out seriously for 4-5 years and most recently went from 182 lbs up to 198 lbs, while maintaining a lean body composition (~13-15% body fat) and I'm 6'3". My objective is to add another 8-10 lbs of lean muscle, but I feel as though I've hit a plateau. I also find that I frequently have changes in mood, with a bias toward feelings of depression - I understand that can be a symptom of low T.

I'm considering TRT, but would like to avoid having to use it for the rest of my life. Some people have suggested short term cycling to boost levels to assist in building muscle, but to discontinue. Three weeks on, one week off, three weeks on, then never again.

Any advice on strategy is very much appreciated.

Thanks.

 

[PAUL-E]

Some people have suggested short term cycling to boost levels to assist in building muscle, but to discontinue. Three weeks on, one week off, three weeks on, then never again.

Any advice on strategy is very much appreciated.

Thanks.

I highly recommend against that as it might make you feel worse than you already do. 3 weeks isn't long enough for testosterone to really due much IMHO
have you checked lh/fsh, thyroid tsh t3 t4 reverse t3?
here is some example of blood tests that should be done
https://www.excelmale.com/forum/sho...e-and-During-Testosterone-Replacement-Therapy

 

[Vince]

I agree with Paul, don't cycle testosterone.

 

[CoastWatcher]

Welcome to Excelmale. You haven't provided us with reference ranges, but, yes, you're on the low end. What about your LH and FSH values? A restart protocol, using Clomid, might be worth exploring if you have secondary hypogonadism. But your idea of a cycle is silly. How do you think that's going to work? "Some people have suggested short term cycling to boost levels to assist in building muscle, but to discontinue. Three weeks on, one week off, three weeks on, then never again." The body, when it recognizes exogenous testosterone will shut down your own, limited natural production in favour of that you have injected. Three weeks later...how is it going to restore itself? It isn't going to happen. Share your LH and FSH and talk to an experienced doctor about the efficacy of a genuine restart.

 

[spencer]

Welcome to Excelmale. You haven't provided us with reference ranges, but, yes, you're on the low end.

My results with reference ranges:

Estradiol: <73 pmol/L (ref range: 0-172)
Total Test: 14.2 nmol/L (ref range: 6-27)
Free Test: 213 pmol/L (ref range: 196-636)

After doing some more reading I plan on following up with a more complete set of tests.

 

[CoastWatcher]

Where do you live? Are you working with a doctor you have confidence in?

 

[spencer]

Where do you live? Are you working with a doctor you have confidence in?

I live in Toronto, Ontario. I have a doctor at the Canadian Men's Clinic, but I wouldn't say it is the best type of service there. I feel like they rush people in and out and just hand out scripts for whatever you ask for. My objectives are to improve body composition and mood, nothing related to ED yet (which is what they specialize in). Unfortunately my family doctor doesn't have enough experience in the field to be much help either. My next source of information is from fitness trainers, who obviously aren't doctors, but have a lot of experience working with people who use TRT.

Ideally I would like to find a doctor that specializes in hormone treatment, but I am having trouble finding one.

 

[CoastWatcher]

I live in Toronto, Ontario. I have a doctor at the Canadian Men's Clinic, but I wouldn't say it is the best type of service there. I feel like they rush people in and out and just hand out scripts for whatever you ask for. My objectives are to improve body composition and mood, nothing related to ED yet (which is what they specialize in). Unfortunately my family doctor doesn't have enough experience in the field to be much help either. My next source of information is from fitness trainers, who obviously aren't doctors, but have a lot of experience working with people who use TRT.

Ideally I would like to find a doctor that specializes in hormone treatment, but I am having trouble finding one.

I live in Toronto. I would avoid the Canadian Men's Clinic - the stories I have heard. I will message you som thoughts.

 

[spencer]

Hello again,

I have had further tests conducted to follow up on my results from June.

My results from June were:

Testosterone: 14.2 nmol/L (ref range 6.0-27.0)
Free T: 213 pmol/L (ref range 196-636)
Estradiol: <73 pmol/L (ref range 0-172)

I had follow-on tests to check for pituitary function and reproductive and gonadal levels, those results are:

FSH: 6.5 IU/L (ref range of 1.3-19.3)
LH: 4.1 IU/L (ref range of 1.2-8.6)
Prolactin: 5.1 ug/L (ref range of 2.6-13.1)
Bioavailable T: 8.9 nmol/L (ref range 3.6-11.2)
SHBG: 69.4 nmol/L (ref range 10.0-70.0)

What sticks out to me is the elevated levels of SHBG and I also find it strange that my bioavailable T is in the high end of the reference range when my Free T is at the bottom end.

I'm meeting with my family doctor tomorrow and have requested a referral to an endocrinologist to figure this all out.

Any thoughts for you all are appreciated!

Thank you.

 

[CoastWatcher]

I'm meeting with my family doctor tomorrow and have requested a referral to an endocrinologist to figure this all out.

Any thoughts for you all are appreciated!

Thank you.

Like all,of us in Canada, you will face certain challenges in obtaining TRT. Those can be overcome with some work. As for a referral, consider Dr. Adam Millar. I am not his patient, but I have heard him speak. His background is in the attached link.

https://www.excelmale.com/forum/showthread.php?3315-Toronto-Dr-Adam-Millar&highlight=Toronto

 

[spencer]

Thanks. I have been in contact with Dr. Millar's office and have requested a referral to him from my family doctor. I expect I will get that referral tomorrow.

 

[CoastWatcher]

Thanks. I have been in contact with Dr. Millar's office and have requested a referral to him from my family doctor. I expect I will get that referral tomorrow.

Very good to know. All the best.

 

[spencer]

Hi everyone,

I just had my blood work done again as part of the admission to Dr. Millar's clinic. My results were as follows:

LH Plasma: 9.1 IU/L (ref: 1.0-8.0)
Total Testosterone P1: 28.0 nmol/L (ref: 10.0-28.0)
SHBG 70.2 nmol/L: (ref: 14.5-48.4)
Free Androgen Index P1: 0.40 (ref: 0.22-0.86)
Bioavail Testosterone: 4.43 nmol/L (ref: 2.00-8.60)

My SHBG continues to be very high. Surprisingly my Total T has doubled since June. LH has also doubled since June.

Any thoughts from the group would be welcome.

Thank you.

 

[johndoesmith]

Hi everyone,

I just had my blood work done again as part of the admission to Dr. Millar's clinic. My results were as follows:

LH Plasma: 9.1 IU/L (ref: 1.0-8.0)
Total Testosterone P1: 28.0 nmol/L (ref: 10.0-28.0)
SHBG 70.2 nmol/L: (ref: 14.5-48.4)
Free Androgen Index P1: 0.40 (ref: 0.22-0.86)
Bioavail Testosterone: 4.43 nmol/L (ref: 2.00-8.60)

My SHBG continues to be very high. Surprisingly my Total T has doubled since June. LH has also doubled since June.

Any thoughts from the group would be welcome.

Thank you.

No E2 test?

What are your symptoms?

when you had these tests done below, did you have them done at the same time as the ones I'm going to list after?

FSH: 6.5 IU/L (ref range of 1.3-19.3)
LH: 4.1 IU/L (ref range of 1.2-8.6)
Prolactin: 5.1 ug/L (ref range of 2.6-13.1)
Bioavailable T: 8.9 nmol/L (ref range 3.6-11.2)
SHBG: 69.4 nmol/L (ref range 10.0-70.0)

Testosterone: 14.2 nmol/L
Free T: 213 pmol/L
Estradiol: <73 pmol/L

 

[spencer]

Those previous results were from June and July of this year. The most recent results are as of two weeks ago.

My symptoms are... mood swings, depression, inability to build lean muscle mass of any significant amount despite strict training and diet for years. Fat is carried in areas more characteristic of a "gynoid" body type. Had gynecomastia as a teen (removed by surgery).

What is an E2 test?

 

[johndoesmith]

Those previous results were from June and July of this year. The most recent results are as of two weeks ago.

My symptoms are... mood swings, depression, inability to build lean muscle mass of any significant amount despite strict training and diet for years. Fat is carried in areas more characteristic of a "gynoid" body type. Had gynecomastia as a teen (removed by surgery).

What is an E2 test?

Well unfortunately, your july results aren't very useful on their own. The LH and FSH are fairly useless without total and free test ran at the same time. It basically adds to the confusion, as your most recent results have high LH and FSH, with a great total test level, but we have no idea what it was in july.

E2 is estradiol.

Did you have symptoms when your most recent tests were done?

 

[CoastWatcher]

As a fellow Canadian, I know you're unlikely to find a sensitive estradiol test. I travel to the States every month so I pull that value with Discountedlabs.com. You will have a standard test run that may dimly help you and your doctor match a number to your symptoms. It is a challenge.

 

[johndoesmith]

As a fellow Canadian, I know you're unlikely to find a sensitive estradiol test. I travel to the States every month so I pull that value with Discountedlabs.com. You will have a standard test run that may dimly help you and your doctor match a number to your symptoms. It is a challenge.

Just curious here, you test your sensitive E2 every month, or do you just test it when you're here in the states so it works with your schedule?

 

[CoastWatcher]

Just curious here, you test your sensitive E2 every month, or do you just test it when you're here in the states so it works with your schedule?

Pull it every month at the present time as part of a study my doctor's running to demonstrate the superiority of the sensitive test. She's part of a networked group of doctors in Canada and Ireland hoping to bring the value of the sensitive test to the attention of other doctors.

Otherwise, I'd pull it quarterly.

 

[johndoesmith]

Pull it every month at the present time as part of a study my doctor's running to demonstrate the superiority of the sensitive test. She's part of a networked group of doctors in Canada and Ireland hoping to bring the value of the sensitive test to the attention of other doctors.

Otherwise, I'd pull it quarterly.

Interesting. You obviously have to pay for this, you don't mind doing so?