Looking for advice in UK

[Sparksy]

56 years old. After presenting with typical low T symptoms my Dr requested blood samples. Results as follows:
Fasted Testosterone 11.1
Shbg 33
Albumin 41
Calculated Free testosterone 226 pcmol/l

Have been advised that these are all within ‘normal’ range and that TRT is unlikely to benefit.
I’m not really sure if these results are significant and whether to go to a private clinic for further advice/treatment?

 

[TescoValueJam]

so 11.1 is imo low, what time was test done? However I know the UK guidelines, and know that some GPs use reference ranges starting at 8.. so yes can imagine the dr saying it's 'normal'.

Sensible next steps;
1) repeat the test in a few days, with a private provider with wider panel - lh/fsh/estradiol etc, and get confirmation,
2) try for natural optimisation first if similar result (body recomposition, diet, supplements, sleep, stress etc)
3) repeat test, if still no bueno, and ongoing symptoms with no other obvious cause, then yes absolutely a reputable trt clinic in UK, with advice to start a clomid/enclomiphene type medication first if you are amenable.

 

[Sparksy]

Thank you for your reply!
The fasted test was 9am. Previously, a non fasted test, also at 9am was 7.6.
I’m confused as to how to interpret the calculated free test result and the appropriate ranges and units of measurement!?

 

[Cataceous]

That is Vermeulen calculated free testosterone, which you can reproduce here. Going by memory, one study came up with a normal range for healthy younger men of about 278-763 pMol/L. My impression is that it's possible for some men to start having symptoms with levels below ~350 pMol/L. It is plausible that you are hypogonadal. The safest way to see if higher testosterone would be helpful is with a short-acting form, such as a nasal gel. A nasal gel has been shown to have less impact on other hormones and systems than conventional TRT.

On this side of the pond we're used to using units of ng/dL for testosterone. The conversion factor is 34.7 pMol/L per 1 ng/dL.

 

[Systemlord]

Have been advised that these are all within ‘normal’ range and that TRT is unlikely to benefit.

Your Free T result is right at the cutoff (225 pmol/L) for being approved for TRT according to the British Sexual Medicine Guidelines.

I can’t believe your doctor is taking the position that you’re normal being so damn close to these arbitrary numbers to be considered for TRT!

You can have a testosterone deficiency with normal testosterone, because no consensus exists defining testosterone deficiency.

You don’t want the NHS to be involved in your TRT treatment anyways. Balance My Hormones in Dorset is a private cash only clinic.

 

[Sparksy]

An update and a question. My GP has prescribed Tostran 2% Gel which I’m happy about. I have not received the Gel yet and so unsure about the actual dosage right now. On doing some research Tostran application is recommended for inner thigh and lower abdomen which are naturally hairy; surely this will impede absorption? My understanding is that alternative brands recommend upper arm/shoulders which are relatively hair free.
Why the discrepancy?

 

[Systemlord]

My GP has prescribed Tostran 2% Gel which I’m happy about.

You got the diagnosis, excellent! I wouldn’t get my hopes up on the Gel being anywhere near optimal treatment, because a lot of guys have trouble absorbing topicals.

The inner thigh is the second best place to absorbed topical T, the testicles being number one, however you shouldn’t ever use gel on the testicles.