Why these different results??

Thread starter #1
All, sorry for the long post and appreciate all the advise but here is my story. I am a 40 yr old male. Work has been stressful the last few years with long hours, bad food, lots of travel and shitty work. About 4 years ago, I noticed that I was having issues maintaining erections, then I noticed I was feeling fatigued, had a lot of body fat, some anxiety, was getting lazier, etc. All this happened over a course of a couple of years. I was overseas and happened to go to a doctor (for something else but mentioned these symptoms as a side note). He suggested I get my T levels checked. They turned out to be low so he suggested I come back to the US and follow up with my doctor. Upon returning, I asked my primary care physician that I wanted to take these tests. Here are the results over time (all AM/ ~10am):

06/2017 - 289/54.3 (Total/ free), Prolactin - 9.1, TSH - 2.34, FSH - 1.8, LH - 2.2

08/2017 - 290/59.5 (total/ free)

He still wanted one more test to be sure. **I also happened to take a one month vacation from work** and got another test done in 09/2017. Results were:

09/2017 - 455/96.5 (Total/ free), Prolactin - 8.5, PSA - 0.3

With these latest numbers, he said everything was fine and not to worry. He gave me some Viagra for the erections but that didnt help much tbh. A year later at the next physical, I requested another set of tests. This time they were:

08/2018 - 222/41.1 (Total/ free), Cortisol - 16.6, FSH - 2.3, LH - 1.5, Estradiol - 36,

These were lower than the tests last year. So he almost agreed to put my on TRT. However, wanting to double check the tests again, he requested another set a month later. It was August again and I had another vacation coming (I usually dont get these long vacations but have started saving up vaca to take) and had a month off again. At the end of the month, the results were:

09/2018 - 455/79.9 (Total/ free)

Again, he said everything is fine and no need for TRT. But here are my questions:

- Why are my TRT levels fluctuating so much? Its the same labs (quest) and same times.
- Could the vacations be a factor? (Work is crazy stressful at times).
- Sometimes I do take some herbs (Ashwagandha) but dont think the levels should fluctuate that much with them.

I almost just wanna try TRT for a year to see if it makes a difference but want to avoid long term issues like loosing ability to have kids, make own T, etc. I definitely feel I have all the symptoms so know something is up but the numbers are confusing me. Any thoughts or suggestions? Are these variations normal? Thanks!
 
#2
could be anything, you seem to have eliminated the obvious variables of using the same lab and doing the draws at the same time. Being "natural", not on TRT...who knows.
 
#3
Viagra will not work if your hormones are deficient, so when Viagra doesn't work it may be your confirmation of an androgen deficiency or imbalance. Most doctors are inept at diagnosing and treating an androgen deficiency, often not ordering the correct testing methodology.

Is that estrogen testing Roche ECLIA methodology or the LC/MS/MS method? The latter is design for men and the former for females E2 testing.

No SHBG labs, not a good sign your doctor is very capable. Your SHBG level will dictate what type of TRT protocol would be best for you.
 
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#4
In think in most instances Estrogen being high, or low, you won't get wood (or usable wood) even with a PDE5i. I'm starting to see something like this in myself.
 
Thread starter #5
Thanks! I should edit to add that the very first test which was done overseas at a non Quest lab was at 1pm so I didnt include that number but for reference it was 155 ng/dl at that time. So 2 results are showing 455 for a 40 year old male, while 4 other tests are showing below 300. So would a doc consider this low T? Can a 4 week vacation really make this much difference? and lastly, is there such a thing as trying TRT for a year and see if symptoms are better (symptoms being what I described above).
 

Vince

Moderator
#6
If you want to remain fertile, I would think that clomid maybe a better choice then testosterone. Because of your low LH and FSH you're definitely secondary so I definitely would try clomid first.
 
#7
Thanks! I should edit to add that the very first test which was done overseas at a non Quest lab was at 1pm so I didnt include that number but for reference it was 155 ng/dl at that time. So 2 results are showing 455 for a 40 year old male, while 4 other tests are showing below 300. So would a doc consider this low T? Can a 4 week vacation really make this much difference? and lastly, is there such a thing as trying TRT for a year and see if symptoms are better (symptoms being what I described above).
Doctors tend to follow the guidelines set forth by the endocrine society which happen to choose a number on the lower end of the ranges thought to be far too low to be considered healthy. TRT will only show good results if working with a doctor that knows what he's doing.

As it is right now you are scoring in the ranges president Trump is seeing in his 70's.

Your best chance of success is to work with an expert hormone specialists who has been doing TRT for awhile, odds are you won't find these doctors inside insurance networks.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:
CONCLUSION:
These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction. Further study is required to evaluate the validity of these testosterone thresholds for CVD risk.
 
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