Needing advice----normal Total T, low free T

Hey guys, I actually posted a thread here a couple months back wondering whether to go the TRT route or not. Well I tried some dietary stuff etc. and took two blood tests a couple weeks back. Just to remind you guys of my symptoms: low energy, feels like I have lost 30% of strength in the gym, zero libido, erectile problems, no morning wood, need many days to recover after running etc., sleep problems.

Just to give you a summary of my previous blood work:

My total testosterone is always in the high 500 range (usually between 550-600). Two years ago when my symptoms started I only used to measure the total testosterone. My solid Total T levels really surprised me as I had all the symptoms of low T. However I was also happy because I thought that my symptoms may be just temporary and would take care of themselves. Unfortunately the symptoms stayed the same. After further searching the web I measured free testosterone (my doc is super cooperative) which came back at the very low end of the reference range (it was 11 on a scale of 10-40). This kinda explained my symptoms. I tried to get that value up through super healthy lifestyle but unfortunately it did not work out.

March 2017:
Total Testosterone 583 (250-830)
Free Testosterone 11 (10-41)

The latest two bloodworks had the following:

Total Testosterone 727 (250-830)
SHBG 76 (25-89)
LH 7.4 (1.2-8.2)
FSH 9.6 (1.5- 16.4)

I then took another one that included "measured" (not calculated) free Testosterone:

Total Testosterone 562 (250-830)
Free Testosterone 2.11 (3.84- 34.4) LOW
Shbg 42 (15-95)
Estradiol 47 (<40) High --> this was the only time I took E2

I haven't been taking any supplements whatsoever. So essentially my body is able to produce LH/FSH in high amounts, and also total testosterone....but unfortunately most of it gets bounded and thus little Free T available. Does anybody know why? Am I primary or secondary or something? Can your testicles be dysfunctional and yet able to produce Total Testosterone in the high 500s? To me it seems as if there is no way around TRT but looking at these results it seems as if my Hypothalamus and testicles are actually working just fine....or am I misreading something? Any advice appreciated

Hi UnsureNewbie, welcome. Nope you are not primary or secondary. U have high SHGB and that is binding up all your T.
You also seem to have a crap load of E2 as well. Your T wants to do everything but be free.

Thanks for the reply. So is there anything I can do other than going on TRT? I really don't know what to do at this point. I want my normal athletic performance/sex life back. I kinda don't like the idea of going on TRT while having a functioning Hypothalamus and testicles but is there really any other choice? I tried every reasonable lifestyle choice possible....to no avail.
You guys know more about all this than I do.....is there any hope...anything left I can do? It boggles my mind that my body actually produces enough of everything but then decides to bind it up. At least I have an explanation now for my symptoms.....

Have you had a complete thyroid panel Did you have the right sensitive estradiol test for men and D3 may help to lower your shbg.

Thanks for the reply. Actually yes, I have had a couple complete thyriod tests and all of them came back in the midrange of the reference range....really not even at the borders of the reference range. My D3 was lowish and I have started to supplement with D3 the last couple of days. As for the estradiol test---I don't know. How can I find out about that?

A question regarding the thyroid: shouldn't any deficiency then also correlate with total testosterone? Or are there disorders were total testosterone remains solid but free T plummets?

I have also noticed that I shave much less than I used to....it has gone from every 3 days to every 7 days.

PLease if you can post all the Thyroid tests you have. Saying things come back normal or midrange isn't worth much, espceically if your Dr is telling you this we can often see less than optimal performance.

My last thyroid test read:

TSH 0.73 (0.35 - 3.5)
FT 4 0.85 (0.62 - 1.28)

Do you see anything suspicious?

BTW I was rethinking the past 5-7 years (I'm 33 now)...and I have to admit that it has been a gradual decline overall....Just 3 years ago I was able to have sex 3-4 times a day...that's absolutely unthinkable today (with such low Free T probably not surprising either)....I have searched the web for ideas but while there are some guys reporting the exact same problems (normal/high T but low Free T ) it does not seem as if there is any specific syndrome that may cause this

THose two tests are pretty much the two most useless tests for Thyroid, should have included Free T3 and reverse T3. If you get the opportunity these are what you need:

TSH
Free T4
Free T3
Reverse T3
Antibodies

UnsureNewbie said:

BTW I was rethinking the past 5-7 years (I'm 33 now)...and I have to admit that it has been a gradual decline overall....Just 3 years ago I was able to have sex 3-4 times a day...that's absolutely unthinkable today (with such low Free T probably not surprising either)....I have searched the web for ideas but while there are some guys reporting the exact same problems (normal/high T but low Free T ) it does not seem as if there is any specific syndrome that may cause this

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Which is it here, your desire to have sex is diminished, or, you can't get or maintain an erection (or both). Those two things are different but often get lumped in to the same thing.

The right to sensitive estradiol test for men.
https://www.excelmale.com/forum/sho...d-be-Tested-with-the-Sensitive-Estradiol-Test

Sub'd. UnSureNewbie I'm in your situation with the exception of estro. Mine is in range, but my SHGB is 74 with the range being 10-50. So far, this thread has given me some more options to explore, and hope I can contribute more.

@Vince Carter: I think primarely my libido is non existant and thus erections are weak. I really never get that "exciting feeling" when around a hot woman....its more of a memory...and thus , since the excitement is not there I don't get really turned on like in the past and thus the erection is weak. I personally think that if I had midrange Free Testosterone I'd have much stronger libido and no trouble with erections. I visited a cardiologist last year and he told me that my big arteries are in great shape...not the slightest bit of arterosclerosis etc. , I live healthy...do execise usually and have been always lean.

@AyePopi: have you had your thyriod checked? Do you have any testicular pathology? I personally had a left testicle varicocele and sometimes ponder whether that may have contributed to my low free T and symptoms (although it seems somewhat farfetched as I corrected it also)...

BTW just to complete things: I do apply Regaine foam regularly to my scalp for 4 years now. I took finasteride 10 years ago for 4 months but went off of it as I thought the potential longterm risks are not worth it.

I also may have a slight case of an autoimmune disease (slightly inflammed gut) but the two doctors that I visited said that it is barely visible at all. Can inflammation cause low free T???

I think what remains mysterious is why my body binds up all testosterone leaving me with no libido, little energy etc.

I only had the TSH test, and it came back at 1.05 with a range of .40-4.50. Wish I would have seen Vince's post earlier about having TSH, Free T4, Free T3, Reverse T3, & Antibodies tested. I'm going to schedule an appt with my Dr. after the holidays to see if he'll test those for me. No other testicular abnormalities. I'm pretty active, & workout 5-6 times per week with a body fat of around 10-12% depending on who is calibrating How many carbs do you get in your diet? I do Rogaine 2x a day, but don't think that has any sides, does it? Has anyone here tried supplementing with Boron? From the National Library of Medicine NCBI

Boron in plasma increased significantly following hours and weekly consumption. Six hours supplementation showed a significant decrease on sex hormone binding globulin (SHBG), high sensitive CRP (hsCRP) and TNF-&#945; level. After one week (in samples taken at 8.00 A.M, only), the mean plasma free testosterone increased and the mean plasma estradiol decreased significantly. Dihydrotestosterone, cortisol and vitamin D was elevated.

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I do supplement worth 3 mg twice a day of boron. I do it because of the studies of boron and bone health.

Boron for bone density
https://www.excelmale.com/forum/showthread.php?7007-Boron-for-bone-density

Kinda funny that you also take Rogaine. I actually can't say whether it has any effect on Testosterone or Free testosterone. There is probably no study on it at all. To me , the idea of it impacting "Free T" is pretty farfetched but you never know. One thing I noticed during around 8-10 blood tests that I've taken over the past 2-3 years was that my prolactin was always slightly elevated (always between 15-25 on a range of 2-15). Again not sure whether it has anything to do with Rogaine but I went off Rogaine for 12 days now and my second blood test (6 days ago) tested prolactin at only 5. I will be going in for thyroid and another prolactin testing tomorrow or in 10 days. I personally think all that is rather a coincidence and not due to the Rogaine. My last blood test was taken at 11 a.m. so my prolactin may have come down naturally. My previous blood tests were mainly taken between 8-9 a.m.
I will keep you updated on this issue.

One personal theory that I'm contemplating is this: Could it be that what my hypothalamus measures is not free testosterone per se, but rather the ratio of LH/FSH and testosterone? like if your pituitary gland needs to produce a lot of LH in order for your testicles to produce midrange testosterone, your brain will command your liver to produce high amounts of SHBG because your brain thinks that otherwise your system would get flooded with androgens? Speaking more clearly: For whatever reason your testicles do not respond optimally to LH, they don't produce as much testosterone as they should. The hypothalamus however cannot directly assess this suboptimal work by your testicles. Your hypothalamus thinks "I'm shelling out a lot of GnRH and thus there needs to be a lot LH and subsequently testosterone in the body. Thus there needs to be higher levels of SHBG to protect against overstimulation of androgens."
How is SHBG metabolism regulated?

There must be some biological explanation why my body, despite clear hypoandrogenic symptoms (zero libido, erectile trouble, decreasedd shaving frequency, little energy) refuses to elevate free testosterone. My only rational explanation for this is that my brain is not adequately recognizing this diminished free testosterone. My brain must be thinking that my testosterone levels are sufficient. It is so frustrating to have high LH, solid total testosterone but come up with low Free testosterone. Its like you studies your brains out for an exam and are in shape to get an A but just decide to not show up because you prefer to smoke pot that morning and watch a movie.

BTW I also work out about 4-5 times a week and have about 12% body fat ( I am 6'2 and about 170lbs)usually but have lost motivation the past 4 weeks due to zero libido etc. What do I need a great body for if there is little performance in the bedroom? LOL.
I usually do eat some sweets here and there but try to keep it in check. I generally feel a little bit better when I strictly limit carbs and eat high in protein and fats.

Hey guys, I have made up my mind. I want to give TRT a shot as i don't know what to do anymore. However , I want to start with the lowest possible dose. I was thinking about injecting 50mg testosterone enanthate twice a week along with 250IU HCG twice a week for overall 100mg testosterone and 500IU HCG per week. As my estradiol is already high I will take 0.5 mg of Anastrazole per week. What do you guys think? Is that reasonable overall or too high or too low? Any suggestions?

BTW I have bought 1ml ampulles containing 250mg testosterone enanthate....I was planning on taking 0.2 ml per injection for a total of 50mg per injection. The only question mark is that I would have to open one 1ml ampulle and keep it for two weeks in the fridge. Will it hold up that long?

UnsureNewbie said:

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BTW I have bought 1ml ampulles containing 250mg testosterone enanthate....I was planning on taking 0.2 ml per injection for a total of 50mg per injection. The only question mark is that I would have to open one 1ml ampulle and keep it for two weeks in the fridge. Will it hold up that long?

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That does not sound very sterile. Home frigs are full of air born mold and bacteria. I take it you are doing this without a doctors guidance or prescription?

Personally i don't think it's a good idea to self manage without a good Dr, but if you are going to, better not to come down with a life threatening infection. I'm with Feeling lost! I would not keep injecting from an open ampule. You're asking for infection.

You can buy sterile sealed vials quite cheaply and transfer the solution with a sterile syringe when you first open the amp. If you're in the US there are some on ebay for about $1 ea qty of 10 Otherwise try https://www.mountainside-medical.com/collections/empty-sterile-vials

Ok I hear you guys and feel intuitively that you are right. Although I'll be extremely cautious, there is risk involved in repeated injections from an open ampulle. I will transfer the testosterone into a sterile sealed vial. Makes much more sense.

The problem here is that I believe no doctor would really agree with going along with TRT because they mostly look at TT and I'm tired of all this trouble. I know one doctor but he is far away.

If done cautiously and everything, is there really a lot of risk involved with going on a 2-3 months 100mg/week testosterone along with 500IU/HCG along with 0.5 Anastrozole trial? And what type of PCT would I have to run? I know TRT is for life but I want to try the following...I want to give this a 3 month try, live even healthier than I am right now (which is already pretty healthy) , have as much Sex as possible during these 3 months and then after running a PCT hope that my body will be somewhat reconditioned and keep a somewhat higher FT in the longterm. I know that the odds are not great that this will work out but I really feel out of options and perspectives right now. It has been pretty tough the last 2-3 years and I really want to get things back in track and feel like I need something to jumpstart me back....to restore confidence etc.

Don't get me wrong. I would still love a natural solution more than anything but after searching the web it just does not seem really likely to find something. I will get another extensive thyroid/liver panel next week but don't think it'll yield much to be honest. I somehow think that maybe over the last 3 years , as I had Sex very infrequently , my body got conditioned into not needing much Free testosterone etc....I don't know...I have no good explanation.