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

Ok guys, new labs in...did liver testing along with another free testosterone testing:


Albumin 59.8 ( 55.8-66.1)
Alpha-1-globuline 3.5 (2.9-4.9)
Alpha-2-globuline 7.9 (7.1-11.8)
Beta-1-globuline 5.9 (4.7-7.2)
Beta-2-globuline 6.5 (3.2-6.5)
Gamma-globuline 16.1 (11.1-18.8)
Bilirubine 1.3 (<1.1) HIGH
GOT 17 (<50)
GPT 10 (<50)
GGT 13 (<60)
Ap 50 (40-130)
3 hormones were taken:
prolactine 9.3 (2.1- 17.7)
E2 estradiol 44 (<40) HIGH
Free testosterone 15.51 (3.84 -34.17)
So in a turn of events…my free testosterone showed up much higher this time around. Last time it was an abysmal 2.11. Unfortunately total testosterone wasn’t taken this time around but during the last 10 blood tests over the past 3 years my morning total testosterone was never below 550.
What to make of this? I agreed with my doctor to retake free testosterone in a couple days or weeks. I was actually getting ready to get on TRT but am becoming a little hesitant now. 15.51 is not really great but it is close to the middle of the reference range. Couple that with my total testosterone of around 600 mostly and I have trouble envisioning much benefit from testosterone therapy. What do you guys think? I still kinda want to get on TRT simply to see a bump in libido but not sure what the right thing to do is...

One thing to add: I started rogaine foam about 4-5 years ago. From 2015-2018 I have taken about 10 blood tests. The previous 8 tests (one p.m. testing aside) always showed above range prolactin in the morning...usually somewhere between 20-25. I have stopped Rogaine since the first week of december and taken 2 blood tests (both morning measurements). Once my prolactin was 5.1 and this time it was 9.3 .....now I really cannot picture rogaine foam elevating my prolactin levels , but the recent labs suggest I should keep an eye on this nonetheless.

BTW....this is getting more and omre frustrating to be honest. I was really getting pumped and excited for getting on TRT and start feeling better. I don't really know what to do anymore....the last 3 years have been extremely lonely and frustrating...I'm trying to keep my head up.

BTW guys ....I took .5 of Arimidex the day AFTER the last blood test (I was anticipating a low free testosterone count anyways and wanted to see if lower estradiol is gonna do anything for my libido etc. before jumping on TRT). How long should I wait so that the Arimidex does not influence my next blood test? It has a half life of 46 hours...so would 1 week be sufficient? Just to be clear....I took the .5 AFTER the last drawing so I was on no meds during my last blood draw. I also find it really annoying that levels fluctuate so much...I mean from 2.11 to 15.51 is almost an 8fold increase without me doing anything...

I would call Defy and get started with them. One of if not the best in USA in treating men/Women with hormone deficiencies. You do NOT want to go solo. It is way too complicated.

I live in europe....

UnsureNewbie said:

I live in europe....

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Sorry I missed that in your post. Where exactly in Europe? Some of our members are from Europe as well and they may be able to to guide you.

That was basically my situation when I started TRT almost 3 years ago.

Although Total T was in the 500-600 range, my Free T was really, really low (can't rememeber right now, but it was low even for a 60+ y/o man and I was only 40 at the time).
SHBG in the mid range.
E2 at the high end.

My symptoms before starting TRT. Very low energy, always tired, not able to gain any muscle mass, no sex drive, ED, mild cognitive issues.
Never been overweight. Always been lean and pretty active physically.

Based on these initial results I didn't have any problems finding first an urologist and then an endo to start TRT here in Spain.

Tried different protocols and dosages during the first year. Now I'm pretty happy with a 125mg shot once a week (tried twice and three times a week as well). I'd suggest to start with 100mg and re-assess from there.

TRT definitely improved my quality of life. Energy is great, libido definitely went up, still some ED that I take care of with pde5 inhibitor meds.

Will be taking bloods again on monday and keep you guys posted.

Would TRT make sense if TT and Free T both come back around midrange? Like TT 550 and FT 16 (3-34) ???

I am definitely not against TRT, but would TRT be beneficial for someone with midrange TT and FT?

Hey guys, it's me again. Latest bloods revealed these results:

Testosterone 5.43 (1.65- 7.53)
Prolactin 8.5 (2.1 - 17.7)
Free testosterone 12.18 (3.84- 34.17)

last bloods had my free testosterone at 16 (3.84-34.17) , total testosterone 550.

So essentially, my total testosterone levels always seem to be between 550-600. I have taken 3 free testosterone tests over the last 4 months. One came back low , the other two came back at slight below the midrange. Could low T still explain my problems or should I be looking elsewhere?

BTW guys, for 1 year my prolactin was slightly but constantly elevated (I think it was elevated in 9/10 blood tests. It was usually somewhere around 20-25. The last 3 tests (since ditching Minoxidil foam) all came back well below the higher end of the range at 5,8 and 10. I cannot really imagine Minoxidil foam increasing prolactin by itself but I will probably start applying it and retaking bloods in 2-3 weeks to see if it can indeed influence prolactin levels.

BTW , overall I'm kinda bummed. I was actually thinking low T is definitely a the origin of my symptoms and was looking forward to TRT. Not sure what to do now.

I think your numbers look fine you don't need TRT but you should look into why your E2 and prolactin are so high.
I would look into what are you eating and sides of any drugs your taking. IMO your E2 is way to high can could be why you are having sex problems
but it also could be something else not hormone related. I'd keep looking.

FeelingLost said:

I think your numbers look fine you don't need TRT but you should look into why your E2 and prolactin are so high.
I would look into what are you eating and sides of any drugs your taking. IMO your E2 is way to high can could be why you are having sex problems
but it also could be something else not hormone related. I'd keep looking.

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You certainly aren't ready for TRT. I'd give both nuts to have those numbers naturally Your latest prolactin numbers look good. I don't see e2, am I missing it? My guess is that you have elevated SHBG, which would be the reason for lowish FT.

I may give TRT a try anyways. I really have no true idea what else to do at this point. I have informed myself and the way I understand it is that there really isn't much to lose with a 3 month trial of Testosterone 100-150mg per week along with 2x 500iu HCG......

BTW I did try AI already (arimidex) but it made no difference unfortunately.

UnsureNewbie said:

I may give TRT a try anyways. I really have no true idea what else to do at this point. I have informed myself and the way I understand it is that there really isn't much to lose with a 3 month trial of Testosterone 100-150mg per week along with 2x 500iu HCG......

BTW I did try AI already (arimidex) but it made no difference unfortunately.

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Don't experiment with TRT, it's too hard to restart your HPTA and I doubt that you will feel any better.

Vince said:

Don't experiment with TRT, it's too hard to restart your HPTA and I doubt that you will feel any better.

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I will agree with Vince some guys shut down their natural production (HPTA) and can't get it restarted.
So for the rest of your life you will have to stick yourself a couple times a week whether you want to or not.

If you are still taking an AI I would not take more than .25/week and if you notice any of the low E2 symptoms stop taking it right away. You think you feel bad now crash your E2 and you will discover a brand new hell.

Are you guys sure about the HPTA? From what I have gathered over the internet, the risk is pretty minimal, especially if you are over 30. I gathered a lot of information and also watched some youtube channel, one by a doctor in LA who stated that the risk is pretty low.

I mean I really really have no clue what to do at this point. I feel like I have looked at every possible lifestyle variable...I haven't left any stone unturned....I don't feel like I have really anything to lose at this point.

The odd thing is I really don't get turned on anymore---watching porn really does not excite me much...being around attractive women also does not really turn me on much at all anymore. I remember a time, just a couple years ago when I would have a rock hard erection just by sitting next to an attractive woman. How can all that be lost so quickly ? The whole sequence has really driven me almost insane at this point. Just 2-3 years ago I had a girlfriend and just hugging her would produce an immediate erection....sometimes just standing next to her was enough to get me started.
How can a guy that almost never smokes or drinks , eats healthy, works out and overall look 5-8 years younger than he is , have seemingly lost all his libido?

BTW , for the rare occassion where I am horny (which happens once in a blue moon), I do have solid erections....but I rarely have that feeling

Vince said:

Don't experiment with TRT, it's too hard to restart your HPTA and I doubt that you will feel any better.

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The duration of trt therapy and age of patient play a role in the recovery.

Younger men have an easier time recovering than older men.

The use of hcg/serms post trt can increase time of recovery 6-12 months as oppose to just stopping trt unaided which can lengthen recovery time up to 2 years.

Older men on long term trt have a lower chance of recovery.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5292276/

Hey guys, it's me again. Well what can I say? Over the past months I have tried several supplements like Tongkat Ali and Arginine in high dosages in order to improve my problems. I'm even trying daily 5mg cialis for 2 months now. While all these things have improved symptoms somewhat, things are still not really satisfiable. I'm now on the verge of giving TRT a shot, there really isn't anything left to do IMO. I feel like I haven't left any stone unturned. I have done as much research as possible and to me it seems that giving this a try is the most rational and sensible thing at this point. There are two options:
1)My symptoms are not hormone related so that the therapy fails: Well then after a trial of say, 3months, I do a PCT and go off everything. From everything that I read and heard---things should go back to normal fairly quickly.
2) I see significant improvement, suggesting that my symptoms were indeed hormone related despite the ok levels. Well then I would have found the culprit and could try to optimize therapy and go along.

At this point I really fail to see any real downside from giving TRT a 3 months try.

I would like to ask you the following: What would be a sensible starting protocol in my case? I'm thinking 60mg Test along with 250IU HCG twice weekly injected. Do you guys think that's a sensible starting point or should I go higher right away?

p.s: One person told me that I don't even need to wait 3 months for trying to sort out the "culpri"--he said if you inject twice weekly (for overall 100-150mg) along with HCG for 1 month you should notice an improvement in libido and overall energy. Take labs after 2 weeks and if testosterone and especially free testosterone is toward the higher end of the range--you should definitely notice improvement. If you don't notice improvement, then the likelyhood of it being hormonal becomes slim. He essentially told me that for most men (not all) some immediate benefits become noticable within days. He said it is rather uncommon for men to need to be on testosterone for several months to notice improvements.

My recommendation is before you would start testosterone, get a complete thyroid panel with TSH, free T4, free T3, reverse T3 and antibodies.

Vince said:

My recommendation is before you would start testosterone, get a complete thyroid panel with TSH, free T4, free T3, reverse T3 and antibodies.

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Agree with what Vince said. Your thyroid is not optimal based on your 12/2017 results of T4 at .085 (.062-1.28) It needs to be higher and you have not posted any further thyroid labs as was recommended back in December. Without a healthy thyroid levels, testosterone therapy will NOT work - many of us know that now.

Here is an excellent explanation by a top thyroid MD of how close the symptoms are of low thyroid and low testosterone are. An easy read.

https://www.restartmed.com/thyroid-symptoms-men/

Thanks for the reply guys, very much appreciated.I contacted my doctor and persuaded him to take thyroid labs. I will get results likely tomorrow and will post.
He did tell me on the phone however that he looked at previous labs and there "wasn't the slightest indication of anything being wrong with my thyroid as all antibody tests were negative and TSH and FT3 and 4 in perfect range." So I don't expect a whole lot there to be honest.

BTW one extremely interesting thing that I found while going through past blood work was this: I think it was in 2009 (I was 25 back then) I took a testosterone test at my urologist and it came back at 384 ng/dl.Another one I took at the age of 22/23 came back at 450. Pretty low for a then 20-25 year old , no? I also took a look at a previous sperm test back at the age of 21 when I considered Varicocele surgery. It came back within normal range but all parameters were toward the extrem lower bottom of the range (like just very very slightly above the lower bottom of the range). After the varicocele surgery things seemed to have improved somewhat. Taking these findings into account I do somehow believe that my problems are androgen based.
My theory is like this: Today we know that Varicoceles can harm not only the affected testicle, but rather both testicles. I still believe that the presence of a grade 2-3 Varicocele on my left testicle from the age of 13 to around 22 , impeded somewhat the maturization of my "system", thus I suffer from these types of problems maybe 10 years earlier than I would have otherwise suffered from. 2 years ago , at the start of my problems I visited a famous urologist who took bloods (testosterone came back at 350 back then but was taken at 12 a.m) and examined my testicles. He said that there was some degree of atrophy to the left testicle. I don't know whether I had posted this before (was kinda uncomfortable to do so). He told me to take testosterone gel right away as my problems are likely androgen dependent. I somehow didn't want to take testosterone back then as I thought I'd find a different avenue of dealing with my problems. However, 2 years later I'm still dealing with this.

I've gone through a very difficult 3 year period guys. Professionally I have however turned things around a great deal. I'm in a very good spot today and things will get better. However the aforementioned problems still bother me a whole lot. I have met a wonderful young woman who I like a lot. She feels the same way about me but has started to wonder if I'm not attracted to her as I hadn't shown any signs of wanting to sleep with her (we know each other for 3 months now). Truth is, there is currently nothing that I would want to do more than sleep with her but on the couple occasions where we were kissing and stuff ,erections were just so-so. Not completely absent, but also not really strong and firm like they ought to be. I know that I was extremely turned on by her beauty but it just did not translate into the type of erections I would get 3-4 years ago (sorry if this was too much detail).
I have tried many supplements etc. etc. but nothing has really put me over the hump (keep in mind I'm taking 5mg cialis anyways). Despite the cialis I do not experience strong nocturnal or morning erections, if at all.

I have done loads and loads of research on the internet (spent countless hours on the web). I have watched numerous videos with doctors online (Dr. Rand for example and many more), read numerous articles about hormone replacement etc. ---from the stuff I have gathered , it seems highly unlikely that I would do great harm by giving TRT a shot. Dr.Rand for example mentions in one of his videos that if you are above the age of 26 (meaning complete maturization of the HPTA axis) and have symptoms of low T despite have normal ranges of T then you should just give it a shot. He goes on to mention in one of his videos that chances of not being able to rebound after going of off TRT (if done correctly) are really slim. I know that some on this board think differently, but am I completely wrong in saying "Trying out 100-150mg testosterone per week along with 500IU HCG per week (split into two doses of 60mg/250IU) for 1 month and seeing what type of results I get from this cannot really harm me that bad?" I mean if the TRT works then I have found the problem and if not , what are the odds that, after a 1month trial with such a low dose along with the addition of HCG I will have wrecked my hormonal axis to the point of no return?

I feel like I have exhausted everything else at this point.