Husband on TRT but LOW free T? Need help

My husband is 69 and has been on TRT (100 mg a week, i inject him twice weekly) since Mid Oct.

His starting numbers BEFORE TRT were:
Total: 304
Free: 23.3

Test in late December (Endo refused to take a Free T)
Total T: 789

That was in a "trough" so to speak. He shoots SUN and WED night and that test was taken the morning before his WED shot. Endo refuses to check Estradiol

Have very low funds but sprung for tests ourselves and this is the test results from last week:

Total: 560
Free: 3.1 (huh??? )
Estradiol sensitive: 24.7

Forgot to add that these are two different labs with different reference ranges. Maybe i shouldn't worry so much about the Free T...

Those tests were taken THURS. We delayed WED's shot because we couldn't get to the lab until Thurs and so we gave him a shot that night.

His Free T is lower than ever??? I don't know what to do about all of this since i am basically trying to be his doctor, the only thing Endo is good for is Rx'ing the shots and maybe ordering Total T which Medicare pays for. I'm not kidding when i say we have very little funds to keep doing testing ourselves.

He does take Optizinc at least 60 mg. Magnesium, D-3 (5,000 IU), DHEA, liver support since he does have non alcoholic liver cirrhosis, DIM, etc.

Endo did not test SGBH. I can try to talk him into it but he's disinterested.

We are still working on his thyroid, he's taking NDT and may have to lower it a bit as his Free T3 came back a bit high and yes we had to pay for that one, also.

ANY advice and input would be greatly appreciated.

Susie

Would be an indicator that his SHBG is very high but w/o labs will not know. And 100mg total per week is a pretty minimal dose, usually a starting point, most guys need to get in to 120-140mg total. Are you using discountedlabs.com....you might find better prices there.

Your husband very likely has high SHBG base off his FT numbers, low SHBG guys tend to have very high FT levels. High SHBG shrinks a guys FT because SHBG isn't releasing enough T, therefore he needs a higher dose to get over the top of that high SHBG. I think you know it's time for another doctor, this one seems unwilling to learn. SHBG increases with age so I wouldn't be surprised if it was high.

The problem most of us face with regards to TRT is doctors learn next nothing about TRT in medical school, most are clueless about what labs to run and when a patient comes into their office requesting labs they know nothing about it, it afends them because they spent years in medical school and you are more informed.

Most go through several doctors before they find one that is knowledgeable enough, if you ever get tired of these clueless doctors Defy Medical are very skilled at managing a guys hormones, except they take no insurance. Most good doctors are going private and the void is filled with clueless robotic doctors who are inadequate and know very little about managing a guys hormones.

I've gone through two clueless doctors and having to manage myself since my doctors are no help, I can't afford to pay out of pocket. I've been messing around for 8 months asking for doctors to increase my dosage and allow me to inject more frequently and so far they have been willing. They don't care as long as I'm within the ranges and not over the limit.

The only way to get accurate FT levels is get Total test, SHBG and albuminto calculate his FT level, direct measure FT are not accurate. Then use an SHBG calculator linked below.

https://naturalbiohealth.com/2015/05/06/shbg-critical-to-your-health/

https://www.artofmanliness.com/2013/01/16/normal-testosterone-levels/

http://www.issam.ch/freetesto.htm

Thank you guys for the responses.

Systemlord, we're with you...no finances and it's frustrating because we have medical insurance and pretty much cannot use it because of the doctors attitude. My husband depends on me researching all of this and pushing those doctors which i have repeatedly to the point of possibly alienating them.

Right now, it's me doing all the work, the Endo does RX the shots so obviously that is good.

This was through discountedlabs and their reference range for the FREE T was 6.6-18.1 and husbands was 3.1

i had asked the Endo about SHBG and he said: [FONT=&quot]I didn't order a SHBG. We don't use the level to assess response to Testosterone replacement or to adjust dose. It will not help up clinically.

okey dokey well there you go. i think to order it from discountedlabs would be over $100.00
So to start, i should ask the Endo if he will up the dosage? Seems fair and for now the right thing to do? if he DOES NOT, then i guess we'll have to figure out how to do this w/o this guys help...

AFA FEELING good, well...he could feel a lot better. Libido is okay..not what it should be but it increased slightly after initiating TRT, energy is meh but i think overall there is SOME improvement, just not what we were hoping but then again he has other health issues to be sure. At least the Estradiol is in an ok range, i had worried about that.

Susie[/FONT]

ReillyJ said:

Thank you guys for the responses.

Systemlord, we're with you...no finances and it's frustrating because we have medical insurance and pretty much cannot use it because of the doctors attitude. My husband depends on me researching all of this and pushing those doctors which i have repeatedly to the point of possibly alienating them.

Right now, it's me doing all the work, the Endo does RX the shots so obviously that is good.

This was through discountedlabs and their reference range for the FREE T was 6.6-18.1 and husbands was 3.1

i had asked the Endo about SHBG and he said: I didn't order a SHBG. We don't use the level to assess response to Testosterone replacement or to adjust dose. It will not help up clinically.

okey dokey well there you go. i think to order it from discountedlabs would be over $100.00
So to start, i should ask the Endo if he will up the dosage? Seems fair and for now the right thing to do? if he DOES NOT, then i guess we'll have to figure out how to do this w/o this guys help...

AFA FEELING good, well...he could feel a lot better. Libido is okay..not what it should be but it increased slightly after initiating TRT, energy is meh but i think overall there is SOME improvement, just not what we were hoping but then again he has other health issues to be sure. At least the Estradiol is in an ok range, i had worried about that.

Susie

Click to expand...

Increasing the dose could also increase E2 and he won't make him feel good and I'm betting your doctor refuses to prescribe an AI which inhibits the conversion of T -->E2 at the higher numbers which your husband needs. Part of being able to manage hormones is understanding how SHBG effects the main sex hormones, SHBG = Sex Hormone Binding Globulin. It regulates a guys testosterone, mainly free testosterone and estrogen. Your husbands doctor is truly an idiot, he really has no idea what he's talking about, he sounds like it's his first day on the job.

https://youtu.be/1Us_AibW0_Y

Look for another doc! I had in the past an urologist that refused all tests request from me only TT was tested. I finally found a GP that was very interested in my concern and I got all the tests I wanted. My luck was that she just had starting to treat her own dad. My luck! She is fantastic beside not being specialized in this area. I even gave her a copy of the basics of test treatment written by Dr Crisler.