25 y/o male low T

[bambam92]

Hi guys been feeling like crap now for sometime. I finally had some lab work done a few months back and my total testosterone came back at 331..with a reference range of 300-1800 ng/dl. My estradiol was 16.8 ...with a reference range of 0-60.7 pg/ml. Probably unrelated but Vitamin D was deficient at 21 for D-25 hydroxy with reference range of 30-100. Took 10,000 IU a day of D3 and now maintenance of 5000...last value was 37. So Trending in right way.

But back to the low test...the Last two years I have had horrible hot flashes...anxiety..low self confidence etc. I used to in high school and first two years of college lift all the time..thousand pound club safely. Now I go in and squatting 225 feels like death...pressing 185 on the bench for 8 reps blows me out. Sore constantly. Never took test in my life...but I want to. Do you think my test levels could be causing these random hot flashes throughout the day I am getting? It is making my life unbearable...randomly start sweating my ass off in a room that isn’t even hot. And I am not really an anxious person...I get anxious due to the hot flashes. So it goes...I feel comfortable ..then all of a sudden notice hot flash..now anxious...now sweating..now anxious people see my sweating. LOL it sounds absurd but it is actually debilitating. Any recommendations for what would be a good cycle for someone new like myself that only wants to get test to adequate level. Again never took test or anything besides protein in my life. Thanks again.

I will attach lab work..thyroid tested and its all good. Ive even had it retested. Thinking that was cause of my issues. My doctor thinks my levels are fine..and not in need of TRT. He thinks its funny..he said something like “if there was no testosterone we wouldn’t need jails.” Lol he is a loon.

 

[MarkM]

Welcome to the forum Bambam!

Let me start off by saying that this forum deals with TRT (Testosterone Replacement Therapy) and not "cycles" as you referred to.

It looks like your blood was drawn after 4PM in the afternoon and anytime you are looking at hormones it is best to drawn them in the morning.

Your Total Testosterone is at the low end of the range at 330. It will naturally decline as the day progresses with its peak being between 6AM and 8am in the morning. However, it is still probably on the low end. The key with testosterone is the Free Testosterone and not the Total anyway. It does not appear that you had the Free Testosterone tested. Although free Testosterone typically only represents 2% to 3% of your Total Testosterone, it is that small fraction that makes all the difference and that small amount is what does all the work.

Your Estradiol is not the proper Estradiol test. The one you took is the one for women and not accurate for men. You need the Estradiol Sensitive LC/MS/MS assay which is more sensitive and will accurately measure the Estradiol in men. That being said, your Estradiol looks very low. Some with low Estradiol and or low testosterone can experience hot flashes.

Your thyroid you think was normal but the proper test were not run. Your Free T4 looks too low and the following tested were omitted by your doctor: Free T3, Reverse T3, and both thryoid antibodies (TPOab and TgAB).

I don't see any test for SHBG (Sex Hormone Binding Globulin).If you were to start a TRT protocol it is absolutely necessary to have that run and know what it is ahead of time. With low Total T and low estradiol I am betting that you also have low SHBG.

Your iron and Vitamin D3 are too low, especially the D3.

I would make sure my thyroid is working properly but your test was not run properly. A poorly functioning thyroid can give you low testosterone symptoms. You need the following test rerun: TSH, Free T3, Free T4, Reverse T3, ant the two thryoid antibodies (TPOab and TgAB). You should also test iron again and test ferritin too.

If this blood test is inclusive of all the test run by your doctor then it is a very incomplete test.

You might be a candidate for TRT but at such a young age I would do more testing before jumping on a treatment that will be a life long commitment.

 

[bambam92]

Welcome to the forum Bambam!

Let me start off by saying that this forum deals with TRT (Testosterone Replacement Therapy) and not "cycles" as you referred to.

It looks like your blood was drawn after 4PM in the afternoon and anytime you are looking at hormones it is best to drawn them in the morning.

Your Total Testosterone is at the low end of the range at 330. It will naturally decline as the day progresses with its peak being between 6AM and 8am in the morning. However, it is still probably on the low end. The key with testosterone is the Free Testosterone and not the Total anyway. It does not appear that you had the Free Testosterone tested. Although free Testosterone typically only represents 2% to 3% of your Total Testosterone, it is that small fraction that makes all the difference and that small amount is what does all the work.

Your Estradiol is not the proper Estradiol test. The one you took is the one for women and not accurate for men. You need the Estradiol Sensitive LC/MS/MS assay which is more sensitive and will accurately measure the Estradiol in men. That being said, your Estradiol looks very low. Some with low Estradiol and or low testosterone can experience hot flashes.

Your thyroid you think was normal but the proper test were not run. Your Free T4 looks too low and the following tested were omitted by your doctor: Free T3, Reverse T3, and both thryoid antibodies (TPOab and TgAB).

I don't see any test for SHBG (Sex Hormone Binding Globulin).If you were to start a TRT protocol it is absolutely necessary to have that run and know what it is ahead of time. With low Total T and low estradiol I am betting that you also have low SHBG.

Your iron and Vitamin D3 are too low, especially the D3.

I would make sure my thyroid is working properly but your test was not run properly. A poorly functioning thyroid can give you low testosterone symptoms. You need the following test rerun: TSH, Free T3, Free T4, Reverse T3, ant the two thryoid antibodies (TPOab and TgAB). You should also test iron again and test ferritin too.

If this blood test is inclusive of all the test run by your doctor then it is a very incomplete test.

You might be a candidate for TRT but at such a young age I would do more testing before jumping on a treatment that will be a life long commitment.

Mark, thank you for the detailed reply. I Will prefer to it’s rightful name as TRT here on out. I will look to have full men’s health lab test done that I believe includes all you mention. Also I wanted to get thyroid antibodies done as you mention... Incase I have something autoimmune going on like say Graves or Hashimoto. Asking my doctor to do this stuff he laughs and thinks I am all paranoid. I only go to a PCP.. haven’t gotten referral to an Endo. I live in Florida and there is Any lab test now everywhere.. but they don’t take insurance so it’s huge $$. I have insurance so would rather not pay out of pocket.

How could I raise estradiol... or is it something like if test increases so would estradiol? Excuse my ignorance on these topics.

I raised my D3 to 37 on a recent test due to 10000 IU vitamin D a day. Will continue to supplement. I heads 50 and above is best.. but no higher than 100 since vitamin d is. Fat soluble and you can take too much. I also confirmed my PTH and calcium levels are normal.. thus ruling out hyperparathyroid or Hypo parathyroid.

How should I go about getting all these tests done? Just flat out ask my doctor? He thinks I am all paranoid .. and it’s a nuisance for me to get these things done thru him.

Thanks again

 

[Systemlord]

Low estrogen causes hot flashes and your estrogen is already recorded as low, it's probably dipping lower at certain times throughout the day. Estrogen is low because testosterone is low, forget about these ridiculous ranges.

Your symptoms are how these things are diagnosed, doctors have forgotten and hyperfocus on these ranges who have undiagnosed sick people within them. It will be extremely difficult to locate a knowledgeable doctor within insurance networks.

My insurance pays for TRT, however it's useless because none of the doctors know what they're doing, most here have gone private. PCP's have no training in male hormones and have no business diagnosing you.

Your options are (1) get insurance to pay for TRT and have a doctor that doesn't know how to manage any symptoms you may experience, (2) go private and pay out of pocket to access a knowledgeable doctor.

 

[Deleted member 16042]

Re: Doctors, it can be the biggest challenge men face to find a doctor that actually knows what they are doing with regard to TRT. The generic endocrinology standards are dated and their implementation often do more harm than good for men who need well managed care. The majority of Endos do not know what is necessary for responsible TRT management.

It seems pretty obvious that your GP is not the one to try to manage this with you. Your best bet is to post asking for doctor recommendations in your area, or go with one of the forum's sponsors, Defy Medical or Dr Crisler. MANY men here are receiving good care from these providers, especially Defy since they are available in all states (as far as I know) via phone consultation.

 

[MarkM]

Mark, thank you for the detailed reply. I Will prefer to it’s rightful name as TRT here on out. I will look to have full men’s health lab test done that I believe includes all you mention. Also I wanted to get thyroid antibodies done as you mention... Incase I have something autoimmune going on like say Graves or Hashimoto. Asking my doctor to do this stuff he laughs and thinks I am all paranoid. I only go to a PCP.. haven’t gotten referral to an Endo. I live in Florida and there is Any lab test now everywhere.. but they don’t take insurance so it’s huge $$. I have insurance so would rather not pay out of pocket.

How could I raise estradiol... or is it something like if test increases so would estradiol? Excuse my ignorance on these topics.

I raised my D3 to 37 on a recent test due to 10000 IU vitamin D a day. Will continue to supplement. I heads 50 and above is best.. but no higher than 100 since vitamin d is. Fat soluble and you can take too much. I also confirmed my PTH and calcium levels are normal.. thus ruling out hyperparathyroid or Hypo parathyroid.

How should I go about getting all these tests done? Just flat out ask my doctor? He thinks I am all paranoid .. and it’s a nuisance for me to get these things done thru him.

Thanks again

As far as raising your estradiol, always remember that E (Estradiol) follows T (Testosterone). So by raising T you will naturally increase E.

 

[madman]

Hi guys been feeling like crap now for sometime. I finally had some lab work done a few months back and my total testosterone came back at 331..with a reference range of 300-1800 ng/dl. My estradiol was 16.8 ...with a reference range of 0-60.7 pg/ml. Probably unrelated but Vitamin D was deficient at 21 for D-25 hydroxy with reference range of 30-100. Took 10,000 IU a day of D3 and now maintenance of 5000...last value was 37. So Trending in right way.

But back to the low test...the Last two years I have had horrible hot flashes...anxiety..low self confidence etc. I used to in high school and first two years of college lift all the time..thousand pound club safely. Now I go in and squatting 225 feels like death...pressing 185 on the bench for 8 reps blows me out. Sore constantly. Never took test in my life...but I want to. Do you think my test levels could be causing these random hot flashes throughout the day I am getting? It is making my life unbearable...randomly start sweating my ass off in a room that isn’t even hot. And I am not really an anxious person...I get anxious due to the hot flashes. So it goes...I feel comfortable ..then all of a sudden notice hot flash..now anxious...now sweating..now anxious people see my sweating. LOL it sounds absurd but it is actually debilitating. Any recommendations for what would be a good cycle for someone new like myself that only wants to get test to adequate level. Again never took test or anything besides protein in my life. Thanks again.

I will attach lab work..thyroid tested and its all good. Ive even had it retested. Thinking that was cause of my issues. My doctor thinks my levels are fine..and not in need of TRT. He thinks its funny..he said something like “if there was no testosterone we wouldn’t need jails.” Lol he is a loon.

First and foremost your labs were done at the wrong time as due to the natural 24 hr circadian rhythm of endogenous testosterone it will peak in the early am (3-10am) and than eventually decline in the late afternoon/early evening.

Testosterone levels can be 25-30% lower in the late afternoon/early evening.

Blood work needs to be done fasted and in the early am (7-10 am).

Three critical blood markers you are missing is your FT, SHBG and estradiol sensitive (LC/MS-MS).

Unfortunately most doctors only test TT when in fact FT is what truly matters as it is the unbound active fraction of testosterone responsible for the positive benefits.

When it comes to trt of course treating symptoms is what truly matters but blood work is critical and needed to determine where ones levels fall within the physiological range regarding overall health markers.

Arguments can be made back and forth regarding ranges for TT/FT levels but when it comes to trt the main purpose is to relieve/improve the patients symptoms of low t and enhance ones overall well being along with minimizing the side effects hence why blood work is needed to understand how said dose of testosterone affects ones overall blood markers!

 

[bambam92]

Ok so went on any lab test now which is near me... they offer the following choices for lab tests related to test and men’s health

https://www.anylabtestnow.com/tests/pre-testosterone-therapy-panel/

That is $300 versus I can get just a total and free test done for $79. I have insurance but they don’t take it. They’re convenient cause I can walk in whenever and get blood work done and results will be emailed to me in 3 days or less. But wow his is expensive for someone on a grad school budget.. but I want to get my health taken care of.

The more expensive full panel does metabolic panel.. I’ve had 2 of them done his past year. It’s unnecessary. Maybe I can piece meal together a custom order? Could you guys list what I should go in and get tested that would be critical in regards to if I have an issue with test? Also I will be sure to go first thing in morning this time. Would this package be adequate for my needs? It’s $199 as opposed to $300.

https://www.anylabtestnow.com/tests/continued-low-t-therapy-panel/

Thanks again guys.

 

[fifty]

Check discount labs or lifeextension for blood tests. They may be cheaper. You can just go to any labcorp and will get your results emailed just as you’re accustomed to.

 

[Jesse-Defy]

You're welcome to order labs through us if you'd like, I'll list our initial panel below:

1. Comprehensive Metabolic Panel- $15
2. CBC- $15
3. Lipid Panel- $15
4. Testosterone Free and Total- $35
5. Estradiol Sensitive- $38
6. DHEA-S- $38
7. TSH-$21
8. PSA-$21
9. LH-$12
10. Sex Hormone Binding Globulin-$44
11. IGF-1-$30

There's no requirement to become a patient, but I can go over that process if you wish. Please email me at [email protected] if you'd like more information.

 

[bambam92]

Update: so I have consulted a physician that specializes in HRT. He ordered labs for total T, free T, estradiol male sensitive, FSH and LH. Will have results tomorrow and will post here.

In the meantime he gave me 12000 IU of HCG and has me taking 300 units daily. I just shoot subcutaneous into my stomach with insulin needle.

He said if my LH and FSH comes back in range that I have primary hypogonad. And I will need to start testosterone. He sold me on the HCG ($$$200 damn) cause even if I end up being primary I want to run HCG to keep my balls from shutting down... HCG acts as analog to LH I learned. So will keep the Leydig cells kicking... also not into idea of scrotum tightening up and balls atrophying.

Here is the interesting part... I asked what his treatment will be dosage wise if my LH and FSH comes back in range and I do indeed have primary and he said:

I will start you on Test Cyprionate 200 mg per week divided into 2 injections. He said I can drop the HCG to 2-3 x a week @ 300 units if this is the route we go as opposed to now I am doing 300 units HCG daily.

He said he thinks I will feel best at a test range of 1000-1200 and that is range he will want me at. He already told me to go donate blood as depending on the labs that come tomorrow I will be starting next week. Guy is very transparent and says too many doctors are scared and looking at numbers only. Says he treats the symptoms. And he has guys my age (25) coming in with test in the 500’s-600’s and he still will give them TRT if they’re indeed primary. He says some people feel fine with total test at 500.. he says others feel like shit. He told me he personally doesn’t let his own levels dip below 1000 or he feels terrible. He is on TRT and open about it.

Wow, what a refreshing breeze to find an MD who is open to TRT like this guy.. and seems to know his shit*. This guy is fucking jacked and 47... so assuming his T levels are at least 1000. Lol. I’m located in south Florida btw so shit is different here.

So will get the bloods tomorrow and will post. But wow if my LH and FSH come back in range and T is still lowish he is starting me up on the following:

- Testosterone cypionate 200mg per week. Dosing is 2 shots per week...100mg per shot.
- HCG 300 units 3x a week
- he will give me thirty 1 mg anastrazole to have on deck Incase my E goes high. But says not to take until 6 week blood work to see where I’m at.

I’m a med student but must admit I was totally ignorant to TRT and still kind of am...but it sounds like this guy is leaving door open to me jumping on TRT under his care. He emphasizes he treats symptoms.. not #’s. Says he will keep eye on my hematocrits.. LDL.. and E levels .. and that I should plan to donate whole blood every 8 weeks if I end up on T with him.

Wow, so how does this docs plan sound? Seems solid from the little I’ve learned in a short while.

 

[bambam92]

Edit: this guy specializes in HRT and doesn’t accept insurance. He is like concierge essentially. Got him off recommendation of a friend

 

[MarkM]

Hi BamBam,

I don't see any test for SHBG (Sex Hormone Binding Globulin).If you were to start TRT it is absolutely necessary to have that run and know what it is ahead of time. It is the key piece that will determine what type of protocol will likely be best for you.

It's good you found a doctor that is open and will treat symptoms and not numbers. That is a big win. But dosing twice per week may or may not be best for you depending on what your SHBG is. Also, 200 mg a week is a whopper of a dose, especially if you have low SHBG. You'll end up with extremely high Free T which is not exactly what oyu want becasue with high Free T will come high Free E.

When you get your lab results you can post them for further discussion. Until then we are only speculating. I hope you did your labs in the morning. That's when blood work needs to be done for hormones.

Thanks for the update.

 

[fifty]

If your LH is low i would try clomid before trt.
The only red flag for me is he’s offering you trt at age 25 and at triple price for hcg.

 

[bambam92]

Hi BamBam,

I don't see any test for SHBG (Sex Hormone Binding Globulin).If you were to start TRT it is absolutely necessary to have that run and know what it is ahead of time. It is the key piece that will determine what type of protocol will likely be best for you.

It's good you found a doctor that is open and will treat symptoms and not numbers. That is a big win. But dosing twice per week may or may not be best for you depending on what your SHBG is. Also, 200 mg a week is a whopper of a dose, especially if you have low SHBG. You'll end up with extremely high Free T which is not exactly what oyu want becasue with high Free T will come high Free E.

When you get your lab results you can post them for further discussion. Until then we are only speculating. I hope you did your labs in the morning. That's when blood work needs to be done for hormones.

Thanks for the update.

I honestly don’t think he mentioned the SHBG. Is this a big deal? I heard you can’t change SHBG.. and some say why worry about something you can’t change? I am totally green to all this so I am asking you genuinely.

And he says he would like to see me in 1000-1200 range for total T for feeling optimal. Again I’m 25. You think 200mg a week of test cypionate would put someone coming from a baseline of 300-400 past 1200 total? Anyways I got the bloods done Friday morning at 9 am this time. Labs are probably in.. his office is closed Thursday though. So will get them tomorrow And these draws were before I started the HCG... so FSH and LH shouldn’t be altered. Started HCG this Monday so day 4 now. Will post all my results tomorrow. I appreciate your help Mark.

 

[Ronnny]

Edit: this guy specializes in HRT and doesn’t accept insurance. He is like concierge essentially. Got him off recommendation of a friend

Hi, babbam92 may I know how much was the initial consulting fee for your HRT doc?

 

[MarkM]

Yes, SHBG is a huge deal when it comes to TRT. Your're right, you can't really change it but you base your entire protocol off of it. Do I believe 200 mg a week for someone 25 could put them well over 1200? Absolutely. If you have low SHBG and inject 100 mg twice a week you'll end up passing most of it's metabolites out in your urine and your Free E will be sky high.

You really should have your SHBG tested if you want to have success. Just trying to point you in the right direction here BamBam.

 

[bambam92]

Hi, babbam92 may I know how much was the initial consulting fee for your HRT doc?

$350 upfront... 250 3 months later but this is for 6 months of being his patient. So $600 total to be seen by him for 6 months. Really not bad. Considering he can script me test and arimidex which will cost me $40 a month with insurance at CVS. Stuff is dirt cheap if you get it scripted.. and LEGAL. He does your labs... looks over your numbers. And if you have concerns he will see you in person. I could well end up only seeing him in person 3 times for the 6 months... so he gets $200 cash a visit in theory. But hey seemed worth it to me. Only thing expensive was the HCG... $200 for 12000 IU. Good god. I got burned on that I now realize. But insurance won’t cover HCG. Test and arimidex insurance covers... and if you don’t have insurance check out the GoodRX app ... literally $10 for 200mg test cypionate with no insurance at all major pharmacies. Just show up to pharmacy and show them the app. So can run 800mg test a month with no insurance for $40 lol.

 

[fifty]

goodrx.com? $33 walmart 200mg/ml 10ml test cyp. nice.

 

[madman]

I honestly don’t think he mentioned the SHBG. Is this a big deal? I heard you can’t change SHBG.. and some say why worry about something you can’t change? I am totally green to all this so I am asking you genuinely.

And he says he would like to see me in 1000-1200 range for total T for feeling optimal. Again I’m 25. You think 200mg a week of test cypionate would put someone coming from a baseline of 300-400 past 1200 total? Anyways I got the bloods done Friday morning at 9 am this time. Labs are probably in.. his office is closed Thursday though. So will get them tomorrow And these draws were before I started the HCG... so FSH and LH shouldn’t be altered. Started HCG this Monday so day 4 now. Will post all my results tomorrow. I appreciate your help Mark.

Again..... your doctor can rant and rave all he wants about getting you to a TT of 1100-1200 ng/dL but without knowing your SHBG what ones TT needs to be is pointless.

SHBG is critical and will dictate ones injection frequency and have a huge impact on the effectiveness of ones trt protocol.

Seeing as we have no idea where your SHBG sits if it turns out to be low/lowish.....than 200mg/week (100mg every 3.5 days) may very well be too high a dose as it will make your FT skyrocket let alone e2/free estradiol and that dose will have a big impact on elevating your hemoglobin/hematocrit.....sure one can easily donate blood to help control levels but it could turn out to be a balancing act as many end up crashing their ferritin/iron due to donating too frequently to try and control their hemo/hemato!

If it turns out you have high SHBG than 200mg/week may be needed in orde to obtain healthy FT numbers as men with high SHBG sometimes have to run TT levels well into the supra-physiological range to obtain a healthy FT.

As has been stated many times TT is good to know but it is not the end all be all as FT is what truly matters since it is the unbound active fraction of testosterone responsible for the positive effects.

If your doctor was on the ball he would be basing your protocol dose/injection frequency on your SHBG and seeing as it was not even tested you are just flying blind.

I understand you are still young and eager to start trt but is is not as simple as hitting 1000+ TT as there is so much more involved.

Of course treating symptoms is what truly matters as oppose to what ones numbers are but do understand that blood work is critical and used as guidance to see how said dose effects ones TT, FT, e2 and other hormonal makers let alone overall health markers in order to minimize side effects and keep the patient healthy long term.