48 years old with 'low normal' levels. TRT?

[evolution69]

Hello All,
I am 48 years old and have been having a noticeable loss of motivation, concentration, and mental sharpness over the past year. Libido had been trending down for a few years also, but is still ok.

I wanted avoid SSRIs but was considering something like Wellbutrin, Modafinil or even Adderall. My T levels are within ‘normal’ range so my regular GP would not even discuss the possibility of TRT, but he also wouldn’t do any tests beyond total T. So, I went to an anti-aging doc and got more comprehensive tests. Here are my numbers below from last week, I am in Canada so I guess the more sensitive Estrogen test is not available. My red and white blood counts are all within normal ranges. My lipids are also within normal range.

I have not been back to see the anti-aging doc for my follow up yet, but I am trying to decide whether to go for TRT if it is an option. I know TT in the 420 range is decent and many would not consider trt at this level, but this brain fog and lack of concentration is really getting me down. My work performance has been declining over the past year as well.

Do you think TRT is worth a shot for someone like me? I know some posters with similar numbers have been advised to try other routes like daily Cialis, but libido isn’t my main concern (although an increase would be nice). I am not overweight and I still exercise semi-regularly but it has been hard to keep it consistent the past while.

Reproductive and Gonadal
Testosterone 14.7 8.4-28.8 nmol/L (424 ng/dl)
Testosterone Free Calculated 279 115-577pmol/L
Testosterone Bioavailable Calculated 6.5 2.7-13.5nmol/L
Method of Vermeulen
The Vermeulen calculation for Bioavailable and Free testosterone has been updated effective January 4, 2016. Results are expected to be 25% lower on average. Reference ranges have been updated accordingly.

Sex Hormone Binding Globulin 37.5 10.0-70.0nmol/L
Estradiol 93 <157 pmol/L
DHEA Sulphate 5.9 <9.8 umol/L
Thyroid Function
TSH 1.51 0.32-5.04 mU/L
T4 Free 14.2 10.6-19.7 pmol/L
T3 Free 4.13 3.00-5.90 pmol/L
Pituitary Function
Luteinizing Hormone (LH) 2.5 1.1-8.8 IU/L
Prolactin 6.2 3.8-20.6 ug/L
Insulin-Like Growth Factor-I 156 61-197ug/L
Adrenal Function
AM Cortisol 261 125-536 nmol/L
If dexamethasone has been given <130 nmol/L.
Tumour Markers
Prostate Specific Ag 1.2 <2.5 ug/L

In Feb 2017 I tested with TT 473 ng/dl and in Feb 2016 I tested with TT 571 ng/dl. Not sure why the drop, but I felt a real downtick in get-up-and-go last fall.

 

[Vince]

It would be nice if you didn't have to go on TRT, it's a not cure for everything and remember "it's a life long commitment".

 

[madman]

Hello All,
I am 48 years old and have been having a noticeable loss of motivation, concentration, and mental sharpness over the past year. Libido had been trending down for a few years also, but is still ok.

I wanted avoid SSRIs but was considering something like Wellbutrin, Modafinil or even Adderall. My T levels are within &#8216;normal' range so my regular GP would not even discuss the possibility of TRT, but he also wouldn't do any tests beyond total T. So, I went to an anti-aging doc and got more comprehensive tests. Here are my numbers below from last week, I am in Canada so I guess the more sensitive Estrogen test is not available. My red and white blood counts are all within normal ranges. My lipids are also within normal range.

I have not been back to see the anti-aging doc for my follow up yet, but I am trying to decide whether to go for TRT if it is an option. I know TT in the 420 range is decent and many would not consider trt at this level, but this brain fog and lack of concentration is really getting me down. My work performance has been declining over the past year as well.

Do you think TRT is worth a shot for someone like me? I know some posters with similar numbers have been advised to try other routes like daily Cialis, but libido isn't my main concern (although an increase would be nice). I am not overweight and I still exercise semi-regularly but it has been hard to keep it consistent the past while.

Reproductive and Gonadal
Testosterone 14.7 8.4-28.8 nmol/L (424 ng/dl)
Testosterone Free Calculated 279 115-577pmol/L
Testosterone Bioavailable Calculated 6.5 2.7-13.5nmol/L
Method of Vermeulen
The Vermeulen calculation for Bioavailable and Free testosterone has been updated effective January 4, 2016. Results are expected to be 25% lower on average. Reference ranges have been updated accordingly.

Sex Hormone Binding Globulin 37.5 10.0-70.0nmol/L
Estradiol 93 <157 pmol/L
DHEA Sulphate 5.9 <9.8 umol/L
Thyroid Function
TSH 1.51 0.32-5.04 mU/L
T4 Free 14.2 10.6-19.7 pmol/L
T3 Free 4.13 3.00-5.90 pmol/L
Pituitary Function
Luteinizing Hormone (LH) 2.5 1.1-8.8 IU/L
Prolactin 6.2 3.8-20.6 ug/L
Insulin-Like Growth Factor-I 156 61-197ug/L
Adrenal Function
AM Cortisol 261 125-536 nmol/L
If dexamethasone has been given <130 nmol/L.
Tumour Markers
Prostate Specific Ag 1.2 <2.5 ug/L

In Feb 2017 I tested with TT 473 ng/dl and in Feb 2016 I tested with TT 571 ng/dl. Not sure why the drop, but I felt a real downtick in get-up-and-go last fall.

Welcome I am also from Canada! Judging by your lab range values I am thinking you had your lab work done at Lifelabs as the other main lab is Dynacare which has slightly different reference ranges. Looking over your labs your Total Testosterone is not really bad but you are 14.7ng/dl under the 50% range of 8.4-28.8 nmol/L as 50% would be 18.4 nmol/L so one could start to feel the effects of low t as you are in the low normal range but not borderline low as in 8-12 nmol/L which is basically called the grey zone and most doctors in the know regarding trt would put you on a 6 month trial of testosterone if your numbers fell between 8-12 nmol/L and most importantly you were experiencing low t symptoms. Your Free T of 279 pmol/L is slightly over the 50% range of 115-577 pmol/L as 50% would be 231 pmol/L and your Bioavailable (which is the combination of free t + albumin bound t which is the active t your body can use as oppose to the t bound to shbg) is 6.5 nmol/L is under the 50% range of 2.7-13.5 nmol/L as 50% would be 8.1 nmol/L and your shbg of 37.5 in a good range as it is just under the 50% range of 10-70 nmol/L as 50% would be 40 nmol/L and shbg is something you do not want too high or too low.
Overall your numbers are average but what really stands out to me is your am cortisol of 261 which is under the 50% range of 125-536 nmol/L as 50% would be 330.5 nmol/L and ones cortisol levels should be closer to the high end of the range in the morning/throughout the day and than drop down lower in the evening and night. You may have adrenal issues going on which can mimic a lot of the symptoms of low t especially seeing that your total t has fluctuated from 571 ng/dl (good levels) to 473 ng/dl (average) to 424 ng/dl (creeping towards low/normal). Before you try jumping on trt as your levels/symptoms could merit treatment if you find the right doctor whom specializes in trt I would strongly suggest you get a 4 point saliva cortisol test to see how your levels fluctuate from the am to pm. Also regarding total t labs always make sure you test in the am after a good nights rest and hopefully stress free week as high cortisol is notorious for blunting a males testosterone levels. Many males that live high stress lifestyles/lack proper amounts of sleep can feel as if they are suffering from low t symptoms when in fact it is their extremely high cortisol that is the roots cause of their average testosterone levels. Keep in touch to let us know how thins pan out as we are all here to help! Before I started trt 7 months ago my total t which I had tested twice was 11.3 and 11.7 nmol/L reference range 8.4-28.8 nmol/L so basically in the grey zone and my free t was 225 pmol/L reference range 196-625 pmol/L so borderline low and my Bioavailable T and shbg were similar to yours. My main symptoms were low energy/loss of libido and irritability/depression, poor concentration along with poor recovery from physical work. Overall I just felt terrible and had gut feeling my testosterone levels were poor. I am 42 years old and had a hard time finding a doctor to treat me as my gp said I was still in range (seriously!) so I demanded a referral to a urologist whom was highly respected and specialized in treating low t so it worked out eventually and I feel amazing now but like I stated you need to look into your adrenals before you pursue trt!

 

[evolution69]

Thanks for the replies madman and Vince!

Good point about the cortisol, I assumed that being in the lower end of the range would be the best. I will ask the doc about the more comprehensive cortisol test. I have been experiencing some sleep issues over the past 8 months or so. I get to bed consistently at a good time in a dark quiet room, but I do experience early morning awakening at times which can be a sign of depression. The anti-aging doc ordered a sleep analysis for apnea which I will do next week.

I know it would be better if I could avoid going on TRT, or at least postpone it for another five or ten years. I do find myself thinking of it like a magic pill. I think that getting up into the 800-1000 range would make me a lot more anabolic physically and mentally more motivated. But it doesn't always seem to work out that way from what I have read. Maybe I will try daily Cialis combined with something else like Wellbutrin or Modafinil and see if I get a motivation and test boost. I am interested in trying Modafinil but it seems quite strong and I am prone to headaches which is one of its side effects. I have heard that SSRIs can lower testosterone levels but I haven't heard whether Wellbutrin or Modafinil can lower them.

 

[madman]

Thanks for the replies madman and Vince!

Good point about the cortisol, I assumed that being in the lower end of the range would be the best. I will ask the doc about the more comprehensive cortisol test. I have been experiencing some sleep issues over the past 8 months or so. I get to bed consistently at a good time in a dark quiet room, but I do experience early morning awakening at times which can be a sign of depression. The anti-aging doc ordered a sleep analysis for apnea which I will do next week.

I know it would be better if I could avoid going on TRT, or at least postpone it for another five or ten years. I do find myself thinking of it like a magic pill. I think that getting up into the 800-1000 range would make me a lot more anabolic physically and mentally more motivated. But it doesn't always seem to work out that way from what I have read. Maybe I will try daily Cialis combined with something else like Wellbutrin or Modafinil and see if I get a motivation and test boost. I am interested in trying Modafinil but it seems quite strong and I am prone to headaches which is one of its side effects. I have heard that SSRIs can lower testosterone levels but I haven't heard whether Wellbutrin or Modafinil can lower them.

Just get the testing done regarding your cortisol/apnea and go from there. I am not deterring you from seeking trt but it is something you have to think deeply about as it is a life long commitment as you will be shutting down your natural endogenous production. *****As I said your levels have varied from 571/473/424 so you need to look into your adrenals as poor functioning can effect overall health. Getting the 4 point saliva cortisol where samples are taken morning/noon/evening/before bed will give you a better picture as your levels are low in the am and may possibly be high in the evening/night which will definitely effect testosterone production in a negative way. Once you are sure these areas are improved upon get a couple more labs (hormone panel) to see where your levels are at and if your total t and especially free t has not improved from most recent labs than look into trt. 427 ng/dl is in the low /normal range and your free t being at 279 pmol/L could definitely be improved upon. Many on trt do well in the 600-800 and some need to be higher 800-1000 albeit as long as your other hormones are in a healthy range especially estradiol. *****