Advice Needed for 4.18 Defy Consult

[src5tt]

Hi all -

I’ve got my consultation with Defy setup with Dr. Saya on April 18 and wanted to make sure I was as prepared as I can be and had a few questions for the vets out there.

About Me:
39 year old males, 20% bf, following a ketogenic diet 3 yrs, lift weights 3-4 days week, 5’9 175 lbs. 3 small children at home (5, 2 , coming soon)

Began looking into hormone optimization after hearing a lot about it online (JRE, exceale, podcasts). Have read all the TOT books on the market and listened to most podcasts, and have of course leveraged the great stuff here!

Symptoms: feeling a little less pep, a little less eagerness, a little less interest in sex (no performance issues just don’t crave it like I did in my 20s).

My labs are below but here are the highlights:

Total T 643.4
Free T 11.6 (1.8%)
Bioavailabile T 295 (45.9%)
SHBG 42.5
Estradiol sensitive 23.9
Free T3 2.6
Free T4 1.29
TSH .981
DHEA 112
IGF1 152
Prolactin 6.9

My questions.

1. It looks like SHBG is my main issue and that I could increase my free T if I brought that down. I’d like to talk to Dr Saya about how to do this (have read about things like DHEA which looks like it could go up, boron, and a few others). With my total t levels where they are it might make sense to do this approach first before starting TRT. Thoughts here? What would you do?

2. On the sex front given there are no-performance issues wondering if getting free t up as outlined below will help.

3. It looks like there may be some ability to optimize my thyroid. What do you think? This should help with tiredness and other symptoms right?

4. Anything you’d avoid or say no to at this point? I feel like I’ve got an ok baseline to monitor from so my gut is try a few things first and monitor bloodwork so if I need TRT a year from now I’ll have a baseline.

Thanks so much in advance. You guys rock!

Scott

 

[Vince Carter]

You can't manipulate SHBG directly one way or another, you play it where it lies. Usually TRT will bring it down but that's probably not a significant number either. Would be typical with 1 or 2 shots per week, the one large shot is where you can have some hope of getting SHBG to come down. A high(er) shbg like you will probably have to run a high TT like 1200+ in order overcome the SHBG and get Free T to come up.

 

[Systemlord]

While you may not have full blown symptoms of low testosterone, you don't sound optimal either. Rarely do men at your age have optimal hormone levels, however I'm quite surprised your symptoms aren't worse because most men would be worse off than you at those Free T levels.

I'm on TRT and would have symptoms with Total T of 400 and Free T at 16. TRT will lower SHBG while increasing Free T, killing two birds with one stone.

While TSH looks great, Free T3 is a little below midrange.

The first set of symptoms for me was exactly the same as you, then energy and then my libido and sexual desire was the last thing to go.

 

[Cataceous]

Personally, with numbers like those I wouldn't start TRT. It greatly complicates your life, and while some symptoms are resolved, new ones may be created. It's nice to see that calculated free T was probably used here. At least the numbers match. You can verify if the units are ng/dL. We see very few guys with low T symptoms until free T falls below 10 ng/dL or so. The median for showing symptoms is probably well below that, more like 6-7 ng/dL if I had to guess. I started TRT with the same SHBG as yours, but half the total testosterone.

I would try the supplements, make sure sleep is good, maybe check vitamin D status. But I'd be in no hurry to add exogenous testosterone to the mix.

 

[src5tt]

Got it. My bias is to exhaust other options before TRT as I can always go that route. What do you all think about the thyroid? Plus I se eating low carb/Keto can increase SHBG so I wonder if adding in some more carb cycling could help?

 

[Systemlord]

Got it. My bias is to exhaust other options before TRT as I can always go that route. What do you all think about the thyroid? Plus I se eating low carb/Keto can increase SHBG so I wonder if adding in some more carb cycling could help?

My advice, get better sleep, eat better, exercise while not overdoing it and keep stress low. If that doesn't work to resolve your symptoms, then consider TRT.

Note, as we age SHBG will increase lowering Free T, at some point in the future you will need TRT.