Being advised TRT - low libido and ED

[Ryan9292]

I’ve just had my blood work back today after having tests for low T symptoms.

I’ve had a real loss of libido lately and was hopeful my varicocele embolisation would have helped a little. But I’m still suffering low T symptoms ; my libido is almost non existent and I struggle with my erections. My blood results that showed concern are below and I’ve been recommended to lose a bit of weight and also start Testavan.

SHBG - 9nmol/l
Total Testosterone - 9.2nmol/l
Glucose Fasting Plasma - 8nmol/l
Haemoglobin DCCT -6.5%
Haemoglobin IFCC - 48nmol/mol

Overall I’m just feeling really sluggish and pretty rubbish to be fair. Would starting TRT help me given my SHBG is in the pits?

 

[Systemlord]

My blood results that showed concern are below and I’ve been recommended to lose a bit of weight and also start Testavan.

You’ll blood tests are very limited. Low thyroid hormones can cause low SHBG.

What about thyroid panel checking TSH, fT3 and fT4?

Would starting TRT help me given my SHBG is in the pits?

You’ll get no definitive answers here. There’s no way anyone could know if TRT will help without knowing how your unique biology response to androgens.

You submit yourself for treatment, cross your fingers, hope for the best, and plan for the worst.

 

[Ryan9292]

My total TT3 is 2.5nmol/l
Free Thyroxine 16.9pmol/l

TSH 1.32mIU/l

So they all appear to be good

 

[Systemlord]

Your original medical problem, the one that is lowering your testosterone, that’s going to determine your response to TRT.

You’re trying to circumvent a disease process, by using TRT, sometimes it works, and sometimes it works for a little while and symptoms return and sometimes it doesn’t work at all.

I was able to come off TRT due to treating my original medical problem that led to lower testosterone.

 

[Cataceous]

It does seem likely that you have underlying metabolic dysfunction. Throwing TRT at this may or may not be useful. So far it is not clearly established that you are hypogonadal. You need to determine free testosterone before reaching a conclusion on that front. The Vermeulen calculation puts your free testosterone on the borderline. But with your low SHBG you should measure free testosterone directly with equilibrium dialysis to confirm where you stand.

I would be aggressive in dealing with the weight and possible metabolic issues. This would include improving diet and exercise if they are lacking. "Low plasma levels of sex hormone-binding globulin (SHBG) are a marker for obesity, insulin resistance, non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes."[R] It seems as though you are pre-diabetic and overweight. Hopefully the other comorbidities are not yet applicable.

If you are hypogonadal then TRT could be considered. TRT may make it easier to improve body composition, but the effect on other parameters is less clear, e.g. [R].