Blood Test Results - What to Make of Um

[Drug350]

I'm 54 yrs young, in good shape, 6'0" / 195 pounds, eat healthy. I've felt run down for several years now, lack of drive, energy, ED issue's, poor sleep (waking up many times all night long) and poor focus, but I'm an engineer for BNSF Railway (USA) and am on call 24/7/365 days a year with 2 hour call. I work an average of 250 hours each month, with no set sleep or work schedule, so I figured it was my job causing most of my issue's. My primary care physician ran blood work as part of my annual physical. Here's my numbers and the normal range alongside:

Total Testosterone = 169 NGDL (200 - 800 NGDL = norm range)
Free Testosterone = 3.1 NGDL (3.1 - 12.8 NGDL = norm range)
Bioavailable Testosterone = 72.6 NGDL (71.7 - 300.0 = norm range)
SHBG = 34 NMOL (13 - 74 NMOL = norm range)
TSH Sensitive w/Reflex = 2.64 uiU ( .030 - 4.50 uiU = norm range)
Prolactin = 14.6 ng/ml (3.5 - 19.4 ng/ml = norm range)
LH = 3 mlU/ml (1.0 - 12 mlU/ml = norm range)
FSH = 4 mlU/ml (1.0 - 12 mlU/ml = norm range)
Estradiol = 21 pg/ml (11 - 44 pg/ml = norm range)
PSA = .05 ng/ml (0.0 - 4.0 ng/ml = norm range)
HCT (hematocrit) = 44% (38.8 - 50.0 % = norm range)


She said my testosterone levels were low and referred me to a Urologist and Sexual Health Doctor within the hospital system. The Urologist ran my bloods 3 more times, first thing in the morning, and each time they came back nearly identical to the first set of numbers above. There were additional blood tests for cholesterol, AIC, etc... I can post too if needed. Based on my numbers above, she recommended starting me on 100 MG's Testosterone Cypionate once a week with bloods drawn again in 8 - 10 weeks. Because all the blood tests came back with a total testosterone below normal range of 200 NGDL, insurance will cover my TRT for life. This is not a "TRT Clinic" or "Wellness Center" so the goal is to get me in the middle of the US Government recommended levels of 400 - 700 NGDL. She stated this several times so she won't allow me to go higher, like 700 + NGDL. I'm not very familiar with all of the above numbers, but most seem in range, except for total testosterone. Does anything stand out besides the low totals ??? With these numbers and the way I've been feeling, would you recommend going on TRT as she's suggested, and does 100 MG's weekly sound right ??? I probably would choose twice weekly injections vs once a week or EOW. Any opinions or advice would be greatly appreciated. Thank you in advance to anyone who takes their time to answer my questions. I greatly appreciate your advice and opinions.

 

[Vince]

I'm 54 yrs young, in good shape, 6'0" / 195 pounds, eat healthy. I've felt run down for several years now, lack of drive, energy, ED issue's, poor sleep (waking up many times all night long) and poor focus, but I'm an engineer for BNSF Railway (USA) and am on call 24/7/365 days a year with 2 hour call. I work an average of 250 hours each month, with no set sleep or work schedule, so I figured it was my job causing most of my issue's. My primary care physician ran blood work as part of my annual physical. Here's my numbers and the normal range alongside:

Total Testosterone = 169 NGDL (200 - 800 NGDL = norm range)
Free Testosterone = 3.1 NGDL (3.1 - 12.8 NGDL = norm range)
Bioavailable Testosterone = 72.6 NGDL (71.7 - 300.0 = norm range)
SHBG = 34 NMOL (13 - 74 NMOL = norm range)
TSH Sensitive w/Reflex = 2.64 uiU ( .030 - 4.50 uiU = norm range)
Prolactin = 14.6 ng/ml (3.5 - 19.4 ng/ml = norm range)
LH = 3 mlU/ml (1.0 - 12 mlU/ml = norm range)
FSH = 4 mlU/ml (1.0 - 12 mlU/ml = norm range)
Estradiol = 21 pg/ml (11 - 44 pg/ml = norm range)
PSA = .05 ng/ml (0.0 - 4.0 ng/ml = norm range)
HCT (hematocrit) = 44% (38.8 - 50.0 % = norm range)


She said my testosterone levels were low and referred me to a Urologist and Sexual Health Doctor within the hospital system. The Urologist ran my bloods 3 more times, first thing in the morning, and each time they came back nearly identical to the first set of numbers above. There were additional blood tests for cholesterol, AIC, etc... I can post too if needed. Based on my numbers above, she recommended starting me on 100 MG's Testosterone Cypionate once a week with bloods drawn again in 8 - 10 weeks. Because all the blood tests came back with a total testosterone below normal range of 200 NGDL, insurance will cover my TRT for life. This is not a "TRT Clinic" or "Wellness Center" so the goal is to get me in the middle of the US Government recommended levels of 400 - 700 NGDL. She stated this several times so she won't allow me to go higher, like 700 + NGDL. I'm not very familiar with all of the above numbers, but most seem in range, except for total testosterone. Does anything stand out besides the low totals ??? With these numbers and the way I've been feeling, would you recommend going on TRT as she's suggested, and does 100 MG's weekly sound right ??? I probably would choose twice weekly injections vs once a week or EOW. Any opinions or advice would be greatly appreciated. Thank you in advance to anyone who takes their time to answer my questions. I greatly appreciate your advice and opinions.

It's pretty hard to tell what levels will be right for you. Most guys do best with their young levels, levels when they were in their early 20s. When most guys never were tested. The only way you know is by trial and error. For me my total testosterone level around 1000 plus, then all my levels are in a good place and I feel my best, other guys need it lower. That's why you just can't set a level and expected to be good.

 

[Systemlord]

so the goal is to get me in the middle of the US Government recommended levels of 400 - 700 NGDL. She stated this several times so she won't allow me to go higher, like 700 + NGDL.

The goal should be symptom resolution whether that’s 500 or 900 ng/dL, because of individual Gene CAG repeat lengths/sensitivity at the testosterone receptors. My endocrinologist has no problem with me running 1052 ng/dL because my Free T levels are still within normal ranges when calculating the Free T using Total T and SHBG per the Tru-T calculator method.

I’m also above normal ranges for hemoglobin and my endocrinologist and hematologist are perfectly okay with it as long as there’s no negative symptoms because my doctors understand I’m not a number, I’m an individual and not a clone created from everyone else.

The standardized normal ranges according to Labcorp are 264-915 ng/dL, not 200-700 ng/dL. So if you’re naturally on the higher end, or slightly higher as some are, basically your doctor is saying too bad soo sad, can’t do it.

The link to a thread below will give you an idea of how everyone’s needs are different when talking about what’s normal for an individual.

At what Free T level do you feel optimal?

 

[sammmy]

They should check your Thyroid hormones before starting TRT.

100mg T per week is the conventional dose, but better split it into twice weekly to reduce the large ups and downs of the circulating testosterone.

 

[Systemlord]

With these numbers and the way I've been feeling, would you recommend going on TRT as she's suggested, and does 100 MG's weekly sound right ???

This is a good starting point, maybe you need more, maybe you need less. Splitting this up 2x weekly will keep your trough (lowest point) levels higher and therefore more consistent hormones throughout the week, which is not always the best thing for everyone.

It would be best if you used 27-29 gauge insulin syringes for two reasons, less tissue damage over time and no wasted medicine like with the non dead-space designed of your average syringe. Ten injections using a non dead-space design wastes 1 mL or one weeks worth of medicine after 10 injections.

Most 10 mL vials are overfilled by 1 mL.

ED is a predictor of future heart, cardiovascular problems and increased mortality. Low-T is like a death sentence if symptoms are present. TRT is recommended.

 

[t_spacemonkey]

good advice here. 100mg is lowish IMHO. I'd start at 120-150mg 2-3x a week.

 

[madman]

The goal should be symptom resolution whether that’s 500 or 900 ng/dL, because of individual Gene CAG repeat lengths/sensitivity at the testosterone receptors. My endocrinologist has no problem with me running 1052 ng/dL because my Free T levels are still within normal ranges when calculating the Free T using Total T and SHBG per the Tru-T calculator method.

I’m also above normal ranges for hemoglobin and my endocrinologist and hematologist are perfectly okay with it as long as there’s no negative symptoms because my doctors understand I’m not a number, I’m an individual and not a clone created from everyone else.

The standardized normal ranges according to Labcorp are 264-915 ng/dL, not 200-700 ng/dL. So if you’re naturally on the higher end, or slightly higher as some are, basically your doctor is saying too bad soo sad, can’t do it.

The link to a thread below will give you an idea of how everyone’s needs are different when talking about what’s normal for an individual.

At what Free T level do you feel optimal?

If you are going to keep mentioning this make sure you give someone the full scoop when it comes to CAG repeat length let alone the sensitivity of the AR.

Could you be one that falls on that higher-end sure but it would seem to be far from common.

A critical point that needs to be kept in mind!

*In humans, the number of AR CAG repeats ranges from as few as 9 to as many as 36, but population averages are typically between 17 and 24

*Based on a total sample of 57,826 males occupying 78 countries, the overall average number of AR CAG repeats was found to be 21.40

Variations in CAG Repeats of Men’s Androgen Receptor Gene

As the mediator of androgen actions, the androgen receptor (AR) plays a central role in establishing both physical and behavioral sex differences. The AR gene contains a CAG repeat polymorphism that is related to the strength of androgen actions on target tissues and that is correlated with...

www.excelmale.com

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]

*In humans, the AR gene comes in many forms, called alleles. The best-studied alleles are those involving a CAG repeat sequence that encodes a polyglutamine tract near the amino end of the androgen receptor. This CAG repeat has different lengths for different people. In humans, the number of AR CAG repeats ranges from as few as 9 to as many as 36, but population averages are typically between 17 and 24 (Chamberlain et al., 1994; Hsiao et al., 1999; Irvine et al., 2000; La Spada et al., 1991). Individuals with higher numbers of AR CAG repeats will normally have diminished testosterone action on cellular functioning, effectively making males with high AR CAG repeats less masculine regarding most sexually dimorphic traits when compared to males with fewer AR CAG repeats (Loehlin et al., 2004; Simanainen et al., 2011)

* Based on a total sample of 57,826 males occupying 78 countries, the overall average number of AR CAG repeats was found to be 21.40. National averages ranged from 17.00 to 23.16. Five countries had averages in the 17.00s; they were Swaziland (17.00), Zambia (17.00), Sierra Leone (17.30), Nigeria (17.58), and Senegal (17.90). Five countries had averages of 23.00 or higher; they were Lithuania (23.00), Mongolia (23.00), Ireland (23.07), Thailand (23.10), and Romania (23.16)

Testosterone and equivocal testosterone levels

Testosterone Therapy With a Man With Equivocal Testosterone Levels (2022) Giovanni Corona, MD, Ph.D., and Mario Maggi, MD Clarifying what is normal testosterone (T) levels is not an easy task. Normal levels should always be determined using a laboratory-specific reference range. Data derived...

www.excelmale.com

Pharmacogenetics of testosterone replacement therapy

Michael Zitzmann (2009) Variable phenotypes of androgen insensitivity exist in humans, mainly owing to defective, mutated androgen receptors. A More subtle modulation of androgen effects is related to the CAG repeat polymorphism ([CAG]n) in exon 1 of the androgen receptor gene, in vitro...

www.excelmale.com

Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring

ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

www.excelmale.com

Men's Response to Testosterone Depends on their CAG Repeats in Their AR Gene.

Androgen Sensitivity: Beyond the Well-Known © Irina A. Khripun*, Sergey V. Vorobyev Rostov State Medical University, Rostov-on-Don, Russia The gonadal and extragonadal effects of testosterone in men have been actively studied in recent years. To date there is no doubt an increased risk of...

www.excelmale.com

Influence of CAG Repeat Polymorphism on the Targets of Testosterone Action

It should be finally acknowledged that the AR CAG repeat polymorphism plays a role in testosterone replacement therapy of males with hypogonadotropic gonadism since shorter AR gene CAG tract lengths was found to yield greater metabolic improvement in response to testosterone administration...

www.excelmale.com

Low SHBG guys

do you take any supps/meds? try to minimize it to trt only if possible and it might start working. Just a few basics. Fish oil, multi-vitamin, magnesium to help me sleep. With my SHBG level, TRT is just not going to work. It is the hand that I have been dealt.

www.excelmale.com

 

[Cataceous]

... 100mg is lowish IMHO. I'd start at 120-150mg 2-3x a week.

However, it's not opinion that 100 mg of testosterone cypionate per week provides an average of 10 mg testosterone per day, which is more than the large majority of men ever make naturally. The weak justification for this as a starting dose is that it helps serum testosterone remain physiological at the end of a weekly injection cycle. The problem is that levels are then excessive early in the cycle. As suggested above, it's better to split the dose into at least two weekly injections to avoid drastic variance in serum testosterone. If you prefer the convenience of weekly injections and insurance is paying then do some research on Xyosted. It has slower absorption, meaning weekly injections don't result in excessive swings in serum testosterone. Some guys do like the auto-injectors better than regular syringes. With this product it's unequivocal that the starting dose is 75 mg per week. Based on blood work you either stay where you are, go up to 100 mg or down to 50 mg. No other doses. The 75 mg dose is closest to average natural testosterone production for healthy young men.

Be aware that there are a couple of other options that might be deemed TRT-lite. Regular TRT, as with injections, typically results in suppression of natural testosterone production. You might not think this is very consequential if your natural production is already low. However, this suppression affects many other hormones, and can cause side effects, both obvious and subtle. The most common issues are testicular atrophy and infertility. You can generally avoid these issues by using short-acting testosterone products, such as nasal gel or troches. The Natesto product in particular has a lot of supporting research showing that it provides the benefits of higher testosterone without significant suppression of HPTA function and fertility. Not everyone can handle these delivery methods long-term, but they still represent a good way to investigate the benefits of higher testosterone without risking major hormonal disruption.

 

[Systemlord]

100mg is lowish IMHO.

I had a 442 ng/dL trough on day #6 on a 75 mg weekly protocol, even with low SHBG. A 50 mg twice weekly protocol and trough levels were 697 ng/dL.

Definitely not low by any stretch of the imagination.

 

[Drug350]

They should check your Thyroid hormones before starting TRT.

100mg T per week is the conventional dose, but better split it into twice weekly to reduce the large ups and downs of the circulating testosterone.

What's the thyroid test called or letters ??? I posted my "TSH (sensitive with refex)" numbers above. I though this was the Thyroid test. My numbers came back showing "TSH = 2.64 uiU/ml (normal = .30 - 4.50 uiU/ml).

 

[Systemlord]

What's the thyroid test called or letters ???

Free T3 and Free T4, the former being the most potent thyroid hormone.

 

[Drug350]

The "normal numbers" I posted above with regard to "Total Testosterone 200 - 745 NGDL" are what my Urologist and the hospital system uses, along with most insurance companies. We all know 200 NGDL is on the very low side and TRT clinics would easily put you on TRT with numbers in the low 200's. Virtually every other government board considers 350 - 900 NGDL more in line with normal, but insurance is all about "maximizing profits". My doctor had me do 3 testosterone blood tests, before 9 AM, in order to have insurance cover TRT. She said if any one of them came back above 200 NGDL, insurance would deny covering TRT and she'd have to fight with them. My 3 tests came back at 169, 182, 196 NGDL, along with my free Testosterone and Bioavailable Testosterone numbers right at the bottom threshold so insurance is covering my TRT, blood tests, and hopefully ancillaries (aromasin, letrozole, HCG, etc...).

 

[Drug350]

Free T3 and Free T4, the former being the most potent thyroid hormone.

So the test is "Free T3 and Free T4" ??? What does the TSH (sensitive with refex) test tell me than ??? I thought "TSH" was a thyroid blood test. I'll definitely look into the "Free T3 & Free T4".

 

[Systemlord]

What does the TSH (sensitive with refex) test tell me than ???

TSH is a stimulating hormone, it’s the signal to the thyroid and it is not a thyroid hormone. T4 is inactive ->Free T4-> Free T3 is where the rubber meets the road!

 

[Systemlord]

She said if any one of them came back above 200 NGDL, insurance would deny covering TRT and she'd have to fight with them.

The guidelines say <300, but some experts recommend TRT above 350 if signs and symptoms are present. One example is an elevations in SHBG which raises the Total T independent of Free T.

Studies show lower libido and vigor occures <500, but again very little info with regards to Free T.

 

[Drug350]

TSH is a stimulating hormone, it’s the signal to the thyroid and it is not a thyroid hormone. T4 is inactive ->Free T4-> Free T3 is where the rubber meets the road!

OK. I'm going to go get these thyroid blood tests done and see where my numbers are. I thought if you had a problem with your Thyroid, you tend to get either fat if your levels are low because of a slower metabolism, and likewise, if you have too much, you tend to be thin and have a very difficult time, if not impossible, gaining weight or putting on muscle because your metabolism is spinning way too fast. Do I have that right ??? Thanks.

 

[Systemlord]

I thought if you had a problem with your Thyroid, you tend to get either fat if your levels are low because of a slower metabolism

Your lipids would be terrible along with increased weight, feeling cold and cognitive problems.

A TSH of 2.64, I doubt there is even a problem.

 

[Drug350]

The guidelines say <300, but some experts recommend TRT above 350 if signs and symptoms are present. One example is an elevations in SHBG which raises the Total T independent of Free T.

Studies show lower libido and vigor occures <500, but again very little info with regards to Free T.

I believe the insurance company, and my doctor, or hospital system, uses the American Association of Clinical Endocrinologists recommendations, which have 200 NGDL as their threshold. This is the lowest of virtually all medical association's and government recommendations which I'm certain is why the insurance companies cherry pick this one particular guideline and use it to deny coverage. Here's several guidelines:


Total Testosterone Cutoff (ng/dL)

American Association of Clinical Endocrinologists8 200

Endocrine Society9 264

American Urological Association6 300

British Society of Sexual Medicine10 345

European Association of Urology11 345

International Society of Sexual Medicine12 350

International Society for Study of Aging Male13 350

 

[Systemlord]

There shouldn’t be one number for everyone! I have heard of men with Free T midrange and symptomatic, go on TRT and get their Free T over 20 and symptoms disappear.

 

[t_spacemonkey]

I had a 442 ng/dL trough on day #6 on a 75 mg weekly protocol, even with low SHBG. A 50 mg twice weekly protocol and trough levels were 697 ng/dL.

Definitely not low by any stretch of the imagination.

my levels, at 180mg total per week (mon-wed-fr) are: total 754ng/dl free: 22.6ng/dl
reading wed before injection
this is quite a difference, with my SHBG ultra low (11). most people tell me i should be higher.