Blood work from PCP

[atl2005]

Hey everyone I'm new here and wanted to share my blood work to get some opinions.

I'm almost 40 and have been experiencing symptoms of low T for several years so I had bloodwork last week at my primary doctor. I feel very fatigued and have almost zero drive. I've worked out for almost 20 years about 5'10 190lbs and don't drink any alcohol. I eat a clean diet probably an 80/20 diet , mostly consisting of lean protein, carbs, some nuts/fruits/yogurt. I don't count macros but I get about 200 grams of protein per day on average.

Total test 622 ng/dl (range 264-916)
SHBG 66 nmol/L (range 16-56)
Free test 1.3% (range 1.6-2.9%)
Free test calculated 81 pg/ml (range 47-244)
Bioavailable test 207 ng/dl (range 131-682)
Estradiol 31 pg/ml (11-43)
LH 5.5 mIU/ml (range 1.7-8.6)
FSH 4.33 mIU/ml (range 1.5-12.4)

All other bloodwork was good including thyroid and vitamin D

My doctor says my total test is way too high to get on TRT but I feel with my symptoms and low free T I need to try out a low dose. Opinions on this ?

 

[Systemlord]

Total test 622 ng/dl (range 264-916)
SHBG 66 nmol/L (range 16-56)
Free test 1.3% (range 1.6-2.9%)
Free test calculated 81 pg/ml (range 47-244)
Bioavailable test 207 ng/dl (range 131-682)

Numbers don't tell the whole story, sensitivity at the androgen receptors, men have different type of androgen receptors, and receptor density as well as the abilities for tissues to respond are all factors in what hormone level is normal for an individual.

You can't have one number for everyone! Most doctors are obsessed with lab ranges to determine normal status and don't see the bigger picture.

As far as starting out on a low dose of Test, unlikely to show good results as you're likely going to need a higher dosage in order to suppress the high SHBG.

My doctor says my total test is way too high to get on TRT

Your doctor is out to lunch, as the majority are untrained in sex hormones! Total T doesn't define testosterone deficiency. The Free T is what drives all the positive effects of testosterone. Total T is a function of SHBG, the higher the SHBG, the higher the Total T, independent of the Free T.

The only difference between your Total T, Free T and SHBG numbers and a guy with a Total T at 400, SHBG at 25 and the same Free T, is the SHBG values.

Decreasing SHBG will not yield higher Free T levels as many falsely believe. The calculated and bioavailable T lab testing aren't perfect.

Your calculated Free T is 8.38 ng/dL, nothing to brag about. It's not uncommon to see men complaining of low-T symptoms at <10 ng/dL.

 

[madman]

Hey everyone I'm new here and wanted to share my blood work to get some opinions.

I'm almost 40 and have been experiencing symptoms of low T for several years so I had bloodwork last week at my primary doctor. I feel very fatigued and have almost zero drive. I've worked out for almost 20 years about 5'10 190lbs and don't drink any alcohol. I eat a clean diet probably an 80/20 diet , mostly consisting of lean protein, carbs, some nuts/fruits/yogurt. I don't count macros but I get about 200 grams of protein per day on average.

Total test 622 ng/dl (range 264-916)
SHBG 66 nmol/L (range 16-56)
Free test 1.3% (range 1.6-2.9%)
Free test calculated 81 pg/ml (range 47-244)
Bioavailable test 207 ng/dl (range 131-682)
Estradiol 31 pg/ml (11-43)
LH 5.5 mIU/ml (range 1.7-8.6)
FSH 4.33 mIU/ml (range 1.5-12.4)

All other bloodwork was good including thyroid and vitamin D

My doctor says my total test is way too high to get on TRT but I feel with my symptoms and low free T I need to try out a low dose. Opinions on this ?

Unfortunately your doctor is caught up on that TT only matters syndrome!

Although TT is important to know FT is what truly matters as its the active unbound fraction of T is responsible for the positive effects.

* the symptoms follow free testosterone they do not follow total testosterone


With a robust TT 622 ng/dL and high SHBG your cFT would be sub-par

SHBG inflating your TT.

Even than would not fret over driving down SHBG let alone anyone making claims that you need to start on a higher dose of T!

It is far from a given that you will need a high dose to achieve a healthy FT even with having high SHBG.

Increasing your TT will increase your FT.

You would need to have your FT tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration especially in cases of altered SHBG to know where it truly sits.

Also keep in mind as of now cFTV tends to overestimate when compared to a standardized gold standard ED assay.

If you had your FT tested using Quests ED assay (most accurate) it may very well come back the same or slightly lower.

If you decide to hop on TTh start low and go slow.

Patience is key!

Have realistic expectations.

Do not get caught up on that more T is better mentality!

Common starting dose regardless of where your SHBG sits (low/normal/high) is 100 mg T/week or better yet 50 mg T split twice-weekly (every 3.5 days).

Most men can easily achieve a healthy let alone high or in some cases absurdly high trough FT on 100-150 mg T/week especially when split into more frequent injections as in twice weekly (every 3.5 days), M/W/F, EOD let alone daily.

Most would never need the higher-end dose of 200 mg T/week to achieve a healthy let alone high FT and yes even men with highish/high SHBG.


Pay close attention (36:29-41:47)

The Most Effective TRT Protocols for High-Performing Men

41:48-52:44 (DHT and estradiol) The medical landscape of testosterone replacement therapy is shrouded in mixed opinions and, much more seriously, in misconceptions… That’s why I sought out the man who is widely known and internationally respected as the “Father of Testosterone Therapy,”...

www.excelmale.com

 

[atl2005]

Numbers don't tell the whole story, sensitivity at the androgen receptors, men have different type of androgen receptors, and receptor density as well as the abilities for tissues to respond are all factors in what hormone level is normal for an individual.

You can't have one number for everyone! Most doctors are obsessed with lab ranges to determine normal status and don't see the bigger picture.

As far as starting out on a low dose of Test, unlikely to show good results as you're likely going to need a higher dosage in order to suppress the high SHBG.

Your doctor is out to lunch, as the majority are untrained in sex hormones! Total T doesn't define testosterone deficiency. The Free T is what drives all the positive effects of testosterone. Total T is a function of SHBG, the higher the SHBG, the higher the Total T, independent of the Free T.

The only difference between your Total T, Free T and SHBG numbers and a guy with a Total T at 400, SHBG at 25 and the same Free T, is the SHBG values.

Decreasing SHBG will not yield higher Free T levels as many falsely believe. The calculated and bioavailable T lab testing aren't perfect.

Your calculated Free T is 8.38 ng/dL, nothing to brag about. It's not uncommon to see men complaining of low-T symptoms at <10 ng/dL.

Thanks so much for this information. I guess I never realized that SHBG being elevated would elevate my total testosterone. A high enough dose to suppress my SHBG will in turn suppress my total T, at least the part made up by the SHBG, but should eventually be enough to get my free test level up above 10?

 

[atl2005]

Unfortunately your doctor is caught up on that TT only matters syndrome!

Although TT is important to know FT is what truly matters as its the active unbound fraction of T is responsible for the positive effects.

* the symptoms follow free testosterone they do not follow total testosterone


With a robust TT 622 ng/dL and high SHBG your cFT would be sub-par

SHBG inflating your TT.

Even than would not fret over driving down SHBG let alone anyone making claims that you need to start on a higher dose of T!

It is far from a given that you will need a high dose to achieve a healthy FT even with having high SHBG.

Increasing your TT will increase your FT.

You would need to have your FT tested using an accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration especially in cases of altered SHBG to know where it truly sits.

Also keep in mind as of now cFTV tends to overestimate when compared to a standardized gold standard ED assay.

If you had your FT tested using Quests ED assay (most accurate) it may very well come back the same or slightly lower.

If you decide to hop on TTh start low and go slow.

Patience is key!

Have realistic expectations.

Do not get caught up on that more T is better mentality!

Common starting dose regardless of where your SHBG sits (low/normal/high) is 100 mg T/week or better yet 50 mg T split twice-weekly (every 3.5 days).

Most men can easily achieve a healthy let alone high or in some cases absurdly high trough FT on 100-150 mg T/week especially when split into more frequent injections as in twice weekly (every 3.5 days), M/W/F, EOD let alone daily.

Most would never need the higher-end dose of 200 mg T/week to achieve a healthy let alone high FT and yes even men with highish/high SHBG.


Pay close attention (36:29-41:47)

The Most Effective TRT Protocols for High-Performing Men

41:48-52:44 (DHT and estradiol) The medical landscape of testosterone replacement therapy is shrouded in mixed opinions and, much more seriously, in misconceptions… That’s why I sought out the man who is widely known and internationally respected as the “Father of Testosterone Therapy,”...

www.excelmale.com

Thanks for this information. I was planning on trying 100mg a week of cypionate and getting my blood tested again in 3 months. I know how I feel and I know I need something to kickstart my energy and libido again, but I also feel my numbers show a deficiency especially in free testosterone.

I don't know why my SHBG is so inflated but now understanding that it causes an artificially inflated total T it makes more sense that I feel drained with a 622 level.

I need to read more on what most people feel is an optimal free test level but I would assume somewhere close to double mine ?

 

[Systemlord]

I need to read more on what most people feel is an optimal free test level but I would assume somewhere close to double mine ?

At what Free T level do you feel optimal?

As the thread title says, I want to compile a consensus and see at what Free T levels our members feel optimal. Please specify if levels are at trough, midpoint or peak. Also detail protocol and time of lab testing in relation to your injections. These poll questions are for Free T only either...

www.excelmale.com

 

[atl2005]

Will adding TRT automatically increase my total T level or is there a chance my total T stays similar if my SHBG is lowered ? The PCP is saying my total T will increase and I'll have to watch my hemoglobin and estrogen levels very close which I assumed would be the case with adding TRT.

 

[Systemlord]

The PCP is saying my total T will increase and I'll have to watch my hemoglobin and estrogen levels very close which I assumed would be the case with adding TRT.

Total T doesn't increase hemoglobin, the Free T is the driving factor for all benefits or side effects on TRT.

Will adding TRT automatically increase my total T level

Total T will increase, but some doctors even ignore the Total T and focus solely on the Free T, since it's the active portion of testosterone.

It sounds like your PCP doesn't know what he's talking about. I'll bet this PCP will freak out if your hemoglobin is a little bit elevated, which isn't really as cause for concern.

The estrogen doesn't need to be in range, it's far more common for it to be well above the ranges on TRT. Also the estrogen normal ranges were derived from men with a Total T <500, most men are running well above this level and therefore estrogen typically runs higher.

https://journals.sagepub.com/doi/10.1177/1557988314539000

Our study did not link high estradiol levels with diminished sexual performance. Paradoxically, patients with low estradiol below 42.6 pg/ml had more patients complaining of low libido as defined by ICD-9 of 799.81 in the problem list. Patients with higher estradiol levels above 42.6 pg/ml had less sexual dysfunction problems identified by their providers.

 

[LotsOfQuestions]

Wow, our numbers are close.
Currently working with a Dr who claimed no need to be on TRT and working with OTC supplements.
Apparently his OTC supplements don't work as well as the ones I was taking prior to his recommendations. His supplements help a bit but based on bloodwork the numbers decreased with his supplements.

Very curious to read how about your results with not only bloodwork but also how in feel in general. My concerns are with memory fog and focus and boners;-)
Hopefully you can post back weekly.

 

[LotsOfQuestions]

@atl2005
Any new updates?

 

[atl2005]

@atl2005
Any new updates?

Hey sorry I haven't been around to post. I've been very hesitant to start the TRT knowing it will be a lifelong process. I've been trying to increase energy and libido through other methods even trying "energizing" antidepressants like wellbutrin and using Cialis but they haven't helped.

I'm at the point now where I never put on muscle and have continued to get weaker and softer no matter how clean my diet is lately. My energy is lower than ever and my sex drive is gone most of the time.

I spoke with my PCP again regarding the blood work and how my total T is falsely high due to SHBG but he simply won't prescribe TRT with a total test over 500. I'm going to have to go to a different doctor if I want to get the testosterone from a local doctor. Seems like everyone in the gym has a guy they get their test from but not sure I trust their guy.