Hello everyone! I haven’t been feeling great lately, so I decided to get my testosterone levels checked. My libido hasn’t been great, daily anxiety, feeling a lack of confidence, and energy levels just feel sub par. Been reading a lot about TRT and think it could improve a lot of my symptoms. Just want some input if you all think TRT would be worth exploring. 30 year old male, 6ft 2in 185 lbs, I workout 3-5 times per week and eat very healthy most days. I have a baby on the way and planning on trying for another in 2-3 years. I’m aware of the fertility effects that come along with TRT, and am open to coming off / starting a fertility protocol if needed. Fertility is one of my biggest concerns with taking the plunge. I’m aware this is most likely a life long commitment that requires you to stay on top of your health. Just want to get peoples’ opinions if you think TRT is worth me looking into.
Total T - 331 ng/dl
Free T - 79.9 pg/ml
E2 - 15 pg/mL
LH - 6.4 IU/L
FSH - 6.6 IU/L
SHBG - 23.1 nmol/L
Current Supplements: Multivitamin, Zinc Magnesium Glycinate, Vitamin D, Fish Oil, Ashwaghanda, Creatine
Tread lightly on who you take advice from as many are still clueless when it comes to free testosterone especially the testing methods!
Always post testing method used/reference ranges.
This is critical.
TT is important to know but FT is what truly matters here as it is the active unbound fraction of T responsible for the positive effects.
Any time you are testing TT/FT/BAT you need to get your blood work done in the early am in a fasted state otherwise your results will be skewed.
Always use the most accurate testing methods TT/estradiol (LC-MS/MS) and FT (Equilibrium Dialysis).
The only way to know where your FT truly sits is to have it tested using what is considered the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.
If you live outside of the US most places would not have access to such so you would need to use/rely on the calculated linear law-of-mass action Vermeulen (cFTV) which will give a good approximation.
Also need to keep in mind as of now the go to calculated method is the the linear law-of-mass action Vermeulen (cFTV) which is considered the most accurate as it has been validated against a standardized ED assay which is the gold standard testing method for free testosterone.
Yes it tends to overestimate slightly but will still give a good approximation.
No one should be using/relying on the known to be inaccurate direct immunoassay.
You can easily calculate your FT using the online calculator which is available to the general public for free.
With a sub-par TT 331 ng/d:L, lowish SHBG 23.1 nmol/L and Albumin 4.3 g/dL (default) your FT 7.99 ng/dL is on the lower-end and falls within what is called the grey zone where some men can experience symptoms of low-T.
Forget getting caught up on the 2.41% as the absolute FT concentration 7.99 ng/dL is the critical value here.
Also keep in mind if you had your FT tested using the most accurate assay it could very well be lower than 7.99 ng/dL!
Most healthy young males would be hitting a cFTV 13-15 ng/dL or better yet tested using the most accurate assay the gold standard Equilibrium Dialysis 10-12 ng/dL and this is a daily short-lived peak to boot we are talking about here.
Trough would be 20-25% lower.
FT <5 ng/dL would be considerd low.
FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.
FT 10-15 ng/dL would be healthy.
FT 20-25 ng/dL would be high-end/high!
Your cFTV 7.99 ng/dL falls in the grey zone 5-9 ng/dL.
Most in the know would treat a man that has a FT 5-9 ng/dL along with symptoms of low-T.
Dr. Morgentaler who would be considered the father of testosterone would treat a man experiencing symptoms and a FT <100 pg/mL/10 ng/dL
Any doctor in the know would treat a man experiencing symptoms with a FT that falls in the grey zone.
Most in the know would most likely treat you unless they felt that you were overweight and cleaning up your diet, exercising and improving sleep along with addressing other issues (metabolic syndrome/obesity, diabetes) as losing adipose especially when you are carrying a lot will have a big impact on increasing your natty endogenous T levels.
Nelson's house u heard it here first!
Dr. Shalender Bhasin!
* over the past 4 decades he has become a global leader in the biology of androgens, sarcopenia and aging related functional decline, his research has shaped clinical guidelines, its informed public health policy particularly around testosterone therapy, anabolic interventions and then the development of function promoting therapies
25:40-34:36
Methods for Assessing Free Testosterone (FT) Levels
Implications of the Inter-monomeric Allostery and...
We do it big here at Nelson's stomping ground!
Dr. Leen Antonio (UZ Leuven)!
She has collaborated with the heavyweights in the field Dr. Bhasin and Dr. Jasuja (Brigham and Women's Hospital)), Dr. Fiers and team (UZ Ghent) on research related to free testosterone.
Just to be clear up any confusion this is Fiers camps data for mFT reference ranges not the harmonized reference range being worked on by the CDC.
*Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies
* mFT levels were measured in 867 men using ED LC-MS/MS as previously reported (1). Subsequently, 95% reference ranges were determined using the non-parametric method
Reference: 1. Fiers T, Wu F, Moghetti P, Vanderschueren D, Lapauw B, Kaufman JM. Reassessing Free-Testosterone...
25th Annual Fall Scientific Meeting of SMSNA!
Grapevine, Texas.
1:14:05-1:29:40
Recommendatios for Dealing with Free T
Concept of Total Hormonal Load
Keep in mind all those men with normal TT and high SHBG!
Reasonable, Evidence-based Recommendation for Managing T
hting its relevance in preventing misdiagnosis and overtreatment of male hypogonadism. Recent findings While there is consensus on measuring total T – comprising sex hormone-binding globulin (SHBG)-bound, albumin-bound, and free T – as a first step in diagnosing male hypogonadism, evidence...
journals.lww.com
INTRODUCTION
Clinical practice guidelines on the diagnosis of male hypogonadism focus on clinical signs and symptoms of androgen deficiency, as well as biochemical assessment of low circulating testosterone (T). However, there is a longstanding debate, as well as a persisting controversy concerning biochemical assessment of serum T and in particular the use (and misuse) of free T. Free T, as advocated by the free hormone hypothesis, represents...
You have numerous options when it comes to maintaining fertility (serms, hCG, T + hCG, T + hCG + FSH).
You could throw Nasal T-gel (Natesto) in there too!
Fertility Preservation in Hypogonadal Men (2018)
Robert J. Carrasquillo and Ranjith Ramasamy
Introduction
Testicular failure is defined as the impairment or loss of both the endocrine functions of the testis (production of testosterone, or T) and exocrine function (production of spermatozoa). Testicular failure can result from the pathology of the testis itself or disorder at any point in the hypothalamic-pituitary-gonadal axis. Primary testicular failure is characterized by normal/low T in the presence of the elevated follicle-stimulating hormone...
Nelson's Excel kicking facts here!
Dr. Bernie dropping gems!
Something everyone needs to keep in mind here!
* There are very few large RCTs comparing theses strategies in the fertility-seeking hypogonadal male!
Limitations/Future Directions
Key Takeaways
