Considering starting TRT. My blood work is attached.

[busydad]

All,

I have some Low-T symptoms most notably brain fog, no drive, ED, and no libido. I believe some of this may be due to me not getting quality sleep. I usually sleep 6-7 hours per night, but even if I get 8 or more hours, I still feel tired. As far as the libido goes though, I can't remember the last time I actually desired sex. I was sure it was Low-T cause I had blood work done a couple of years ago and my total T was 430 and a few years earlier when I had a test done it was in that same range. So recently I've had blood work done 3 times in the past 3 months and my total T has been between 630 and 680 with my free-t being around 13. I'm 46 years old so I believe the Total-T is a decent number.

My Dr. wants me start on 80 mg of Cypionate 2x per week. He seems to think that its my Free-T that is the problem. I'm just not sure if I'm ready to start TRT yet. I'm really just looking to get my libido and my "drive" back.

I've attached my blood work.
I'd like some opinions. Maybe some other options or should I start TRT.

Thanks

 

[Systemlord]

A high LH value usually means testicular failure. As for your high end SHBG and low creatine, I would have a closer look at your liver.

Isolated increases in SHBG will increase the Total T and not necessarily the Free T.

The Direct Free T method is unreliable, the calculated method Free T is 11.3 ng/dL.

TRT will increase the hematocrit and hemoglobin, which are both circling the drain!

Total T doesn’t define testosterone deficiency, the Free T is what matters, which interacts with all the tissues that cause all the positive benefits. If you don’t have the Free T testing in the past, I’m afraid you don’t have a complete picture of your hormone status.

 

[FunkOdyssey]

The calculated free T here is 11 ng/dl, which is not really that low. It's possible TRT might help, but it isn't a slam dunk with these levels.

I would probably first pursue the "still feel tired despite enough sleep" problem, which might be driving everything else. Have you ruled out sleep apnea? Any mental health issues like depression?

 

[Belekas]

The calculated free T here is 11 ng/dl, which is not really that low. It's possible TRT might help, but it isn't a slam dunk with these levels.

I would probably first pursue the "still feel tired despite enough sleep" problem, which might be driving everything else. Have you ruled out sleep apnea? Any mental health issues like depression?

I agree. My FT was below reference range before starting TRT and yet my libido was high af but I always had it like that even during the hardest times. I'd exhaust all other options and seriously before pulling the switch and entering the dark side : )

 

[Vince]

Your age and do you wish to remain fertile?

 

[DaveK22]

All,

I have some Low-T symptoms most notably brain fog, no drive, ED, and no libido. I believe some of this may be due to me not getting quality sleep. I usually sleep 6-7 hours per night, but even if I get 8 or more hours, I still feel tired. As far as the libido goes though, I can't remember the last time I actually desired sex. I was sure it was Low-T cause I had blood work done a couple of years ago and my total T was 430 and a few years earlier when I had a test done it was in that same range. So recently I've had blood work done 3 times in the past 3 months and my total T has been between 630 and 680 with my free-t being around 13. I'm 46 years old so I believe the Total-T is a decent number.

My Dr. wants me start on 80 mg of Cypionate 2x per week. He seems to think that its my Free-T that is the problem. I'm just not sure if I'm ready to start TRT yet. I'm really just looking to get my libido and my "drive" back.

I've attached my blood work.
I'd like some opinions. Maybe some other options or should I start TRT.

Thanks

Just curious...if any of the following apply?
- used hairloss drugs? (finasteride aka Propecia)
- used Accutane?
- tested for sleep apnea?

 

[FunkOdyssey]

Just curious...if any of the following apply?
- used hairloss drugs? (finasteride aka Propecia)
- used Accutane?
- tested for sleep apnea?

Good questions. I have most of those symptoms after taking accutane 25 years ago.

 

[DaveK22]

Good questions. I have most of those symptoms after taking accutane 25 years ago.

Search my old posts about permanent hormonal damage from taking Accutane. I'm living proof and reason I'm on TRT. It's very similar to PFS

 

[busydad]

The calculated free T here is 11 ng/dl, which is not really that low. It's possible TRT might help, but it isn't a slam dunk with these levels.

I would probably first pursue the "still feel tired despite enough sleep" problem, which might be driving everything else. Have you ruled out sleep apnea? Any mental health issues like depression?

The Dr said he would like to see my free T in the 20-30 range. He has also ordered an at home sleep test for me to check for the sleep apnea. No mental health issues that I'm aware of.

 

[busydad]

Just curious...if any of the following apply?
- used hairloss drugs? (finasteride aka Propecia)
- used Accutane?
- tested for sleep apnea?

No history of hairloss drugs or accutane. My Dr. has arranged for an at home sleep test, so we will see how that turns out.

 

[busydad]

Your age and do you wish to remain fertile?

I'm 46 and done with kids.

 

[FunkOdyssey]

The Dr said he would like to see my free T in the 20-30 range. He has also ordered an at home sleep test for me to check for the sleep apnea. No mental health issues that I'm aware of.

This 20-30 ng/dl free T range is a common target for what we call testosterone optimization therapy (TOT), which is distinguished from testosterone replacement therapy (TRT) by shooting for numbers higher than our normal physiology. Natural, healthy young males do not have free T numbers of 20-30 ng/dl -- they actually fall between 10-20 ng/dl. You're on the low end of that already, which is why I say there's a possibility TRT will help, but not a strong possibility.

 

[Vince]

I'm 46 and done with kids.

Since you no longer wish to have kids. TRT may be a good fit for you.

 

[busydad]

This 20-30 ng/dl free T range is a common target for what we call testosterone optimization therapy (TOT), which is distinguished from testosterone replacement therapy (TRT) by shooting for numbers higher than our normal physiology. Natural, healthy young males do not have free T numbers of 20-30 ng/dl -- they actually fall between 10-20 ng/dl. You're on the low end of that already, which is why I say there's a possibility TRT will help, but not a strong possibility.

This is good info, thank you. Would you consider this target of 20-30 ng/dl "enhanced" for lack of a better term? I made it very clear to the Dr that I was just looking to get rid of my symptoms that seem to be pointing towards low T.

I did find the blood work that I had done about 13 years ago. This was done at a fertility clinic when my wife and I were struggling to have kids. They did the blood work cause my sperm counts, motility, and morphology were all over the place.

 

[FunkOdyssey]

This is good info, thank you. Would you consider this target of 20-30 ng/dl "enhanced" for lack of a better term? I made it very clear to the Dr that I was just looking to get rid of my symptoms that seem to be pointing towards low T.

I did find the blood work that I had done about 13 years ago. This was done at a fertility clinic when my wife and I were struggling to have kids. They did the blood work cause my sperm counts, motility, and morphology were all over the place.

Yes, 20-30 ng/dl would be considered enhanced. You're going to see better body composition, strength, recovery from workouts, etc at that level. Other benefits of testosterone, in terms of mood, cognition, energy, libido, and erectile function may be better at that level or may worsen compared to a bit lower level. It depends on the individual. The physical benefits scale proportionately with the dose but there comes a point where other aspects of well-being will start backsliding.

Your 13 year old blood work showed a total T of 435 ng/dl, however there is no SHBG level for us to use to calculate free T, so we don't know how that compares.

 

[busydad]

Unfortunately, none of my old blood work has SHBG or free T testing. The other test I had was back in 2018. I had told my GP that I was feeling kind of shitty, no libido, no morning erections. The only hormone she had checked was total T and that came back at 416.

Is it not odd that 5 and 10 years ago my total T was in the 400's and now is in the 600's?

I was thinking about trying enclomiphene but since LH is already high, I don't know if I'd see any benefit from it.

You mentioned my hematocrit and hemoglobin being low. Is this a concern?

I've been thinking about starting on the TRT and giving it 6 months to see if it does help me out. I'm just concerned that my body might not come back from being on vacation lol.

Again thank you so much for your thoughts. As you can tell I'm really unsure of what my next step is.

 

[FunkOdyssey]

Unfortunately, none of my old blood work has SHBG or free T testing. The other test I had was back in 2018. I had told my GP that I was feeling kind of shitty, no libido, no morning erections. The only hormone she had checked was total T and that came back at 416.

Is it not odd that 5 and 10 years ago my total T was in the 400's and now is in the 600's?

I was thinking about trying enclomiphene but since LH is already high, I don't know if I'd see any benefit from it.

You mentioned my hematocrit and hemoglobin being low. Is this a concern?

I've been thinking about starting on the TRT and giving it 6 months to see if it does help me out. I'm just concerned that my body might not come back from being on vacation lol.

Again thank you so much for your thoughts. As you can tell I'm really unsure of what my next step is.

It is a little odd that your total T is higher now, but it could be a result of lifestyle improvements or an increase in SHBG due to diet, aging, improved insulin sensitivity, or something else.

The fact that your LH is high is a data point that supports hypogonadism. Your brain is calling pretty loudly for more T from the testes. The low hematocrit and hemoglobin while iron and ferritin levels are good may also be a hypogonadism indicator, assuming there is no nutritional deficiency involved.

I think I would see how the at home apnea test turns out first. If there's no apnea I would probably give TRT a shot at that point.

 

[Systemlord]

I'm just concerned that my body might not come back from being on vacation lol.

In the majority of cases, men return to baseline. It’s rare I hear of men who don’t.

 

[Systemlord]

You mentioned my hematocrit and hemoglobin being low. Is this a concern?

Testosterone significantly influences, hematocrit and hemoglobin. Testosterone increases during acute exposure to high altitude, and hematocrit and hemoglobin follows.

Men on TRT at sea level tend to have similar hematocrit levels to those at higher altitude.

 

[madman]

All,

I have some Low-T symptoms most notably brain fog, no drive, ED, and no libido. I believe some of this may be due to me not getting quality sleep. I usually sleep 6-7 hours per night, but even if I get 8 or more hours, I still feel tired. As far as the libido goes though, I can't remember the last time I actually desired sex. I was sure it was Low-T cause I had blood work done a couple of years ago and my total T was 430 and a few years earlier when I had a test done it was in that same range. So recently I've had blood work done 3 times in the past 3 months and my total T has been between 630 and 680 with my free-t being around 13. I'm 46 years old so I believe the Total-T is a decent number.

My Dr. wants me start on 80 mg of Cypionate 2x per week. He seems to think that its my Free-T that is the problem. I'm just not sure if I'm ready to start TRT yet. I'm really just looking to get my libido and my "drive" back.

I've attached my blood work.
I'd like some opinions. Maybe some other options or should I start TRT.

Thanks

I have some Low-T symptoms most notably brain fog, no drive, ED, and no libido. I believe some of this may be due to me not getting quality sleep.

So recently I've had blood work done 3 times in the past 3 months and my total T has been between 630 and 680 with my free-t being around 13. I'm 46 years old so I believe the Total-T is a decent number.

Although having healthy free testosterone levels is critical lack of quality sleep, excess stress (physical/mental), and poor diet can easily hammer down libido/have a negative effect on erections, and cause a lack of drive/motivation/fatigue.

Dysfunction thyroid/adrenals can easily mimic low-T symptoms.

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

On your most recent labs, you are hitting a robust TT 682 ng/dL and although your SHBG is high (not very high), based on the known to be inaccurate direct FT immunoassay your FT level is not low.

Something that many lack the understanding of is just because one has high/highish SHBG it is not a given that they have low/bottom-end FT as again it depends on where your TT sits.

Unfortunately, you never had your FT tested using an accurate assay.

The only way to know where your FT level truly sits is to have it tested using what is considered the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

This is critical, especially in cases of altered SHBG.

Even then we can easily calculate your FT by taking your TT, SHBG, and Albumin.

The most commonly used is the linear law-of-mass action cFTV.

With a robust TT 682 ng/dL, high SHBG 51.7 nmol/L, and Albumin 4.6 g/dL your FT would be 11 ng/dL which is far from low although it is under where a healthy young male would be at peak which is around 13-14 ng/dL.

Free & Bioavailable Testosterone calculator

Also, keep in mind as of now cFTV tends to overestimate when compared against the gold standard Equilibrium Dialysis so your FT may very well be somewhat lower but it still would not be low/bottom-end.

The shit kicker here is if you retested it using the gold standard Equilibrium Dialysis although it may be somewhat lower doubtful it would be really low but it may be in what we call the grey zone for you as in sub-par which can easily cause low-T symptoms for some men.

If anything I would at least retest using an accurate assay.

Where does your BF% sit?

Also, keep in mind that your estradiol is high mind you it was not tested using the most accurate assay (LC/MS-MS).

Chances are you if you jump on TRT you will be a high aromatizer.

Your LH is just above the top end but not very high.

What really stands out is your RBCs, hemoglobin, and hematocrit are at/near the bottom end yet your iron/ferritin is normal.

Hypogonadal men often present with markedly lowered hemoglobin and erythrocyte concentrations.

My Dr. wants me start on 80 mg of Cypionate 2x per week. He seems to think that its my Free-T that is the problem

If you mean 80 mg twice weekly (160 mg T/week) run and find a new doctor as 160 mg T/week is too high a dose to start someone on.

We always say start low and go slow on a T-only protocol!

The common starting dose is 100 mg T/week or 50 mg T twice weekly (every 3.5 days).

Most men on TRT are injecting 100-200 mg T/week whether once weekly or split into more frequent injections such as twice-weekly (every 3.5 days), M/W/F, EOD, or daily.

Even then most men would never need the high-end dose of 200 mg T/week to achieve a healthy FT level.

Are there outliers sure but they are far and few.

Most and let me repeat that MOST men can easily achieve a high let alone very high trough FT levels of 100-150 mg T/week especially when split into more frequent injections.

You need to think this one through before you jump in head first.