Expertise on my TRT needed

[Seagal]

I think it's here (D) now common to prescribe Testogel. IMHO, it's worth to give it a try.

https://service.kade-besins.de/testogel/fi/testogel-dosiergel-fachinformation-drkade-besins.pdf

If it works, i.e. achieving subjective proper T level, then it has the advantage that it mimics circadian T levels, eg daily max min between 850 and 330.

 

[M!ck]

I think it's here (D) now common to prescribe Testogel. IMHO, it's worth to give it a try.

https://service.kade-besins.de/testogel/fi/testogel-dosiergel-fachinformation-drkade-besins.pdf

If it works, i.e. achieving subjective proper T level, then it has the advantage that it mimics circadian T levels, eg daily max min between 850 and 330.

Hi Seagal, you’re in Germany too?
Gel would not be my first choice as I’m having small kids. I know it should have less impact on the hematocrit, but I would try the injection route first again, with lower dose and daily naringenin would be my plan.

My prescription for Test E is ready, it’s just myself holding me back. Would you personally classify my T level to be low enough?

 

[Seagal]

Hi Seagal, you’re in Germany too?
Gel would not be my first choice as I’m having small kids. I know it should have less impact on the hematocrit, but I would try the injection route first again, with lower dose and daily naringenin would be my plan.

My prescription for Test E is ready, it’s just myself holding me back. Would you personally classify my T level to be low enough?

Jawohl
I wish I could get that detailed labs you got. Do you have 'privat insurance'?
You know, in Germany T levels are purely determined based on TT, at least for regular folks. What can cause low libido and fatigue besides low T? And what can cause low T symptoms? I would try to rule out all other possible issues (sleep, sports, nutrition, overweight, too much stress overall, alcohol,...). Some men on TRT find themselves struggle again with fatigue and low libido after a few months. Since you could get a prescription, I would go for it.

 

[M!ck]

Jawohl
I wish I could get that detailed labs you got. Do you have 'privat insurance'?
You know, in Germany T levels are purely determined based on TT, at least for regular folks. What can cause low libido and fatigue besides low T? And what can cause low T symptoms? I would try to rule out all other possible issues (sleep, sports, nutrition, overweight, too much stress overall, alcohol,...). Some men on TRT find themselves struggle again with fatigue and low libido after a few months. Since you could get a prescription, I would go for it.

Moin
So you’re on Gel?
I have no private insurance, just have visited multiple docs, 2 endos, 2 uros and have my pcp done all the checks that I wanted. Even did a screening of my testicles, all good.

Sleeping 8 hours each night, no smoking, no alcohol since years, processed food like junk only once a week. Going only 3 times a week to the gym as I cannot revover more than that. Even with moderate sessions. Feeling that working out takes my energy of me even more. Since COVID in November I haven’t seen the gym and my total T came back high as 400, which has never been that high in years.

Maybe I’m having kind of exercise induced hypogonadism, working out since 25 years, lived the bodybuilding lifestyle, but never touched any steroids. Oh yeah and during puberty I was a fat kid, maybe that played a role too, had a gyno surgery with 21 yo.

@Systemlord is it important to get DHEA measured? That’s one thing that I don’t have yet.

 

[Systemlord]

@Systemlord is it important to get DHEA messaured? That’s one thing that I don’t have yet.

I would if I were you.

 

[M!ck]

I would if I were you.

Have read lots of mixed reviews that even when DHEA is low that a supplementation should be avoided due to uncontrollable side effects and for men it’s mostly aromatizing into estrogen. Did you see cases where a supplementation of only DHEA was working?

 

[Seagal]

Moin
So you’re on Gel?
I have no private insurance, just have visited multiple docs, 2 endos, 2 uros and have my pcp done all the checks that I wanted. Even did a screening of my testicles, all good.

Sleeping 8 hours each night, no smoking, no alcohol since years, processed food like junk only once a week. Going only 3 times a week to the gym as I cannot revover more than that. Even with moderate sessions. Feeling that working out takes my energy of me even more. Since COVID in November I haven’t seen the gym and my total T came back high as 400, which has never been that high in years.

Maybe I’m having kind of exercise induced hypogonadism, working out since 25 years, lived the bodybuilding lifestyle, but never touched any steroids. Oh yeah and during puberty I was a fat kid, maybe that played a role too, had a gyno surgery with 21 yo.

@Systemlord is it important to get DHEA messaured? That’s one thing that I don’t have yet.

Yes, I'm on testogel. And HCG, and take DHEA.
Regarding gym workload (over)training stress: exactly what I've thought is happening here many times but never dared to elaborate....
For clarification: I'm not against TRT+, BB TRT, TOT or whatever one wants to call it.

 

[M!ck]

Yes, I'm on testogel. And HCG, and take DHEA.
Regarding gym workload (over)training stress: exactly what I've thought is happening here many times but never dared to elaborate....
For clarification: I'm not against TRT+, BB TRT, TOT or whatever one wants to call it.

who’s prescribing that HcG for you? Uro? In Germany it’s rare that I see it in a regular treatment.

I would never touch trt for BB purposes, for me it’s the mental heath, energy and missing libido. Each afternoon even if I don’t work or workout I suffer from brainfog.

There a some studies about training and low t-levels, it’s interesting.

Link

 

[Seagal]

who’s prescribing that HcG for you? Uro? In Germany it’s rare that I see it in a regular treatment.

I would never touch trt for BB purposes, for me it’s the mental heath, energy and missing libido. Each afternoon even if I don’t work or workout I suffer from brainfog.

There a some studies about training and low t-levels, it’s interesting.

Link

Unfortunately I don't have a prescription for HCG...
M!ck, please don't misunderstand my remarks. If your T levels are causing low energy, brainfog etc then go on TRT.

 

[M!ck]

Unfortunately I don't have a prescription for HCG...
M!ck, please don't misunderstand my remarks. If your T levels are causing low energy, brainfog etc then go on TRT.

all good Buddy, didnt get you wrong
I just want to make sure that I am going into the right direction.

 

[M!ck]

Have meassured free T, pls see attached:

@madman i would like to ask for your point of view on my bloods if you dont mind
there's another pair of bloods in my previous post.

 

[madman]

@Systemlord, good question, i am just unsecure about it as my level is not that low anymore. When i was down to 200, it was a no brainer to me.

Have meassured free T, pls see attached:

This is the only set of labs that matters as it is your most recent (Jan 11/2024).

Unfortunately, you are missing the most critical blood marker free testosterone.

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Your TT converted is 405 ng/dL but unfortunately, we have no idea where your FT level sits as it was never tested.

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.

If you do not have access to such in your country then you will need to use/rely upon the calculated method (cFTV).

Keep in mind as of now cFTV tends to overestimate when compared against a standardized gold standard Equilibrium Dialysis assay.

Even then we could have calculated it using the cFTV if we had your SHBG and Albumin mind you we can use the default for Albumin 4.3 g/dL.

Unfortunately, you never had your SHBG tested.

You need to get another set of labs done and test FT or find out where your SHBG and Albumin sit so you can calculate it as this can be done online for free.

Free & Bioavailable Testosterone calculator

Jan.11/2024

 

[M!ck]

This is the only set of labs that matters as it is your most recent (Jan 11/2024).

Unfortunately, you are missing the most critical blood marker free testosterone.

Keep in mind that although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.

Your TT converted is 405 ng/dL but unfortunately, we have no idea where your FT level sits as it was never tested.

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.

If you do not have access to such in your country then you will need to use/rely upon the calculated method (cFTV).

Keep in mind as of now cFTV tends to overestimate when compared against a standardized gold standard Equilibrium Dialysis assay.

Even then we could have calculated it using the cFTV if we had your SHBG and Albumin mind you we can use the default for Albumin 4.3 g/dL.

Unfortunately, you never had your SHBG tested.

You need to get another set of labs done and test FT or find out where your SHBG and Albumin sit so you can calculate it as this can be done online for free.

Free & Bioavailable Testosterone calculator

Jan.11/2024
View attachment 41445

Thanks for your time.
Unfortunately this time it did not get tested by my pcp.

Last year I head 2 measurements at my Endo with free T: 8.36 pg/ml & 8.11 pg/ml.

That time no total T and no shgb was tested. It’s damn difficult in Germany to find someone who knows what he is doing.

Had my pcp to measure Albumin, shbg and total T, (see attached) it’s 2 years ago but I don’t feel any better, so i expect it to be around the same. Btw I am getting my T levels checked since 12 years, as I’m having issues since then. They only once came as “high” as 405. They were always between 200 & 380 (total)
2019 my free T measured came back at 7.0 ng/l. I cannot tell which assay was used to get those levels.

2021 another Endo measured shgb too, it was sitting at 23.5 with total T at 3.86 ug/l.

I am kind of lost in Germany as there is no clinic, just have my pcp covering the test subscription as he is willing to treat my symptoms.

So for me my free T is always hovering around 8 and I am wondering if this is low enough.

 

[M!ck]

Either way, your FT level is well under where a healthy young male would sit which would be 13-15 ng/dL when using/relying upon the cFTV method.

found your post in another thread. So based on that my levels would be far away from that. Would you start over again with that levels?

 

[madman]

found your post in another thread. So based on that my levels would be far away from that. Would you start over again with that levels?

Again you need more recent labs to see where your FT level truly sits.

TT means nothing without knowing where your SHBG truly sits.

If your FT level is truly low/subpar (low-normal) and you are suffering from symptoms then I would seek out treatment.

 

[M!ck]

Again you need more recent labs to see where your FT level truly sits.

TT means nothing without knowing where your SHBG truly sits.

If your FT level is truly low/subpar (low-normal) and you are suffering from symptoms then I would seek out treatment.

Did you see my recent post with my SHBG results? It’s not recent, but will give an indicator about it as it has been measured twice with almost the same level. Sorry to bother you, but I feel so lost.

 

[madman]

Did you see my recent post with my SHBG results? It’s not recent, but will give an indicator about it as it has been measured twice with almost the same level. Sorry to bother you, but I feel so lost.

I am here to help.

Feel free to PM me anytime.

Yes, this was 2 years ago, and although there is a good chance that it may still be hovering in the low 20s you need to know where it truly sits as of now.

Chances are if it is still in the lowish 20s and your most recent TT is 405 ng/dL then your FT would be subpar.

 

[M!ck]

I would if I were you.

Here we go, I received my new labs. DHEA is on the lower end but in range. Thinking about trying to supplement a bit of it. Does it make sense?

My total T is still over 4, I am happily surprised about it.
Came from 2 total T 4 years ago, and it’s a big difference symptom wise. I still feel not as energetic as on Trt but a bit better.

 

[M!ck]

Here we go, I received my new labs. DHEA is on the lower end but in range. Thinking about trying to supplement a bit of it. Does it make sense?

My total T is still over 4, I am happily surprised about it.
Came from 2 total T 4 years ago, and it’s a big difference symptom wise. I still feel not as energetic as on Trt but a bit better.

just received free T, it's: 6.3 ng/L - that seems low :-/

 

[FunkOdyssey]

just received free T, it's: 6.3 ng/L - that seems low :-/

Yes, officially by-the-book hypogonadal low.