Expertise on my TRT needed

[M!ck]

Yes, officially by-the-book hypogonadal low.

Just wondering, the ref range is showing 4,81-22,42 pg/ml. I don’t have a thinking issue there that my value is low? Is the ref range strange?

 

[Systemlord]

Just wondering, the ref range is showing 4,81-22,42 pg/ml. I don’t have a thinking issue there that my value is low? Is the ref range strange?

You’re not going to get a definitive answer, whether or not your levels are low or not. You need to think about it a little bit differently. Hormones are like a light dimmer switch, raise the switch higher, and the light becomes brighter and brighter the higher you raise the switch, the hormones anabolic effects become more noticeable the higher the level.

Reference ranges for FT are poorly established, often times men experience symptoms long before FT levels drop below range. In fact, many experts, believe that FT in the bottom 25% to be a sign of hypogonadism.

 

[FunkOdyssey]

You’re not going to get a definitive answer, whether or not your levels are low or not. You need to think about it a little bit differently. Hormones are like a light dimmer switch, raise the switch higher, and the light becomes brighter and brighter the higher you raise the switch, the hormones anabolic effects become more noticeable the higher the level.

Reference ranges for FT are poorly established, often times men experience symptoms long before FT levels drop below range. In fact, many experts, believe that FT in the bottom 25% to be a sign of hypogonadism.

This is right of course, but when you are below 65 pg/ml or 6.5 ng/dl free T you are unequivocally hypogonadal by the conservative official guidelines of a majority of endocrinology associations.

 

[M!ck]

This is right of course, but when you are below 65 pg/ml or 6.5 ng/dl free T you are unequivocally hypogonadal by the conservative official guidelines of a majority of endocrinology associations.

This is so confusing, 4 years ago, i had the same check, same doc, same lab.
Ref was 8.3 - 40.1 ng/l and now it is showing 4,81-22,42 pg/ml

For what i know and what online calculators tell me pg/ml vs ng/l should be the same.

Now i came around with 6.x pg/ml and look at the old reference range and everything is ok. I am below, have my inner peace and i can start. But the new ref range is mixing me up. Sorry to bother you, but there is no doc around that can help me with knowledge. Just my PCP with the script :-D

 

[FunkOdyssey]

This is so confusing, 4 years ago, i had the same check, same doc, same lab.
Ref was 8.3 - 40.1 ng/l and now it is showing 4,81-22,42 pg/ml

For what i know and what online calculators tell me pg/ml vs ng/l should be the same.
View attachment 42354

Now i came around with 6.x pg/ml and look at the old reference range and everything is ok. I am below, have my inner peace and i can start. But the new ref range is mixing me up. Sorry to bother you, but there is no doc around that can help me with knowledge. Just my PCP with the script :-D

The lab ranges for total and free testosterone are dropping as the population becomes sicker. That has no bearing on what the optimal values are. More people becoming hypogonadal does not change the definition of hypogonadism.

• International Society for the Study of the Aging Male (ISSAM) says a free T of less than 65 pg/mL = hypogonadism.
• International Society for Sexual Medicine / International Consultation for Sexual Medicine (ISSM/ICSM) says a free T of less than 65 pg/mL = hypogonadism.
• European Association of Urology (EAU) says a free T of less than 220 pmol/L (63.5 pg/mL) = hypogonadism.

Like Systemlord said, these hormones and their effects operate on a spectrum like an analog dial. There are also variations in men's androgen receptor sensitivity and other factors that prevent us from drawing definite conclusions based on a lab test alone. When your level is low enough though (like yours is), a decision to start treatment should be easier to make.

Finally, TRT is not for life. People take it for a few months and stop all the time. You yourself have used it before and come off successfully. I don't really understand why you are agonizing over the decision so much.

 

[Systemlord]

I don't really understand why you are agonizing over the decision so much.

Indecisiveness, being scared, worrying are a symptom of low testosterone.

 

[M!ck]

The lab ranges for total and free testosterone are dropping as the population becomes sicker. That has no bearing on what the optimal values are. More people becoming hypogonadal does not change the definition of hypogonadism.

• International Society for the Study of the Aging Male (ISSAM) says a free T of less than 65 pg/mL = hypogonadism.
• International Society for Sexual Medicine / International Consultation for Sexual Medicine (ISSM/ICSM) says a free T of less than 65 pg/mL = hypogonadism.
• European Association of Urology (EAU) says a free T of less than 220 pmol/L (63.5 pg/mL) = hypogonadism.

Like Systemlord said, these hormones and their effects operate on a spectrum like an analog dial. There are also variations in men's androgen receptor sensitivity and other factors that prevent us from drawing definite conclusions based on a lab test alone. When your level is low enough though (like yours is), a decision to start treatment should be easier to make.

Finally, TRT is not for life. People take it for a few months and stop all the time. You yourself have used it before and come off successfully. I don't really understand why you are agonizing over the decision so much.

Thanks for that @FunkOdyssey , i am going to print out the EAU definition and will contact my Endo with that. Appointment is requested.
I am kind of unsure to go with my PCP along the ride, as i would be the only patient in his office who gets T prescribed by him. If i have questions, he says, you need to know it on your own. The Endo on the other hand is having more knowledge about it, even not enough, but at least more. Its a guy i can talk with.

I am so sure that my levels are low enough and that i will greatly benefit from it. Each day i am thinking, wow i act like a grandpa, feel tired, i need my T boost. On the other hand i am thinking about my sides that i had developed while on T (sleep apnea, bad headache for days, that made me actually stop trt cause i was scarred of stroke or something. Giving @Systemlord absolutely right, i have the worrying, to be scarred of something and a big Indecisiveness, which my wife hates the most.

I really appreciate that you still answer me, and give me good points to go in the right direction, i need that for my mind. I even have a diary and log each day how and when i feel bad, with pictures of my tired eyes. Also have a list with symptoms and all the links telling me what negative consequences low T has.
But my mind is still f*cked and scarred. I dont know..
Hopefully my Endo will chime in and i will feel better with some doctors supervision on me.