First Test Results from GP - Now what?

[wisedave]

Hello,

I am new here and hope to learn loads about my health as a 54m from the UK. I've been doing some poking around the web and YouTube and in looking at how I feel in general, felt I may have some testosterone issues and want to see if TRT is right for me.

I went to my GP and they did some blood work. They checked my Serum Testosterone Level and it came back with a score of 9.4 nmol/L. They say that "normal levels" are between 6.0 and 27.0 so the Doctor said I was "normal".

In your opinion, would it be worth it to come out of pocket to see a specialist and see what they say the next steps should be? I exude many of the classic symptoms of low test -

• E.D.
• Fatigue
• Overweight
• Losing muscle mass
• low libido
• brain fog

The stories I am seeing is that people that start TRT can have amazing results. I just generally feel like crap and "low" most of the time and don't think at 54 I should feel this way.

With a score of 9 on my bloodwork, the NHS won't really do anything so I want to take control of my health and wellbeing from here.

What are your thoughts on that reference level and desire for increased overall energy and well being?

Thanks for the insight!

Cheers,

Dave

 

[Systemlord]

went to my GP and they did some blood work. They checked my Serum Testosterone Level and it came back with a score of 9.4 nmol/L.

These Total T levels are below the cut off point according to the British Society of Sexual Medicine. You do qualify for TRT under the NHS guidelines. I’m afraid you’re dealing with the doctor that’s operating outside his scope of medicine.

The UK or NHS is one of the worst places to get treatment for low testosterone. It is for this reason the majority of men get treatment through Balance My Hormones, or The Men’s Health Clinic.

Testosterone Level: How Low is Too Low? Health Consequences of Low Testosterone

I was able to summarize all available studies on testosterone blood levels and how they are linked to several health issues. I will add references soon. Low Blood Levels of Testosterone and Associated Risks: < 450 ng/dl (15.3 nmol/l) - Risk of metabolic syndrome Reference: Dhindsa, S...

www.excelmale.com

https://bssm.org.uk/wp-content/uploads/2023/02/guidelines-on-adult-testosterone-deficiency-with-statements-for-uk-practice.pdf

A TT concentration lower than 12 nmol/L and Free T lower than .225 pmol/L qualifies for TRT under the NHS. That doesn’t mean men above these levels can’t experience symptoms of low-T, or won’t show benefit on TRT.

So your options are, play the doctor lottery and hope the next doctor is more knowledgeable than the last one, unlikely, or go to the Balance My Hormones or Men’s Health Clinic, and get treatment.

 

[madman]

Hello,

I am new here and hope to learn loads about my health as a 54m from the UK. I've been doing some poking around the web and YouTube and in looking at how I feel in general, felt I may have some testosterone issues and want to see if TRT is right for me.

I went to my GP and they did some blood work. They checked my Serum Testosterone Level and it came back with a score of 9.4 nmol/L. They say that "normal levels" are between 6.0 and 27.0 so the Doctor said I was "normal".

In your opinion, would it be worth it to come out of pocket to see a specialist and see what they say the next steps should be? I exude many of the classic symptoms of low test -

• E.D.
• Fatigue
• Overweight
• Losing muscle mass
• low libido
• brain fog

The stories I am seeing is that people that start TRT can have amazing results. I just generally feel like crap and "low" most of the time and don't think at 54 I should feel this way.

With a score of 9 on my bloodwork, the NHS won't really do anything so I want to take control of my health and wellbeing from here.

What are your thoughts on that reference level and desire for increased overall energy and well being?

Thanks for the insight!

Cheers,

Dave

Welcome to Nelson's domain Dave!

Forget getting caught up in the reference ranges especially when it comes to the bottom end!

Many men can suffer from hypogonadism/low-T with a TT in the low-normal range let alone even in the normal range in cases of men with high SHBG which would have their FT low/lowish.

Signs and symptoms of low-T along with labs showing low/sub-par free testosterone are what truly matters.

TT does not paint the full picture as you also need to know where your SHBG sits then you can see where your FT truly sits.

When it comes to testing using the most accurate assays is critical especially when it comes to testing free testosterone.

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.

Blood work should always be done in the early am in a fasted state let and make sure you are well rested.

We always want to test (TT, FT, and BAT) when blood levels peak in the early am.

The natural endogenous 24-hour circadian rhythm of a healthy young male has T levels peaking (highest point) in the early am upon awakening whereas the nadir or trough (lowest point) will be in the evening.

If you weight train it would be advantageous to take a week off before getting blood work done.

As you can see you are hitting an absurdly low TT 9.4 nmol/L (271 ng/dL) and with a TT in the mid-high 200s it is a given that your FT will be lowish/low even if you had low SHBG.

Most men can easily get treated with a TT <300ng/dL.

Even though they are very strict in the UK and many doctors are clueless when it comes to treating men for low testosterone with a dismal TT 9 nmol/L SHBG you would still qualify for TRT under the most recent BSSM Guidelines.

The best piece of advice would be to seek out a doctor who specializes in treating men for low-T.

Stay far away from those dime-a-dozen run-of-the-mill T-clinics that would be more than happy to jack you up on T from the get-go!

Start low and go slow on a T-only protocol we say.

Patience is key especially when starting TRT.

Keep us posted.

British Society for Sexual Medicine Guidelines on Male Adult TD

The British Society for Sexual Medicine Guidelines on Male Adult Testosterone Deficiency, With Statements for Practice (2023) Geoffrey Hackett, Michael Kirby, Rowland W. Rees, T. Hugh Jones, Asif Muneer, Mark Livingston, Nick Ossei-Gerning, Janine David, Jeff Foster, Philip A. Kalra, Sudarshan...

www.excelmale.com

LABORATORY DIAGNOSIS

It is important that clinicians familiarise themselves with their local laboratories. TD is a diagnosis made from clinical symptoms and abnormal biochemistry. Clinicians need to appreciate that “reference ranges” quoted by laboratories represent the normal population and that the “action levels” recommended by BSSM refer to men with clinical symptoms of TD (Fig. 2). Just as reference ranges on normal lipids are inappropriate for men with T2DM and for secondary prevention in CHD, reference ranges for testosterone are not designed to replace evidence-based guidelines. Wide variations in laboratory practice for testosterone testing in the UK may lead to variations in patient care and potentially result in some patients with TD not being identified. Improvements in the standardization of testosterone assays and the consistency of reporting between laboratories are required.

Where TT levels are close to the lower normal range (8–12 nmol/L), the FT level should also be checked (LoE1, Grade A) [4,5]. Where the TT levels are <12 nmol/L, serum LH and FSH levels should also be measured. Where TT is borderline or low to normal, particularly in obese and older men, SHBG levels should also be checked (LoE 2, Grade C) [6]. In the case of known or suspected abnormal SHBG levels, FT should also be measured (LoE 1, Grade A). LH levels should be assessed to differentiate between primary and secondary TD (LoE 2, Grade A) [4]. Serum prolactin levels should be measured when both LH and FSH levels are low. A very low TT (<5.2 nmol/L), and low LH and FSH are more likely to be associated with hyperprolactinemia, or when secondary TD due to a pituitary tumor or other pituitary disease is suspected
THRESHOLDS FOR T THERAPY


Regarding the thresholds for treatment intervention in symptomatic men, BSSM [1,5] and ISSM guidelines recommend the following:

• TT level <12 nmol/L or FT <225 pmol/L (<0.225nmol/L) (based on two separate 8–11 am levels), usually requires T Therapy (LoE=1 Grade A) [1].
• TT level >12 nmol/L, or FT of >225 pmol/L (>0.225nmol/L), does not require T Therapy (LoE=Grade 1Grade A) [1].

• Levels between 8–14 nmol/L may require a trial of T Therapy for a minimum of 6 months, based on symptom (LoE = 3, Grade C) [117]. The BSSM also says (Table 4):

• Evidence supports the treatment of men with TT levels <14 nmol/L in symptomatic men with prediabetes to prevent progression to overt type 2 diabetes (LoE=2 Grade B) [53].

• A FT level <225 pmol/L (0.225 nmol/L) provides supportive evidence for T Therapy in the presence of appropriate symptoms (LoE=1 Grade A) [122]. Additional recommendations include:

• Raised LH levels and testosterone below normal or in the lower quartile range, indicate testicular failure, so T Therapy should be considered based on symptom severity [123].

• Raised LH levels in men with normal testosterone levels but symptoms of TD, should be considered as TD [26].

• Data from EMAS [123] found that clinical symptoms and all-cause mortality were more closely related to calculated FT (LoE 2 Grade=B) [124].




Fig. 2. BSSM Guidelines 2022. Diagnosing and managing TD in adult men. BSSM: British Society for Sexual Medicine, TD: testosterone deficiency, TT: total testosterone, LH: luteinizing hormone, FSH: follicle-stimulating hormone, SHBG: sex-hormone-binding globulin, FT: free testosterone, DRE: digital rectal examination, PSA: prostate-specific antigen, CV: cardiovascular, CVD: cardiovascular disease, ED: erectile dysfunction, hCG: human chorionic gonadotropin, T Therapy: testosterone therapy. For men with TT levels <5.2 nmol/L plus low LH and FSH or increased prolactin levels, refer to endocrinology or arrange a pituitary MRI to exclude a pituitary adenoma [2,15]. The T4DM study [53] showed a 21% reduction in progression to T2DM by treating T <14 nmol/L in men with pre-diabetes.

 

[Systemlord]

most recent BSSM Guidelines.

Link kindly please!

 

[madman]

Hello,

I am new here and hope to learn loads about my health as a 54m from the UK. I've been doing some poking around the web and YouTube and in looking at how I feel in general, felt I may have some testosterone issues and want to see if TRT is right for me.

I went to my GP and they did some blood work. They checked my Serum Testosterone Level and it came back with a score of 9.4 nmol/L. They say that "normal levels" are between 6.0 and 27.0 so the Doctor said I was "normal".

In your opinion, would it be worth it to come out of pocket to see a specialist and see what they say the next steps should be? I exude many of the classic symptoms of low test -

• E.D.
• Fatigue
• Overweight
• Losing muscle mass
• low libido
• brain fog

The stories I am seeing is that people that start TRT can have amazing results. I just generally feel like crap and "low" most of the time and don't think at 54 I should feel this way.

With a score of 9 on my bloodwork, the NHS won't really do anything so I want to take control of my health and wellbeing from here.

What are your thoughts on that reference level and desire for increased overall energy and well being?

Thanks for the insight!

Cheers,

Dave

The stories I am seeing is that people that start TRT can have amazing results.


Hate to be the bearer of bad news but I would not set your expectations too high.

The majority should notice improvements in mood, energy, libido/erectile function, body composition, recovery, and overall well-being once healthy FT levels are achieved but it is far from a given, and to what degree depends on many other factors.

No amount of testosterone is going to overcome a lack of quality sleep, poor diet, excessive stress (mental/physical), and lack of exercise.

Top it off dysfunction thyroid/adrenals can easily hamper the overall effectiveness of a TRT protocol.

Having healthy testosterone levels is only one piece of the puzzle.

Too many are caught up in that more T is better mentality which can easily have one in for a bumpy ride struggling with sides till the cows come home.

Running too high a trough FT level can be just as bad as having too low a FT level in many ways especially when it comes to libido/erectile function let alone mood.

Too many factors are involved especially when it comes to libido/erectile function as they are multi-factorial.

Hard to say how one would fair on TRT as it is not so cut and dry.

For some men it can do wonders as in life-changing in many ways, for others they will be better off than before but have nothing to brag about, many may end up struggling with ups/downs for years to come and some will be far worse off.

 

[madman]

Link kindly please!

The link to the thread is in post #3