Labs complete - next steps?

[DinoTheFF]

Hey all, reaching out and looking for a little advice and feedback from the community.

Background:

47 y/o M

6’0 210lbs

Workout usually for an hour 4 or 5 times per week. Mix of cardio and weights.

I’m a full time firefighter and I know that comes with issues that can affect overall health.

Over the year or so I’ve felt drained/exhausted/low energy especially during workouts. My sleep is ok I generally sleep 6-7hrs a night, but with the job that’s always an issue. Diet is ok, could probably be dialed in a little better. I know I probably can be better about upping protein and lowering carbs.

Sex drive is always good, erections are still hard but not what they used to be, still get morning wood 4 or 5x/week. My biggest concern is low energy, lethargic, strength loss, and putting on a little weight around the belly.

My latest labs:

FSH: 2.8

LH: 4.5

Prolactin: 7.0

E2: 15.3

DHEA: 296

Total Test: 423

SHBG: 25

Free Test: 9.8

IGF1: 123

Didn’t know really where to look for TRT help so I found Relive…basically a strip mall health clinic. They are recommending 180mg/wk split into 3 pins (MWF 60mg each day). $125/month for all supplies and test needed.

So that’s where I’m at, just looking for feedback and advice from those here. Any help or info is greatly appreciated. Thanks in advance!

 

[radman]

Hey all, reaching out and looking for a little advice and feedback from the community.

Background:

47 y/o M

6’0 210lbs

Workout usually for an hour 4 or 5 times per week. Mix of cardio and weights.

I’m a full time firefighter and I know that comes with issues that can affect overall health.

Over the year or so I’ve felt drained/exhausted/low energy especially during workouts. My sleep is ok I generally sleep 6-7hrs a night, but with the job that’s always an issue. Diet is ok, could probably be dialed in a little better. I know I probably can be better about upping protein and lowering carbs.

Sex drive is always good, erections are still hard but not what they used to be, still get morning wood 4 or 5x/week. My biggest concern is low energy, lethargic, strength loss, and putting on a little weight around the belly.

My latest labs:

FSH: 2.8

LH: 4.5

Prolactin: 7.0

E2: 15.3

DHEA: 296

Total Test: 423

SHBG: 25

Free Test: 9.8

IGF1: 123

Didn’t know really where to look for TRT help so I found Relive…basically a strip mall health clinic. They are recommending 180mg/wk split into 3 pins (MWF 60mg each day). $125/month for all supplies and test needed.

So that’s where I’m at, just looking for feedback and advice from those here. Any help or info is greatly appreciated. Thanks in advance!

What units are you using for the Free Test?
That value doesn't make sense with your normal Total Test.
Typically Free Test is reported in pg/ml and the normal range is 35-155 at Quest.

Free Test is the main value to look at to determine if your symptoms are related to low T or not. Most of your symptoms could be explained by many other things, same for all of us.

 

[DinoTheFF]

What units are you using for the Free Test?
That value doesn't make sense with your normal Total Test.
Typically Free Test is reported in pg/ml and the normal range is 35-155 at Quest.

Free Test is the main value to look at to determine if your symptoms are related to low T or not. Most of your symptoms could be explained by many other things, same for all of us.

Hey, thanks for the reply. The units were ng/dl and done through the clinic, not Quest.

 

[JorgeF]

man i get why you’re looking around, firefighter schedule alone can make you feel like you’re running on fumes even if you’re doing “all the right things”

just based on what you posted, i don’t see some obvious “you’re crashed and need a big dose asap” situation. total t at 423 isn’t amazing, but it’s not in the gutter either, shbg looks normal, lh/fsh look normal-ish, prolactin fine, e2 is kinda low-ish but not crazy. libido being good and still getting morning wood most days also makes me think your low energy might be more sleep/recovery/stress driven than purely testosterone

the strip mall clinic jumping straight to 180/wk and 3x/week pins feels like a cookie cutter “everybody gets the same plan” thing. could it work? sure. but i’d wanna know if they actually plan to adjust based on how you feel + follow up labs, and if they’re watching the stuff that actually bites guys on trt like blood pressure and hematocrit. you’re already in a job that messes with sleep and stress hormones, so adding something that can raise hct/bp without a tight follow up plan is not my favorite setup

if you haven’t yet, i’d honestly repeat the labs once more early morning (like real early, fasting if you can) just to confirm where you’re actually sitting, and i’d make sure they ran tsh/free t4, cbc, lipids, a1c, cmp too. also worth thinking about sleep apnea even if you “sleep ok” because a lot of dudes with decent sleep hours still sleep like trash quality wise, especially with shift work

what time was your blood draw and was it after a rough shift or a normal sleep night? do you know the lab ranges for that free t number (9.8 can be low or fine depending on units/range)? and what’s your blood pressure running lately plus do you snore or wake up feeling unrefreshed a lot?

 

[radman]

Hey, thanks for the reply. The units were ng/dl and done through the clinic, not Quest.

Gotcha. Well that is 98 pg/ml, or well within the normal range, which comports with your Total T. So you aren't hypogonadal. It is often said that symptoms are what matters and that many men are symptomatically hypogonadal even when within the normal range. However, I think this probably applies mostly to men with borderline (ie. 250-350) Total T, or particularly borderline Free T. So while it's possible you feel better on the TRT, I wouldn't count on it, and if you do feel better it will be hard to disentangle placebo effect or just feeling better on higher levels (without actually being hypogonadal to start with). Let us know how it goes.