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!
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.
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Welcome to Nelson's house!
When posting labs you should always include the reference ranges/testing methods. used especially when it comes to the most critical fraction free testosterone.
Shooting in the dark here without knowing what time your labs were done as you need to test TT/FT/BAT in the early am as we want to test at peak and in a fasted state otherwise your results would be skewed.
Even then you are missing critical blood markers RBCs, hemoglobin and hematocrit which wiill be driven up when using exogenous T and it is critical to know where your baseline sits before jumping on therapy.
Throw in thyroid/adrenals too as any dysfunction can easily mimic symptoms of low-T.
Lack of quality sleep or excess stress (physical/mental) can easily hammer down your T.
Sleep is critical.
You need a full set of labs.
Blood work should be done for TT, FT, estradiol, SHBG, DHT, prolactin, Vit D DHEA-S, LH/FSH, PSA, full thyroid panel (TSH, Free T3, Free T4, Reverse T3, antibodies), salivary cortisol (Four Specimens), lipids, CMP, CBC, and CRP.
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.
The only way to know where your FT truly sits would be testing it using the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.
Otherwise you would need to use/ rely on the next best method which would be the go to calculated linear law-of-mass action Vermeulen (cFTV).
If you do not have access (highly doubtful if you reside in the US) to such then you would need to use/rely upon the go to calculated linear law-of-mass action cFTV which will give a good approximation but keep in mind it tends to overestimate FT.
As I have stated numerous times on the forum you always have the option of using/relying on calculated FT which would be the linear law-of-mass action cFTV as it has already been validated twice (1st time was done using TT/SHBG assays no longer available) and was then eventually re-validated using current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.
Yes it tends to overestimate slightly but it is nothing to fret over!
*Calculated free T using high-quality T and SHBG assays has been considered the most useful for clinical purposes [99]. All algorithms suffer from some inaccuracies, including the variable quality of SHBG IAs[100], not replicating the non-linear nature of T-SHBG binding, different and inaccurate association constants for SHBG and albumin binding [101], and variable agreement with equilibrium dialysis results[99,100]. However, until further developments in the field materialize, the linear model algorithms [in particular, the most used Vermeulen equation [102]] appear to give, despite a small systematic positive bias, acceptable data for the clinical management and research[37,103]
Chances are you FT was testing using the calculated method.
If we take your not so stellar TT 423 ng/dL, somewhat normalish SHBG 25 nmol/L and Albumin 3.5 g/dL then your FT 9.8 ng/dL would not be considered low but is well under where a healthy young natty male would sit at peak 13-15 ng/dL.
Even then your FT 9.8 ng/dL falls within what would be called the grey zone 5-10 ng/dL where some men can experiences symptoms of hypogonadism.
FT <5 ng/dL would be considerd low.
FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.
FT 10-15 ng/dL would be healthy.
FT 20-25 ng/dL would be high-end/high!
The majority of men will do well with a trough FT 15-25 ng/dL depending on the injection frequency.
Also need to keep in mind that if your FT was tested using the calculated method it would most likely be lower then 9.8 ng/dL if you had it tested using the most accurate assay the gold standard ED.
I would try to avoid most of those so called T-clinics/mills as they are notorious for overmedicating men on T from the get go let alone many will throw in an AI off the hop to boot.
180 mg T whether injected once weekly or more frequently is overkill off the hop.
The standard starting dose across the board by those in the know is 100 mg T/week or 50 mg T splt twice-weekly.
The majority of men on TTh are injecting 100-200 mg T/week whether once weekly or split into more frequent injections.
The majority of men can easily hit a healthy/high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.
Yes there will always be those strays/outliers that may need the higher-end dose 200 mg T/week but it is far from common as in RARE!
Believe it or not some men can hit stellar levels injecting <100 mg T/week especially when split into more frequent injections.
Always best to start low and go slow on a T only protocol so you can see how your body reacts to testosterone and where said protocol (dose t/injection frequency) has your trough TT and more importantly FT, estradiol let alone critical blood markers RBCs, hemoglobin and hematocrit.
There will always be time to increase the dose if need be or throw in hCG.
Downfall of starting T + hCG off the hop is if you run into any issues it will be hard to tease out and keep in mind adding in hCG will bump up your FT and estradiol.
Again post the refernce ranges/testing methods used and when your bloodwork was done.
Nelson's house u heard it here first!
Dr. Shalender Bhasin!
* over the past 4 decades he has become a global leader in the biology of androgens, sarcopenia and aging related functional decline, his research has shaped clinical guidelines, its informed public health policy particularly around testosterone therapy, anabolic interventions and then the development of function promoting therapies
Pay attention to 25:40-34:36 of the presentation where he explains the importance of measuring free testosterone using a standardized Equilibrium Dialysis method!
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