Low Free T

[sammmy]

This is your time line gathered from your previous posts. Correct anything that is wrong:

1. You started TRT 8-10 years ago due to low T symptoms - sexual and body composition. My guess is that you were low normal free T, like me. You felt your symptoms drastically improved on TRT but did that continue after the initial honeymoon of 1.5 months? The honeymoon period stimulates the nervous system and everything feels better but it doesn't last. Many chase their tail later trying to reproduce the honeymoon.

I am assuming your last blood test was done at trough in the morning, before you do your weekly T shot?

2. You have been taking Finasteride for hair loss in the last 20 years without problems.

3. Your doctor reduced your T dose from 0.4mL/week to 0.15mL/week. When was that? Before starting the blood pressure and statin drugs, at the same time, or after?

4. You have started blood pressure and statin drugs 1.5-1 years ago when you noticed "a disconnect with your dick". You were talking about that in December 2022 and stated then that the problem appeared in the last 6 months. Was that before the blood pressure and statin drugs or after you started taking them?

5. Have you measured recently your blood pressure at rest at home (morning after getting up and evening before going to bed) and was it high? Measuring BP at doctors office may lead to higher values - in my case 20 units higher in systolic and diastolic.

All that revolves around the idea that your previous dose of TRT which was a normal starting dose might have caused higher blood pressure and that currently you don't have it, which will allow you to drop the BP medication and see if that improves your sexual functioning.

6. Did you have these "5 extra pounds" around the midsection on your previous higher dose of TRT? Can your current body composition be described as skinny with some flabbiness around the midsection? Was it like that on your previous higher dose of TRT?

 

[Seth]

Ask your doctor to prove it, show you a randomized placebo controlled study supporting his claim.

I assure you , he will be unable to do so!

That's a good suggestion

 

[Seth]

This is your time line gathered from your previous posts. Correct anything that is wrong:

1. You started TRT 8-10 years ago due to low T symptoms - sexual and body composition. My guess is that you were low normal free T, like me. You felt your symptoms drastically improved on TRT but did that continue after the initial honeymoon of 1.5 months? The honeymoon period stimulates the nervous system and everything feels better but it doesn't last. Many chase their tail later trying to reproduce the honeymoon.

I am assuming your last blood test was done at trough in the morning, before you do your weekly T shot?

2. You have been taking Finasteride for hair loss in the last 20 years without problems.

3. Your doctor reduced your T dose from 0.4mL/week to 0.15mL/week. When was that? Before starting the blood pressure and statin drugs, at the same time, or after?

4. You have started blood pressure and statin drugs 1.5-1 years ago when you noticed "a disconnect with your dick". You were talking about that in December 2022 and stated then that the problem appeared in the last 6 months. Was that before the blood pressure and statin drugs or after you started taking them?

5. Have you measured recently your blood pressure at rest at home (morning after getting up and evening before going to bed) and was it high? Measuring BP at doctors office may lead to higher values - in my case 20 units higher in systolic and diastolic.

All that revolves around the idea that your previous dose of TRT which was a normal starting dose might have caused higher blood pressure and that currently you don't have it, which will allow you to drop the BP medication and see if that improves your sexual functioning.

6. Did you have these "5 extra pounds" around the midsection on your previous higher dose of TRT? Can your current body composition be described as skinny with some flabbiness around the midsection? Was it like that on your previous higher dose of TRT?

Yes, the blood test was done the morning before my shot. The doctor reduced my dose a couple of times. Then wait a few months and retest it. That got me down from .4 ML twice a week to where I am now. The blood pressure drug started first. I don't remember exactly when, but the cholestrol one came later. My current symptoms came on gradually. Maybe it was a combination of lowering the T, along with adding in the other drugs.
Prior to starting the drugs, my blood pressure was creeping up. When he started me on the meds, I was about 145/90. Now it's around 110/70. I haven't tried measuring it at home in a long time. I do have a home tester so I could do that. They used to say 120/80 was good, but now they are saying that's borderline high. Seems they have lowered the range for normal BP.
I didn't have the extra pounds back on the higher dose. Overall, I have lost weight, but gained fat around my middle. Yes, I would say I'm skinny flabby around the middle. My guess is a loss of muscle mass and a gain of fat. When I first started T, I lost fat and gained muscle. Now, it's the opposite. I don't remember how long the honeymoon phase lasted, but overall I felt way better back then.

 

[sammmy]

The most efficient course in your case is to test your blood pressure at home (morning before breakfast and evening before bed - the evening will be lower) on the current low dose TRT. If it's normal, drop the blood pressure medication for a few days and retest: it is normal if it stays 120/80 or below.

If your blood pressure remains normal without the BP medication, you can drop the medication. You can also drop the cholesterol medication for a month and see if your sexuality improves.

I would do that before you increase the TRT dose - your blood pressure might be affected negatively.

 

[Seth]

The most efficient course in your case is to test your blood pressure at home (morning before breakfast and evening before bed - the evening will be lower) on the current low dose TRT. If it's normal, drop the blood pressure medication for a few days and retest: it is normal if it stays 120/80 or below.

If your blood pressure remains normal without the BP medication, you can drop the medication. You can also drop the cholesterol medication for a month and see if your sexuality improves.

I would do that before you increase the TRT dose - your blood pressure might be affected negatively.

Thanks. I appreciate the feedback and suggestions. I will try that.

 

[madman]

Thanks for your reply. I'm injecting .15 ML of T weekly. I was taking .4ML but my doctor had be reduce it as my Total T was 1372, which was too high in his opinion. At that time, my free T was 182 and my SHBG was 84.4

I don't have any of those other medical or lifestyle conditions you mentioned. I exercise 5 to 6 days a week and take daily cialis. About a year ago, I was put on blood pressure and cholesterol medication. This is when I first noticed the changes. Low energy, depression, low libido, loss of morning wood and soft erections when I can get them. My doctor said these medications wouldn't have any effect on this. Maybe it's just a coincidence. But I feel like I did before I ever started taking TRT.

Report	Result	Ref. Range	Units		Status	Lab
TESTOSTERONE	645	300-720	NG/DL		Final	CPL
SEX HORM BIND GLOBULIN	86.2	19.3-76.4	NMOL/L	HIGH	Final	CPL
CALC FREE TESTOSTERONE	69.4	47.0-244.0	PG/ML		Final	CPL

I would have asked off the hop what your protocol was (dose of T/injection frequency) let alone were labs done at the true trough (lowest point) before your next injection.

You stated that you are injecting .15 mL (15 units) 200 mg/mL strength T once weekly.

Never heard of anyone prescribing 30 mg esterified T whether splitting up the dose or in your case once weekly.

This is ridiculous!

Your doctor is out to lunch or better yet on his way home!

As I have stated numerous times on the forum 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.

More importantly, when it comes to testing FT you need to use/rely on accurate assays such as the gold-standard Equilibrium Dialysis or Ultrafiltration, especially in cases of altered SHBG to know where your FT level truly sits.

The FT level you posted was calculated using the linear law-of-mass action cFTV which is available free online.

You could have figured it out on your own if you plugged in your TT, SHBG, and Albumin.

Keep in mind as of now that cFTV tends to overestimate when compared to a standardized Equilibrium Dialysis assay (most accurate) so your FT level may very well be somewhat lower.

Seeing as blood work was done at the true trough (7 days) post-injection with a robust trough TT 645 ng/dL, Albumin 4.37 g/dL and very high SHBG 86.2 nmol/L your trough FT 6.94 ng/dL is right at the bottom end reference range.

Even though you are hitting a robust trough TT your SHBG is very high.

Again good chance your trough FT may be even somewhat lower if you had it tested using an accurate assay (ED/UF).

Even then your peak TT/FT would be far from stellar.

Hard to believe any would feel good throughout the week let alone just before your next injection.

Two options here either increase your dose and stick with once weekly or better yet increase your dose and inject twice weekly.

Injecting twice-weekly will clip the peak--->trough and blood levels will be more stable throughout the week let alone you will be able to get away with running a lower weekly dose while still achieving a healthy trough FT.

The downfall with injecting once weekly is the big difference in peak--->trough and blood levels will not be as stable throughout the week.

Although some men prefer/fare well injecting once weekly many others will struggle due to the rollercoaster effect which can have a negative impact on mood, energy, libido/erectile function, and recovery.

Another problem is many get caught up in that more T is better mentality aiming for a high/absurdly high trough which is a big mistake when injecting less frequently as peak TT, FT, and estradiol levels will be through the roof.

Huge difference between someone running a trough FT 20-30 ng/dL injecting once weekly vs daily or EOD!

Keep in mind when it comes to sides (cosmetic/blood markers) peak--->trough FT plays a big role let alone where you run steady-state.

Running too high an FT even when injecting daily can lead to issues.

Running too high a trough FT on any injection protocol can be just as bad in many ways as running too low a trough FT especially when it comes to libido/erectile function a mood.

Also, tread lightly on what BP meds you dabble with as they can easily have a negative impact on erectile function.

 

[Seth]

Report	Result	Ref. Range	Units		Status	Lab
TESTOSTERONE	645	300-720	NG/DL		Final	CPL
SEX HORM BIND GLOBULIN	86.2	19.3-76.4	NMOL/L	HIGH	Final	CPL
CALC FREE TESTOSTERONE	69.4	47.0-244.0	PG/ML		Final	CPL

I would have asked off the hop what your protocol was (dose of T/injection frequency) let alone were labs done at the true trough (lowest point) before your next injection.

You stated that you are injecting .15 mL (15 units) 200 mg/mL strength T once weekly.

Never heard of anyone prescribing 30 mg esterified T whether splitting up the dose or in your case once weekly.

This is ridiculous!

Your doctor is out to lunch or better yet on his way home!

As I have stated numerous times on the forum 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.

More importantly, when it comes to testing FT you need to use/rely on accurate assays such as the gold-standard Equilibrium Dialysis or Ultrafiltration, especially in cases of altered SHBG to know where your FT level truly sits.

The FT level you posted was calculated using the linear law-of-mass action cFTV which is available free online.

You could have figured it out on your own if you plugged in your TT, SHBG, and Albumin.

Keep in mind as of now that cFTV tends to overestimate when compared to a standardized Equilibrium Dialysis assay (most accurate) so your FT level may very well be somewhat lower.

Seeing as blood work was done at the true trough (7 days) post-injection with a robust trough TT 645 ng/dL, Albumin 4.37 g/dL and very high SHBG 86.2 nmol/L your trough FT 6.94 ng/dL is right at the bottom end reference range.

Even though you are hitting a robust trough TT your SHBG is very high.

Again good chance your trough FT may be even somewhat lower if you had it tested using an accurate assay (ED/UF).

Even then your peak TT/FT would be far from stellar.

View attachment 41113

Hard to believe any would feel good throughout the week let alone just before your next injection.

Two options here either increase your dose and stick with once weekly or better yet increase your dose and inject twice weekly.

Injecting twice-weekly will clip the peak--->trough and blood levels will be more stable throughout the week let alone you will be able to get away with running a lower weekly dose while still achieving a healthy trough FT.

The downfall with injecting once weekly is the big difference in peak--->trough and blood levels will not be as stable throughout the week.

Although some men prefer/fare well injecting once weekly many others will struggle due to the rollercoaster effect which can have a negative impact on mood, energy, libido/erectile function, and recovery.

Another problem is many get caught up in that more T is better mentality aiming for a high/absurdly high trough which is a big mistake when injecting less frequently as peak TT, FT, and estradiol levels will be through the roof.

Huge difference between someone running a trough FT 20-30 ng/dL injecting once weekly vs daily or EOD!

Keep in mind when it comes to sides (cosmetic/blood markers) peak--->trough FT plays a big role let alone where you run steady-state.

Running too high an FT even when injecting daily can lead to issues.

Running too high a trough FT on any injection protocol can be just as bad in many ways as running too low a trough FT especially when it comes to libido/erectile function a mood.

Also, tread lightly on what BP meds you dabble with as they can easily have a negative impact on erectile function.

I didn't know the free T was a calculation. I thought it was an actual measurement of the amount in my blood. Thanks for clarifying that and for the suggestions.