Low T (and symptoms) - looking for recommendations

[Jeffchat6537]

56M and am struggling with low Testosterone (Total) 195.00 ng/dL, low free T (Free Testosterone (Direct MS Assay) 24.50 pg/mL (poor cut off is 3.7)), depressed Estradiol (from 2021 – but no recent score) and moderately high SHBG (SHBG 52.00 nmol/L). FSH and LH are normal. My lipids (Total Cholesterol - 213 mg/dL on October 3, 2025 / LDL - 111 mg/dL on October 3, 2025 / HDL - 87 mg/dL on October 3, 2025) aren’t awesome (especially lp(a) - 439 nmol/L on October 6, 2025 and ApoB -100 mg/dL on October 7, 2025), but a CCTA at 54 revealed no hard or soft plaque and my hs-CRP is quite low (0.2 mg/L on October 3, 2025). While I’ve been trending toward lower and lower T levels for some time, the recent changes/symptoms are more precipitous and significant. These correspond with weight loss (intentional) as I started tracking calories and trying to be better balanced around calories in/out.

Symptoms: No morning erection, loss of libido, increased irritability, possible fatigue (my long cardio sessions are getting shorter)

Mitigations (to date):

• Diet: good diet, lots of protein and fiber, tend toward no added sugar foods and less processed, recently added lean meats back into my diet after decades of being a pescatarian – but still prioritize fish (usually a tin of kipper snacks or sardines with a large salad)
• Exercise: weight training 3-4 times per week (every other day) for 30-40 minutes (protocol is very similar to P90X), cardio 6+ days per week averaging over an hour per day with varied intensity,
• Sleep: recent sleep has been good as measured by oura ring and deep sleep improved significantly with the change in calorie consumption.
• Weight: Optimal, though I recognize that being too lean can cause a reduction in T
• Stress: modest and hs-CRP reflects this.
• Supplements:
  • Doctor's Best Superior Sleep with Sensoril, Formula Contains Ashwagandha, 5-HTP, L-Theanine & GABA – Oct 2023 – no impact/discontinued
  • Ashwaganda – no noticeable effect, discontinued
  • Piping Rock L-Arginine L-Citrulline Supplement | 1500 mg – Sept 12, 2025 – no impact so far
  • Nootropics Depot Tongkat Ali Extract Capsules | 200mg – started Oct 6th, 2025 (resting T in late November)
    • Oct 20 – possible some very modest impact on libido
• Other Supplements:
  • Nutricost Grass-Fed Whey Protein Concentrate (Unflavored) 5LBS - Undenatured, Non-GMO, Gluten Free
  • Nutricost Casein Protein Powder 5lb - Micellar Casein, Non-GMO, Gluten Free (Unflavored)
  • Pure Encapsulations Lithium (Orotate) 1 mg | Support for Calmness and Behavior | 90 CapsulesNutricost Magnesium Oxide 750mg, 240 Capsules - 420mg of Magnesium, Non-GMO, Gluten Free
  • NOW Foods Supplements, Magtein™ with patented form of Magnesium (Mg), Cognitive Support*, 90 Veg Capsules
  • SlowMag Muscle + Heart Magnesium Chloride with Calcium Supplement to Support Muscle Relaxation, Occasional Muscle Cramping & Heart Health, High Absorption,
  • Barlean's Omega 3 Fish Oil Supplements, 600mg Fish Oil Pills with EPA & DHA, Softgels for Joint, Brain, & Heart Health, Orange Flavored, 250 Count
  • Healthy Origins Vitamin K2 100 mcg (MK-7, Non-GMO, Gluten Free, Cardiovascaular Support, Bone Support), 180 Veggie Gels
  • Doctor's Best High Absorption CoQ10 with BioPerine, Vegan, Gluten Free, Naturally Fermented, Heart Health & Energy Production, 100 mg 60 Veggie Caps
  • Healthy Origins UC-II 40 mg (Undenatured Type II Collagen, Non-GMO, Gluten Free, Joint Support), 120 Veggie Caps
  • Nature Made Vitamin D3 2000 IU (50 mcg), Vitamin D Supplement for Bone, Teeth, Muscle and Immune Health Support, 400 Tablets, 400 Day Supply
  • BulkSupplements.com Creatine Monohydrate Powder - Micronized Creatine Powder, Unflavored - Pure & Gluten Free, 5g per Serving, 500g (1.1 lbs) (Pack of 1)
  • Nutricost Niacin (Vitamin B3) 500mg, 240 Capsules - with Flushing, Non-GMO, Gluten Free – 2 tablets
  • Jarrow Formulas Methyl B-12 1000 MCG and Methyl Folate 400 MCG, Extra Strength, Cellular Energy Metabolism and Cardiovascular Health Formula(1) With P-5-P
  • Solgar Zinc Picolinate 22 mg, 100 Tablets - Promotes Healthy Skin - Supports Immune System, Normal Taste & Vision - Antioxidant – Non-GMO, Vegan, Gluten Free, Kosher - 100 Servings (added back in Oct 14th)
• Other Medications:
  • None

Potential Causes:

• Recent Weight Loss / Body Composition - Recently (past 3-4 months) started tracking calories and have reduced excess fat from a high of 167 to 152. Body fat should currently be between 10-11% (validated by iDXA and some additional weight loss with no appreciable change in workout routine).
• Over training - Recovery days could be an issue (trying to do 2 on 1 moderate – but am not always successful)
• Toxins/Diets - Recently increased the amount (a lot) of Mate Factor Chai Yerba Mate – possibly there is some heavy metal contamination with all the herbs. Also – while we use consumer labs as much as possible to vet for heavy metals in supplement list – that’s a big list and lots of opportunity for things to sneak in.

Next Steps:

• Understand the root cause
  • Engaged with PCP – asking about various options and have shared a previous version of most of the above.
  • MRI or similar on pituitary to rule out something there
  • Additional Testing?
• Retest labs in late November – but need to add an E2 test, DHT and heavy metal panel
• I’m leaning toward enclomiphene as a next step
• If ineffective would look at this recommendation - TRT + HGH (Peptides that make you release more of your own GH won’t work at your age). Be assured that with a microdosing protocol of just 20mg of Test / day and 2IU of HGH one hour before bed

Further Thoughts - Supplements

• Tadalafil? Test if this is a libido thing? Also – thinking there are ancillary benefits to this drug..
  • Potential cardiovascular benefits
    • Because tadalafil improves blood flow throughout the body, research suggests it offers a number of cardiovascular benefits.
    • Lowered risk of heart attack and stroke: A large 2024 study of men with ED found that those who were prescribed tadalafil had significantly lower risks of adverse cardiac events, stroke, and venous thromboembolism compared to those who were not.
    • Lowered blood pressure: In addition to treating high blood pressure in the lungs (PAH), the drug may also contribute to lower systemic blood pressure.
    • Improved endothelial function: Tadalafil may help repair and restore the lining of blood vessel walls, which is beneficial for overall heart health and longevity.
  • Uses under investigation
    • Some evidence indicates that tadalafil may offer other benefits, though further research is needed.
    • Raynaud's phenomenon: By improving circulation, tadalafil has shown promise in treating Raynaud's, a condition that causes blood vessels in the fingers and toes to narrow in response to cold or stress.
    • Cognitive health: Tadalafil can increase cerebral blood flow, which may have implications for cognitive health and age-related cognitive decline. However, studies have so far been inconclusive regarding its effect on Alzheimer's risk.
    • Athletic performance: Some evidence suggests that tadalafil may increase muscle pump, improve exercise endurance, and speed up recovery in athletes due to its effect on blood flow. However, this is an off-label use and should only be considered in consultation with a healthcare provider.
• Finasteride (Propecia) is an oral medication that significantly reduces DHT levels, a primary cause of hair loss in those taking testosterone.
  • The primary drugs that can help prevent hair loss when taking testosterone are finasteride and dutasteride, which block the conversion of testosterone to DHT. Both are 5-alpha reductase inhibitors, but dutasteride is a stronger version. Another common medication is minoxidil, which can help manage DHT-related hair loss by preventing DHT from binding to hair follicles. It is important to discuss these options with a physician before starting any medication, especially when on testosterone therapy.