Low total T, skeptical and looking for second opinion

[dasein]

Despite fully optimizing training and nutrition (under the guidance of some top coaches--I absolutely murder myself in the gym and in the kitchen), I haven't been seeing results appropriate to the efforts, so was suggested by them to take a look at my hormones so here we are.

Age: 30

Total T: 343 (348-1197 ng/dL)
Free T: 13.18 (5.00 - 21.00 ng/dL)
Vit-D: 98 ng/mL
PSA: 0.6 (0-4 ng/mL)
IGF-1: 194 (98-282 ng/mL)
Estradiol: 19.6 (8.0-35.0 pg/mL)

Thyroid
TSH: 2.18 (0.45 - 4.5 uIU/mL)
T4: 7.0 (4.5-12.0 ug/dL)
T3: 32 (24-39%)
Free Thyroxine: 2.2 (1.2-4.9)

Lipids:
Total cholesterol: 195
HDL: 64
LDL: 120

Symptoms: ED, lethargy and low motivation, stubborn body fat, low libido, depression, in my opinion lots of it probably due to stress

Visited a doctor of alternative medicine, who has much experience prescribing TRT, and sent me away with a low dose cream (150mg/wk) that's on its way. I think the doctor might have said that an AI is compounded into the cream.

I am very concerned about shutting down my HPTA for nothing, so I'm thinking about getting a second opinion before I start the medication, but cost is a concern if I go to, say, Defy Medical. I have one main concern, and that is the cost of shutting down my HPTA and fertility for possibly what is a very low dose of TRT that might not be worth the benefits.

I neglected to bring this issue up with my doc, but perhaps I should have? Is it as big of an issue as I'm making it out to be? It sounds like fertility issues are basically almost completely reversible on HCG down the road, am I understanding this correctly? At this point,

a) would it be advisable to get the LH/FSH/SHBG/Prolactin data right before going forth with the treatment?

b) Should I just go ahead and get these done at Labcorp? If I get a second opinion at Defy, could they just pick up my existing blood work instead of having to redo them? The costs are building up quickly so I want to be careful before paying for stuff out of pocket. Don't have insurance that would cover this.

Thank you!

 

[CoastWatcher]

Despite fully optimizing training and nutrition (under the guidance of some top coaches--I absolutely murder myself in the gym and in the kitchen), I haven't been seeing results appropriate to the efforts, so was suggested by them to take a look at my hormones so here we are.

Age: 30

Total T: 343 (348-1197 ng/dL)
Free T: 13.18 (5.00 - 21.00 ng/dL)
Vit-D: 98 ng/mL
PSA: 0.6 (0-4 ng/mL)
IGF-1: 194 (98-282 ng/mL)
Estradiol: 19.6 (8.0-35.0 pg/mL)

Thyroid
TSH: 2.18 (0.45 - 4.5 uIU/mL)
T4: 7.0 (4.5-12.0 ug/dL)
T3: 32 (24-39%)
Free Thyroxine: 2.2 (1.2-4.9)

Lipids:
Total cholesterol: 195
HDL: 64
LDL: 120

Symptoms: ED, lethargy and low motivation, stubborn body fat, low libido, depression, in my opinion lots of it probably due to stress

Visited a doctor of alternative medicine, who has much experience prescribing TRT, and sent me away with a low dose cream (150mg/wk) that's on its way. I think the doctor might have said that an AI is compounded into the cream.

I am very concerned about shutting down my HPTA for nothing, so I'm thinking about getting a second opinion before I start the medication, but cost is a concern if I go to, say, Defy Medical. I have one main concern, and that is the cost of shutting down my HPTA and fertility for possibly what is a very low dose of TRT that might not be worth the benefits.

I neglected to bring this issue up with my doc, but perhaps I should have? Is it as big of an issue as I'm making it out to be? It sounds like fertility issues are basically almost completely reversible on HCG down the road, am I understanding this correctly? At this point,

a) would it be advisable to get the LH/FSH/SHBG/Prolactin data right before going forth with the treatment?

b) Should I just go ahead and get these done at Labcorp? If I get a second opinion at Defy, could they just pick up my existing blood work instead of having to redo them? The costs are building up quickly so I want to be careful before paying for stuff out of pocket. Don't have insurance that would cover this.

Thank you!

Welcome to Excelmale. Your instincts have served you well and you raise excellent questions. You did not receive a full workup prior to being given a prescription. You need LH, FSH, prolactin, SHBG, and a PSA. To start TRT in the absence of these results is nothing short of foolish. How can a protocol be devised if your SHBG isn't known? Are you dealing with primary or secondary hypogonadism? The FSH and LH will tell you that. If your prolactin is high it must be dealt with or you will go nowhere with TRT. A PSA is an absolute necessity that must be repeated at regular intervals for all TRT patients. These aren't "nice to have" lab tests...they provide diagnostic guidelines.

Any doctor who prescribes an AI in the absence of elevated estradiol/sensitive, along with symptoms presented by the patient that reflect such an elevation, isn't to be trusted. It's poor medicine. You deserve better treatment than you have received so far. Look at it as an investment in your future.

 

[Vettester Chris]

Those thyroid labs are outdated, the T3 is a vintage index /uptake, gives you zero data on the state of your thyroid hormone. You have TSH (good), get Free T4, Free T3, Reverse T3, antibodies (TPO & TgAb). If you have iron, ferritin, CBC's, metabolic, etc., it will also be helpful?

CW has spot-on advise (as normal) on the direction to take for your low testosterone. Follow through with the steps he is suggesting and you will be on the right track!