My Father is 70 years old and we just got his labs done. I'd like your advice

[Sb32]

Hello, my Father is 70 years old and is not feeling good. He has diabetes, I offered to check his lab panels and we got his results. He said he would be willing to get on TRT if he needed it.

His Ferritin was 48 ng/ml on 8/15/2025
his A1C was 7.3% with an estimated Average Glucose was 163 mg/dl on 8/15/2025

He's currently on metformin 2500mg daily

What do you guys think? I'd like your opinion. Thanks!

 

[Vince]

Personally, I don't believe he needs TRT. He does need to control his diet. If he could go on a low-carb diet it would definitely help his diabetes. It would be scary to have that high of a A1C.

 

[Cataceous]

His Vermeulen calculated free testosterone is 9.8 ng/dL. It's considered borderline, but not really into hypogonadal territory. I would not be looking at that first as a cause of his issues, particularly if sexual function is ok. Of course being diabetic harms sexual function on its own. Having LH high in range could be suggesting the beginnings of testicular insufficiency. This is common in older men. I would definitely not consider traditional TRT at this point. A relatively safe way to check if higher testosterone is useful is with a trial of testosterone nasal gel. This short-acting form of testosterone is less disruptive of everything else.

Can you be more specific about how he is "not feeling good"? The lab work isn't saying too much otherwise—except there's a slight electrolyte imbalance, he might be heading towards anemia, and estradiol seems low relative to testosterone.

 

[Sb32]

His Vermeulen calculated free testosterone is 9.8 ng/dL. It's considered borderline, but not really into hypogonadal territory. I would not be looking at that first as a cause of his issues, particularly if sexual function is ok. Of course being diabetic harms sexual function on its own. Having LH high in range could be suggesting the beginnings of testicular insufficiency. This is common in older men. I would definitely not consider traditional TRT at this point. A relatively safe way to check if higher testosterone is useful is with a trial of testosterone nasal gel. This short-acting form of testosterone is less disruptive of everything else.

Can you be more specific about how he is "not feeling good"? The lab work isn't saying too much otherwise—except there's a slight electrolyte imbalance, he might be heading towards anemia, and estradiol seems low relative to testosterone.

He feels tired all the time, fatigue, low mood, and depression

 

[WhiteMale]

I too think some attention with the Diabetes would be the most helpful. Numbers otherwise seem to be pretty good for a 70 YO. Liver, kidneys, thyroid, Estrogen, all look good. Free T is borderline as noted, SHBG level is driving that but there's nothing to do there that isn't TRT. TSH IMHO is a poor test on it's own but I don't see a problem there but T3/Free T3 could be something to look at.

 

[Seagal]

That's the T reference for <39 yrs.
How is the blood pressure.
Would fix low sodium levels.
Check B12 and folate.
Metformin is a high dose and maybe too high. Is it once per day or split?

 

[Mastodont]

I would second that metformin might be the source of unwellness, on another note, again we see that prediabetes is not always accompanied by low shbg.

 

[Observer]

His Vermeulen calculated free testosterone is 9.8 ng/dL. It's considered borderline, but not really into hypogonadal territory. I would not be looking at that first as a cause of his issues, particularly if sexual function is ok. Of course being diabetic harms sexual function on its own. Having LH high in range could be suggesting the beginnings of testicular insufficiency. This is common in older men. I would definitely not consider traditional TRT at this point. A relatively safe way to check if higher testosterone is useful is with a trial of testosterone nasal gel. This short-acting form of testosterone is less disruptive of everything else.

Would you be able to go into more detail about the idea of trialing TRT with a short-acting form?

Similar to the OP, my free testosterone is in a gray zone as to what could be considered deficient, though it's on the lower end of that gray zone. A part of me wants to jump into treatment, but I'm also hesitant due to the uncertainty of its necessity mixed with the significant commitment of trialing a longer ester.

To roughly determine the effectiveness of full treatment, could someone get a reasonably accurate preview of testosterone's potential for symptom relief while keeping suppression to a minimum? Could TNE be used as an alternative to nasal gel?

@Willyt, also a question for you with your TNE experience.

 

[Cataceous]

Would you be able to go into more detail about the idea of trialing TRT with a short-acting form?

Similar to the OP, my free testosterone is in a gray zone as to what could be considered deficient, though it's on the lower end of that gray zone. A part of me wants to jump into treatment, but I'm also hesitant due to the uncertainty of its necessity mixed with the significant commitment of trialing a longer ester.

To roughly determine the effectiveness of full treatment, could someone get a reasonably accurate preview of testosterone's potential for symptom relief while keeping suppression to a minimum? Could TNE be used as an alternative to nasal gel?

@Willyt, also a question for you with your TNE experience.

Verified short-acting forms of TRT at this point include testosterone nasal gel and buccal troches. It appears that absorbing 1-1.5 mg of testosterone via short-acting delivery methods 2-3 times per day does not result in a complete shutdown of the HPTA. I consider this highly desirable, as there are known and likely also unknown negative consequences of the long-term suppression of HPTA hormones, which include kisspeptin, GnRH, LH and FSH.

C

Thread 'Is GnRH suppression hurting us?'

Jan 26, 2020

Admittedly the last thing we need is some other nebulous danger to worry about that may not even exist. Read on at your peril.

TL;DR: Testosterone replacement therapy suppresses the production of GnRH. Receptors for GnRH are found in places besides the pituitary. One animal model suggests GnRH may have health benefits independent of its stimulation of LH and FSH production.

The background: Gonadotropin-releasing hormone, or GnRH, is the signal the hypothalamus uses to tell the pituitary gland to secrete luteinizing hormone and follicle stimulating hormone. Luteinizing hormone (LH)...

• Cataceous
• gnrh hpta suppression
• Replies: 63
• Forum: Testosterone Side Effect Management

• 

C

Thread 'Kisspeptin suppression under TRT: Can it affect mood and libido?'

Jul 19, 2020

TD;LR: Kisspeptin may affect how we act and feel. It seems plausible that a TRT-induced reduction in this hormone is a problem for some men.

I’d previously asked if suppression of GnRH by TRT is a problem. The literature at least hints that it is possible. The situation with kisspeptin may be similar. The kisspeptin hormone sits near the top of the male sex hormone cascade. It helps stimulate GnRH production, which in turn leads to LH and FSH, which leads to testosterone and then estradiol. Testosterone and estradiol then provide negative feedback for kisspeptin production in the...

• Cataceous
• kisspeptin libido mood trt
• Replies: 27
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

Via Natesto, the evidence is showing that short-acting testosterone can alleviate the symptoms of hypogonadism. What you won't get is the boost to athleticism seen with the supraphysiological doses used in some forms of conventional TRT, e.g. injecting 100+ mg TC/week. Some appear to get away with these higher doses, at least in the short run, but others experience side effects, which can include high hematocrit, elevated estradiol, impaired libido and sexual function, infertility, etc.

The nasal gels and buccal troches are not the most convenient ways to boost testosterone. I have been researching other forms that could also be short-acting, but so far nothing definitive has come of it. Testosterone suspension seems to have both short and long acting behavior. For me, at least, it requires very low doses to maintain HPTA function, even with the help of exogenous kisspeptin(-10) and GnRH. TNE in oil is a question mark. Possibly it has some promise, but so far nobody has done enough testing to see what's really going on with it. I developed a water-based testosterone solution, but I haven't characterized the pharmacokinetics yet and the subjective results have not been that encouraging.

See also:

C

Thread 'Pharmacokinetic Profile of Testosterone Suspension: A Case Study'

Jun 27, 2025

Lately I’ve been insinuating that some testosterone suspension products may qualify as fast-acting, and therefore be in the same league as testosterone nasal gels and buccal troches. The “fast-acting” quality is important if the goal is to retain HPTA function in the presence of exogenous testosterone. It was time to put my money where my mouth is in order to see what’s actually happening when I inject testosterone suspension.

The results are promising, but not as definitive as I’d hoped for due to some confounding factors.

Materials and Methods

The product used was Pharmacom...

• Cataceous
• pharmacokinetics testosterone suspension
• Replies: 17
• Forum: Testosterone Basics & Questions

• 

 

[Observer]

Verified short-acting forms of TRT at this point include testosterone nasal gel and buccal troches. It appears that absorbing 1-1.5 mg of testosterone via short-acting delivery methods 2-3 times per day does not result in a complete shutdown of the HPTA. I consider this highly desirable, as there are known and likely also unknown negative consequences of the long-term suppression of HPTA hormones, which include kisspeptin, GnRH, LH and FSH.

C

Thread 'Is GnRH suppression hurting us?'

Jan 26, 2020

Admittedly the last thing we need is some other nebulous danger to worry about that may not even exist. Read on at your peril.

TL;DR: Testosterone replacement therapy suppresses the production of GnRH. Receptors for GnRH are found in places besides the pituitary. One animal model suggests GnRH may have health benefits independent of its stimulation of LH and FSH production.

The background: Gonadotropin-releasing hormone, or GnRH, is the signal the hypothalamus uses to tell the pituitary gland to secrete luteinizing hormone and follicle stimulating hormone. Luteinizing hormone (LH)...

• Cataceous
• gnrh hpta suppression
• Replies: 63
• Forum: Testosterone Side Effect Management

• 

C

Thread 'Kisspeptin suppression under TRT: Can it affect mood and libido?'

Jul 19, 2020

TD;LR: Kisspeptin may affect how we act and feel. It seems plausible that a TRT-induced reduction in this hormone is a problem for some men.

I’d previously asked if suppression of GnRH by TRT is a problem. The literature at least hints that it is possible. The situation with kisspeptin may be similar. The kisspeptin hormone sits near the top of the male sex hormone cascade. It helps stimulate GnRH production, which in turn leads to LH and FSH, which leads to testosterone and then estradiol. Testosterone and estradiol then provide negative feedback for kisspeptin production in the...

• Cataceous
• kisspeptin libido mood trt
• Replies: 27
• Forum: When TRT Is Not Enough (ED, Libido, & More)

• 

Via Natesto, the evidence is showing that short-acting testosterone can alleviate the symptoms of hypogonadism. What you won't get is the boost to athleticism seen with the supraphysiological doses used in some forms of conventional TRT, e.g. injecting 100+ mg TC/week. Some appear to get away with these higher doses, at least in the short run, but others experience side effects, which can include high hematocrit, elevated estradiol, impaired libido and sexual function, infertility, etc.

The nasal gels and buccal troches are not the most convenient ways to boost testosterone. I have been researching other forms that could also be short-acting, but so far nothing definitive has come of it. Testosterone suspension seems to have both short and long acting behavior. For me, at least, it requires very low doses to maintain HPTA function, even with the help of exogenous kisspeptin(-10) and GnRH. TNE in oil is a question mark. Possibly it has some promise, but so far nobody has done enough testing to see what's really going on with it. I developed a water-based testosterone solution, but I haven't characterized the pharmacokinetics yet and the subjective results have not been that encouraging.

See also:

C

Thread 'Pharmacokinetic Profile of Testosterone Suspension: A Case Study'

Jun 27, 2025

Lately I’ve been insinuating that some testosterone suspension products may qualify as fast-acting, and therefore be in the same league as testosterone nasal gels and buccal troches. The “fast-acting” quality is important if the goal is to retain HPTA function in the presence of exogenous testosterone. It was time to put my money where my mouth is in order to see what’s actually happening when I inject testosterone suspension.

The results are promising, but not as definitive as I’d hoped for due to some confounding factors.

Materials and Methods

The product used was Pharmacom...

• Cataceous
• pharmacokinetics testosterone suspension
• Replies: 17
• Forum: Testosterone Basics & Questions

• 

Thanks, really fascinating stuff. That gives a non-TRT user like myself a lot to think about, and it's probably information that should be offered to borderline cases for consideration before treatment is started. Especially the questions regarding potential harm from GnRH and kisspeptin suppression. Avoiding HPTA shutdown while extracting the hormonal benefits really does seem to be the holy grail.

I wonder, when utilized as more of an intermittent supplement (1-2x/week) rather than as a daily treatment, do you think something like TNE could be beneficial at select moments when higher testosterone is advantageous, such as before/during/after intense exercise? And do you think the vast amount of trough time between uses would keep the body functioning in its natural capacity?

I realize this wouldn't be a great solution for those who are truly hypogonadal, but perhaps it could be a preferable solution for those who are on the fence whether they're legitimate candidates for full TRT.