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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
New Member Question Re "Standard Range=86.98 - 780.10 ng/dL"?
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<blockquote data-quote="Mr. Clark" data-source="post: 195062" data-attributes="member: 41940"><p><span style="font-size: 15px"><span style="font-family: 'Arial'">I'm 58 years old, generally in good shape. I used to work and run regularly (3-4 times per week) but I've been somewhat limited for about a year due to COVID. I still work out at home with dumbells and run and use a stationary bike several days per week, but these are relatively short workouts/runs/bike sessions. I'm 6'0" about 190 lbs. My weight right now is probably about 10 lbs above my average for the past 20 years (my weight has tended to be quite steady right around 180 lbs).</span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'"></span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'">I have very little sex drive, and I've felt significant fatigue/lethargy the past several years, and difficulty concentrating/staying motivated at work (I'm a lawyer, which requires constant "self starting" to churn through the mountains of documents I face every day). I'd say the decline in sex drive and energy levels started about 6-8 years ago, and it really accelerated the past 2-3 years. I don't really feel depressed, just lethargic. Also, I don't experience the same "runners high" and general sense of well being I used to after running or working out. Now it is just a grind to exercise, and there's little mental boost.</span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'"></span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'">I asked my primary care doctor about a testosterone test, and it came back at 137 ng/dL, with a SHBG of 17.8 nmol/L. Using the Free and Bioavailable T calculator (<a href="http://www.issam.ch/freetesto.htm" target="_blank">Free & Bioavailable Testosterone calculator</a>) results in free T of 3.49 ng/dL = 2.55 %, and bioavailable T of 81.8 ng/dL = 59.7 %.</span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'"></span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'">The test results list Standard Ranges of 21.63 - 113.13 nmol/L for SHBG and 86.98 - 780.10 ng/dL for testosterone. </span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'"></span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'">My doctor says he does not prescribe TRT unless someone is outside the "normal range" (i.e. the "Standard Range" listed with the test results). In other words, my T level would need to be below 86.98 ng/dL. I mentioned my symptoms of lethargy and no sex drive, and my doctor offered to refer me to an endocronolgist. My general impression is that he goes strictly by the numbers for everything, perhaps for fear of having his license suspended or revoked.</span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'"></span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'">Based on a few google searches, it appears to me that the "Standard Range" is for a Siemens ADVIA Centaur testosterone test system. The "Standard Range" is the middle 95% determined according to CLSI EP28-A3c of a group of 137 men between the ages 50-89 (see page 10: <a href="https://www.accessdata.fda.gov/cdrh_docs/pdf15/K151986.pdf" target="_blank">https://www.accessdata.fda.gov/cdrh_docs/pdf15/K151986.pdf</a>)</span></span></p><p> <span style="font-size: 15px"><span style="font-family: 'Arial'"></span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'">First question: does anyone know if this particular Siemens test is accurate? The "Standard Range" seems low*, but it's hard to know if this is because this test produces a lower total T number than other tests, or if the group of 137 men ages 50-89 happened to have lower T on average. Also, it's unclear if there may have been quite a few men near the upper end of the age range, which would push the middle 95% numbers down.</span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'"></span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'">Second question: should I go to an endocronologist, or is this a waste of time?</span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'"></span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'">In general, I just want to get my T back to a middle normal range (hopefully this will help with the lethargy, sex drive, etc.). I've never been able to put on a lot of muscle mass working out, and I'm not trying to pack on a lot of muscle at my age. I could stand to lose 10-15 lbs of fat, but I'm not trying to bulk up.</span></span></p><p></p><p></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'">*For example, one paper lists a range of 215-878 for healthy men ages 50–59 ("Male Testosterone: What is normal?," Barrett-Conor, Clinical Endocrinology 2005;62(3):263–64.)</span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'"></span></span></p><p><span style="font-size: 15px"><span style="font-family: 'Arial'">The American Urological Association "(Evaluation and Management of Testosterone Deficiency (2018)" states: "1. Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone."</span></span></p></blockquote><p></p>
[QUOTE="Mr. Clark, post: 195062, member: 41940"] [SIZE=15px][FONT=Arial]I'm 58 years old, generally in good shape. I used to work and run regularly (3-4 times per week) but I've been somewhat limited for about a year due to COVID. I still work out at home with dumbells and run and use a stationary bike several days per week, but these are relatively short workouts/runs/bike sessions. I'm 6'0" about 190 lbs. My weight right now is probably about 10 lbs above my average for the past 20 years (my weight has tended to be quite steady right around 180 lbs). I have very little sex drive, and I've felt significant fatigue/lethargy the past several years, and difficulty concentrating/staying motivated at work (I'm a lawyer, which requires constant "self starting" to churn through the mountains of documents I face every day). I'd say the decline in sex drive and energy levels started about 6-8 years ago, and it really accelerated the past 2-3 years. I don't really feel depressed, just lethargic. Also, I don't experience the same "runners high" and general sense of well being I used to after running or working out. Now it is just a grind to exercise, and there's little mental boost. I asked my primary care doctor about a testosterone test, and it came back at 137 ng/dL, with a SHBG of 17.8 nmol/L. Using the Free and Bioavailable T calculator ([URL="http://www.issam.ch/freetesto.htm"]Free & Bioavailable Testosterone calculator[/URL]) results in free T of 3.49 ng/dL = 2.55 %, and bioavailable T of 81.8 ng/dL = 59.7 %. The test results list Standard Ranges of 21.63 - 113.13 nmol/L for SHBG and 86.98 - 780.10 ng/dL for testosterone. My doctor says he does not prescribe TRT unless someone is outside the "normal range" (i.e. the "Standard Range" listed with the test results). In other words, my T level would need to be below 86.98 ng/dL. I mentioned my symptoms of lethargy and no sex drive, and my doctor offered to refer me to an endocronolgist. My general impression is that he goes strictly by the numbers for everything, perhaps for fear of having his license suspended or revoked. Based on a few google searches, it appears to me that the "Standard Range" is for a Siemens ADVIA Centaur testosterone test system. The "Standard Range" is the middle 95% determined according to CLSI EP28-A3c of a group of 137 men between the ages 50-89 (see page 10: [URL]https://www.accessdata.fda.gov/cdrh_docs/pdf15/K151986.pdf[/URL]) First question: does anyone know if this particular Siemens test is accurate? The "Standard Range" seems low*, but it's hard to know if this is because this test produces a lower total T number than other tests, or if the group of 137 men ages 50-89 happened to have lower T on average. Also, it's unclear if there may have been quite a few men near the upper end of the age range, which would push the middle 95% numbers down. Second question: should I go to an endocronologist, or is this a waste of time? In general, I just want to get my T back to a middle normal range (hopefully this will help with the lethargy, sex drive, etc.). I've never been able to put on a lot of muscle mass working out, and I'm not trying to pack on a lot of muscle at my age. I could stand to lose 10-15 lbs of fat, but I'm not trying to bulk up.[/FONT][/SIZE] [B][/B] [SIZE=15px][FONT=Arial]*For example, one paper lists a range of 215-878 for healthy men ages 50–59 ("Male Testosterone: What is normal?," Barrett-Conor, Clinical Endocrinology 2005;62(3):263–64.) The American Urological Association "(Evaluation and Management of Testosterone Deficiency (2018)" states: "1. Clinicians should use a total testosterone level below 300 ng/dL as a reasonable cut-off in support of the diagnosis of low testosterone."[/FONT][/SIZE] [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Testosterone Basics & Questions
New Member Question Re "Standard Range=86.98 - 780.10 ng/dL"?
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