Normal free but low total. Doctor recommends TRT.

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Background: 25 year old male, 5'10'', 190lbs, body fat 18% or so (eye test), reasonably active (lift weights 4-5 times per week), sleep is decent (7-8hrs of sleep fairly consistently).

I have done two sets of bloodwork (both early in the day) spaced about 5 months apart. Relevant numbers:

• Total test: 324->343 ng/dl.
• Free test: 18->18.5
• FSH: 2.7->3.4
• LH: 2.5->5.6
• SHBG: 15->15.4

Any comments on how this looks? My doctor suggests TRT based on the increased FSH and LH but low total T. Given that my free T is normal, though, would these numbers merit TRT?

 

[Systemlord]

• Total test: 324->343 ng/dl.
• Free test: 18->18.5
• FSH: 2.7->3.4
• LH: 2.5->5.6
• SHBG: 15->15.4

Any comments on how this looks? My doctor suggests TRT based on the increased FSH and LH but low total T.

What are the reference ranges for the Free T and what testing method was used to measure the Free T?

The direct immunoassay is inaccurate and shouldn't be relied upon for accuracy, the equilibrium dialysis is more accurate.

I haven't seen you mention a single symptom of low testosterone.

Given that my free T is normal, though, would these numbers merit TRT?

Recommendations on the diagnosis, treatment and monitoring of hypogonadism in men

Hypogonadism or Testosterone Deficiency (TD) in adult men as defined by low levels of serum testosterone accompanied by characteristic symptoms and/or signs as detailed further on can be found in long-recognized clinical entities such as Klinefelter syndrome, ...

www.ncbi.nlm.nih.gov

Unfortunately, no consensus has been reached regarding the lower TT threshold defining TD, and there are no generally accepted lower limits of normal TT [60]. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not.

Meanwhile the number of CAG (cytosine–adenine–guanine triplet) repeats in androgen receptor differs in men and influences the androgen receptor activity [61–64] (Figure 1). Hence testosterone sensitivity may vary in different individuals.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men: A Locally Weighted Regression Analysis - PubMed

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold...

pubmed.ncbi.nlm.nih.gov

Testosterone Week: What's a "Normal" Testosterone Level and How to Measure Your T

 

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Your TT is really low. TF is more than 5% of TT, which seems to me not real. Bad symptoms, consistent with low TT?