Seeking sanity check on doc's advice to start TRT

[plasmanut]

Hey guys, new here. I'm hoping to get a sanity check before I move any further into TRT.

I'm 53 and fighting classic low T symptoms the last 3-4 years. I've put a lot of effort into improving diet, cardio, and resistance training but not seeing changes in these symptoms. Seven years ago I was diagnosed with ED (which Silldenafil helps somewhat), but in the last 3 noticed a big shift in body composition from muscle to abdominal fat. Increased resistance/core training at that point but haven't seen results but has progressively gotten worse. I've also had other classic symptoms of lower libido and losing motivation in hobbies and socializing.

A few weeks ago I had a physical and blood work with my primary care doc who did a hormone panel. Even though my numbers were all in range, he is recommending TRT as an option based on an above average SHBG value (120mg/week test cypionate administered twice weekly).

He's seen this in other patients and it has helped. He also mentioned the LH/FSH are high which tells him the body is signalling it needs more T but is not producing.

Here are my labs (Labcorp):
Total T: 564 ng/dL (Range: 219-916)
SHBG: 55.8 nmol/L (Range: 19.3-76.4)
Free T (calc): 81.7 pg/mL (Range: 35.8-168.2)
LH: 7.0 mIU/L (Range:1.7-8.7)
FSH: 10.8 mIU/L (Range: 1.5-12.4)
Estradiol: 23.0 pg/mL (Range: 7.6-42.6)
PSA: 0.3 ng/mL
Hematocrit: 40.2%

Based on this, a couple of questions:

• Does this course of treatment make sense for me with his notion of high SHBG?
• Would it be wise to get a second opinion?
• Would a 3 month trial allow me to determine if this is working and would it also be reversible if not?

Thanks a bunch.

 

[Phil Goodman]

1.) hard to tell from limited information. Your levels “look” good on paper, but that doesn’t mean there isn’t an issue. A starting dose of 100-120 is reasonable and usually results in a good spot for most patients, so from that perspective it makes sense… but again there could be other issues causing your problems.

2.) a 2nd opinion wouldn’t hurt, but what if they say you’re fine or that test isn’t the issue? Then you’d need a 3rd opinion to break the tie of just be left to break it on your own.

3.) 3-6 months should be enough time to determine whether testosterone would help with energy, motivation, sex drive, and body composition. If you stop after six months there would likely be somewhat of rough transition but that is unique to each person. Some have a really tough time and some bounce back to pre-trt with little to no issues.

 

[madman]

Hey guys, new here. I'm hoping to get a sanity check before I move any further into TRT.

I'm 53 and fighting classic low T symptoms the last 3-4 years. I've put a lot of effort into improving diet, cardio, and resistance training but not seeing changes in these symptoms. Seven years ago I was diagnosed with ED (which Silldenafil helps somewhat), but in the last 3 noticed a big shift in body composition from muscle to abdominal fat. Increased resistance/core training at that point but haven't seen results but has progressively gotten worse. I've also had other classic symptoms of lower libido and losing motivation in hobbies and socializing.

A few weeks ago I had a physical and blood work with my primary care doc who did a hormone panel. Even though my numbers were all in range, he is recommending TRT as an option based on an above average SHBG value (120mg/week test cypionate administered twice weekly).

He's seen this in other patients and it has helped. He also mentioned the LH/FSH are high which tells him the body is signalling it needs more T but is not producing.

Here are my labs (Labcorp):
Total T: 564 ng/dL (Range: 219-916)
SHBG: 55.8 nmol/L (Range: 19.3-76.4)
Free T (calc): 81.7 pg/mL (Range: 35.8-168.2)
LH: 7.0 mIU/L (Range:1.7-8.7)
FSH: 10.8 mIU/L (Range: 1.5-12.4)
Estradiol: 23.0 pg/mL (Range: 7.6-42.6)
PSA: 0.3 ng/mL
Hematocrit: 40.2%

Based on this, a couple of questions:

• Does this course of treatment make sense for me with his notion of high SHBG?
• Would it be wise to get a second opinion?
• Would a 3 month trial allow me to determine if this is working and would it also be reversible if not?

Thanks a bunch.

Your TT is inflated due to your high SHBG and your free T the most critical fraction which was calculated using the linear law-of-mass action Vermeulen is sitting around 8 ng/dL which falls in what is known as the grey zone.

Most healthy young natty males would be hitting a cFTV 13-15 ng/dL and this would be a daily short-lived peak to boot!

140226: Testosterone Free, Profile I

Labcorp test details for Testosterone Free, Profile I

www.labcorp.com

FT <5 ng/dL would be considerd low.

FT 5-9 ng/dL would be considered the grey zone where some men may experience symptoms of low-T.

FT 10-15 ng/dL would be healthy.

FT 20-25 ng/dL would be high-end/high.

Even then you never had your FT tested using the most accurate assay which would be the gold standard Equilibrium Dialysis.

The only way to know where your FT truly sits is to have it tested using the most accurate assay ED especially in cases of altered SHBG.

Although cFTV will give a good approximation it tends to slightly overestimate so chances are your FT is lower than 8 ng/dL.

Dr. Morgentaler who is considered the father of testosterone with decades of experience (research/clinical experience) in the field would treat a man with symptoms of T deficiency and a FT<10 ng/dL.

Any doctor in the know would tell you the same!

You would definitely be a candidate for a 3-6 month trial and putting in 6 months would be ideal!

If you ver decided to stop you will go back to baseline.

If anything you can retest your FT using the gold standard ED if you are convinced that your FT needs to be lower before jumping on exogenous T.

You can easily pay out of pocket and use Nelson's discounted labs as it would be the most cost effective option.

Testosterone, Free (Equilibrium Dialysis) and Total, MS | Discounted Labs

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

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Otherwise you can use Labcorp or Mayo Clinic.

500726: Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences)

Labcorp test details for Testosterone, Free, Mass Spectrometry/Equilibrium Dialysis (Endocrine Sciences)

www.labcorp.com

https://www.mayocliniclabs.com/test-notifications/attachment.php?id=73010

Your LH/FSH are on the high-end but not really high.

Even then your hematocrit is sitting in the basement and chances are your ferritin/iron is low or it could be due to sub-par FT.

I would test your ferritin, serum iron, TIBC/transferrin saturation.

If you end up starting therapy the standard starting dose across the board by those in the know is 100 mg T/week or 50 mg T split twice-weekly.

No need to jump in at 120 mg T/week.

There will always be time to increase the dose/manipulate injection frequency or add in hCG if need be.

Always best to start low and go slow on a T-only protocol so you can see how your body reacts to testosterone and where said protocol (dose T/injection frequency) has your trough TT and more importantly FT, estradiol and critical blood markers RBCs, hemoglobin and hematocrit.

Your hematocrit is already sitting in the basement so you would not have to worry about driving it up too high!