test 720, what now?

[jim876]

I signed up for blood work through defy and have my labs back, and it seems to show my natural test level is normal:

Testosterone 720 ng/dL (348 - 1197)
Free Test 18.8 ng/dL (6.8 - 21.5)
Estradiol Sens 17.7 pg/Ml (8.0 - 35.0)

I haven't had an appointment with the doctor to discuss the results yet, but what should I expect? Is this something a TRT clinic would treat, or does this show that Low-T really isn't what I have?

My main symptom is inability to gain muscle and/or lose fat when lifting weights. Although I'm also usually tired and feel like I've never quite gotten enough sleep.

If I eat a calorie surplus I do gain a little muscle along with far too much fat. Then when I switch to a calorie deficit all my muscle gains quickly melt away while the fat lingers and eventually reduces to my baseline level. So roughly speaking the gains during my "bulking" phase are 50% muscle and 50% fat, then when I "cut" I lose 50% fat and 50% muscle, thus ending exactly where I started.

I can follow any meal plan, I know how to track calories and macros, and I know how to lift on an established routine. I understand how weight lifting with bulk/cut phases is supposed to work, and for me it flatly doesn't (5+ years)

I've read a few stories here and elsewhere about people with low testosterone having the same issue and then finding with TRT that suddenly lifting weights actually works. But those stories are often people who test at maybe 250. How high does testosterone need to be to achieve decent results in the gym. And by "decent results" I don't mean steroid sized results, I mean any gains at all in body composition. And with me at 720 will I be a candidate for TRT?

 

[CSI007]

Candidate for TRT? If you have no other symptoms then I would say no. How old are you? Your T levels look good for someone in their 30s and 40s.

 

[Vince Carter]

I would say your not an HRT candidate but your tests could reveal Thyroid or possible even Adrenal issues that need attention...they tested more than what you're showing us, please post or attach the full results and we can get some discussion on the other issues that might be present.

 

[Henry]

Damn, I would kill to have those natural levels.

 

[AbsoluteZ3R0]

It's extremely unlikely that testosterone is the root of your issues (your natural levels are excellent). As others have mentioned, it may come down to some other issue.

 

[jim876]

Yeah, I guess it's not low. It just seems like I've read of people being naturally 200ish and boosting to over 1000, and it's a little frustrating to be at 720 but have no means to boost further. I'm already using supplements like creatine and d-aspartic acid and heavy lifting that should already be nearly maxing out my natural values. Although admittedly maybe that's not the problem and maybe I don't need to boost further (age 43 fwiw).

I feel weird about posting my whole lab, although being anonymous maybe I shouldn't.

My thyroid level is maybe a little high at
TSH 3.1 uIU/mL (0.45 - 4.5)

But I guess I should just schedule a visit with the Dr first. I just wanted some idea if I should go in expecting TRT treatment in hopes of boosting me from the middle of the range to the top of the range, and it sounds like that wouldn't be the usual course.

 

[madman]

Yeah, I guess it's not low. It just seems like I've read of people being naturally 200ish and boosting to over 1000, and it's a little frustrating to be at 720 but have no means to boost further. I'm already using supplements like creatine and d-aspartic acid and heavy lifting that should already be nearly maxing out my natural values. Although admittedly maybe that's not the problem and maybe I don't need to boost further (age 43 fwiw).

I feel weird about posting my whole lab, although being anonymous maybe I shouldn't.

Nothing to be ashamed of you are just looking for advice. As others have stated 720tt with free t in the upper end most at your age would be ecstatic to have those natural levels. If someone were between 200-400 they would definitely notice a difference especially with body composition changes when training but as far as going from 700-1000+ high end of normal physiological range not so much regarding muscle growth. Would not be worth shutting down your endogenous t let alone dealing with the commitment as trt has worked wonders for many but there are also those that feel worse off and struggle in the long run. When one wants to go beyond the so called natural genetic limit supra-physiological doses of testosterone/aas would provide far greater benefits in relation to muscle mass/strength gains than having high/normal physiological levels. Poor diet/lack of sleep/over training can all throw a wrench in ones progress. You need to look into things deeper to see if other hormones related to thyroid/adrenals are optimal.

 

[Systemlord]

I agree with Vince Carter, your blood work (minus thyroid numbers) looks fantastic for a 43 year old! It's quite clear if you having a problem it isn't your testosterone causing problems.

 

[Vince Carter]

No responsible practitioner is or should be putting you on T with those numbers.

Now that you've provided TSH...it's indeed high, you should retest that to verify and if it's still >2.0 add in more tests like T3, T4, Free T3, Reverse T3, and antibodies.

 

[Esq]

I can relate. I'm 36, and my natural levels (as of February) are 702 total and and 17.5 free. I also can relate to your comments about body composition. I have strugged with the same. I eat at a 10-15% surplus with perfect macros and devoted commitment to tried and true training programs and gain mostly fat, a little muscle, and fail to get much stronger. Then, I eat at a 10-15% deficit, lose what little strength and muscle I gained, and retain much of the fat. I've seen little progression in the big lifts (squat, deadlift, and bench press) in over two years despite training regularly, and almost no overall changes in body composition regardless of whether I'm 145 pounds or 175 (at 5'9"). I either look skinny-fat or chubby. It is extremely frustrating.
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That, coupled with fatigue, lack of motiviation, difficulty concentrating, low libido, and a host of other symptoms, is what brought me to Defy earlier this year. At your levels, you still may be a candidate. Defy has made clear it is an option for me and that my levels don't "disqualify" me. I find it ironic that so many people on TRT forums say "treat the symptoms, not the numbers," but apparently that doesn't apply if one's numbers are above whatever threshold the person believes is "good," regardless of symptoms. Sure, 702 is considered "good" by most, but I feel like shit most of the time. I don't care about the numbers, I care about feeling better. I don't want to go on TRT without trying everything else, but I also refuse to rule it out just because my natural level is above 700.
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With all of that said, I highly recommend you avoid even considering TRT until you've examined all other potential causes of your symptoms and explored other treatments. In my case, I have been on clomid for some 6 months (along with anastrozole and then exemestane to treat high-ish e2). While clomid caused my levels to go through the roof, it did not alleviate my symptoms (other than a brief honeymoon spell about a week in). Thyroid issues have been ruled out, though we are monitoring cortisol levels to see whether there are adrenal issues. I'm also having a sleep study done next week to rule out sleep apnea.
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I am stopping clomid immediately after my consult with Dr. Saya this morning. After 6 weeks, we'll retest the numbers again to see where they land once the clomid is out of my system. Depending on that, and the results of the sleep study, if I remain symptomatic then Dr. Saya said I can try a 6 month trial of TRT to see how I respond. I'm not sure whether I will regardless of what happens over the next 6 to 8 weeks, and he cautioned that even with a short 6 month trial there is no guarantee I'll return to my pre-TRT natural levels, but the point is that I am a "candidate" for TRT with Defy, even with natural levels some would consider quite good.
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Work with Defy, rule out any and all other potential causes of your symptoms and try whatever non-TRT treatments they suggest. If nothing else works, then giving traditional TRT a try may be an option.
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I'm sure many will disagree, but I'm sympathetic to your situation.

 

[AbsoluteZ3R0]

I can relate. I'm 36, and my natural levels (as of February) are 702 total and and 17.5 free. I also can relate to your comments about body composition. I have strugged with the same. I eat at a 10-15% surplus with perfect macros and devoted commitment to tried and true training programs and gain mostly fat, a little muscle, and fail to get much stronger. Then, I eat at a 10-15% deficit, lose what little strength and muscle I gained, and retain much of the fat. I've seen little progression in the big lifts (squat, deadlift, and bench press) in over two years despite training regularly, and almost no overall changes in body composition regardless of whether I'm 145 pounds or 175 (at 5'9"). I either look skinny-fat or chubby. It is extremely frustrating.
.
That, coupled with fatigue, lack of motiviation, difficulty concentrating, low libido, and a host of other symptoms, is what brought me to Defy earlier this year. At your levels, you still may be a candidate. Defy has made clear it is an option for me and that my levels don't "disqualify" me. I find it ironic that so many people on TRT forums say "treat the symptoms, not the numbers," but apparently that doesn't apply if one's numbers are above whatever threshold the person believes is "good," regardless of symptoms. Sure, 702 is considered "good" by most, but I feel like shit most of the time. I don't care about the numbers, I care about feeling better. I don't want to go on TRT without trying everything else, but I also refuse to rule it out just because my natural level is above 700.
.
With all of that said, I highly recommend you avoid even considering TRT until you've examined all other potential causes of your symptoms and explored other treatments. In my case, I have been on clomid for some 6 months (along with anastrozole and then exemestane to treat high-ish e2). While clomid caused my levels to go through the roof, it did not alleviate my symptoms (other than a brief honeymoon spell about a week in). Thyroid issues have been ruled out, though we are monitoring cortisol levels to see whether there are adrenal issues. I'm also having a sleep study done next week to rule out sleep apnea.
.
I am stopping clomid immediately after my consult with Dr. Saya this morning. After 6 weeks, we'll retest the numbers again to see where they land once the clomid is out of my system. Depending on that, and the results of the sleep study, if I remain symptomatic then Dr. Saya said I can try a 6 month trial of TRT to see how I respond. I'm not sure whether I will regardless of what happens over the next 6 to 8 weeks, and he cautioned that even with a short 6 month trial there is no guarantee I'll return to my pre-TRT natural levels, but the point is that I am a "candidate" for TRT with Defy, even with natural levels some would consider quite good.
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Work with Defy, rule out any and all other potential causes of your symptoms and try whatever non-TRT treatments they suggest. If nothing else works, then giving traditional TRT a try may be an option.
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I'm sure many will disagree, but I'm sympathetic to your situation.

I think we are all in agreement with Defy's methodology, however, the conclusion we've arrived at is that if your natural levels are 700+ with free testosterone in the upper range, then testosterone is almost certainly not the cause of your issues. I remember your initial post. You are a lawyer, correct? In any case, assuming all else fails, Defy is offering you trt as a last resort because it makes just about everyone feel better. There is a very good chance that you don't need it and that it won't reverse whatever symptoms you are experiencing, but it will almost certainly result in overall improvement anyway. If I were in your shoes and I knew that trt would make me feel even 5% better (after ruling everything else out), I would go for it.

 

[Esq]

I think we are all in agreement with Defy's methodology, however, the conclusion we've arrived at is that if your natural levels are 700+ with free testosterone in the upper range, then testosterone is almost certainly not the cause of your issues. I remember your initial post. You are a lawyer, correct? In any case, assuming all else fails, Defy is offering you trt as a last resort because it makes just about everyone feel better. There is a very good chance that you don't need it and that it won't reverse whatever symptoms you are experiencing, but it will almost certainly result in overall improvement anyway. If I were in your shoes and I knew that trt would make me feel even 5% better (after ruling everything else out), I would go for it.

Yes, I am a lawyer, but I don't see how that's relevant. (See what I did there?) All kidding aside, what you said is more or less what I was trying to say in my post, but perhaps the point did not come across. I'm not trying to argue that I (or the OP) suffer from hypogonadism or clinical low testosterone, but if treating the symptoms is the mantra, my symptoms line up quite nicely.
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Like I said above, I'm still very undecided on whether I'll give TRT a try (and that decision certainly will wait until after my sleep study), but as you said, if there is a chance TRT will help me feel more like a healthy guy in his mid-30s and less like a worn out, out-of-shape guy twice that, I will give it a hard look. I'm comfortable with that because I feel like I've ruled out many other potential causes.
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I'm sure others can relate, but it is extremely frustrating to do all the right things from a sleep, exercise, diet, and lifestyle standpoint and feel this way. I know how I used to feel, and to be honest I felt significantly better when I was in my 20s and did all the wrong things from a sleep, exercise, diet, and lifestyle standpoint. And I refuse to chalk it up to just "getting older."

 

[madman]

Body composition, gaining muscle/losing fat are the only symptom the op described and should be no reason for any doctor not matter how experienced to treat a patient with trt that had labs resulting in a 700+ tt with a free t in the upper range. Sure someone with truly low t or borderline low t 200-350 that started trt and had their levels increase to the upper end 1000-1200(which is being lowered next week to 900+) would definitely notice improvements in body composition changes but going from a 700+ tt to 1000+ highly doubtful there would be a drastic difference in muscle gains and unless the op had borderline or low free t than highly unlikely testosterone is his issue. I am not aware of any literature stating that patients without low t symptoms such as low energy/low libido/ed/mood issues that have healthy total t/free t are candidates for trt treatment based solely on inability to gain muscle/loose fat. Would seem unethical to me to shut down a persons natural production with his lab results just to attain improvements in body composition. There are also a lot of things to think about as if he decides to start trt hematoctit/hemoglobin will increase and he may need to start donating blood,e2 will increase so he may end up needing an A.I which could cause further issues to deal with and he will be shutting down his hpta so no more lh/fsh and may need to start using hcg. Considering all this there are some who will feel worse overall and struggle to always find that sweet spot let alone dealing with libido/ed issues which can happen. Sure many feel way better on trt like night/day but it is not a given. I am all for improving ones health and feeling the best they can but with his levels he should be looking into many other factors especially regarding muscle/fat loss.

 

[jim876]

Thanks, I agree about not taking TRT lightly and me likely not being a candidate. We'll see what other avenues the Dr might suggest.

 

[Esq]

Agree entirely madman. If body comp is the only issue, then TRT is not the answer. I only meant that when multiple symptoms are present and most other causes and treatments are ruled out, TRT might be an option worth trying even with acceptable natural levels. Put another way, OP's natural levels might not automatically disqualify him if other symptoms are present and other methods are tried first. I'm certainly not advocating TRT just to improve body comp in men with generally healthy levels.

 

[ryox82]

With your body comp issues, have you tried following a keto style diet at maintenance and let it ride for a few months?

 

[British Indian Guy]

Interesting thread! I read about a guy who had this condition:https://en.wikipedia.org/wiki/Mild_androgen_insensitivity_syndrome

MAIS. Men with this condition have high testosterone levels but have symptoms of low testosterone. They actually need supraphysiological testosterone levels to feel normal. It is very rare though.

 

[DLK]

Main symptom, Not able to build muscle or lose fat: Is it possible the effort you put into your workouts is lacking?

 

[Garme]

@dlk tstosterone builds muscle easily even before working out so thats unlikely reason

 

[CoastWatcher]

@dlk tstosterone builds muscle easily even before working out so thats unlikely reason

No one is disputing that testosterone contributes to the development of muscle, but the member is not in exogenous testosterone (and TRT at therapeutic levels isn't going to produce the results one would see if a cycle is being run). I think DLK raised a fair question.