Testosterone: "Normal" test numbers, and what they mean?

[hdrider]

I am 51 years old and experiencing symptoms of low T. I have read Nelson Vergel's very helpful book, but I am still unclear about whether my T is low, based on my test results. My doctor did a T test last year upon my request (before I had any idea that TRT was even a mainstream option). He assured me that I have a "normal" T level. I asked him for the numbers. They are:

Testosterone Total 479 (range 250-1100)
Testosterone Free 97.6 (range 35-155)

(I don't understand why the Free T number does not correspond to the scale generally shown, between 9 and 26)

I have had ED problems for a few years. Initially Cialis (daily) worked great. However it has gradually stopped working, and over the last 6 months my sex drive is way down too.

I am in very good shape, not overweight, don't smoke, drink 2 or less drinks per day, exercise regularly with weights and cardio in addition to a job which keeps me very active, and am not depressed. I am HIV-. The only health problem I have had is elevated blood glucose, up to 117, now down to 105 at last test, by maintaining a very healthy diet and avoiding all sweeteners and limiting carbohydrates.

I am about to go back to my doctor for another physical, and I am going to be more aggressive about trying to get a solution to my ED and low libido. I am going to request another T test as well, however if it comes back "normal", then I have a feeling the doc is again going to tell me that T is not the problem because it's "normal".

So could a man have a T test of 479 and still benefit from additional T?
Are there any other tests that I could request a general practitioner to run to shed more light on the problem, before consulting a specialist?

I want to be as informed as possible before the doctor visit, so I can get maximum value from it. I also want to keep my current doc as my GP, but want to see a specialist for TRT or other related treatments if warranted, without creating resistance from him, which may be tricky.

 

[Nelson Vergel]

Hdrider

Thanks for your kind words about my book.

Insurance companies will not pay for any total testosterone over 350 ng/dl nowadays. It used to be easier but it is getting much more difficult for doctors to prescribe if you want insurance reimbursement. However, if you get a prescription for a compounded testosterone injection or cream you do not have to deal with the insurance police. The cost is pretty much close to what you would pay as copay if you were to use insurance.

Even a fasting glucose of 105-117 can create ED issues. Even though you are not overweight and are obviously taking care of yourself, you may have insulin resistance.

Will a testosterone blood level of over 700 ng/dL help you? It may but there is no way to find out unless you try. For older men as ourselves, testosterone has been shown to improve sexual drive but the ED data is all over the place. Some of us also take 5 mg twice a day of Cialis (some do OK with 5-10 mg once a day) plus HCG while on TRT to really get the erectile hardness we are seeking. Some men who still do not get the erection results they seek even with that protocol may chose to use TRIMIX, which has a efficacy rate of close to 100 percent if used right.

By the way, free testosterone is usually 2-4.5 percent of total. Yours seems really high. But we also know that those with hyperglycemia have low sex hormone binding globulin, so that may be the reason.

 

[hdrider]

Thanks, Nelson.

I'm not too concerned about getting insurance to pay for anything. I'm self-employed and the only insurance that has been available has had a deductible of $2,000 per year, which now will raise to $6,000 per year with the affordable care act. It only covers basic wellness care (annual physical, immunizations, etc.) until I expend $6K out of pocket.

So the most important thing right now is to figure out what is the right thing to do for my health and well-being. Then I can worry about how I can pay for it.

By the way, free testosterone is usually 2-4.5 percent of total. Yours seems really high. But we also know that those with hyperglycemia have low sex hormone binding globulin, so that may be the reason.

So that would be good right? More free testosterone should be helping me rather than hurting me?

 

[Nelson Vergel]

Yes, more total and free can be good as long as your doctor helps you manage hematocrit, PSA, blood pressure, estradiol, and acne. Many guys are able to keep TT and FT levels in the upper side of the range without any side effects.

 

[Gene Devine]

hdrider - My advise to you is to find an excellent anti aging Physician in your area particularly one who is A4M accredited.

This type of Physician is on the cutting edge of interventional medicine and may be your best bet for the proper evaluation of your symptoms and getting the correct care.

 

[hdrider]

Thanks. When I see my doctor I will ask him for recommendations, however he may not be very knowledgeable in this subject matter.
Any recommendations for places to look in Chicago, along with the reasons you would recommend? A quick google search brings up tons of places nearby, but I have no idea whether they are just handing out T or are actually doing a proper evaluation.

 

[Gene Devine]

If I lived in Chicago I'd go see Dr. Robert Goldman, MD.

http://drbobgoldman.com/

 

[Dave Barry]

It's laughable to use the world "Affordable," in the same sentence as noting that your deductible has increased $4,000/year.

 

[hdrider]

Dave I don't want to turn this political, but as a self-employed person I am FAR better off now with the affordable care act than I was before.

Before, every couple of years my health insurance was cancelled, and I had to re-apply. Luckily I had no health problems because if I did, they would have likely excluded it as a pre-existing condition, or denied me coverage entirely. On top of that, I only had about 3 plans available to choose from and they were very difficult to compare. Many people I know could not find coverage at any price, because they had some type of problem. Now all that is in the past.

The new health insurance marketplace gives me a choice of 61 different plans from several different companies, and they are all laid out so I can compare them. Some have lower deductibles, but taking everything into account, the one I am choosing looks like the best for me. My monthly premiums for health insurance are going to drop very significantly under the ACA, and I will be able to keep my same doctor.

I still will probably end up paying most of my costs out of pocket unless I have a major health issue, but that's no different than it was before. For those of you that get health insurance provided by your employer: Count your blessings.

 

[Dave Barry]

Hdrider,

I am self-employed as well and pay for my own coverage. First of all, what kind of coverage did you have that it was cancelled every couple of years? I'm glad that Obama's plan is working for you as you are one of the few people I have heard that are saying that. My plan from BCBS (of ten years running) is being cancelled in 7 months, due to the fact that it does not cover sex change operations or pay for maternity care for me so my plan is not good enough. Keep in mind that my plan paid for $187,000 worth of bills for 2013, at the total cost of $900 above my monthly premiums. Similar coverage (granted, I can have a sex change operation and will be covered in the maternity ward if I become pregnant so in theory it is better), is astronomically higher per month, with a higher deductible based upon my current income. I am truly happy that the new plan has worked out for you, but personally, I am getting screwed. Regardless, you are correct, this is not the place for political debate as I could go on for hours about this subject. The bottom-line is that I hope when it's all said and done that the average U.S. citizen is better off.