Would love some advice on whether I should get TRT?

[gymbunny123]

Hi folks,

I have gone to a few doctors who say my numbers are great for a 30 year old guy. I've tracked my numbers for the past 2 years and have improved them with lifestyle changes (stopped drinking, smoking etc). My total T raised from 450 --> 550 and my free T from 7 --> 9.

I still feel like shit and cannot get a proper hard on. I don't get morning wood and have zero interest in sex. I'm also anxious most of the time with really bad fatigue and low confidence. Looking at the numbers below is this a hormone issue?

Testosterone 550 ng/dl (264-916 ng/dl)
Free Testosterone 9.5 ng/dL (5.05-19.8 ng/dL)
SHBG 43 nmol/L (18.3 - 54.1 nmol/L)
Oestradiol 16 pg/ml (0 - 55 pg/ml)
Prolactin 326 mU/L (86-324 mU/L)
LH 4.9 mU/L (1.7 - 8.6 mU/L)
FSH 1.6 mU/L (1.5 - 12.4 mU/L)

Any advice is appreciated. I'm not on any medications.

 

[captain]

Are you taking any medications?

 

[Vince]

Before you consider going on trt, I would make sure your thyroid levels are all good. I would at least have it checked once, just to rule it out. I would have the TSH, free T4, free T3, reverse T3 and both antibodies checked.

Poor thyroid levels can affect your testosterone levels.

 

[gymbunny123]

Are you taking any medications?

no meds.

 

[gymbunny123]

Before you consider going on trt, I would make sure your thyroid levels are all good. I would at least have it checked once, just to rule it out. I would have the TSH, free T4, free T3, reverse T3 and both antibodies checked.

Poor thyroid levels can affect your testosterone levels.

Thanks - i got some of these checked.

Free T4: 18.85 pmol/l (range: 12-22)
TSH: 2.35 mU/L (.27 - 4.20)

 

[Cataceous]

Calculated free testosterone is about 17 ng/dL, which isn't great on the Tru-T scale of 16-31. Calculated free estradiol is about 0.36 pg/mL, which is also on the low end. So no, your numbers are not "great" for a 30-year-old guy. Maybe you should add in more detailed thyroid testing, including free T3 and reverse T3. But your sex hormones are low enough to be a source of your symptoms.

 

[Vince]

Thanks - i got some of these checked.

Free T4: 18.85 pmol/l (range: 12-22)
TSH: 2.35 mU/L (.27 - 4.20)

Those levels look okay. You probably don't have any thyroid issues. It would have been nice though, if your doctor have given you a complete thyroid panel.

 

[Systemlord]

You more than likely don't have access to accurate testing methods for measuring FT, few do and the direct immunoassay which is inaccurate and overestimates FT levels, so inaccurate testing is being used and your doctors are saying your levels are great. The Tru-T calculator shows your FT at the bottom of the ranges as Catacrous pointed out.

Sadly most doctors are not well informed as to the appropriate testosterone level for a given age and are perfectly fine with a 20 year old and 80 year old scoring the same testosterone level. The 80 year old is more than likely suffering from at least one disease associated with aging and are being comparing to a 30 year old otherwise healthy young man.

Those are pretty low standards, is unacceptable and in 10 years the normal ranges will decrease yet again and a young man with come to this forum and ask the same question you are, I'll tell him his levels are no good and he will respond, but my levels are normal.

When we look at the average, your levels are way below average, your slightly elevated SHBG is making things worse decreasing FT levels, if SHBG was cut in half, TT would drop considerably and your situation wouldn't be that much better because now TT is lower.

Your symptoms are a dead ringer for low testosterone, you've hit all the key symptoms, fatigue and low confidence and no interest in sex. If you're expecting a managed healthcare doctor to be educated on the subject of normal testosterone, think again.

 

[gymbunny123]

Those levels look okay. You probably don't have any thyroid issues. It would have been nice though, if your doctor have given you a complete thyroid panel.

Agreed. Do you think its possible for me to see some sort of a benefit from TRT? I feel like im running out of options!

 

[gymbunny123]

Sadly most doctors are not well informed as to the appropriate testosterone level for a given age and are perfectly fine with a 20 year old and 80 year old scoring the same testosterone level. The 80 year old is more than likely suffering from at least one disease associated with aging and are being comparing to a 30 year old otherwise healthy young man.

Those are pretty low standards, is unacceptable and in 10 years the normal ranges will decrease yet again and a young man with come to this forum and ask the same question you are, I'll tell him his levels are no good and he will respond, but my levels are normal.

When we look at the average, your levels are way below average, your slightly elevated SHBG is making things worse decreasing FT levels, if SHBG was cut in half, TT would drop considerably and your situation wouldn't be that much better because now TT is lower.

appreciate that Systemlord (great name btw!). What options do I have in your opinion? Im willing to do almost anything at this stage.

 

[Systemlord]

You need to locate a doctor that specializes in fixing hormonal problems, you need to look at an anti-aging or sports medicine doctor.

It's difficult to recommend a specific course of action because your location will determine your options.

 

[captain]

Maybe check for an adrenal problem. Adrenals can cause bad fatigue and anxiety.

 

[gymbunny123]

Maybe check for an adrenal problem. Adrenals can cause bad fatigue and anxiety.

I think that would mean low blood pressure and weightloss aswell. I dont have those. My main issue is libido and erections. My free T may be affecting this.

 

[captain]

Dr. Crisler and others have said they look at DHEA when there is a libido problem. DHEA is an adrenal hormone.