40M - Here's my bloodwork and situation - should I do it?

[gonads11]

M40 - don't want any more kids. generally active. healthy weight and overall healthy.

The bad:
- High high stress/anxiety job
- Constantly exhausted and need coffee
- Sleep is poor
- When I work out I feel sore and tired and my brain won't work for at least 2 days
- absolutely zero libido and want to have sex with my girlfriend (causing issues)
- just a general feeling of old/tired/lethargic/no motivation
- No energy and don't want to do anything in my free time just be on couch

The numbers:
- consistently high SHBG eats up all my free testosterone
- consistently high LH

I read that anything under 10 free testosterone with symptoms is considered a candidate.

I just want to feel like a strong, capable man for me and my family.

I'm going to a TRT specialist doc today.

Thoughts/experiences anyone been in same situation?

 

[gonads11]

Oh forgot - Prolactin and PSA and all other bloods normal as well.

 

[t_spacemonkey]

I was. at 42 /high stress/anxiety job (high tech), no libido, took a week to recover from a hard gym day. TRT was a life changer.
now, as a side note, the note that your shbg eats up all your T has really no basis, as in this is a cause of any of your symptoms. your free T is definitely low, I would highly expect that **proper** TRT will improve your life.

 

[gonads11]

I would highly expect that **proper** TRT will improve your life.

Thankyou so much. This is very helpful. By proper TRT are you saying something like
100mg/week cyp + HCG?

This is what I'm looking to start with. The clinic I visited was terrible. Dr had no idea what he was talking about - and only injects once every 2 weeks and wanted to prescribe HGH as well. I ran.

 

[t_spacemonkey]

Thankyou so much. This is very helpful. By proper TRT are you saying something like
100mg/week cyp + HCG?

This is what I'm looking to start with. The clinic I visited was terrible. Dr had no idea what he was talking about - and only injects once every 2 weeks and wanted to prescribe HGH as well. I ran.

protocol is highly individual, most guys run 120-180mg Tcyp/weekly range. some do great on HCG some don't. you need to do trial and error. for someone like me, with single digit shbg, Tprop at a daily dose of ~30mg is where i feel best, which is high end dose, with 3x1000IU HCG/week. but this might not be you. with high shbg you might be ok with a different protocol. i think the key is to find a clinic which is willing to work with HOW YOU FEEL and not what your lab numbers look like

 

[Systemlord]

- consistently high SHBG eats up all my free testosterone

This isn't how it works, SHBG doesn't lower Free T, SHBG has no influence on testosterone production. LH is the determining factor and the testicles response to stimulation.

Your testicles aren't getting the job done indicated by your high LH. Basically your pituitary gland is screaming at your testicles to start producing more T, but that isn't happening.

 

[madman]

View attachment 46379


M40 - don't want any more kids. generally active. healthy weight and overall healthy.

The bad:
- High high stress/anxiety job
- Constantly exhausted and need coffee
- Sleep is poor
- When I work out I feel sore and tired and my brain won't work for at least 2 days
- absolutely zero libido and want to have sex with my girlfriend (causing issues)
- just a general feeling of old/tired/lethargic/no motivation
- No energy and don't want to do anything in my free time just be on couch

The numbers:
- consistently high SHBG eats up all my free testosterone
- consistently high LH

I read that anything under 10 free testosterone with symptoms is considered a candidate.

I just want to feel like a strong, capable man for me and my family.

I'm going to a TRT specialist doc today.

Thoughts/experiences anyone been in same situation?

Your FT was most likely tested using the calculated method as the linear law-of-mass action cFTV would have your FT 9.87 ng/dL if your Albumin sits at 4.97 g/dL.

Most healthy young males are hitting a cFTV 13-15 ng/dL and this is a short-lived peak.

Trough would be 20-25% lower.

The only way to know where your FT truly sits is to have it tested using what would be considered the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG.

Keep in mind if you had your FT tested using the most accurate assay the gold standard Equilibrium Dialysis it would most likely be a little lower as cFTV tends to overestimate slightly when compared against a higher order reference method/standardized ED assay.

Might be hitting around 7 ng/dL and even than it would not be flagged as low but it is subpar.

Regardless your FT is subpar as you are experiencing symptoms.

If you end up jumping on TTh the common starting dose is 100 mg T/week or better yet 50 mg T twice-weekly (every 3.5 days).

Always best to start low and go slow on a T only protocol as we want to see how your body reacts to testosterone and where said protocol (dose of T/injection frequency) has your trough FT let alone other critical blood markers such as RBCs, hemoglobin and hematocrit once your blood levels have stabilized (4-6 weeks TC/TE).

You will always have time to increase your dose let alone add in hCG if need be.

Proceed with caution when it comes to who treats you as many of those dime a dozen run of the mill T-clinics will jack your T off the hop let alone throw in an AI to boot!

The majority of men can easily hit a healthy let alone high trough FT injecting 100-150 mg T/week especially when split into more frequent injections.

Yes there are some outliers who may need the higher-end dose 200 mg T/week but it is far from common as in RARE!

Again best piece of advice is to start low and go slow on a T-only protocol!

Patience is key!

Age-stratified reference ranges for directly measured (ED LC-MS/MS) serum free testosterone in healthy men

Just to be clear up any confusion this is Fiers camps data for mFT reference ranges not the harmonized reference range being worked on by the CDC. *Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies * mFT...

www.excelmale.com

We present 95% mFT age-stratified reference ranges

Age category (years)	Median mFT (ng/dl)	95% mFT reference range (ng/dl)
25-29 (n=148)	10.3	5.6 - 17.1
30-39 (n=252)	9.7	4.9 - 18.1
40-49 (n=207)	8.0	4.3 - 13.5
50-59 (n=146)	7.0	3.8 - 12.6
60-69 (n=114)	5.9	3.3 - 11.9

*The gold-standard for the determination of FT levels is considered to be directly measured free testosterone (mFT) using equilibrium dialysis followed by mass spectrometry (ED LC-MS/MS). However, no widely accepted reference ranges are available for this clinical parameter. We established mFT reference ranges for healthy men aged 18 to 69 years


*Serum samples were analyzed from healthy men participating in the SIBLOS/SIBEX and EMAS studies, both population-based cohort studies


* mFT levels were measured in 867 men using ED LC-MS/MS as previously reported (1).


Reference: 1. Fiers T, Wu F, Moghetti P, Vanderschueren D, Lapauw B, Kaufman JM. Reassessing Free-Testosterone Calculation by Liquid Chromatography–Tandem Mass Spectrometry Direct Equilibrium Dialysis. J Clin Endocrinol Metab. 2018;103(6). doi:10.1210/jc.2017-02360

 

[gonads11]

Again best piece of advice is to start low and go slow on a T-only protocol!

Extremely helpful madman thankyou very much.

It's a shame going to these clinics here who have vastly different knowledge to this forum and other places/doctors online that know what they are talking about.

 

[gonads11]

This isn't how it works, SHBG doesn't lower Free T, SHBG has no influence on testosterone production. LH is the determining factor and the testicles response to stimulation.

Your testicles aren't getting the job done indicated by your high LH. Basically your pituitary gland is screaming at your testicles to start producing more T, but that isn't happening.

Probably didn't explain this correctly. The SHBG and Albumin *bind (not eat) - rendering my free T lower from what I understand?

Thanks anyway.

 

[Systemlord]

Probably didn't explain this correctly. The SHBG and Albumin *bind (not eat) - rendering my free T lower from what I understand?

It's more complicated than that. Imagine a potted plant, the soil represents the SHBG molecule, the water the Free T. You poor the water onto the soil, once the soil has reached full saturation, the soil can hold no more water (Free T), the rest is spillover or free T in circulation.

Often times when Free T is low and SHBG is high, you have multiple factors at play. Let's say you're cutting, significantly reducing calories to look ripped. This can have a huge impact on testosterone production and increases in insulin sensitivity which then increase the SHBG.

So SHBG doesn't lower Free T.

See post below ->

 

[Systemlord]

20 year-old full hormone panel. Thoughts?

Hi all, I am 20 y/o and had all of my hormones checked recently. My endocrinologist basically said my labs are confusing af. I just thought I’d post them here to see what you guys think. Many things are out of wack but it’s weird because some are high and others are low. Let me know if you...

www.excelmale.com

This is a perfect example, this 20-year-old has free testosterone above the normal range and high SHBG and isn’t on TRT. This effectively blows the idea out of the water that high SHBG decreases free testosterone.

Total Testosterone LC/MS: 1,238 H (250-1100) high
Free Testosterone Equilibrium Dialysis: 195.6 H (35-155) high
LH: 5.4 (1.5-9.3)
FSH: 5.3 (1.6-8)
SHBG: 65 H (10-50) high
Estradiol, Ultrasensitive LC/MS: 36 H (<=29) high
Estradiol, Free: 0.72 H (<=0.45) high

 

[gonads11]

So SHBG doesn't lower Free T.

Very interesting. Thanks!

This was also something to learn: "Your testicles aren't getting the job done indicated by your high LH. Basically your pituitary gland is screaming at your testicles to start producing more T, but that isn't happening."

Based on your experience and my bloodwork - would it be worth exploring if T (say T-cyp at 100mg/week in 2 doses) for 8 weeks improves my symptoms as @madman suggested?

Changing no other variables. And getting bloodwork after this experiment?

Or are there other interventions to increase free T?

 

[gonads11]

This is a perfect example, this 20-year-old has free testosterone above the normal range and high SHBG and isn’t on TRT. This effectively blows the idea out of the water that high SHBG decreases free testosterone.

Agreed. Great example. Appreciate you taking the time to help me wrap my head around it!