Considering starting TRT. My blood work is attached.

[busydad]

I have some Low-T symptoms most notably brain fog, no drive, ED, and no libido. I believe some of this may be due to me not getting quality sleep.

So recently I've had blood work done 3 times in the past 3 months and my total T has been between 630 and 680 with my free-t being around 13. I'm 46 years old so I believe the Total-T is a decent number.

Although having healthy free testosterone levels is critical lack of quality sleep, excess stress (physical/mental), and poor diet can easily hammer down libido/have a negative effect on erections, and cause a lack of drive/motivation/fatigue.

Dysfunction thyroid/adrenals can easily mimic low-T symptoms.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

On your most recent labs, you are hitting a robust TT 682 ng/dL and although your SHBG is high (not very high), based on the known to be inaccurate direct FT immunoassay your FT level is not low.

Something that many lack the understanding of is just because one has high/highish SHBG it is not a given that they have low/bottom-end FT as again it depends on where your TT sits.

Unfortunately, you never had your FT tested using an accurate assay.

The only way to know where your FT level truly sits is to have it tested using what is considered the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration.

This is critical, especially in cases of altered SHBG.

Even then we can easily calculate your FT by taking your TT, SHBG, and Albumin.

The most commonly used is the linear law-of-mass action cFTV.

With a robust TT 682 ng/dL, high SHBG 51.7 nmol/L, and Albumin 4.6 g/dL your FT would be 11 ng/dL which is far from low although it is under where a healthy young male would be at peak which is around 13-14 ng/dL.

Free & Bioavailable Testosterone calculator

View attachment 38235

Also, keep in mind as of now cFTV tends to overestimate when compared against the gold standard Equilibrium Dialysis so your FT may very well be somewhat lower but it still would not be low/bottom-end.

The shit kicker here is if you retested it using the gold standard Equilibrium Dialysis although it may be somewhat lower doubtful it would be really low but it may be in what we call the grey zone for you as in sub-par which can easily cause low-T symptoms for some men.

If anything I would at least retest using an accurate assay.

Where does your BF% sit?

Also, keep in mind that your estradiol is high mind you it was not tested using the most accurate assay (LC/MS-MS).

Chances are you if you jump on TRT you will be a high aromatizer.

Your LH is just above the top end but not very high.

What really stands out is your RBCs, hemoglobin, and hematocrit are at/near the bottom end yet your iron/ferritin is normal.

Hypogonadal men often present with markedly lowered hemoglobin and erythrocyte concentrations.






If you mean 80 mg twice weekly (160 mg T/week) run and find a new doctor as 160 mg T/week is too high a dose to start someone on.

We always say start low and go slow on a T-only protocol!

The common starting dose is 100 mg T/week or 50 mg T twice weekly (every 3.5 days).

Most men on TRT are injecting 100-200 mg T/week whether once weekly or split into more frequent injections such as twice-weekly (every 3.5 days), M/W/F, EOD, or daily.

Even then most men would never need the high-end dose of 200 mg T/week to achieve a healthy FT level.

Are there outliers sure but they are far and few.

Most and let me repeat that MOST men can easily achieve a high let alone very high trough FT levels of 100-150 mg T/week especially when split into more frequent injections.

You need to think this one through before you jump in head first.

I meant 40mg 2x per week. So 80mg total per week.

I've been thinking about TRT for 2 years now, so by no means do I want to rush into this. Sometimes it just gets more confusing.

I've changed up my diet, get about 180 minutes of zone 2 cardio and I've lost about 50 lbs in the past 2 years. I'm 5'11" and 220 lbs. I'm guessing I'm still probably around 30% bf so I still have work to do. I'm going to start adding in 2 full body weight sessions per week to see if I can break through this plateau.

I just want to feel better at this point, and truly just want my sex drive back, but I don't want to risk my health to do it.

 

[Willyt]

Dude most guys here would kill for those pre-TRT numbers. Listen to the words of wisdom on this thread and run from that doctor. TRT will shut down your natural production and it ain't easy to bring it back.

 

[Systemlord]

TRT will shut down your natural production and it ain't easy to bring it back.

It was easy for me, 4.5 weeks after stopping TRT, HPTA is back up and functioning.

Absolute statements weakens your argument.

Dude most guys here would kill for those pre-TRT numbers.

A free testosterone level can be adequate, and you still might not get the effect at the cellular level.

That’s because the bi-lipid membrane is inflamed, independent of gene CAG repeat numbers. If you can’t get the testosterone (Free T) through the bi-lipid membrane, it can’t interact with the T receptor.

So the absolute hormone level on it’s own is almost meaningless without taking into account other factors.

@busydad has three markers supporting a case for hypogonadism, the high LH value, and the lower end hemoglobin and hematocrit, with what appears normal iron status.

 

[Willyt]

It was easy for me, 4.5 weeks after stopping TRT, HPTA is back up and functioning.

Absolute statements weakens your argument.


A free testosterone level can be adequate, and you still might not get the effect at the cellular level.

That’s because the bi-lipid membrane is inflamed, independent of gene CAG repeat numbers. If you can’t get the testosterone (Free T) through the bi-lipid membrane, it can’t interact with the T receptor.

So the absolute hormone level on it’s own is almost meaningless without taking into account other factors.

@busydad has three markers supporting a case for hypogonadism, the high LH value, and the lower end hemoglobin and hematocrit, with what appears normal iron status.

Oh please what a load of bullshit. Great advice. I am not doubting the OP is experiencing problems, but blaming Low T for it is nonsense. No wonder TRT gets such a bad rap in the media.

 

[Systemlord]

I am not doubting the OP is experiencing problems, but blaming Low T for it is nonsense.

You seem pretty sure about that.

His pituitary is telling a different story.

Imagine he starts TRT and his symptoms start to melt away… Sometimes your posts come back to haunt you.

 

[Willyt]

You seem pretty sure about that.

His pituitary is telling a different story.

Imagine he starts TRT and his symptoms start to melt away… Sometimes your posts come back to haunt you.

First my apologies for the snarky message yesterday as I was in shitty mood at the time. I have respect for you as longtime poster.

We just have different opinions here. One of the things I've learned over my TRT journey is that the HPG axis is such a delicate thing. The disruption from TRT on a guy with healthy levels of T production would be my concern.

 

[busydad]

First my apologies for the snarky message yesterday as I was in shitty mood at the time. I have respect for you as longtime poster.

We just have different opinions here. One of the things I've learned over my TRT journey is that the HPG axis is such a delicate thing. The disruption from TRT on a guy with healthy levels of T production would be my concern.

The disruption from TRT on a guy with healthy levels of T production would be my concern.

Thats my concern also.

I feel like the TRT clinics I've visited either online or in person are just looking to make money and don't have my best interests in mind. They want me to buy their compounded testosterone for a ridiculous price and sell me a bunch of other supplements. On the other hand my GP has very little knowledge about hormones or doesn't want to bother. I wish I could find a local Endocrinologist that deals with HRT and could diagnose me properly.

 

[busydad]

I'm really considering taking enclomiphene for 4-6 weeks to see if that helps. If the enclomiphene helped with the symptoms, wouldn't that be a good indicator of low-T? Then I could switch over to regular TRT.

In my mind at least I'm not shutting myself down, and if it doesn't improve symptoms then low-t is likely not the culprit.

 

[Systemlord]

I'm really considering taking enclomiphene for 4-6 weeks to see if that helps. If the enclomiphene helped with the symptoms, wouldn't that be a good indicator of low-T?

Some men are non-responders to enclomiphene, so no, maybe not the best diagnostic tool to determine if what you’re experiencing is from insufficient testosterone.

TRT has a higher success rate than hCG and enclomiphene, because you’re taking something without toxins and chemicals, which has the potential to decrease the side effects.

Same things goes for hCG, some men feel great on it, some nothing, some feel good at first, then bad, and others can’t tolerate it at any dosage.

TRT has high satisfaction rates.

They want me to buy their compounded testosterone for a ridiculous price and sell me a bunch of other supplements.

It’s similar to buying a new car, tell the salesmen you don’t need any of the extras.

Often times you don’t need them anyway. Whenever you see a clinics treating everyone the same, you know these people don’t know the first thing treating people’s individual needs.

 

[FunkOdyssey]

TRT has a higher success rate than hCG and enclomiphene, because you’re taking something without toxins and chemicals, which has the potential to decrease the side effects.

*except typically benzyl benzoate / benzyl alcohol which I am now paranoid about.

 

[Systemlord]

*except typically benzyl benzoate / benzyl alcohol which I am now paranoid about.

These might be considered toxins, even though they’re most commonly found in some teas, and foods including apricots, snap beans, cocoa, cranberries, because plants contain toxins, but a very small percentage, a few percent for the entire vial.

 

[busydad]

Some men are non-responders to enclomiphene, so no, maybe not the best diagnostic tool to determine if what you’re experiencing is from insufficient testosterone.

If I did respond well to it through and my symptoms subsided, wouldn't that be a decent indicator that I need more testosterone?

 

[Willyt]

I'm really considering taking enclomiphene for 4-6 weeks to see if that helps. If the enclomiphene helped with the symptoms, wouldn't that be a good indicator of low-T? Then I could switch over to regular TRT.

In my mind at least I'm not shutting myself down, and if it doesn't improve symptoms then low-t is likely not the culprit.

If you are concerned about shutdown, another option (read rabbit hole) you could try is nasal T gel, which is a very quick acting form of T that minimizes shutdown. You can search for Natesto which is popular brand.

A few guys have had success on nasal gel, but it remains somewhat of a niche versus injections. Not sure if will give you relief from the symptoms you are experiencing.

Here are my notes on two experiments I ran with nasal gel/cream:

My pre-workout Natesto experiment - Embrace your natural trough!

What if you could enjoy the benefits of exogenous testosterone - even if on a limited basis - while minimizing many of the usual side effects? I was determined to find out through a very unscientific experiment with Natesto, a short-acting nasal testosterone gel discussed numerous times on...

www.excelmale.com

My notes on Empower nasal T gel experiment

I recently undertook a very unscientific 10 week experiment with Empower's nasal testosterone gel (similar to Natesto) to see if such a short-acting form of T could increase my baseline natural production. The idea is consistent with some of the Natesto studies that @madman has cited. NASAL T...

www.excelmale.com

 

[Systemlord]

First my apologies for the snarky message yesterday as I was in shitty mood at the time. I have respect for you as longtime poster.

No worries, I’ve had bad moments myself. Thank you for the apology.

 

[busydad]

What are you guys think about my estrogen level from the research I’ve done it seems that high estrogen mimics most of the symptoms I am having. Mine is above normal, but is it high enough to cause any issues at 65.4 pg/ml?

 

[Gman86]

all I can do is give u advice that I would want someone to give to me in ur position. Which is to find a good clinic, like Defy medical, and get on TRT. I would personally skip HCG and/ or Clomid monotherapy, if I were u, but it wouldn’t be a horrible idea to trial either, to see if raising ur test levels made u feel better. Problem is ur E2 is very high proportional to ur test levels, especially ur free T level. And Clomid and HCG are both notorious for raising E2, usually more so than straight test would. It looks like ur getting plenty of LH signaling from ur pituitary. Ur testicles just aren’t producing enough testosterone to overcome ur high SHBG level. So actually now that I think about it, I’m not sure if something like HCG mono would even work, since it’s just gonna send the LH signal directly to ur testicles. If ur naturally higher LH levels aren’t doing the trick to have ur testicles produce enough test, I don’t see how having HCG send that same signal is going to help much. Same goes for Clomid. It’s just going to send more LH and FSH to ur testicles, which isn’t really ur issue. Ur getting enough signal. Plus, Clomid can raise SHBG even further. So in ur situation, I think both HCG mono, and/ or Clomid mono would not be smart.

I’m a pretty good person to advise u, simply because my labs prior to TRT were somewhat similar to urs, plus I’ve personally tried HCG and Clomid monotherapy. Here are my pre-TRT labs, as well as my labs on HCG mono, and Clomid mono

PRE TRT LABS:

8-5-15
ON NOTHING

Total T - 584 (348-1197 ng/dL)
Free T - 7.3 (9.3-26.5)
SHBG - 57.1 ( 16.5 - 55.9).
E2 NOT sensitive - 14.6 (7.6-42.6)
Prolactin - 9 (2.0-18.0)
LH - 3.5 (1.7-8.6)
FSH - 2.3 (1.5-12.4)
TSH - 1.2 (0.450-4.500)
T4 free - 1.15 (0.82-1.77)
T3 free 3.4 ( 2.0-4.4)
DHEA-S 486.0 (138.5-475.2)


11-2-15
ON NOTHING
Total T - 691 (250-1100 ng/dL)
Free T - 73.9 (46.0-224.0)
Bio T - 161.6 (110.0-575.0 ng/dL)
SHBG 45 (10-50)
E2 Sensitive- 25
IGF 1 - 294 (63-373)
DHEA-S - 411 (106-464)
Albumin - 4.7 (3.6-5.1)

HCG MONO LABS:

12-30-15
HCG - 2000IU/ week split into EOD dosing (Pregnyl HCG)
Anastrozole 0.25mg 2x/ week (0.5mg total per week)

Total T - 1185 (250-1100 ng/dL)
Free T - 171.7 (46.0-224.0)
Bio T - 345.6 (110.0-575.0 ng/dL) SHBG 39 (10-50)
E2 Sensitive - 43
DHEA-S - 615 (106-464)
Albumin - 4.4 (3.6-5.1)



2-11-16
HCG - 2000IU/ week split into EOD dosing (Pregnyl HCG)
Anastrozole 0.25mg 2x/ week (0.5mg total/ week)

Total T - 1193 (250-1100 ng/dL)
Free T - 168.9 (46.0-224.0)
Bio T - 362.1 (110.0-575.0 ng/dL)
SHBG 39 (10-50)
E2 Sensitive - 55
DHEA-S - 729 (106-464)
Albumin - 4.7 (3.6-5.1)





4-12-16

HCG - 1000IU/ week split into EOD dosing (Pregnyl HCG)
Anastrozole 0.25mg 2x/ week (0.5mg total per week)

Total T - 579 (250-1100 ng/dL)
Free T - 71.4 (46.0-224.0)
Bio T - 143.8 (110.0-575.0 ng/dL)
SHBG 38 (10-50)
E2 Sensitive - 11
DHEA-S - 452 (106-464)
Albumin - 4.4 (3.6-5.1)


CLOMID MONO:

6-27-16
CLOMID 50mg/ day
Anastrozole 0.25mg 2x/ week (0.5mg total per week)

Total T - 1535 (250-1100 ng/dL)
Free T - 98.5 (46.0-224.0)
Bio T - 198.4 (110.0-575.0 ng/dL)
SHBG 91 (10-50)
E2 Sensitive - 51
DHT - 78 (16-79)
HCT - 46.5 (38.5-50.0)
Prolactin - 3.9 (2.0-18.0)
DHEA-S - 550 (106-464)
Albumin - 4.4 (3.6-5.1)
LH - 11.3 (1.5-9.3)
FSH - 3.1 (1.6-8.0)

POST CLOMID MONO WHILE ON NOTHING:

8-31-16 labs were while on this protocol

Total T - 601 (250-1100 ng/dL)
Free T - 54.3 (46.0-224.0)
Bio T - 116.4 (110.0-575.0 ng/dL)
SHBG 53 (10-50)
E2 NOT Sensitive - 23
IGF 1 - 204 (53-331)
DHEA, LC/MS/MS 324 (61-1636)
B12 - 1434 (200-1100)

 

[Gman86]

As u can see, after being on both HCG mono and Clomid mono, my levels all returned to exactly where they were when I was completely natural, with low T symptoms. In the high majority of men, even if u go on TRT, and decide to stop, for whatever reason, ur levels should simply return to around where they were prior to starting TRT. Obv this depends on ur age when u started, and age when u go off. If ur 30 when u go on, and 40 when u go off, it’s only safe to assume ur natural levels could be lower than they were when u were 30

 

[Gman86]

HCG mono made me feel better in a lot of ways, but I just wasn’t able to control the gyno that I was getting while on it. My nipples were so itchy that I would literally scratch them until they bleed.

And on clomid mono I felt the worst I’ve ever felt in my life. WAY worse than when I had low T. Felt extremely depressed, and suicidal at times. Normally I don’t even experience depression at all, so this was extremely ouT of the norm for me. It was a very dark time while on Clomid mono. Don’t see myself ever touching the stuff again as long as I live

 

[Gman86]

I went to multiple doctors and clinics prior to finding defy, and most of them were a total waste of time and money. I even went to an endo, and he was the worst of them all. Endo’s dont get trained in testosterone therapy. There’s really no money in it in an insurance based medical system. They get trained mostly in things like diabetes treatment and thyroid treatment. Things where theres a good amount of meds that they can prescribe and make a lot of money off of. I can’t recommend defy medical enough. Been very very happy with them for years now

 

[Systemlord]

There’s really no money in it in an insurance based medical system. They get trained mostly in things like diabetes treatment

Diabetes is a very profitable disease, it leads to complications down the road! A non-stop revenue generating disease.

If a doctor is going to bother with being trained in TRT/HRT, it makes sense to focus solely on male/female hormones and prescribe TRT/HRT every day all day, outside of mainstream medicine.

Dr. Jordan Grant, a urologist in Texas, is quitting his profession and going into private cash pay TRT/HRT.