Dad now son at 19 low t

[charile12]

I got DX at 40 years old with secondary hypogonadism and have been on trt since. I remember I had lowish LH and FSH. Tried clomid which brought up LH moderately but did not bring up my testosterone enough. Also felt not well on it. I believe I have some primary and secondary. Because I have a testicle that has a heterogeneous echotexture. That's just my belief that one testicle may not be working well.

So my son soon to be 19. Is athletic, strong and muscular up until a few months ago.
I did get a baseline when he was around 16.
T was 345
LH 4.2
FSH 2.1
Shbg 15.6
I didn't raise any red flags then because he was in the middle of puberty even though his t should have been higher most likely.

Now almost 19 he measured
T 319 Ng/dl. LCMS assay (300-950)
LH 3.8 (1.3-9.8)
FSH 1.9 (.8 - 7.2)
Prolactin 11.6 (4-15.2)

Not happy. Any thoughts? Any further tests?
I am awaiting a repeat testosterone test.
My son feels like he can't put on muscle anymore and lost some. And has low energy. And I see he has mood swings.

 

[Vince]

I got DX at 40 years old with secondary hypogonadism and have been on trt since. I remember I had lowish LH and FSH. Tried clomid which brought up LH moderately but did not bring up my testosterone enough. Also felt not well on it. I believe I have some primary and secondary. Because I have a testicle that has a heterogeneous echotexture. That's just my belief that one testicle may not be working well.

So my son soon to be 19. Is athletic, strong and muscular up until a few months ago.
I did get a baseline when he was around 16.
T was 345
LH 4.2
FSH 2.1
Shbg 15.6
I didn't raise any red flags then because he was in the middle of puberty even though his t should have been higher most likely.

Now almost 19 he measured
T 319 Ng/dl. LCMS assay (300-950)
LH 3.8 (1.3-9.8)
FSH 1.9 (.8 - 7.2)
Prolactin 11.6 (4-15.2)

Not happy. Any thoughts? Any further tests?
I am awaiting a repeat testosterone test.
My son feels like he can't put on muscle anymore and lost some. And has low energy. And I see he has mood swings.

I would use T as a last resort. I would see a specialist I would hate for him to become infertile at just a young age.

 

[FunkOdyssey]

I got DX at 40 years old with secondary hypogonadism and have been on trt since. I remember I had lowish LH and FSH. Tried clomid which brought up LH moderately but did not bring up my testosterone enough. Also felt not well on it. I believe I have some primary and secondary. Because I have a testicle that has a heterogeneous echotexture. That's just my belief that one testicle may not be working well.

So my son soon to be 19. Is athletic, strong and muscular up until a few months ago.
I did get a baseline when he was around 16.
T was 345
LH 4.2
FSH 2.1
Shbg 15.6
I didn't raise any red flags then because he was in the middle of puberty even though his t should have been higher most likely.

Now almost 19 he measured
T 319 Ng/dl. LCMS assay (300-950)
LH 3.8 (1.3-9.8)
FSH 1.9 (.8 - 7.2)
Prolactin 11.6 (4-15.2)

Not happy. Any thoughts? Any further tests?
I am awaiting a repeat testosterone test.
My son feels like he can't put on muscle anymore and lost some. And has low energy. And I see he has mood swings.

Enclomiphene might be a better option than TRT for such a young man, to boost his levels while maintaining HPTA function and fertility. Check out the board sponsor Maximus for that: https://www.maximustribe.com/testosterone/enclomiphene

 

[charile12]

The repeat testosterone test was 249.

 

[Systemlord]

FSH 1.9 (.8 - 7.2)

The low end FSH is a more reliable indicator of hypogonadism that LH.

 

[charile12]

The low end FSH is a more reliable indicator of hypogonadism that LH.

Ok. I wonder what they will recommend for a guy that needs to be fertile.

Am hoping with supplements can get the t closer to 500 with no need for trt for now

 

[Systemlord]

Am hoping with supplements can get the t closer to 500 with no need for trt for now

This is nothing more than wishful thinking, testosterone supplements are a scam that pray on desperate people. There’s a reason why there’s a warning label on the side of these supplements, “not used to treat or diagnose medical conditions.”

 

[charile12]

Update testosterone result at 8am.
362 ng/dl total
277 ng/dl bio available

Despite the lowish total, the bio seems in good range?
Or does the bio not matter when total is low?

No range given for bio available since Under 20.

 

[Systemlord]

Or does the bio not matter when total is low?

I'm not going to sugar coat it for you, these results are poor. You're not going to have high normal optimal Free T with a 362 Total T, regardless of where your SHBG sits.

It's the same deal as with Free T lab testing, the ranges are poorly established and the lab testing itself is flawed. The total T as it is isn't 100% accurate.

You can take one sample of blood, split it into two and get plus or minus 70 ng/dL. This is as good as it gets.

 

[madman]

I'm not going to sugar coat it for you, these results are poor. You're not going to have high normal optimal Free T with a 362 Total T, regardless of where your SHBG sits.

It's the same deal as with Free T lab testing, the ranges are poorly established and the lab testing itself is flawed. The total T as it is isn't 100% accurate.

You can take one sample of blood, split it into two and get plus or minus 70 ng/dL. This is as good as it gets.

I'm not going to sugar coat it for you, these results are poor. You're not going to have high normal optimal Free T with a 362 Total T, regardless of where your SHBG sits

No doubt!




It's the same deal as with Free T lab testing, the ranges are poorly established and the lab testing itself is flawed.

For the time being this can be easily remedied by choosing the same lab and more importantly same assay (most accurate) which would be the gold standard Equilibrium Dialysis.

Even then you always have the option of using/relying upon calculated FT which would be the linear law-of mass action cFTV as it has already been validated twice as the 1st time was done using TT/SHBG assays no longer available and eventually re-validated using current state-of-the-art ED method (higher order reference method) let alone more recently against CDCs standardized Equilibrium Dialysis assay.

Yes it tends to overestimate slightly but it is nothing to fret over!

Again just to put this in perspective most healthy young males would be hitting a FT 10 ng/dL tested using the gold standard Equilibrium Dialysis assay (most accurate) or a cFTV 13-15 ng/dL and this is a short-lived peak to boot!

Trough would be 20-25% lower.

More importantly a FT in the low 20s whether cFTV or standardized ED assay would be very high!

Everyone needs to hammer it in their heads that a trough FT 30 ng/dL is absurdly high.

We are talking f**king TROUGH here too not peak!

Soon enough this S***T SHOW will be coming to an end once the CDC implements their new standardized ED assay let alone harmonized reference ranges for free testosterone!

Can't f**KING wait to put all of this to rest!

For the time being you have 2 F**KING options in the mix to use/rely upon when it comes to testing free testosterone!

Testosterone, Free (Equilibrium Dialysis) and Total, MS - Most Affordable and Accurate Test

Get an affordable and accurate testosterone test results with our Total Testosterone, M and Free (Equilibrium Dialysis) test. Visit DiscountedLabs.com for more information.

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Free & Bioavailable Testosterone calculator

Comparability of Free Testosterone Measurements- Results of the Interlaboratory Study

Assessment of free testosterone (FT) has been recommended as a biomarker for diagnosis and management of hypogonadism and female hyperandrogenism. Reliable laboratory measurements are essential for correctly diagnosing and treating these diseases. FT is currently measured using direct commercial...

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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...

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*We established mFT reference ranges for healthy men aged 18 to 69 years




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

In the current study, we used a state-of-the-art direct ED method to reassess FT in sets of representative serum samples. This method takes advantage of the ability of a highly sensitive and accurate measurement of T by liquid chromatography–tandem mass spectrometry (LC-MS/MS) to reliably measure the low FT concentration directly in the dialysate after ED. This more straightforward method avoids potential sources of inaccuracy in indirect ED, such as those resulting from tracer impurities or from measures to limit their impact (e.g., sample dilution). We then used the measured FT results to re-evaluate some characteristics of two more established and a more recently proposed calculations for estimation of FT.

SHBG gene polymorphisms and their effects on serum SHBG, total and free testosterone concentrations in men

https://research.rug.nl/en/publications/novel-techniques-for-the-quantification-of-protein-biomarker-isof PDF (pp.176-199) INTRODUCTION Sex steroids are main drivers of sexual development and play a fundamental role in many physiological processes in both men and women [1,2]. As such...

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*our results show no substantial effects of most of these SNPs on free T concentrations. This indicates an only limited effect, if any, of the SHBG SNPs on free T concentrations and is compatible with the view that it is the free T concentration that is primarily determined through hypothalamic-pituitary feedback regulation, which annuls the effects of altered SHBG binding on free T concentrations in healthy men

*Further, no effects of SNPs were observed on the difference between calculated and measured free T, indicating a minimal effect of SNPs on calculator performance

*In this study, we have shown that SNPs that potentially affect SHBG concentration or binding affinity for sex steroids are common in a population of healthy men but that effects of these SNPs on SHBG and testosterone concentrations were mostly mild.

*In contrast, directly measured free T concentrations were unaffected as were also the differences between measured and calculated free T

 

[madman]

I'm not going to sugar coat it for you, these results are poor. You're not going to have high normal optimal Free T with a 362 Total T, regardless of where your SHBG sits.

It's the same deal as with Free T lab testing, the ranges are poorly established and the lab testing itself is flawed. The total T as it is isn't 100% accurate.

You can take one sample of blood, split it into two and get plus or minus 70 ng/dL. This is as good as it gets.

Next time give people something to chew on!

What is it you are having a hard time understanding here?