I’ve had low T symptoms for around 4 years now. Libido, morning erection, hard gainer, increased fatty tissue, lacking drive etc.
SHBG between 80-100 ish
Free T around 0.25 nmol/L
I’m 34, fit and heathly. Lift 4 times per week, decent diet, cardio 2-3 times per week. 170lbs 5’9”
I’ve seen a couple of endos who basically shrug shoulders and offer the blue pill!
I’m reluctant to hop on TRT because my system is working, I’m also hoping to get my other half pregnant soon.
I’ve considered proviron, but chickened out before taking any.
Any last suggestions before going on the TRT route? Should I get a more detailed thyroid panel for example, even though it all seems be be within the reference ranges from my tests so far.
Blood work below (I hope the table has formatted correctly) for the last year. But I have results going back 4 years that basically show the same story.
I’ve read this forum back to front, so I’m just clutching at straws really. Thanks all.
| | |
16 Feb 2024 | 20 July 2024 | 5 Sep 2024 | 9 Oct 2024 | 6 Nov 2024 | 7 Jan 2025 | 7 Apr 2025 |
| | | | | | | | | |
| FSH |
1.5-12.4 IU/L | |
3.1 | 2.8 | 2.6 | 3.4 | 3.3 | 2.8 | 3 |
| LH |
1.7-8.6 IU/L | |
4 | 2.7 | 3.5 | 4.1 | 2.8 | 3.1 | 3.6 |
| Oestrodiol |
41-159 pmol/L | |
120 | 106 | 47.1 | 90 | 54.7 | 85.6 | 68.2 |
| Testosterone |
8.64-29 nmol/L | |
30 | 23.7 | 19.1 | 25.3 | 26.1 | 29.4 | 22.1 |
| Free test Calc. |
0.2-0.62 nmol/L | |
0.362 | 0.3 | 0.177 | 0.284 | 0.23 | 0.269 | 0.241 |
| T:Cortisol |
Ratio | | |
0.065 | 0.03 | | | | |
| Free androgen |
Index 35-92% | | |
34.1 | 19.8 | | | 28 | |
| Prolactin |
86-324 mIU/L | |
136 | 181 | 279 | 213 | 201 | | 312 |
| | | | | | | | | |
| PSA Total |
<2.6 ug/L | |
0.518 | | | 0.435 | 0.645 | | 0.43 |
| | | | | | | | | |
| Haemoglobin |
130-180 g/L | |
141 | 144 | 142 | 135 | 149 | 153 | 150 |
| Haematocrit |
0.4-0.52 L/L | |
0.421 | 0.438 | 0.433 | 0.404 | 0.439 | 0.455 | 0.445 |
| Red Cell Count |
4.4-6.5 10^12/L | |
4.38 | 4.51 | 4.41 | 4.1 | 4.59 | 4.67 | 4.52 |
| MCV |
80-100 fL | |
96.1 | 97 | 98.3 | 98.4 | 95.7 | 97.4 | 98.4 |
| MCH |
27-32 pg | |
32.1 | 32 | 32.2 | 32.8 | 32.4 | 32.8 | 33.3 |
| MCHC |
320-360 g/L | |
334 | 330 | 327 | 333 | 339 | 336 | 338 |
| RDW |
11.5-15 % | |
13.5 | 15.3 | 14.1 | 14.1 | 13.2 | 14.6 | 14 |
| White cell count |
3-11 10^9/L | |
3.9 | 3.1 | 4.5 | 3.2 | 4.5 | 4.3 | 4.3 |
| Neutrophils |
2-7.5 10^9/L | |
1.6 | 1.1 | 1.9 | 0.9 | 1.5 | 1.5 | 1.2 |
| Lymphocytes |
1.5-4.5 10^9/L | |
1.6 | 1.5 | 2 | 1.6 | 2.2 | 2.4 | 2.4 |
| Monocytes |
0.2 - 0.8 10^9/L | |
0.4 | 0.3 | 0.4 | 0.3 | 0.4 | 0.2 | 0.4 |
| Eosinophils |
0 - 0.4 10^9/L | |
0.3 | 0.2 | 0.2 | 0.2 | 0.2 | 0.2 | 0.3 |
| Basophils |
0 - 0.1 10^9/L | |
0.1 | 0 | 0 | 0 | 0.1 | 0 | 0 |
| Platelet Count |
150 - 450 | |
213 | 216 | 185 | 215 | 268 | 226 | 211 |
| MPV |
7-13 | | |
10.7 | 12.1 | 11.5 | 11.3 | 11.3 | 11.3 |
| | | | | | | | | |
| Creatinine |
60 - 120 umol/L | |
85.9 | 83.2 | 86.9 | 92.6 | 92.6 | 90 | 80 |
| eGFR |
>60 | |
>90 | 90 | >90 | >90 | >90 |
>90 | >90 |
| Urea |
2.5-7.8 mmol/L | | |
5.5 | 7.2 | | | 8.9 | |
| | | | | | | | | |
| Bilirubin |
<22 umol/L | |
11.4 | 19 | 10.9 | 10.8 | 12.8 | 14 | 8 |
| ALP |
30 - 130 U/L | |
48 | 56 | 53 | 52 | 58 | 56 | 67 |
| ALT |
<45 U/L | |
24 | 17 | 23 | 31 | 26 | 35 | 29 |
| GGT |
<55 U/L | |
20 | 16 | 16 | 19 | 19 | 23 | 19 |
| | | | | | | | | |
| Total Protein |
60 - 80 g/L | |
68 | 70 | 69 | 69 | 72 | 71 | 72 |
| Albumin |
35 - 50 g/L | |
46 | 48 | 48 | 49 | 50 | 50 | 49 |
| Globulin |
19 - 35 g/L | |
21 | 23 | 21 | 20 | 22 | 22 | 23 |
| SHBG |
18.3 - 54.1 nmol/L | |
79.4 | 69.4 | 96.7 | 80.9 | 107 | 105 | 81.4 |
| | | | | | | | | |
| HbA1c |
20 - 41.999 mMol/Mol | |
26 | 32 | 29 | 26 | 28 | 25 | 24 |
| | | | | | | | | |
| Total Cholesterol |
<5 mmol/L | |
6.5 | 5.74 | 5.34 | 5.54 | 5.21 | 5.3 | 6.65 |
| LDL |
<3 mmol/L | |
3.49 | 3.04 | 2.78 | 2.85 | 3.07 | 2.79 | 3.87 |
| Non HDL |
<4 mmol/L | |
3.81 | 3.47 | 3.18 | 3.26 | 3.46 | 3.2 | 4.22 |
| HDL |
>1 mmol/L | |
2.69 | 2.27 | 2.16 | 2.28 | 1.75 | 2.1 | 2.43 |
| Total : HDL |
<6 ratio | |
2.42 | 2.53 | 2.47 | 2.43 | 2.98 | 2.52 | 2.74 |
| Triglycerides |
<2.3 mmol/L | |
0.71 | 0.95 | 0.88 | 0.91 | 0.85 | 0.9 | 0.77 |
| Triglycerides:HDL |
<.87 ratio | | | | | | |
0.4 | |
| Apolipoprotein A1 |
>1.25 g/L | | | | | | |
1.7 | |
| Apolipoprotein B |
<1 g/L | | | | | | |
0.96 | |
| Lipoprotein A |
<76 nmol/L | | | | | | |
51.1 | |
| APOB:APOA |
,0.7 ratio | | | | | | |
0.6 | |
| | | | | | | | | |
| CRP HS |
0-3 mg/L | | |
0.897 | <0.15 | | | 0.29 | |
| | | | | | | | | |
| Utica Acid |
200-430 umol/L | | |
314 | 282 | | | 245 | |
| | | | | | | | | |
| Iron |
10-30 umol/L | | |
28.5 | 17.5 | | | | |
| TIBC |
45-81 umol/L | | |
55.9 | 51.6 | | | | |
| UIBC |
12-43 umol/L | | |
27.4 | 34.1 | | | | |
| Transferrin Sat. |
25-45% | | |
51 | 33.9 | | | | |
| Ferritin |
30 - 442 ug/L | |
104 | 180 | 127 | 67.5 | 138 | 110 | 198 |
| | | | | | | | | |
| TSH |
0.27 - 4.2 mIU/L | |
1.82 | 2.15 | 2.55 | 2.1 | 2.39 | 3.25 | 3.13 |
| Free T3 |
3.1 - 6.8 pmol/L | |
3.5 | 3.4 | 3.4 | 3.9 | 3.3 | 3.4 | 3.4 |
| Free Thyroxine |
12 - 22 pmol/L | |
15.9 | 16.9 | 15.7 | 17.3 | 19.3 | 15.7 | 18.6 |
| | | | | | | | | |
| Folate Serum |
7-35 nmol/L | | |
15.1 | 7.4 | | | | |
| B12 active |
37.5-188 pmol/L | | |
150 | 115 | | | >150 | |
| Vit D |
50-250 nmol/L | | |
96.8 | 111 | | | 180 | |
| | | | | | | | | |
| DHEA Sulphate |
4.34-12.2 | |
4.3 | 5 | 4.3 | | | | |
| Cortisol |
133-537 | | |
365 | 502 | | | | |
| | | | | | | | | |
| Thyroglobulin |
<115 kIU/L | | |
17.3 | 15.7 | | | 15.7 | |
| Thyroid peroxidase |
<9 kIU/L | | |
9 | 10.2 | | | <9 | |
Unfortunately a common scenario misunderstood by many doctors where they are caught up on TT when FT is what truly matters.
The TT is inflated due to very high SHBG which would result in a bottom-end FT!
Just to clear up any confusion here keep in mind that the bound fractions albumin/SHBG still serve a purpose and are not useless binding proteins as many stinking up all those so called HRT/men's health forums let alone those so called gurus polluting the net!
As has been stated numerous times on the forum over the years although TT is important to know FT is what truly matters as it is the unbound fraction of T responsible for the positive effects.
Free testosterone and its metabolites estradiol and DHT are where it's at!
In order to know where your free testosterone truly sits one would need to have it tested using what would be considered the most accurate assay the gold standard Equilibrium Dialysis especially in cases of altered SHBG!
f you do not have access (highly doubtful if you reside in the US) to such then you would need to use/rely upon the go to calculated linear law-of-mass action cFTV which will give a good approximation but keep in mind it tends to overestimate FT.
As I have stated numerous times on the forum 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 (1st time was done using TT/SHBG assays no longer available) and was then 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!
*Calculated free T using high-quality T and SHBG assays has been considered the most useful for clinical purposes [99]. All algorithms suffer from some inaccuracies, including the variable quality of SHBG IAs [100], not replicating the non-linear nature of T-SHBG binding, different and inaccurate association constants for SHBG and albumin binding [101], and variable agreement with equilibrium dialysis results [99,100]. However, until further developments in the field materialize, the linear model algorithms [in particular, the most used Vermeulen equation [102]] appear to give, despite a small systematic positive bias, acceptable data for the clinical management and research[37,103]
hting its relevance in preventing misdiagnosis and overtreatment of male hypogonadism. Recent findings While there is consensus on measuring total T – comprising sex hormone-binding globulin (SHBG)-bound, albumin-bound, and free T – as a first step in diagnosing male hypogonadism, evidence...
journals.lww.com
INTRODUCTION
Clinical practice guidelines on the diagnosis of male hypogonadism focus on clinical signs and symptoms of androgen deficiency, as well as biochemical assessment of low circulating testosterone (T). However, there is a longstanding debate, as well as a persisting controversy concerning biochemical assessment of serum T and in particular the use (and misuse) of free T. Free T, as advocated by the free hormone hypothesis, represents...
Looking over your most recent labs Jan/April 7th if we take your TT, SHBG and Albumin and use the calculated linear law-of-mass action Vermeulen (cFTV) your free testosterone would fall in the bottom-end seeing as although you are hitting a robust TT your SHBG is absurdly high!
Your CFTV results were 7.76 and 6.94 ng/dL.
Also keep in mind that cFTV tends to overestimate slightly so chances are where your FT truly sits is even lower!
A FT 5 ng/dL is low and 5-9 ng/dL would be the grey zone for some!
Most healthy young males would be hitting a cFTV 13-15 ng/dL and this is a daily short-lived peak to boot!
Trough would be 20-25% lower!
Your FT is well under where a healthy young male would sit!
Jan.7/2025
Apr.7/2025
Not sure why you are so concerned about hopping on TTh as even though it will result in shut-down of the hpta and have have a negative impact on fertility you can easily minimize/prevent this from happening through the addition of hCG which mimics LH.
LH stimulates the Leydig cells in the testes to produce ITT (intratesticular testosterone) and ITT/FSH stimulates the Sertoli/germ cells located inside the seminiferous tubule lobes to produce sperm.
When one uses exogenous testosterone/AAS it results in shut down of the HPG axis and the pituitary no longer secretes LH/FSH.
Lack of LH causes atrophy of the Leydig cells which are located between the seminiferous tubules and lack of ITT/FSH causes atrophy of the Sertoli/germ cells which are located inside the seminiferous tubules. The cells shrink and become dormant.
The body no longer produces endogenous testosterone and sperm production is halted.
The Leydig cells only make up 10-20% of testicular volume as oppose to the germ cells/seminiferous tubules (where sperm is produced) which make up almost 80% of the testicular volume so a majority of the shrinkage results from atrophy of the germ cells/seminiferous tubules.
Basically comes down to exogenous testosterone use results in significant suppression of spermatogenesis which leads to
testicular shrinkage as a majority of testes volume is made up of germ cells located in the tightly bundled seminiferous tubule lobes where sperm is produced.
Not only does FSH stimulate sperm production but ITT alone is also playing a strong role.
Regarding the use of hCG we can take it along with trt to maintain fertility/prevent
testicular shrinkage.
The use of hCG will mimic LH and result in stimulating the Leydig cells in the testes to produce ITT which will have a big impact on stimulating the Sertoli/germ cells located inside the seminiferous tubule lobes to produce sperm and this will cause an increase in testicular volume.
The use of Clomid stimulates LH and FSH which will increase testosterone/sperm production and maintain testicular size.
Look over the threads in post # 3!
Bringing you the latest and greatest!
Nelson's house is where it's at!
15:47-17:57 (T levels on therapy/sides)
* The right answer is you've got to keep testosterone within the normal range which is 200/300-1000 ng/dL but its very hard to do and make the patient feel well, they will feel better in the higher-end of that regimen rather than the lower-end
In this episode, Dr. Amy Pearlman interviews Dr. Larry lipshultz, one of the most prolific and well known hormone specialists in the world. He is Professor of Urology and Chief of...
