Lab Results for a 25 yo, not sure if my results were low enough to warrant TRT at my age

[nocapistrano]

I recently got my bloodwork done and the results show low, but not too low test levels and it's got me on the fence about whether trt is a good option or not.

Results:
T: 370 ng/dl on a scale of 264-916
Free T: 12.4 pg/ml on a scale of 9.3-26.5
LH: 2.6 mIU/ML on a scale of 1.7-8.6
SHBG: 21.3 on a scale of 16.5-55.9
Let me know if anything else that may have been tested is applicable and I can provide it

my symptoms are:
- fatigue. My wife says that it's like I'm incapable of getting out of bed even after a full 8 hours and even on days with good sleep I am pretty tired all day.
- brain fog. I have a lot of trouble concentrating throughout the day.
- trouble falling asleep. I'm talking between 1-3 hrs to fall asleep. 1 hour if I am not watching a bunch of TV before bed, 3 if heavy screen time. I can usually still get good sleep if I'm smart about my morning schedule, but this is still a problem
- sexually, nothing too alarming but all these metrics have gone down over the years which seems a bit odd at my age.
- low motivation.

I have in the last few years made improvements to my lifestyle which has helped a bit:
- weight lifting 3-4 times a week pretty consistently for about a year and a half. I and my wife have noticed that I have made noticeable muscle gains but still experience the symptoms described above.
- high protein diet.
- going to bed earlier
- better diet. I eat almost exclusively homemade food, good quality ingredients, high fat, high protein.
- stopped smoking weed entirely

My concern is that my levels aren't exceptionally low so it may not be the cause of all these issues and it may be a mistake to commit to lifelong treatment. Although, if this helped with even just the fatigue (though brain fog would be nice too), I think my quality of life would be greatly improved.

 

[sammmy]

Test estrogen, thyroid hormones, 4 points cortisol, CBC with differential, comprehensive metabolic panel.

You may want to try taking digestive enzymes with meals, to see if that improves the fatigue.

 

[nocapistrano]

Here are full results

 

[sammmy]

Is your doctor aware of those? You have elevated lymphocytes, eosinophils. Neutrophils and platelets also seem elevated although "normal". This looks like activated immune system - infection?

The metabolic panel show elevated bilirubin and a liver enzyme, which is related to liver health. Any supplements?

 

[nocapistrano]

Is your doctor aware of those? You have elevated lymphocytes, eosinophils. Neutrophils and platelets also seem elevated although "normal". This looks like activated immune system - infection?

The metabolic panel show elevated bilirubin and a liver enzyme, which is related to liver health. Any supplements?

I got over an infection a few weeks back, so it could be related to that. I also had two drinks the night before my test which could explain liver markers being a bit elevated. I will be discussing with the clinic I went through soon, though in doing some research here because I'm sure the clinic will be biased towards TRT for me and I want to have a good understanding before then.

 

[sammmy]

Best is to repeat the test in a month and see if these abnormalities persist. If they do, go to real doctor to investigate those further.

A TRT doctor will just tell you that you have low normal T and that TRT may be beneficial. However it will not address the immunity issue, if any.

 

[Systemlord]

sexually, nothing too alarming but all these metrics have gone down over the years which seems a bit odd at my age.

This is NOT normal for a 25 year old, more like a man in his 60's! You have the testosterone level of a older man, not to mention your estrogen is far from healthy and I wouldn't be shocked if you developed osteoporosis at this E2 level.

The Direct Free T method isn't accurate, often it overestimates, retest using the equilibrium dialysis or ultrafiltration method.

TRT is warrantied for men with symptoms of low-T and lower values and not only for older men with lower levels.

The guidelines can treat up to 433 ng/dL, the problem is getting insurance companies to cover treatment and doctors recognizing you have a hormonal problem, and even then most insurance companies will not cover TRT 350>.

 

[DragonBits]

I got over an infection a few weeks back, so it could be related to that. I also had two drinks the night before my test which could explain liver markers being a bit elevated. I will be discussing with the clinic I went through soon, though in doing some research here because I'm sure the clinic will be biased towards TRT for me and I want to have a good understanding before then.

Your results look a little like mine when I was 43 before TRT, similar T, a lot lower E.

I was taking a lot of DHEA, that caused my ALT to be 57, higher than normal, worth keeping track of, but not a big deal. The dhea did nothing for me other than to put me seriously over the top of a normal range.

I was taking DHEA at the time for the same symptoms you are feeling. Only thing that really helped was when I started TRT at age 57.

I would keep an eye on PSA of 1.2. Mine was 1.2 also at age 43, PSA nearly always goes up the older you get, especially after ~55. TRT typically causes a small rise, like to 1.6, but I would guess your PSA will be over 4.0 at some time. Maybe next time, get a PSA with %free more to get baseline than thing concern. Prostate size has a linear effect on PSA, so bigger will cause more PSA to be created.

Your elevated lymphocytes, eosinophils. Neutrophils is IMO minor, likely caused by that recent infections. When you retest you can see if that is still a problem, I would add HS-CRP which you give you a baseline for inflammation, which any infection (along with other things) will cause that to rise. Ideally HS-CRP should be under 1.0.

If you do start TRT, think about fertility. Get your sperm frozen or use HCG. No idea what it costs to freeze and keep sperm.

I don't have any testosterone results from before age 43, but I feel my T dropped for some reason after age 40. But it stayed the same at ~350 even when I quit TRT for a year in my early 60s (currently 70). So my total natural T didn't continue to drop.

You can try various things, it could be emotional, but my guess your fatigue will only be helped by going on TRT.

 

[DragonBits]

@nocapistrano

One other thought.

A herb called kratom gave me a lot of extra energy, you need to take a smaller dose, like less than 2 grams, large doses 8+ grams, makes you sleepy.

It lasts about 4-5 hours.

 

[Drug350]

@nocapistrano

One other thought.

A herb called kratom gave me a lot of extra energy, you need to take a smaller dose, like less than 2 grams, large doses 8+ grams, makes you sleepy.

It lasts about 4-5 hours.

Be careful with using Kratom. It's addicting and can have some terrible withdrawals if you start using it daily for an extended period of time. For energy, see if you're doctor can write you a script for "Provigil" or "Nuvigil". It's used for narcolepsy and "shift work disorder". It's a schedule 4 drug with little risk of addiction or tolerance and works really well, especially once you get the right dose set up for your needs. I've used it on my job for 20 years now and it works great.

 

[MarcoFL]

Be careful with using Kratom. It's addicting and can have some terrible withdrawals if you start using it daily for an extended period of time. For energy, see if you're doctor can write you a script for "Provigil" or "Nuvigil". It's used for narcolepsy and "shift work disorder". It's a schedule 4 drug with little risk of addiction or tolerance and works really well, especially once you get the right dose set up for your needs. I've used it on my job for 20 years now and it works great.

Agree on Provigil. I used it when I had a very important meeting but not everyday use.

 

[DragonBits]

Do you have any problems getting "Provigil" or "Nuvigil", or generically modafinil? I see it's prescription, not sure if most docs will prescribe for 20 years .

Is it easy to get without a script? I know it's a controlled substance, but popular drug on forums, I would give it a try, it seems mostly harmless. Though I am not sure of the advantage vs Kratom.

Here is something amusing from a NIH study.

"a later review done by this group on their own research showed that modafinil did improve neurocognitive performance in average IQ subjects but not high IQ subjects"

Mechanisms of modafinil: A review of current research - PMC

The novel wake-promoting agent modafinil has been in use for the treatment of several sleep disorders for a few years and is now undergoing clinical trials for its use in the treatment of stimulant addiction, but its primary mechanism of action ...

www.ncbi.nlm.nih.gov

Kratom is available OTC in most states, I could buy it in a local smoke shop here though it's more expensive. I believe it is banned in 6 states.

Kratom, it maybe mildly addicting, sometimes I forget to take it, the only thing I notice is feeling a little more tired. it's not real obvious. But it could be just me, maybe others have a different experience. I take it for the extra energy / mental focus, not really to stay awake.

It does interfere with the typical high you get with cannabis. I never take it after 3PM, except for friday's when I stop over at a friend's house. He likes to smoke pot and have a few beers, if I don't take Kratom I have a hard time staying awake, so then I take some shortly before I leave the house.

A lot of people take kratom to help get off of their opioid / alcohol addiction. Kratom, is a selective and full agonists of the μ-subtype opioid receptor (MOR), but not the other receptors involved with opioids, and at any dose it doesn't interfere with breathing.

Now some people on forums take a lot. Like 20-30 or more grams a day. I know it's suppose to make you sleepy, but not sure what else they get out of a high dose.

I think more importantly to the OP, modafinil or kratom are just band aids to the main problem of low testosterone.

Be careful with using Kratom. It's addicting and can have some terrible withdrawals if you start using it daily for an extended period of time. For energy, see if you're doctor can write you a script for "Provigil" or "Nuvigil". It's used for narcolepsy and "shift work disorder". It's a schedule 4 drug with little risk of addiction or tolerance and works really well, especially once you get the right dose set up for your needs. I've used it on my job for 20 years now and it works great.

 

[Ribeye]

I recently got my bloodwork done and the results show low, but not too low test levels and it's got me on the fence about whether trt is a good option or not.

Results:
T: 370 ng/dl on a scale of 264-916
Free T: 12.4 pg/ml on a scale of 9.3-26.5
LH: 2.6 mIU/ML on a scale of 1.7-8.6
SHBG: 21.3 on a scale of 16.5-55.9
Let me know if anything else that may have been tested is applicable and I can provide it

my symptoms are:
- fatigue. My wife says that it's like I'm incapable of getting out of bed even after a full 8 hours and even on days with good sleep I am pretty tired all day.
- brain fog. I have a lot of trouble concentrating throughout the day.
- trouble falling asleep. I'm talking between 1-3 hrs to fall asleep. 1 hour if I am not watching a bunch of TV before bed, 3 if heavy screen time. I can usually still get good sleep if I'm smart about my morning schedule, but this is still a problem
- sexually, nothing too alarming but all these metrics have gone down over the years which seems a bit odd at my age.
- low motivation.

I have in the last few years made improvements to my lifestyle which has helped a bit:
- weight lifting 3-4 times a week pretty consistently for about a year and a half. I and my wife have noticed that I have made noticeable muscle gains but still experience the symptoms described above.
- high protein diet.
- going to bed earlier
- better diet. I eat almost exclusively homemade food, good quality ingredients, high fat, high protein.
- stopped smoking weed entirely

My concern is that my levels aren't exceptionally low so it may not be the cause of all these issues and it may be a mistake to commit to lifelong treatment. Although, if this helped with even just the fatigue (though brain fog would be nice too), I think my quality of life would be greatly improved.

Definitely test thyroid. I am (low) hypothyroid and I can tell you, no matter how much sleep you get, you never feel really rested. When you start on medication, you will feel a huge improvement in energy levels and you feel. Your sleep symptoms sound a lot like mine before treatment. If yours are low and treatment isn't cutting it, push the doc to give you more or if he or she will not, there are others on line who will treat you for symptoms as well as the right blood level. You can be nearly if not symptom free.

 

[Sergel]

At your age I would go back to basics...

• Sleep... You sleeping? Sleep apnea? Overweight?
• Exercise... Start pumping iron...
• Food... Get your diet in order...

Many things you can do at your age. Remember TRT is a life long commitment. Starting in your 20s is signing up for a long dependence on an external source of T... and remember that coming off T is no fun...

Sometimes we just feel like shit for a while, I would try everything but pharmacology...

Your mileage might varry

 

[Ribeye]

View attachment 28978View attachment 28979View attachment 28980

Here are full results

I would still suggest a little more in depth testing for thyroid. Minimally, free T3 and Free T4. Your TSH is in the bottom quartile of the window for your lab, suggesting your Axis is saying to your thyroid you are making plenty of T4 (which gets converted to T3) slow down some. But, you need to know how much T4 your body is actually making, and is it being converted to available T3 which is what actually does the work. With TSH this low, your free levels should be at least in the median of the window for each. if not, you may well need supplementation. If this is a subclinical hypothyroid, it is very common. You may need to push your doc to get your levels in the upper half the therapeutic window, to start feeling better. In addition, do you have thinning hair, get cold easily, bouts of either constipation or diarrhea, flue like aches, joint soreness with little explanation why, daytime drowsiness even with a good nights sleep previously? These are all symptoms of being hypothyroid.

 

[tareload]

T: 370 ng/dl on a scale of 264-916

This is NOT normal for a 25 year old, more like a man in his 60's!

 

[Systemlord]

sexually, nothing too alarming but all these metrics have gone down over the years which seems a bit odd at my age.

Lab Results for a 25 yo​

Nice selective reading there readalot.

 

[DragonBits]

Be careful with using Kratom. It's addicting and can have some terrible withdrawals if you start using it daily for an extended period of time. For energy, see if you're doctor can write you a script for "Provigil" or "Nuvigil". It's used for narcolepsy and "shift work disorder". It's a schedule 4 drug with little risk of addiction or tolerance and works really well, especially once you get the right dose set up for your needs. I've used it on my job for 20 years now and it works great.

FYI

I tried modafinil (Provigil), it works well, I like it.

I think it's better than kratom, but not the same effect.

modafinil works well for focus, fighting sleepiness. My only negative is it's long half life, it can easily interfere with sleep. For that reason, you really have to think about how to use it daily. It does build up in the blood, but has little if any tolerance problems.

Kratom tends to suppress appetite along with giving energy, but I don't think it does anything for focus. Kratom also has a much shorter halflife.

 

[Drug350]

FYI

I tried modafinil (Provigil), it works well, I like it.

I think it's better than kratom, but not the same effect.

modafinil works well for focus, fighting sleepiness. My only negative is it's long half life, it can easily interfere with sleep. For that reason, you really have to think about how to use it daily. It does build up in the blood, but has little if any tolerance problems.

Kratom tends to suppress appetite along with giving energy, but I don't think it does anything for focus. Kratom also has a much shorter halflife.

I had very similar issue's with Provigil / Nuvigil keeping me awake when I wanted to sleep, but after a lot of different trials and errors, I found it's all dose dependent. I work as an engineer on the railroad. I never go to work or sleep at the same time. I'm on call everyday with a 2 hour on duty call, both at home of at the away from home terminal hotel. I also average 220 - 276 hours on duty each month. This schedule, or lack thereof, is BRUTAL !!!! Many days or nights I'm taking Provigil / Nuvigil to stay awake while running, and then I get to the hotel, and I have to get into bed and get some sleep because my phone will ring approximately 12 hours later to come back out and work another train back home. In the beginning, I had major issues with Provigil / Nuvigil keeping me awake when I needed to sleep, and I would end up having to take sleep aids like Sonata, Ambient, or OTC sleep aids in order to get the sleep I desperately needed. What I learned was to make sure if I thought I may have issue's staying awake upon taking my on duty call, I would make sure I took Provigil / Nuvigil as soon as possible, giving myself approximately 8 - 14 hours before I would be jumping in bed. On some occasions, I thought I was OK to work all night without needing any Provigil / Nuvigil, only to get halfway to the away terminal, and find myself dieing to stay awake. On those trips, I learned to take half a dose, and it would be enough to keep me awake and going for several hours, and didn't interfere with my sleep. Provigil / Nuvigil has been a huge help with my job and I don't know what I'd do without having this available. Adderall obviously works great too, but it's extremely difficult to get nowadays and it obviously can lead to dependence and withdrawals if taken regularly.