My Low T Odyssey - Returning to TRT?

[Cm]

Had a bunch of labs done recently in anticipation of going back on TRT after a 1 1/2 year hiatus. I was on TRT for about 10 years (Androderm patch, AndroGel, then Axiron) but went off it for a while after my PSA levels began going up and down. After a battery of tests and a negative prostate biopsy my urologist concluded the fluctuation was due to inflammation that has since cleared up. Anyway, my total T from my labs last month came in at 438 (ref. range 250-1100 ng/dL) and my free T at 46 (ref. range 35 - 155 pg/mL). When I met with a new endocrinologist (my old one retired while I was off T) he said my levels were normal and so I did not need TRT.


Initially I did not disagree. But after reading up more on the issue and coming across Websites such as this one, I'm wondering If I should settle for "normal" or seek a more optimal level. While my level may be normal, it seems on the low end. I've been experiencing low sex drive (to my wife's dismay), on-and-off fatigue, joint soreness, minimal to no gains in the gym, and some stubborn belly fat I can't seem to lose despite lifting 3-4 days a week, running sprints once or twice a week and regularly intermittent fasting.

Is it unrealistic to expect to be prescribed testosterone with my numbers? I'm not sure what my optimal level would be (age 58, 5 ft 10, 170), but I know it is not where I am now. For convenience's sake i would prefer gels or creams to injections, but am not sure gels can get me to an "optimal" level. While I was on the patch and gels, I actually didn't notice much difference (the highest my total T ever got was about 550 from an initial low of about 250, but mostly ranged from 350 to 450). Wondering if maybe the prescribed dosage was too low? Or maybe the gel just doesn't cut it and I need to go with injections?


Any feedback would be most appreciated, thanks..

 

[CoastWatcher]

Welcome to Excelmale. Your numbers are far from what they should be, but what other test results do you have? Was your thyroid fully evaluated, beyond the TSH level? DHT, DHEA, Prolactin, Estradiol/sensitive, along with a CBC and CMP? How do you sleep? It's been noted that there are legions of men with undiagnosed/untreated apnea problems, which hammer hormone levels. Any additional information you have would help us focus the conversation.

On a different note, I'd urge you to be open to injections if TRT is resumed. In my own opinion, and I inject every day (16mg every morning), injections are quick and efficient. Topicals fail to produce optimal results in many men.

 

[Cm]

TSH 3rd generation was 2.61.
T4, free was 1.3.
T3, free was 2.8.
DHT and DHEA not tested.
Prolactin was 6.0.
Estradiol was < 15 (< OR = 39 pg/mL)
LH was 4.1
All CBC values were normal.
Glucose was 105 (nonfasted.) All other CMP values normal.
The only problem with sleep is I don't get enough of it, usually 5 to 6 hours a night. I usually wake up around 4 a.m. to hit the gym by 5, so I can get back home in time to take my son to school before work. Lately I have been forcing myself to get more sleep by turning in earlier, and now get 7 to 8 hours a night. Has seemed to help a bit in how I feel.

I was thinking of setting up a consultation with Dr. Saya. I live in Florida and his office is only about 20 minutes away.

 

[CoastWatcher]

TSH 3rd generation was 2.61.
T4, free was 1.3.
T3, free was 2.8.
DHT and DHEA not tested.
Prolactin was 6.0.
Estradiol was < 15 (< OR = 39 pg/mL)
LH was 4.1
All CBC values were normal.
Glucose was 105 (nonfasted.) All other CMP values normal.
The only problem with sleep is I don't get enough of it, usually 5 to 6 hours a night. I usually wake up around 4 a.m. to hit the gym by 5, so I can get back home in time to take my son to school before work. Lately I have been forcing myself to get more sleep by turning in earlier, and now get 7 to 8 hours a night. Has seemed to help a bit in how I feel.

I was thinking of setting up a consultation with Dr. Saya. I live in Florida and his office is only about 20 minutes away.

You'd certainly get excellent advice if you consulted with Defy Medical. Dr. Saya is a moderator her at EM and contributes regularly. Given the fact that you've followed a TRT protocol in the past, I would think that getting it right, avoiding the errors so many doctors lead patients into, would be a high priority for you. Obtaining care from someone who knows how the game is played is such an important variable.

 

[Cm]

You'd certainly get excellent advice if you consulted with Defy Medical. Dr. Saya is a moderator her at EM and contributes regulalrly. Given the fact that you've followed a TRT protocol in the past, I would think that getting it right, avoiding the errors so many doctors lead patients into, would be a high priority for you. Obtaining care from someone who knows how the game is such an important variable.

Thanks for the advice CoastWatcher.