Normal Total Testosterone, Low Free T and E2 - Would you start TRT?

[DrSheldor]

Hello everyone!

Been very thankful for all the constructive content on these forums over the last few months as I've been trying to sort through my situation.

I am a 41 year old male who had the usual slew of symptoms discussed on these forums: brain fog, poor recovery, trouble putting on muscle, lower libido, erectile issues, etc.

Got checked twice for my total testosterone, once was 540 with a free of around 7 (labcorp). This prompted more detailed labs which I've attached here:

My question is that with the super low Free T and rock bottom E2, these seem like they could potentially explain my symptoms. Feels weird to start TRT with total T ranging between 460-540, but with the Free and E2 so low do I need to at least consider that TRT is the answer? Appreciate any experience/thoughts or advice, thank you!

 

[Systemlord]

Feels weird to start TRT with total T ranging between 460-540, but with the Free and E2 so low do I need to at least consider that TRT is the answer?

FT drives the effects of testosterone, it’s the unbound portion of T (FT), the TT is a function of SHBG. My TT several years ago was 91 and SHBG 11, FT 7.8. Now my TT is 438, SHBG 37 and FT 8.4. Notice how my TT changed and yet my FT remains largely unchanged.

Whatever is driving up your SHBG is also driving up your TT, independent of the FT. TT is less relevant, FT is what truly matters.

 

[FunkOdyssey]

Feels weird to start TRT with total T ranging between 460-540, but with the Free and E2 so low do I need to at least consider that TRT is the answer?

Yes, with the combination of symptoms and low free T and E2, you should "at least consider that TRT is the answer."

 

[Cataceous]

The direct free testosterone test correlates poorly with better methods and should not be used. Nonetheless, the Vermeulen free testosterone calculation also points to lowish numbers. Your total testosterone is artificially boosted by your highish SHBG, and therefore is not useful as an indicator of hypogonadism.

Given that your free testosterone is borderline and you have symptoms I'd say you are a candidate for TRT. If you go this route then I'd steer you towards a less intrusive form, at least initially. Testosterone nasal gel has the significant advantage of not disrupting other hormones as much as other forms of TRT do.

 

[DrSheldor]

I do appreciate everyone who has weighed in, I find it challenging because most symptoms of low testosterone can be caused by multiple things, including poor sleep and stress, which, with busy careers and kids etc who amongst us doesn't have those as well right?

Part of me wonders if it would be crazy to do a 6-12 week trial of testosterone replacement to see if directionally the symptoms improve. While I know it takes many months for max benfit from TRT, it seems like if you make it 3 months with no improvement one could surmise in my situation that perhaps it is not the low Free T causing the issues.

 

[FunkOdyssey]

While I know it takes many months for max benfit from TRT, it seems like if you make it 3 months with no improvement one could surmise in my situation that perhaps it is not the low Free T causing the issues

Yes, assuming you've raised free T enough to move the needle.

 

[Seagal]

I do appreciate everyone who has weighed in, I find it challenging because most symptoms of low testosterone can be caused by multiple things, including poor sleep and stress, which, with busy careers and kids etc who amongst us doesn't have those as well right?

Part of me wonders if it would be crazy to do a 6-12 week trial of testosterone replacement to see if directionally the symptoms improve. While I know it takes many months for max benfit from TRT, it seems like if you make it 3 months with no improvement one could surmise in my situation that perhaps it is not the low Free T causing the issues.

Or you could start by improving sleep and reducing stress. TRT won't compensate for that.

Note, that there is a honeymoon phase with TRT where most men will feel much much better but it mostly levels out after about 2 months. If low T was the reason for the symptoms men will still feel better after the honeymoon phase. On the other hand if the life style or other health issues were the cause of the symptoms, you probably will be back to the pre TRT status.

 

[DrSheldor]

Or you could start by improving sleep and reducing stress. TRT won't compensate for that.

Note, that there is a honeymoon phase with TRT where most men will feel much much better but it mostly levels out after about 2 months. If low T was the reason for the symptoms men will still feel better after the honeymoon phase. On the other hand if the life style or other health issues were the cause of the symptoms, you probably will be back to the pre TRT status.

I agree, could probably get a little more sleep, maybe. Stress is difficult given career, and three kids with the oldest in the teen years. I would love to reduce that stress somehow! Ha

I didn't include it in my initial post, but another data point:

I did a DEXA Scan in November 2023 and in January 2025, so 14 months between. I was extremely consistent with my diet, weighing food, using macrofactor, and I lost 20lbs during a cut with 4-6 weight lifting sessions per week with progressive overload and going to failure or 1 RIR. Then did a slow bulk back up to a little below my initial weight. Second DEXA scan showed a net increase of 4 lbs in 14 months, was very demoralizing after as hard as I had worked and as consistent as I'd been. Essentially lost 6 lbs of muscle, and then gained 10lbs of muscle on the bulk. That was the factor that led me to go get my testosterone re-tested.

 

[Phil Goodman]

You sound a lot like me when I started.. good total t but low free. That was three and a half years ago and I don’t regret my decision at all.

I do think 12 weeks would be long enough to give you an idea of whether or not trt will improve your quality of life, but consider that the side effects may also be more prevalent during that window. For example, I’ve never really had an issue with stress or anxiety but there were times when I was dialing in when it become a temporary issue. Also, if you are wanting to expedite the experiment then you may want to try something like cream since you don’t have the spend the first five weeks just getting to a steady state. Or as cataceous pointed out, maybe go with the nasal or oral routes as they would have less impact on other processes. Honestly, with just a 12 week experiment I wouldn’t see recovery being much of an issue if you just stopped cold turkey at that point.

The hesitancy is definitely understandable though, and ultimately no one can make the decision for you. It really just comes down to the pros and cons of trt.

 

[BadassBlues]

41, just about right as far as when these things start to manifest. Just curious, what is your BMI? Do you have excessive abdominal fat?

Also, have you had your thyroid and adrenal function tested?

I would hesitate starting TRT until you have established the basis of your symptoms. There are many factors that can have an effect on SHBG, free T and Estrogen. You would likely just end up chasing numbers and making things worse. Your testicles are obviously working. To my mind, the problems seem to be elsewhere.

 

[DrSheldor]

I appreciate everyon's opinion, it is a tough decision. Agree on having to consider the pros/cons of TRT, what I find challenging is that broadly I know the pro/cons of TRT but based on the huge spectrum of experiences it is hard to tell what my specific pro/cons are without actually going on it. I could go on it have no benfits and have nothing but side effects, or I could go on it have better sleep, actually build muscle for once, have a restored libido/ed and wonder why I waited so long.

That said, it really does help to hear a variety of opinions and so I am thankful for those of you who have weighed in with advice or thoughts about what you'd do in my shoes. I'll keep thinking on it and researching!

 

[FunkOdyssey]

I know the pro/cons of TRT but based on the huge spectrum of experiences it is hard to tell what my specific pro/cons are without actually going on it. I could go on it have no benfits and have nothing but side effects, or I could go on it have better sleep, actually build muscle for once, have a restored libido/ed and wonder why I waited so long.

This isn't realistic. I'll tell you a more plausible worst case scenario: it doesn't resolve your original complaints, but your body composition, gym performance, and aesthetics improve significantly. It's going to put more muscle on you, because you are not a special flower immune to the primary effect of testosterone.

Then you would have the decision to make of whether to continue on the trt path for the gains alone or whether to return to normie life.