Who Started TRT w/ "Normal" Levels @ What Age?

[Systemlord]

It seems that EC works well in increasing testosterone, no questions about it. These numbers look good, however, I don't feel any different and most of the issues I related above remain the same.

I can tell you clomid blocks the effects of estrogen by attaching to the E2 receptors, it's one reason why there are no perceived benefits on clomid is a lot of cases.

This is common when using clomid and enclomiphene good labs and no perceived benefit.

 

[Systemlord]

Total Testosterone: 787 ng/dL. (Reference Range: 250-827 ng/dL)
SHBG: 44 mol/L (Reference Range: 22-77 nmol/L)
Testosterone Bioavailable: 190.1 ng/dL (Reference Range: 110.0-575.0 ng/dL)
Free Testosterone: 88.7 pg/ml (Reference Range: 46.0-224.0 pg/mL)

Your Free T levels aren't that great either.

 

[aneuman]

Thanks guys.

I've read about enclomiphene blocking estrogen receptors, the question is being a "Selective" estrogen receptor modulator, is it highly selective for the receptors at the hypothalamus/pituitary only? If so it should not cause any problems with estrogen receptor in other parts of the body. If it attaches to ER at other part of the body/brain, then its effect on libido, etc. are to be expected, but in that case it means EC/CC are not really highly selective ERMs

In a month I'll visit my andrologist again, will discuss the path going forward. I'd hate to use Cypionate and see my trusty balls go on full retirement when they are still able to contribute to society but I hate even more feeling crappy, so something's gotta give.

 

[CanadaJim]

I can attest to the libido killer aspect...I started with 12.5mg daily (for a week)...then switched to 25mg daily. At 12.5mg there did not seem to be any sides. But as I said I had only been on this dose for a week. After switching to 25mg my libido disappeared. I only did that for just under 2 weeks before stopping (I have blood work in a month so I wanted to give my system a chance to normalize and get back to baseline). I'm 54...I've jumped on and off the self prescribed trt train a few times over the last few years...concerned that I may have f'd up my system. Hopefully the upcoming blood work will provide a better picture....

 

[Cataceous]

...
Any other "old" people here with similar experiences? This is definitely NOT like the wonderful but short-lived experience I had with HCG.
...
"... improvement in hypogonadal symptoms may require at least 3 months of eugonadal levels before symptoms improve"
...

It's true that it can take many months to experience all of the benefits of normalized testosterone. So do give it some time. However, there may still be other issues. Have you measured progesterone? Prolactin?

...
I've read about enclomiphene blocking estrogen receptors, the question is being a "Selective" estrogen receptor modulator, is it highly selective for the receptors at the hypothalamus/pituitary only? If so it should not cause any problems with estrogen receptor in other parts of the body. If it attaches to ER at other part of the body/brain, then its effect on libido, etc. are to be expected, but in that case it means EC/CC are not really highly selective ERMs
...

The problem is that the selectivity is not so well characterized, and most of the research so far pertains to clomiphene. We know the zuclomiphene isomer is agonistic in bone and the liver, overpowering possible antagonistic effects of enclomiphene in these systems. However in the hypothalamus and pituitary enclomiphene's antagonism dominates, even though zuclomiphene alone is known to have strong agonistic effects that cause HPTA suppression.

One hypothesis, based on very limited data, is that men with above-average estrogenic activity are more likely to have good results with enclomiphene than those with below-average activity.

 

[CanadaJim]

Your Free T levels aren't that great either.

It's curious how reference levels differ...I had my SHBG done and it indicated high as it was 51.8nmol/l. The normal range reference was 11-50 nmol/l. According to aneuman's reference range I would be higher end of normal...

 

[aneuman]

It's true that it can take many months to experience all of the benefits of normalized testosterone. So do give it some time. However, there may still be other issues. Have you measured progesterone? Prolactin?

These are some other labs:

Prolactin: 6.1 mIU/mL (Reference Range: 2.0-18.0 ng/mL)

By the way, prolactin has been going down (9.2 in 2020, 7 in 2021, now 6.1)

ESTRADIOL,ULTRASENSITIVE, LC/MS: 31 pg/mL (Reference Range: < OR = 29 pg/mL)
DHEA SULFATE: 228 mcg/mL (Reference Range: 250-1100 ng/dL). Before that, my E2 level was around 27 pg/mL and Total T was 492 ng/dL (all natural, no interventions of any type) and I had the low libido and feeling like crap symptoms.

This progesterone test is an old result, before after the crash I had with HCG, when my TT levels were 309 (about 3 months ago, back in December)
17-HYDROXYPROGESTERONE: 72 ng/dL (Reference Range: 37-129 ng/dL)

Curiously, even though Estradiol 31 pg/mL is considered HIGH by Quest, it is equivalent to 3.1 ng/dL, which is less than 5 ng/dL. See below:

"In addition, a study by Ramasamy et al. in 2014 showed that libido was increased in men receiving TST when testosterone levels were >300 ng dl-1 and estradiol levels were >5 ng/dl. Most compelling is the fact that in men with serum testosterone <300 ng dl-1, sexual drive was seen to be markedly higher when estradiol levels were >5 ng/dl. In addition, when patients with low testosterone were treated with letrozole, a potent aromatase inhibitor, libido was decreased, suggesting that complete elimination of estradiol and decreasing the T/E ratio too severely, adversely affects sexual desire in men"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854098/

Could it just be that men feel better when they have high T simply because high T also implies higher E2 (up to certain limits) due to aromatization and that it is the higher E2 (around 5-7 ng/dL maybe) what restores the libido, etc, and not necessarily T itself? It's very common it seems that anastrozole kills libido en many men on TRT, or so I've heard.

So it could be that my estradiol works better in the low 20pg/mL or that I need at least 50 ng/mL. Definitely I don't think I'd need T levels above 800 to solve these issues.

By the way, I've been taking Cialis 5 mg daily for years due to BPH (along with Alfuzosin at night) and I have the nagging feeling that Cialis has something to do with lack of penile sensation and libido, can't put my finger on it on why, but I've felt the correlation. It's known that Tadalafil lowers estradiol (E2). Any thoughts on that?

I'm very thankful to all the people that has responded. You guys are making a tough period easier and less stressful. Your suggestions and comments are all welcome and well taken.

Thanks.

 

[Wolverine]

These are some other labs:

Prolactin: 6.1 mIU/mL (Reference Range: 2.0-18.0 ng/mL)

By the way, prolactin has been going down (9.2 in 2020, 7 in 2021, now 6.1)

ESTRADIOL,ULTRASENSITIVE, LC/MS: 31 pg/mL (Reference Range: < OR = 29 pg/mL)
DHEA SULFATE: 228 mcg/mL (Reference Range: 250-1100 ng/dL). Before that, my E2 level was around 27 pg/mL and Total T was 492 ng/dL (all natural, no interventions of any type) and I had the low libido and feeling like crap symptoms.

This progesterone test is an old result, before after the crash I had with HCG, when my TT levels were 309 (about 3 months ago, back in December)
17-HYDROXYPROGESTERONE: 72 ng/dL (Reference Range: 37-129 ng/dL)

Curiously, even though Estradiol 31 pg/mL is considered HIGH by Quest, it is equivalent to 3.1 ng/dL, which is less than 5 ng/dL. See below:

"In addition, a study by Ramasamy et al. in 2014 showed that libido was increased in men receiving TST when testosterone levels were >300 ng dl-1 and estradiol levels were >5 ng/dl. Most compelling is the fact that in men with serum testosterone <300 ng dl-1, sexual drive was seen to be markedly higher when estradiol levels were >5 ng/dl. In addition, when patients with low testosterone were treated with letrozole, a potent aromatase inhibitor, libido was decreased, suggesting that complete elimination of estradiol and decreasing the T/E ratio too severely, adversely affects sexual desire in men"

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4854098/

Could it just be that men feel better when they have high T simply because high T also implies higher E2 (up to certain limits) due to aromatization and that it is the higher E2 (around 5-7 ng/dL maybe) what restores the libido, etc, and not necessarily T itself? It's very common it seems that anastrozole kills libido en many men on TRT, or so I've heard.

So it could be that my estradiol works better in the low 20pg/mL or that I need at least 50 ng/mL. Definitely I don't think I'd need T levels above 800 to solve these issues.

By the way, I've been taking Cialis 5 mg daily for years due to BPH (along with Alfuzosin at night) and I have the nagging feeling that Cialis has something to do with lack of penile sensation and libido, can't put my finger on it on why, but I've felt the correlation. It's known that Tadalafil lowers estradiol (E2). Any thoughts on that?

I'm very thankful to all the people that has responded. You guys are making a tough period easier and less stressful. Your suggestions and comments are all welcome and well taken.

Thanks.

I agree with Systemlord, your free T isn't good. It is your free T and not total T that you should be focused on and is what gives you the positive T effects. See how you feel with your free T towards the top of the range (take TRT and/or reduce SHBG). Many men on here are over the top of the free T range. In order I tried: creams, pellets, injections (cypionate) and now hyrdrogel. By far injections and hydrogel have been the best. I had stable levels on injections but wanted to try hyrdogel given its reviews here and wanted more to mimic natural daily levels. Hydrogel applied to the scrotum will most likely greatly increase your all your related levels, including T, free T and DHT. 50mg (one click) had me at 888 total T (1100 top range), free T at 211 (155 top range) and DHT at 287 (top range 65). My SHBG usually hovers around 20. As you can see, my DHT is more than 4 times the top of the range. I have switched application site to 1 click on each shoulder every morning in an effort to bring down the DHT. Work in progress.

 

[Systemlord]

In order I tried: creams, pellets, injections (cypionate) and now hyrdrogel. By far injections and hydrogel have been the best. I had stable levels on injections but wanted to try hyrdogel given its reviews here and wanted more to mimic natural daily levels.

Don't forget about Jetanzo, it's right there next to topicals as far as more closly mimicking the circadian rhythm.

Jetanzo also produces higher DHT than injections and higher Free T than topicals.

 

[madman]

Don't forget about Jetanzo, it's right there next to topicals as far as more closly mimicking the circadian rhythm.

Jetanzo also produces higher DHT than injections and higher Free T than topicals.

If anything that title would go to transdermal (T-patch) or topicals (once daily in the am).

*In 34 men from a multicenter, phase 3 study of a transdermal T patch system for TD, nightly applications of 2 patches (5.0 mg/day) resulted in peak levels occurring in the morning after application and decreasing slowly until system removal, mimicking the circadian patterns reported in healthy, young men

*Similar to the 2.5 mg/day and 5.0 mg/day systems, peak T levels occurred 8 hours post-application, mimicking diurnal variation when the patch is applied at night.




Definitely not that oral T.

*As oral TU is given twice daily, there were 2 serum T peaks between 20.8 and 24.3 nmol/L (600 and 700 ng/dL) approximately 4 hours after administration, 2 sub-therapeutic troughs (<6.9 nmol/L or <200 ng/dL) 12 hours after administration, and a peak-to-trough ratio approaching 4

*Men using nasal and oral T products are able to achieve mean serum T levels that are within the normal range, but they experience several T peaks and troughs throughout the day because of the multiple daily dosing regimens required (2 or 3 times/day). This results in a PK profile that significantly deviates from the endogenous PK profiles of both younger and older patients




Even then keep in mind many using transdermal tend to prefer the creams applied twice daily (am/pm) over the standard gels applied once daily in the am.

*The daily dosing frequency of the topical gel products results in a PK profile with a resemblance to that of endogenous T in younger males

Applying creams twice daily in no way mimics the natural 24 hr circadian rhythm of a healthy young male let alone even when applied once daily some men are still hitting really high FT levels post >12 hrs (look over Nelson's threads)!

Top it off that many using the creams are running absurdly high TT/FT levels well above what they were producing in their prime!




PK of TTh and Diurnal Variation of Testosterone

3.4 Transdermal T patch

The FDA originally approved ANDRODERM®, 51 a non-scrotal transdermal T patch, in 1995, with the 2.5 mg/day and 5.0 mg/day systems. This method of delivery allows T to be continually absorbed without dose accumulations for 24 hours. 52-56 In a 24-week, multicenter, randomized 1:1, parallel-group study comparing the PK, efficacy, and safety of a transdermal T system with IM TE injections in 66 men with TD, daily application of 2 transdermal T patches (5.0 mg/day total) resulted in morning T levels within the defined normal physiologic range (10.6–35.7 nmol/L, or 306–1,031 ng/dL) in 96% of patients over weeks 2 to 24. 54 At week 16, T Cavg was 17.9 ± 6.1 nmol/L (517 ± 176 ng/dL) compared with 1.9 ± 2.2 nmol/L (55.4 ± 62.8 ng/dL) at baseline. Peak T levels were reached approximately 8.2 hours after application, with a Cmax of 26.5 ± 9.6 nmol/L (765 ± 277 ng/dL). In 34 men from a multicenter, phase 3 study of a transdermal T patch system for TD, nightly applications of 2 patches (5.0 mg/day) resulted in peak levels occurring in the morning after application and decreasing slowly until system removal, mimicking the circadian patterns reported in healthy, young men.52

A reduced dosing regimen for either 2.0 mg/day or 4.0 mg/day systems applied nightly was evaluated in an interventional study enrolling 40 men with TD for 4 weeks (Clinicaltrials.gov identifier: NCT01104246). This reduced dosing regimen was approved in 2011, and manufacturer data show that following 28 days of transdermal T application, 97% (34/35) men with TD were able to achieve Cavg within 10.4 to 35.7 nmol/L (300–1,030 ng/dL). 51 Mean Cmax values with 2.0 mg/day and 4.0 mg/day treatment were 22.5 ± 5.0 nmol/L (648 ± 145 ng/dL) and 24.1 ± 5.5 nmol/L (696 ± 158 ng/dL), respectively. Similar to the 2.5 mg/day and 5.0 mg/day systems, peak T levels occurred 8 hours post-application, mimicking diurnal variation when the patch is applied at night.




3.8 Oral testosterone undecanoate (TU)

Historically, oral TTh with non-esterified T has been unsuccessful in delivering physiological T due to first-pass hepatic metabolism; to overcome this, high doses were needed to achieve measurable serum T levels.86 A new, oral TU formulation delivered via a self-emulsifying drug delivery system was developed to promote solubilization and absorption of the lipophilic TU in the gastrointestinal tract, and in March 2019, became the first oral TTh approved by the FDA. In a phase 2 study, 200 mg oral TU administered twice a day resulted in 87% of men achieving average serum T levels within the physiological range (10.4–34.7 nmol/L, or 300–1,000 ng/dL), and none of the men had serum T levels >52 nmol/L (1,500 ng/dL). 87 Peak T levels were reached 4 to 5 hours after administration, and levels steadily decreased to baseline at approximately 12 hours unless a second dose was administered. As oral TU capsules are recommended to be taken with a meal, serum T levels appear to be modulated by dietary fat content. 88 Cavg and mean Cmax serum T levels were approximately 2-fold higher when 200 mg oral TU was administered with food compared with fasting. 87 Dietary fat was found to affect mean serum T levels achieved with oral TU; meals with higher fat content increased serum T concentrations. In a phase 3 study comparing the efficacy and safety of 237 mg oral TU given twice daily with once-daily 60 mg topical T solution, 87% (145/166) of men with TD treated with oral TU were able to achieve a mean Cavg within 8.7 to 31.4 nmol/L (252–907 ng/dL), meeting the primary objective.89 At the final study visit on day 105, the mean Cavg was 14.0 nmol/L (403 ng/dL) and Cmax was 34.9 nmol/L (1,008 ng/dL). As oral TU is given twice daily, there were 2 serum T peaks between 20.8 and 24.3 nmol/L (600 and 700 ng/dL) approximately 4 hours after administration, 2 sub-therapeutic troughs (<6.9 nmol/L or <200 ng/dL) 12 hours after administration, and a peak-to-trough ratio approaching 4.




4. Diurnal Variation in Serum T Levels

Diurnal variation in endogenous serum T levels in healthy men is well documented, with the highest T levels in the morning and lowest values in the afternoon and early evening, although the amplitudes of peak and trough levels vary by age. In 1983, a study by Bremner et al showed that there was a clear difference between serum T levels in normal young men (mean age 25.2 years) and older men (mean age 71.0 years).5 In young men, serum T levels were highest in the morning, falling to their lowest levels approximately 12 hours later and gradually increasing again to peak levels the next morning. Furthermore, a study to determine how endogenous T levels vary over clinic hours revealed that in 30- to 40-year-old men, morning total T levels are 30% to 35% higher than levels measured in the mid to late afternoon. This amplitude in daily endogenous T variation decreases with age, with a morning-to-afternoon difference of only 10% in 70-year-old men.90 The morning-to-afternoon total T ratios in young and older men were approximately 1.3 and 1.1, respectively, similar to what was observed in the Bremner study. These observations have led to recommendations in various clinical guidelines, including those of the American Urology Association in 2018, to obtain early morning blood tests for the diagnosis of TD, a threshold defined as <10.4 nmol/L (300 ng/dL). 3 While endogenous serum T exhibits a clear diurnal pattern in young men that appears to be blunted naturally as men age, there does not appear to be much diurnal variation for DHT, SHBG, LH, FSH, or E2, regardless of age.90

Diurnal variation appears to be absent in men with TD. Using a population mixed-effect analysis, Gupta et al showed that no circadian rhythm was detected in men with TD, and the mean endogenous T levels in men with TD (serum T levels <10.4 nmol/L, or 300 ng/dL) were much lower than in healthy young (mean age, 28 years) or older (mean age, 71 years) men. 91 Consistent with the literature, their modeling of circadian T in healthy young and older men revealed peak-to-trough ratios of 1.3 and 1.2, respectively. Additionally, univariate analysis of cross-sectional data from 3,007 older men (≥40 years) showed that the proportion of men with serum T levels <10.4 nmol/L (300 ng/dL) did not significantly change during the day (P<0.11), further supporting that endogenous T diurnal variation is absent in men with TD.92 Results from a study by Shlykova et al evaluating endogenous T levels over a 24-hour period in 21 healthy male volunteers showed that men with baseline serum T levels <10.4 nmol/L (300 ng/dL) did not demonstrate diurnal variation within the 24-hour sampling period. 93 To understand the circadian rhythmicity of T levels in men with TD, a population kinetic model built by Gonzales-Sales et al, using baseline T profiles from 859 men with TD, predicted a base T value of 8.3 nmol/L (239 ng/dL), with the amplitude of oscillation estimated to be 1.1 nmol/L (32.4 ng/dL). 94 Their model also predicted that a stretched cosine function was more suitable to describe the circadian behavior of T levels of men with TD, as trough levels occurred approximately 5 hours after peak T levels, and levels then increased until the next peak occurred approximately 19 hours later.94

A variety of exogenous TTh are available to increase serum T to physiologic levels in males with TD and may alleviate symptoms associated with TD.2 Some T replacement options more closely mimic the circadian levels of T identified in older men, whereas other options seem to provide PK profiles closer to those of younger men (Fig. 1 [Please put figure as close as possible to this callout] and Table 1). Some TTh options provide profiles that exceed the frequency of the natural T circadian rhythmicity.

Once-weekly SC TE injections bring mean T levels into the physiologic range within 24 hours after the first dose, with a total T Cmax/Cmin ratio of 1.8. The PK profile appears to mimic the flatter profile of older males’ endogenous T.95 IM T injections can cause both supratherapeutic T levels post-injection and subtherapeutic levels during the dosing interval, and depending on the formulation and dosage, peak-to-trough ratios of IM TC and TE range between 2 and 5.3. Longer-lasting TU injections do not demonstrate the supratherapeutic peaks of other IM formulations, with trough levels occurring at later time points after each injection and a peak-to-trough ratio of approximately 2.6 to 2.8. All IM TTh preparations result in PK profiles that are unlike those of the normal diurnal variation of healthy young or older men.

Daily transdermal gels and solutions, and nasal and oral T products, provide a consistent serum T level within the physiologic range in most patients. The daily dosing frequency of the topical gel products results in a PK profile with a resemblance to that of endogenous T in younger males.

Men using nasal and oral T products are able to achieve mean serum T levels that are within the normal range, but they experience several T peaks and troughs throughout the day because of the multiple daily dosing regimens required (2 or 3 times/day). This results in a PK profile that significantly deviates from the endogenous PK profiles of both younger and older patients.

*No single formulation appears to provide an exposure profile that would resemble diurnal variation of both young and older men.

*The importance of diurnal variation of endogenous T is not fully understood, but there may be additional factors (eg, sleep quality and duration) that may influence endogenous T levels.96 However, further clarification is needed for the association between the circadian timing of sleep loss and its effect on T levels.




Figure 1. Extrapolated mean steady-state serum total testosterone concentrations. Estimated diurnal T in young men (blue, age range: 23-28 years) and older men (yellow, age range 58- 82 years). Red arrows indicate the time of T administration. Dotted lines indicate Cavg over the dosing interval of 168 hours. Black lines in each panel represent mean steady-state T profiles of A) weekly SC TE administration; B) average mean T profiles for IM TC, TE, and TU over 2 weeks; C) 900 mg subdermal T pellets; D) 4.0 mg daily transdermal patch; E) average mean T profiles of 100 mg TESTIM® /VOGELXO®, 40 mg FORTESTA®, 1.62% AndroGel®, and 2% AXIRON®; F) nasal gel T at day 90 three times daily; G) 30 mg buccal mucoadhesives applied twice daily, and H) twice daily 200 mg oral TU capsules.

*For products with ≥1 daily dose, we extrapolated data over 1 week to compare all PK profiles consistently. For products with dosing regimens of longer than a week (eg, IM injections and T pellet implantation), only the PK profile in the first week following dosing is presented; these data do not reflect average concentrations throughout the entire dosing interval.

IM, intramuscular; SC, subcutaneous; T, testosterone; TC, testosterone cypionate; TE, testosterone enanthate; TU, testosterone undecanoate.



D. Transdermal T-patch (4.0 mg daily transdermal patch)

E. Topical gels and solutions (average mean T profiles of 100 mg TESTIM® /VOGELXO®, 40 mg FORTESTA®, 1.62% AndroGel®, and 2% AXIRON®)

H. Oral capsule (twice daily 200 mg oral TU capsules)

 

[madman]

I agree with Systemlord, your free T isn't good. It is your free T and not total T that you should be focused on and is what gives you the positive T effects. See how you feel with your free T towards the top of the range (take TRT and/or reduce SHBG). Many men on here are over the top of the free T range. In order I tried: creams, pellets, injections (cypionate) and now hyrdrogel. By far injections and hydrogel have been the best. I had stable levels on injections but wanted to try hyrdogel given its reviews here and wanted more to mimic natural daily levels. Hydrogel applied to the scrotum will most likely greatly increase your all your related levels, including T, free T and DHT. 50mg (one click) had me at 888 total T (1100 top range), free T at 211 (155 top range) and DHT at 287 (top range 65). My SHBG usually hovers around 20. As you can see, my DHT is more than 4 times the top of the range. I have switched application site to 1 click on each shoulder every morning in an effort to bring down the DHT. Work in progress.

No point in stating such unless he had his FT tested using an accurate assay (Equilibrium Dialysis or Ultrafiltration) which I highly doubt was even done!

 

[madman]

Your Free T levels aren't that great either.

Still, commenting on that without asking how his FT was tested?

This is getting old!

 

[madman]

Your Free T levels aren't that great either.

Get back to me on that one when he has it tested using an accurate assay!

070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp

Labcorp test details for Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS

www.labcorp.com

 

[aneuman]

Get back to me on that one when he has it tested using an accurate assay!

070038: Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS | Labcorp

Labcorp test details for Testosterone, Free, Equilibrium Ultrafiltration With Total Testosterone, LC/MS-MS

www.labcorp.com

I don't know what type of assay they did, honestly. Here's a screenshot of Quest historical results since I started on this journey in 2019, if this helps. Prior to January 2022, all the numbers are my natural numbers. The dip you see after January 2022 was after 3 months go HCG (first months was amazing, the remaining two were horrible) the upward slope after January 2022 was enclomiphene citrate 12.5 mg ED

 

[JYD21]

Just got some updated labs from Quest. 45 y/o.

TESTOSTERONE, TOTAL, MALES (ADULT), IA 441 (250-827 ng/dL)
ALBUMIN 4.0 (3.6-5.1 g/dL IG )
SEX HORMONE BINDING GLOBULIN 32 (10-50 nmol/L IG)

TESTOSTERONE, FREE 62.1 (46.0-224.0 pg/mL)
TESTOSTERONE,BIOAVAILABLE 114.1 (110.0-575.0 ng/dL)
VITAMIN D,25-OH,TOTAL,IA 33 (30-100 ng/mL IG)

Free test looks low to me.

FSH 3.5 1.6-8.0 mIU/mL IG
LH 4.4 1.5-9.3 mIU/mL IG
PROGESTERONE <0.5 <1.4 ng/mL IG
PROLACTIN 6.0 2.0-18.0 ng/mL IG
ESTRADIOL 17 < OR = 39 pg/mL IG
DHEA SULFATE 148 61-442 mcg/dL

I tend to have lower E2 as well. Unsure if they did E2 sensitive or what.

 

[JYD21]

Just got some updated labs from Quest. 45 y/o. Not on TRT yet, but still lurking. My numbers are lower normal and my symptoms have been low libido, less muscle growth, a bit of depressions, but the last two years have been rough with job loss, starring a new one, relationship issues.

Curious what you guys think of these numbers.

I tried to edit/update my first message, but I can't for some reason. Here's a fuller panel:

TESTOSTERONE, TOTAL, MALES (ADULT), IA 441 (250-827 ng/dL)
ALBUMIN 4.0 (3.6-5.1 g/dL IG )
SEX HORMONE BINDING GLOBULIN 32 (10-50 nmol/L IG)

TESTOSTERONE, FREE 62.1 (46.0-224.0 pg/mL)
TESTOSTERONE,BIOAVAILABLE 114.1 (110.0-575.0 ng/dL)
VITAMIN D,25-OH,TOTAL,IA 33 (30-100 ng/mL IG)

ESTRADIOL 17 < OR = 39 pg/mL IG
DHEA SULFATE 148 61-442 mcg/dL

Free test looks low to me.

PSA (FREE AND TOTAL) IG
PSA, TOTAL 0.8 < OR = 4.0 ng/mL
PSA, FREE 0.2 ng/mL
PSA, % FREE 25 L >25 % (calc) - THIS WAS FLAGGED, HIGH

FSH 3.5 1.6-8.0 mIU/mL IG
LH 4.4 1.5-9.3 mIU/mL IG
PROGESTERONE <0.5 <1.4 ng/mL IG
PROLACTIN 6.0 2.0-18.0 ng/mL IG


THYROID PANEL IG
T3 UPTAKE 39 H 22-35 % - THIS WAS FLAGGED, UNSURE WHY
T4 (THYROXINE), TOTAL 6.4 4.9-10.5 mcg/dL
FREE T4 INDEX (T7) 2.5 1.4-3.8
TSH 0.92 0.40-4.50 mIU/L IG
T4, FREE 1.3 0.8-1.8 ng/dL IG
T3, FREE 3.3 2.3-4.2 pg/mL IG
THYROID PEROXIDASE IG ANTIBODIES 1 <9 IU/mL

LIPID PANEL, STANDARD
CHOLESTEROL, TOTAL 117 <200 mg/dL IG
HDL CHOLESTEROL 46 > OR = 40 mg/dL IG
TRIGLYCERIDES 73 <150 mg/dL IG
LDL-CHOLESTEROL 56 mg/dL (calc) IG
CHOL/HDLC RATIO 2.5 <5.0 (calc) IG
NON HDL CHOLESTEROL 71 <130 mg/dL (calc) IG

COMPREHENSIVE METABOLIC IG PANEL
GLUCOSE 102 H 65-99 mg/dL - THIS WAS FLAGGED, HIGH
UREA NITROGEN (BUN) 21 7-25 mg/dL
CREATININE 1.16 0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN 76 > OR = 60 mL/min/1.73m2
SODIUM 141 135-146 mmol/L
POTASSIUM 4.2 3.5-5.3 mmol/L
CHLORIDE 109 98-110 mmol/L
CARBON DIOXIDE 28 20-32 mmol/L
CALCIUM 9.0 8.6-10.3 mg/dL
PROTEIN, TOTAL 6.4 6.1-8.1 g/dL
ALBUMIN 4.0 3.6-5.1 g/dL
GLOBULIN 2.4 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.7 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.8 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 42 36-130 U/L
AST 18 10-40 U/L
ALT 24 9-46 U/L

HEMOGLOBIN A1c 5.0 <5.7 % of total Hgb IG

CBC (H/H, RBC, INDICES, IG WBC, PLT)
WHITE BLOOD CELL COUNT 4.1 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.22 4.20-5.80 Million/uL
HEMOGLOBIN 15.9 13.2-17.1 g/dL
HEMATOCRIT 47.3 38.5-50.0 %
MCV 90.6 80.0-100.0 fL
MCH 30.5 27.0-33.0 pg
MCHC 33.6 32.0-36.0 g/dL
RDW 12.3 11.0-15.0 %
PLATELET COUNT 193 140-400 Thousand/uL
MPV 9.3 7.5-12.5 fL
IRON, TOTAL 93 50-180 mcg/dL IG
FERRITIN 93 38-380 ng/mL IG
VITAMIN B12 391 200-1100 pg/mL IG

 

[JYD21]

Curious what you guys think of these numbers.

I tried to edit/update my first message, but I can't for some reason. Here's a fuller panel:

TESTOSTERONE, TOTAL, MALES (ADULT), IA 441 (250-827 ng/dL)
ALBUMIN 4.0 (3.6-5.1 g/dL IG )
SEX HORMONE BINDING GLOBULIN 32 (10-50 nmol/L IG)

TESTOSTERONE, FREE 62.1 (46.0-224.0 pg/mL)
TESTOSTERONE,BIOAVAILABLE 114.1 (110.0-575.0 ng/dL)
VITAMIN D,25-OH,TOTAL,IA 33 (30-100 ng/mL IG)

ESTRADIOL 17 < OR = 39 pg/mL IG
DHEA SULFATE 148 61-442 mcg/dL

Free test looks low to me.

PSA (FREE AND TOTAL) IG
PSA, TOTAL 0.8 < OR = 4.0 ng/mL
PSA, FREE 0.2 ng/mL
PSA, % FREE 25 L >25 % (calc) - THIS WAS FLAGGED, HIGH

FSH 3.5 1.6-8.0 mIU/mL IG
LH 4.4 1.5-9.3 mIU/mL IG
PROGESTERONE <0.5 <1.4 ng/mL IG
PROLACTIN 6.0 2.0-18.0 ng/mL IG


THYROID PANEL IG
T3 UPTAKE 39 H 22-35 % - THIS WAS FLAGGED, UNSURE WHY
T4 (THYROXINE), TOTAL 6.4 4.9-10.5 mcg/dL
FREE T4 INDEX (T7) 2.5 1.4-3.8
TSH 0.92 0.40-4.50 mIU/L IG
T4, FREE 1.3 0.8-1.8 ng/dL IG
T3, FREE 3.3 2.3-4.2 pg/mL IG
THYROID PEROXIDASE IG ANTIBODIES 1 <9 IU/mL

LIPID PANEL, STANDARD
CHOLESTEROL, TOTAL 117 <200 mg/dL IG
HDL CHOLESTEROL 46 > OR = 40 mg/dL IG
TRIGLYCERIDES 73 <150 mg/dL IG
LDL-CHOLESTEROL 56 mg/dL (calc) IG
CHOL/HDLC RATIO 2.5 <5.0 (calc) IG
NON HDL CHOLESTEROL 71 <130 mg/dL (calc) IG

COMPREHENSIVE METABOLIC IG PANEL
GLUCOSE 102 H 65-99 mg/dL - THIS WAS FLAGGED, HIGH
UREA NITROGEN (BUN) 21 7-25 mg/dL
CREATININE 1.16 0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN 76 > OR = 60 mL/min/1.73m2
SODIUM 141 135-146 mmol/L
POTASSIUM 4.2 3.5-5.3 mmol/L
CHLORIDE 109 98-110 mmol/L
CARBON DIOXIDE 28 20-32 mmol/L
CALCIUM 9.0 8.6-10.3 mg/dL
PROTEIN, TOTAL 6.4 6.1-8.1 g/dL
ALBUMIN 4.0 3.6-5.1 g/dL
GLOBULIN 2.4 1.9-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO 1.7 1.0-2.5 (calc)
BILIRUBIN, TOTAL 0.8 0.2-1.2 mg/dL
ALKALINE PHOSPHATASE 42 36-130 U/L
AST 18 10-40 U/L
ALT 24 9-46 U/L

HEMOGLOBIN A1c 5.0 <5.7 % of total Hgb IG

CBC (H/H, RBC, INDICES, IG WBC, PLT)
WHITE BLOOD CELL COUNT 4.1 3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT 5.22 4.20-5.80 Million/uL
HEMOGLOBIN 15.9 13.2-17.1 g/dL
HEMATOCRIT 47.3 38.5-50.0 %
MCV 90.6 80.0-100.0 fL
MCH 30.5 27.0-33.0 pg
MCHC 33.6 32.0-36.0 g/dL
RDW 12.3 11.0-15.0 %
PLATELET COUNT 193 140-400 Thousand/uL
MPV 9.3 7.5-12.5 fL
IRON, TOTAL 93 50-180 mcg/dL IG
FERRITIN 93 38-380 ng/mL IG
VITAMIN B12 391 200-1100 pg/mL IG

Bump. With my Free T, Bioavailable T, and E2 being on the lowend/cusp, I'm giving substantial thought to starting TRT. I'm talking to a functional wellness doc who focuses on wellness about it.

 

[Cataceous]

Your numbers are indeed borderline, but I still wouldn't risk conventional TRT yet. Repeating from the first page: Do you have access to a testosterone nasal gel, either generic or Natesto? These products can give you higher peak testosterone without too much HPTA suppression. If this didn't help then low testosterone may not be the issue. Enclomiphene is an alternative—it stimulates the HPTA and can give a guy nice testosterone numbers. However, the reported subjective results are mixed, so it would be my second choice.

 

[JYD21]

Your numbers are indeed borderline, but I still wouldn't risk conventional TRT yet. Repeating from the first page: Do you have access to a testosterone nasal gel, either generic or Natesto? These products can give you higher peak testosterone without too much HPTA suppression. If this didn't help then low testosterone may not be the issue. Enclomiphene is an alternative—it stimulates the HPTA and can give a guy nice testosterone numbers. However, the reported subjective results are mixed, so it would be my second choice.

My understanding of Natesto is the studies they've done show that it doesn't negatively affect normal testicular function like injections or the once daily gels, so you don't need additional meds like clomid or hcg. He said since it's a low dose 3x a day your system isn't flooded with abnormal levels and your hormone production doesn't shut down.

I've been reading the qualitative data on both Natesto & enclophamine and it is indeed subjective.

I am very curious as to why, if we have so many downsides to starting TRT injections, it is so widely the 'go-to' once you reach that point in how you feel & your labs.

 

[Cataceous]

...
I am very curious as to why, if we have so many downsides to starting TRT injections, it is so widely the 'go-to' once you reach that point in how you feel & your labs.

A few reasons of the cuff: Nasal gel and enclomiphene are relatively new options. Clomid has been around, but it's effectively like taking estrogen with your enclomiphene, further reducing the odds of success. TRT can give great honeymoon periods. If you avoid the acute problems of excess then it may take a while for other problems to become apparent. By then you might not be sure TRT is to blame. There's also more awareness of the benefits than of the problems. Testosterone does aid athleticism, after all.