30, Low Free T, Should I Start?

Pharma / TRT Testosterone Replacement
1

Hey all,

age: 30
height: 5’8"
weight: 145lbs
waist: 30"
describe body and facial hair: very sparse body and facial hair
did to grow fast or slow and steady as a teen: slightly slow, nothing abnormal
testes ache or hurt? ever? a few times after marijuana use
mood: inconsistent, sometimes pretty good, sometimes can’t get out of bed or irritable
depression: sometimes, mostly related to feeling shitty, unable to do anything, anhedonic
libido: sometimes really good, sometimes non existent
get cold easily? a change?: handle cold okay most of the time
dry skin, brittle nails?: dry skin, nails seem fine
use iodized salt?: not in years. started supplementing 02/2018
eat much sea food? not as much lately
exposure to chemicals? nothing out of the ordinary
ever used hair loss drugs? no
Rx and OTC drugs: moderate marijuana + alcohol abuse in teens and early 20’s. cocaine, adderall, MDMA, < 10 times each.

I’m so glad to have found this forum - the wealth of information here is incredible. I’ve been dealing with symptoms of low T on and off for 6 years now, sometimes it’s fine and I feel pretty good, and other times I’m completely bedridden, no motivation, and my body feels like it’s 150 years old.

Finally, after being fed up with these symptoms I decided to get my bloodwork done. Here are the results, and I would love help interpreting them.

About me:

Never done any AAS. Drank alcohol and smoked weed in above average quantities throughout ages 18 - 24, also experimented with cocaine, MDMA, a few times.

30 y/o. 5’8" 145 pounds. < 15% body fat. I’m 30, but I receive comments all the time about how young I look. I could probably pass for an 18 year old. I have almost no body hair except for my genital area. Eat pretty healthy, lots of fruits and vegetables, good fats, high quality proteins,

My symptoms are: anxiety, depression, trouble falling asleep, slow recovery from workouts, excessive joint clicking, low energy, low sex drive, mild ED, brain fog, low mental alertness. Lately have been feeling brief dull aches in the scrotum area above my testicles (not the testicle itself)

I just got my labs back and would super appreciate any help interpreting them. Would you recommend I start TRT? Are there signs of other underlying symptoms? Thanks!

Blood drawn at 11:35am, 13 hours fasted

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Any help interpreting why my Free T is below normal, and whether it’s a good idea to start TRT or not would be great. Thanks! I’m mainly looking for an improved enjoyment of life, mentally and physically.

2

Your popping and clicking joints is from low E2 levels, I experienced it myself for more than a year when low T which can happen with low FT. Your E2 is on the lower end which suggests your natural E2 levels were on the higher end ranges.

Guys with higher SHBG need more T in order to have healthy free T levels, high SHBG scavenges sex hormones and while you’re not high on the ranges, you’re high for you as an individual which doctors have a problem understanding as they believe everyone is a cookie cutter clone.

You will do well with T in the high normal range as you hold on to your T well so weekly to twice weekly injections will serve you well. TSH indicates possible iodine deficiency, for TRT to work require optimal thyroid hormones and results obtained will directly reflect your thyroid functioning. Do you get iodine in salt? You might try supplementing iodine and selenium.

A full thyroid panel checking T4, fT4, fT3, rT3 and antibodies is needed to see why TSH is slightly elevated, TSH needs to be closer to 1.0 as most progressive doctors begin thyroid treatment at 2.5. We see a lot of guys started on TRT with undiagnosed thyroid issues and guys often wonder why TRT isn’t working and can have the same symptoms as low T.

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3

TSH should be nearer to 1.0 and your thyroid function will be low, see “oral body temperatures” below. Post your temperatures and history of using iodized salt.

Low thyroid function can wreck energy, libido and mood, even when TT, FT and E2 are optimal. And thyroid can also mean that TRT makes one feel worse because with low thyroid function your body cannot keep up with the increased/restored metabolic demands of TRT.

TRT will bring on the facial hair, thicken arm/leg hair and body hair may come on over a period of years.

Total cholesterol would be better near 180. I am concerned that you are harming yourself with an extreme low fat diet.

Labs should be LH and FSH. LH is released in pulses with a short half-life. FSH with its long half-life is often a better indicator of LH status than LH itself.

If FSH is quite high relative to LH, testicular cancer is suspected and it is a young man’s disease. So something to keep in mind. A few have had this indication here.

Start reading and working on these issues and search for a TRT doc in parallel. Avoid 200mg T per week, not right for your body type and age.

Self inject 50mg T twice a week subq over upper legs, not IM, #29 1/2" 0.5ml insulin syringes

0.5mg anastrozole at time of T injections, further reading required…

250iu hCG subq EOD to protect testes and fertility.

Dull ache above testes might be prostatitis [increases PSA] or hernia. Ask doc to check this out and examine your testes. PSA=1.4 seems high for your age. Watch over time typically not looked at at your age. Any urine flow problems or ache after ejaculation? Ache can also be vascular problems that are often surgically corrected.

Do not do labs soon after ejaculation as this can shift PSA upwards.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

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Thank you guys… I appreciate the advice/support so much that I want to cry a bit. Hopefully that’s the hormones talking…

I just ordered an iodine + selenium supplement, and a digital thermometer. Will start taking temperature readings.

I have my initial consultation scheduled 2 weeks from now with a telemedicine clinic (Defy). Will see what they say, and will work on getting my full thyroid panels and FSH done.

Regarding my fat intake, I tend to eat meals containing butter, olive oil, chicken, eggs, beef, or fish, 2-3x per day. I have been on a 9-hour time restricted eating window (10am - 7pm). Could that be a culprit with the cholesterol?

I have noticed an ache/burning sensation deep inside the base of my penis after ejaculation from time to time.

5

Use glass thermometer and not a digital one. The difference between 1 degree is huge and digital is not accurate enough.

Interesting I’ve noticed a burning sensation after ejaculating as well as my erections and get better and better, perhaps yours is going in the other direction due to a low T environment. I quit doing it for now because it’s getting painful.

6

I got the results of bloodwork I got through my PCP. The good news… I’m STD free. The bad news, I may have some underlying health conditions. I know you are not doctors @KSman @systemlord but any advice is appreciated.

My serum creatinine levels, and Urobilinogen levels are at the absolute bottom of the range. A quick Google is telling me this might mean biliary obstruction in my liver? There was also trace microscopic blood in my urine which as a result my PCP is having me retake the urine test.

There are also some stark differences in my TSH and Free Testosterone levels even those these tests were taken 1 day apart. These results were a day earlier at approx 11am, and the previous bloodwork I posted in my original post were from the day after at approx 11:30am:

TSH: 3.390 - next day → 2.290
Free T: 13.00 ng/dL ref range (5.00-21.00) - next day → 8.7 pg/mL ref range (9.3-26.5) after 24 hours

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They were both LabCorp tests, but taken at different facilities. Any thoughts appreciated.

7

Look like thyroid output is changing one day to the next causing your SHBG levels to climb when TSH is lower (more fT3) and then dropping causing your free T and TT to be affected. A lower TSH means more SHBG, higher TSH lower SHBG, when SHBG goes up TT follows and shrinks free T and SHBG goes down free T goes up.

Normally TSH doesn’t fluctuate widely during the day, or from day to day. You need to gain control of your thyroid.

8

A quick update: I’ve been taking Iodine, Selenium and Vitamin D supplements daily and it’s made a huge difference. My insomnia is gone and my motivation, energy and libido are back to an acceptable level where I can perform well enough to not get fired from my job.

However, I’m still thinking about continuing with TRT for overall life improvements - I’m genetically on the nonathletic and low sex appeal spectrum and believe TRT might help. I’ve already paid for my initial consultation which is tomorrow. I guess rather than hovering around 600ng/ml at best, I’d rather have a constant 8-900+.

9

Finished my consultation today, was prescribed:

Test-C: 70mg E3.5D
AI: .125mg E3.5D
HCG: 500IU E3.5D
DHEA: 40mg daily

Thoughts on dosage? Does it seem right?

10

Quick update:

Took my first dose yesterday, this is the protocol I am starting with:

Test-Cyp: 50mg E3.5D
140IU HCG: the day before and 2 days before each Test injection (= 4x/week)

I took my test shot Friday morning and was already feeling good the day of. It’s the morning after now and I’m still feeling great - I hope this lasts.

Observations:
I feel like myself again, motivation to workout, to organize/clean the apartment, and I enjoy socializing again (this is very important to me). More motivated to tackle things at work, less disgruntled by constructive criticism.

I’m less addicted to vegging out watching YouTube videos - it doesn’t seem interesting to me anymore. My erection quality last night was “powerful” - my ejaculation had a very pungent smell that I’ve never experienced before… I’m becoming a virile young dude :wink:

I did however still have trouble falling and staying asleep.

Hoping this lasts - I feel like I have the energy now finally to make all the life improvements I’ve been attempting and falling short of for years.

11

So you eliminated ai and dhea?

12

It won’t last, the TRT honeymoon phase will end in 1-3 weeks when you pituitary will notice testosterone in your bloods and will assume your testes are working again, then your pituitary gland will shutdown. It happens to most but not all.

Do not be alarmed, 6 weeks after the crash you’ll start feeling good again.

13

Yes for now, since it seems many people are successful without AI if they dose more frequently. I also couldn’t find any conclusive evidence on how DHEA has any benefits - it sort of seemed the doc was just trying to upsell me.

My plan is to introduce as few variables as possible, that way I have a better idea of what to tweak after my next blood work if anything needs tweaking.

I did buy the DHEA and AI and have them on hand if I decide they are needed. Will keep posting periodic updates

14

Ok, thanks systemlord for the reality check. I will curb my enthusiasm then so as to not get involved in any commitments that I might not be able to follow through on should/when the crash comes.

15

Your welcome,

Many have quit TRT many different times and restarted TRT do to this fact not ever knowing what’s going on. Doctors should inform their patients of this fact but often don’t know themselves, most doctors know very little about male hormones.

16

Quick update: I understand what people mean by the roller coaster…

The 24 hours after injection I feel great, but that seems to drop off very quickly after that and back to how I felt before but weirder. I think I’m having high e symptoms as my emotions are all over the place and I find myself wanting to talk about feelings and shit with my coworkers.

Since my last post I took one AI capsule (.125mg) not sure whether it helped or not. I also took my second shot at 60mg test instead of 50.

My sleep has been terrible which may be a large contributor to the whackiness I feel. Anxious, hot, emotional, cant focus, un alert/spaced out.

Anyone who’s been through this have tips? My urge is to keep experimenting with the dosing, but I know that can’t be the right thing to do.

17

If you don’t remain consistent your blood levels will never stabilize, each time you add or subtract dosages or (AI’s) your blood levels fluctuate wildly for weeks do to the change. The reason you feel the way you do is because your pituitary gland is shutting down, the moment you start increasing or decreasing AI dosage going based off how you feel, you will surely fail at TRT.

You keep experimenting and you’ll always feel terrible.

18

Yea that makes sense systemlord, it’s tough to resist in the moment when everything’s going haywire, but agreed - my intention is stick as close to the protocol as possible, until my next set of bloodwork to tweak doses.

Quick update:

Last night I realized that I have sleep apnea - I woke up mid-dream because I wasn’t breathing. This definitely explains a lot why I don’t usually get great sleep. I thought my PCP was a total quack when she brought up the possibility of sleep apnea as the cause for my poor condition. I guess because I’m quite skinny and don’t snore much I didn’t think it was a possibility. Luckily I agreed to schedule a sleep study with her which I will see what can be done.

It kinda makes me wonder if I really need TRT at all if I just get my sleep apnea sorted out – hesitantly, I’m still going to go through with it and see if I can get it dialed in.

Yesterday I did end up taking my dose of AI that I was trying to see if I could do without - it helped quite a bit and within an hour or two. That ‘wired’ on edge feeling went away and I got a decent night’s sleep, minus the waking up part.

Observations:
Although I didn’t feel fantastic today, because I didn’t sleep great and I’m still dialing in my dose, I did have one of the best sessions in the gym that I can remember.

It was subtle, but noticeable. It almost seemed my coordination was better, I was able to really concentrate on my muscle movements and have really tight form, and I didn’t feel exhausted between sets.

19

Your body is going through changes right now, give it time. The longer you’re on TRT the better you will feel, some guys are still noticing improvements beyond a year.

20

Quick Update:

It’s been just about 3 weeks since I’ve started. I wanted to keep my protocol strict and only modify after blood tests, but alas, I’m impatient and ended up modifying my protocol.

For the past week or so I’ve been doing 34mg Test-C EOD, along with 240IU hCG EOD for a total of 119mg T and 840 IU hCG every week. I don’t take an AI on a regular basis, although my nips were lookin a bit puffy last week so I took one .125mg capsule. It seemed to help.

Although it’s only been a week or so on this protocol I feel pretty dialed in. Things have been going great. Nothing spectacular, just feeling good, energy and motivation to workout and get things done, muscles feeling harder than normal. I think I am retaining a bit more water too - not too much, but how much I probably should be retaining. It looks and feels good.

Overall, I’m feeling great. Sleeping slightly better, and overall just feeling how a man with a good job, decent family, and great friends should feel - uplifted and energetic, rather than depressed and lifeless, unable to keep up. Also my libido is great, nothing too distracting, but the mental and physical aspects of my libido are both feeling rock solid.

I’m sure I still have a long road ahead, of positive change. I’m curious to see how my bloodwork will come back. There could be room to up my dose a bit, although how I’m feeling now is completely sufficient to be the foundation I’ve been needing to keep up with life, and even become the person I’ve been wanting to be and know I can become.

I think I’ve definitely lived a large portion of my 20’s deficient in T. I’m feeling more like myself again - not in any kind of grandiose way, my vitality just hasn’t been there when I needed it, and I finally feel like it’s coming back.