Bloodwork Shows Low T. Endo Says It Is Normal

Pharma TRT
122

Appointment done with the very first doctor that identified my low T levels years ago. I guess more or less all questions have been clarified.
I´ve been qualified again as hypogonadal. Primary. Nothing has changed much since, but the trend is to get lower with age with occasional fluctuations but never reaching optimal levels.

Doctor didn´t say it is an obligation to do TRT. However, should it be my choice and if I decide to do so, he will help me through the process. And also said he´d do so himself without hesitation should he needed to. He´s very open to hormone optimization in men and women.

TRT would be done via bio-identical T gel (I guess nothing was mentioned about scrotal cream). I mentioned injections, but it doesn´t seem to be the preferred method. I´m concern about safety of transferring it to wife or kids accidentaly and also logistics - I believe it´s applied in the morning and If I want to go to the beach in the morning…don´t know what to do as it needs to get dry and wait 3-4 hours before swimming and such.

I was told the objective would be to treat symptoms (not exactly numbers per se but always within range as a reference) with the lowest needed dose and to mimic as close as possible our natural T cycle and its daily pulses.

I believe the Gel treatment is more expensive and perhaps not comparticipated by the NHS, which is something not good at all and i need to find out.

Right now, I have to repeat labs (I think the point is to have one more Pre-TRT starting reference). Also prescribed me a supplement “ON Optimen” to see if it helps with anything even if I decide not to do TRT.

He didn´t say “no”, but didn´t recommend the injection route saying it´s different from bio identical. And would also require daily (or close to) injections. I´ve read too many controversy around this topic. I asked if T isn´t always T ? He said “Yes and No. The approach would be with Gel”.

In reality, I´m more affraid of TRT than doing injections myself…
Meanwhile I have to think about it.

123

Your doctor is operating in the dark and doesn’t any ideal what he’s talking about. Talk about clueless.

124

Then, i really don´t know what to do.

He explained that the difference in the “carrier” of T injections to my system would not enable to be as close as possible to our natural T production.

But he seemed to be more favourable to daily applications which is good, saying the 2 week protocols could never work.

125

When you mentioned you were concerned about transfering to the kids and wife, that should have been the end of topical discussion and he should have recommended injections at that point. This is what a competent doctor would have done and would shows good judgement.

126

Sorry, may have explained wrong. I am concerned about it, but I didn´t manifest it at the time. I was overprocessing too much new info.

It will be something I will discuss when I present him my labs. I would prefer injections for convenience and wouldn´t mind doing it EOD.

Anyway, is the Bioavailable T Gel less effective when compared to injections ?

If he says only the gel can be used… I really dont know what to do. I´d like have more possibilities at hand just in case.

127

The problem with gels is men typically don’t absorb well, or if they do it only for the short term. The injectables doesn’t have these downsides, 100% is absorbed and in my opinion is more convenient to inject two times per week as opposed to 1-2x daily gel.

Studies show more lean muscle mass in the lower extremities on injections vs topicals. However topicals produces more DHT vs injections and DHT is responsible for libido and wellbeing on TRT.

I have heard accounts when men went from topicals to injections and notice a less robust libido.

128

Yes, I just read about it stopping to work after months or a few years. I can´t tell, however without trying. But I need to be sure there´s a feasable plan B with this doctor in the case the gel stops working or I just decide not to use it at all for safety reasons transferring it to others.

I just researched and found a difference in the chemical formula too :

Bio T : C19H28O2
Cypionate T : C27H40O3
Enanthate T : C26H40O3

When Cypionate or Enanthate reach our muscle/skin after injection, do they convert to the same substance as the bioidentical ? Is there really a purpose in the process to use the substance in its natural or “reference” form ?
Don´t want to get too technical about this, but just wondering if the “identical” form has any advantage per se over the others and if it exists in injectable form.

129

He’s technically correct, but that’s not the point of TRT really. You want to resolve symptoms in the easiest most convenient way for each person. Nasal gels and oral undecanoate more closely mimic natural T production, but they’re not the most effective.

130

My doctor is not an Endo. He´s also not an urologist. He´s a general healthcare doctor and family planning also specializing in anti-aging medicine. For both women and men.

He suggested the gel due to the fact that it is the closed way to mimic our natural production based on our cyrcadian rhythm. He defended daily applications are the best approach because our body naturally produces the hormone on a daily basis, which is the natural impulse. I liked the fact that he was not a fan of the 200mg / 2-week rollercoasters or similar protocols as i´ve seen those widely rejected around here for obvious reasons.

I just need to know that in the longrun If I ever need to switch to injections, he will accept the protocol change. That makes me feel way more comfortable with the process.

I have a question : If I didn´t have this issue with my low hormone levels and instead, my normal levels would be 600 total (just an example) and I didn´t have any health issues and/or suffer any side effects from my own natural production, would it mean that If I tried replicate those 600 with exogenous T I would still be pretty much safe as in the natural version of myself ? Same DHT conversion, same estradiol, same contribution to BPH stress, same hematocrit, and so on ?
Or, simply because it is an exogenous source, it doesn´t matter… I will always run the risk somehow just because it is exogenous ?

Just trying to understand.

131

Last labs prescribed by doctor who suggested the T Gel treatment :

Hemoglobin = 16.4
Hematocrit = 46.7
Glicemic = 79
All other parameters from Hemogram are normal and within the same registered values since years ago.

Total Cholesterol = 136
HDL = 38
Triglicerid = 106

Ractiv C protein = 0.005mg/dl
Creatininemia = 0.88mg/dl

AST = 22 U/I
GGT= 18 U/I

TSH = 2.79 mUi/ml
FT4 = 0.99 ng/dl
FSH = 3,80 mUi/ml
LH = 3.34 mUi/ml
17 Beta Estradiol = 29.8pg/ml
Total T = 315,3 ng/dl
Free T = 23,24 pg/ml
DHT = 0,43 ng/ml
Free PSA = 0,21 ng/ml

Main questions before I make the decision :

  • Do I have a good Free T, specially when compared to Total T ?
  • My DHT seems low. Is this a sign that I don´t convert too much of my T to DHT? What does it mean and is it a good indicator?
  • My free PSA seems to be low. Is this good for a TRT candidate ?
  • Any issue with Thyroid ? Only TSH and FT4 seem to have been tested… My TSH has already been 1,7 and 2 before. Seems higher now.
  • E2 - I only have two records of it : 27 and 29. Compared to my current T, does it mean I will expect a fair increase if I use external testosterone ?
  • Why are my LH and FSH usually around 3 or 4 with my low total levels? Shouldn´t they increase or decrease based on my Free T or Total T ? Because my Total T is low (is Free T too?) and it seems my HPTA axis is not reacting accordinly as if they accept it as if i´m currently adjusted to what I am supposed to be. Does it mean that my body understands my current testosterone levels are correct ?
  • Do I quality for primary or secondary hypo ?
  • Any other aspect worth mentioning from the more expert eyes around here ?

Thank you

132

Reference ranges allows us to critic Free T results.

Low DHT is a sign of low-T because testosterone is converted to DHT, so if you have low-T DHT it’s also expected to be low.

The pituitary in response to low-T is supposed to increase the LH in order to get the T higher, when this doesn’t occur this is secondary hypogonadism.

133

OK, got it - i´m secondary hypo. But we dont know if primary too. I already had a big highter LH and even lower testosterone. Can I have both primary and secondary ?!

134

It’s possible to have a mixture of both, but your most recent labs are showing secondary.

135

Understood. Unsure if it´s worth it to understand the cause for that or if it´s just me…

136

The great majority of secondary cases as far as the cause of low LH are unknown because pituitary testing doesn’t reveal anything.

I believe in time they will find it is something down steam of the pituitary gland causing the lower LH.

So finding the cause of your low T may be elusive.

137

That was the response of my doctor. He said we could run a dozen exams and still dont find the reason for the pituitary lack of performance at my levels. And that It could even be just me, the way that I am. My characteristic, but a “flaw” in design.

But, on the other hand, we could fix the issue by taking the hormone.

138

I´ve been wondering in the last days about this. I don´t have testosterone level tests before 37yr. I know, we should have a record, but it has never been tested through my teen years or early adulthood. No doctor was sufficiently educated in this matter to bring up a record that could later on be useful for reference.

Some of the symptoms I´ve been feeling in the last 5 years with more or less intensity (fatigue being the worse and most common) and also day sleepiness sometimes, are in fact not “that” new for me. I can recall, that, at least since i´m 23/24 i´ve been feeling them over the years. And not always with a progression for the worse. It fluctuated.
They, however, improve with good sleep (can´t go to bed after 22:30, otherwise i enter the fatigue spiral again). My recovery ability is limited, so this is an important aspect to consider. Perhaps due to low T, who knows.

Also, phisically, I didn´t see that much of a change since i´m 20 or so. Same weight (69-72kg) with little variation on body mass composition. Sometimes leaner, sometimes with a bit more muscle and fat volume but overall, roughly the same. Wife agrees on this…
Without sports, the “easy-ness” to loose body mass and the struggle to get it back has always been the same. Since all the time.
Well, if there are physical similarities, the energy levels are not the same, though. But meanwhile I got older, ended college, started to work and changed for more demanding jobs a few times, had 2 kids and this plays a toll in our energy levels too. We are only human !

Still, it puts things into perspective, that, maybe… i have never had great testosterone levels since the 20s. A little higher perhaps (by nature), but not that higher…

Would this make any sense, @systemlord ?

1 Like
139

I don´t have recent labs, but don´t expect any increase in my serum levels based on the way that I feel. I pretty much have tried any possible increase using a natural approach.
Reality is I´ve been getting some “lows” lately again. Again, i´m feeling like i´m below water level.

Surprisingly my libido is fine or at least “acceptable”. I have reasonable interest and i am able to function in that regard.
What worries me is that my sense of fatigue is present and my energy levels are completely off. I´m starting to feel sleepy in the afternoon and tired, exhausted after lunch. Sleep does not fix me enough for the next day and sometimes body “hurts” without apparent reason.

I wonder if this could be related to my testosterone levels. To save some time from reading labs in this thread, it usually goes from 280 to 330ng/dl as an average for total and 8 ng/dl as free T (using the calculator). SBHG = 19 and E2 = 29.

I´m trying to delay as much as I can TRT, and I dont even know if my issue related to testosterone levels, but my recent years bloodwork is not showing anything abnormal.
But, the reality is I´m having more days OFF than ON.

Also, my recovery from gym is terrible as after a “normal” session I´m sorred for the next 2 days. I only do Gym work twice a week and need to manage my energy to be able to do it a second time during the week and have some energy left for the daily activities.
Even a recovery from a cold takes forever as I feel sick and with inflamation for a long time.

For some, this would be a “no-brainer”. But shouldn´t the Libido be constantly off too if low T was the problem? Not that it´s high (it used to be higher), but I can have sex normally without ED. Don´t ask me to do it twice the same day, but It could happen. Rarely.

Fatigue / exhaustion is what worries me. I could say I feel like a guy with 70 years old, but that´s not entirely true. It´s more about not feeling right and being able to function through the day. When I feel like this I want to “stretch” soooo bad…like a lazy man.

It also worries me from a professional perspective. I am not as productive as I used to be. Sometimes I just can´t for as much as I try. Drinking coffee doesn´t fix and sometimes makes me feel even more tired and look like shit when I look in the mirror. I see what looks like a “burn-out” face.

Is this compatible with the symptoms you had prior to TRT?

140

There are studies showing men experience the symptoms of low T when between 300-400 and other studies showing problems below 440.

If your T drops any further, then you may very well start to have erectile and libido problems.

141

I was miserable at 305ng and decided to start TRT. Libido is more than just T levels (although that’s a big part) and your e2 is very much in range and is likely giving you what libido you have now.