Follow-Up Labs Pre-TRT: Testosterone Rising?

[otus]

Question for you all.

Tested Total Testosterone 367 five years ago but wasn’t interested in TRT because I didn’t have any symptoms.

Flash forward five years and my libido is gone, occasional ED is now chronic, taking lots of naps, and 8 weeks into jiu jitsu classes 4x a week, the weight is barely coming off me (calories/macros have been in check since starting new exercise routine). My annual physical was due, so he ran another test and my Total T was 250. Seems pretty obvious that it would be declining with age (and not the healthiest lifestyle).

So I get a referral to a urologist, but it’s a three week wait to get in. I know my insurance is going to want two sub-ref range tests, and I’m impatient, I head to a local outlet of a nationally-franchised men’s clinic because they are offering free bloodwork with a consultation. I test with them (their free test is also just Total T - nothing else) and I come back at 403.

Now I finally get in to see my urologist. He’s not interested in the clinic’s blood test, and draws blood as we speak about my condition. He thinks I’m a perfect candidate for TRT and offers me my first shot on the spot and he’ll teach me how to pin right away. I say yes, I pretty much do the pinning myself (watched a lot of videos) and walk out with an Rx for 10 weeks at 100mg week (once a week pinning, I can do twice a week at home if my est seems high at the 5 week follow-up).

So I fill my Rx, and now my bloodwork comes back from the urologist. I’ve attached a photo, but basically Total T: 438, SHBG: 49.03, Free T 6.99, Testosterone Bioavailable 163.8.

These numbers are all in range. My urologist is out for a few days and will follow-up with me before my next pinning.

Am I still a candidate for TRT? Should I continue past my first shot? What should I make of my varying numbers (second test that came in higher was taken an hour after I flew in from a non-sleep weekend in Vegas and was taken at 3pm, so I would’ve thought it would be low).

When I asked my doc about what my target ranges would be, he said he didn’t even want to get into the numbers with me. He was more concerned with how I feel and that how I felt would determine what range I should be in. I thought that was the right answer, and I don’t think he’s going to pull the Rx with these new numbers, but I’m curious as to what you all thought.

[systemlord]

@otus

Seems pretty obvious that it would be declining with age

There are 85-year-old men with high testosterone and no disease.

Testosterone doesn’t decline due to age alone, it declines due to developing a cluster of medical conditions that lower it.

The most common causes is metabolic syndrome, diabetes and obesity.

@otus

, I head to a local outlet of a nationally-franchised men’s clinic because they are offering free bloodwork with a consultation. I test with them (their free test is also just Total T - nothing else)

This is a red flag only testing Total T, it means either they don’t know what they’re doing or anybody with a wallet can get TRT.

@otus

These numbers are all in range.

That doesn’t mean these levels are healthy or that you won’t have symptoms. Men below 550 are at 30% greater risk of heart attack and death by any cause and studies show loss of vigor and libido below 500.

[systemlord]

@otus

He was more concerned with how I feel and that how I felt would determine what range I should be in. I thought that was the right answer

That’s because it is the right answer. I wish the reverse were also true when men complain of symptoms and have low normal T.

@otus

I don’t think he’s going to pull the Rx with these new numbers, but I’m curious as to what you all thought.

This doesn’t change much, your Free T is still in the gutter and there seems to be no consensus for the lower limit for Total T and Free T defining testosterone deficiency.

[otus]

Thanks for the replies. Just got my Estradiol tests back and it was 15.7 on the 403 test and it was 16.5 on the 438 test.

I guess these are also low range and cause of low libido?

Question: Does starting low estradiol mean that I’m less likely to have est spike over range once TRT kicks in?

[blshaw]

@otus

I guess these are also low range and cause of low libido?

Your free test and E2 are both on the low end. Once you start TRT you will aromatize more and your E2 will likely rise with it.

@otus

Does starting low estradiol mean that I’m less likely to have est spike over range once TRT kicks in?

You are certainly in a better position than somebody with abnormally high E2 in the absence of Testosterone. Numbers are numbers though and some people get symptoms with numbers that appear normal. Also, keep in mind its OK to have higher E2 in the presence of normal to optimal Testosterone. It doesn’t mean man boobs or big waist necessarily.

[systemlord]

@otus

Just got my Estradiol tests back and it was 15.7

That’s an estrogen deficiency and osteoporosis is likely if spent long enough at these levels.

@otus

I guess these are also low range and cause of low libido?

Both the estrogen and T value are low enough to negatively affect libido. A normal healthy estrogen levels is 20>.

Your Free T levels are in the gutter.

[highpull]

@otus

Am I still a candidate for TRT? Should I continue past my first shot?

Yes and yes.

@otus

He was more concerned with how I feel and that how I felt would determine what range I should be in. I thought that was the right answer,

Agreed.