Incidental Low T Finding. I May Have Had Low T for Many Years

Pharma / TRT Testosterone Replacement
1

Background:

based in UK, 33 years old, no medical problems, in good shape (BF 13-15% probably), decent diet. I do feel tired and mood can be flat with a bit of general anxiety, but I cope quite well as i’ve always felt like this really. Little gynae perhaps, thought this was probably just left over from puberty. Normal male characteristics although I can’t grow any facial hair apart from my chin, never thought too much about this. I’ve always had a low libido, I do admit i’ve always thought something might be wrong here as it seemed disproportionately different from my peers growing up, I just didn’t seem to be as motivated by sex as they were, but I just thought that was normal for me. I did have some ED troubles when younger, but just attributed this to performance anxiety, started nofap a number of years ago which did help a little. In a long term healthy relationship and like a classic male never talked about any of these worries and somehow it hasn’t affected things too much, she’s brill.

Now I went for some bloods 18 months ago as part of a fertility screen (partner has PCOS) as it was taking some time to conceive.

Came back all normal apart from (taken at 12pm):

Total Test: 8 nmol/l or 231 ng/dL (UK range 10-28)

We agreed to recheck wondering if it was a spurious result.

Second labs, fasted at 9am (FBC, U&E, TFT and LFT all normal):

  • Total test: 9 nmol/l or 260 ng/dL (UK range 10-28)
  • SHBG: 43 nmol/L (14.5 - 48.4)
  • FSH: 5.4 (1.5-12.4)
  • LH: 5.5 (1.7-8.6)
  • Prolactin 423 ( 86 - 324)

Free Androgen Index 21% (34 - 106) [Guessing this is a surrogate for free test)

So basically hypogonadism with inappropriately normal LH/FSH and mildly raised PL.

GP wanted to refer me to endocrinology but we had just conceived naturally so I never got back to him.

To be honest it was a big shock, but thinking about it I do think I have been experiencing the symptoms for some time but i’ve always just explained them away. Spent 18 months trying to increase the level naturally (good sleep, more weights in gym, better diet) but retest showed:

  • Total test 10 nmol/L or 289 ng/dL (10-28)
  • FSH 5.4
  • LH 4.7
  • SHBG 41
  • Free androgen index 24%
  • Prolactin 229 (86-324)

Over the last few years i’ve started to experience migraines of increasing frequency and intensity, so I agreed with my GP to go and see an endo just to make sure there isn’t a pituitary lesion. Am waiting for that this month (5 month waiting list).

Sometimes I think i’ve got symptomatic low T and must have had this for years but kind of just functioned with it? Other times I think this is all in my head and i’m wasting everyone’s time and some people have low levels but that’s just normal for them?

The idea of starting a lifelong medical treatment scares me. I’m kind of struggling to come to terms with this, as i’m younger than the typical low T patient and it is emasculating to find out my Testosterone levels are so low. We’ve just conceived again so I keep telling myself everything’s fine and i’m just making it up, but something deep down is telling me I have been explaining away symptoms of low T for many years, and i’m curious to know what life would feel like with normal levels…

Thanks for reading

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Your testosterone is very low and SHBG high and I expect Free T to be equally as low. Low T men often complain of headaches and is do to low estrogen which sometimes accompanies low T. It’s very common for low T men to lack confidence, lack appropriate aggression, become more docile and are always apologetic which will likely change when on TRT and your inner circle will take notice.

You should be more frightened of the consequences of having low T and the diseases associated with aging, osteoporosis, heart attacks and cardiovascular events. I don’t believe you’ve ever had normal testosterone levels. As of now you have the testosterone levels of a old man and will live a shorter life as a result if you do not elevate your levels.

As it stands now we have no idea how much testosterone is free and circulating in the bloodstream which could even be worse than your Total T score. Beware doctors in the UK as far as TRT knowledge are living in the stone age, most men are forced to get TRT at private clinics in order to get proper treatment.

It wouldn’t be a bad ideal to have IGF-1 tested.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk.

Testosterone and the Heart

Testosterone (T) has a number of important effects on the cardiovascular system. In men, T levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk. Low T levels in men may increase their risk of developing coronary artery disease (CAD), metabolic syndrome, and type 2 diabetes.

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Go see the endo. You may have actually never fully developed. You would be a candidate for TRT, but you could possibly get the situation corrected and produce naturally at normal levels.

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Its not a big deal, doesnt make you less of a man. Im 31 and 6 months into TRT I concieved 2 children with rediculously low T. Most men i work with in the construction field are afraid to approach me. Im told I am intimidating and look like im ready to kill someone. All while walking around with as much T as the average woman. Its worse now because im leaning out and my muscles are really starting to harden up. I know one guy i work with on TRT. Hes embarrassed and tells people hes on steroids. I however am not embarrassed and will talk about it with anyone who is curious. Dont get worked up over “lifetime treatment”. Would you rather be medication free for another decade or so until the bomb finally drops and your body is destroyed and in need of many medications after years spent rapidly decaying from tanked T

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@hardartery
Thanks, got the appointment later this month. Well I’ve never really thought that, apart from non existing facial hair, the other male characteristics seem in check. But with levels these low I guess somethings clearly not right somewhere …

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@systemlord
Thanks for the reply and linking the studies. Interesting read. Would be good to do more literature research.

I am certainly more on the relaxed end of the personality spectrum. I sometimes wonder if I have ever had normal levels after puberty as well, but other times I feel like it’s all in my head and I should just get on with it as I have some sort of function. If I didn’t stumble across the blood test I would never have gone to the doctor, although that probably speaks more about me as I’m sure lots of other people would… I guess that’s what I mean when I’m saying deep down I feel like this explains a lot. Will see what happens at the endo, although I have a feeling all investigations will come back normal and i’ll not have any explanation as to why my levels are so low…

When I’ve calculated free T it’s always been considerably lower than normal but not had a serum sample tested yet.

Thanks again.

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@jimmy401
Cheers - I know what you’re saying. It’s come as a bit of a shock so has taken some time to process. Posting and talking about it has helped tho

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Under UK guidelines, you qualify for TRT. It’s just a matter of getting a good informed doctor and appropriate protocol. Sustanon 125-150mg once weekly should be your first choice and not Nebido.

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@systemlord Ok thanks, interested to see what endo says and if they recommend TRT.

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The UK is the worse place other than Australia for TRT, doctors typically are extremely ignorant in TRT so do not get your hopes up too high because I would hate for your hopes to be crushed.

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@systemlord I’m prepared for it. GP asked endo if they wanted to see me and they said yes, but I think just to investigate for pituitary lesion. If they don’t offer TRT I might ask for a trial or ask a private doc as I think my levels are rather low and keep wondering how I’d feel if they were corrected. Might make no difference at all, but only one way to find out. Cheers.

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Update

Saw the endo (NHS). Thinks secondary hypogonadism a possibility. Booked MRI head and offered a trial of TRT after another set of bloodwork. Thought it would be interesting to try it and see how I feel. Discussed consequences of reduced fertility, no plans for more kids but you never know. Mentioned coming off a short trial it should recover ok, longer treatments may need fertility drugs but no guarantees. Nebido vs gel: Went for the Nebido (know you guys don’t like this but will give it a go).

If repeat bloods show the same picture should start with first injection in a couple of weeks I guess. Not quite sure how I feel about it all still, but think I will find it difficult if I don’t try it. Problem is a lot of the symptoms are vague and non specific and I may not have sought out a doc at all if I didn’t get the result in by accident. But reasoned a trial of 6 months or so will show me one way or another!

Cheers

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Please check my thread about my exp. with Nebido.

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I went and read your thread and to be fair you only took one shot of nebido. I am not saying it is right for op or anyone for that matter, but you did not use it long enough to even somewhat adjust to it.

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If you notice no benefits do not blame it on TRT, blame it on nebido as 6 months isn’t enough time to reach equilibrium on nebido. You still have to dial-in which takes most men several months or longer because if you dosage is suboptimal, you will need to makes adjustments and those changes will take longer to realize changes.

The half life of nebido is approximately 90 days compared to cypionate 7-8 day half life and takes 40 days to reach a stable state. This is why it takes 6 weeks for levels to balance out, nebido takes much longer.

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@systemlord thanks I’ll keep an open mind and give it time. Appreciate the pharmacodynamics, I’ll give it the 6 months trial and not expecting miracles.

@pita13 sorry to hear you had a bad experience, hope you’re doing better now mate.

@rise80 thanks for the reply

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update

Endo bloods

Total Testosterone 8 nnmol/L (230 ng/dL) Range 10-30 nnmol/L

SHBG 39

Mid range LH and FSH again (inappropriately normal)

PRL/TSH/T3/T4/IgF/HBA1C all normal

Crazy how low test is, and how long it may have been like this for …

MRI in a couple of weeks.

Waiting to hear when I’m due first Nebido injection. Some days feel normal, other days convinced I’ve got symptoms, interested to see what happens with TRT (hopefully not going bald), will keep updating.

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I hope your doctor understands every man will require a different dosage and injection frequency rather than just shooting for normal levels.

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Probably not. I’ve compromised with myself that I will give it a go; if in the 6 months I have periods where I feel genuine benefits but I feel protocol not suited to me I’ll happily go private to get it corrected, because I’m under no illusions the NHS has time nor resources to do this. But honestly I am skeptical about the private sector here (mostly gps with special interests copying US protocols) and the business model clearly favours low threshold for prescribing TRT. Which I guess is why I wanted to explore this with the NHS first, as if they want to treat me I know I really must qualify…

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Also - normal levels for me (mid range) would be over a 100% increase which is pretty crazy really