29 Y/O Male. I have been experiencing some symptoms of low testosterone for a while now mainly, brain fog, low competitive drive (sports), low libido, social anxiety. I weight train 2-3 times per week (SL 5x5) and play ice hockey 1-2 times a week. I eat a low carb, high fat, high protein diet and supplement with fish oil, vit d3, vit k2, magnesium and zinc. Also get 7-8 hours of sleep each night.
Went to my Dr and got some blood work done (see below). Sorry about the units (Canadian).
I had my follow up with the Dr who ordered the labs today. As expected, he said total T was in good shape. However, free and bio were in “ok” shape and could be a bit more “optimal” which surprised me. We went through symptoms again and he said that it might be beneficial to try a low dose Androgel and see if symptoms improve. He said that injections would push levels too high. I had some reservations with this and declined the Androgel as I don’t see the benefit as I think this would shut down my natural production and replace with a low dose of gel (might be wrong here).
He then offered an alternative of 250 iu of hCG twice a week as a little bump to see if that helps the sypmtoms at all. Have declined this as well but wanted to get some input from you guys on a small dose hCG and if it would result in a bump to higher end of normal free and bio T levels. Would there be a benefit at all?
I can tell your doctor doesn’t do TRT often as his knowledge is lacking. Your free T is a problem, 0.36 nmol/L = 1.67 % and 2-3% is considered normal by those that know what the hell they’re doing.
AndroGel is horrible and so is your doctor, the reason why your doctor wants you on AndroGel and not injectables is because he makes $300 for each prescription of AndroGel and makes nothing if he prescribes you injectables.
You need a new doctor one who does TRT on a daily basis, unfortunately that cuts out most insurance doctors. You need to go private and find someone who does this sort of thing on a regular basis.
50mg twice weekly puts me at 600-700 ng/dL, that’s not considered too high according to the normal ranges, your doctor is a scared he won’t know how to manage your levels if they do get high, that’s why you need a new doctor.
Thanks for the reply man. The scary thing is that this was a Dr who is supposedly a hormone replacement expert and it was out of pocket. It seems hard to find a Dr well versed in TRT in the Vancouver area.
I went to this Dr when my GP woundnt even call my labs. Here in BC, the only way to get certain tests done is through a physician.
I would assume that the 250 IU of hCG wouldn’t help out as he thinks?
Let’s see, HCG is can be expensive and Androgel has a patented delivery system both of which bring in big profit, he circled around to Androgel, skipped testosterone (no profit) and back around to Androgel (huge profit). As if HCG can’t get your levels too high, this doctor is full of crap.
The sad truth is most doctors find TRT too difficult to manage.
I would not jump on trt. If you lower your shbg down a bit your free will increase. Your testes appear to be producing a very good amount of t. Why shut them down again at this point?
Check thyroid panel. Medication and supps can increase shbg and maybe overtraining.
His TT isn’t the problem, his free T isn’t optimal so his results in the gym will be hampered and he has symptoms we can’t ignore. SHBG is causing problems.
[UPDATE]
After doing some research on this forum and other places, I went back to the Dr for a discussion. I told him the wife said absolutely no gels (the truth). He then prescribed by test cyp. However only at 50mg/week with 250iu of HCG. From my limited knowledge, that sounds like a recipe for disaster.
I was down in the US doing some shopping with the wife and I decided to get some bloodwork done using discounted labs while I was down there to compare the results to my labs in Canada before starting to take anything. When comparing, I noticed after conversion the results were quite close. However, the ranges were quite different.
Please find updated labs attached from LabCorp. Any commentary would be greatly appreciated.
This doctor is scared stupid of TRT, fear will always guide him. This doctor has no training on how to properly administer TRT. You’ll end up lower than you are now. Say goodbye to this doctor. You require large doses of testosterone do to high SHBG, 140mg weekly split up one or two times a week is a good starting point. It’s the only way to get SHBG down far enough to free up some of that free T.
You need possibly 3 times the testosterone doctor is prescribing, this doctor has no business prescribing testosterone.
HCG 250iu a week?! That won’t work, you need a minimum of 250iu 2-3 times a week, possibly 250iu EOD for some.
Canada, UK socialized medicine needs to go the way of the dodo bird or evolution of medicine will never happen.
Thanks for the reply. I figured as much. This doc was at a men’s clinic that is supposed to specialize in TRT.
Maybe I will try my GP again and try and get a referral to an endo. He wouldn’t based on my original Canadian bloods as they were “in range”. Will try again with the US tests. However, I’m not expecting much from either my GP or an endo up here.
Specialization does not always come with expertise.
Thyroid:
TSH looks good, fT3 seems perfect.
Now check oral body temperatures, see below, to see if the rest of your thyroid function is good. I assume that you have been using iodized salt.
SHBG is high. SHBG is made in the liver to scavenge sex hormones. AST/ALT do not indicate liver issue that could increase SHBG. E2 is not elevated or an obvious cause. This creates a lot of non-bioavailable SHBG+T that inflates TT so TT overstates your T status. That reduces FT and FT or bio-T is the the lab to be looked at. Your doc was misled by this. You do need TRT.
LH/FSH suggest mixed primary/secondary hypogonadism. You should test prolactin as a prolactin secreting pituitary adinoma could be depressing LH/FSH which might otherwise be high as seen in primary, masking that condition and itself.
At 29YO you really need to watch out for your fertility.
Gels are not good for athletes who will sweat and shower the T from their skin.
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.
I have been monitoring my body temps for a week or so after reading all the stickies. Morning temps were taken around 7:00AM and afternoons at around 2:00PM
AM - 97.8
PM - 98.6
AM - 97.8
PM - 98.8
AM - 97.6
PM - 98.7
AM - 97.9
PM - 98.9
Yes, I use iodized salts to taste on everything I make. After hearing a podcast a few years ago which commented on how big of a problem iodine deficiency is, I made sure to only buy iodized salt. I also started adding a few drops of Lugols to my morning green smoothies back then for a while. I will still occasionally add a drop if I know I haven’t had much iodized salt for a few days.
As for testing prolactin, I will see if I convince my wife of another shopping trip down to the US in the upcoming weeks and visit LabCorp again (shouldn’t be too hard).
My biggest concern with starting TRT is fertility. We are planning on trying for our first kid next year and plan on having at least one more after that if all goes well. If I am able to find a doc, I think I will get a full sperm analysis done prior and freeze some if I have swimmers to be sure. My other thought would be to continue to tough it out and hold off TRT for a couple years until after kids.
Was trying to think back as to what could be the root cause of high SHBG and low free T. I did run a few courses of Accutane as a young kid. I think this was when I was in Grade 7 so around 13 years old I believe. Did wonders for my acne but I have dealt with very dry eyes, lips and nosebleeds ever since.
Could there be a connection? Albeit, just guessing here and can’t know for sure.
No because there are many others who didn’t take Accutane who come in here daliy that show elevated SHBG who are also young. People who took Accutane had similar experiences to those who took Finasteride, permanent sexual dysfunction.
A lack of FT is your problem, experienced doctors don’t trust directly measured FT, but TT + SHBG which is calculated since we know 2-3 percent is normal. Your below 2 percent, so trying to educate the doctors on how to do their job, well good luck with that.
Went to my GP today with my US blood tests. The previous doc I was dealing with was at a men’s clinic. He seemed on board that low free t could be causing my symptoms, which surprised me. He told me of 3 alternatives for now. 1) Gels, which he advised against (this got my hopes up). 2) test-u capsules (never heard of this). 3) injections in his office once a month (damn, so close).
He then said he wants me to try the capsules at 80mg per day for 3 weeks and if it helps out with my symptoms, we can move forward with TRT and explore all options. When I mentioned self injecting once or twice a week, he did seem receptive. I am thinking of trying the capsules for the 3 weeks and going back and saying it is helping and then try and move to an injection protocol. Or who knows maybe the capsules will help but I find it weird that I have never seen them discussed.
Oral testosterone isn’t safe for the liver, it doesn’t sound like this doctor has any experience in male hormones. Gels make tons of profit for him, test-u capsules sounds patented and injection once a month doesn’t work. There’s a 12 year old study out there that shows why one injection every 2 weeks doesn’t work.
Stupid doctor isn’t paying attention to the half life of the medicine he’s injecting which is 5-8 days, less for low SHBG guys. So once a month injection means you’ll hit zero long before the month is over. TRT really brings out the dumbest people for everyone to see, they can no longer hide among the intelligent people.
When doctors had out prescription drugs they are always paying attention to half lives, but not so with TRT. Strange.
The name of the capsule is Andriol. From what I have read, it is designed to bypass the liver but I have also read that it doesn’t seem to do much to increase testosterone levels as the bioavailability is only 7%. 80mg x 7% x 7 days = 39 mg of test u per week.
Whenever a doctor is pushing for gels and the last option is injections, he’s all about wanting to make profit from it, your health is a distant second. He will probably make less money giving you injections since test is so cheap.
He probably doesn’t know the first thing about hormone management, you know what you need to do.
The jist of what I have gotten from the 2 doctors seen so far is that they agree that free testosterone is low. However, they see it as just out of range and think that you can supplement with a little bit of testosterone. They seem to think that taking testosterone adds to your existing and don’t factor in any shut down.
My search for a knowledgeable doctor continues! There appears to only be two anti-aging clinics around that offer TRT and have been to one of them so I guess I will try the other. This one has a steep price tag however of $600 per visit for the appointment alone.
