Hello
First time posting here.
I’m a 44 yr old pretty fit and lean endurance athlete. I’ve been feeling like dogshit for a few years. Mostly bad brain fog, depression, low confidence, low energy/motivation and no libido.
I got my levels checked thru quest labs. Total testosterone wasn’t bad at 606 and e2 at 22 but free testosterone was 56 pg/ml.
Just wondering if that was considered low?
Thanks for the help!
Your symptoms are the answer to your question. You are in the malaise stage of life. Petering out so to speak.
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Endurance training in excessive intensity and volume is not good for your health. It is pretty common to see crashed testosterone among other issues in endurance athletes. TRT is probably a good option if your plan to continue that lifestyle. Be sure to check thyroid an other health markers as well before starting.
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Do you think trt would help?
At 44 it will only help. You’re in decline. You’re slowly losing your drive. Before you know it, all you’re going to wanna do is binge watch Golden Girls, and cuddling will be sufficient for you.
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Yes, most likely. you have high SHBG, you can see that with your lowish E2 as well.
Can you clarify this? The Quest reference range for FT (direct) in pg/mL is 9.3-26.5. In your case that’s almost double the highest end of the range… or was yours a calculated value? Did you get a SHBG measurement?
Reference range is 35-155 pg/ml.
Says it’s determined by medfusion ?
Probably this:
TESTOSTERONE, FREE (DIALYSIS) AND TOTAL,MS Status: Final 
Result Date: 05/29/21 08:51 AM
| Analyte | Result Value | Ref. Range | Units | Out of Range | Lab | ||
|---|---|---|---|---|---|---|---|
| — | — | — | — | — | — | — | |
 |
TESTESTOSTERONE, TOTAL, MS | 874 | 250-1100 | ng/dL | Z3E | ||
| For additional information, please refer to https://education.questdiagnostics.com/faq/FAQ165 (This link is being provided for informational/educational purposes only.) (Note) This test was developed and its analytical performance characteristics have been determined by medfusion. It has not been cleared or approved by the FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. | |||||||
|
TESTESTOSTERONE, FREE | 185.1 | 35.0-155.0 | pg/mL | H | ||
| (Note) This test was developed and its analytical performance characteristics have been determined by medfusion. It has not been cleared or approved by the FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. |
If you consider your symptoms unacceptable, you will likely feel quite a bit better if you triple your free testosterone.
Hey guys I really appreciate the advise!
I’m sorry I doubled posted, I lost connection while I was joining the forum and thought I did something wrong. It won’t happen again.
All thyroid marker seem to be within range.
Anything else I should look for?
Just realized this morning that I seem to have lost 1” in height. Yikes
Thanks again!
I would personally retest for the following things. Then jump on TRT based on the results of the second test.
Also, I assume you’re sleep is good?
CBC
CMP
TT (LC/MS)
FT (Direct)
SHBG
E2 (sensitive)
PSA
Prolactin
My symptoms began when I turned 40. But I ignored them and changed my lifestyle. Still… it was not enough. The decline had already been staged and I was becoming its victim. TRT doesnt stop the roll, it just rewinds it a bit and lets it all play at a slower rate. I had no choice but to take the plunge after seeing 3 consecutive tests over the course of 3 years, and I was nearing the end all too soon. Low test is a shock for those who notice it,and once you get used to it, you can live a normal life til you die. But the getting used to it part is not fun.
My psa was .7
Everything on my cbc was all normal.
On my cmp looked good except my ast was a little high probably due to exercise?
Also I’ve been experimenting with a low carb carnivore ish diet. Seems to keep my body composition in check.
I sleep like a rock but have never been able to sleep very long … like 6-7hrs.
I used to compete at a pretty high national level but I’m not really racing anymore. I just do endurance style exercising to help me sort of meditate along with some body weight exercises. Trying to make some lifestyle changes along with 3 young daughters:) one just born.
Probably drink too much coffee like 2-3 strong cups but no alcohol.
Also is sensitive e2 different from ultra sensitive?
Sorry for the novel and all the questions but this has been very helpful!
Often used interchangeably.
ECLIA vs LC/MS/MS TESTING FOR E2
The ECLIA test (aka immunoassay or IA) for E2 management is commonly used for those on TRT. It is not an incorrect test or a test for women, but simply one way to check estradiol levels. The other commonly utilized test is the LC/MS/MS method (aka liquid chromatography dual mass spectrometry, sensitive or ultrasensitive). It is the more expensive of the two. There are inherent advantages and disadvantages to each of these two methods. I have been fortunate to be able to speak with professionals who work with both methods. One is a PhD researcher for Pfizer and the other is a medical doctor at Quest. I’ll summarize their comments.
The ECLIA method is the more reliable of the two in terms of consistent results. The equipment is easier to operate thus accuracy is less reliant on the skill of the operator. If the same sample were to be tested twenty times, there would be very little, if any, difference in the results.
The ECLIA method is not as “sensitive” in that it will not pick up E2 levels below 15pg/mL. If your E2 level with this test is 1-14pg/mL, the reported result will be “<15”. Because of this, it is not recommended for menopausal women, men in whom very low levels of E2 are suspected, or children. In other words, if your levels are below 15pg/mL, and it is important to know if the level is 1 or 14pg/mL, you do not want this test. For us, this is likely moot, since if you are experiencing low E2 symptoms and your test comes back at <15, you have your answer. For a woman being treated with anti-estrogen therapy for breast cancer, it may be necessary to know if the E2 level is zero or fourteen because therapeutically, they want zero estrogen.
A disadvantage to IA testing is that it may pick up other steroid metabolites, which in men would be very low levels, but still could alter the result. Another potential disadvantage is that elevated levels of C-reactive protein (CRP) may elevate the result. CRP is elevated in serious infections, cancer, auto-immune diseases, like rheumatoid arthritis and other rheumatoid diseases, cardiovascular disease and morbid obesity. Even birth control pills could increase CRP. A normal CRP level is 0-5 to 10mg/L. In the referenced illnesses, CRP can go over 100, or even over 200mg/L. Unless battling one of these serious conditions, CRP interference is unlikely.
The LC/MS/MS method will pick up lower E2 levels and would be indicated in menopausal women and some men if very low E2 levels are suspected and it is desired to know exactly how low, children and the previously mentioned women on anti-estrogen therapy. It will not be influenced by elevated CRP levels or other steroid metabolites.
While some may believe the ECLIA test is for women, on the contrary, as it pertains to women on anti-estrogen therapy, such as breast cancer patients, the LC/MS/MS is the test for women as CRP levels are a consideration and it is necessary to know if the treatment has achieved an estrogen level of zero.
On the other side of the coin, LC/MS/MS equipment is “temperamental” (as stated by the PhD who operates both) and results are more likely to be inconsistent. Because of this, researchers will often run the same sample multiple times.
It is not clear if FDA approval is significant, but this appears on Quest’s lab reports: This test was developed, and its analytical performance characteristics have been determined by Quest Diagnostics Nichols Institute San Juan Capistrano. It has not been cleared or approved by FDA. This assay has been validated pursuant to the CLIA regulations and is used for clinical purposes. This statement is on LabCorp’s results: This test was developed and its performance characteristics determined by LabCorp. It has not been cleared by the Food and Drug Administration.
It is unlikely that any difference in the same sample run through both methods will be clinically significant. Estradiol must be evaluated, and it should be checked initially and ongoing after starting TRT. It obviously makes sense to use the same method throughout. Most important are previous history and symptoms related to low or high E2. Those are correlated with before and after lab results. Any estradiol management should not be utilized without symptoms confirmed by lab results.
Your Free T is near the bottom of the ranges, these levels aren’t going to sustain a youthful lifestyle, high libido and energy. Your endurance training is likely why you have low Free T and if you had checked your SHBG, it will be on the higher end binding up most of your Free T and shifting it to the inert Total T.
Starvation can increase SHBG (made in liver) ei. endurance training while not consuming enough calories. I would also test for LH, FSH and prolactin on your next round of testing.
You pretty much figured me out. I spent most of the time from 16- late 30s massively overtraining and under eating.
I’ve made significant changes in the last 4 yrs or so. I jog or ride avg of 1.5 hrs/day. I’m probably exercising the least now than ever before. And eating plenty of calories now.
Things seem to be getting worse mentally.
Just wondering if it’s possible to recover naturally thru lifestyle or if TRT is best.
I did try some PEDs in my mid 20s. But it was a shitshow not having a clue about what and how to take it along with mostly fake gear .
I can barely even remember what I took…
Except I did make tren once from finaplex. Bad choice! Didn’t take it for long. Ha
Thanks for the advise!
It seems like you’ve already made the attempted and failed because you probably spent too much time overtraining and undereating.
On my last labs, injecting 100 mg IM, E5D, my free T was 260. Total was 889. E2(LC/MS/MS) was 42. That was 8 or 9 months ago. I know that what’s on paper doesn’t correlate with how one feels and most of the time I feel exhausted. My urologist scripted me for 200 mg per week. Hypothetically or in reality, would doubling my dose to increase free T, whether a single injection or splitting it, be beneficial? My urologist believes the higher the free T, the better.