Low-Normal T, Doc Says All Good. Where Do I Go Now?

Pharma / TRT Testosterone Replacement
1

Hi everyone,
This is my first post on this forum. I’ve read plenty of posts and wanted to explain my situation and ask for advice.

I’m 29 years old. Lifting for about 3 years now.

I am 5’8 and used to be obese (230 lbs). First year of lifting was just fad dieting and hitting the machines. I wouldn’t even call it lifting but it got me to the gym. I lost 80 lbs and at 150 was skinny and fat (25% BF).

Read more and second year of lifting, started the bigger leaner stronger program. Diet was better. Lifts after a year were:
BP 145 (initial 95)
OHP 45 dumbbells (initial 25)
Deadlift 205 (initial 135)
Squat 185 (intial 105)
Weight 160 BF 18%

I started to plateau and got help from the personal trainer at the gym. Check in every 2 weeks with him. Tracking diet. Made progress but quite minimal. In 10 months, my lifts were as follows:
BP 160
OHP 65 dumbbells
Deadlift 235
Squat 225
Weight now is 167 lbs, BF 18-20.

Talking to the trainer, he was disappointed in the progress. Discussed more, he said I had symptoms of low T (low libido, energy, erections hit or miss) so I should get them tested.

I got tested, total T at 8 and 8:30 AM, two months apart was 301 and 320 Ng/dL. Between the two levels, I increased my lifting to 4x per week, ate enough healthy fats, fixed my sleep. I do cycling regularly but it didn’t really affect my levels. At 29, reading more, I felt this was low and the trainer agreed.

Granted he’s not a doctor, I went to an Endo, and was told these levels are normal.

Conflicted as to what should be my course of action now? There are TRT online clinics but I’m skeptical. I also read here people go to several doctors before they’re heard, so is that something I should do, aka doctor shop? Or is everything truly normal and I’m just being paranoid?

Sorry for the long post! I’m learning tons from this forum! Thank you!

2

Most important to address is : how do you feel in your daily life ? Do you feel you lack energy at work, hard time recovering from exercise, low focus, lack of motivation ? All these should be evaluated in context with reasonability and good judgement. Also, to acknowledge TRT is for life.

Unfortunately, the reality is 300ng/dl of total is not that great. For many it will make them feel tired and depressed. For some it´s Okay. But also, a lot of men don´t feel that bad. But generaly speaking what matters is how we feel.

As many of us, we have no records of our hormone panels since our late teen or early adult life days. That would be important as a reference.

But, I´d say a complete hormone panel is mandatory to fully understand your hormone profile.

Also, doctors tend to say you´re fine at 300ng/dl of total T. If I was a doctor, I couldn´t assume that by only testing total T. Yes, they´re right… you´re not suppresed and probably functioning, but that is on the low side and many of us report symptoms at that level.
Just because it falls within the Total T lab range, it doesn´t mean it is appropriate.

Next time you have the chance, request labs for (at least) :

  • Total T
  • Free T
  • SHBG
  • E2 sensitive
  • LH + FSH
  • DHEA
  • Prolactin
  • TSH
  • T4
  • Free T3

This will help more experienced users around here to give you some guidance.
Good luck

3

Thanks kikero for your input!

It’s funny you mention depression as because of my symptoms (low energy, poor motivational drive, excessive sleepiness), my PCP suggested I might be depressed and wanted to discuss starting an SSRI. I told her my mood is good but she said depression comes in many forms- I haven’t made a decision about starting that yet, especially since the sexual side effects might just worsen on an SSRI/SNRI. I have poor libido and have lost morning erections on I’d say 5 out of 7 days.

I used to be on the college team and had testosterone checked once when I was 21 years as part of a random doping screen and my total Test at the time was only 269 at 7:40 AM. Within range but that seems low and it didn’t flag as abnormal! The range on that lab is 218 to 988 for my age group. So maybe I’ve been low for a long time?

I had my annual physical and my TSH/FT4, vitamin D and iron profile was normal. I also had SHBG done, which was right smack in the middle:

SHBG (Sex Hormone binding globulin) RESULT(s) 36.24 nmol/L – REFERENCE RANGE(s) 13.0-71.4

I can message her to request the other labs.

I understand the lifelong commitment and fertility issues etc. I’m conflicted about what to do next, how strongly should I pursue this and frustrate myself chasing doctors. I don’t want supra physio doses but just what my body needs or should be making. I don’t want this to limit my potential to be the best me I could be.

The other question is the chicken or the egg – is depression causing lowish T? Or is lowish T causing the depressive symptoms?

4

You need to get the full comprehensive labs done all at once. What @kikero stated is accurate. You can’t diagnose primary or secondary hypo without them and you can’t do it after you start T. So do it now. I’m not keen on 29 year olds starting TRT especially when they open up with… weight training… progress in the gym etc. You should have a medicinal need for it other than wanting to be more jacked. I’m NOT accusing you of this, i’m just skeptical. So make sure you have plenty of other symptoms and want to pursue something that is a lifetime process.

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5

The problem with going the TRT route is that your natural T will lower if/when you stop taking it… as in it is likely not to return to normal values. Given your age, are you prepared to pin 2x per week for the next 40 years? It’s one seriously long comittment.

Are you doing what you can to optimize your natural T levels already? Sleeping 8 hours regularly, eating properly?

I’m 28 and in the same boat, but I’ve chosen not to pursue TRT at this time because I don’t want to stab myself that many times tbh. Obviously, this is more your decision to make; a TRT clinic would likely take you in as a patient and paycheck.

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6

There is no consensus at what TT and FT levels a person may experience symptoms of low-T. Studies show low-T can start to show symptoms between 300-400 while some can experience symptoms sooner.

Androgen sensitivity, CAG repeats 24> with normal testosterone in the presence of symptoms can be considered a state testosterone deficiency.

A lot of endocrinologist have a caveman mindset and think TT values must be below 300 (299) to have low-T and know very little about sex hormones, and a lot specialized in diabetes and thyroid disorders and not TRT.

These levels are NOT normal for a 28 year old, but are normal for an old man in his 80’s. These symptoms are being caused by low-T.

Did your doctor check active portion of testosterone, the Free T?

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7

I had depressive symptoms at 397 ng/dL and anxiety, you need testosterone, not a frankenstein drug. Take a man and go from high normal T to the low normal ranges and watch a transformation take place in the mindset of that man.

Testosterone also increases the release of dopamine, a neurotransmitter responsible for pleasure.

8

Thank you for the replies.

I see what you guys mean about the lifelong commitment about injections twice a week for life, that’s something I’m giving a lot of thought to. I really don’t want to be jacked, I understand this is a drug that can be abused. But if me levels are not where they should be despite 2 months of trying to optimize sleep, diet and exercise, perhaps I should pursue it.

The PCP only did total T and when it came back lower advised to make some lifestyle changes and then recheck with SHBG. When I went to Endo, he said no further labs are needed since all is normal. Smh.

So from what I gather, I should ask to get the comprehensive panel done, see the whole hormone profile and then go on from there?

I’m also reading TRT experiences on this forum and some are great and some aren’t. But if I’m missing this hormone and replacing it helps, then I might be willing to make the commitment.

9

Correct. This is mostly because TRT isn’t a cure all. Some guys never needed it. Also, think about what groups comes to the forums. Enthusiast and then guys with problems. Most guys just follow the TRT doc protocol given and have no issues. Even those on crap protocols.

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10

Testosterone cypionate is not a drug, it’s a testosterone molecule bioidentical to the real McCoy and therefore your body recognizes it as testosterone and responds by shutting down the natural production.

This is more common than you think and it can be hit or miss with these doctors when testosterone is in the conversation. These normal reference ranges are almost useless. The androgen receptor has varying degrees of sensitivity which is determined by the number of CAG repeats.

Dr. Abraham Morgentaler has determined the guidelines for determining a testosterone deficiency are inadequate and is trying to implement change.

The prevalence of hypogonadal symptoms increases with TT levels below 12.1 nmol/L (350 ng/dL) have shown that testosterone deficiency symptoms may also be seen with TT levels as high as 15 nmol/L. This study showed that the prevalence of loss of libido or vigor increased at testosterone concentrations below 15 nmol/L or 433 ng//dL.

These two completely different studies actually back each other up. It’s going to be a tough sell for your doctor to say your levels are normal after assimilating this information and wouldn’t pass the laugh test if he attempted to do so.

So realistically TRT should be offered to men consistently near or below 15 nmol/L or 433 ng/dL and also testing of AR gene CAG repeats (24>) for those with normal testosterone levels above 15 nmol/L or 433 ng/dL presenting with symptoms and only then can a diagnosis be made.

11

There are in the normal range, and you got the likely answer from most docs/endos/uros. Go to a clinic and they will get you sorted out

12

The reality is :

  • You´re still a very young man. That doesn´t mean you loose the right to treat your symptoms as long as you have them. But first you should try managing them without T medication.

  • Do you really feel like shit most of the days? We all feel like shit sometimes, with or without TRT and it´s all a matter of how frequent it is based on your lifestyle and how much it is affecting you from having a happy and normal professional and personal life.

  • Having good eating and sleeping habits, exercise (doesnt need to be intense, it needs to be smart) and correct suplementation can dramatically increase your life quality. Even with your “Low-normal” T levels. This should also be included in the TRT plan to make it work properly.

  • If I were you, I´d get the full hormone panel labs first. Get your references and monitor your plan from now onwards. Your plan should include what I mentioned above. Give it time… a few years and you´ll see that you may actually feel better, not worse! Eventually, the day will come when you realize that low T is really affecting you and you´ve tried it all. That´s the time when you´re ready.

It´s been 5 years since I know I have low T. Just like you. I´m 41 now. I have good and bad days. Eventually, the time for TRT will come in a few years time if needed and when I find the right doctor.

There are guys which have a hard time getting dialed in (either because they´re not patience enough or because it doesn´t work on their system well). And others who just get the weekly shot and that´s it…end of the story.

The main purpose of TRT, IMO, is to make you function well if all else fails helping you in this regard. Don´t get me wrong… you are on the low-T side and it seems you´ve been that way since a young age. Just try to manage it the best way you can before jumping on T and find a doctor that has good judgement and understanding of all your concerns.

13

Wow thank you all so much! I appreciate the perspectives!!

So I think I’ll get my baseline testing done. Implement lifestyle changes, see where things go in 6 months and test again, see how I feel and take it from there.

I am not a fan of biweekly injections for life and small testicles lol either. I’ll update the post when I get my comprehensive panel done!

14

That seems like a good start now that you know what to do. Give it a few years, not just months.

Beware that side effects of TRT are not limited to testicle shrinkage. It includes fertility issues, gynecomastia, blood pressure, prostate enlargement, libido balance, red blood count, hematocrit, ferritin among other adverse “reactions” from our body while trying to adapt in dialing-in phase or later on in life.
In most cases this is not an issue if you stay within the normal range, but just to get an idea that TRT make more sense if you´re on top of it with frequent blood analysis and doctor visits as well as an healthy lifestyle.

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15

Great information. Thank you so much guys!