Hello T Nation folks!
Hoping for guidance as I’m considering starting TRT after a few years of gradually worsening Low-T symptoms with blood work over the past 3-4 months that confirming it. Typical Symptoms: Low energy, easily fatigued, no libido, ED, building/maintaining muscle despite same training/nutrition, poor recovery, mood/anxiety/depression, poor sleep.
After seeing the first tests horrendous results I ready through this forum and the other TRT forums to learn all I could. I’ve seen many of the High SHBG/Low Free T posts/new user cases, and consensus seems to be split. Is High SHBG the egg causing the low Free T chicken or vice versa? So I almost hesitated in posting this but everyone’s case/profile is different so went ahead. During the past 3 months, to avoid TRT as a last result, I’ve tried to attack this problem naturally by optimizing diet, sleep, training, and lifestyle but up until yesterday the monthly bloodwork showed virtually no progress.
Last week I met with an Endo and now have a script for 100mg/week of Test C on a 2x/week protocol but paused yesterday when my last blood results came in and I finally saw progress in the critical areas: SHBG, Free T, unbound androgens (although FSH is still sky high.)
At this point I’m weighing hitting the TRT easy button to hopefully start being able to live life again and not feel like everything is wading through a swimming pool versus giving this natural experiment more time for symptoms improvement and some objective numbers ultimately reaching at least the mid- to upper mid range numbers (Free T 15<, SHBG down to 30ish etc.)
Understanding TRT is not actually an easy button but a lifelong commitment and diligence I’m cautious to jump in until I’ve ruled all causes out so went all in on the Marek labs, posted below. Here’s other info:
Quick bits:
• 43 yo. 5’8”, 160lbs, 15% BF.
• Diet: Pretty dialed-in Protein 20%, Carb 45%, Fat 35%. Intermittent Fast 16 hours avg.
• Sleep: Decent 6-7 hours/night. No Sleep apnea (AHI only 2)
• Exercise: Lift 2x/week. DL’s, Squats, compound etc. for 45-60mins. Walk 3-4miles or Zone 2 cardio 2-3x/week. Was doing lifts at 0-1 RIR level intensity but eased up recently to rule out overtraining.
10/30 Blood Test (Free T via Equilibrium Dialysis)
• TT: 680 ng/dl (ref range 264-916)
• FT: 5.4 ng/dl (ref 52-280)
• FT%: .8% (ref 1.5-3.2%)
• DHT: 53 ng/dl (ref 30 - 85)
• Free DHT: 1.8 pg/ml (2.3-11.6)
• Notes: 11/10: Cut daily fluticasone nasal spray (apparently raises SHBG)
11/25: (learned about SHBG’s role binding Free T, Free DHT, and E2, included)
• TT: 673 ng/dl (ref range 264-916)
• FT: 4.7 ng/dl (ref 52-280)
• E2: 13.3 pg/ml (ref 8 – 35)
• DHT: 40 ng/dl (ref 30 - 85)
• FDHT: 1.44 pg/ml (2.3-11.6)
• SHBG: 87 nmol/L (ref 16.5 – 55.9)
• Cortisol: 13.3 ug/dl (ref 6.2-19.4)
• LH: 6.2 miU/ml (ref 1.7-8.6)
• FSH: 14.3 miU/ml (ref 1.5-12.4)
• Prolactin: 6.2 ng/mL (ref 3.9 – 22.7)
• Progesterone: 0.3 ng/ml (ref 0-0.5)
• Notes: 11/25 started Boron 6mg/day, Tongkat Ali 100mg/day to knock down SHBG.
11/30: Full metabolic panel, liver (SHBG cause?), thyroid…
• TT: 653 (ref 264-916)
• FT: 6.5 (ref 52-280)
• E2: 15.7 (ref 8 – 35)
• DHT: 46 (ref 30 - 85)
• FDHT: 2 (ref 2.3-11.6)
• SHBG: 84.5 (ref 16.5 – 55.9)
• Cortisol: 10.4 (ref 6.2-19.4)
• LH 4.8 (ref 1.7-8.6)
• FSH 11.6 (ref 1.5-12.4)
• Prolactin: 5.4 (ref 3.9 – 22.7)
• Progesterone: 0.3 ng/ml (ref 0-0.5)
• TSH 2.6 uiu/mL (ref .450-4.5)
• FT3: 3 pg/ml (2 - 4.4)
• FT4: 1.39 ng/dl (ref .82-1.77)
• DHEA Sulfate: 346 ug/dl (ref 103-416)
• IGF-1: 164 ng/ml (84-270)
• Insulin: 3.2 uiu/ml (2.6 – 24.9)
• Ferritin: 111 (30-400)
• Vitamin D: 82 ng/ml (30-100)
• AST: 33 (0-40)
• ALT: 28 (0-44)
12/30
• TT: 601 (ref 264-916)
• FT 6 (ref 52-280)
• E2 10.7 (ref 8 – 35)
• DHT 36 (ref 30 - 85)
• FDHT: 1.84 (ref 2.3-11.6)
• SHBG: 88 (ref 16.5 – 55.9)
• Notes: starting 1/1 Boron upped to 12mg/day. Cut all lifting and only exercise was walking daily for 3-4 miles) to rule out overtraining.
Sleep improved to about 9 hours/night during this time over the previous ~7/night.
o Cut out Alcohol (was previously only 1-2x month around 3-4 drinks)
1/22: added more Thyroid to rule out as that as cause
• TT: 609 (ref 264-916)
• FT: 7.9 (ref 52-280)
• E2 9.9 (ref 8 – 35)
• DHT 38 (ref 30 - 85)
• FDHT: 2.17 (2.3-11.6)
• SHBG 67 (ref 16.5 – 55.9)
• Cortisol: 13.6 (ref 6.2-19.4)
• LH 4.9 (ref 1.7-8.6)
• FSH 11.4 (ref 1.5-12.4)
• TSH 3.1 (ref .450-4.5)
• FT3 3.1 (2 - 4.4)
• FT4: 1.53 (ref .82-1.77)
• Thyroid Peroxidase (TPO) Ab01: 31 (ref 0-34)
• Reverse T3: 21.7 ng/dl (ref 9.2-24.1)
So my levels are still really poor, but I’m encouraged that SHBG dropped, Free T jumped while Total T remained the same, and free androgens all increased but still looking at that high FSH number.
Should I give the natural attempt a few more months or start the TRT?
I realize this is a lot of info and appreciate any insight into the data and advice from the community.