Total T Level of 12.1 nmol/L (348 ng/dL) - Advice Sought

Pharma TRT
1

Ok, so very quick back story. I’m a 34 year old male living in the UK. Until around four years ago, I was very overweight - 6ft approx 240lbs. Anyway, through a combination of diet change and regular weight training I dropped down to circa 150lbs with a decent body composition.

However, somewhere along the way something went wrong. I found it increasingly difficult to lose / maintain weight and noticed that I’d gain weight very quickly when stepping out of my super-healthy regime. For instance, last Christmas over three days of indulgance (nothing crazy), I gained around 15lbs that was still there three weeks later.

Along with this, I’ve been feeling incredibly tired, joyless and depressed with absolutely no sexual appetite whatsoever. Several visits to the doctor achieved nothing.

Anyway, eventually I decided to pay to go and see a private Endocrinologist. He recommended a series of blood tests including total testosterone and SHBG.

I’m still waiting on my SHBG result, but my total testosterone level came back today as 12.1 nmol/L which I believe equates to 348 nd/dL. When I look at my results online it says that this falls within the ‘normal’ range, however looking further into it it also looks to be below average for an 85 - 100 year old man and certainly well below average for a man my age.

So really, a a few quick questions:

  1. Am I right in thinking that this is an abnormally low range for a generally healthy, physically active guy in his mid-thirties, and is it likely this is the reason I’ve been feeling so dreadful and struggling with weight maintenance (which is also making me feel dreadful)?

  2. Is it likely a consultant Endocrinologist would prescribe medical treatment such as TRT based on this alone (not knowing what my SHBG is yet)?

  3. Having looked at the potential side effects of TRT, I’m a bit worried. I want to solve the problems I’m having but I don’t particularly want acne, breasts or a stroke. Are these likely to be genuine concerns if TRT is administered properly?

  4. If I do end up on TRT, any recommendations as to the best method? There seem to be a number of options, each with their own unique pros and cons.

Thanks for taking the time to read this guys - I’m hoping this is the beginning of the end of this episode for me; the last two years have been a living nightmare.

Thanks

Jonny

2

You’re in the normal range alright, but not for someone your age. Your levels are in fact lower than 95% of men on planet earth, so ask yourself how this is considered normal. You actually qualify for TRT under UK guidelines.

We are in the myst of a low testosterone epidemic in the western civilization, a 50% reduction is sperm in the last several decades and low testosterone earlier in life and a generational decline in testosterone.

If you look at the average testosterone levels every decade, it’s going down and has been declining for several decades. There results indicate that in recent years we have seen a substantial, and as yet unrecognized, age-independent population-level decrease in T in men.

The first physical sign of low testosterone is gaining fat around the midsection. If you doctor tells you levels are normal, get another doctor immediately, or better yet go to Balance My Hormones (in Dorset) or The Men’s Health Clinic.

Cost of hormone-disrupting chemical exposure in Europe in billions

What’s a “Normal” Testosterone Level

You doctor may be of no help, forms like this one is invaluable for seeking advice.

You are essentially playing the doctor lottery, this is a field of medicine doctors don’t usually excel at, it’s an area of medicine that’s been ignored for far too long. Most doctors don’t know what normal testosterone really is, they believe in range is normal without any consideration for age.

You’ll want enanthate, sustanon a second is choice, if the former this injection frequency should consider your pre-TRT estrogen levels, if you don’t have estrogen labs, it may make the process of dialing in a little more difficult.

Also another important labs is your SHBG levels, if low you may need very frequent smaller injections and will always not need high testosterone to feel normal. There are some men with moderate to high SHBG that are sensitive to hormonal fluctuations and need more frequent dosing.

You often here these man state it doesn’t even feel like they’re on TRT, it’s the same with high estrogen for some men.

3

Thanks for the thoughts and advice - much appreciated. I kind of get that GP’s in the UK would revert to broad ranges that don’t consider age / physical condition etc., but surely a specialist Endocrinologist would have sufficient knowledge to make the right call, no?

Really hope I can get myself fixed! :slight_smile:

4

You would think, but many patient experiences say otherwise.

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5

The endocrinologist is the worst type of doctor you can go to. He will tell you your levels are “in range” and you have no problem. Which is a total crap.

6

Interesting. Where exactly should I go in that case?

7

An endocrinologist or urologist are the specialists that would handle TRT. Like any other doctor, there are crap ones and there are fantastic ones.

The footwork to find referrals, recommendations, and check credentials/testimonials is always a patient’s responsibility.

I didn’t quite follow your post. Are you still 150-165 pounds? And trying to lose more weight? At 6-feet tall, that’s legitimately malnourished and a very likely underlying cause of your hormone issues, which means TRT would be a Band-Aid solution at best.

Details of your current training and diet regime?

8

Nope, endocrinologist mostly specializing in thyroid and diabetes, that’s what they learned in medical school, not TRT. The UK, the NHS is the worst place to get TRT and most of the time these poor guys are told their levels are normal, but to the properly educated doctors, normal is where 95% of men in your age group are scoring.

The endocrinologist are the worst, GP and urologist are generally better at TRT. Most doctors still believe TRT causes prostate cancer and heart attacks which the current studies don’t support, this is why men are kept midrange or lower because of the belief high exogenous testosterone feeds prostate cancer and that low testosterone is prostate cancer friendly.

This isn’t to say all endocrinologist are bad, the experienced endocrinologist are few and far between where you’re left playing the doctor lottery for several years in some cases. Most of the time men find someone willing to prescribe, but getting assistance with managing side effects is another matter entirely.

What makes TRT even more difficult is dosing recommendations are almost non-existent, a one size fits all protocol is given to all men, but TRT requires a problem solver, a troubleshooter to figure out what’s best for the individual. These doctors don’t have that kind of time, they have 40 patients to shuffle though so they can get home to their family.

I’m lucky if I get 10 minutes with my doctors, by then they are telling me that our time is up.

9

No, sorry, for clarity I’m currently somewhat heavier than that. I went on holiday / vacation for two weeks in August, gained almost a stone and have crept up a pound or so every couple of weeks since then. This is despite weight training and a healthy diet (a regime which enabled me to lose the weight in the first place).

Diet-wise, I’m high protein (lean white meats and plat proteins mainly), low carb with a little fat and lots of leafy greens and non-starchy veg etc. Because of my issues of weight maintenance, calories are kept low - certainly well below what should be my TDEE.

Training-wise, I weight train typically 3 - 4 times a week and fit in cardio where I can. In terms of strength, I bench press 80kg, bicep curls 25kg - not super-strong, but probably a fraction above average compared to other guys where I train (which is a white collar, office-type gym) so I’d have thought that would have contributed to relatively healthy T-levels. Evidently not.

10

I shaved 2 inches off my waist doing nothing other than injecting testosterone for 6 weeks, very little effort on my part which reminds of a a clinical study where two groups of men, one group was given TRT and told not to excercise and the other group wasn’t given TRT and told to excercise.

The later group lost no fat around the waist and some actually gained weight while the other group which performed no exercise losing up to 2.5 inches off their waist! You can’t play the weight loss game if you don’t have enough testosterone.

11

To be clear so everyone has the full story: You’re currently diabetic and carrying 30+% bodyfat. Whatever improvements you made via TRT were built on sand because you didn’t have the fundamentals of diet and exercise in place. You cannot use yourself as an example of any type of successful physique improvements, though I do agree that you apply little effort to your health.

Disagree. I’d say you shouldn’t play with Testosterone if you don’t understand basic nutrition and exercise.

Getting into a study war is always lame, but there was a study that showed TRT plus exercise improved Testosterone levels better than TRT without exercise. So… let’s go with common sense on this one and not try rationalizing an avoidance of diet and exercise.

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12

So you’re, like, 180ish? That’s a healthier weight for your height. (Healthier as in not underweight.)

Low carbs combined with low fat intake is terrible for natural Test production. Fixing either or both of those in your diet would be a better place to start.

13

You have no idea what I’ve done to restore my health, my diet is much improved and am working with my doctors to restart TRT which I had my first injection today. I went over with my endo today my device glucose results and fine tuning my diet to minimize glucose spikes.

Just because I’m was having problems with deficiencies doesn’t at all take away from progress however short lived because its repeatable. Just because I don’t update my thread.in a timely manner doesn’t mean I’m not making lifestyle changes.

My glucose while sleeping is consistently in the 80’s in the last 2 weeks, obviously my diet “was” a big part of the problem, being off TRT didnt help.

14

Whose fault is that? I do know that you started a thread (a few, actually), were extremely sparse on relevant details, got a ton of intelligent guys asking follow-up questions to better help you, and then completely bailed.

‘Timely manner’ nothing. You’re going 2, 3, 4 weeks between posts in your own threads, flat-out ignoring direct/tagged questions while consistently posting dozens and dozens of times elsewhere in the forum daily.

It’s very clearly a choice to not reply to the people who’re offering help, and that’s why it’s irksome to see you positioning yourself (deliberately or not) as some sort of go-to TRT advisor on the forum.

You want to help others and give some input? Awesome. That’s obviously what the site is for. But I see your posts flavored with a big dose of ‘do as I say, not as I do’ because your own health is in such dire need of attention and I don’t think the people you’re replying to know exactly who’s offering the advice.

EDIT: I know I’ve been riding your ass about this for a while, but it’s because I want the overall quality of the entire forum to improve and accountability for everyone/quality control is part of that. It’s no different than addressing a detrained beginner with extensive posts in the Beginners forum citing studies and talking about what should work.

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Sorry guys, didn’t mean to start an argument here. Clearly, TRT has its benefits for many people but it has its downsides and shouldn’t be treated as some magical panacea. That’s what I’m hearing / reading anyway.

I should get my SHGB results tomorrow, but is a reading of 12 nmol/L sufficient to warrant TRT or should I pursue more natural options first?

Thanks!

16

Yes that’s low. If you’re having symptoms and are low then it’s probably worth considering.

You should get free T and shbg tested too but with total T that low I’m not sure if knowing those will make much difference

17

So, I’ve had some more results back today. 25-Hydroxy Vitamin D came back as 25 nmol/L, abnormal, and I’ve been prescribed Colecalciferol 40000 IU Capsules.

I realise there’s a link between Vit D and T - is it possible that this is the cause of my low testosterone levels? More importantly, is correcting vitamin d alone likely to bring about an improvement in T?