Very Low Free T. Doctor Recommends TRT

Pharma / TRT Testosterone Replacement
1

Hi everyone,

Feel like I’ve been hit by a truck with this news and really could use some advice on how to approach my situation. Sorry if a lot of this is common knowledge but I’m quite new to this world…

Some background: 32M, fit, eat well. Lift 3-4 days a week, do sports 1-2. 6’0, about 180 pounds.

For about a month now, I’ve had very debilitating yet “vague” symptoms of major fatigue (never feeling well rested despite 8+ hours of sleep, constant urge to sleep throughout day), lethargy (no motivation to work out due to feeling so tired), absolute no gains at the gym (no soreness even post-work out), muscle mass decreasing, depression, anxiety, “brain fog” (hard to concentrate or speak properly), as well as “cracking” sound of the joints constantly and stiffness, especially in neck. So yeah…quite a lot. Libido wise, no boner problems but drive is definitely down. I’ve been desperately searching for answers. Have done CBC, metabolic, lead…everything normal. Doctors said it’s probably stress related, ofcourse.

It wasn’t until I read up on my symptoms that I saw a very strong correlation to low free T. As it so happens, I was born with an undescended testicle which has since died off, leaving me with just one (albeit until recently a good one). Had my testosterone levels checked a few years back more routine based and everything looked super strong. That said, back when I was a kid, my Urologist warned me I might have issues in the future given my condition.

So, went to my Urologist. He ordered the works. Total T, Free T, E1, E1. Results are as follows:

Estradiol 27.3 pg/mL Range = 7.6 - 42.6 pg/mL
Estrone 56 pg/mL Range= 15 - 65 pg/mL
Total Test 479 ng/dl Range = 264 - 916 ng/dl
Free Testosterone 6.4 pg/mL Range = 8.7−25.1
SHBG 46.2 Range = 16.5−55.9 nmol/L

As you can see, my Free T is desperately low. I think I’ve found out what been causing all my symptoms…:(.

So now I need to decide what to do. The doctor recommended starting immediate TRT, but also said I need to be ready to commit to it for life and open to the possibility of becoming infertile. As a 32 male who wants to have kids…this really sucks. But I can’t imagine living like this, so if that’s what it takes, then I’ll do it. He also suggested we could “try” a medication called “Clomid” which would bring down estrogen while possibly raising Free T but he said it’s only a 50/50 shot of it working. He said the decision now is really up to me. I asked if there’s anything health wise that might be causing my low free T and he said other than stress, probably not. I’m not obese and my other tests are normal…his exact words were “probably pure back luck”.

So what do you guys suggest? Should I jump right into TRT? I’m suffering right now and can’t imagine continuing living in this weird state of purgatory so I gotta do something. Is there anything I should try before jumping into TRT? Any other tests you recommend? Any other health problems are life style changes that could be contributing? Is there a chance possibly the test is wrong because I took it in the afternoon? (I recently read T levels get lower as the day progresses). Insight here would be really appreciated as this is the lowest I’ve ever felt in my entire life (have a 2 week vacation to Spain in just over a week so this is just an absolute major downer).

2

Going off your Total T and very low Free T numbers you’ll need levels above 800, the problem your doctor must overcome is the insurance companies getting in the way, managed healthcare doctors are forbidding from allowing levels above 800, you may need levels above 1200 to get Free T to the optimal ranges.

Lets hope your doctor understands all of this. You can add HCG+FSH injections to your TRT protocol, TRT is not going to kill fertility, maybe hamper it a little but that’s what HCG and FSH are used for.

Your single testicle isn’t cutting it anymore, it’s doing the work of two. There is only one option here and it’s TRT.

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3

Thanks for the reply!

So you agree though, given my numbers, TRT is needed? When you say 800, I assume you are referring to Total T, correct? The Urologist seems to have a speciality in low test (though it’s not one of those TRT clinics), so I would think he would know how to properly handle.

Anything else to possibly suspect or is it just probably random bad luck low free t? Also, do you think the symptoms line up?

Thanks!

4

Your Free T is lower than old men, its below range. There is no question testosterone is almost as low as dead men. Your heart needs optimal testosterone near the top of the ranges.

Total T should not be your only goal post, Free T is the stuff in circulation and only thing that matters and needs to be at the top of the ranges.

We see guys complaining of low T symptoms at 15 pg/mL, this should be the point at which TRT is offered.

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5

Okay, so seems like TRT might be the wise thing the do here.

I was semi-wondering if perhaps any supplements, like Zinc, or something might help but guessing my level is so out of range the difference would be negligible.

I just want to feel like a normal person with energy again.

6

One other thing I should mention that I seem to be finding a link to based on posts here, is that I’ve been on Klonopin (.5 mg a day) a day for about 3 years for anxiety. I’ve been wanting to taper it off so I’ve recently cut my size in half to .25mg a day.

Could my tapering off the medication cause this massive drop in my T levels?

7

Being on Klonopin could well be lowering your test, not coming off of it. Your SHBG is high, causing low free T, and taking the blood in the afternoon definitely skews the results lower. Your T is highest first thing in the morning which is when it is typically tested. The elevated SHBG is likely medication related, what else are you taking?
Side note, Clomid will not lower your estrogen, it will in fact almost certainly elevate it along with your testosterone, and I wouldn’t give it 50/50 odds.

8

Not taking anything else besides protein post workout.

I’ve also been tested a few times while on Klonopin (a higher dose) and labs were normal. This is a first that I’m so low.

9

Technically, Clomid will not reduce estrogen, it tricks the brain (hypothalamus) into not “seeing” estrogen so it signals the pituitary to signal the testicle to make more testosterone, therefore also increase E2.

I’m assuming FSH and LH levels were obtained. I’m wondering if your testicle is maxed out and incapable of making more, and you need much more if it were to overcome your higher SHBG status.

I think you’re looking at TRT as your best option. Gook luck.

10

In my case it did lower my testosterone and is why I’m on TRT in the first place, I was on it for 30 years and I had no problems before I started tapering. I started tapering off in 2015 and immediately started having symptoms, months later I lost lots of muscle mass and erections were waning.

There is sometimes a price to pay for taking prescription drugs, you want to take the body out of a natural state and rewire the brain, be prepared to pay the price.

Over the years I have heard accounts of people getting low testosterone on Klonopin and those who would see low testosterone after tapering off of it. I believe it’s the effect of tapering that lowers testosterone for some people.

11

Would you suggest TRT while tapering then or wait?

Symptoms are just insufferable though and I don’t know how long I can stand this.

12

You’ve got other pre-existing problems to help explain why testosterone is low.

13

I repeated the labs today. If there’s no improvement, I feel I have no choice but to go for it. This is no way to live.

14

Be prepared to either inject frequency or use an estrogen blocker because I expect estrogen sides considered where estrogen current sits with Free T so low.

Large infrequent injections is not recommended! I would either inject smaller doses ED or EOD, moderate doses twice weekly is only going to drive up estrogen.

15

Got repeated labs back. 6.2 free T.

Agreed to start TRT with my urologist and had first jab. 200 m/g loading dose he said and then apparently 100 next week.

He’s really stressing that I’m looking at significant chance at having no kids and to freeze sperm right away (especially considering one testicle).

16

This isn’t how TRT is done, it doesn’t sounds like your doctor is very experienced at all. Spend some time here on T-Nation and you’ll never hear anyone talk about loading dosage. Your levels become stable after 6 weeks of injecting the same dosage.

I doubt 100mg will be enough given how low your levels are, I smell trouble ahead and I’m usually right about these things. I think you doctor doesn’t wants your Total T above 800 which is actually what you need, except insurance based doctors are hogtied by narrow insurance guidelines to keep Total T levels <800 ng/dL.

Rarely do managed healthcare doctors optimise your levels, they only care about in range normal levels. Be prepared to seek private care for your TRT.

17

I think you’ll do just fine. Nothing wrong with a loading dose, although I think it’s better to start low and work your way up. But he only gave you one “high” dose. The SHBG is moderately elevated and will drop with the elevated test levels. You may need more than 100 mg a week, but many many men are fine at that dose.

18

Well, he’s the head of Urology for one of the biggest hospitals in LA, so hoping he knows his stuff when it comes to TRT. So are you saying 200 is too low? Too high?

19

It’s individual. There are guys on 80 mg/week, I’m on 185mg/week and not at the top of the range.

20

Thanks.

Can anyone speak to possibly doing HCG alone? I literally am just walking out of another Urologist’s office for a second opinion, and he suggested no more Test and instead do HCG shots which he says much safer and wouldn’t cause infertility or shrinkage.

God, the conflicting treatment recommendations are so frustrating. Just trying to get back to normal.

I’m sorry guys for the million questions.