Was My Endo Right?

Pharma / TRT Testosterone Replacement
1

Went to an Endo a few years ago. Ran a bunch of tests. MRI, bone density, both were good. They ended up basically telling me “Yea, you’re fine” but I just found out they never read me ALL of my last bloodwork. Just said I was good.

I’m tired, can’t gain muscle, gaining fat quicker, can’t focus. I think my T is low.

I’m getting blood drawn this week, and I’m not sure which panels to ask for. I’m doing this independently.

Here were my last results: taken around 9:00am, fasted.

Prolactin 4.84 2.64-13.13
FSH 1.95 1.27-19-26
TSH 1.09 .34-4
Test 355 205-781
SHBG 18.8 13.3-89.5
Free test 2.6% 1.6-2.9
Free test 95 pg/ml 33-227
Bio 222 131-682
Test total 2.82 1.75-7.81

Then next time around:
Prolactin 4.22
LH 1.49
FSH 1.51
Test 204
SHBG 19.4
Free test 2.51%
Free test 51 pg/ml
Bio 120

32 (tests were at 30)
130lbs (hasn’t really changed in a few years)
5’8”

Any help is appreciated.

Also, as a side note. Sometime I click on links in the sticky, and the answer just links me back to the sticky. Is that normal?

2

You need to include lab ranges and units of measure because different lab companies have different reference ranges for total and free testosterone.

You will find as lot of doctors determine normal status by lab ranges without considering your age. It’s more concerning to see a young 21 year old man at 355 than it would be to see an 85 year old man at the same level. You should be paying attention to where healthy men with no health problems at your age are scoring in the reference ranges.

In my experience sick care doctors are not very knowledgeable in sex hormones are are taught in range is normal and it is when you take into account the age of the individual, young men at the top of the ranges and old men at the bottom. You are seeing levels either on the bottom or below the reference ranges and you can forget about putting on muscle at these geriatric levels.

You’re a lightweight for a 30 year old man, I would look at IGF-1 levels which represent growth hormone levels. Both LH and FSH are low, I would like to know what time of day these labs are drawn. TSH looks excellent and is optimal, I don’t expect thyroid problems.

Your doctor either lied to you or just isn’t very knowledgeable in the area of sex hormones, very common in sick care. All of my endo’s aren’t very knowledgeable either, I have to bite my tongue not to correct them when making incorrect statements because it will fall on deaf ears and it just annoys them.

You’ll find a link to sample of healthy men in the population of all ages compiled from here. It would seem our medical system just doesn’t consider low testosterone a priority to treat and tend to make excuses why you don’t need it and really it’s the stigma of steroids why men are told their levels are normal when in fact they aren’t.

It’s starting to change and doctors are starting to come around, but many are still unconvinced and still believe TRT causes prostate cancer and are fearful of prescribing it.

3

Your test numbers look low, but hard to be specific without ranges. And the stickies for this particular forum are best ignored quite honestly.

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4

Thanks for the reply. I went ahead and updated my original post.

5

This pretty much ecos what I thought, your levels are low. If you look at other men your age a large majority are nowhere near these levels, but like I said earlier our medical system doesn’t care about low normal testosterone levels. You best bet is to look into anti-aging which is where the knowledgeable able doctors seem to practice hormones.

You’ll probably need a two or more injections per week, your doctor didn’t check for estrogen, I see some men with low testosterone who are estrogen dominant and the one weekly injections usually ends badly. The majority of men with LH <3 will report low testosterone symptoms.

You can probably get TRT from a doctor under your insurance if you put up a fight, but I doubt your doctor will know how to prescribe it or be able to to remedy any symptoms encountered, I mean the guidelines aren’t helpful and injections every 2 weeks needs to stop because it just isn’t an optimal way to replace testosterone.

You’re better off going with a place like Defy Medical (telemedicine) if you have trouble locating a local private doctor. There are lots of other telemedicine options and there’s a market for these types of businesses because of the lack of knowledge in sick care pertaining to sex hormones.

6

Obviously you’d never want to recommend self administering this type of stuff, but assuming I understand the risks, and do a lot of research, I’m imagining that is the route I’ll take. I’ve read too many horror stories of people taking this or that for months before getting test injections, or even the doctor giving gel first. I’d rather skip all of that.

I’m probably going to take hCG as well, because of things I’ve read of testicular pain without it.

I won’t administer an AI until I get bloods. This I’ve heard different things on. Some say to start with it, others say to do as necessary.

I’m thinking of starting an actual cycle of Test E @ 500mg a week, in two doses. Then finishing with PCT just to see if maybe that would kickstart me. I know it may not be the 100% reasonable thing to do, but I’m tired of putting in work and seeing no results. I also understand I won’t see results from that cycle for 4 weeks, but that’s ok.

I plan on doing bloodwork 4 weeks in. And then bloodwork after I finish PCT. if levels are still bad, and I go back to feeling bad, I’ll go 60mg twice a week, and check levels 4-6 weeks later.

If there is any belief that I’d be happy just starting TRT, and is start seeing good results (compared to now), let me know and I might just skip the cycle part.

I know some guys blast and cruise, but I’m not aware of anyone starting trt with a blast. Maybe that’s a horrible idea?

Thanks again for the help. You’ve just confirmed what I’ve suspected to be true after all of my research.

7

You’re a good candidate for TRT. You should probably be 35lbs heavier. Your best bet is to find a doctor that specializes in TRT, in other words, TRT (or HRT if we’re including women) is all they do.

Unfortunately, going to a GP or average endocrinologist for this is not much different than taking your car to a transmission shop when you need a brake job. It’s just not what they do.

8

TRT can help build muscle, but gene’s will have the final say so. HCG might cause you to be miserable as it does many others. We don’t get many men who rave about HCG, quite the opposite.

I initially had testicle aching, but soon became a none issue, testicle shrinkage was minimal. You have low SHBG, anything other than a replacement dose is asking for trouble.

9

@joshdrummer
I wouldn’t start out with HCG. It will make getting dialed in on Test more complicated. 120mg/week is a low dose that is usually reserved for the guys that have issues with TRT. 150mg/week is probably a better starting point.

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10

Sounds good. I’ll hold off on a cycle and focus on dialing in the correct dosage. So basically just test @ 75mg twice a weeg. Blood work in 4 weeks to see where levels are and if an AI is needed?

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It’s unlikely you’d need an AI at 150mg/week. Many guys don’t need it at 500mg/week. You may want to give it 5-6 weeks for bloods just to be sure you get a good read on what the new dose is doing.

12

Want more side effects, start out at 75mg twice weekly, most guys need weekly doses closer to 100mg.

I’m far from average, I only need 7mg daily enanthate (49mg weekly) or 5mg cypionate daily (35mg weekly). I’m a freak if nature and hyper respond to everything. I have low SHBG as well.

13

So your suggesting, that because of my low SHBG, I should start out low, and I would also be better dosing more often?

Would cream or gel be better for me?

Also, subQ or IM?

I’d prefer not to do it daily, if at all possible. I’d like to reduce side effects, but feel better.

14

Do one or two injections a week. Pick one option and stick with it for at least a few months. Gel sucks, cream is a personal choice. I wouldn’t start with it, it’s pretty fussy for starting out. Do Test ONLY initially. You are unlikely to need an AI at any of those doses, and don’t let SHBG influence your dosing decision. HCG is fine later - but don’t use more than one new thing at a time or you will not know what drug is causing what reaction.

15

You just may need daily injections if your SHBG decreases too much, hard to know without E2 testing, but you’re lean so who knows. The creams can work, but I would never recommend gels.

The injection method you’ll have to figure out, it’s up in the air as far as which will show the best results. I wouldn’t dare place a bet on it.

16

FSH/LH aren’t great thus signifying perhaps secondary hypogonadism

To get a further grasp regarding you’re situation it’s importsnt to know

  • what’s you’re lifestyle like?
  • diet? A lot of processed foods/ foods rich in phytoestrogens?
  • what prescription medications do you take
  • do you like what one would consider a high stress lifestyle
  • what are you’re sleep patterns like
  • do you take recreational drugs (including tobacco and alcohol, they’re all lumped into the same category in my opinion)

Prolactin isn’t elevated, thus the notion of a prolactin secreting pituitary rumour inducing secondary hypogonadism is off the books.

Do you have labs regarding thyroid function, adrenals? What about concentrations of various vitamins (particularly vit D, magnesium, zinc and iron). A CBC would also be immensely helpful

How’s you’re sense of smell, there are many variables at stake here and I think it’s important to figure out the root cause before jumping on lifelong treatment

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Most people are doing 150-200mg week doing once or twice weekly. They don’t know what SHBG is and all they care about is how much better they feel. There are some folks which will become ever more evident to you the more time you spend here that have mental issues where they over analyze themselves into feeling like shit. They come up with problems that there are no answers for and they end up spending years complaining about never getting it right but also love to give advice. Good luck

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18

No, SHBG has nothing to do with dosage or injection frequency

19

Would recommend you to take it slowly. With such a low SHBG you don’t need TT levels of 1500 to achieve good freeT levels.

Start with twice 40 mg per week. This will double to triple your current T levels to 500 to 600 ng/dL on average. Assess after 6 weeks and if you don’t feel fine increase your dose.

Starting at 150 to 200 mg a week will go along with a higher probability of developing side effects. If you finally end up at 200 perfectly fine, but work your way up instead of risking sides.

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20

Josh, keep in mind that everyone here wants to help. We are limited by our personal experiences, those of others in which we are personally aware, and by what we read.

Don’t overthink this. Many do, especially those on the internet. Think of all the guys on TRT, include those treated by their GPs, endocrinologists, urologists, (200mg every two weeks), those with TRT clinics and those underground with black market sourcing. The vast majority take 150-200mg injections once a week, I’d say about 85-90%. They are not on the internet discussing their day to day (hour to hour?) feelings, emotions, energy levels, libido and erections. They do not know what SHBG is, what E2 is, what a half life is, or what an aromatase inhibitor is. They are happy with their results. We can all debate what approach is best. Bottom line, go with what works for you.

Once weekly will most likely be fine. If you notice you have a bit of a drop off during the week, try twice. As for dose, your levels are pretty low, 100mg won’t do it. Won’t hurt to try, you may get levels to mid range and be very happy with that. Most guys will feel better towards the high end of total testosterone and the top of, or maybe a little higher, the free testosterone range. If you are like nine out of ten, you’ll end up with 150-200mg per week.

While we are all different and there are outliers, don’t get hung up on “dialing in.” Start with whatever, live your life, stay with it 6-8 weeks and access. Make changes if needed.

By the way, below is from a guy taking 200mg, once a week, and has been for at least a couple of years. Doing great.

SHBG 3