26. Normal Total T, Low Free T - Clomid or TRT?

I’m 26 and go to the gym regularly and have a healthy lifestyle. Gym is a PL routine focused on bench, squats, and deads 4 days per week. I’ve always had a lower sex drive than usual, and have had ED recently multiple times and just little interest in sex. I feel like sex drive has decreased even more over past couple years. I was overweight as a kid and had gyno and even had gyno surgery at age 20, I have since gotten in good shape. I have used OTC natural test boosters a couple of times (and saw good results actually), but never and PH or test injections.

Results from Doctor and normal ranges (test was taken in the morning):

Total Test - 793 (348-1147)
Free Test - 10 (9-27)
LH - 5.5 (1.7-8.6)
FSH 4.21.5 (1.5-12.4)

The doctor basically gave me the choice of either trying Clomid or TRT. I think my main issue is Free Test, as my sex drive feels shut down and Free Test matters a lot for that. It is barely within “normal” range.

I’ve read Clomid can be effective, especially in those who are younger and healthy who may have secondary hypogonadism. I am not opposed to TRT necessarily but if Clomid could fix the problem, then why not give that a shot. I am just afraid it wouldn’t do anything since my LH and FSH are in the normal range.

Any help would be appreciated. Thanks.

You need to test your E2. Have a Estradiol Sensitive lab done. High E2 will cause the symptoms you’re experiencing. It’s also helpful to get your Thyroid tested.

Please read these stickies found here: About the T Replacement Category - #2 by KSman

Read “advice for new guys” and post the additional info about yourself.

We do see a lot of intense young guys who are over-training and having hormone problems. There are several factors that can be involves. Rather that speculate, it is better if you study the stickies and see what you feel sticks to your case. Also note references to stress and adrenal.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Labs: - always post with lab ranges - you have some of these now

  • TT
  • FT
  • E2
  • prolactin
  • LH/FSH
  • SHBG
  • CBC
  • hematocrit
  • TSH
  • fasting cholesterol - can be too low
  • fasting glucose

Looking at your labs there is a problem that TT is high relative to FT. This suggests that SHBG is high. Starvation diets can do that and intense over-training can look like starvation to your body. We need to know age=26, height, weight and waist size as well as other things that you will see in the advice for new guys sticky.

Your metabolic rate is greatly determined by thyroid function and not using iodized salt can simply slow down every cell in your body with symptoms largely the same as low T.

Your thinking re existing LH/FSH and prospects for clomid has some merit. Delay medication until you get more labs done. Note that clomid has nasty side effects for many guys, not rare, and that the SERM Nolvadex does not do that and works just as well - most docs do not have that knowledge.

Stop judging things by “normal range”. Many aspects of your life are not good right now. Normal range is simply a statistical bell curve capturing most of the sample population and there can be a lot of unwellness in that “normal”. Doctors make the mistake that normal range means healthy. Doctors are mostly into disease management. What you need is health optimization.

Thanks for getting back to me and giving me some good information.

I will call the doctor back and ask for more tests before starting any treatment.

If SHBG or E2 is high, what would likely be the treatment?

Also, I am about 5’11 and 186lbs. Around 10-12% bf. I wear 32" waist pants.

This info is in the suggested stickies.
Lowering E2 requires an Aromatase Inhibitor, the the drug of choice for that is Arimidex/anastrozole.

There is no way to lower SHBG directly. Higher E2 increases SHBG by the liver and higher free testosterone [FT] or bioavailable T [Bio-T] can lower SHBG. Liver problems can reduce E2 clearance rates, so AST/ALT is of interest. Some medications can reduce E2 clearance. Starvation diets can increase SHBG as part of a spectrum of resultant hormone problems.

I went for more labs KSman. You were right about the AST/ALT. My SHBG is also way above normal, which makes sense why Total Test is normal and Free Test is low. Here are the additional lab results:

Estradiol - 29.6 pg/mL (7.6-42.6)
SHBG - 77.6 nmol/L (16.5-55.9)
Prolactin - 8.6 ng/mL (4-15.2)
TSH - 2.61 uIU/mL (0.45-4.5)
AST - 69 IU/L (0-40)
ALT - 62 IU/L (0-44)
Hematocrit - 44.7% (37.5-51.0)
WBC - 8.7 x10E3/uL (3.4-10.8)
RBC - 4.74 x10E3/uL (4.14-5.80)

I eat a lot of food. It’s been at least 6 months since I’ve been in a calorie deficit, and even then I wasn’t starving. I eat 200+ grams of protein per day, lots of fruits, veggies, and carbs. At least 70 grams of fat per day. Also drink 1-2 gallons of water per day and hardly any alcohol.

Is it safe to assume it’s not a thyroid issue? I likely get plenty of iodine in my diet, I consume 1-2 cups of yogurt per day and have other sources also.

I’m concerned about my liver numbers being out of range. And E2 is higher than what is probably desired, and SHBG is definitely way too high.

Also, I should mention that I took Finasteride 3 years ago for a 6-month period. The side-effects (little / oily ejaculation, tingling nipples, anxiety) gradually got worse and worse until I had to stop. Things got better after I stopped but I have no idea if I fully recovered. I do know that no man should ever take that drug.

0.5 mg/week anastrozole in divided doses would be a good thing.

Did you have sore muscles from training that can elevate AST/ALT?

I trained the morning before my 2nd lab testing. I did squats and lunges and was later quite sore (this was 2 days ago). I am still quite sore. So this could cause elevated liver enzymes? Soreness?

I read you had success with using Anastrozole and read other testimonials. I have also read Anastrozole without exogenous testosterone would provide no benefit. I wonder why there is conflict. In theory it sounds like it could help me, though. I feel like TRT would be a last resort since my total test is already high. Hopefully lowering E2 would be the key.

I’m also wondering if Avena Sativa could help me?

I am curious about my TSH level. It is at 2.61, which is higher than it should be. I’ve been taking my temperature, and am 96 degrees first thing in the morning. I have a lot of symptoms of hypothyroidism (often coincide with hypogonadism).

I read the Thyroid sticky. I do not think I am Iodine deficient because I eat a lot of yogurt, eggs, corn, tuna, etc. and always have. I take a multi also. Any advice on lowering the TSH levels? I bought Iodoral but not sure if that’s actually a good idea now.

The idea that dairy has a lot of iodine bleed through from when iodine teat wash was universal in dairy operations and cows also had mineral salt blocks with iodine.

If you diet was iodine sufficient, hardly anyone would be deficient, most are these days.
Do higher dose iodine, must have selenium and watch body temps and note changes to mood, energy and clarity of thought. You judge the effects. If you feel better, you confirm deficiency and know the fix. If it does not work, you have the alternative issues to address.

Yes, muscle soreness alters AST/ALT and can wreck the value of that lab result.

Heavy training with low thyroid function typically stresses the adrenals. Insert possible subsequent concerns re adrenal fatigue and elevated rT3.

I started taking Iodoral about a week ago and I would like to think I am feeling a little better overall. My temps are still around 96 most of the time though according to my oral thermometer.

I talked to the doctor about possibly using Anastrozole and he said my Testosterone to Estrogen ratio was too high for me to be a candidate, and would only be prescribed if my ratio was less than 10:1. Currently I have a TT of 793 and E2 of 26.9 which is ratio of 29:1.

I still feel like my sex drive isn’t what it should be. He basically told me to see another doctor to evaluate further.

From day 1 he just wanted to put me on Cialsis without addressing any possible hormone issues so I found him questionable anyhow.

At a minimum I would like to do blood work again in 2 months to see if my hormones have improved from Iodoral alone.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.