T Nation

35, Pretty Sure I am Headed Toward TRT

Hi all – looking for some reassurance that my numbers are consistent with my symptoms and my decision to do TRT is not blindingly against what the objective data says to people with more experience/knowledge in this area.

35 years old


32" waist

180 pounds

My build is kind of average? I used to be skinny fat around 165 pounds, but in my early 30’s I did a real lifting routine and put some muscle on my frame as well as a lot of fat, up to 220 pounds, and have never been able to get rid of belly fat and love handles since after dieting back down to 180. Have also carried some fat around breast area even when I was skinny.

No issue with facial hair

No history of serious health/medical conditions. Started looking at TRT due to loss of libido and even performance issues with wife. Also, now at 35 I subjectively feel like there has been a notable drop in my energy/focus/sense of wellbeing since even early 30’s.

I don’t take any other OTC drugs. No hair loss yet, so no hair loss drugs

Total T: 631 ng/dl (264 - 916)
Free T: 8.9 pg/ml (8.7 - 25.1)
TSH: 3.550 uiu/ml (0.450 - 4.500
LH: 3.1 miu/ml (1.7 - 8.6)
E2: 19.7 pg/ML (8.0 - 35.0)
SHBG: 58.3 nmol/L (16.5 - 55.9)

Am I missing any key numbers? My lab work covered a lot more.

Diet/Exercise: I eat around 2200-2400 calories a day, until I get up to about 185 pounds and then I eat around 1800 a day until I get back down to 180. I have no problem adjusting my diet. I don’t eat junk food but I’m not exactly salads and organic salmon all the time either. When I’m not paying attention I suspect my macros are around 40/30/30 carbs/protein/fat–not because I think that’s a magic ratio, just because that’s how I eat. I lift 3-4X per week, about 35 minutes per session, focusing on compound barbell movements.

No ball aches.

I still get morning wood. My erection issues have been spotty and included losing steam mid-session with the wife, which is definitely new.

High SHBG= Low free T! Your hypothyroid. Your numbers suck. No wonder you feel like crap. Your not headed there… You are there. You need to take control of your health buddy.

Your hormone panel looks fine expect is ruined by high SHBG, in other words your liver is ruining the day. I was just about to say stay away from plant based diets, no need. As men get older their SHBG levels usually increase, TRT is the most effective way to suppress SHBG.

Often when a guy starts TRT his SHBG level will decrease, how much depends on the dosage and frequency of injections. You will do well with large weekly injections which is reserved for high SHBG guys.

TSH is a real problem, I’m surprised your doctor hasn’t addressed it yet. Any doctor that only checks TSH is clueless, your doctor has failed to check actual thyroid hormones. Your need fT3, rT3, T4 and antibodies tested as you are hypothyroid. Confirm by checking body temps using a glass thermometer, you need to be 97.7 waking and 98.6 at 12 noon. We know that isn’t going to be the case.

TRT will not do much for you with the current state of your thyroid, TRT attempts to restore metabolic rates (fat burning) that your thyroid can’t match often making you feel worse. TSH become elevated when your pituitary gland detects low thyroid hormones or low fT3 which directly correlates to your body temps. Thyroid ranges are to wide and are mostly useless.

Your thyroid requires iodine, you are likely iodine deficient. Do you consume iodized salt? Most are iodine deficient.

Thanks Man. I confess I didn’t spend much time with the thyroid stickies until you posed this but now I have. I’ll start checking temps and consider iodine supps.

This was totally off my radar so I have no idea whether any salt I consume is iodized or not. I’ll be more dialed in going forward.

97.2 this morning.

So I’m looking into iodine and the disgareements about this shit make T supplementation seem non-controversial by comparison.

My rough plan is to go with 12.5 mg/day (plus companion nutrients including selenium) until…some event I’m not clear on, at which point I lower to a maintenance dose which is also unclear, but probably no more than about one milligram.

Is there any thought/wisdom on whether it’s problematic to start both T and iodine supplementation at the same time? Should I try to get thyroid locked in first before starting with T?

You should check thyroid, iodine supplementation won’t work if thyroid a mess, mainly if rT3 is elevated it will do nothing.

Where are you located?

Most guys who come here have some thyroid problems, so do you.

FT is low
so FT–>E2 is low and E2 thus lower end

SHBG is high creating more non-bioavailable SHBG+T that lowers FT and inflates TT so that TT overstates your T status. TRT can change this as more bio-T reduces. But SHBG can be elevated by liver problems, so do liver lab work. https://en.wikipedia.org/wiki/Sex_hormone-binding_globulin#Conditions_associated_with_high_or_low_levels

LH is not so bad, but you need to test LH/FSH together. LH is released in pulses with a very short half life. FSH often is a better indicator of LH status than LH lab results.

TSH is way too high and should be closer to 1.0
Thyroid lab ranges are quite useless and too broad.
Doc sees “normal” but you are not.

Labs: - FASTING!
fT4 [please not T3, T4 or indexes etc!]
rT3 - reverse T3
AST/ALT or liver panel that doc selects.
fasting glucose
fasting cholesterol
AM cortisol - do at 8AM or 1 hour after waking

Your thyroid function could be poor because you are not using iodized salt. Whole family can be affected.

Low thyroid function lowers body temperature, lowers energy and libido and is quite depressing and symptoms are largely the same as low-T, so you have a double hit.

If you do TRT without addressing thyroid you could feel worse.

Low thyroid function explains fat gain.


  • feeling cold easier
  • sparse outer eyebrows
  • low: libido, energy, mood
  • possible brittle nails or general hair thinning
  • dry skin

Evaluate you overall thyroid function via oral body temperatures, see below. Check others in your home.

When we see low-T + low thyroid function + training we expect adrenal issues caused by lost natural energy been replaced with adrenalin. rT3 can increase that starts to block fT3 receptors and adrenal fatigue is next. See the thyroid basics sticky noting references to: rT3, training, adrenal fatigue and Wilson’s book.

Please read the stickies found here: About the T Replacement Category

  • 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.