37, Low T, Full Labs, Guidance Welcome

Pharma / TRT Testosterone Replacement
1

First post, read the stickies, hope i got this right

  • age: 37

  • height: 6’

  • waist: 30.5"

  • weight: 150lbs

  • describe body and facial hair: normal facial hair, very little upper body hair, almost no leg hair, normal pubic hair

  • describe where you carry fat and how changed: stomach, trunk, and chest (unchanged)

  • health conditions, symptoms [history]:

  • low energy, fatigue, hard time putting on muscle

  • low total + free T, see labs below

  • varicocele removed age 21, hydrocele as a result of that surgery, removed 1 year later

  • heaviest i’ve been was 183lbs, lost a lot of weight over last 18 months through dietary changes (see below)

  • Rx and OTC drugs, any hair loss drugs or prostate drugs ever:

  • Nexium from age 16-28, then fixed through dietary changes

- describe diet:

  • avoidant/restrictive food intake disorder (ARFID) as a kid, ate only 10 or so beige foods until I was 13
  • from age 13 until a year ago, bad diet - no veggies, lots of carbs, not enough protein. wore a continuous glucose monitor and figured out I was borderline prediabetic despite “normal” a1c levels, started taking diet more seriously, ultimately adopting keto FODMAP diet (wild caught fish, pasture raised meat/poultry + veggies, olive + coconut oil only, basically) for past 3 months.

- describe training: mix of basic strength training and cardio today, but hasn’t been consistent in the past
- testes ache, ever, with a fever: no
- how have morning wood and nocturnal erections changed: no problems here

** additional context:** i want to have kids in the next year

Labs (Quest):

Glucose - Fasting: 81.00 mg/dL 65.00-99.00
Hemoglobin A1C: 4.50 % 0.00-5.70
eAG: 82.45 mg/dl 82.00-154.00
BUN: 22.0 mg/dL 7.00-25.00
Creatinine: 0.92 mg/dL 0.40-1.50
eGFR: 112.0 mL/min/1.73m2 60.00-160.00
Sodium: 137.0 mEq/L 135.00-146.00
Potassium: 4.61 mEq/L 3.50-5.30
Chloride: 99.0 mEq/L 98.00-110.00
CO2: 28.0 mEq/L 19.00-30.00
Anion Gap: 14.6 mEq/L 6.00-16.00
Protein - Total: 6.9 g/dL 6.10-8.10
Albumin: 4.5 g/dL 3.60-5.10
Globulin - Total: 2.4 g/dL 1.90-3.70
Calcium: 10.0 mg/dL 8.60-10.40
Alk Phos: 81.0 IU/L 36.00-130.00
AST: 26.0 IU/L 10.00-35.00
ALT: 38.0 IU/L 6.00-29.00
Bilirubin - Total: 0.5 mg/dL 0.20-1.20
Total WBCs: 3.90 k/cumm 3.80-10.80
RBC: 4.79 m/cumm 4.20-5.80
Hemoglobin - Male: 13.9 g/dl 13.20-17.10
Hematocrit - Male: 43.2 % 38.50-50.00
MCV: 90.2 fL 80.00-100.00
MCH: 29.0 pg 27.00-33.00
MCHC: 32.2 g/dL 32.00-36.00
Platelets: 204 10E3/µL 140.00-400.00
MPV: 11.1 fL 7.50-11.50
RDW: 13.6 % 11.00-15.00
Neutrophils - %: 59.1
Lymphocytes - %: 28.5
Monocytes - %: 8.5
Eosinophils - %: 2.6
Basophils - %: 1.3
Neutrophils - Absolute: 2.3 k/cumm 1.50-7.80
Lymphocytes - Absolute: 1.11 k/cumm 0.85-3.90
Monocytes - Absolute: .33 k/cumm 0.20-0.95
Eosinophils - Absolute: 0.1 k/cumm 0.00-0.50
Basophils - Absolute: .05 k/cumm 0.00-0.20

Cholesterol - Total: 260 mg/dL 125.00-199.99 [HIGH]
Triglycerides: 75 mg/dL 0.00-149.99
LDL Cholesterol: 168 mg/dL 0.00-99.99 [HIGH]
HDL Cholesterol: 74 mg/dL 40.00-100.00
Non-HDL Cholesterol: 186 mg/dl 0.00-129.99 [HIGH]

Vitamin D (25-OH): 33.0 ng/ml 30.00-100.00
Vitamin B12: 550.0 pg/ml 200.00-1100.00

TSH: 2.42 µU/mL 0.40-4.50

Testosterone Total: 576.0 ng/dl 250.00-1100.00
Testosterone Free: 41.9 pg/ml 46.00-224.00 [LOW]
Testosterone Bioavailable: 102.73 ng/dl 110.00-575.00 [LOW]
Sex Hormone Binding Globulin: 67 nmol/L 10.00-50.00 [HIGH]
FSH: 5.1 mIU/ml 1.50-9.30
LH: 4.6 mIU/ml 1.50-9.30
Estradiol: 16.0 pg/ml 0.00-39.00
Prolactin: 5.4 ng/ml 2.00-18.00
DHEA-S: 120.0 µg/dL 85.00-690.00
IGF-1: 134.0 ng/ml 53.00-331.00

Repeated some of the bloodwork a week later, this time with a different doctor testing with Labcorp:

TSH: 1.920 uIU/mL 0.450-4.500
Thyroxine (T4): 7.4 ug/dL 4.5-12.0
T3 Uptake: 35 % 24-39
Free Thyroxine Index: 2.6 1.2-4.9

Testosterone: 287 pg/mL 264-916
Free Testosterone(Direct): 3.7 pg/mL 8.7-25.1 [LOW]
DHEA-S: 143.0 ug/dL 102.6-416.3
Cortisol: 16.9 ug/dL 6.2-19.4
LH: 6.3 mIU/ML 1.7-8.6
Prolactin: 5.8 ng/mL 4.0-15.2
Estradiol: 13.7 pg/mL 7.6-42.6
IGF-1: 133 ng/mL 90-278
SHBG: 62.7 mol/L 16.5-55.9 [HIGH]

I’m most interested in seeing if I can kickstart this without TRT first, esp since I want to have kids soon. any guidance/opinions welcome!

2

Testosterone can help build muscle but your genes determine how much muscle you can build.

The ability to build muscle is more than just about having healthy testosterone.

Your IGF-1 is low given your age. The optimal IGF-1 for ages 31-40 is 135-220 on average, which puts you at the bottom end. A low IGF-1 is linked to low muscle mass.

An IGF-1 below 80 increases the risk of disease and mortality, something to keep an eye on as you age.

For a comparison, I’m going to be 51 soon and my IGF-1 is 189-220. I have muscle without ever having gone to the gym.

TRT has a 73% chance of making your infertile in the short term. hCG and FSH in conjunction with TRT has a high probability of making you fertile again. These compounds can be more expensive than previously because compounding pharmacies can no longer make hCG and FSH.

Clomid is another option for regaining fertility, but usually means stopping TRT for a time. It can take anywhere between 3-12 months to produce enough sperm and make you fertile again.

Hypercalcemia can cause fatigue, lethargy and muscle weakness.

3

Men with low FT and E2 will carry their fat in the mid section because estrogen determines where fat is distributed. I took an aromatase inhibitor once, knocked my estrogen down to 12 and belly fat accumulation increased quickly!

4

Really appreciate the reply.

I had miskeyed the calcium number - it is 10.0 flat.

Is there anything that can be done about this?

The doctor I went to prescribed 25mg of clomid daily as a starting point.

5

Peptides will increase your natural IGF-1 levels, no guarantees it will translate to more muscle.

You have to inject 1-2x daily.

This isn’t a long term solution, clomid blocks estrogen in many organs throughout the body, including the heart, liver, pancreas and the brain. A lot of men feel horrible on it, clomid can cause psychological problems, mood problems, vision problems and even suicidal thoughts.

By far the worse side effects profile of any drug out there!

6

Look up the Metabolic Diet, and follow it strictly for 6 months to clean your system out.
Run new labs and see what your numbers look like at that time.
HCG is not expensive and 90% of the time your fertility issues will be resolved as well as your baseline Testosterone levels increasing.

7

You’re unlikely to get the results you’re looking for using clomid given the fact that your LH is already near the top end of the ranges and FT is very low, indicating your testicles are struggling and more stimulating hormone isn’t likely to see much of an increase in FT at all.

8

when starting TRT my igf-1 was like 60.
then couple months later, with added weight lifting it went up to 240 or so. (too lazy to lookup now but what upper top reference range)
nothing else in addition to 120mg/week T cyp at that time. (now on a higher dose)