T Nation

Advice for Low Libido, Insomnia? Bloodwork Attached


#1

Hi guys,

I am new to the forum. Wanted to get some advice from you guys regarding my situation. I am a 42 year old guy with good diet and lifting at the gym 3-4 days a week ( 167 lb, 5’ 11"). Since 2017 (when I reached 40), I started having symptoms such as depression, severe anxiety and pretty bad insomnia. I have always been a good sleeper before this. I also started having very low libido, and weak erections (again my sex drive was pretty decent before this).

I did my first blood work in 2017 and at that time my T levels came back as pretty low (272 ng/dL). I had a couple of blood tests done within a few weeks and and the numbers were consistently low. I went to an urologist and endo, and both wanted me to try anti-anxiety meds and SSRIs first. I was on a very low dose SSRI for about a year and since then my T levels have improved to 400s. But sleep is still poor, and libido is not satisfactory at all and it looks like my T levels are stuck in the 400s. Here are the results from my latest blood work.

Should I think about TRT or is this redeemable in other ways ? I would like to avoid exogenous T, but after 2 years my patience is depleted, and I feel like I have few options.

My Blood test results from 3/15/2019 (Quest)

DHEA 232 (70-495 mcg/dL)
Estradiol 28 (<= 39 pg/ml)
T Free 79.5 (35 - 155 pg/mL)
T Total 474 (250 -1100 ng/dL)
FSH 2.6 (1.6 -8.0 mIU/mL)
LH 2.9 (1.5-9.3 mIU/mL)
SBGH 17 (10-50 nmol/L)

Cortisol 16.8 mcg/dL (4-22)
GH <0.1 (<= 7.1 ng/ml)
IGF1 202 (52-328 ng/mL)

Glucose 89 (65-99 mg/dL)
Insulin 4.6 (2.0 - 19.6 uIU/mL)

Thyroid
Free T4 index 2.2 (1.4-3.8)
T3 updake 30 (22-35%)
T3 free 3.2 (2.3 - 4.2 pg/mL)
T4 total 7.4 (4.9 -10.5 mcg/dL)
T4 free 1.1 (08-1.8 ng/dL)
TSH 2.46 (0.4-4.5 mIU/L)

Cholesterol total 197 (<200 mg/dL)
Trigylcerides 68 ( <150 mg/dL)
HDL 47 (> 40 mg/dL)
non-HDL 150 ( <130 mg/dL)

5/12/2017 (labcorp)

T total 272 ng/dL(348 - 1197)
T free 5.3 pg/mL (6.8-21.5 )
PSA 0.4 ( <=4.0)
LH 5.2 mIU/ mL(1.7-8.6)
FSH 3.5 mIU/mL (1.5-12.4)
Prolactin 11.6 ng/mL (4.0-15.2)
Esatradiol 16.2 pg/mL (7.6 - 42.6)
SBGH 25.9 nmol/L (1.5-55.9)


#2

The problem with blood testing is it doesn’t tell you where your levels were last week or the day before your lab draw, only in those few hours and if you test often enough, you’ll start to see a bigger picture. You’re painting a picture that shows levels are between suboptimal to downright low, your symptoms match up with classic low testosterone.

There are a lot of men out there who have low libido, depression and anxiety and are scripted SSRI’s when the cause is undiagnosed low testosterone. The problem with doctors these days is they treat the symptoms and not the cause of those symptoms, a doctor can spend a fraction of their time scripting you SSRI’s instead of dipping deeper for the cause of symptoms.

Your LH confirms low testosterone status, also you Free T is suboptimal. Your SHBG seems to be binding androgens very strongly and is (genetic) why your Total T looks respectable, but the balance is tipped against your Free T.

Your mention of extreme anxiety hints that while TRT may worsen your anxiety, I think some of your anxiety isn’t related to low testosterone. I expect men to have some anxiety when testosterone is low, but not extreme anxiety. TRT can give you the confidence to manage your anxiety and keep it at bay.

Your anxiety may be partly to blame for low testosterone and more than likely these SSRI’s are also partly to blame as well. Low testosterone can cause poor sleep, poor sleep could be caused by sleep apnea and both of these can cause low testosterone.


#3

Spend the money and find a real trt doc. Don’t use these sick cars ducks who jsut want to benefit big pharma and get you hooked on meds that treat the symptoms. Sickening if you think of it. Oh depression and anxiety. Wanna try ssri? Not a big deal but it Might make your T levels worse, sex life wollmplummet and you will be physically addicated…

You seem to have low t yes and will it get better? No clue. Guys who do well and fix t don’t come on here and tell us. Everyone with ssri and low t get son trt. Or younger guys take chlomid or HCG and etc.

At your age I would jsut get on trt. Your past midway of life and the goal form now forward is to live as well as possible. Or try to get yourself sorted out and then get on try if all else fails. There really aren’t many other options than the obvious.

I’m your age at 40 and started trt a couple few months ago.

Jsut do yourself a favor and use a real trt specialist not these guys. You won’t even really need any guidance if you find someone whose legit like The doc I use.


#4

Thanks for the responses :slight_smile: One of the things which no doctor has recommended is a pituitary MRI. Do you guys think that I should ask for one just to rule out pituitary tumors etc ? All these symptoms suddenly became pronounced since about 2 years back - so that’s why I am searching for answers. I would say I have always had anxiety issues and I have been working on it, but it seems to have worsened over the last 2 years.


#5

Just curious, are you seeing a T-clinic for TRT or an endocrinologist/urologist ? Thanks.


#6

A trt doc . I found Dr. Keith nichols on YouTube and loved his approach . Flew out and met him. Great doc he just tells you what to do and you don’t have to second guess it all.


#7

Endos and uros are not taught trt in med school. Unless they learn it themselves and go take courses and become certified your wasting time


#8

That about sums it up, they only learn if they so choose. If you think about it from a financial standpoint only, it makes no sense to learn how to do TRT.

The only return you’ll see is a healthy, happy, grateful patient.


#9

And it annoys me every time. They have an oath when they start practicing. But it’s forgotten the moment they get into the world.