Bad Fatigue, Just Had Bloodwork Completed

41 years old. I felt good up until a year or two ago. 5’10 weighing around 190 (18% body fat). Gym lifting was going well; benching close to 300, squat 400, and deadlift 500.

Everything really started going downhill last year. I started feeling extremely fatigued most of the time and my lifts starting slowly dropping. I also gained about 10lbs. Went to my PCP, he ran a bunch of bloodwork including T-411ng/dl (250-1100 range) and Free T-79.3pg/ml (35-155 range). Cholestrol took a major uptick from prior years but he said nothing to worry about and dismissed my weight gain and strength loss.

Fatigue has gotten worse so I asked my doctor for a full panel:
Cholestrol total: 209
HDL: 49
Triglycerides: 57
LDL: 145

DH: 29 (16-79ng/dl range)
Estradiol: 16 (<29pg/ml range)
Testosterone: 306 (250-1100 ng/dl range)
Free: 52.6 (35-155 pg/ml range)

FSH: 4.0 (1.6-8.0 mlU/ml range)
LH: 5.3 (1.5-9.3 mlU/ml range)
TSH : 0.78 (0.40-4.50 mlU/ml range)

White cell count: 6.0 (3.8-10.8 range)
Red cell count: 5.24 (4.2-5.8 range)
Prolactin: 6.5 (2.0-18.0 range)
PSA: 0.3 (<4.0 range)

My lifts are down 20% across the board despite being 20lbs heavier. I’m fatigued all of the time, muscles ache sometimes for no reason, and my bad cholestrol has increased (while good decreasing) the past year out of nowhere. Dr says I’m still in normal range and he doesn’t think that’s the problem.

Just majorly frustrated. I’m too tired to play with my kids most of the time, my gym performance is failing, and I’m gaining a lot of fat.

Thanks for the help in advance fellas

What’s your diet, sleep, and training like?

It is the problem. Someone could have almost triple your total and free testosterone levels, and you would both be “normal”. I’d bet heavily that the other guy would be a lot happier.

You’re going to want to find a practice that does TRT exclusively. It will have to be outside of an insurance based practice, as according to their guidelines, you are fine and probably just need an anti-depressant so you will be happy and not care about not feeling well.

Wouldn’t be a bad idea to get your thyroid checked also

Diet is good for the most part. Keep protein around 180 grams per day. Cheat of burgers and fries with kids a day or two a week is likely.

Sleep around 7-8 hours a night. Sometimes brain fog even after that amount will last a couple hours.

Lift 3 days a week, push/pull.

Most guys feel best at the high end of normal on free T or even a bit beyond that… you’re barely at the low end.

I agree on getting thyroid checked too. Free T3, Reverse T3, Free T4, TSH.

I think you will feel a lot better getting your free T up to the high end or a little over as well.

With fatigue, you absolutely need a complete look at your thyroid function. Be sure to get all of the above. Many Dr’s don’t know about rt3 or think it’s important or too expensive, but it’s a sleeper thyroid marker that if elevated, will give you hypothyroid symptoms in the face of other optimal thyroid numbers.

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It would seem doctors are only concerned with keeping you alive, doctors are not overly concerned with low normal testosterone numbers, their world is ruled by reference ranges, in range is normal and both Total T and Free T are in range.

You should focus on the healthy ranges and optimising all your levels, sick doesn’t optimise your health, this is preventive medicine keeping you in an optimal state of health.

You need to seek out a doctor that primarily prescribes TRT on a daily basis and not some ordinary doctor in the sick care system because most will be no help because they specialized in other areas of medicine and not necessarily TRT.

You should find an anti-aging clinic that allows at home self injection so you can optimize treatment, a lot of these TRT clinics have no idea how to manage men on TRT, use the review system to choose the appropriate clinic.

I don’t see any thyroid testing, good thyroid levels are needed for TRT to work.

Thanks for the info gentleman.

My doctor ordered the TSH testing (came back 0.78 of a range between 0.40-4.50 MlU/ml) but not the Free T3, Reverse T3, or Free T4. I’ll check into my local rejuvenation clinics and request these additional tests so I can get a full picture.

TRT may be the possible step for me. I’ve read and watched a lot of videos and read personal experiences on it. Anger issue was a concern which seems to be a myth. Overall, the experiences I saw were positive.

Found a local rejuvenation clinic. I did read here they may not be the best at dialing it in. DEFY looks like a good option with the blood monitoring and assistance.

I read the beginning can come with an uptick in anxiety. I have a concern it could possibly interfere with work

Yea your low, strenuous workouts don’t help either. As we age, if we are going to workout like we did when we were younger, then we need the T levels we had when we were younger.