T Nation

Benefit From TRT? Any Other Supplement Strategy? (Lab Results)

21 year old male.

Testosterone: 741.8 ng/dL
Free Testosterone: 15.6 pg/mL
Globulin: 2.1 g/dl
Albumin: 4.6 g/dl

I went to the doctor recently for a viarety of blood tests concerning my lack of energy and low motivation that has been snowballing over the years.

He says the blood tests came back with no metabolic explanation for the fatigue and other problems. But I read that your levels at the age I’m at should be higher, particularly my free testosterone should be at 26-28 pg/ml instead.

Would there be any other explanation for a lack of free testosterone? Any recommendations of supplementation, or should I pursue TRT, other ideas?

Your lab testing is very limited, there could be thyroid problems, mineral deficiencies, liver problems etc. Your testosterone while not optimal may not be a problem, hard to tell with all the lab test missing.

Your problems could be do to poor sleep, sleep apnea, depression and/or anxiety or undiagnosed disease. A lot of doctors are not very well educated on the subject of sex hormones.

According to the the leading expert at Harvard, Dr. Abraham Morgantaller, men <15 pg/mL (6.8-26.5) will likely show benefits on TRT.

The lack of Free T is likely do to high SHBG, it binds sex hormones and in your case is binding up some of you usable testosterone. High SHBG is either genetics, starvation diets (cutting) or something wrong with the liver which is where SHBG is produced.

The question you should be asking yourself is are these your best numbers or your worst. If they are your best, then levels are lower when not testing.

What would I need from a lab test to know more? I had a lot of blood screenings done at once. My doctor says thyroid and everything was normal, but mentioned sleep and depression issues.

I don’t know where to go for any hormone-related treatment or what further I can do here besides ask for trt that I don’t qualify for.

Sleep study would probably be next. Are you overweight? Do you snore? If you’re not sleeping properly your T will be crushed.

I don’t snore. I’ve got a bit of abdominal fat but still 135 at 5’9. Most of the time I sleep okay, I don’t think a sleep study is going to show me much Revelation. I’m still feeling one, but it doesn’t feel like sleep is desperate

What are the ranges for those? If they are Quest the total range is 250-1100 ng/dL and the free test range is 35-155 pg/mL. If that is the case, your free testosterone is very low, and that’s around 0.2% free testosterone. Ideal is thought to be between 2-3%.

Ok. Vitamin D, blood pressure, RHR, stress levels? How is your diet?

From MyQuest.com which is my portal to my tests:

TESTOSTERONE, FREE

295.6 H

Range - 35.0-155.0 pg/mL

This test was developed and its analytical performance

characteristics have been determined by Quest


Lab Corp ranges are dramatically different:

Testosterone, Free, Direct

Free Testosterone(Direct) 11.5 pg/mL 9.3 − 26.5 01

Mine is direct, don’t know where i’d even go for a quest test. Also, my blood pressure is fine. More than fine. And stress isn’t a factor here. I’m 21, I’m ALWAYS stressed.

Your doctors states thyroid levels normal, but the reference ranges your doctor uses to determine normal status are not normal, this is a problem because most doctors are using dated ranges. A normal TSH is <1.5 which is where 95% of the population scores, the normal free thyroid hormones Free T3 normal ranges are still under debate.

Reference ranges for TSH and thyroid hormones

Though TSH remains the most commonly used endocrine test in clinical practice, the issue of an appropriate TSH, and to a lesser extent, free T4 and free T3 reference ranges is still under debate. First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L.

There is the problem, your doctor was taught what normal is in medical school, now new information is out and now we know normal is something very different, that the normal ranges are NOT normal.

Your doctor is using reference ranges that included sick people with hypothyroidism. All day every day people search the internet because something isn’t right, they are told by their doctor that their hormone levels are normal and that any problems are in your head.

The evidence for a narrower thyrotropin reference range

Debate and controversy currently surround the recommendations of a recent consensus conference that considered issues related to the management of early, mild, or so-called subclinical hypothyroidism and hyperthyroidism. Intimately related to the controversy is the definition of the normal reference range for TSH.

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group.

Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter. The remainder with higher values are outliers, most of whom are likely to have underlying Hashimoto thyroiditis.

The optimal ranges for Free T is 20-26 pg/mL, this is the optimal range for men under 30 years old and is where all the really good hormone specialists are seeing their patient feel optimal and all other biomarkers optimal as well.

Though I understand most of that, all being said what are you suggesting? A new doctor? Another screening? A new hospital? Accepting that medical science has evolved, what the actual fuck am I supposed to do here. Tell my doctor he’s wrong and to go back to school?

  • Testosterone, bioavailable
  • Testosterone, free
  • Estradiol (sensitive assay)
  • Steroid Hormone Binding Globulin
  • Follicle Stimulating Hormone (FSH)
  • Luteinizing Hormone (LH)
  • Dihydrotestosterone (DHT)
  • Complete Blood Count (CBC)
  • Prostate Specific Antigen (PSA)
  • Blood Chemistry Panel
  • Metabolic Panel
    Also prolactin
    Vit d and folate.
    Thyroid panel

You think your doctor will speak up when he thinks you need treatment, think again. Your insurance company is the one who decides gets treatment, not your doctor. Doctors are not their own masters anymore, the insurance company dictates everything your doctor does. I remember back in the 70’s before insured health was leashed upon us, many in the industry stated it would be the death of healthcare.

Now everytime your doctor looks are your labs, he must ponder will insurance companies cover treatment, if no then he will tell you that your levels are normal. If all doctors based treatment decision based of the more updated reference ranges, million on people would now be eligible for treatments and insurance companies would lose hundreds on millions.

Insurance companies are not about to let this happen, congress is starting to fight back creating new laws. Paying out of pocket for current medical needs is becoming more popular, you cannot remain in an optimal state of heath going to your average insurance based doctors, not when insurance companies are pulling your doctors stings.

You have to be pretty bad off before sick care doctors will offer treatment, you have to have the hormone levels are a 90 year old man (<300) before TRT is prescriobed. Up to 70 percent of the treatments for chronic conditions are denied medical coverage by insurers, according to the data.

Your current doctor will not be very helpful, you doctor mentions he cannot explain your metabolic issues, then you research and discover your levels are hanging on suboptimal.

This basically means all this hormone stuff is above his pay grade, your doctor probably doesn’t even know where the average man your age is scoring in Free T, you are lower than other men in your age group.

You will likely not find a doctor in managed health care that truly understand hormones, sex hormones are excluded in medical school and the doctors pushing the boundaries of hormones are mostly private in anti-aging and sports medicine.

Great to know. Do nothing.

You may find a doctor if your lucky that will treat you and treat you optimally. Its up to you if you want to do nothing no one said that. You can keep fighting for care in insurance networks or go outside insurance where doctors do specialize in this stuff

He’s saying you are likely going to need a private doc that specializes in this type of thing. Maybe you’ll get lucky, but not a lot of us do.

Maybe smugness and sarcasm aren’t your best bet right now, bud. People here want to help you but you’re basically a pouty teenager who’s not getting answers (to exceedingly complicated questions, btw) fast enough. I know it goes against every fiber of your being, but try to be patient. And maybe smoke less pot. It seems to make you irritable. Just a suggestion.

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How dya know he smokes po-… Nevermind

Those reefer cigarettes will kill you ya know. May I point to a pivotal piece of literature

@kushkenobi, take note

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