T Nation

Bioavailable Testosterone

EDIT: So based on my labs below, is there enough information here to warrant TRT or at least a trial? I just don’t really know what to do and it’s up to me. Would appreciate some insights and direction. Don’t worry, I won’t hold anyone to any direction they provide here. I just need some professional help and I can’t find that here in Canada. This is the next best thing… or possibly better.
thank you for your help,

I’ve had a blood test that’s showing my BT at 3.4 and the range looks to be 4-11. He only tested the following for Reproductive and Gonadal. Everything else in past blood work has been in range. Total T was 350 about 2 months ago.

Estradiol 44 pmol/l
Progesterone 0.8 nmol/l
Dehydroepiandrosterone [DHEA-S] 7.5 umol/l
Testosterone Bioavailable 3.4 nmol/l

I’m wondering if this warrants another TRT cycle or if there is something else I can try before I go that route again. It’s been almost a year since I came off of TRT as it was causing me some challenges and I didn’t see any benefit other than physical gains. In fact when I was on TRT, my levels were all over the place and could never find a balance. I was doing weekly injects of 25 Cypionate and also tried androgel.

Ok, first, always post all of your labs, with ranges. This only helps your case.

Another TRT Cycle? TRT shouldn’t be cycled on and off. You can attempt a HTPA restart, or do SERM or HCG instead of TRT.

You were injecting 25mg a week? That’s extremely low. Are you sure this was the amount?

Attempting to post labs below. I came off because my levels wouldn’t stabilize after trying some different injection amounts and timelines. Sorry, I was on 25mg every 3-4 days as per some insights I received in this forum. Then to Androgel which I don’t ever want to do again. So maybe I’ll have to go back to TRT. My endocrinologist wouldn’t do SERM or HCG. I live in Canada and we don’t have any TRT specialists. Only Endocrin… very difficult to sort out proper treatment here. I’ve been suffering with debilitating depression, fatigue, and anxiety for a couple of years now which I believe is tied to a few different layers. Just trying to figure out if this (Low-T) is still one of them. Thank you for your help.

I didn’t see If your SHBG was drawn.

So why were you only taking 50mg a week? That’s not unheard of, but highly unusual. I had to use very small amounts at first to acclimate myself because I had bad anxiety but then I titrated up and am at 100 a week now.

If you have a higher SHBG that amount will do absolutely nothing.

Can you do trt again and try 50mg twice a week?

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Weekly injections it’s no wonder you levels were unstable, levels peak in 24-48 hours and then decline at different rates and SHBG can play a role. You keep mentioning TRT and cycle in the same sentence, they aren’t remotely the same thing. TRT is for life and is therapeutic levels, those who cycle on and off typically are injecting supraphysiological doses of testosterone, they are rolling the dice on their health.

25mg weekly is enough testosterone for a small child, it doesn’t sound like what you’ve been doing resembles TRT at all. The majority of endocrinologists are TRT ignorant and don’t specialize in the area of sex hormones, they are more into thyroid hormones and diabetes.

Doctors that typically have been doing prescribing testosterone has done so outside of traditional medicine in the private sector, sports medicine and anti-aging who optimise health which isn’t something state healthcare/insurance based medicine does. This is why doctors have no idea what they are doing.

Typical weekly TRT doses are 100-200mg weekly two or more injections per week, the majority of men find stable levels on two injections per week, others more often. There are lots of private hormone specialist in Canada, you just have to find them.

Not sure if I can start again, or want to start again. I was hoping that my levels would rebound because it was determined that my low T levels were being caused by a medication I had taken and subsequently withdrew from. In addition to some adverse effects I was having with aggression and anxiety, I decided to get off to see if my levels would come back on their own. Total T rebounded from 87 to 350 but I thinkI’m stuck there and my bioavailable looks pretty low now so I’m not sure what to do. I don’t really want to be on T but if I have to in regards to quality of life then I will.

I’ve never had the SHGB test. It will take me awhile to get this test as it’s not that easy here in Ontario, Canada to get blood taken.

thank you,

The same happened to myself, I was fine until I started withdrawing off Klonopin, I never recovered as withdrawing off these medication stresses out the glands in the body and sometime never return to normal.

In reality you were likely put on these medications because of low testosterone, there are a lot of men on these SSRI’s whose problem is low T, instead they are scripted these drugs which mask the symptoms for awhile.

You mention to your doctor that you are depressed, he scripts you an SSRI instead of ordering a hormone panel.

Your LH seems to be on the low side and while cholesterol is normal/high your hormones downstream from cholesterol are quite low

Your t4 to t3 conversion isn’t stellar either, what’s the diet?

You’d actually make a pretty good candidate for a SERM, I suggest starting with Clomid for a month then move on to a less estrogenic SERM like Nolvadex or Toremifene but unfortunately in Canada finding a doc that supports this sounds like mission: impossible. Maybe suggest them an HCG test. Again good luck with that.

Yes… convincing my Endocrin to do something out of the box (for Canada) will be difficult at best.

The diet is mostly meat and some vegetables. Eggs, and a small amount of gluten although I’m trying to cut it out completely, butter, cheese and yogurt. Rice, no sugar, caffeine, alcohol or drugs. Once a week I’ll eat a few burgers or a pizza but that’s rarely the case these days. Pretty clean diet from what I understand to be clean without doing something that will cause me to lose more weight than I already have.

Where are the fruits and tubers? Those will be big improvements to your diet.

I’m doing grapes, bananas, a few apples here and there. By tubers I’m assuming you mean potatoes? Anyway… still trying to figure out if this bioavailable testosterone test warrants TRT treatment. I would rather give HCG a go but I don’t know much about it and I’m not sure my doctor will go for it.

I’d be a little careful with the fruits. Your fasting glucose is looking good now but you are starting to creep up there. What that means is that your diet is pushing you towards a problem area but your great insulin sensitivity is keeping that in check. The older you get the worse that’s going to get.

Also, your hematocrit is slowly climbing over time. Keep your eye on that, especially if you are considering TRT. I would expect to see you on the high side due to the fact that you live in Canada (higher elevations), but it needs to paid attention to nonetheless.

How’s your active lifestyle? Workout?

Body composition?

As far as trying HCG over TRT, that will depend on your short term goals. Do you plan on having kids / more kids? The only benefit of HCG at 44 years old is to try and maintain fertility. Your natural production is on the decline so the HCG is going to eventually lose its ability to keep your levels up. Test injections will put you where you want to be and keep you there, but the trade off is loss of fertility. That’s a factor that only you can determine.

Wow, how on earth did you get an Ontario doctor to req for all those tests?! Magnesium and Copper? Did you have to pay out of pocket, and if not, is your doctor taking new patients?

Ok. So I should stay away from sugar completely?

I don’t understand hematocrit tied to TRT. I guess I can look it up. How would I manage it?

I work out a few times a week; mostly strength training but I don’t overdo it. Some cardio; 10-15min after my workout. I walk my dog a couple of times a day but that’s it.

Body composition is lean and muscular. Little to no fat. I’ve been trying to gain weight but it’s very hard as I’ve been in an anxious depression for about 3.5 years. 5’10" 146lbs.

thank you,

I saw a functional medical doctor (ND + MD). My GP has been pretty good as well. I’ve been unwell for a few years now. Mostly because of a protracted Benzo withdrawal (2 years since my last dosage) and associated mental crap. I haven’t been able to tolerate any meds or they haven’t worked so I’m trying to fix whatever biological challenges I can. So far, nothing has really worked.

I’ll pretty much do anything at this point to be rid of this depression and anxiety… I’m not sure TRT is the answer but maybe I need to give it another shot. If it’s just going to make my anxiety worse then it’s definitely not the right path. I guess I could try a couple of injections and see how I feel but I think it takes some time to build up correct?

You and me both, it seemed like withdrawal never ended. There are some who believe it may take several years to return to normal, I doubt if it’s even possible.

Not necessarily, but I would monitor blood glucose (get a cheap meter from the pharmacy). HCT is related to the increased rbc, but it essentially makes your blood thicker. A high blood glucose level can also cause thickening of the blood. When you compound the two together, you’re looking at problems.

To lower blood sugar, reduce your carbs. To reduce your RBC, and subsequently HCT, go donate red blood cells or lower your test dosage.

Be careful of ferritin levels though if you choose the donate route.

Fruits aren’t going to impact blood sugar at all though. Maybe bananas because of the extra starch. Table sugar (so 50% Fructose) used to be given to diabetics since it doesn’t do any harm on blood glucose.

Maybe don’t load up too much on tubers (potatoes yams squash etc) but still a much better source of vitamins and minerals than grains with the same starch content - which WILL spike your blood glucose unless you eat a bit of fat and fibrous veggies and maybe vinegar.

There are plenty of reasons to go for HCG even after the age of 40yo. People who reason in terms of “HCG=fertility” should read up on LH critical importance in the metabolism of cholesterol (via the p450scc enzyme) to begin with, meaning neurotransmitter benefits on top of obvious heart disease benefits. LH receptors are pretty much all over the body and have functions we have yet to fully uncover.

So never go full bro doing “just T”