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Bloodwork - Considering TRT

Hi all. I’m a 32 fit guy. I lift, diet and am overall healthy. Well, I do have some fat, especially around waist and chest. Since adolescence I’ve been suffering with these deposits of fat but always kept a semi lean body. So, it’s been 2/3 years that I feel lots of hormonal fluctuations. I can count on my fingers the periods of time when I was horny or had a nice hang. Most of the time I’m with almost no libido, also scrotum very high. A shy penis overall, as well as tired, no motivation etc. And well, it’s happening now again, so I decided to do some bloodwork to think about doing TRT. I’ll paste it below (DHT is missing), it’s in portuguese but I believe you guys will understand it.

I hope you guys can give me some guidance.

If I’m reading this right free test (livre) is a little low, total testosterone is mid range, SHBG is higher but in range, and LH is pretty low. E2 (estradiol) is on the low side but makes sense given your other numbers.

Based on just the numbers it’s hard to say you need TRT. But numbers are not symptoms. You’re reporting classic symptoms of low testosterone, and your numbers aren’t bad, but they’re not great.

Thanks for the reply, Iron. Well I’ve been testing T for a while and it has never been over the 400’s. Not even when I was highly committed with lifting and dieting, low bf etc. What could pretty low LH and FSH mean?

Sounds good, strength training, eating right, not obese or diabetic.

Sounds bad, especially for a 32y/o, that is not normal. I’d look into TRT. Check fT3 if you can.

It means it’s pointing to a pituitary failure, your testicles are perfectly fine. Your TSH is awfully high indicating a thyroid problem and if you do have a thyroid problem, TRT will not work very well and could make things worse.

You should check free thyroid hormones (Free T4/Free T3/Reverse T3) and antibodies.

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Would be fix thyroid or testosterone first?

Am thinking thyroid.

Op I would do thyroid antibodies and free t3

Most of the time, I start with both. However, it is based on the individual, their needs, goals, priorities and objectives, as well as their labs.

If you want me to pick one or the other, for men, it would be testosterone. It will almost always help them and we can add thyroid later if we want to take it to the next level.

If only one for a woman, then usually thyroid. Get some energy and get them not feeling tired all the time, lose a little weight, libido improves. We can always add test later. By far, most of the women will want to start with both.

Again, lab values will enter in to this, especially if one of them is practically non existent. To me, this is a long discussion with the patient which results in an informed and shared decision making process.

As for the OP, he needs testosterone. On follow-up, I’d get TSH again, fT4 and fT3. Hold off on antibodies for now. I’m getting away from rT3 testing. While interesting, it doesn’t change what I do since I use T3/T4 combinations anyway and it saves the patient some money.

Thanks for the reply. I’ll check the other hormones. About the thyroid, I got it checked last August and it was high. My endo prescribed T4 hormone and I got better for about 2 months. I didn’t have time to get back to him, but well, considering this recent exam, I believe my thyroid problem is serious.

Would it be better to postpone TRT and fix thyroid first? Maybe I’ll need to do thyroid hormone therapy for life as well.

So you are on t4? Endo needs to adjust meds until your thyroid is fixed. This is a process.

It sounds like your thyroid treatment isn’t dialed in yet, typically people dialed in on thyroid treatment have a TSH closer to the median value (<2.0). You’re not even close to being dialed in.

I forgot to add PTH (Parathyroid Hormone)

15.0 TO 65.0 PICOG/ML

I went to the endocrinologist in september (TSH was about the same as now) and he prescribred T4. So I ran it for a month (30 pills of levothyroxine) and should’ve got back to him after 6 weeks. But I didn’t because I started feeling better. This feeling lasted for a month or two. Then I checked blood last week and voilà, TSH high again. Sorry for the misunderstading, I should’ve been more clear.

You were given drugs that helped make you feel better, so instead of going back to the doctor and telling them that you were better, you just…skipped that part. C’mon, man. Tighten up.

I know… Now I realize I f’ed up. I’m addressing that as well.

Yeah I wasn’t sure if I was reading that one right… guess I was.

Obviously… go back and get more…? It’s a treatment, not a cure, unfortunately.

It seems so, indeed. I might need to use it for life