T Nation

Considering TRT, Correct Bloodwork Protocol?

Hi All,

I would like to know from the forum if I am on the right track in my thinking for starting on a low TRT protocol. A dosage of: Test E/C (120mg-180mg pw – split into 2/3 doses), an .AI (1 mg – or slightly less, pw – split into 3-4 doses) and possibly 250 IU’s of HCG twice a week. The reason I’m adding an .AI from the start is that my E2 is very high. Age 48 Male, overall healthy, and lift 5 times a week with cardio EOD (light jogging).

Height: 6 ft.
Weight: 89 Kilos.
Blood Test taken: 9.40 am in a fasted state.

LH: 6 IU/L
FSH: 10 IU/L
GH: 0.5 mIU/ L or 0.1665 ng/mL
IGF-1: 25 nmol or 191 ng/ml
SHBG: 57 nmol/L
Total Test: 24 nmol/L or 692.208 ng/dL
Free Test: 343 pmol/L
E2: 149 Pmol/L or 40.58 pg/mL
Prolactin: 49 mIU/ L or 2.303 ng/mL
PSA: 0.58 ug/L
Free PSA: 0.2 ug/L
Cortisol: 480 nmol/L or 17.4 ug/dL
CRP: 0.4 mg/L
DHEA: 3.7 umol/L
Hemotocrite: .46
LDL: 2.85 mmol/L or 110 mg/dL
HDL: 1.06 mmol/L or 40.9 mg/dL
Total Chol: 4.4 mmol/L or 170mg/dL

The report didn’t have a BIO available Test result, but an online calculator which takes into account (Albumin, SHBG and Total Test) gave a 9.23 nmol/L. I have other indicators on the report, if requested, but unfortunately didn’t request Thyroid panel.

Any help would be much appreciated.

With a TT of 692 why do you think you need TRT? Your E2 is not that high. At the high end but not super high. Your Free testosterone also looks good.

Thanks for the quick reply. I am considering this for a few reasons, energy levels lately seem to be lowish, libido could do with an increase, and would be nice to get a little better gains in the gym.

My free test of 343, i took that as to be on the lowish side. As the range on the report was: 150-700 pmol/L.

Do you think if i took this to a Doctor specializing in TRT he would say to hold off ?

Tough to say. Depends on the doc. TT of almost 700 at 48 years old puts you at the high end. For your age Free T is also ok. I’m sure plenty of docs would not prescribe for you with these levels but you may be able to find one that will.

It’s not impossible that TRT might make you feel better, but there are certainly plenty of people starting TRT with values half of yours or worse that wish they had those numbers.

If you decide to start I’d give the same advice as I tell pretty much everyone. 150-180mg/week, split it to 2-3x a week and don’t take anything else. No AI. No HCG. Give it 8 weeks.

With your TT that high you’ll be hard pressed to find a doc who will Rx test. But you could look at some ways to lower SHBG and free up some test.

With your total t levels where they are, I think I’d look elsew here first. Get the thyroid panel done. How is your sleep? If you think it’s good are you sure? A sleep study isn’t out of the question. How about stress?

I’d think about getting everything else checked out first over the next 6 months first. It’s easy to fixate on something even in the presence of evidence that it’s not the issue.

The if you do give it a trial you’ll need to find a doc that’ll treat you with those numbers; might take some doing. You’re best argument is that you’ve investigated all these other things to no avail and want to give it a trial run. And you’ll need to get a high enough dose to bump you up above where you are now or you’ll feel a ton worse.

Good Luck

Apart from eating loads of veggies and protein, I have never smoked and I rarely drink these days. So, I’m not sure outside of meds, how could i lower it as well as my E2?

My bodyfat is reasonable at <20 (according to comparing to reference photos online). I am working to improve that at the moment, while work is at a standstill.

Thanks for the reply.

I will look at getting some more bloodwork done before the end of year (probably end of Oct), and i will make sure i get the thyroid panel included.

My sleep is good and i don’t feel stressed at all. Just completed a few years work in the middle east, and now back home decompressing for the past 3 months and enjoying the winter weather which i have missed.

thanks again.

Vegetarian based diets high in protein substantially increases SHBG.

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I didn’t know that.

I should be more clear. Loads for veggies for lunch and dinner, but always with meat/chicken. I take fish oil, i’m not on any meds, dont drink coffee, havent had any alcohol since Feb, no smoking.

I have been in a calorie deficit for the last 6 weeks, if that makes any difference.

Carbs. Carbs will help lower SHBG and keto has been shown to increase SHBG (I believe the links for this info are searchable in the forum). Add in some carbs is one way. Boron is another.