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Continue to Look into TRT?


#1

Age: 34
Height: 5’ 9"
Waist: 33.5"
Weight: 168

Some background: For the past decade or so, I’ve been struggling with constant fatigue and tiredness. For a long time, I was told repeatedly by doctors that this was due to my depression (which I’ve been treated for). After hitting 30 and still having these symptoms despite my depression being managed, I started pushing my doctor to investigate other possibilities.

This led to my thyroid being thoroughly checked (they actually thought I had a tumor, but it turned out to be an error with the test…), a sleep study (ruled out apnea), my previous doctor even had me take iodine supplements for a while. I have also been tested multiple times for diabetes and saw a neurologist to rule out any neurological issues.

And then my doctor suggested in passing that she could check my testosterone levels, though quickly dismissed that as a possiblity. I started researching it myself and was amazed at how many boxes I checked off (I’ll list symptoms below). There were so many problems I’ve had that I never realized could be related, but mostly ignored due to thinking it was normal or because I was so focused on the struggle with fatigue. I was told there was no problem with my bloodwork, but I asked to have my results sent to me and decided to check my estradiol levels myself since I also had a lot of symptoms for high estradiol.

Turns out she did the bare minimum of testing, and this is what I got back:

Free Testosterone: 11.3 (8.7-25.1 pg/mL)
Testosterone (Total): 4.41 (3.48-11.9 ng/mL)

And my estradiol (sensitive) test: 45 (8-35 pg/mL)

Presented with my estradiol levels and the list of symptoms I made, my doctor agreed that while my testosterone levels aren’t low, they are sub-optimal for my age and could explain my issues. However, she doesn’t treat low T due to fears of infertility and suggested I go to find a low T center (saying that they’d take me more seriously and an endo would likely just rule it out based on the numbers alone).

Which brings me to today. I decided to have my testosterone levels retested, hoping I’d get levels a little lower to make it easier to get treatment. I got my results today:

Testosterone (Serum): 592 (264-916 mg/dL)
Free Testosterone: 14.1 (8.2-25.1 pg/mL)

And, obviously, these results indicate everything is normal and well within range. (The odd thing is the first test was taken within a a couple hours of waking up, while this one was taken after a night of no sleep.)

Symptoms:

Describe Body and Facial Hair: I can grow a full beard and would actually say my body hair is above average.

Describe Body Fat: I’ve always had fat in my belly, lower back, butt, and thighs. I actually cut my weight down last year to 140 and still had fat in these areas despite being able to see my abs.

Health Conditions and Meds: Only thing of note is depression, which I manage with Wellbutrin. I also have a history of kidney stones which are prevented with daily potassium citrate supplements.

Diet: I believe I have a pretty well-rounded diet. I avoid processed food and track my calories very closely. I’ve currently been trying to bulk, so my calories are higher than normal.

Training: I do weight training 3-5 times a week dependent on energy levels.

Testes Ache: Very, very rarely do I have this happen. It usually lasts a couple days then goes back to normal. I’d estimate it doesn’t happen more than 2 or 3 times a year.

Morning Wood: I can’t remember the last time I woke up in the morning with an erection. If I wake up during the night to go to the bathroom, I’ll occasionally have one, but it’s not common and goes away quickly.

Other symptoms:

  • Low libido
  • Weak erections and difficulty keeping them
  • Low semen volume
  • Difficulty progressing in the gym and building muscle (been training for 3 years and have little to show for it)
  • Gain fat easily
  • Brain fog, difficulty concentrating
  • Fatigue
  • Anxiety
  • Depression
  • Dull orgasms

Symptoms of High Estradiol:
(Taken from here, hard to find a credible source, so not sure how accurate this list is)

  • Acne (primarily chest and back)
  • Moodiness
  • Lethargy
  • Insomnia
  • Soft erections
  • Enlarged prostate - I do have symptoms consistent with BPH: difficulty starting urination, frequent urination (up to 20 times a day), weak flow, bladder never feels completely empty, wake up multiple times during the night to go
  • Constipation
  • Gynecomastia (minor, I think, but diagnosed by an endo)
  • I’ve always felt my testicles are a bit on the smaller side

I understand this is very limited information to go on, but my main question is whether or not I should let today’s test results discourage continuing down this path. Is there a reason my numbers would jump like this or is that to be expected? Could one of the tests just be an odd fluke? If not, would my estradiol be enough of a concern that a T specialist wouldn’t turn me away? Could more thorough bloodwork (LH, SHBG, etc.) provide a better indication of what’s going on despite seemingly normal T levels?

Any advice would be greatly appreciated.


#2

When you say you check your thyroid did you do a full thyroid panel checking more than TSH? You also need SHBG tested, if your SHBG is low or high it could explain why you feel symptoms of low-T. Best indicator for thyroid is oral mercury thermometer, check thyroid sticky for how to check it. I’ve seen a few guys who had their T levels bounce around from low to just above midrange in a short amount of time with me being one of them before I began treatment.


#3

Yes. I have a family member who had thyroid cancer, which is one of the reasons that was one of the first things my doctor investigated. Unfortunately, that was a couple years back and the doctor I was seeing at the time moved, so I don’t have those results. When I went for an x-ray, they thought they found a lump, but the ultrasound ruled that out and it was determined it was just an x-ray artifact. But my family member made sure they tested the right things. I know they at least tested T4, T3, Free T4, and TSH. I had recent bloodwork done that included TSH and it was 1.6 (0.45-4.5 mcIU/mL).

So, despite the T bouncing around, you still think it could be a T problem? I would’ve liked to have gotten more bloodwork done, but my doctor basically seemed like once the determination was made, she wants a specialist to handle anything else (had to get the T retested on my own, even). I know a specialist is certain to send me for more thorough bloodwork, but do I have enough information to even get that far with one? Today’s results are discouraging me since I thought I finally found out what was causing me to feel like crap all these years, but I’m afraid a specialist will see the numbers and not take me seriously.


#4

Hey, I have similar symptoms as you. I am 20 years of age, but I have my test checked multiple times and my results were 11.3, 11.7, and 9.7. my estradiol was 22. I (from the reaserach I have seen) honestly believe that majority if not all the symptoms are related to my testosterone levels. So for you having the same test levels I would place my money on that. your estradiol will also make those effects more noticeable. I am considering trt but before i do i want to find the cause of my low test. I haven’t taken hormones and I belive this is a primary problem for myself. Is their any problems you cant think of why your test is low. I feel its always good to what causes low test before jumping into trt. This is my opionion but I am not a medical professional.


#5

Don’t underestimate SHBG, it can cause a lot of problems if it’s out range.


#6

They don’t make finding the stickies on this site intuitive. Here is this forums version of a FAQ. It is a must read


#7

Your Testosterone level is not exactly optimal varying from low to Ok. You are only 34 years old, it would often be much higher. And yes levels change by the hour and the day. There is a guy here who recommends a 24 hr tests done three different days that average that stuff out. Sounds spendy to me but I can see where that would work best.

Your estradiol levels are very high considering that your Testosterone levels are low. And Gyno is the give a way. Your symptoms, even if your Testosterone levels were never below 595 woulds be typical of a guy who has Gyno and and estradiol levels that high


#8

It would help if you posted all of your test results with ranges here. Otherwise everyone is just guessing


#9

@dopeboy604 I can’t really think of any reason why it’d be low. I’ve put a lot of effort into living a healthier lifestyle over the past few years, including completely changing my diet and being a lot more active. I’ve also never done anything like steroids, so it’s not like I inadvertently screwed up my levels. Seems like something I’m not going to be able to figure out without a doctor.

And, good luck getting figuring out your issues! If I’ve learned anything from this, it’s that doctors don’t know everything. You know your own body better than anyone else, so be your own advocate. If there was anything I could go back and tell my 20 year-old self, it would be that. I waited far too long to realize it, just trusting whatever a doctor told me, and ended up wasting many good years of my life as a result.

@systemlord Alright, thanks for the feedback. I have to ask: You said you had something similar happen where your T levels jumped back to midrange. Did that make it complicated to get treatment? Also, did your problems end up being rooted in SHBG?

@verne I read through all the stickies before I posted (been lurking here the past couple weeks actually). I either didn’t find something that answered my question or I’m just overthinking things.

Unfortunately, I posted all the test results I’ve been able to get thus far. I plan to get more (and will post an update when I do). Having my T levels go up just really threw me off. Like I said, this is an issue I’ve been trying to figure out for years, and I’ve had a lot of things look like strong possibilities (thyroid cancer, sleep apnea, digestive issues, etc.) before falling apart. I guess I just wanted to make sure it didn’t look like the same thing was happening with this before I spent the money it’d require to look deeper into this.

I appreciate the responses I’ve gotten here. It’s reassured me, and I’ll be looking into a clinic this week.


#10
  • What has been your history of using iodized salt?
  • There must be a problem or there would not have been an X-ray done.
  • See below re oral body temperatures and thyroid.
  • please find more thyroid labs

Labs:
TT, FT, E2, LH/FSH, prolactin, E2, CBC, hematocrit, AST/ALT, AM cortisol [at 8AM or 1 hour after waking up]

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.