T Nation

Defy Approved Me for TRT After Seeing Labs, But Should They Have?

So, I finally found a reputable TRT clinic, and I had my labs drawn with them, and a guy by the name of Dr. Calkins gave me a the green light for TRT after looking at my labs. I actually have a consultation with him next week.

About me: 28 year old male 183lbs, 6’0”. My
Issue: low energy, absent morning erections, weakness in gym, some depression and anxiety, tend to hold fat, had gyno.

Here are the labs, I need your honest opinion, do you think I should be on TRT. I’d like to note that the labs were collect at 2:22pm as seen by the pictures (mentioning that because I’ve been told T is highest in the morning then steadily drops off)

I’ve also had a full thyroid panel done by my family doctor few months ago, that came back normal.

I’m also including labs from 5 months that my doc drew up, a lot of interesting and drastic changes in values since then but I felt same.

When I look at your Total T, Free T, SHBG and LH I do see some problems. Your LH is high normal and Total T should be as well and isn’t, Free T is considered low given your age as the ranges go all the way to 26 pg/mL and you’re at 17.6 (about midrange), a lot of guys complain of low testosterone midrange and lower on ranges accounting for age.

What’s midrange for me is different for you since you are younger, so this puts you in a different category from say a 45 years old where the ranges top out at 21.5 pg/mL. Even at my age of 46 symptoms of low testosterone don’t disappear until I hit 20 pg/mL.

How about prolactin? A cutting edge clinic not checking prolactin OR DHT :man_facepalming:t3:
Or iron?
Or vit d3? What medication do you take or took?

Of course they went you on trt. :moneybag::moneybag: This is life long. You need to cover your bases and make a confident decision. If not you may end up stopping cause you will tell yourself what if …

I wonder if your issue is dietary. Your cholesterol is on the low end to. Cholesterol is needed for hormone making.

I would investigate further. Did you see an endocrinologist? Nice to see am cortisol and acth checked as well - for adrenal function.

Maybe Also a testicular ultrasound being your lh is solid make sure testes are good.

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I had plenty of symptoms with a free test running between 14-16. You can always stop if TRT does not work for you.

He’s 28 not 40. He needs to investigate further.

There are several things to consider. TRT clinics are in business to sell testosterone. If you want it, and there is no overt reason not to provide it, they will.

Many, if not most, of them treat symptoms over numbers, and I think rightfully so. You have symptoms consistent with low testosterone. While your results are not horrible, you certainly might feel better if you had more testosterone.

I am surprised there was not a closer look at your thyroid. Even though TSH looks good, it would be nice to see your free T4, free T3 and reverse T3, especially given your symptoms. That would be unless your family doctor included those tests in the full panel ordered.

There is a small chance op can have a pituitary tumor, testicular tumor or varicocele, adrenal issues. But trt clinic don’t really care about that. They Really don’t get to a possible underlying disease. It’s a pity.
Maybe it’s part of the consultation with defy. Idk

They did not even check iron , prolactin or dht. And should check key vitamins. Wtf

Right, agree, but they cannot do a physical exam over the phone.

True. But they can order. Not sure if basis needs to be Physical exam though.

We made our point. A person esp in the USA should not start at a trt clinic.

If they ran 1 blood test and then prescribed, that’s malpractice imo. They should run numerous bloods to show a pattern of low T. Not just one test.

How many tests did they run to confirm? You’re not even out of range.

Great point. Need at least 2 tests to confirm low t. I really think in this case needs to investigate other things first

You think? Often, with a given history and blood tests, it is obvious. How many repeat tests do you think are needed?

Certainly get that with this particular example, but 300 and 900 are both within range and I bet one guy is a lot happier than the other. Ranges are for insurance companies so treatment can be more difficult to obtain. Some feel good at 500, some do not.

Absolutely. One test is not enough to confirm needing treatment, ESPECIALLY given he isn’t out of
Range.

i would only defy or other trt clinic if i exhausted all endos (if pituitary or thyroid), have done several labs and endos only offers bad protocols. if thats the case, then yeah why not a clinic? op did not gave us much info. lifestyle?

I would try to look for the cause of your symptoms elsewhere to make sure you are on the right path. And while I understand people who criticize ranges, you are really not that low in my opinion.
Your low cholesterol is interesting, mine is low as well (130). I read a lot about it and that it may possibly cause hormonal problems. A doctor said below 140 is where you may not have enough cholesterol to build sufficient amounts of testosterone. Just a thought. Make sure you are eating a lot of healthy fats, if you eat animal products, try eating food high in cholesterol and give it a few weeks to see if this makes a difference.
Try the easy things first before you commit to TRT.

That’s incredibly one sided, is the sick care system any different profiting on prescription drugs, treatments and surgeries?

image OP here. I also have full lab results of labs from 5 months ago, which are from my personal doc. this includes levels as well as well a thyroid panel. It seems my lab values improved after 5 months, but I generally felt the same. I managed to drop my TSH levels of 2.59 to 1.2 using iodine as well as you can see by my recent results above.

And my diet does include plenty of healthy fats, I don’t know why my total cholesterol is so low. I eat whole eggs every morning and snack on nuts everyday, and my diet has at least fish twice a week, while supplementing with fish oil.

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Thyroid labs look good, Free T3 is midrange, Reverse T3 is 15 ng/dL or lower which is ideal. I would expect to see Free T higher in someone with an SHBG of 23, your SHBG binds T well given the lower value.

DHT will increase on TRT. Cholesterol is needed to manufacture hormones, are you on statins?

Of course it is different. It is worse. Very often, the treatment you get depends on the type of specialist you see.

It is just the way it is and I wouldn’t put TRT doctors on any moral high ground. Just like any other business, identify a need, a demand for your products or services, fill the need. If they do not put anyone on testosterone, they will not have a business. Nothing wrong with that, it’s OK, but let’s be honest about it.

What’s a good deal? Two satisfied parties.

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Doesn’t look as though thyroid is an issue. I would go on testosterone, double those levels and I bet you’ll feel good.