T Nation

Do I Need TRT or Should I Investigate Further?

Hello all,

Would just like to say first of all thanks to all who contribute to this forum there’s so much knowledge in here. Compared to what we can extract from GPs in our usual 5 minute visits there is an encyclopedia worth of info on here about hormones, etc.

I’ve suspected I’ve had low levels of T for a few years due to my symptoms (low libido, fatigue, joints cracking, back pain (could be due to desk job), brain fog, slight anxiety, dry skin). I’d say the worst of which is brain fog and libido. However my total testosterone numbers are what I would say ‘low normal’ (15-18 nmol/L), however free T is rock bottom of the range.

Therefore I think it might be worth looking into some of my other numbers that are on the low end of normal first like folate and B12 which are at the very low end of normal, and also have similar symptoms to low T. Vitamin D level is also something I want to get tested, which I will ask my GP for soon. What do you guys recommend as a plan of action? (Hopefully the image of my bloods have uploaded ok!)

Also should add I have tried clomid in the past and it always gave my pretty horrible low mood/ headaches so had to get off it after a few days so never figured out if that would increase T or not.

Age: 35
Height: 6ft
Weight: 14st (196lbs for the yanks)
Location: UK

Previous health conditions: Varicocele to my left testicle, had corrective key-hole surgery on the NHS when I was 22 or 23 (had it since my mid-teens however and feel like it has damaged that testicle as it seems slightly smaller than the right one).

Activity level: Used to enjoy lifting weights but have been off and on over the years due to lack of motivation…, now have young kids and not got the time (or motivation/ energy) at the moment but usually I feel better when lifting weights and it alleviates my symptoms at bit after 2-3 months of regular lifting (3 times a week).

Diet: Quite healthy usually eat meat and vegetables for dinner and try to eat fish 2-3 times a week. Avoid processed foods mostly, but still eat a small amount of chocolate, biscuits etc daily. Tried paleo in the past and it also seemed to help but was hard to stick to. But the fact it helped makes me think I may have a food intolerance that’s affecting nutrient absorption (hence the low folate/ vitamin b12).

Forgot Thyroid numbers:

TSH: 1.29 mIU/L (0.27-4.2)
Free T3: 5.45 pmol/L (3.1-6.8)
Free Thyroxine: 16.8 pmol/L (12-22)

I got these tests done last year, but was very busy at the time and put this off til now (struggled along… was lifting weights for a few months too which helped a bit!)

Calling on: @dextermorgan @johann77 @dbossa @highpull @enackers

Any advice would be much appreciated.

Cant remember the names of all the experts here… blame the brain fog!

Given your age, symptoms and labs, I think TRT is worth trying since the other options you mentioned aren’t possible for you. Most note significant improvement fairly quickly (within two to four weeks) so giving it three or four months should tell you if TRT is your solution. I’d also get a current and complete workup, thyroid, etc. Good luck, I hope you can find help as I understand the NHS will likely not be helpful.

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Thanks highpull I feel it might be worth a trial too. Only way to get it though is private due to my numbers so will need to pay for it for the rest of my life which is daunting, but I’m prepared to do it if its required. Most clinics I’ve looked at charge around £100-150/month (+ blood tests). My thyroid numbers are fine - I’ll add them to original post.

Only other thing is I want to try and optimise my vitamins, etc first and perhaps get back exercising and see how things go for 3-4 months first. Or do you feel that’s pissing in the wind (so to speak)?

DHEA-S is also high… but not sure what that means (if anything). Some adrenal gland issue maybe… not sure.

I do, unless there is a significant deficiency, most don’t seem to “feel” that much better with vitamins. I’m just guessing though, and I take a ton of supplements. I think you’ve been feeling this way for too long. However, nothing wrong with trying everything else first and you can then start TRT with an “I’ve tried everything else” approach.

Doubtful, it’s not crazy high. Glucose levels normal? I’d check it again.

My fasting glucose was 4.8 nmol/L (range: 3.5 - 6.0).

My levels were higher than yours and TRT has been life changing for me (after the initial learning curve).

Yeah your case is pretty inspirational to be honest!

Did you have a closer look into other vitamins, minerals, etc. before or after you got onto TRT?

Dude I have a dream life now and that’s after dealing with shit like depression my whole life and never really knowing what true happiness felt like. I cherish every second I get to live this way. I owe a lot of it to TRT and this forum and try to give back whenever I can. I wish everyone could figure their’s out and get there too. It wasn’t an easy road.

The clinic just ran the bare minimum. After a while on TRT I got all that checked on my own. One thing that has helped immensely is sublingual methylated B12 (sublingual methylcobalamin). I take 1000mcg day. My b12 levels were 700 (250-1200) and were considered decent but now that I supplement and they are top range I feel really good. Lots of clean energy and positive effect on well-being.

I get it from Amazon

I also use Magnesium GLYCINATE before bed entry night. 400-600mg

5,000iu of vitamin D
2000mg of vitamin C
Vitamin K2

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I think I’m gonna try optimising vitamins/ minerals once I get all the baseline values first, then re-check them in 3 months to see where I’m at and how I feel then go from there. I’ll also start some regular exercise/ lifting again.

Thanks for the help @dextermorgan

Exercise/lifting is very important for mental health. When Covid hit and the gyms closed I didn’t work out for months and there was a major difference in my attitude and wellbeing. Anyone on TRT should definitely be doing some form of exercise at the very least. Otherwise you just have a nitrous bottle on your car that isn’t even hooked up.

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@slim85 Agree with Highpull.

Find those guys at balance my hormones in the UK. they have a website and can help you find a doctor that will give you TRT properly.

Your thyroid numbers look ok, but you should also check reverse t3 if you have any signs of serious fatigue. TRT might resolve these issues though.

You need a good doctor and he can help you with this. I hope.

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I wouldn’t waste my time with minerals and vitamins if I have low t symptoms. Get on TRT asap. Fixing diet and health usually doesn’t raise T values much. T is very beneficial for your overall health regardless. Form mental health to cv health and etc

Men today have less hormones than man 50 years ago. Even 30 years ago. Most men need T. Toxincs in our air, food and homes are a big reason why. One day soon I imagine more and more men will be on TRT simply to keep themselves healthy and cancer/ illness free. Kind of how plant workers wear protective gear. Men and woman will need protective gear if the corporations continue ruining our products, food and the air we breathe.

IMO, it is worth a try, since his numbers are pretty close to average. It might not work, but IMO thinking about TRT for the 3 months he is planning on adjusting lifestyle will not hurt in the long run.

Yikes man those numbers are not average. My father is 75 and has his numbers. Probably more since his free t is 15 and 500 total.

Not even close to average for his age.

His first TT is 518 ng/dL, second test TT is 435 ng/dL. Free test is only calculated not measured, but SHBG is pretty average, so I would say he is just a bit below normal. IMO, it is worth trying to get levels up, unless OP is okay with the trade off of the negatives of TRT (pinning, cost, fertility) for the positives of TRT. I think with general health optimization, OP could get to right about average. It is okay to want to be more than average too.

My Test levels were about 100 points under OPs, and I went on TRT because I wanted to be above average.

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Got my Vitamin D test done 63.6nmol/L (50 - 175) which is considered ‘insufficient’ (not deficient) so I’m now taking a 4000IU supplement. Along with that I’m taking folate to try increase that number too. I’ll see if I have any symptom relief in 2-3 months time.