T Nation

Doctor Says T Levels are Low But Does Not Prescribe TRT

Hi team,
I am age 26 male , looks skinny, no muscle , weak bones , sparse to no facial hear , no chest hair , high pitch voice. I am facing difficulty in lifting weights and constant fatigue and also face sleep issues. So , i decided to go to a Low T clinic to get my blood levels drawn. The lab results came out and doc says my testosterone levels are at normal range for my age and i have Vitamin D deficiency and vitamin B12. So the doctor suggested that with the below levels of T my insurance may not treat it as low T levels in order to start the therapy. So he prescribed me to take Vitamin D supplements daily until 2-3 months so that the free T levels could consume more percentage to oppose what i am producing.I did not completely get the link between Vitamin D and Testosterone levels.What should i do now. Should i seek and Endo to check my hormones again or follow doctors advice i taking the Vitamin D supplements. Please suggest.

I am attaching my Lab tests here:

Vitamin D levels:Result- 14L , reference level: 30-100 ng/ml
LH: 3.4 miU/ml reference level: 1.5-9.3
FSH: 1.8 miU/ml reference level: 1.6-8.0

T levels:
First test :
total T: 351 ng/dl
Free: 57.5 pg/ml
Bio available: 130.8 ng/dl

Second test:
total T: 403 nd/dl
Free:81.0 pg/ml
Bio Available: 163.1 nd/dl

The doctor says because of the two different results my insurance will not treat as too low T to start a therapy. I am really not sure if my levels are low for my age.

Your testosterone levels are not normal for your age, men at your age are scoring in the high normal ranges. This has more to do with the insurance company not wanting to pay for treatment, insurance companies tend to set the bar pretty low and the reason is clear.

Often men are told there are normal not because they are actually normal, but because insurance refuses to pay for treatment, so they doctor turns around and says, you’re normal. Often the doctor has no clue what normal is and just follows guidelines which are in serious need of an update.

There are clinics out there that would offer you treatment except you will have to pay out-of-pocket, Defy Medical is such a clinic and is a reputable anti-aging clinic.

351 and 403 nd/dl for your tt is on the low end especially for being as young as you are but they are within normal range. I had 301 on my first test and it wasn’t until I hit 264 that he just recently started me on trt. Im 34 years old thou and had past anabolic usage. You are still pretty young and that’s prob why. I would say try grinding it out hard in the gym, heavy weight less reps. Put an honest effort in and diet as well. If in 6 months of honest dedication and you still feel like shit retest and ask to see a endocrinologist

Generally the medical world considers below 300ng/dl dispite everyone is different and needs more or less testosterone.

Endocrine society did landmark testosterone trail showing tt in men of all ages and ranges. This will show you where you stand

https://academic.oup.com/view-large/64847960

The ranges for testosterone and what’s considered normal is so blurry, I see guys scoring under 250 ng/dL at a very young age and are not symptomatic at all, yet you see guys coming in here complaining of symptomes dipping below 500 ng/dL.

The endocrine society I believe got it wrong in deciding on a cutoff point of 300 ng/dL for the reason mentioned above, the cutoff point where symptoms start to surface is going to be different for everyone.

The studies clearly show the cutoff point to be much higher in the ranges for the majority of men if this study below has anything to say about it.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

hey shiva,
your T lvls are not normal for your age.
as you know TRT once you start it, its for life.
You could try to increase it naturally, considering that you are young. If does not work in 2 months , consider start on TRT.
For me (im 40) came from T 380 to 760 . Some supplements and diet/lifestyle changes works really well:
1- Cut sugar (high IG carbs) , sleep!!! (in realy dark place)
2 - Vitamin D 10k ui / day., vit C , iodine (lugol) , curcumin.
3 - high protein diet, (eggs, liver(B complex vit), meat, oily fish(omega3 fats)
4 - Coconut oil, brazilian nuts, avocados.
5 - Cruciferous vegetables
6 - heavy complex exercises
7- control estrogen and bodyfat

i hope that can help you.

Thanks. My doctor is a specialized clinic Director who specialized in LowT treatment here in St.louis. Even my LH and FSH levels seems to be low but doc says there is no pitutiary failure/tumour. I always have low energy , fatigue , cant put on muscle.I am at 145 lbs and 5’8.Do you think i should have a second opinion may be with an Endocronlogist.

yeah I was expecting the levels to be very low. Some times i feel i may have Kallmann Sydnrome which is kind of Gondotrophic Hypogondaism. But looking at my T levels i was suprised. Doc suggested to take 10000 IU units of Vitamin D supplementation for 2-3 months and come back to me. If i do not see any increase levels in free Testosterone which he said the goal is to bring from 57.5 to 150 then may be we can start Therapy. May be he felt I am young and absolutely no necessity for a TRT therapy immediately.

I see that. The doctor says the LH and FSH are perfectly sending signals to testes and nothing wrong with pitutiary. By looking at my Hematocrit level (44.2) doc says my blood looks too thin and even if i take TRT it wont be thick in future and cause any cardio vascular diseases.

How does he know? Does this Dr have x-ray vision.
Did you check prolactin levels? Estradiol? Thyroid? Igf? Cortisol? Acth? Did he say anything about adrenal functions? That’s what am cortisol and acth help evaluate

You still have a high pitched voice. Have you not gone through puberty fully? Is your penis size average? Pubic hair? Hair on your legs? Do you ejaculate and what color? Height? Do you have a sense of smell? Did the clinic comment on your testicles size?

They did not take an X-ray vision.
Estradiol level:25 pg/ml
TSH: 0.67 miu/L
T3 total: 138 ng/dl
T4 free: 1.2 nd/dl
cortisol:0.255 mcd/dl

He did not discuss about prolactin and adrenal functions.
You still have a high pitched voice- yes.
Have you not gone through puberty fully- I am thinking so and said “may be” i did not go through to it but the doctor did not pay attention to it.
Is your penis size average- Yes.
Hair on your legs- very Sparse.
Do you ejaculate and what color- Yes and the serum color is thick white.
My height is 5’8 nd i have sense of smell.
Did the clinic comment on your testicles size- they did not check at all.

Do not go back to the clinic. They are not good.

How can they say your pituitary is fine with lowish LH and FSh. Prolactin must be checked. If it’s elevated you may have a pituitary tumor. That’s 1 way to tell.
They did not check your balls. Wtf.
I ask because you may not know what normal ball size is the clinic would. Unless you have a mate to compare. But it would be awkward because you need to feel the size.

You definitely should see an Endocrinologist. Even a pediatric one. Look up a good one. This is complex stuff. You need an Endocrinologist to evaluate you as well.

White thick. That’s good. Drink more water maybe less thick then.

Write down all you symptoms. Like puberty things even though your 27. Voice , little hair, etc. Erection issues.

Can you post the cortisol range and what time you took the test. Cortisol highest in the morning.

This is personal but if you penis size is let’s say above average over 5.5 inches(13.9 cm) You probably don’t have kallman.

Also if you don’t pay for the test try to get clinic to order testicular ultrasound. And pituitary MRI. And if you don’t pay for labs get a script to check prolactin, acth, ferritin, igf1

Of course not. They want you to pay trt out of pocket.:moneybag::moneybag: That’s their goal. Must see an Endocrinologist and then maybe a urologist.

Systemlord, there shouldn’t be any reason for concern having an underwhelming/low TT when one’s FT is in higher range, correct?

Testosterone Total 18.3 nmol/L (6.1-27.1)
Testosterone Free Calculated 565 pmol/L (110-660)
SHBG 14 nmol/L (13-89)

ie: who cares if TT is low when FT is higher end?

How current is that study? I have an old one from 1996, that shows around 100 ng/dl higher values (or about 35% higher) for the 19-39 age group. I had to average a few age groups together from the older study to get the same age range.

Here is that study:
http://elitemensguide.com/testosterone-levels-by-age/

I have a feeling that most men would feel best at the top of the range (or a safe level above the normal range, that doesn’t cause adverse sides).

https://www.endocrine.org/about-us

Study was done in 2017

You’re failing to understand that an endocrinologist who takes insurance is going to tell you the same thing as the clinic, the insurance company will not cover treatment until you score two seperate times below 300 ng/dL which may not happen for years to come. I know you don’t want to pay for TRT, but you have no choice.

A lot of doctors inside these insurance networks have to accept lower rates (wages) and now all you’re left with are those who are TRT ignorant, so seeking that level of care is asking for complications because most doctors have no clue what they are doing and those that do likely don’t take insurance because they have a skill most doctors do not.

Insurance companies will roadblocks in your path to prevent you from getting covered. Paying cash for healthcare is starting to make more sense, at least you’re getting your money’s worth instead of these monthly installments that get you nothing when you actually need treatment.

So in 21 years we have seen a ~35% decline in TT. So what is in the 50 percentile range now, would have been in the ~10 percentile range in 1996.

The fact that most insurance now won’t cover T replacement until you are around 250 ng/dL (because that is the 5th percentile) is crazy, since we know that you would have been in the 5th percentile at 350, 20 years ago.

We should only use free T, and the bottom of the range should be set at were no symptoms occur.

Wrong. OP is not on a mission to get trt. He’s in a mission to investigate WHY?

Do you understand it’s not normal for a 20 year old to go on trt. Yes it could be. Must investigate. There are hundreds of diseases and conditions.

What if the OP has pituiu tumor.