T Nation

Fatigue, Depression, Brain Fog. Got Low T Results, Next Steps?

Hey there,

People on reddit recommended I post here, I hope this isn’t the wrong place.

29 year old guy here. I have the typical symptoms: low energy, brain fog, decreasing libido, depressive mood, no real sense of purpose, etc. I tried an SSRI for depression which helped a bit but didn’t really get myself much out of the hole. I also gained a lot of weight in the past 15 months. I went from “fit” to “sedentary belly” to obese in that time.

I got my test checked this month. My doctor measured it twice. My results showed that I had lower values here. These are the results:

Test: 278 (2.78 ng/ml according to my result sheet)

SHBG: 10.6 nmol/l

Free Test calc: 3.28%

I’m scheduled to see a specialist soon to discuss potential TRT or other options.

In your experience, what could help here? What can I expect?

Yeah, you’re pretty low. I think sub 300ng/dl on 2 tests is the standard for treatment in the normal doctor world (not a clinic, etc)

The problem is usually they’ll want to start you on 200mg e2w. Now a lot of guys don’t have a problems with this and nevery think twice about it. You’ve come to a trt forum which typically is frequented by people that have struggled with that standard protocol and the doc won’t change it or they’re looking to optimize their treatment.

Don’t assume you’ll have all the problems that various members here experience.

Typically you’ll feel better if you inject weekly or twice a week, rather than e2w, but maybe not enough to matter to you or be worth the hassle. I inj 3 times a week some do eod or even every day.

If you start, it’ll take some time to feel all the effects/get the benefits. Hard to know until you get I to it, everyone is different.

Thanks for your reply. This helps a lot.

What is the sort of number I should be hitting with successful treatment or better: what should I be aiming for?

I also was told (in the other forum where I asked) that the SHBG value is very low and that TRT might not play well with that. I wasn’t too sure about that. I will ask my doctor of course but if anyone has any input on that, I’d appreciate any help.

Don’t aim for a number. As long as you’re in range(ish) you go based on how your symptoms resolve at dose X. Chasing numbers can work fine, but it’s not as precise as symptom resolution.

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Your shbg is pretty low but trt can work with that. Around here you’ll see guys with low shbg tend to inj more frequently even every day but you’ll have to tinker with it a bit probably to find what works for you.

It really hard to determine where your numbers should be to and most around these parts don’t really target a number. That said, a lot guys seem to start getting all their symptoms resolved when their free t gets to about 25pg/ml(units?) or higher. Some need to get to 40+, but they seem to be outliers. Mine is about 32-33 I’ll probably keep it here for a bit. But everyone is different you may feel awesome at 16.

Starting doses are typically 100mg to 200mg per week. I’d probably split the difference if I had the choice, then wait about 6-8 weeks and see how you feel and where your numbers are. If you feel awesome leave it alone. If you still have some symptoms you may want to think about a dose bump if you have some new symptoms and the original ones are gone maybe a dose reduction.

Kinda have to play it by ear. Most likely don’t worry about e2, check your hematocrit to make sure it’s not sky high.

Then just go have a great life, try not to think about your trt much.

Thank you and @iron_yuppie a lot. This really helps.

My last question here: I am 29, so fertility is definitely a concern for me. I know TRT and fertility is a pretty complex situation. Do you (or anyone else reading the thread) have any specific threads or resources you can point me to so I can understand the connection a bit better. What I found online so far was quite ambiguous and didn’t really help me all that much.

Yes it is complex/complicated. First thing I’d do if this was a concern is have a fertility test done before starting anything. Are you fertile right now. Most likely yes, but at least you’ll know.

I don’t have a specific link or anything, though your should check out dextermorgan’s recent thread on this.

From what I’ve read, the vast majority of guys, that were fertile to begin with, can regain fertility by starting hCG for a few weeks/months. Some may need to add hMG as well. Some may need to stop trt all together, though that seems to be rare. Is it possible you won’t be able to recover, yes, but that’s also quite rare. I’d wager that most guys that can’t were infertile to begin with and didn’t know it.

If you’re really concerned you can have some semen frozen ($$$) as a hedge agaist it.

There are some people who just have genetically low SHBG, other causes are low thyroid hormones (Free T3) and diabetes. If these are the only tests you have starting TRT at this point is inappropriate.

Beware TRT is a field of medicine where even so called specialists tend to struggle with regards to getting the correct information as there is a lot of conflicting studies out there. The treatment protocols tend to be inadequate and some doctors are unwilling to improve upon.

Usually daily injections are needed for those running into problems as it relates to low SHBG, because TRT will suppress SHBG with larger infrequent injections unless low SHBG is the result of diabetes.

In my case TRT increases SHBG more than doubling it do to having diabetes.

The fertility question comes up a lot and the answers are always a little unsatisfying. Either you’ll have troubles or you won’t. You’ll find out ex post facto. As such you can do things like use HCG while on (highly recommend) and if you run into issues down the road there are options available, most of which work most of the time. There are no guarantees, though.