Free T Normal and Total T Low?

What is the significance of the Free Test being normal and Total being low?

Thanks to KSman and the other folks for the good info.

Here is my latest bloodwork from Quest Diagnostics:

FSH 3.5 (1.-8.0 mIU/mL)
LH 7.6 (1.5-9.3 mIU/mL)
PROLACTIN 7.5 (2.0-10.0 ng/mL)
fax blurry 1.44 (0.40-4.5 mIU/L)
Test, Total 181 (250-1100 ng/dL)
Test, Free 2.64% (1.5-2.2%) (ratio)
Test, Free 47.8 (35.0-155.0 pg/mL)

Just got an MRI to rule out pituitary issues and semen sample for god knows what. Get results next Tuesday and see my doc.

This is the 3rd out of 4 blood tests where T came back low in the last few years. Note that the Free Test ratio is high which would happen if total is low (free/total the bigger the denominator the bigger the ratio)

I am also experiencing low labido, erection problems, depression and low energy.

What is the significance of the Free Test being normal and Total being low?

Your FT is not FT but is FT% of TT. So while your %FT is high, it is a % of TT which is very low. Your TF absolute probably sucks too.

What the heck is “fax blurry” - malfunctioning office equipment?

You have the classic symptoms of low testosterone and you need T+AI+hCG.

You have testicular insufficiency. Your T is low and your pituitary is putting out higher amounts of LH to compensate. Some will have LH go over the range. Typically one looks for pituitary problems when LH is low. I am not totally familiar with LH levels and diagnosis, just a warning.

You should have been on TRT earlier. TRT does not interfere with the ability to scope your head.

You also need to be tested for serum E2. It can be high if you are fat or low if you are lean. But it does not take much to dominate the effects of what FT you have. My expectations are that the use of an aromatase drug is universally needed when on TRT.

If your thyroid levels are low, you are definitely not a candidate for transdermal gels, patches or creams.

Not testing E2 and not testing FT absolute makes me wonder about your doctor(s).

If you have any prostate/urine flow problems, that can be caused by elevated E2 levels - relative the FT levels. The eky word is estrogen dominance or unopposed estrogen.

Prolactin is high. The MRI will show or rule out a pituitary tumor as a cause. If you had an orgasm near term before your lab work, higher prolactin readings would be expected - and misleading. Ditto for PSA. Never do blood draws for PSA after a doctor gives you the finger [DRE].

You need a PSA test before TRT to rule out obvious prostate cancer - along with the DRE.

Avoid drugs to reduce hair loss or prostate size if you can.

Universal recommendation.

  1. Self inject 100mg test cypionate or ethane per week. Many doctors are puppies of the transdermal drug sales reps.

  2. 1mg/wk Arimidex as a start, until E2 labs provide a basis for change. You want E2 in the lower 20’s in a scale of [0-53pg/ml]. Most docs will not understand this.

  3. To keep your testes from waisting away, inject 250iu hCG SC EOD. Most docs will not understand this.

  4. If you can get compounded 5% testosterone cream, apply to you member ED. Tell your doc that you want to apply to your scrotum. This will improve sensitivity where some feel otherwise numb. This will also improve DHT levels… an important hormone. It is ok for women to run T on there clits for HRT, but for some reason, it is not seen the same way for men. Apply .25ml ED.

MRI came back normal. Which is to be expected considering my FSH and LH weren’t low.

Yeah, fax blurry meant I couldn’t read what that item.

I did list my free testosterone at the bottom.

Here it is again.

Test, Free 47.8 (35.0-155.0 pg/mL)

This still at the low end of the normal range. Still curious if there is any signifance of Free T being normal but Total T being low.

Here is the ratio:

Test, Free 2.64% (1.5-2.2%) (ratio)

Seeing the Uro at 1pm today.

Have most guys had better success with with Urologists or Endocrinologists?

So here is my plan for feeling the doctor out on his knowledge and willingness to work

One ask him how many patients he has treated for low T.

What were their ages?

What kind of treatment did they receive?

What kind of responses did they have to the treatment?

How soon does he usually do follow up labs after starting treatment?

Does he check E2? (does he understand that E2 will go up and has he ever prescribed an AI like Adex)

What about testicle shrinkage and fertility during TRT? Have you ever presrbied HCG to restore normal testicular functioning and appearance?

Does KSMan or HappyDog have a guide for screening your doctor?

Thanks again for the help guys!!!

So just got back from the Uro.

Here is what happened:

Doctor to have treated 100s of patients for low T. Got defenesive when I asked him this.

Dr says he only does shots for the older guys and every two weeks. No self administer offered. Must come in office.

Dr says he doesn’t monitor E2 unless I have symptoms. I.E. Gyno.

Said that just becuase you have more T does not mean more E2. Example he sighted was that he has more T than me and not necessarily more E.

Do you guys have any sources other than empirical evidence to support aromotase is more common during TRT? It’s not that I don’t believe it. It’s just hard to argue based on empirical evidence you got from a forum on the internet.

He does not do anything for testicles while on TRT (no hCg) and says it probably won’t effect fertility.

He rescribed 1 tube of 1% testim a day. Gave me a sample and some activation coupon to get 30 days free. (implies drug rep has a referal program).

Has anyone ever had success on the gel without an AI or HCG?

Wondering if I should start looking for another doc. Maybe an Endo that I should screen on the phone. Do you guys have guidelines for screening docs over the phone? Usually do not to actually get to talk to the doc on the phone when making a first appt.

We see endos and uros that are dumb and bull headed. You need to go shopping. Many GPs se,f study and know what to do… but they are hard to locate and many are word of mouth only, avoiding advertising and harassment from State boards of medicine and from insurance companies.