T Nation

Had Bloodwork Done. Your Opinions of Me Starting TRT?

Hi there,

Been thinking optimizing my testosterone levels for few years now.
Three years ago my test levels were really low, both free and total just right above the lowest end of the spectrum.

Had blood test done again now, Total 20.3 (10-38) and free being 299 pmol/l (230-575). TSH 4.3 mU/l (0.4-4.5) and T4F 15.2 (11-21). Thyroid being very good in my opinion. Test still a bit low, but almost in the middle of the range.

Stress management is pretty ok, I have plenty of stress occasionally but I manage it ok though. Sleep is good, libido is not so great but erection problems never had. I mean I have sex pretty much everyday. Eat good,
very natural and use vitamins/supplements.

Still i’m kinda missing this sensation running with tank full of juice.
I would do enathate 1ml/e5d and aromatase inhibitor.
Age 34 now. What do you think, should I just pin it for the rest of my life starting now or wait until my natural test will fade away?

What does this mean, exactly? It sounds like you’re not having any noticeable symptoms.

Are you having it whether you feel like it or not? Or is daily nookie a downgrade from what you were used to?

That’s not a dose. Dosing involves milligrams. Also, it’s putting the cart before the horse to discuss, but this thread gets into why you may not need to start an aromatase inhibitor (AI) from day one.

Personally, I don’t think there’s a reason for you to begin 45+ years worth of medication because I’m not clear on what issues you hope to address.

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Thyroid is not alright, TSH >2.5 usually indicates a problem and you will not be able to metabolize testosterone in the liver with low thyroid hormones which you haven’t even tested yet. TSH closer to 1.0 is optimal. Free T3 is the most potent thyroid hormone, Free T3, (not TSH or Free T4) increases body temperatures and metabolism.

Reference ranges for TSH and thyroid hormones

First of all the distribution of TSH reference range is not normal, with median values (also depending on population iodine intake) usually between 1-1.5 mU/L. On the other hand, upper TSH reference limit is (assay-dependent) usually around 4.2-4.5 mU/L. There is also an argument that significant number of patients (up to 30%) with TSH above 3.0 mU/L have an occult autoimmune thyroid disease.

The evidence for a narrower thyrotropin reference range

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group. Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter.

You’ll get no argument from me, testosterone is low. SHBG should be considered before starting or chosing a TRT protocol. SHBG binds sex hormones and when on the lower end, more frequent injections may be necessary.

Your symptoms seem borderline low testosterone, not terrible like most men scoring these numbers. Having lower testosterone can make it to where minor stress turns into a big deal, TRT can make you calmer where the moderate stressful situations are no big deal.

SHBG is most likely in the mid 20’s, enanthate injections 60mg twice weekly, 25-30mg EOD or sustanon 65mg twice weekly is recommended. If having high estrogen sides inject smaller doses more frequently, this will lower estrogen. Stay away from AI’s if you can help it.

Please note, men with lower than normal testosterone have more aggressive prostate cancer and increased mortality (cardiovascular & heart diseases) with many diseases associated with low testosterone.

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

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction.

Yes im having it whether or not im feeling it, just to keep my girlfriend satisfied. What a job it is.

Right, Im hoping to address occasional depression/moodiness, fatigue, overall decreasing performance, I think. However, it’s very difficult to say if my testosterone is the reason for occasional moodiness and fatigue. I would say i’m interested into optimizing my test levels and feel better overall. Thank you for you thoughts, appreciated.

Obviously you’re correct. I was incorrectly thinking that higher TSH=good. Need to consult my doctor about my thyroid. Not interested starting any thyroid medication though.

Thank you for your thoughts, I do feel that I could do better with higher T.

Why are you not interested in starting thyroid? TRT more than likely will not help you if you are hypothyroid.

Sounds like you’re not interested in feel good, TRT will do little for you when there are thyroid problems because you won’t be able to metabolize testosterone, high levels will do nothing. High TSH usually always means there’s a problem even with good numbers.

We have other members here who refuse thyroid treatment in the presents of high TSH and are constantly struggling or feel nothing from TRT no matter what their testosterone levels.

Long story short, I have been tested by endocrinologist last year and according to the doc, I do not have problems with thyroid, no hypo nor hyper and don’t need medication. This last bloodwork is misleading I would say.

It’s difficult to find a good endocrinologist these days, most are operating on outdated knowledge and do not stay updated on the late news on treatment protocols. I’ve given you enough information to suggest your doctor is not paying attention and is probably practicing medicine the way it was taught to him many years ago, believing in range in normal only the ranges aren’t normal at all.

I can tell this is going to be a difficult road for you, blindly believing your endocrinologist is your first mistake. The managed healthcare system is rigged against you by insurance companies unwilling to pay out on your behalf, it is set up to deny treatment to save money on healthcare and save insurance companies money.

One could argue you problem is thyroid related and not testosterone related, low thyroid function has the same symptoms as low testosterone.

Google “Optimal VS Normal Thyroid Levels for all Lab Tests & Ages”.

This is becoming a self fulfilling prophecy, you endocrinologist hasn’t even tested the master thyroid hormone Free T3, Free T3 will show how much thyroid hormone is soaking into your cells and activating your T3 receptors.

It’s a common blunder for doctors to skip Free T3 testing and is a mistake to assume you are converting T4 ->Free T3 properly, some convert excess to Reverse T3 and have high Free T4 and low Free T3 and this could help explain high TSH.

High TSH is always an indication the pituitary gland isn’t happy with the amount of thyroid hormone in the body and in turn elevated TSH to correct the situation.