Have I Done Enough Testing to Start TRT?

Visited my endocrinologist and he has told me he has done everything to test me to find the problem with my low testosterone but was not able to find the problem. I asked for a testicle scan and he said it was not needed, mentioned an MRI and also said it was not necessary but I want to figure out the problem. Has these tests been extensive enough to start treatment with no further testing?

Blood work:
Thyroid Function
Free T3 4.6 pmol/L 2.6-6.0
Free T4 12.7 pmol/L 9.0-19.0
TSH 2.53 mIU/L 0.40-3.50

SHBG 18 nmol/L 15-50
Testosterone 7.4 nmol/L 11.5-32.0 L
Free Androgen Index 41.1 % 15-100
Calculated Free Testosterone 187 pmol/L 260-740 L

Prolactin (Total) 303 mIU/L 85-500

Albumin 44 g/L 37-50
Total Protein 76 g/L 65-85
Alpha 1 Globulin 3.0 g/L 1.0-3.0
Alpha 2 Globulin 7.9 g/L 4.0-10.0
Beta Globulin 7.9 g/L 5.0-11.0
Gamma Globulin 13.0 g/L 7.0-16.0
Total Globulin 32 g/L 22-38

Metals, Blood
Serum Copper 15 umol/L 12-22

Iron Studies
Iron 11.7 umol/L 5.0-30.0
TIBC (Calculated) 56 umol/L 46-70
Saturation 21 % 10-45
Transferrin 2.5 g/L 2.0-3.2
Ferritin 59 ug/L 30-300

FSH 5.9 IU/L 1.0-12
LH 2.4 IU/L. 0.6-12

Growth Hormone(s)
Growth Hormone 1.3 mIU/L 0-15

Caeruloplasmin 0.25 g/L 0.15-0.33

Cortisol am 483 nmol/L 138-650

Albumin 45 g/L 39-50
Total Protein 76 g/L 65-85

ACTH 3.8 pmol/L Ref range <12.1

ACE(s) (Even though it was high, he did a chest X Ray and it was cleared)
S-ACE 81 U/L Ref range 8-70

IGF-1 (Liaison) 57 nmol/L Ref range 22-73

HbA1c 5.4 % 4.0-5.6
HbA1c (IFCC) 36 mmol/mol 20-38

Semen analysis
Came back with results showing I am very fertile

I think so. Unfortunately, maybe fortunately, usually a cause can not be determined. If one is found, it often is not good news.

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The cause it’s usually primary or secondary hypogonadism. Meaning it’s the testicles or the pituitary. Treatment same for both - TRT

What’s that s-ace lab?

Your results look like you don’t have any underlying disease.

Maybe it happened when you hit your head? Who knows. Maybe your balls are not producing enough. Treatment TRT.

How old are you?

Sometimes it’s just idiopathic

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SHBG 18 nmol/L 15-50
Testosterone 7.4 nmol/L 11.5-32.0 L
Free Androgen Index 41.1 % 15-100
Calculated Free Testosterone 187 pmol/L 260-740 L”

Depends on where you are in the world. But to answer your question you stated on the post, in the US, these numbers would be enough to start you on TRT and be covered by insurance in most cases. On top of that, if your Endo doctor agrees, you will have provider approval as well. Depending on blood work, clinics sometimes require you to have to see an Endo or your primary care provider to start at their clinic.

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I did have a head injury at about 11-12 years old. Smacked my head on the corner of a table, paramedics came in and said i needed no stitches though they were wrong and i woke up with a lot of blood on my bed. Rushed to the hospital and got my stitches. I was not concussed during the injury though. I think its best to get a brain scan now that i think about it. I am 20 years old.

So get the brain/pituitary MRI then. So you don’t have to worry