T Nation

Help with Blood Labs and What to Do Next

Hello all… I got my yearly blood labs back today and am looking for some input…

From what I’ve been reading online, it looks like i’m secondary?

FSH is 1.46
LH is 3.54
Total T is 269 ng/dl
Free T is 57 pg/ml
SHBG is 23
D3 is 27
Free T4 1.01 ng/dl
TSH 1.96 uIU/ml
PSA .8 ng/ml
Hematocrite 46%
Free T3 4.13 pg/dl
E2 is 26

My cholesterol was good (HDL in the 50s and total under 170) and my glucose was 80, so also good

I am 39 (40 in November), 6’5" 265lbs (muscular but definitely overweight), have a desk job but have light exercise in the evenings.
The highest my total T has been since i started testing, was 527 ng/dl (but that was at 2pm…didnt know to test early, back in 2012) and my highest free T was 93 (also at 2pm, in 2012)… i was way more active back then, lifted regularly and only weighed around 230lbs (if that makes any difference) but my diet and sleep were not that great.

My doctor has prescribed 100mg per week of testosterone cypionate, self injected at home (any frequency and IM or SubQ etc is up to me) and then re-access after 8 weeks.

I do have panic disorder that i’ve been able to manage pretty well for the past decade… the main reason i havent started shots is due to worries that it could cause that to become worse… yet i also wonder if it could make it better?

With all of that said, knowing that (had i tested at 8am instead of 2pm…and had a better sleep and diet habit) my total t was likely in the upper 500s or 600s back in 2012… should i start TRT, or does anyone here think that if i drop back down to around 210-220 lbs and bring my Vitamin D up…get back to lifting and exercising and following a good diet… could i get myself back to the 5-600 range? Or would i be wasting my time and should just start TRT?
Anyone with panic attacks/panic disorder go on TRT and have good or bad results from it?

Thanks again for all of the tips/advice etc… feel free to ask any questions, also!

It’s always a good idea to get fit so it wouldn’t be a waste of time. It is possible if you get your diet in order, reduce stress, proper sleep and exercise and you could increase your levels. No guarantees but possible.

Being that you are almost 40 I wouldn’t expect to get back to levels you were at 8 years ago. Everyone is different. Some feel fine in the 400’s.

From what I have read, this would have no effect. It was a nice idea, but in real life it doesn’t matter for your T level. It is obviously your call, and it is never a bad idea to try everything else before committing to something likely to be permanent. That said, I seriously doubt it would make much difference and that is by no means heavy for 6’-5. Low T will definitely be causing loss of muscle mass which has a downstream effect of making fat gain easier and fat loss harder among other things. I would start at once a week injections and IM, personally, to start out. And I’d tell you to not stress about it, but I have a feeling there’s no way around it for you - you will stress out initially.

getting in shape is definitely not a waste of time, nor is exercise or good diet etc… i plan to do those things anyhow… i just meant would i be spinning my wheels trying to boost my #s back up naturally?
I’ve been “low” for so many years now, that it has become “normal” to me, even though i know it is not “normal”, if that makes sense?

over fat, if not overweight lol it puts my BMI at around 32-33… medical studies show that T drops when BMI is over 25, for most all men… and i do appreciate the reply… in my mind i think i could raise my #s way up naturally, but also know that it could take me 2 years to get there naturally or 2 months with TRT…and that is no small difference.
Yeah, i may or may not stress over it… the thought of an injection doesnt bother me, my girl is diabetic and takes 4-5 shots per day… it is just the “not knowing” how i will react to it… i know SOME guys have anxiety after 4-6 weeks and some dont… i just hate thinking that if it didnt work for me/i didnt like how i felt, i’d be shut down by the time i knew for sure. (slight OCD in that i overthink everything, good or bad lol)

Only shutdown while you are on it. MOST people with low T feel A LOT better on TRT.

Your main concern is getting the correct dose. 100mg may be fine, but probably is low. The blood work at 6-8 weeks tells you where you’re at with the dose. It really is way smaller of a deal than people make it out as in their head ahead of time.

I’ve read anxiety issues get better for quite a few people… some are able to stop or at least very much reduce their anti anxiety meds and feel better because of it.

100mg is probably too low. A lot of people on a dose like that will feel better for a few weeks then get worse. The first few weeks you still have your natural production (however little that is) + the extra you’re injecting, so 100mg might be enough for a little bit to get you to decent levels, but fairly quickly your natural production will stop and you’ll be left with only what you’re taking, meaning levels then decline. So, just keep an eye out for that.

If it were up to me I would start people at 150 or 180mg/week, 3 injections per week. You’re a big guy so I’d lean even more towards the high end of that but if you have a doc that is willing to work with you on it then I’d play the game and let him move you up to what you need.

my cousin is also a fairly large guy and started his TRT 10 weeks ago, now (same doctor). He was taking a subQ shot every 3rd day for a weekly total of 63mg per week (he wanted his #s to be low so that he would be prescribed a higher dose)… after 6 weeks, that 63mg per week had him right at about 500 total T… so he has since bumped it up to EOD subQ shots and raised the dose to 80mg per week, to see where that puts him. He had done TRT in the past and come off… he was doing 100mg per week in a once per week IM injection and his #s on 63mg per week subQ (shots every 3rd day) were actually higher… so i do think that more frequent shots make a difference, it seems

Honestly you will most likely be spinning your wheels. Odds are your levels will not go up much or at all. If you are crazy about working out and have a large calorie deficit things could actually get worse. On the other hand you could try for 6 months and see. All you have to lose is 6 months time. That’s not a lot of time. TRT will be for the rest of your life. On the other hand if you are depressed and feel absolutely miserable 6 months could feel like an eternity. FWIW not everyone starts TRT and feels better immediately.

More frequent shots will definitely make a difference in trough levels. I stared at 120mg at 1 shot per week. My trough was 410. I upped it to 140mg and went to EOD. My labs at that level were 1200. In 13 months I’ve tried everything from 120mg to 180mg and still don’t feel optimal. I feel better than when my levels were 250 but still not ‘optimal’. I am going to reduce my dose to 30mg EOD, 105mg per week and see how I feel after 8-12 weeks.

Having a higher trough level and flatter level is not for everyone. I prefer once a week shots.

What are your trough levels? I’d love to take one shot a week but I found when I injected larger amounts my skins felt extremely oily. I always felt like I was sweating. Even my hands were super oily to the point where I didn’t want to shake anyones hand.

my SHBG is pretty low considering my blood glucose is low normal and i havent injected test yet…so that coupled with my panic issues, i figured every day or every other day would be my best bet… my girl is diabetic and has to do 4-5 shots a day, so if she can do that, i can do one without problem

Mid 800’s at 185mg a week. Not the top of the range for my doc’s lab. I’d have to look it up, but I think that the range is to 1000.

Those are not necessarily connected. TRT can actually increase SHBG in some guys because they need the T to be healthy, and the improved health raises the SHBG out of the basement for them.

I’ve never been sure which was better, high or low SHBG

Higher SHBG (near top of range) is considered a marker for longevity and good health, based on the studies. Low SHBG is usually an indicator of health issues, or really high androgen levels.

Well mine is low…but so is my testosterone…but I’m otherwise healthy and my blood labs are all really good, minus the hormones part

I’m a vampire apparently

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