Help with Labs - Pre TRT

48 yrs old. 6’3” 230 lbs. Lift 4 days per week and eat healthy most of the time.

Edit - Symptoms - Low energy, slow recovery, bad sleep, sore joints and diminished libido. No ED issues.

E2 not tested.


You have high SHBG and low Free Testosterone. This means your body has a hard time freeing up testosterone and thus needs more than most. Looking at Total T does not matter, I’d focus on fixing FT since this is the testosterone that is used by your body.

Also I’d work on fixing the Cholesterol.

Based on your results, age, and already active lifestyle, TRT seems like the clear solution assuming you have the usual symptoms.

Thanks. I’m meeting with my doctor a week from Tuesday. Not sure how that will go since the lab seems to think since total T is in range that I’m fine.

Yeah most regular docs will just see that total and say you’re fine. You may have to consider a private doc unless you win the doctor lottery and get one willing to look at free T being that low.

Yep. He’s going to need a private doctor or a TRT clinic like Defy.

Thanks guys. I’ll follow up after I talk to the doc.

I just had the exact same issue.
Normal total T, high SHBG, low free T.

Doc would not prescribed anything. I am currently reaching out to defy for a second opinion on my results.

Good luck and post what you find out.

You will need a “private doctor” to treat you for one simple reason, healthcare providers must maintain TT levels <800, once I scored an 829 and my TRT prescription was in jeopardy and canceled and I had 90 days to show a decrease or I would have been forced off TRT.

Guys with high SHBG and high TT are going to need quite a bit more TT to achieve healthy FT levels, you’ll more than likely need TT levels 800>. If you seek TRT from a sick care doctor, it’s more than likely you will be kept suboptimal and will still be symptomatic.

Technically FT levels are in range, but this in no way means FT is in the healthy ranges, there’s an optimal range for every biomarker and it’s never good to be at the bottom of the range on anything…

Thanks for the input

Thanks. Will do.

Update: Met with the doctor today. He said with my level around 600 he would not recommend going on T at this time. He prescribed Clomiphene daily and wants to see if that will stimulate the numbers higher.

He wants me to retest in six weeks.

Labs in first post.

Does he understand what low free T means? Clomid will increase SHBG typically and not do a lot of good where you need it. But I’m assuming you probably know that already.

Yeah, thinking I may try a clinic either locally or online for a second opinion.

Thanks for the reply.

Of course. Triple your free testosterone and you’ll feel better. You can see what the Clomid does, but ultimately it’s not a long term solution anyway. See if you can get E2 checked.

I asked about E2 testing and he said unless I was experiencing symptoms, like gyno, then he didn’t think it was necessary.

I guess the real question is in the short term if it’s worth trying the Clomid or if I should just pursue a different doctor?

That’s unfortunate. Now, if you do have possible high E2 symptoms, you will not have a reference point to work from. It’s kind of like getting a baseline PSA prior to starting TRT. You didn’t have prostate symptoms, did you? Maybe not a pure analogy and it is what it is anyway.

That’s a good question. Will he insist you stay on Clomid indefinitely, or be open to switching you over to testosterone once it has been proven increasing test helps you? Or, will he move you to testosterone if you don’t do well with Clomid?

No prostate symptoms. I did have a DRE and everything was normal.

Unsure of your second question. In talking to him about it I get the feeling he treats the number more than the patient. He mentioned the Clomid possibly raising my total in the 900-1100 range and solving the problem.

I think, if anything it would be a short term solution. Curious if a clinic, online or otherwise, would require new labs or use the numbers I just got.

Stay away from clomid. Its not a long term solution and you don’t want to be on it indefinitely. You should focus on losing some weight and getting healthier overall. Investigate some natural ways to lower SHBG. Your LH and FSH numbers are on the lower end and you are producing good amounts of T. This is a good sign that your Testicles are high functioning. And you arent experiencing any ED at the moment. All good things. What is your bodyfat percentage?

I think overall I’m in good health. My bodyfat is in the low 20s. I workout regularly and eat overall pretty healthy. I’ve lost about 40 lbs. in the past year.

That’s my point. Following his logic, no E2 symptoms, no E2 test. Yet no prostate symptoms, but a PSA test?

Does that mean he thinks you can stop Clomid, and you’re fixed. Or, just stay on it? Either way, those will not work for you.

They may want some additional tests, but if those are recent, there is no reason to repeat them.