Interesting Dr Visit

I would not jump on trt. If you lower your shbg down a bit your free will increase. Your testes appear to be producing a very good amount of t. Why shut them down again at this point?

Check thyroid panel. Medication and supps can increase shbg and maybe overtraining.

His TT isn’t the problem, his free T isn’t optimal so his results in the gym will be hampered and he has symptoms we can’t ignore. SHBG is causing problems.

[UPDATE]
After doing some research on this forum and other places, I went back to the Dr for a discussion. I told him the wife said absolutely no gels (the truth). He then prescribed by test cyp. However only at 50mg/week with 250iu of HCG. From my limited knowledge, that sounds like a recipe for disaster.

I was down in the US doing some shopping with the wife and I decided to get some bloodwork done using discounted labs while I was down there to compare the results to my labs in Canada before starting to take anything. When comparing, I noticed after conversion the results were quite close. However, the ranges were quite different.

Please find updated labs attached from LabCorp. Any commentary would be greatly appreciated.



This doctor is scared stupid of TRT, fear will always guide him. This doctor has no training on how to properly administer TRT. You’ll end up lower than you are now. Say goodbye to this doctor. You require large doses of testosterone do to high SHBG, 140mg weekly split up one or two times a week is a good starting point. It’s the only way to get SHBG down far enough to free up some of that free T.

You need possibly 3 times the testosterone doctor is prescribing, this doctor has no business prescribing testosterone.

HCG 250iu a week?! That won’t work, you need a minimum of 250iu 2-3 times a week, possibly 250iu EOD for some.

Canada, UK socialized medicine needs to go the way of the dodo bird or evolution of medicine will never happen.

Thanks for the reply. I figured as much. This doc was at a men’s clinic that is supposed to specialize in TRT.

Maybe I will try my GP again and try and get a referral to an endo. He wouldn’t based on my original Canadian bloods as they were “in range”. Will try again with the US tests. However, I’m not expecting much from either my GP or an endo up here.

Specialization does not always come with expertise.

Thyroid:
TSH looks good, fT3 seems perfect.
Now check oral body temperatures, see below, to see if the rest of your thyroid function is good. I assume that you have been using iodized salt.

SHBG is high. SHBG is made in the liver to scavenge sex hormones. AST/ALT do not indicate liver issue that could increase SHBG. E2 is not elevated or an obvious cause. This creates a lot of non-bioavailable SHBG+T that inflates TT so TT overstates your T status. That reduces FT and FT or bio-T is the the lab to be looked at. Your doc was misled by this. You do need TRT.

LH/FSH suggest mixed primary/secondary hypogonadism. You should test prolactin as a prolactin secreting pituitary adinoma could be depressing LH/FSH which might otherwise be high as seen in primary, masking that condition and itself.

At 29YO you really need to watch out for your fertility.

Gels are not good for athletes who will sweat and shower the T from their skin.


Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

Thanks for your reply.

I have been monitoring my body temps for a week or so after reading all the stickies. Morning temps were taken around 7:00AM and afternoons at around 2:00PM

AM - 97.8
PM - 98.6

AM - 97.8
PM - 98.8

AM - 97.6
PM - 98.7

AM - 97.9
PM - 98.9

Yes, I use iodized salts to taste on everything I make. After hearing a podcast a few years ago which commented on how big of a problem iodine deficiency is, I made sure to only buy iodized salt. I also started adding a few drops of Lugols to my morning green smoothies back then for a while. I will still occasionally add a drop if I know I haven’t had much iodized salt for a few days.

As for testing prolactin, I will see if I convince my wife of another shopping trip down to the US in the upcoming weeks and visit LabCorp again (shouldn’t be too hard).

My biggest concern with starting TRT is fertility. We are planning on trying for our first kid next year and plan on having at least one more after that if all goes well. If I am able to find a doc, I think I will get a full sperm analysis done prior and freeze some if I have swimmers to be sure. My other thought would be to continue to tough it out and hold off TRT for a couple years until after kids.

Was trying to think back as to what could be the root cause of high SHBG and low free T. I did run a few courses of Accutane as a young kid. I think this was when I was in Grade 7 so around 13 years old I believe. Did wonders for my acne but I have dealt with very dry eyes, lips and nosebleeds ever since.

Could there be a connection? Albeit, just guessing here and can’t know for sure.

No because there are many others who didn’t take Accutane who come in here daliy that show elevated SHBG who are also young. People who took Accutane had similar experiences to those who took Finasteride, permanent sexual dysfunction.

A lack of FT is your problem, experienced doctors don’t trust directly measured FT, but TT + SHBG which is calculated since we know 2-3 percent is normal. Your below 2 percent, so trying to educate the doctors on how to do their job, well good luck with that.

Went to my GP today with my US blood tests. The previous doc I was dealing with was at a men’s clinic. He seemed on board that low free t could be causing my symptoms, which surprised me. He told me of 3 alternatives for now. 1) Gels, which he advised against (this got my hopes up). 2) test-u capsules (never heard of this). 3) injections in his office once a month (damn, so close).

He then said he wants me to try the capsules at 80mg per day for 3 weeks and if it helps out with my symptoms, we can move forward with TRT and explore all options. When I mentioned self injecting once or twice a week, he did seem receptive. I am thinking of trying the capsules for the 3 weeks and going back and saying it is helping and then try and move to an injection protocol. Or who knows maybe the capsules will help but I find it weird that I have never seen them discussed.

Oral testosterone isn’t safe for the liver, it doesn’t sound like this doctor has any experience in male hormones. Gels make tons of profit for him, test-u capsules sounds patented and injection once a month doesn’t work. There’s a 12 year old study out there that shows why one injection every 2 weeks doesn’t work.

Stupid doctor isn’t paying attention to the half life of the medicine he’s injecting which is 5-8 days, less for low SHBG guys. So once a month injection means you’ll hit zero long before the month is over. TRT really brings out the dumbest people for everyone to see, they can no longer hide among the intelligent people.

When doctors had out prescription drugs they are always paying attention to half lives, but not so with TRT. Strange.

Yeah, seems to be the case!

The name of the capsule is Andriol. From what I have read, it is designed to bypass the liver but I have also read that it doesn’t seem to do much to increase testosterone levels as the bioavailability is only 7%. 80mg x 7% x 7 days = 39 mg of test u per week.

Have also read it is quite expensive.

Whenever a doctor is pushing for gels and the last option is injections, he’s all about wanting to make profit from it, your health is a distant second. He will probably make less money giving you injections since test is so cheap.

He probably doesn’t know the first thing about hormone management, you know what you need to do.

Yeah the in office injections is a red light too. Probably $350 for a .15c syringe and needle and $3 worth of test.

The jist of what I have gotten from the 2 doctors seen so far is that they agree that free testosterone is low. However, they see it as just out of range and think that you can supplement with a little bit of testosterone. They seem to think that taking testosterone adds to your existing and don’t factor in any shut down.

My search for a knowledgeable doctor continues! There appears to only be two anti-aging clinics around that offer TRT and have been to one of them so I guess I will try the other. This one has a steep price tag however of $600 per visit for the appointment alone.

They assume because its a bio identical hormone that it adds to what you already have, how dare they presume to assume without fact checking.

Hey @mm14

I’ve been monitoring and reading on this board and others for a while now. Was interested to come across your post lastnight and led me to make an account here. I have a very similar profile to yours and also live in Vancouver. I am 28 Y/O and as a result get very little interest from family physicians to address my symptoms. As stated here too many times, hormone imbalance seems to be very poorly understood by most.

Below are some of my basic test results. I’ve had a series of bloodwork done over the last 2 years since I’ve been dealing with this issue, leading me to conclude high SHBG (Have had it above 50 both times tested, 1 year apart). As a result, I likely have low free T. My calculated free T and Bioavailable T say otherwise, but hardly believe that’s accurate from what I am learning on these boards. I also am doubtful of this as your direct free T results came back below range. Considering we have similar T and SHBG levels, I would be willing to bet I’m low end of range or even below if I was to test using the direct method.

Total T: 24.1 (8.4 - 28.8 nmol/L)
SHBG: 53.1 (10.0 - 70.0 nmol/L)
T Bioavailable Calculated: 9.2 (2.7 - 13.5 nmol/L)
T Free Calculated: 391 (115 - 577 pmol/L)
LH: 3.1 (1.1 - 8.8 IU/L)
FSH: 1.4 (IU/L)
Estradiol: 67 (<157 pmol/L)

I have a few questions, what is your most prominent symptom? Mine is definitely the sexual dysfunction. Very low libido, essentially non existent with ED issues and low sensitivity. Moderate mood/depression/anxiety issues, but not sure at this point if the depression related sides have developed as I am constantly thinking about this and how to move forward.

Secondly, how did you manage to get the Labcorp tests? I would also like to get a few tests done that aren’t offered up here. Direct Free T and Sensitive E being two of them. I see you mentioned Discount Labs. Did you run into any road blocks ordering through them, and then presenting to Labcorp during day of blood draw since you weren’t a U.S. Resident?

Lastly, any luck with the trt clinic? I tried to contact one a few weeks back but was told i was too young and to see a family doc lol. Keep going around in circles. Endo’s won’t touch my case as my Total T is normal. Haven’t even gotten the chance to get infront of one as they decline my family doctor’s referral. Seems like you’ve had a bit more luck with your family physician at least prescribing some form of T even if it was low dose. I saw a Urologist yesterday with the same story, he told me to see an Endo haha!

Would appreciate an update on your case. I have started some preliminary discussions with Defy Clinic at this point to see if they work with Out of Country Patients. This was going to be my last resort, and looks like I am at that road now.

Sorry for the long post, thought we might be able to help each other out since our cases are very similar.

Hey man, I understand your struggle of trying to find good help in our area.

Unfortunately, I can’t comment on your numbers as I lack the knowledge to do so but if you set up your own thread, members smarter than myself will comment. All I can say is that your free t % is 1.62% when it should be 2-3%. Similar to myself, as all your labs are mid range, you will have troubles finding a dr who will believe you are low t. However, once armed with LabCorp numbers that came back as low (out of range) free t, my luck changed a bit. Lifelabs reference ranges per their website are from age 13-100 so a huge range when LabCorp breaks it down by age ranges so that could be where the big difference is.

  1. My main symptom is brain fog. It gets so bad in the afternoon, I find it very hard to get any work done. The second is my lost competitive drive/motivation/fatigue. I played high level hockey and lacrosse growing up and loved the competitiveness. Now, I have no interest and have lost all competitiveness. Other than that, I get bad anxiety now in crowds and completely shut down when I used to thrive in those scenarios. My libido is pretty much non-existent. However, no ED issues. When we have sex, my wife always has to initiate as I just have no interest but once we get things going, I don’t have ED issues.

  2. I just ordered the tests on discounted labs, printed the req and took it to the LabCorp in Bellingham. No issues at all. They see Canadians there all the time given their location. A lot of people on AAS do the same to manager bloodwork as it is so hard to get in BC.

  3. I got into one clinic which is where my post started. Given your numbers are better than mine, you likely won’t have any luck with treatment there and the Dr. lacks a lot of knowlegde. My GP was on board as we have been working on these symptoms for over 2 years (wouldn’t test testosterone before as he said I was too young) and I can back armed with the LabCorp test showing low free t. However, he has no idea what he is doing as he only prescribes Andriol or once per month in-office shots. I have an appointment next week at an anti-aging clinic so we will see how that goes. So still no luck for me.

I also have spoken with Defy. You can do consult only appointments. Or if you have a mailing address in the US, they can send your scripts to it as long as it is not a PO Box as long as you get all your blood tests done in the US. However, it is up to you to cross your scripts back into Canada. It is illegal for Canadians to import prescription drugs into Canada but there is a caveat that they may use enforcement discretion to permit Canadians returning from abroad to bring on their person a 90 day supply. I have calls and emails into Health Canada to ask if this scenario would fall under this exception but no reply yet.

Really appreciate the informative reply man!

This is super odd. This hit me over a weekend of partying out of nowhere about 2 years back. Not sure if you’re experience was more of a slow onset. The sudden change is what has me more confused than anything. The fact that there was a hormonal shift hard enough to cause major changes in the body and leave me feeling this way.

I just ordered a series of labs from discount labs this morning as well. Will try to get down to Bellingham over the next short while to give my blood draw.

You raise a good point in saying that if you are armed with Labcorp Results indicating below range Free T, you will have a higher likelihood of getting a doctor’s attention. It’s almost comical as to how many different family doctor’s I’ve visited now. Even gave the whole Naturopath route a try but to no avail.

Next step is to get these Labcorp tests done. I think I will follow through with the Advice only consult with Defy as well to get their input. Have you only started discussions with them, or have you committed and followed through with a phone consultation with them already? Also is the anti-aging clinic you will be visiting the one with Dr. Frame?

Hoping your consult goes well!