T Nation

Is TRT Right for Me? Need Advice

My story starts in 2017 I’m 26 and I’m going through some stressful shit, I am about 5’10 180lbs and I was working out 5 days a week body fat about 12 percent, my now ex wife takes off with my 1 year old, ruins my life I get depressed I start loosing muscle and my workouts suck I’m tired no sex drive, life is bad I go in to the doctor to get my total and free test and all other labs
Total 625 (250-900) range
free 4.1 (4.3-30.4) range
Estradiol 17 (14-53) range
Sbgh 34.4 (11-80)

I had her retest a month later and the results were about the same
Total 595
Free 4.2
Estradiol 19

Doctor told me I was fine and to try to de-stress my life which I have done my best to do, but the symptoms never got better and some got worse, no energy, no sex drive, working out became harder and harder, Shitty mood swings plus now I had anxiety and insomnia to top it all off
2 years later I go get my test done again December of 2019 I am now 29 feeling 70 this time the guy is a specialist he take my blood and the tests show
We did the blood test twice a month apart the results were
Total 450.5 (180-900)
Free 7.62 (3.3-26.8)
Estradiol 18.3 (14-53)
Sbgh 45.99 (10-80)
Fsh 2.51 (1-14)
Lh 6.37 (1.4-7.70)
Igf-1 215.3 (90-271)

My doctor is concerned with my symptoms and says my level are in range but def lower than he would like to see from a 29 year old athletic male he also seems very concerned with the 150 point drop in 2 years what do you all think??

Low Free Testosterone is never acceptable. TRT will only work if you have normal thyroid and cortisol levels. I recommend testing:
-Free T3
-Free T4
-Reverse T3
-24 Hour Saliva Cortisol test (Blood is meaningless as cortisol is bound in blood. Saliva measures free cortisol and is very accurate)

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Had my free t3 and t4 tested
T4 1.46 (0.71-1.7)
T3 2.33 (.270-4.20)
I was told that all seems ok

These results make no sense, SHBG would have to be elevated to get these results.

This is more like it, these results indicate TRT might be needed. Your SHBG is the problem and is binding up most of your Free T, your pituitary gland is responding correctly, but isn’t enough to overcome the elevated SHBG.

Certain medications (antidepressants, anxiety meds), diets and starvation can increase SHBG. If these explanations can’t explain the high SHBG, then I’m afraid there may not be much you can do about it other than starting TRT.

I will say this, your SHBG is super sticky binding up a lot of hormones, normally to see these T/FT ratios, I see SHBG much higher in other men and that’s because the stickiness of SHBG varies from person to person. I once saw a guy with SHBG at 78 and his Free T was good and he had about the same Total T.

The Total T is junk, you want to focus on Free T which is the hormone interacting with your tissues.

These levels are no good and are below range and therefore abnomal, TRT will not work with these thyroid levels. It would be akin to injecting water. So if thyroid treatment is started, the SHBG will increase worsening your T situation.

You more than likely will need TRT and thyroid treatment.

Do you have TSH or Reverse T3?

Optimal VS Normal Thyroid Levels for all Lab Tests & Ages

Can you explain why the thyroid levels are no good if they are in the middle of the healthy range? I am currently taking no medications at all

Free T3 is the active thyroid hormone and is below range, Free T4 isn’t the active hormone. Your T3 receptors interact with Free T3, there are no T4 receptors in the body.

Free T3 is where the rubber meets the road. I can’t believe your doctor thinks everything is normal, he’s ordering these tests and doesn’t even know how to interpret them.

I’m some random guy on the internet with no medical degree, your doctor should be able interpret these labs. If I see good Free T4 and low Free T3, I want to look at Reverse T3. The thyroid converts T4->Free T4,->Free T3 and Reverse T3 when you are sick or the body is under stress.

Healthy people have TSH 1.0-2.5, Free T3 50-80% of the ranges, Free T4 midrange and Reverse T3 <15 ng/dL.

This is telling me your doctor doesn’t understand anything about hormones, I had stopped TRT in April and my endo had been monitoring my natural testosterone levels, three times we checked my testosterone levels and everytime levels were different (119->146->91). This is because levels are different every day, higher one day, lower the next and is a normal natural daily fluctuation.

I remember feeling better on some days and not on others. You get better sleep one night, testosterone is higher the next day, so if you check levels everyday your going to get a different result. You doctor doesn’t even understand anything about what he’s doing and is operating in the dark.

My advice is fire him and find another doctor asap!

What if someone has good FT4 and FT3? Would the elevated RT3 and TSH be irrelevant?

As one gets older their body become less efficient and it’s not uncommon to see older people with high TSH (6.0-8.0). The older people don’t get around quite the same as younger people, they have disease and high Reverse T3 sometimes as a result of disease.

You can see the optimal ranges of health people without disease or thyroid problems, this is what we should compare.

I think you misread their t3 number 2.33 is mid range low end is 0.270 according to their posted range.

My bad I didn’t see the ., therefore his thyroid is probably fine, however testosterone is not ok and his doctor isn’t going to be any help managing this guy on TRT. At this age Free T should be at the top of the ranges, Free T is terrible.

Agreed that free t is very low. That range given with a low of 3.3 is ridiculous.

My TSH was 1.53 range( 0.30- 4.20

So now that that my t3 is good what do you think

So do you think trt will give me what I need to have energy,sex drive and feel normal again?

You want Free T3 midrange or higher, TRT should work for you. Sorry for the confusion but my glasses are not bifocal and things up close are not as defined.

No it was my fault I should have put 0.270 lesson learned,

I think it’s a worth a shot, if you can find a good doc,