T Nation

Making Sense of Doctor's Advice

Hi

So, I’ve finally had all of my test results back and had the chance to speak to my doctor, a private Endocrinologist, to go over them. As I understand it, the pertinent results are:

Serum testosterone level 12.1 nmol/L
Serum sex hormone binding globulin level 31 nmol/L
Serum albumin level 42 g/L

As he explained it, my 12.1 nmol/L reading is low, but that only matters in the context of the other two results. Using those results, he calculated that my free testosterone level was 0.255 nmol/L (2.1% of total).

Based on this, he said I was fine and didn’t need to worry - testosterone wasn’t the reason behind my symptoms. I know there’s some skepticism of doctors on here; does that advice sound fair and correct?

Any advice appreciated. Thanks!

What’s a “Normal” Testosterone Level

Your doctor is wrong and just because he is private doesn’t mean he will be knowledgeable, this doctor is a quack. Your Total T is 345 and SHBG 42, this doesn’t bode well for Free T and this becomes about symptoms and optimal levels of Free T.

I can tell you a guy with Free T at the top of the ranges will have a higher quality of life, will have more energy and be able to build more muscle when compared to a man at the bottom of the ranges. The quality of life between these two individuals will be dramatic.

When I calculate your Total T, SHBG and albumin, I get 0.211 nmol/L = 1.74 %, your levels are at the bottom of the ranges and you are symptomatic. It’s very difficult to find good TRT docs these days, especially in the UK.

Go to Balance My Hormone in Dorset, enjoy a high quality of life.

Before I opened this thread, I made some assumptions. I saw one response. I assumed it was going to be systemlord, and I assumed he would be saying the doc is wrong. And BAM, spot on. This shit is really getting old man. Damn near every fucking post is about you bashing doctors. FUCK!

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I simply stated I think this doctor is wrong and is an unqualified person making this assessment that this guy’s levels are normal, if you agree that this guy’s testosterone is low at 348, then to that I say the problem is you are all worked up over something else in your life and go for a walk and calm down because you seem unhinged.

You’re having a real hard time over some guys opinion, sounds like you need a break.

Let’s not derail this guys thread.

I’d have a hard time thinking 340 TT and 42 SHBG could yield a very reasonable free T value either, despite the fairly predictable previous response by everyoneknowswho

What issues are you having, etc.?

Main things I’ve noticed are low mood / depression, complete loss of libido and an incredibly hard time with weight maintenance. I made a concerted effort to get down to around 10% bf last year and made it, but it was excruciating and i just balloon whenever I deviate from that regimen (e.g. I go on holiday / vacation).

Is it worth me contacting some private TRT clinics? Are they responsible / safe?

I don’t know how things work over in the UK, it can’t be much different over there, but here private doctors are still bound by the same ethics as any sick care doctors, but do enjoy more medical freedom, like choosing to prescribe TRT to someone with even average T numbers if the doc feels the patient will benefit where most of the time the NHS or sick cares docs would not.

Any doctor can prescribe TRT to anyone even with normal numbers if the doc thinks the patient will show a medical benefit. You actually qualify for a 6 month trial of TRT according to the UK guidelines with your numbers, maybe your doc doesn’t know or is unwilling to give you that opportunity.

You could at the very least inform him that you do qualify for a 6 month trial of TRT at 12 nmol/L.

Thanks - regards the 6 month trial you reference, do you have a link or anything which refers to this?

British Society for Sexual Medicine guidelines on adult testosterone deficiency, with statements for UK practice

Thresholds for testosterone therapy

Regarding the thresholds for treatment intervention in symptomatic men, British Society for Sexual Medicine (BSSM) and International Society for Sexual Medicine (ISSM) guidelines recommend the following:

  • TT level lower than 8 nmol/l or FT level lower than 180 pmol/l (<0.180 nmol/l; based on 2 separate levels from 8 to 11 AM) usually requires testosterone therapy.
  • TT level higher than 12 nmol/l or FT level higher than 225 pmol/l (>0.225 nmol/l) does not require testosterone therapy.

Your Free T is 0.211 nmol/L = 1.74 %, not 225> pmol/l.

  • levels from 8 to 12 nmol/l might require a trial of testosterone therapy for a minimum of 6 months based on symptoms.

provide ranges on what your numbers are. Also lifestyle diet, and stress play a part in libido, quality of life. How old are you? How much weight did you drop? What do you eat? Exercise? Resistance training? What were your T levels when you felt good? Current emotional state? A dr can’t look at your current levels and say they are in range and you are fine. Well, they can, but you may need to self pay and try drugs. If everything else is good, diet, exercise, lifestyle, stress, then I would try drugs.

I problem solve for a living you can’t rule out things without actually checking them first.

Nope. Your testosterone is low. Given your level, even with low SHBG you’d be low on free testosterone. Assuming there is no reasonable explanation for your symptoms and low total testosterone level, there is blood work to yet be obtained and life style/health issues to be considered, you’re certainly a candidate for TRT. Whatever you do, do not focus solely on lab numbers.

Using the correct value for SHBG (31 not 42) the calculated feeT is at 0.255 nmol/L = 2.11 %.

Anyways depending on your age give TRT shot and see what happens. Ideally get a second test done to confirm.

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Thanks for the advice guys. I’ve spoken to a couple of private clinics including those mentioned on this thread. I’m a little nervous but feel like I need to give it a shot.

If I were to try TRT for a few months and it either didn’t improve my symptoms or I suffered any unwanted side effects, is it relatively easy to come off?

Thanks!

A few months, it took me two years to find the appropriate dosage and injection frequency. If you’re going to give three months, consider it takes 12 months to show maximum benefit provide you’re on the right protocol.

You doctor might not even prescribe the appropriate protocol and actually be the reason why you quit which is very common. You need to be prepared to give TRT a couple of years of your life.

The side effect can be managed by protocol adjustments and having a good knowledgeable TRT doc is critical. I don’t know if coming off TRT will be easy, it was for me and with no drugs or PCT restart protocols.