Need Advice on Levels: 429 Total T, 6 Free T

My total test is 429 ng/dl (in range) but my free test (calculated) is 0.217 nmol/L or 6 ng/dl [1.45%]. I don’t know what the range should be but online it appears low.

Both albumin and SHBG are relatively high @ 50 g/L and 51 nmol, but in range.

Have all the symptoms (no libido, ed, no morning wood, terrible anxiety, bad sleep, sweats, depression for 1.5 years)

How do my levels look for a 29yo active male? What are my options?

Other results:
17-beta oestradol: 68 pmol/l [Low] (range 99.40-192.00)

Albumin 50 g/L (range 35.00-50.00)

Free T4: 5.59 pmol/L (12.00 -22.00)

Progestrone: 0.53 nmol/L (Did not include ref range but also did not say it was Low)

Prolactin: 253 mU/L (range 86.00-324.00)

What is your sleep like? What is your diet like? What is your stress like? Drug use? The US pres in his 70s has higher T than you so yeah its low. And low E2 to boot which will cause problems.

Sleep is average (get about 7 hours a night but always wake up at least once to use toilet)
Diet is average - good (sugar main issue). BMI is 25 which is deemed just about outside of normal.
Stress is high from the anxiety and depression
Drug use in the past but dont drink or take drugs for over 1.5 years now.

My doc has sent out for FSH & LH.

Yeah he wants to make sure you pituitary is functioning properly. Have you had a TSH reading lately? Do you supplement with vitamins/minerals?

I am 31, I have tested total T 3 times before treatment. Came back at 479, 379, and 390 ng/dl. I always try to make my tests reflect my normal life. I was typically getting insomnia 2-3 nights per week, so I think the 379 ng/dl was after an average or poor night of sleep, and the 479 ng/dl happened on a night of excellent sleep. My free T was measured twice at 14 and 10 ng/dl.

It is a good idea to test multiple times to get a good idea of where you likely fall.

Your free T is terrible. I had all the symptoms at my levels of free T listed above. My sleep has gotten better since TRT too.

What should I expect my FSH & LH to be with my current levels? (ie low or high)

Yes TSH was 2.35 mU/L (range 0.27-4.2)

Do not supplement yet (contemplating Vit D).

Thanks for the solid advice man!

Good to know man. I’ve had 3 tests so far (and just did a 4th today).

My first came back as 57 ng/dl (2 nmol!) – yes thats correct and hence why my doc started investigating. I do think that was a lab error though judging by next two.
Second came back as 458 ng/dl (15.9nmol)
and third came back with 429 ng/dl

Albumin/SHGB both stayed consistently high-normal in 50’s. E2 was lower and lower each time.

I would expect the level to be indicative of your condition which we dont yet know. From that reading you can determine if you have primary or secondary hypogonadism. IF that is indeed the situation.

Let your doc do his thing and if TRT is your option then come back and we can give more input. But considering you are still within normal range you may not get a script.

Is vit D low?

What is your calcium level? Have you done any genetic testing? High SHBG would explain low T and low E2.
This study indicates calcium could help you.
You could try some calcium and Vit D supplementation and see what that does for the next blood test. Calcium Citrate would be the best option for calcium in most cases.
Sleep is a circular problem. Crap sleep hurts test levels, and low test hurts sleep.

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Welcome fellow irishman,

You need to remove any idea that you can fix this naturally, isn’t going to happen. You’ll never produce enough testosterone to get over the top of that SHBG level. We are all biochemically, Free T is low and SHBG is one cause, the other is not much testosterone is being produced.

You need to find a doctor that doesn’t only treat the ranges, there’s a world of difference between a doctor that treats the reference range and one who treats the ranges and symptoms. When a doctor participates in managed healthcare, he/she must follow strict insurance guidelines put in place to deny treatment, it’s what insurance companies have always done, make it different to pay out of claims.

You should probably find a doctor in anti-aging who treats the symptoms as I doubt your doctor understands how to play this TRT game anyway. Clomid will not work for those with low Free T and high SHBG, clomid will increase SHBG along with Free T by about the same ratio, Free T will still be low and SHBG even higher.

HCG will not work either.

You need to throw excess androgens at the SHBG problem, this will suppress SHBG low enough to increase Free T, however you will need supraphysiological doses (1000+) your sick care doctor will not allow do to strict insurance guidelines (<800 ng/dL).

Getting TRT private is your only course of action.

It is important to find out why testosterone is low because I went on TRT and started having problems after the first 6 months, the cause of low testosterone was staring me in the face in my original labs. I had a deficiency in iron and vitamin D which is common when withdrawing off certain prescription drugs.

Prescription drugs can increase SHBG.

Your doctor can advise whatever he wants, that is not actually controlled by any insurance company or drug manufacturer. Your insurance may not be willing to pay for something. That is entirely different than saying that doctor can only do what he is told. He can do or say whatever he wants. The difference is that someone who does more than TRT will want to know what else is going on with you and not merely throw testosterone at it. Treating symptoms is the worst care there is, treating causes while considering what the symptoms tell us is the best care.
You wouldn’t want to ignore hemachromatosis or cancer because 250 mg a week makes you feel better.

Thanks man. Very insightful.

Agree re my low-normal T and high SHBG – its just a matter of finding someone who will treat.

Are you based in ireland? Would you be open to sharing the doc who prescribed you TRT?

I am due to get Vit D tested this week and also have my first endo appointment at the end of the month.

Thanks man.Calcium was included in my last bloods.
2.43 mmol/L (2.15-2.50) - i think thats good. VIT D is getting tested this week.

America, we have telemedicine clinic here, you can walk into a clinic are get TRT in the same way you can walk into a liquor store and buy beer if your levels are low.

If you start TRT deficient in iron, vitamin D or any other important vitamin, you will be expected to have problems.

I started out with a doctor that had no idea what he’s supposed to do, prescription labels says 200mg every 2-3 weeks, the hormone has a half life of 7 days on average, so 3 weeks is insane.

You could inject testosterone twice weekly and very do well, I don’t expect nebido to work for you, the half life is too long, you need excess androgens to hit your system to knock SHBG down.

See if you can get sustanon or enanthate, the latter being the best choice. Gels are generally poorly absorbed, I would try gels out before I would nebido.

You need Free T high normal, midrange is suboptimal for some men. I do better at the top and even better higher.

Calcium level is fine. I had to convert it to know. That doesn’t really have anything to do what is indicated in that study. It is probably a similar mechanism to the one that lowers E2 in some people by taking zinc.