T Nation

Need Pre-TRT Advice

I’m 50 years old. About 5 years ago, I felt like I lost my ambition and drive. After doing some research, it seemed that low T may be a possible cause. I went to my GP and had it tested. He said it was fine. I questioned him again in 2016 and had it tested. Again, he said it was fine(results below). I feel like things have gotten worse and I’m at the point to just try TRT and see if it helps. I already have some on the way from a teleclinic. I’m not sure I made the right choice after reading posts on Tnation. I’m not sure the initial blood tests were thorough enough. I did order more tests for my own reference and those are attached. Now I’m lost. My total T on the last test was higher than ever. My SHBG was lower.
I am hoping someone can look at my history and give me some advice. I’ve tried to be as thorough as possible without going overboard. Please let me know what other additional info is needed.
Diet: generally higher protein lower carbs but I don’t follow anything strict
Body: I have been fairly muscular since 30yrs old. Lower body fat level, but still carried a little in lower belly. In last 6-7 years have lost muscle, getting a lot of fat in lower back and abdomen. When I try to work out, it feels like ligaments hurt more than muscle.
Hair: thick all over on body. Bald head started in 20’s. Beard thick.
Skin: my skin used to be oily and prone to acne. In the last 6-7 years it is not oily or as prone to acne. I had to use benzoyl peroxide daily into my 40’s.
No current medications. Was on Finasteride for about 15 years haven’t used in last 5-7 years. I have taken Prozac in the past but not currently.
Sex drive has been a little less for 3-4 years slowly getting worse. Seems really bad for last year. Erections not as good. Sensation not as good. Morning wood is generally non-existent.

Previous values
Date Total Test (range) SHBG (range) Free Test (range)
2015 11.4 pg/ml(8.7-54.7)
2016 554ng/dl(280-800) 41nmol(10-57) 103pg/ml(47-244)
5/2019 639ng/dl(250-1100) 80nmol(10-50) 8.5ng/dl(4.6-22.4)
1/2020 615ng/dl(264-916)

2-2020



Your 2019 labs are a little sub par from the limited info but the recent labs which are comprehensive look pretty damn good for 50 honestly. Your SHBG is holding back the Free T a bit but its still mid range. Hell… you’re 50 so if you want to give TRT a go just be prepared that it may be for life. I don’t know if you would recover those levels should you choose to cease use and you may be pot committed. Getting that Free T up and aromatizing a little more E may help in the bedroom as well as your mental state. This would be a situation where you are more treating the symptoms versus the labs though.

I was also on this for almost 10 years. Look up post Finastride syndrome. This is a bad news drug for some guys and quite frankly not worth it for keeping your hair. Glad to see you are no longer on it.

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Your Testosterone is good. Post Finasteride syndrome is the problem.
Your Adrenal function has weakened as evidenced by your low DHEA-S.
Do a 24 Hour Saliva Cortisol test. Your cortisol is likely very low throughout the day. PFS messes with the adrenal function as inhibition of the 5-AR enzyme also impacts this and Progesterone>Cortisol pathway. Stay away from SSRI’s they mess with your libido as well. Take 5-HTP as this converts to Serotonin and is 100% natural.

You will need to take herbs and follow a good diet to recover. Panax Ginseng is very good for your cortisol production and it balances your hormones naturally to an optimal level. I’d also test your Free T3, Free T4 and Reverse T3. But, the cortisol will be the most important because if it is low (And I’d bet money that it is low in your case) thyroid hormone can’t work either, leaving you functionally hypothyroid even if levels of thyroid hormones are normal as Free T3 won’t be able to enter the cells without sufficient cortisol.

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@TRT_Phoenix

I was on finasteride and then dutasteride for 5-6 years total. I’ve oftentimes wondered if an adrenal issue is part of my problem too but am confused on what to test after some posts saying the saliva tests aren’t very accurate… I’ve improved some from TRT but not like the night and day life changing difference a lot of people report.

My dhea is on the low end of “normal” as well.

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The lower estrogen could cause issues with erectile strength and wouldn’t be the first time a guy complained of weak erections in the mid teens.

Those with Post Finasteride Syndrome experience loss of androgen action on target tissues even with properly elevated hormone levels. Some don’t encounter problems until Finasteride is ceased.

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This was my cortisol on the blood test from 5-2019. first thing in AM and fasted.

Thyroid test from 11-2019 below
Vitamin B12 and Folate

Vitamin B12

1443high

Reference Range: 232-1245 pg/mL

Folate (Folic Acid), Serum

19.4normal

Reference Range: >3.0 ng/mL

Uric Acid

Uric Acid

5.1normal

Reference Range: 3.7-8.6 mg/dL

Thyroxine (T4)

Thyroxine (T4)

8.0normal

Reference Range: 4.5-12.0 ug/dL

Thyroxine (T4) Free, Direct, S

T4,Free(Direct)

1.29normal

Reference Range: 0.82-1.77 ng/dL

Triiodothyronine (T3)

Triiodothyronine (T3)

108normal

Reference Range: 71-180 ng/dL

DHEA-Sulfate

DHEA-Sulfate

165.8normal

Reference Range: 71.6-375.4 ug/dL

TSH

TSH

1.670normal

Reference Range: 0.450-4.500 uIU/mL

Thyroid Antibodies

Thyroid Peroxidase (TPO) Ab

<6normal

<6

Reference Range: 0-34

Thyroglobulin Antibody

<1.0normal

<1.0

Reference Range: 0.0-0.9

Thyroglobulin Antibody measured by Beckman Coulter Methodology

Triiodothyronine (T3), Free

Triiodothyronine (T3), Free

3.1normal

Is it abnormal for T levels to go from 615 to 780 in a week? Could there be an error on the lab work? In my past lab total t has been 550-639. Seems odd to jump 165. labs at same time of day and fasted.
I posted a reply with my thyroid levels.
Would you try the TRT if you had it ordered and it was on the way? I’ve been chasing my tail for 5 years with doctors on this.

Hormones levels aren’t static, they fluctuate every day, in fact if you test every day and levels will always be different.

It seems you have tried to resolve these issues without success, if it were me and I exhausted all other avenues, I would try TRT.

If you’ve gotten trt prescribednd the meds are on their way, if I may ask, what protocol was prescribed? Meds, dose and inj freq.

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Blood testing for cortisol is meaningless in most cases because it measures bound cortisol.
A 24-Hour Saliva Cortisol is very accurate and it actually measures free cortisol that is available to your body’s tissues. You will save yourself a lot of time and frustration by doing the Saliva test. It will be low and it needs to be addressed.

How?

By dealing with the root cause. Stress, trauma, injury. For many bacteria, viruses, parasites, fungal overgrowth, SIBO, intestinal dysbiosis caused by antibiotic use.

Do we know what TRT does to cortisol levels? If your cortisol is low when you start TRT, are there any studies to show what we can anticipate happens to cortisol levels (if there are any effects)?

Saliva is the gold standard for cortisol testing. Do yourself a favor and get it done. TRT does not work if cortisol is low.

If cortisol is low when you start TRT, you will not get the benefits that TRT is supposed to do. Your cortisol levels will decrease from your starting point, hence TRT makes your situation worse. It is inevitable because steroids are guaranteed to suppress both the HPTA AND the Glucocorticoid production (cortisol). One needs to treat the root cause of low cortisol levels prior to initiating TRT.

Here’s the reply from @johann77 the last time you stated that.

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@wolf359 I didn’t write the amounts because he said I will get instructions. 2x week and will haves test, hcg and aromatase inhibitor.I can post it later

You enjoy being his lackey, huh? Follow the INSTRUCTIONS on the saliva kit.
IT HAS ZERO TO DO WITH HYDRATION. Fill the tube half way. If the patient fails to do this, it is user error. It states it can take up to 30 minutes or more depending on the the patient’s saliva flow. So, stop backing people’s comments that you know NOTHING ABOUT.

The test itself is extremely accurate, the gold standard for saliva testing bio-available hormones.

“Saliva testing has been used in scientific testing for decades and has been shown to be highly accurate. It is the most reliable way to measure free, bioavailable hormone activity — those hormones actually doing their job at the cell level. Standard blood and urine tests do not measure bioavailable hormone levels. Numerous scientific studies have shown a strong correlation between the levels of steroid hormones in the blood stream and the bio-available levels of steroid hormones in saliva. Peter T. Ellison, Ph.D. of the Department of Human Evolutionary Biology, at Harvard University, Cambridge, MA, has used this method of hormone testing in cross-cultural comparisons of hormone levels among women living in industrialized vs. non-industrialized countries. (Human Reproduction vol.8 no.12 pp.2248-2258, 1993; Human Reproduction Vol.17, No.12 pp. 3251–3253, 2002.) His research in the field is the subject of his 2001 publication, On Fertile Ground: A Natural History of Human Reproduction (Harvard University Press). In addition, saliva hormone testing more accurately reflects tissue uptake and response of hormones delivered through the skin in creams, gels, or patches than blood or urine tests.”

Collection instructions videos.

The issue has NOTHING to do with a patient not filling the tube, I’m not sure where you’re getting this? We aren’t backing anyone’s comments, but you sure don’t seem very interested in responding to someone that actually knows enough to debate you on this… instead you just get pissed off when me and @dextermorgan bring it up. @johann77 has been very good at helping put some facts / studies behind (or against) things that are commonly said here. If he’s wrong then prove it. I’m sure he would be happy to have learned something as much as the rest of us.

Is anyone even saying the test at the lab itself is inaccurate? From what I understand, the lab can accurately determine how much cortisol is in the vial of spit. The problem is the amount of cortisol actually being deposited into the tube will vary based on how quickly someone is producing saliva. i.e. tons of saliva means you can fill the tube more quickly, which means a lower concentration of cortisol. Slow saliva production takes longer to fill which means more cortisol ends up in the same sample, resulting in a higher reading from the lab.

Quoting a lab that’s trying to sell something as your proof is not exactly confidence inspiring. It really isn’t.

Again, I just want to know who is right and what the facts are. Both of you guys know more than I do about this, but when he questions what you’re saying (and provides studies to back up what he’s saying) and you just ignore it, what are we supposed to think? If someone told me I was wrong and I had proof I was right, I’d be sharing it. Why aren’t you doing the same?

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@ncsugrad2002
Extremely well said

@TRT_Phoenix I would hate for someone to do a test that may be worthless and start treating themselves based on inaccurate results so I’m sorry if I hurt your feelings but this forum is for folks to find the knowledge that makes them better. No one is keeping score or cares who is more knowledgeable. They just want to feel good again. When @johann77 first came here I wasn’t a big fan but he’s definitely schooled me on shit I thought was legit but turned out it wasn’t. I would feel horrible if I gave someone information that led to them feeling worse because I didn’t know any better and I’m sure I have. I’ve been on the receiving end myself. I followed a member’s info like it was gospel when I first found this forum and that led to me having one of the worst years of my life. If I can keep someone from having to go through that then I definitely will.

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