Hello! I have put in a lot of work to understand this topic, but I am left with a few questions that are causing some frustration. I'll rattle off the basic stats and add questions to the end.
Complaints: Primarily brain fog, serious mental fatigue, lack of motivation, poor short-term memory and concentration, low or low-ish sex drive. Progressively worsening over the past 6 years.
Pre-TRT labs (03/13-04/14):
8am Total (300-1080 ng/dL) - 354, 340
Free (47-244 pg/mL) - 106, 101
2pm Total (300-1080 ng/dL) - 102
TSH (0.3-5.0 uIU/mL) - 1.204, 1.95
FT4 (0.8-1.8 ng/dL) - .97
Glucose (70-100 mg/dL) - 94, 88
Albumin (4.2-5.2 g/dL) - 4.5
Protein Total (6.7-8.4 g/dL) - 6.6, 7.2
Pre-TRT labs (05/10):
LH (1.5-9.3 mIU/mL) - 4.6
FSH (1.4-18.1 mIU/mL) - 6.3
E2 (10-40 pg/mL) - 25
SHBG (17-65 nmol/L) - 20.0
Prolactin (2.1-17.7 ng/mL) - 6.9
Post-TRT lab (05/23):
8am Total (300-1080 ng/dL) - 340
Protocol: 100mg test cyp weekly (injections on 05/10, 05/16, 05/23)
1) What are the implications of my SHBG level relative to E2?
2) I see lots of information about high and low SHBG, but what is the threshold for good low-normal SHBG (more free T) and problematic low SHBG?
3) It's been 2.5 weeks since first injection, and I feel significantly MORE tired than I did before. Today is 3 days after my third injection, and my test level should be well above baseline, but I feel absolutely exhausted despite sleeping 10 hours last night.
4) The total of 269 prior to third shot is obviously too low. Any suggestions on adjustment to protocol in light of test results on the whole?
Thanks so much to anyone who can help me out with this. I would see an endo, but the earliest appointment is in mid-October.
EDIT w/ additional information:
- age: 32
- height: 5'11"
- waist: 36"
describe body and facial hair: Beard is very dense along jaw with thinner patches on cheeks and center of chin. Body hair is thick on arms and legs and moderate on torso, but the hair is very fine. I do have semi-bald patches on the backs of calves, but I assume that's from wearing long pants every day. Hair online forehead hairline has rapidly thinned (not receded) in the past year, which has not happened to any other males in my family.
describe where you carry fat and how changed: Fat is heavily concentrated in torso, especially "spare tire" (but no pot belly), chest, and back. Fat is also disproportionately stored subcutaneously. Even when my body fat was low enough to see my abs, I still felt "flabby" to the touch. There hasn't been a change to this distribution, but I've had a much harder time losing fat and an easier time gaining fat since about 6 years ago.
health conditions, symptoms [history]: Dx with adult ADHD in 2013. Dx with Restless Leg Syndrome in 2011. Father also dx with RLS and with low T at age 50 during routine screening after about 10 years of symptoms.
Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Vyvanse 50mg. Mirapex .25mg.
describe diet: No appetite for breakfast due to Vyvanse, but I'll sometimes eat a cup of Greek or Mexican yogurt. Amy's frozen dinner for lunch at work. Dinner is usually 4-5 eggs with protein and salsa or a grilled sandwich with a half pound of shaved turkey/chicken, one slice of cheese, and some chips/crackers. On weekends I eat lots of street tacos, and overeat corn chips and salsa. I don't drink anything with sugar, but I do drink a lot of Fresca and Crystal Light (trying to phase out the aspartame).
describe training: From 2007-2010 I lifted 3-4 days per week and did cardio 2-3 days per week. From 2012-2016 I lifted with a trainer for 30 min x3-4 days per week with 30 min cardio after lifting. Haven't been to the gym in about a year due to recovering tennis elbow and lack of motivation.
testes ache, ever, with a fever?: No, with the exception of blue balls one time when I was 18. I get a fever 1-2 days every 2-3 years during flu season.
testes more generally: Definitely descended. Also on the small side and almost always "high and tight."
sex drive/performance: This one is hard to explain. My sex drive is definitely intact, but it's missing the part where I feel motivated to actually have sex. I never had a problem getting a functional erection, but sensation has definitely diminished. It also tends to lose rigidity and sensation in proportion to how vigorously it's handled, which is frustrating. In other words, hard and fast is a boner-killer and vice versa. This has lessened somewhat with first few injections.
how have morning wood and nocturnal erections changed: Morning wood mostly disappeared but has reappeared since my second injection. I'm not sure what a nocturnal erection is.
get cold easily?: Yes, constantly. When I was in peak physical shape (165lb, 14% BF), cold was intolerable. My fingers and feet still get very cold, but this is a side-effect of Vyvanse.
dry skin, brittle nails?: Dry skin my entire life. No brittle nails as far as I'm aware.
use iodized salt?: Yes, and I am a lifelong over-salter. I also eat a LOT of eggs (18-24 per week).