T Nation

Should I Try TRT? Bottom Range Levels

Hello all,

I was recommended this forum by a friend, so I hope I may receive some pointers on my situation. I`ll try to be as on point as possible.

  • I`m a 27 year old male, apparently healthy. Low stress, sleep well on a daily basis, eat healthy and work out moderately (i.e., very conscious about not overtraining and keep volume low). When I was around 20 years old, I was severly burned out after several years of too high expecations of myself: highly stressed, severly underslept, physically demanding full-time job, student, heavy duty training and too strict diet at times. This lead to a kind of nervous breakdown that put me out of business for a long while. I wonder if I may have hurt my body in some way leading up to this.

  • I used to work as carpenter and with a physically demanding job, stress and not always sleeping enough, I reasoned that feeling tired, zapped and with low libido was normal. After quitting my job, eliminating stress and sleeping adequately and beyond, I felt even worse. Actually, I felt terrible and spent as much time I could in bed. Extreme fatigue and zero libido. This made me realize that something was very wrong in my body.

  • Test results came back “normal” and my doctor said everything is okay. I noticed that ferritin was elevated (300+), indicating inflammation or hemachromatosis. I was met with ridicule for bringing it up, but after my ferritin reached 700 and I did not get any better, I finally got to consult a specialist. Prior to visiting the specialist, I had donated blood and since my ferritin levels dropped quite a bit and all the other supporting tests for hemachromatosis was negative, they concluded that I did not have the condition.

  • I then decided to stop worrying and just go on with life. My condition improved considerably from rock bottom, but I still felt like shit at times. After a few months, I just had to be honest with myself and realize that I don`t feel well or healthy. Main symptoms being lack of energy, fatigue and very low libido. This eventually led me to convince my doctor to try clomiphene treatment, 25 mg every day. This led to a measured boost in testosterone and I also felt much better physically, although libido did not improve that much. Eventually, the effect seemed to wear off and my doctor decided to not give me any more because she feared I may develop cancer.

  • Fast forward I later got to a doctor who wanted me to try a combo of various natural supplements, but also 50 mg of DHEA. For the first weeks I felt like shit, but I wonder if perhaps I did feel better at times using this. I think I had better libido on average, but the test results did not show any significant changes. I then asked for clomiphene and wanted to try that along with DHEA. After two weeks, I did not feel any better and even worse, so I decided to quit.

  • I have tried various natural supplements like Maca, Ginkgo Biloba, etc, but none of them seem to work. I once tried Tongkat Ali and seemed to get a good boost (not measured) from that, but I got too excited, forgot to cycle it and it seemed to wear off. Maybe it would be worth another shot?

  • There is a cyclical tendency with my state of being. I experience days where I feel very well and even raging libido. The feeling well and raging libido is not necessarily experienced together. I often experience high liido during periods where I have been tired and stressed. As late as 4 weeks ago I had a week of raging libido in my body where I needed to release multiple times daily and really felt like a sexual being. That is all gone now.

  • The last time I checked ferritin it was 200, which definitely is not low considering that I donate blood every 3 months. But probably nothing to worry about.

So, here I am, feeling kind of clueless about what to do. Maybe low testosterone is my real problem or maybe it is a symptom of something else. The doctor I have previously been with said that he would consider letting me try TRT if the prior combo failed (which it did).

However, I notice that I have lot of resistance against TRT, especially since I dont feel I can trust the knowledge of this doctor and because I fear that something else might explain my issues. The fact that I function well at times make me believe that I have the potential to function on my own without assistance under certain conditions, whatever the hell they are. What I would really prefer is to simply get well and function well on my own, but maybe thats not an option?

If I knew for a fact that I needed TRT, I dont think I would hesitate, although I feel it is a last resort for me. On the other hand, Ive been struggling for quite a few years now and I`m certainly not getting any younger.

Without giving the complete panel now (will do if anyone is interested), my testosterone have been measured in the range 390-429 ng/dL naturally. 507 ng/dL after one month of clomiphene.

So, guys. Any help on how to proceed from here would be highly appreciated. Ill even pay for good advice as Im really at the end of my ropes here.


Johan Nes

Look at the bloodwork stickey–that is a good start. You need to get the proper tests done.

Also investigate your ferritin levels. If they got up to 700, that is a huge issue that needs treatment by a hematologist. Could very well be causing the rest of your issues and associated low T.

[quote]VTBalla34 wrote:
Look at the bloodwork stickey–that is a good start. You need to get the proper tests done.

Also investigate your ferritin levels. If they got up to 700, that is a huge issue that needs treatment by a hematologist. Could very well be causing the rest of your issues and associated low T.[/quote]

Hello and thank you for your reply.

I have taken multiple tests, so I will post them in the next post.

Regarding the ferritin levels, I was convinced that I had hemachromatosis, but was met with ridicule from several doctors when I brought it up. Finally, I managed to get tested for the HFE gene which was negative. This test is not conclusive, since it is possible to have hemachromatosis without that mutation, but other tests on the iron panel was normal. Combined with the fact that my ferritin dropped from just beneath 700 to 200 after one donation, the hematologist I saw concluded that it was highly unlikely that I had any problems related to iron overload.

Elevated ferritin may indicate some kind of chronic infection or inflammation if Ive done my homework correctly and that would fit very well with my state around that time as I was SEVERELY exhausted and ached all over my body. I am ten times better today and Im able to funtion well on average, but the symptoms remain and my libido in particular is low.

March 2009

PS-T3-FREE: 3.8 pmol/l (2.6 - 5.7)
PS-T4-FREE 12 pmol/l (9 - 24)
PS-TSH 1.22 mU/l (0.35 - 4.70)
PS-ANTI-TPO <3 (0 - 15)

CORTISOL 264 nmol/L = 9.57 ug/dL
TESTOSTERONE 14.9 nmol/L = 429 ng/dL
ESTRADIOL <0,07 pmol/L = < 0.07 pg/mL
PS-FSH 2 ie/l (1 - 12)
PS-LH 2 ie/l (2 - 12)
PS-SHBG 36 nmol/L (13 - 60)
PS-PROLACTIN 145 ie/l (0-580)

August 2010

PS-T3-FREE: 4.6 pmol/l (2.6 - 5.7)
PS-T4-FREE 14 pmol/l (9 - 24)
PS-TSH 2.73 mU/l (0.35 - 4.70)
PS-ANTI-TPO <3 (0 - 15)

CORTISOL 748 nmol/L = 27.12 ug/dL
TESTOSTERONE 13.6 nmol/L = 391 ng/dL
ESTRADIOL <0,07 pmol/L = < 0.07 pg/mL
PS-FSH 2 ie/l (1 - 12)
PS-LH 6 ie/l (2 - 12)
PS-SHBG 17 nmol/L (13 - 60)
PS-PROLACTIN 145 ie/l (0-580)

22nd November (after using 25 mg clomiphene daily for 1 month)

Estradiol 0,10 (0,04-0,18)

FSH 3 (1-12)

LH 9 (2-12)

Testosterone 17,6 pmol/l or 507 ng/dl

SHBG 31 (13-60)

Now, I have never measured free testosterone directly at a lab, so assuming I could use the calculator at testim, it would read like this:

March 2009 - Free testosterone = 8.39 ng/dl

August 2010 - Free testosterone = 11.0 ng/dl

November 2010 (after one month of clomiphene) - Free testosterone = 11.1 ng/dl --> If my math skills are correct, serum testosterone increased by over 30%, but due to increased SHBG, free testosterone is pretty much unchanged.

October 2011 (after being off clomiphene for a while) = Free testosterone = 9.77 ng/dl

I am retrieving new bloodwork from the doctor today, that I can post later today.

Age: 28

Height: 178 cm

Waist: 97 cm

Weight: Don`t have a weight here, but roughly 78 kg/171,5 lbs give or take. I would estimate my BF% to be just under 20, but it would probably be higher if I did not put in as much effort as I do to watch what I eat.

Describe body and facial hair: Hairy legs, ass, around genitals, but not so much on upper body. Some chest hair.

Ability to grow a beard, but don`t grow very fast.

Describe where you carry fat and how changed:

I carry most of my fat around the belly, hips and ass. That`s where I always had it.

Health conditions, symptoms [history]: I believe I wrote enough about this in my opening post, but let`s just say that I was severly stressed, overworked and underslept for a long, long time which eventually lead to some kind of nervous breakdown (anxiety and a moderate depression). I had to quit all training and stress for over a year and only very slowly could resume weight training again, since my body “remembered”.

I wonder if this could indicate adrenal fatigue.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever

No drug use to speak about. Never used anti-depressants, but occassionally took oxazepam to fight anxiety. Nothing to speak of though.

Lab results with ranges: See prior post.

Describe diet [some create substantial damage with starvation diets]: When I hit rock bottom I was actually on a calorie deficit and intermittent fasting regime, but it was a mild deficit. Since then, I`ve been eating on a surplus.

Diet is moderately healthy, eating lots of protein, but also ample carbs and fats. Fruits, vegetables, milk, meat, egg, chicken, fish, potatoes, rice, pasta, oat meal, nuts, etc.

Describe training [some ruin there hormones by over training]: Currently I lift weights 2-3 times per week and cardio whenever I feel up for it.

I certainly trained too much in the past, but now I`m very cautious about this and train with a low-volume regime and try to avoid training to failure.

Testes ache, ever, with a fever?: Not sure what is meant by a fever, but yes, I have noticed it at times.

-How have morning wood and nocturnal erections changed:

As a youth, I always woke up with wood and typically carried it for the first hours of the day and had spontaneous erections throughout the day.

I cant say exactly when this changed, but lets just say that for the last years, a true morning and nocturnal erection is VERY rare.

Today, I woke up fairly limp, but worked up a decent woodie by my own mental effort. I guess that don`t count. Some days I wake up with a 50% erection perhaps, but a true raging morning wood? Pretty much never.

Bloodwork from 27th of January 2012

T4-FREE - 18,2 pmol/l (11-23,0)
T3-FREE - 4,8 pmol/l (3,5-8,5)
TSH 1,6 mU/l (0,2-4,0)

TESTOSTERONE 13 nmol/L = 375 ng/dl
FREE TESTOSTERONE 10.5 ng/dL (Calculated with this calculator using SHBG and total testosterone: http://www.issam.ch/freetesto.htm)
ESTRADIOL <0,06 pmol/L = < 0.06 pg/mL F
FSH 2 ie/l (1 - 12)
PS-LH 2 ie/l (2 - 12)
SHBG 17 nmol/L (13 - 60)

DHEA 18,3 nmol/L (referance range for men aged 31-50: 6-18 nmol/L) Comments from the lab: Marginally above upper levels. High DHEA can be seen with tumors in the adrenal glands or defects in the adrenal glands steroid synthesis. CONTROL IS RECOMMENDED UNLESS THE PATIENT HAVE BEEN TAKING SUPPLEMENTS.

As I have been taking DHEA as a supplement, I suppose I`m safe.

Zinc is rather low, but low enough that it could explain my issues? I have not supplemented for the last months, but have done so heavily in the past. Maybe I have trouble absorbing it or maybe the level is not particularly low. Not sure how to interpret this lab results.

Other than that, LH and testosterone levels are obviously low. According to this site, the average/normal testosterone level in my age group is 617.



The ferritin levels dropped to just below 100 on the last two tests including the most recent one, so I think it`s fair to say that I can rule out hemachromatosis or other conditions related to high ferritin. I entertain the possibillity of having had a chronic infection or inflammation when I hit rock bottom earlier, which would explain the elevated ferritin at the time.

For now, I have pretty much decided to try TRT and see what happens.

Is there any reason not to at this point? Do I have any other options? Its been three years now and Ive been trying a lot of stuff. I dont see any lifestyle changes that could improve my situation. For one, I sleep adequately every night and dont have a stressful life.

What do I risk by trying TRT now?

Should I consider trying HCG monotherapy first?

Or can I start with testosterone + HCG and try tapering off exogenous testosterone further down the road and see if I can function on HCG alone? Possibly try to taper off that eventually as well?

Thanks in advance for any help.


Johan Nes

[quote]Johan Nes wrote:
What do I risk by trying TRT now?

Should I consider trying HCG monotherapy first?

Or can I start with testosterone + HCG and try tapering off exogenous testosterone further down the road and see if I can function on HCG alone? Possibly try to taper off that eventually as well?

Any help would be greatly appreciated.


Any input all guys? Did I say something wrong?

Im visiting my doctor tomorrow and I really want to know my stuff by then and what to do. Ive settled on a game plan on my own, but I still would prefer some input here.