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Should I Try TRT - Total T 685, Free T 124 - Labs Attached

Hello everyone. Appreciate any advice you have. I just turned 40 this year and have been experiencing low energy and mood, fatigue, and low libido for the past few years.

My labs came in at:
Total Testosterone 685 ng/dl (250-1100)
Free Testosterone 124.0 pg/ml (35.0 - 155.0)
TSH 1.54 mcIU/ml (0.55 - 4.78)
T3 109 ng/dl (54-163)
T4 7.2 mcg/dl (4.8-10.4)
B12 352.0 pg/ml (180 - 914)
VIT D 29 ng/ml (30-100)

I consulted with a men’s health clinic and they recommended 200mg test C injected weekly with an AI. From my understanding, that is a high starting dose.

Is it worth a try to fix the low energy symptoms?

This is a cookie cutter protocol, that they would literally give to anyone who can pay, with zero regard for you or for what is good for you. Do not have anything to do with them. Starting with 200mg is not uncommon, and may be fine. Starting with an AI is asking for trouble, you should not touch one without actual demonstrated need. And there is nothing wrong with your labs. Test is not an “Energy booster”, it’s a powerful hormone. Take some vitamin D and get some exercise.

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In my opinion, no you should not try TRT. Your free testosterone, which is the hormone that is bioavailable to exert its effect on cells and that is responsible for your mood, wellbeing, libido, etc, is at the very high end of the reference range.

Based on my experience with hypogonadism, chronic fatigue & mental health, this sounds like it could be depression & anxiety. Your thyroid & testosterone levels look really good, I personally would recommend you see a doctor who specialises in mental health and get a mental health screen done. You may benefit from CBT / psychotherapy.

You should also look at the following areas of your lifestyle and see if anything needs to change. Make sure you are:

  • Sleeping 8-9 hours a night, make sure you are not looking at screens right before bed as this kills your quality of sleep,
  • Eating a diet focused on whole foods, avoid processed refined junk, avoid vegetable oils, avoid soft drinks, avoid refined sugar, etc, make sure you are eating enough healthy calories,
  • Get checked for vitamin deficiencies, primarily; vitamin D, iron, B12 and zinc,
  • Focusing on stress management
  • Exercise every day, find what works for you and what you enjoy doing.
  • Get tested for coeliac disease. It is very common for this condition to go undiagnosed for years and years.

We look for medicine and supplements for quick fixes, however more often than not fixing these issues requires lifestyle changes, effort and consistency on your behalf.

Good luck

EDIT: Just saw your vitamin D is very low. I would suggest to start supplementing at 5000IU per day to bring this up. B12 can also be improved, my doctor wants me above 600, so you can also start supplementing with methylcobalamin 1000mcg per day to help bring this up.

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I doubt your testosterone levels are the reason for your symptoms, usually your testosterone would need to be lower to produce these symptoms. Your thyroid hormones look great as well as your TSH.

You need to look a little harder for the cause of your symptoms. I have seen guys shut down their natural production for something as simple as an iron deficiency.

As for that TRT protocol, deficiently looks like a cookie cutter protocol (AI’s) that screw men up real bad and we have to set them straight. Most men don’t need AI’s and there are ways around having to use it, but your clinic is in the business of making money, patient care looks to be afterthought because AI’s can cause hair/bone loss.

Smells like a T-mill to me, hand over the cash here you go.

Thanks everyone for the advice! I will look at Vitamin D supplements and implement some lifestyle changes.

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Did you get your Iron / ferritin checked? Low Vitamin D and Iron strongly point to possible celiac disease. Just another point to consider.

Sitting in a the cab of heavy equipment all day isn’t going to help his Vitamin D either, you don’t generate Vitamin D if you’re behind glass for your sun exposure.

These cases are always interesting. The first thing to ask yourself is how much these symptoms are impacting your life. Is this affecting your work, marriage, other relationships, enjoyment of life? Only you can make this determination. Keep in mind you’re not sick, many people simply roll through life feeling as you do, so this is an elective process.

Second, take the least invasive route you can. That means diet and exercise. Take some supplements, maybe try gluten free, dairy free, sugar free diets, or all the above. Read the labels? No, if it has a label, don’t eat it. Do some strength training. If that helps your energy levels, you feel better, mood is better and maybe libido is better as well.

There is a saying in medicine that if you think you’re healthy, you haven’t had enough tests. Go to a psychotherapist, you’ll need counseling. Go to your GP, you’ll need anti depressants. Go to a psychiatrist, same thing. Go to a gastroenterologist, you’ll have bowel disease, go to an allergist, you’ll be treated for allergies. And, yes, go to a TRT practice, you’ll get TRT.

Everyone talks about evidence based practice these days, but in the context that means solely following the literature. Aside from the published literature, EBP is a three legged stool, with one being the desires and needs of the patient and the other being the experiences of the clinician. If it’s me, you’d be included in a shared decision making process and with a proper physical examination, a more in depth consultation than we’ll have here, thorough explanation regarding the pros and cons of testosterone, informed consent, and you wanted to try TRT, I’d give it to you. In my experience, you double your total testosterone and free testosterone, you’ll feel a lot better.

By the way, did they check E2? You did not post a result. Assume they did, since recommending an aromatase inhibitor, but I would not take one.

You don’t even know his weight and height @highpull but you are like yeah you want to try trt and put a monkey wrench in your entire endocrine system to see if that helps?

Op basically is thinking about trt as an energy booster…

I understand you said you would discuss with patient but trt should be last option. Perhaps shouldn’t even be an option at this point.

This is crazy shit. So op needs a total t of 1400 and free t of 250 to feel good…

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Re read what is said, especially the second paragraph.

Fourth paragraph, third sentence.

You guys crack me up. As you may or may not know, I come for the old AAS/PED days. If TRT is a monkey wrench, we bulldozed it.

These aren’t particularly relevant, but if it was a consult then @highpull would be able to see for himself and have both of those numbers. And, he is right - generally speaking. If you crank up free and total testosterone you feel better, unless something else is seriously wrong with you. Guys on a cycle feel awesome for a reason. That doesn’t make it the best option, or a healthy option as a long term constant thing, but it’s the outlier that doesn’t feel awesome with more test.

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Don’t know. Maybe.

JFC. Did they offer you 30 days worth of Oxy with six remaining refills too?

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Agreed…TRT might help but your vit D is pretty low, that might be a root of some of your issues.