T Nation

Starting TRT with "Normal" Levels?

First post here: Been trying to make the jump for a year to start TRT.

6’0 height, 160 lb weight, Total T crashed down to about 275 ng/dl after losing about 50 lbs a little over a year ago. The numbers improved but the symptoms got worse.

Doctor (anti-aging clinic) suggests I start TRT for symptom relief. I started to experience virtually every “Low T” symptom over the past few years. It was tolerable until the mental stuff recently hit, bad anxiety, depression, brain fog, etc. Very nervous to start this therapy as I don’t think I could handle feeling worse at the moment.

Last Year I had a total T @ about 280 ng/dl (range 280-1100)
This year I had other labs come back at total T between 400-660.Most recent was total t @581 ng/dl.
Free T has been between 6 and 10.46 ng/dl (range 1.9-27)
SHBG has been between 43 and 67 nmol/l (range 14.55-94.6)
LH is 3.4 mIU/ml (range 1.5-9.3)
E2 is 22.5 (range < 40) non sensitive i believe

I’ve never used steroids, or been any type of hormones.

Absolutely no endurance, zero libido, and the opposite of a “sense of well being” that you often hear TRT patients say they get.

Not looking to increase gym gains or anything like that as I don’t even have to stamina to complete a workout.
I was told that it’s less about levels and more about symptom relief- and also that I had a higher shbg which could attribute to symptoms.

Doctor says he’d like to see me double my free and total t numbers, but specifically he said he wants free t about 20 ng/dl at least.

I know I’m not extremely low, and most people would call this in the normal range. Has anyone had these types of levels and had success with TRT?

Any advice, opinions and expertise welcome

Also wondering if I can just start with T and add HcG Later if needed. Doctor wants to start me on both, but I’m pretty freaked out about the HcG because theres so many differing experiences and opinions on it. Not trying to ever have any more kids- but I understand it can help with mood and libido?


First question, yes. You went to an anti-aging clinic with symptoms of aging. They have stuff for that. You’ll feel a lot better if you double your free testosterone. While labs are important, and necessary, it is more about how you feel.

Second question, yes, in fact, unless you are trying to conceive, or concerned with testicular atrophy, there is no need for hCG. However, some report benefits of overall well being and fat loss with hCG.

Last question, yes, more energy, increased strength, more muscle, more sex? Yes, your mood will improve quite a bit.

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Be aware 280 ng/dl is disease state levels, men with low testosterone have a higher mortality rate than those midrange testosterone levels and high normal testosterone have the least health problems.

Don’t get caught up in the normal range which is taken from a population who eats processed foods, breathes polluted air and leads unhealthy lifestyles, 40% of the population is obese so the sample that created the ranges is tainted. We are all bio chemically unique and everyone processes androgen differently, what’s normal for me isn’t normal for you.

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Woow woow woow slow down.

You lost a good amount of weight, your hormones are off balance.

You went to an anti aging clinic where their purpose is to sell you a solution.

You need to take a few steps back imo.

Firstly you should try a restart, if after 6 months of the restart this did not improve the situation. Then yes look at your options.

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I lost the weight over about 7 months in 2017. I’ve maintained the same weight (and even added a little back) for over a year. So it’s been over six months with numbers improving somewhat but symptoms have remained and gotten worse.

How old are you?

34 years old

I think I would do TRT.

Even if you brought down your SHBG, your TT is still really low.

Do you do keto? IF? medications?

Not doing keto but lower carb in general- have higher glucose (prediabetic ranges) so another reason I have been looking at T replacement is insulin resistance issues. I basically ate like shit throughout my 20s, and am paying for it now.

I try to do IF about 10/14 but have been finding it hard to maintain.

No meds but taking d3, liposomal c, b12 methyl, and mag glyc.

IF and lower carb increase SHBG.

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Don’t jump on the TRT bandwagon too early. Some people on here act like its a club you just join and it seems they want more members. Remember TRT is for life. It makes you feel good for a few months but then you level out. If your numbers are improving I would wait and continue to monitor them. It takes time to recover.

LMAO. I couldn’t have said it better. Especially relevant to the under 30 crowd.

The young guys really need to dot the i’s and cross the t’s. This is complicated stuff - the entire Endocrine system…

How do you know this? Any links to studies or info would be appreciated. Thanks

I have high SHBG, and have spent the last 2+ years trying to figure out how to lower it. Just type in those keywords into google.

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You think so? I generally would agree with that, but he’s 34.

Plus, this:

“every “Low T” symptom over the past few years. It was tolerable until the mental stuff recently hit, bad anxiety, depression, brain fog, etc. Very nervous to start this therapy as I don’t think I could handle feeling worse at the moment.”

And, this:

“Absolutely no endurance, zero libido, and the opposite of a “sense of well being” that you often hear TRT patients say they get.”

I think I would start TRT if I were you, BUT, I would make sure that I was able to do it on my own terms. Don’t jump with the first doc that will give you a shot unless they are willing to let you have a say in your protocol. A little reading on this forum will give you all the info you need to see what a decent protocol should look like for starting, and what a nightmare a bad protocol can be.

You need to get a full, thorough blood panel done to get a snapshot of where you are right NOW. Do not use bloods that are from last year or even last month. See where you are at this moment.

Then start with T only and get that dialed in before you start adding other compounds if needed. You may need to research for another few months and visit several docs, and may even have to go to a private source, but believe me, you’ll regret it if you don’t get this right early in the game.

Start as low as you can. Stay the course and don’t start changing shit until you have reached stabilization (6-8 weeks). It may take a while to get the test dosage and injection frequencies optimized, but it’s not as hard as some make it. Just takes some common sense and patience.

We are here to help whichever route you take man, and I will definitely NOT welcome you to the club. It sucks to realize that you have to start putting needles into your body to feel normal for the rest of your life, but in the end I believe it is worth it. It’s not a glamour show, but once you level out you realize that you forgot how good it felt just to feel normal.

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Go slow and ease into it. Take my experience as support for that advice.

I was in a very similar situation with normal T levels - just turned 38 in Aug and was coming off 9 months of a test optimizer supplement from a reputable fitness website - and although total T was showing 487 and 553 from my PCP office, E2 was 22, I had no libido but when I did I had weak erections and ejaculating didn’t have any real sensation; testicular atrophy, loss of muscle mass (not strength), depression and dark (not quite suicidal) thoughts, total brain fog, would cry randomly, etc. All the while I was physically healthy (5’9” 168, fit and working out 5 days a week). Sorry long backstory.

A wellness doc prescribed me 200mg/ml test cypionate at 1ml per week (2x 0.5ml M, F) with 1ml HCG on MWF. I was also told to take 150mg of DIM as an estrogen blocker.

Unfortunately for me now I’ve been on TRT since early October and just recently started to reduce my dosage of test due to terribly high E2 levels and symptoms (78 and 68 were readings in Nov and Dec) and symptoms have been nearly as bad as pre TRT except now I have an extra 15 lbs on me.

Long way to say, explore all options before you go in and if you do go slowly. The comment was made - it is the entire endocrine system that you start to mess with and once you start the ride hang on.