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Test Results - Need Advice (34Y/O)

Have low libido, mental fog, sleep a lot. Eat pretty clean, work out (dependent on caffeine) 3x per week. Sick and tired of feeling crappy so I went to me doc and endocrinologist. First panel was similar to the one below.

Most Recent Test Results
Testosterone, Total-345.4 ng/dL (280.0-1,100.0 ng/dL)
Sex Hormone Binding Globulin-27 nmol/L (11 - 80 nmol/L)
Testosterone, Free 71 pg/mL (47 - 244 pg/mL)
Testosterone, % Free-2.1 % (1.6 - 2.9 %)
Testosterone Bioavailable-191 ng/dL (131 - 682 ng/dL)
Luteinizing Hormone- 2.5 mIU/mL (1.5 - 34.6 mIU/mL)
Fsh-2.8 mUnits/mL (1.4 - 18.1 mUnits/mL)
Estradiol, Serum-25 pg/mL (<=40 pg/mL)
**Metabolic panel all normal

Question: Endocrinologist suggests staying hydrated and getting a sleep study. What a joke. Do I just bite the bullet and go to an HRT clinic? Anyone have success with Defy?

I don’t think you have much choice.

Looks that way

For an old man, not for a young man. You’re low enough for a reasonable doctor to prescribe TRT given your age.

A sleep study isn’t a bad idea.

Not a joke. Been on TRT for 5 years and still fatigued. Sleep study changed my life.

How so? The endo was hinting at sleep apnea or some other kind of disturbance. Wife says she has never noticed anything. I rarely even snore.

Before you go to a trt place:

Do what the Dr said - sleep study.

Did the endo check prolactin?

I would do a pituitary mri and testicles ultra sound.
Though severe disease unlikely you need to cover your bases.

Then I would go to urologist, they may order the testicle ultrasound, and have them run their own labs. Each specialist has their own way of looking at things and usually order tests that they determine need to be done.

If you follow a process similar to what I outlined, you will be thankful later when you start 2nd guessing why you are on trt at 34.

Once you start trt it will be difficult to determine cause. Even though you may not find one before. You need to try.

I had sleep apnea. Pretty severe. I’m not old nor overweight but nonetheless have it. CPAP and I’m no longer fatigued. I was sleeping 8 hours a night before or so I thought turns out I was not breathing 90 times an hour. Anyway if your sleep isn’t up to par your hormone levels won’t be either.

Thanks for following up

Prolactin was around 5. Endo said it was normal, suggesting normal pituitary function. Also, normal liver enzymes, iron, thyroid.

No problem. I guess my point is that yeah your hormone levels are subpar but I would still do the sleep study regardless of whether you start TRT. Hopefully you have decent insurance so it only comes down to a crappy night in a sleep center.

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Can anyone recommend an online service or is it better to go to a clinic?

I can recommend my clinic. Very fast and professional. Run by Jeffrey Ruterbusch (think I spelled it right). $150/mo all included

Defy Medical (telemedicine/walkin clinic) is above and beyond in the type of care you’ll receive from your typical sick care doctor. Prices are $150-$200 monthly depending on how many other services you get.

Once you get all dialed in you can opt for shorter doctor consultations to save money in the long term. I use Defy and am happy with their services.

The majority of men never truly know why testosterone is low, testing usually shows everything is normal and yet LH and testosterone are suppressed.

I believe a lot of guys reason for low LH and low testosterone is going to be something upstream of the pituitary gland that we aren’t testing as of yet.

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That’s for the knowledge my dude.