T Nation

To TRT or Not? Alternatives?

44 yrs, 5’10" 260 lbs.

Total Testosterone 4.92 ng/mL (2.80 ~ 8.00)
Testosterone Bioavailable 0.61 ng/mL (0.80~3.20) LOW
FSH 3.37 (1.50 ~ 12.40)
LH 4.39 (1.70 ~ 8.60)
Cortisol (ECLIA) 209.60 nmol/L
Estradiol (ECLIA) 25.21 pg/mL (7.63~42.60)
Estradiol (RIA) 15.90 pg/mL (Men: 15.00~71.00)

  1. Trt or no?
    1a) If no, alternatives?
    1b) If yes, recommend any particular protocol? This will have to be all self-administered.
  2. Any special reason my bio-available is so much lower than my total test?
  3. Any other notes or thoughts about the numbers/labwork? I know what each one means individually but not what the mean, taken as a whole.

Thank you gentlemen.

Too early to assume you need TRT without more labwork.

Read all of the sticky’s first. Make sure you read the advice for new guys sticky and the thyroid sticky.

What is your iodine intake like?

I would start by taking morning temps and afternoon temps to see how your thyroid is functioning. Morning temps should be at 97.7 ish and afternoon hitting 98.6. When one is hypothyroid many of the symptoms and issues can impact your sex hormones. It is best to at least consider this and rule it out before thinking about a lifetime commitment of TRT.

But for starters read the sticky’s and provide more info on your first post…

1 -Please read the advice for new guys sticky and do look into thyroid and iodine issues as above.

You have a degree if primary hypogonadism and some secondary. At your age, these things are mostly age related. Have you had your testes examined to see if there are any vascular abnormalities?

Bio-T is very low. So your E2:T balance makes you estrogen dominant. Your TT is mostly T+SHBG that is inert and exaggerated. I suspect that you are not clearing E2 via your liver or something is creating a lot of SHBG. You have more lab work? AST/ALT? Please post all labs and other details in the above sticky. List all meds, Rx and OTC and list medical conditions, current and significant past.

Also suspect insulin resistance or thyroid problems based on your weight.

I don’t think that you can fix your T levels without TRT and TRT may enable fat loss and improved quality of life. But TRT is complex. Please see (1), but more info from you might change this picture.

[quote]KSman wrote:
1 -Please read the advice for new guys sticky and do look into thyroid and iodine issues as above.

You have a degree if primary hypogonadism and some secondary. At your age, these things are mostly age related. Have you had your testes examined to see if there are any vascular abnormalities?

Bio-T is very low. So your E2:T balance makes you estrogen dominant. Your TT is mostly T+SHBG that is inert and exaggerated. I suspect that you are not clearing E2 via your liver or something is creating a lot of SHBG. You have more lab work? AST/ALT? Please post all labs and other details in the above sticky. List all meds, Rx and OTC and list medical conditions, current and significant past.

Also suspect insulin resistance or thyroid problems based on your weight.

I don’t think that you can fix your T levels without TRT and TRT may enable fat loss and improved quality of life. But TRT is complex. Please see (1), but more info from you might change this picture.[/quote]

This kind of insight is exactly what I was looking for, thank you.

A month before the labs I posted above, I had total testosterone, PSA, SPGT and SPOT done.
Total Test at that time was 382, range of 200-1000. (Note, this was a different lab then my more comprehensive tests above)
PSA was 0.4 with the only range provided as > 4.0 being high.
SPGT/ALT was 41.5 (0-38)
SGOT/AST was 34.6 (0-40)

The GP doctor said though they were highish in the range, it wasn’t anything to worry about since I wasn’t going to take the gel caps.

I had a thyroid panel done a while back in the military since I was always pushing the weight limit but I don’t recall the numbers. I wasn’t educated at the time and they just said “No thyroid problems”. I haven’t had an updated one done yet, or checked temps/Iodine.

There’s not a lot more to add. I take only Omeprazole for heartburn and a multivitamin. I never did test. I used to take an ECA stack when I was semi-in shape but that’s it, otherwise.

Fat ass that I am, I like lifting and work out pretty frequently (though I run out of gas pretty quickly). I wasn’t working out when I took the first test, I was by the time i took the second, for about a month.

No smoking, get drunk once a week.
Had a massively painful attack 6 years ago that the ER said they thought was a gall stone but they weren’t sure and it never recurred so…yeah. Broke an arm once in the gym. That’s it, no other significant medical events.

Diet is a lot of chicken, eggs, ribs and beef when I am being good and comfort food like pizza and peanut butter sandwiches when I am feeling bad. Not a big fan of veggies but I try to throw them in here and there.
Lastly, I am travelling in third world countries some so I don’t always have access to great labs/equipment. For example, they strangely have Nebido and Test caps here but they don’t have any other form of test in the pharmacies.

[quote]KSman wrote:
Have you had your testes examined to see if there are any vascular abnormalities?

I suspect that you are not clearing E2 via your liver or something is creating a lot of SHBG.
[/quote]

Sorry, missed these two questions previously. I have not had my testes examined. I didn’t even know that was a thing…I mean, as far as TRT goes.

On the second part, do you think that taking something to lower E2 might help, if my liver is not clearing it fast enough and that is causing my low bio-available scores?

I would focus on bringing T numbers up. E2 is not bad now, but when you compare it to low T numbers, it’s reasonable to think that it will go up if T does.

You could try a good T booster. I had good luck with AlphaMale years ago. Guessing there are quite a few good options now, and maybe a bit less expensive. It would be good to take something for E2. DIM, Boron and/or Calcium d-Glucarate would be on my list. Any kind of liver support wouldn’t be a bad idea. I have trouble clearing estrogen.

if that doesn’t work, or is too expensive, you could try a low dose SERM or HCG. Both are pretty cheap and easy to get without a script. E2 control will be important.

Take action on thyroid and body temperature issues to see if this is a factor.

Checked temp at 11 am, when I normally wake up, and again at 4 pm.

36.3c / 97.34f both times.

It’s not the morning but that’s when I consistently wake up so it’s kind of MY morning. Not sure how that works, exactly.

That is low. You have a degree of functional hypothyroidism and all of the cells in your body are running slow. But we need more temperature readings to verify this state.

Look into iodine issues ID’d in prior posts and tell us.