T Nation

To TRT or Not to TRT at 34


So I am having trouble deciding whether to do this or not. After reading the sticky on this my Urologist is most likely in the category referred to not knowing anything about TRT and I am only getting to talk to the PA now that he recommended the TRT. I originally was referred there by my GP for a varicocele and in doing blood tests they found low T and high Prolactin. At that point they scheduled an MRI (possible pituitary adenoma) and prescribed AndroGel, but I got worried and called and doc agreed to postpone until MRI. MRI was all good and nothing else the doc wanted to do besides starting my TRT and checking back in 5 weeks.

I have read that varicocele surgery could boost T and bring back to a better level so I'd prefer to get that fixed. Should I push my Urologist to refer me to his colleague that he said would perform a micro-surgical varicocelectomy if I insisted? Or should I get more blood info and ask for alternative treatment?

Here's all of my info:
I did have a blood test I am trying to get form an old doctor, I was 26, my T was 330 on scale 300-1000.

Current Levels (still have to get actual test from doc to post real #s)
T 281 on scale 249-836
Prolactin 17.4 on scale 4-15.2 (doc said could indicates pituitary issue, hence the MRI)
CBC-White 3.6 on scale 4-10.5
CBC-Red 5.59 on scale 4.1-5.6
Hemoglobin 17 on scale 12.5-17

I am 34 years old, 6', 195lb, 34" waist. I have thick facial hair and moderate but thick body hair. I tend to carry all of my fat on my belly, chest and face, it's at about 18% and even at my lowest I could only get down to 13-14%. My symptoms of low T are energy levels, low libido, mild ED (maintaining not getting but morning wood is less frequent), and little muscle mass (hard gainer). I do also have testicular pain sometimes after workouts, most likely related to the varicocele.

Training regimen was Starting strength. Currently on a recovery workout 3x strength, 2xHIIT due to arm injury limiting lifting weight.

I eat 5-6 small meals/day, currently ~3600 calories, with a cheat day on Sat. where I still eat a lot and don't worry about fat/carbs. I was doing a little less food with about 3/4 GOMAD, that has been the only time I have seen any muscle gain and I got about 22-23lb of muscle.


I would not recommend anyone start on HRT without first testing for at the very least Thyroid (TSH, free T4, Free T3), 8am Cortisol, and Estradiol (sensitive).

if you have a medical condition that can be treated and could possible enable your system to keep up, then why not give it a try before going on a lifetime HRT program?


Waking body temps would be useful data in support of need for thyroid labs.
Get cold easily?
Dry skin?

You should get the varicocele fixed, independent of other considerations. Then your T recovery levels will drive the need for TRT.

Did you read: http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/prototype_advice_for_new_guys

For reference, this is a good male panel:


Yeah PureChance, I haven't taken the Androgel because I really wasn't comfortable after reading about TRT and how hard it would be to even get my natural T back after TRT in some cases. Glad that I wasn't alone in that thought and thank God for this forum and the internet...

So I updated my blood tests results also adding CBC white blood cell which was low and I read could be caused by hypothyroidism... Something else to look into I guess.

I did read the new guys thread, and I will look into blood tests and another doctor. I prefer to do it through a doctor since my ins. will pay for tests with a much smaller co-pay then $400 if I can find a good doctor who knows what to order.

I will get waking body temps starting tomorrow as long as I remember. I don't get cold easy at all, mostly always warm. I do have some dry skin but only in a few places.


So I went to see my GP today and she is looking into the potential thyroid issues and will run another test for T and prolactin. She agreed with the decision of not taking the androgel and said I should pursue the surgery on varicocele as well. She also referred me to a group of endocrinologists to follow-up on the low T if nothing comes from the thyroid workup she is doing.


I guess I was wrong to hope of the GP actually getting a male blood panel as she suggested she would when they drew multiple vials saying they would re-test stuff. Well after getting the test back she only tested for TSH and Porlactin again.

TSH is 1.77 with a range 0.45 - 4.5
Prolactin is 18.7 with a range 2.5-22.5

She said that even though prolactin was high it was still "normal" as well as TSH...so no thyroid issue according to the GP. Guess I'll have to wait on the endo and see if I win the game of doctor roulette this time...


I have seen multiple case of this from patients/clients that high prolactin levels may be due from low thyroid or thyroid deficiency at the cellular level. You would need to get further testing of the thyroid to rule this out along with adrenal saliva test. I would look to why prolactin is high such as dopamine deficeincy, low b-6, zinc, and other factors that may help to rebalance the levels. Find a new DR. I actually will be working with one in austin texas that is extremely open minded. I will taking the same integrative approach with him that I have been with Dr Overbeck.


TSH=1.77 is normal? My TSH came back at 1.6, was .98 before surgery problems. So checked my temps, 97.2 AM and 97.7 for the rest of the day. Having success with large iodine doses, up to 98.2 on day three.

I guess my TSH=1.6 was normal too.

And I feel better. I feel more normal now!


Just an update, and I finally got my full test results (doc is across town and wouldn't mail them to me) to post here.

My endo said my LH is low and put me on Tamoxifen, 3 months ago. I should have some updated test results in a week or so when they get them back to me.

Here are my blood tests from April, which was the first time I had a full panel of tests done at the same time. There's at least one duplicate test because they sent it off to 2 different labs:

Test = Result Units (Low Range-High Range)
Prolactin-Serum = 15 ng/mL (3-18)
Monomeric Prolactin = 14 ng/mL (3-18)
% Macroprolactin = 7.00% n/a (n/a-n/a)
ACTH-Plasma = 29.9 pg/mL (7.2-63.3)
Estradiol = 36.2 pg/mL (7.6-42.6)
DHEA Sulfate = 285.9 ug/dL (160-449)
Testosterone-Free = 7.3 pg/mL (8.7-25.1)
Glucose = 94 mg/dL (65-100)
BUN = 24 mg/dL (5-21)
Creatinine = 1.12 mg/dL (0.5-1.4)
B/C Ratio = 21.4 Ratio (12-20)
Sodium = 142 mmol/L (135-145)
Potassium = 3.9 mmol/L (3.5-5.3)
Chloride = 107 mmol/L (98-110)
CO2 = 28 mmol/L (24-31)
Anion Gap = 7 mmol/L (n/a-n/a)
Calcium = 9.4 mg/dL (8.4-10.4)
Total Protein = 6.7 g/dL (6.3-8.2)
Albumin = 4.6 g/dL (3.5-5)
Globulin = 2.1 g/dL (n/a-n/a)
A/G Ratio = 2.2 Ratio (1.1-1.9)
AST = 23 U/L (7-37)
ALT = 29 U/L (0-43)
Alk Phos = 66 U/L (24-120)
Total Bili = 1 mg/dL (0.1-1)
GFR = 79.8 n/a (60-130)
Ferritin = 116 ng/mL (15-200)
WBC = 3.6 K/uL (4.1-10.9)
RBC = 5.04 M/uL (4.2-6.3)
Hemoglobin = 15.9 g/dL (12-18)
Hematocrit = 45.8 % (37-51)
Platelet Count = 164 K/uL (140-440)
MCV = 90.9 fL (80-97)
MCH = 31.6 pg (26-32)
MCHC = 34.8 g/dL (31-37)
RDW = 12.9 % (11.5-14.5)
MPV = 7.8 fL (-)
Neutrophils% = 55.7 % (37-80)
Lymphocytes% = 39.4 % (10-50)
Monocytes% = 4.9 % (0-12)
Neutrophils# = 2 K/uL (2-6.9)
Lymphocytes# = 1.4 K/uL (0.6-3.4)
Monocytes# = 0.2 K/uL (0-0.9)
FSH = 5.7 miU/ml (0.7-11.1)
TSH = 2.05 uiU/mL (0.4-4)
Free T4 = 1.14 ng/dL (0.63-1.67)
Prolactin = 16.6 ng/mL (2.5-17)
T3 = 129 ng/dL (81-178)
Thyroid Update = 29.2 % (24-35)
LH = 3.8 miu/mL (0.8-7.6)
Cortisol = 11.3 ug/dL (5-25)
Testosterone total = 263 ng/dL (245-1600)
HCG = Negative Yes/No (n/a-n/a)


Test is low. Free test is low. E2 is high. DHEA-s is low. Take a look at the thread I started recently to see what has worked relatively well for me so far. Nothing extreme. Getting sleep, getting E2 down to 20ish, Magnesium Gel, and Vit D supplimentation worked really well for me considering where I started. Trying DAA right now and will be testing again in a couple of weeks. AlphaMale worked pretty well but is a bit to expensive to run all the time.


Please list reference ranges..


Reference ranges are there, just in a terrible to read format.


Sorry about the format, I keep them in a spreadsheet so I can plot changes over time, but cutting and pasting that made a mess on the forum that doesn't allow either markup or multiple spaces/tabs. I've cleaned up the old results and will do the same in the future exporting CSV and post process with awk on the unix command line to get it to look a little cleaner. I should have more blood test results on Monday and will do the same with the format.


You could just post your spreadsheet up on google docs and start posting the links...some of us have found that very helpful...


I wish I could do that, unfortunately my google docs are shared with some business associates, coworkers and members of other organizations that I am involved with that I am not willing to have my medical information exposed to. At least here I am only publicly identified by my username, I can format things somewhat acceptably on here and make due.


That's cool. I think you can select not to share it with anyone that you don't provide the link to, but I understand your desire for privacy. Or you could create another account on google I suppose.


Previous tests were from 4/6, this new test is from 7/18. Using Tamoxifen increased FSH, LH and Test, but also pushed my Estradiol way up. I guess that would partially explain why I really haven't been feeling the results. I did ask the doc and he said the tamoxifen was going to raise E2 levels and it wasn't anything to worry about, even though like dhickey said E2 of around 20 is ideal and higher will reduce effects of test. Even with the meds I still have somewhat low total test (free looks better, but about 14th percentile on the total test). Will Test keep going up on tamoxifen? I've been on for 3 months now and had hoped to feel some better result by now.

Test = Result Units (Low Range-High Range)
Estradiol = 48.2 pg/mL (7.6-42.6)
Testosterone-Free = 14.5 pg/mL (8.7-25.1)
Glucose = 85 mg/dL (65-100)
BUN = 17 mg/dL (5-21)
Creatinine = 1.16 mg/dL (0.5-1.4)
B/C Ratio = 14.7 Ratio (12-20)
Sodium = 142 mmol/L (135-145)
Potassium = 3.9 mmol/L (3.5-5.3)
Chloride = 106 mmol/L (98-110)
CO2 = 25 mmol/L (24-31)
Anion Gap = 11 mmol/L (n/a-n/a)
Calcium = 9.2 mg/dL (8.4-10.4)
Total Protein = 6.9 g/dL (6.3-8.2)
Albumin = 4.6 g/dL (3.5-5)
Globulin = 2.3 g/dL (n/a-n/a)
A/G Ratio = 2 Ratio (1.1-1.9)
AST = 20 U/L (7-37)
ALT = 21 U/L (0-43)
Alk Phos = 57 U/L (24-120)
Total Bili = 1 mg/dL (0.1-1)
GFR = 76.6 n/a (60-130)
Ferritin = ng/mL (15-200)
WBC = 3.7 K/uL (4.1-10.9)
RBC = 4.91 M/uL (4.2-6.3)
Hemoglobin = 15.5 g/dL (12-18)
Hematocrit = 43.7 % (37-51)
Platelet Count = 158 K/uL (140-440)
MCV = 88.9 fL (80-97)
MCH = 31.6 pg (26-32)
MCHC = 35.5 g/dL (31-37)
RDW = 12.7 % (11.5-14.5)
MPV = 7.6 fL (n/a-n/a)
Neutrophils% = 44.6 % (37-80)
Lymphocytes% = 48.8 % (10-50)
Monocytes% = 6.6 % (0-12)
Neutrophils# = 1.7 K/uL (2-6.9)
Lymphocytes# = 1.8 K/uL (0.6-3.4)
Monocytes# = 0.2 K/uL (0-0.9)
FSH = 13.6 miU/ml (0.7-11.1)
LH = 6.5 miu/mL (0.8-7.6)
Testosterone, total = 441 ng/dL (245-1600)


Free Test should go up if you get your E2 down. My free test went from 7.9 to 14 when I got my E2 down from 41 to 22.7. These tests were about a year apart, so take them for what they are worth. My supplimentation was about the same between tests. I did add some Vit D between the two. I am guessing total T would go up as well, but I didn't have total T tested on the second one.


How do you feel at these levels?


Pretty much the same. The only thing that has improved has been ease of losing weight, although that's not my goal... I have lost about 11lbs (related to a surgery and forced 5 weeks of time with no workouts).