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TRT Helpful in My Case? Evaluate My Labs

43-year-old male. 6’4" and 180 lbs. Not overweight, generally lean, low blood pressure, and no known health issues. Not on any medication, but occasionally use ED drugs. I have the following history of symptoms:

  • Libido: noticed it starting to diminish in late 30s, now it’s pretty much gone. I have no desire to initiate sex, ever.

  • ED: also noticed this starting to occur in late 30s, but wasn’t too bad at first but it has become much worse over time. Now, if my girlfriend initiates sex, I can perform if I’ve prepared with Cialis, but it’s a crap shoot. If I’m able to perform without drugs, which might not happen at all, maintaining the erection is a challenge, and sometimes I just focus on making sure the lady is taken care of and then give up rather than try to maintain until completion. I NEVER get morning wood or spontaneous erections. It’s been years since either of those have happened.

  • Sleep issues: this has been a growing problem over the past few years. I’m able to reduce severity, but not entirely cure, if I really focus on good sleep hygiene.

  • Depression: I definitely have it. Probably mild Major Depressive Disorder. I’ve tended towards the depressive side my whole life. It’s MUCH better than it was in my 20s, and I have learned how to cope with exercise and lifestyle habits so I wouldn’t have to resort to medication, but my girlfriend and others often comment on me being grumpy.

  • Mental clarity and memory: I can tell I’m not as sharp as I used to be but I’m sure that happens with age. My memory used to be 100% solid, but it’s definitely not what it used to be. I’m not forgetting where I live or anything, but I don’t recall conversations and details as well as I used to.

Honestly, if not for the sex issues, I would just deal with everything else.

I got tested when i was 40 and the above issues were starting to bother me. Total T came back at 760 so i obviously wasn’t a TRT candidate. I even saw a urologist, who prescribed Trimix, which works really well for the ED, but who wants to have to stick a needle in their dick anytime they want to have sex?

Now, at 43, all the symptoms are worse, so I got tested again (twice in the last week actually). First test was just Total T and second test was full panel. I’m including labs, but the gist is:
Total T: first test was 523, second test was 576 (264-916)
Free T: 7.5 (6.8-21.5)
Estradiol: 29.2 (7.6-42.6)

Doc at the T clinic said that even though Total T was in the mid-normal range, because free T is at the bottom of the desired range, he’d like to see me with total T over 700 at least and free T much higher than it currently is. He’s recommending the usual 100mg a week. What are your thoughts?

Thanks in advance.

You were a candidate probably years ago, the problem is you sought help from someone untrained in evaluating a testosterone deficiency, SHBG was never tested because the doctor that ordered your labs had a complete lack of understanding in endocrine disorders related to HPTA and sex hormones.

SHBG binds sex hormones, testosterone, estrogen, thyroid hormones and even insulin. An elevated SHBG will see Total T high and Free T low, TRT is more than likely the only treatment that can correct your testosterone deficiency do to elevated SHBG.

Beware of these TRT clinics, they care not about inconveniencing you forcing you to come into the office 52 times a year. Most men with elevated SHBG levels do better on one or preferably two weekly doses since the half life of T-cypionate is 5-7 days, once weekly will see levels higher in the first couple of days and lower by day 7.

Most sick care doctors get TRT wrong, endocrinologist, urologists and GP’s because neither specialize in this area of medicine.

The labs I got when I was 40 did not include free T, but did include SHBG. The current labs included above do include free T, but do not include SHBG. So I have the following:

3 Years ago:

  • Total T: 759 (348-1197)

  • Free T: unknown

  • SHBG: 45.1 (16.5-55.9)


  • Total T: 576 (264-916)

  • Free T: 7.5 (6.8-21.5)

  • SHGB: unknown

Is it a concern that current labs don’t include SHGB with the free and total T values I have? And yeah, doc wanted me to do pellets. I said I prefer to self-inject. So he recommended I self-inject 200mg the first week (as some sort of booster shot to get me started) and 100mg a week after that in 1 weekly injection. I would obviously split that up and inject twice a week at minimum.

3 years ago a mistake was made because we didn’t know how much Free T was circulating in your blood, so really no proper diagnosis could be made. Now you have Free T labs indicating low Free T, SHBG testing while important is less relevant but should be measured in the future every 6 months.

The fact that SHBG wasn’t tested is yet another indication this clinic is less thorough and cutting corners which is what happened 3 years ago. The telemedicine clinic I’m signed on with tests Total T, Free T, SHBG and estrogen at a minimum to see where my levels are scoring to track my progress.

I had a consultant yesterday and the doctor was able to see a few lab values on the lower end and was able to determine without testing iron that I was borderline deficient which is more than likely why my Total T and Free T decreased on a dosage that previously had my Free T in the high normal ranges and now were significantly lower.

I imagine had I been with a clinic that skipped on important testing, I may never have known of the borderline iron deficiency and never would have known to change my diet to include more steak which I cut back 3 months ago.

Gotcha. Thanks for your input.

No offense … SHBG is a $38 test and either indicates a problem or eliminates a problem. Your total T has dropped over two years. A big question would be would did your SHBG do?

And if I may ask, why did you want o self-inject instead of pellets? What was the deciding reason?

Wait. He’s a candidate?

He’s got total test between 500-700 on numerous tests. Cmon

Stay off trt and find the solution. Check into sleep apnea. Get a more comprehensive blood panel. High e2? Prolactin too high?

Trt is for life and I personally wouldn’t touch it in your shoes.

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With your total test level you will likely need more than 100mg a week. The low free testosterone level is obviously the problem. It would be nice to know SHBG, FSH, LH, prolactin, DHEA-S and VitD levels.

I’ve been thinking about this for a few years and have been very hesitant to start TRT. I don’t take the decision lightly. But the potential benefits are a real draw. I do want to know more before I make a decision though. I got more blood drawn yesterday and ordered everything. DHT, prolactin, SHGB, etc. Should have all that back in a week or so.

Why would my total T indicate a need for more than 100mg/week? I’m new to this so what might be obvious to some isn’t obvious to me.

Mostly that it’s less expensive, easier to adjust, don’t have to have minor surgery several times a year with the risk of pellets being extruded from the insertion site. Believe me, I don’t love the idea of maintaining an injection schedule and all those plastic syringes going to a landfill isn’t exactly green, but when looking at all the factors, pellets don’t seem like the way to go for me.

Because your total testosterone is not low, but your free testosterone is, you will need to run your total test higher to get your free test up to a decent level. Nothing wrong with starting with 100mg/week, but I’m guessing it won’t be enough.

Cost … probably injections are less expensive … pellets are $750 for up to six months.

Risk of Extrusion … With BioTE trained doctors, risk of extrusion is minuscule. All extrusion studies were done prior to BioTE and all reference both Testopel and the previously taught insertion method. EVERY study is more than 5 years old … and again, is not BioTE. Your doctor will disclose his extrusion percentage. Mine is ZERO. And if you do not take it easy that first week, yes, I agree that the chance of extrusion increases.

Minor Surgery … yes, I know because of the medical definition this is true. But it really is such a stretch to consider it surgery when you have it done. And yes, you must take it easy for a week, and yes, your butt hurts a little for a week.

BUT … your T levels are at a high within 48 hours … and yes, you begin a downward slope, but if done correctly, you don’t experience issues … It does take one or two cycles to determine the best number of pellets to insert.

No needles, no injection schedule, no other drugs USUALLY necessary except Dim.

No action necessary for up to six months.

Sorry to hijack the thread … and I don’t expect to change your mind … but I would like to present facts about pellets rather than the circulating fiction.