T Nation

Two Low T Tests, Need Advice

So, I’m a 35 year old man. I have been suspecting low testosterone issues for some time, and got a test a few months back. 289 ng/dL. Even though the lab reference range gave something in the 240s, I read online less than 300 is low and should be looked into. So I went to a PCP about it. Got a total and free testosterone result. 271 ng/dL, with 51.8 pg/mL free. The first visit he actually seemed more amenable to looking at it and then maybe referring me to a specialist. But he didn’t seem to care at all after the second test.

Both these numbers are still at the low end or below a lot of the different standards I’ve seen. I’m gonna go ahead and pursue other opinions, including talking to an endocrinologist tomorrow. I’m wondering, are there any other serum concentrations I should mention that might be worthy of testing, or really any other information I should go in armed with? There seems to be a lot of resistance in medicine to treating or even taking into consideration low testosterone.

I also have been reading about clomiphene citrate as an option that doesn’t come with some of the side effects exogenous testosterone does, are there any thoughts on that?

LOL. The opposite is closer to true for most guys. Talk to the endo. The lab ranges matter, as it’s not a standardized test exactly. One labs 271 could be another labs 340. “Under 300” is not an applicable statement on it’s own.

Would it be worthwhile to compare the ranges and then where the 271 would fall inside that given range to get a better idea of where it would fall in “that” range? I actually made a point of doing both tests with different lab companies. From what I have heard though, those lab ranges are based on just creating a statistical range from their average result, not from any diagnosis of symptoms occurring outside of it.

What are the issues with clomiphene? It sounds like there are some I haven’t heard of.

Not exactly. Individual equipment varies as well, and they use different co-efficients to calculate depending on the lab and equipment. It’s easiest just to see where it is in relation to the given range. You should not be at the bottom at your age though, FWIW.
Clomiphene causes bloating, discomfort, spot in your vision that can become permanent, out of ratio E2 to test which can cause it’s own issues. And, some guys just react poorly to it in their own way. Of course some guys have zero issues. You don’t know until you try.

Well, both tests had a bottom end of the range of 249 and 250 respectively. But yeah, my total seems to be somewhere in the high 200s at any given time.

No matter whether you are 200, 300 or 400 if you have symptoms you are deficient. Lab ranges are extremely flawed and being at the low part means 99 percent you are deficient to some degree. Symptoms of low t with being below the MIDDLE of the range in 99 percent of cases means deficiency.

From here you have a few options: To try to naturally fix your lifestyle(very low chance to improve test levels enough like that), to try clomiphene monotherapy or push for TRT with an EXPERIENCED provider.

The endocrinologist most likely will not help you. They dont like testosterone, dont know how to use it, fear it as something bad and are generally clueless about it

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I did specifically scout this place out because it had positive testimonials from guys who go there for TRT.

Why not give it a try? It will likely raise your numbers. It did for me and prior to starting clomiphene my numbers were very similar to yours. If you have side effects just stop taking it. To not try something because it has potential side effects doesn’t make sense - because everything has potential side effects.

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Yep he can try it

I have yet to see someone that has had less than 300 in testosterone with symptoms, getting that up to a high level and feeling great without TRT.

You can try clomid but it is not a medication without some nasty effects and if I was in your shoes, I would first figure out why I have such a low level of testosterone. If you for example have a chronic infection, or high prolactin, then it would be important to get that fix (and then use TRT unless your numbers magically becomes high). Adding TRT might fix the symptom of low T but it is important to found out why you have low T. I would still start TRT if I was you but I would make sure to role out something more problematic.

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Yep me too

It is good to do what you can to find out but most people cannot. Usually it is a combination of bad lifestyle for a few years, genetic predisposition and environmental toxins.

Yeah, it is just more about ruling out something more serious so that you will get full effect from the TRT.

Finding out what’s causing it is something I really set out into this wanting to do more than anything else. It was really disheartening when after the second test the PCP just went “eh, these are fine” and then basically steamrolled the any attempts to discuss further and just wanted to try and sell me on taking statins.

Have you had more tests to share like lh + fsh?

Ferritin + iron and hs-crp to look for inflammation?

CBC?

LH or FSH no, I’ve not gotten tested. I’m hoping they will do that when I go in for testing at the endocrinologist monday, along with other things like prolactin. Ferritin, Iron, and hs-crp I don’t think were tested at all. Both blood tests included CBC though and those were both fine.