Very Low T, Scared to go on TRT/HCG Advice Needed

Well you have two options, remain as you are or go on TRT and live a normal optimal life. I would start TRT without HCG in the beginning and add it later if you want.

As it stands you will never produce enough testosterone naturally. I do not expect good results at all with your TSH at 3.73, TRT will not work when there are thyroid problems. We still have no idea about the most important thyroid hormone, Free T3 which needs to be at least mid-range to see favorable results on TRT.

Free T3 is the single most important thyroid lab test, it soaks into your cells and give them energy, without enough of this hormone TRT will not work.

Hi systemlord,

It is great to hear from you.

It is unfortunate that I might not be able to produce enough testosterone naturally as I was hoping that I would only need some supplements to get my testosterone back on track.

The doc has included Free T3 in the blood tests so we will see what happens once the tests happen. If it looks like I need to go on TRT I hope it is not difficult to take the shots since that was also one of my worries.

You will hopefully get trained on how to do a shot. It’ll be a pain the first dozen or so times you do it. You will feel like you’ll never get the hang of it. It will also hurt a little more at the beginning before your muscle gets used to being pinched.

Eventually - and it doesn’t take long - it will be practically second nature. And in the main, they end up not really hurting either. I just did one earlier and it was absolutely painless.

I was terrified of shots, and giving yourself them is definitely weird at first. It’s like - try punching yourself in the face. Which, by the way, actually hurts more.

But as long as you work clean and stay mindful of what you are doing with storage and the like, it becomes barely more trouble than taking a dump.

Provide you use 27-29 gauge insulin syringes and not those harpoons prescribed by most doctors, life on TRT will be painless.

Supplements do not really do anything, unless you have low testosterone do to a severe iron deficiency or some other mineral deficiency, TRT is needed.

Free T3 can be good, but if Reverse T3 is high, a portion of your Free T3 will be unavailable to your cells and could be a reason for elevated TSH.

It really isn’t a problem once you learn how to do it. I use 22g, 1in needles which are painless. However, you might look into scrotal creams.

So I was able to get more bloodwork done which is slightly more detailed than before. Hopefully this can shed some more light on why my T is so low.

Hematology
WBC 9.8 4.0 - 11.0 x E9/L
RBC 5.31 4.50 - 6.00 x E12/L
Hemoglobin 139 135 - 175 g/L
Hematocrit 0.429 0.400 - 0.500 L/L
MCV 81 80 - 100 fL
MCH 26.2 27.5 - 33.0 pg
MCHC 324 305 - 360 g/L
RDW 13.2 11.5 - 14.5%
Platelet Count 290 150 - 400 x E9/L
Differential
Neutrophils 4.6 2.0 - 7.5 x E9/L
Lymphocytes 4.4 1.0 - 3.5 x E9/L
Monocytes 0.5 0.2 - 1.0 x E9/L
Eosinophils 0.3 0.0 - 0.5 x E9/L
Basophils 0.1 0.0 - 0.2 x E9/L
Immature Granulocytes 0.1 0.0 - 0.1 x E9/L
Nucleated RBC 0 /100 WBC

General Chemistry
Bilirubin Total 5 <20 umol/L
Alkaline Phosphatase 111 40-129 U/L
Gamma Glutamyl Transferase 48 14-62 U/L
Alanine Aminotransferase 34 <50 U/L

Thyroid Function
Thyroid Stimulating Hormone [TSH] 2.58 0.32-4.00 mIU/L
Thyroxine Free [Free T4] 13 9-19 pmol/L
Triiodothyronine Free [Free T3] 4.7 2.6-5.8 pmol/L

Pituitary Function
Luteinizing Hormone [LH] 1.8 1.0-7.0 IU/L
Prolactin 10.6 4.0-19.0 ug/L

Tumour Markers
Prostate Specific Antigen 0.23 <4.0 ug/L

Reproductive and Gonadal
Estradiol 128 <162 pmol/L
DHEA-S 10.6 < 15.0 umol/L
Testosterone 5.2 8.4 - 28.8 nmol/L

Serum Proteins
C Reactive Protein (High Sensitivity) 17.95 mg/L

Bone Markers
25-Hydroxyvitamin D 100 75 - 250 nmol/L

I will have the results for the SHBG soon.

We still need an iron panel, low MCH is indicating microcytic anemia. It’s amazing that your doctor is not investigating a possible iron deficiency, all of my doctors (10 ER Docs/ GP) missed my iron deficiency and is one of the most difficult to diagnose.

I had to go to my doctors and show them my labs, then doctors and states “this is iron deficiency”. Doctors are overworked and in short supply, they cannot catch everything.

You need an iron panel, CBC and ferritin to diagnose iron deficiency. A high sensitivity CRP test is usually normal below 10.0 mg/L, higher is indicating risks for cardiovascular disease and it seems you are well on your way.

Low testosterone, hemoglobin and hematocrit isn’t helping matters.

Testing in incomplete, previously TSH was 3.73 and Reverse T3 was needed. Tomorrow your TSH could be higher like it was previously. Hypothyroidism can start out with high TSH and normal thyroid hormones.

In iron deficiency you would lose the metabolism boosting properties of thyroid hormones. You clearly have inflammation if C-reactive proteins has anything to say about it, iI would not be surprise to see elevated antibody testing indicating hashimoto’s disease.

Unfortunately I am out of luck on getting Reverse T3 as that is not available in Canada. So besides the iron panel is there anything else that I would need done?

Would you say that there is a thyroid issue that is causing my Low T?

This is your problem. Pituitary isn’t generating enough LH to do much. Quit worrying about your thyroid, it’s probably just fine, worry about lack of LH.

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Yes my LH and FSH are both very low which could be the reason my testosterone is also very low. I dont know which vitamins or minerals are needed to increase them. I know people have used clomid with success but it will be difficult to get it without a prescription. I also need to rule out the possibility of a tumour.

If possible cross the border and get RT3 tested, you should be willing to do anything for your health.

So I found out that Reverse T3 is indeed available in Canada it’s just not easy to get. I am going to go to my doctor and try to convince him to get me a RT3 blood test but it wont be easy especially if I tell him that I did some research online.

It’s because of cost, it costs 3x as much as the other thyroid testing. I had to wait 2 weeks to get my results for Reverse T3.

What would be the best way to approach this with my doctor? I have to strongly convince him that I need the RT3 test.

Just explain it to him. They aren’t generally unreasonable, especially the young guys. The old guys can be difficult sometimes (except the military ones, I like doctors that were military docs before they went into regular practice). Where are you in Canada?

I am in Ontario.

Dr. Lawrence D. Komer is in Burlington, Ontario. He treats men and women hormonal problems.

I have been to him. He just wanted to give me the shots instead of figuring out the root cause of the problem.

The root cause often eludes us men unless your have a testicular failure or pituitary tumor, otherwise be prepare to spend a lot off money and time. More often low testosterone cannot be corrected naturally.

Your pituitary is shot, not much you can do about it except move forward.

So I went for SHBG blood work. Here are the results:

SHBG 13 12 - 60 nmol/L