T Nation

Would I Benefit from TRT?

Hi,

I would just like to get your guys opinion on whether you think I could benefit from trt or not.

I seem to really vary from how well I feel from sometimes feeling pretty decent with good energy to often feeling rubbish with really low energy and poor libido. I know there is a link to the kind of things I eat and lifestyle in general. But just seems I’m over sensitive at times. I’ve had t check over the last year or two and I can range from 12nmol/l total and .25 nmol/l free and be feeling quite rubbish and then when I really doing my absolute best with life style and reaching 17 nmol/l total and 3.5 nmol/l free. And I will be eating really well and exercising regularly to achieve that.

Also I’ll add that I’m 28 years old and I have body fat likely around 15%.

Just wondered if you’ve dealt with guys with these kind of numbers before.

Cheers,
Tom

Could you provide some details regarding the lab work?

Ranges? SHBG? E2? Method for determination of free T?

Those number aren’t great. Did you mean “.25 nmol/L” free?

Thanks for your reply.

Here’s my blood work from when I’m on the lower side.

D.H.E.A Sulphate 9.860 umol/L (normal range .44 - 13.40

Follicle stim. Hormone 2.84 IU/L (normal range 1.50 - 12.40)

Luteinising Hormone 2.32 IU/L (normal range 1.70 - 8.60)

Testosterone 12.1 nmol/L (normal range 7.60 - 31.40)

Free Testosterone (calculated) .254 nmol/L (normal range .30 - 1.0)

SHBG 28.9 nmol/L (normal range 16.00 - 55.00)

Free Androgen Index 41.87 ration (normal range 24 - 104)

17-Beta Oestradiol 41.6 pmol/L (normal range 41.00 - 159.00)

Thanks

Since then when I’ve really worked hard to get lifestyle and habits as good as I can.

TT is 17 nmol/l
FT is .35 nmol/l
Estrogen is 65 pmol/l
SHGB is 35 nmol/l

And with those values I do feel reasonably good but just feel like I’m way to sensitive to life style factors then I should be.

Hope that info helps.

It does, thanks.

I have.

Did you mean .35?

It wouldn’t likely impact treatment, but I’d get prolactin and IGF-1 checked.

I would look into it. I’d also evaluate your lifestyle, however, at age 28 you should be able to handle some pretty reckless behavior without feeling terrible and trashing libido.

Thanks for replying so quickly.

I’ve had prolactin checked a few times and is normally top 3rd of the ref range.

Never check igf. But will look into it.

Life style wise I know I can make myself feel pretty reasonable if I do everything in my power but it’s literally like walking a tightrope sometimes. Eg. even 1 alcoholic drink or 1 cup of coffee or any amount of refined sugar can make me feel terrible. Other times I can deal with a little bit. I’m definitely not the sort of person who can pig out for the day and drink a load and be ok the next day. I’ll be out for the week.

Same with exercise I realised I pretty much have to get up the same time every morning and do a modest work out to have any chance of consistent sleep at night. If I don’t I will expect have at least 2-3 nights a week without being able to fall asleep until 1 hour before getting up.

Just seems like it’s a lot of management involved just to feel good.

Your testosterone seems low to me. And your lh and fsh seem low.

Perhaps secondary hypogonadism?

At your age I would do a pituitary MRI and testicular ultrasound.

Did you do your labs within 1 hour of getting up in the morning after a decent night sleep?

That’s when your testosterone should be the highest. I see your free t was actually low.

So you take any medications or supplements? Please list

Also fasting glucose ? A1c?

I’ve tried for mri with my gp but won’t authorise as prolactin isn’t high enough apparently.

Blood test always taken first thing in the morning fasted with as best sleep as I can get.

Blood glucose has always been pretty spot on when I’ve had it tested.

Thyroid labs have also been pretty good tsh always between 1-2 and upper middle of the range for t4 & t3. Never had rt3 tested.

That’s because an MRI is not needed. If you are going through your insurance company, they would not cover it anyway. Documentation must be provided for every order and even then, they are routinely challenged.

If you would be willing to pay out of pocket, you could get one. Usually, the facility will agree to charge what insurance reimbursement would be and that is a fraction of the fee, sometimes as low as 25%.

There is a saying in health care: If you think you are healthy, you haven’t had enough tests.

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