low'ish total testosterone level but high free T-level - reason?

[subnet]

hey 'guys' - my second blood test came back with a total test serum level of 359 (previous was 241) but with a free testosterone level of >49 picogram/mL. With the LabCorp numbers showing free testosterone guidelines as being:

* 30-39 years 8.7-25.1 picogram/mL
* 40-49 years 6.8-21.5 picogram/mL

I will be 40 in 1 month, but regardless my free level is MUCH higher than the top end. Everything I've read is about having low free-test levels with either high or low total test level, but I haven't been able to find anything about high free testosterone level (very high) with a low total testosterone level. I have symptoms of low testosterone (irritability, weight gain, poor sleeping, hot flashes) but am otherwise healthy (5'10" and 190lbs).

Everyting else tested by my Endocrinologist was in the 'normal' range (PSH, etc.). She wants to re-test in a month for the free level, but I still want to explore options regarding my total level since I would like it to be higher and get rid of my symptoms.

Is there any reason my free level would be so high when the total level is low?

[ZonaDave]

your T is unbound...good news!

[subnet]

hmmmmm - thanks ZD - unbound means that my body is free to use it right (I remember reading), but since it's so high and my total T level low, does it mean perhaps that my body isn't or can't use it properly?

[ZonaDave]

what's your current TRT protocol?

[subnet]

no protocol or treatment - went to my PCP because of symptoms, T came in at 241, he sent me to an endo, SHE wanted another test which came back at 359 and great than 49 free...

So nothing has changed, I'm TRT-less, but my free T is high apparently but total is low. I was hoping to go on TRT to feel better but it's not going to happen with this Dr. Am checking out other options in my area (Houston) and have found one that apparently is good for this (Opal Medical). Out of Network with insurance so that scares me because of $$. Was hoping to just get a 2nd low result for the endo and go on gel.

[flatscat]

no protocol or treatment - went to my PCP because of symptoms, T came in at 241, he sent me to an endo, SHE wanted another test which came back at 359 and great than 49 free...

So nothing has changed, I'm TRT-less, but my free T is high apparently but total is low. I was hoping to go on TRT to feel better but it's not going to happen with this Dr. Am checking out other options in my area (Houston) and have found one that apparently is good for this (Opal Medical). Out of Network with insurance so that scares me because of $$. Was hoping to just get a 2nd low result for the endo and go on gel.

What was your free t in the first lab work?

[subnet]

wish I knew but he didn't test for that

my total T was 216 actually and not 241 like I said (not that it's a big deal) on the first test

[ZonaDave]

i get a kick out of doctors using the "range" as the only guide to make a decision. the Total T range is a joke and should only be used as a "reference".

when i first started having low T symptoms i was 36 years old and my Total T was close to 700! a few years later my symptoms got considerably worse and my Total T was 366. only then did a doc put me on TRT.

now i'm at 1250 on my shot day and feel like a new man.

some guys do fine on low TT while others need to be alot higher. there's only one way to find out...try it and see what happens.

i think it's time to find a new doctor. before you make an appointment, talk to the doc on the phone and ask him some questions about his procedures for administering TRT. any doc that's worth while will take the time to consult with you over the phone before making an appointment.

i'd love to be a doctor. it's one of the few occupations where your clients don't have to see any results but you still get paid.

[flatscat]

wish I knew but he didn't test for that

my total T was 216 actually and not 241 like I said (not that it's a big deal) on the first test

Wonder if the lab screwed it up? Did you say you were going in for another round of lab work? Bet it comes in a lot lower next time.

[subnet]

well my first was taken in the afternoon so I would expect it to be lower...

[flatscat]

I was talking about the free t number - I am wondering if the >49 number is false.

[subnet]

Oh -i see - I guess it could be. Was thinking about not going back but maybe should just for somw confirmation on the #'s. Still thinking about contacting another clinic.

[subnet]

ok - have an update finally!

Received the info from my 3rd round of bloodwork. This time I asked them to measure my E2 (Estradiol) level even though the endo said it wasn't needed unless I was showing signs... I didn't agree but she put it on the test

Total Test serum = 225 (range 241-827)
Free Test = 43.1 (range 8.7-25.1)
Estradiol = 45 (range 0-53)

She decided to put me on Androgel 5mg for 2 months then re-test. From what I've read, I should experience things getting better, then starting to get worse again since my body will stop producing T itself. I am also concerned that my Est level is at the high end of the range. I think until I show that in 8 weeks my numbers are lower, I am stuck with the 5mg of Androgel and no AI.

Still unsure why my free T is high? With my Est level being 45, should I be looking at an AI to knock it down?

Thoughts?

[ZonaDave]

wow, your Free T is really good for not being on anything. i don't think i've ever seen that before. most guys have both low Total and Free T when seeking treatment.

you might do well on just and AI treatment by itself. would she go for putting you on .25mg of adex 2x/week without the androgel ?

[subnet]

everthing I've read never points to having a high free but low total - it's strange. I thought about just the AI as well, but still wouldn't I want to boost my T anyways? I guess from what I've read, by lowering Est, it should raise T right?

Also, I have an appointment with an Aging/Longevity doctor next week so plan to go to him and see what he says about treatment, rather than just throwing Androgel at me and thinking it's the answer... it's just $$ I guess!

[flatscat]

I have never seen anyone's labs look like this either - your E2 numbers are high end and in theory the AI should lower that number which should increase total t - but "in theory" doesn't look like it applies to you - how are you feeling?

This is very interesting and I am sure there are a number of us following - let us know what the anti-aging doc says please.

Thanks,

Flats

[subnet]

how do I feel? well I have all the symptoms of low T, other than my erections aren't bad. Irritability, lower libido, poor sleep, trouble concentrating - all these apply. The biggest for me is hot flashes, like I'm burning up and constantly hot.

I'll definitely update after I see the anti-aging doc on Tuesday. He's supposed to be good - I'm confident that I'll know a lot more after that visit. Of course, I might have a lot more unanswered questions but at least this is a specialist in the right area. As I said, my endo didn't even want to test for Estradiol because she didn't think it was important, so my confidence in her HRT info isn't high at all.

[zaggahamma]

how do I feel? well I have all the symptoms of low T, other than my erections aren't bad. Irritability, lower libido, poor sleep, trouble concentrating - all these apply. The biggest for me is hot flashes, like I'm burning up and constantly hot.

I'll definitely update after I see the anti-aging doc on Tuesday. He's supposed to be good - I'm confident that I'll know a lot more after that visit. Of course, I might have a lot more unanswered questions but at least this is a specialist in the right area. As I said, my endo didn't even want to test for Estradiol because she didn't think it was important, so my confidence in her HRT info isn't high at all.

i've never heard complaints of hot flashes to such degree...it seems like your biggest symptom but you do mention all the others....so glad youre getting help...

yes the total and free test levels have always confused me...i've read where all that matters is the free test, etc., but then why would you have the poor symtoms with yours so high...

anyway...the anti aging clinics ARE the way to go....you'll pay a lil more, yes, but if you can afford it you'll save time from going doctor to doctor starting with the lil doses of gel and coming back and blah blah blah

just my .02

[ZonaDave]

hot flashes and sweating is common with high E2 and probably low E2 for that matter...

[subnet]

and here we go with another update

So I finally am able to get into the anti-aging clinic today and wow, it was GREAT! Finally being able to talk to a Dr. with him actually knowing more about TRT than from what I know after reading here and other places. I spent over an hour with him, talking to him about every thing I had in my little pea-brain. Again, this is what this guy does, he has written books about Andropause so he's very well versed.

So I'm trying to remember everything we covered... it's not entirely fresh in my mind, but we discussed numbers quite a bit (levels), and I asked him about my high Free T level, to which he says that the free-T test is often quite unreliable and he doesn't put too much faith in what it is at. Since I'm having the hot flashes and not feeling well, then we need to do things to fix it. At one point, he starts mentioning HCG , that we may need it at some point, also talks about AI's. Talkes about a new form called Nebido to which I of course know about from reading here.

Mentiones that we really need to know why I'm low, either primary or secondary, and that by looking at my other numbers, he's not sure but thinks it's primary. Also talked about a possible link between vasectomy's and low T later in life, that it's something he's considered. Wants to put me on gel for 1 month, retest and then go from there. He said he's not all about numbers but how the patient feels. Wants to check my Ferritin level (amount of iron in the blood), but of course Test and Estradiol to see if it's still high or what has happened after a month on the gel. After this test, we'll decide on what kind of cocktail is needed (if one is needed), including AI if necessary, and also HGC etc.

I asked what he like regarding the administration of Test, gel, etc. and he was open to anything and mentioned pellets, gels, injections. First try gel, but he said that injections are OK but it's difficult to get to the office every 2 weeks so most of his patients don't do that. I was surprised at the every 2 weeks rather than every one however? He then said that if it was difficult for me to come in (it isn't but I didn't say), that he could teach me how to self-inject! I guess it was then that we got on the Nebido discussion.

Anyways, it was nice to finally talk to someone who really knew his stuff, and the fact that he was very upfront in trying to make me feel right based on how I feel and not just going by the book of numbers. He wants to start slow with the gel just to change one thing at a time and get a different baseline, and said that maybe my hot flashes will go away with just the gel, but that he'll fix it regardless. He asked if I wanted to get more of this work done and then he can refer me back to the Endo, but I said I'd rather stick with him of course!

One thing is that he said I already have some gyno that sucks but nothing I can do now other than make sure my E2 levels are in-check.

So, bottom line, is that if anyone is getting no-where with their PCP or their specialist, really do your homework and see if there's someone who specializes in this. It was a welcome relief. I'm already looking forward to my one-month visit.

[zaggahamma]

and here we go with another update

So I finally am able to get into the anti-aging clinic today and wow, it was GREAT! Finally being able to talk to a Dr. with him actually knowing more about TRT than from what I know after reading here and other places. I spent over an hour with him, talking to him about every thing I had in my little pea-brain. Again, this is what this guy does, he has written books about Andropause so he's very well versed.

So I'm trying to remember everything we covered... it's not entirely fresh in my mind, but we discussed numbers quite a bit (levels), and I asked him about my high Free T level, to which he says that the free-T test is often quite unreliable and he doesn't put too much faith in what it is at. Since I'm having the hot flashes and not feeling well, then we need to do things to fix it. At one point, he starts mentioning HCG , that we may need it at some point, also talks about AI's. Talkes about a new form called Nebido to which I of course know about from reading here.

Mentiones that we really need to know why I'm low, either primary or secondary, and that by looking at my other numbers, he's not sure but thinks it's primary. Also talked about a possible link between vasectomy's and low T later in life, that it's something he's considered. Wants to put me on gel for 1 month, retest and then go from there. He said he's not all about numbers but how the patient feels. Wants to check my Ferritin level (amount of iron in the blood), but of course Test and Estradiol to see if it's still high or what has happened after a month on the gel. After this test, we'll decide on what kind of cocktail is needed (if one is needed), including AI if necessary, and also HGC etc.

I asked what he like regarding the administration of Test, gel, etc. and he was open to anything and mentioned pellets, gels, injections. First try gel, but he said that injections are OK but it's difficult to get to the office every 2 weeks so most of his patients don't do that. I was surprised at the every 2 weeks rather than every one however? He then said that if it was difficult for me to come in (it isn't but I didn't say), that he could teach me how to self-inject! I guess it was then that we got on the Nebido discussion.

Anyways, it was nice to finally talk to someone who really knew his stuff, and the fact that he was very upfront in trying to make me feel right based on how I feel and not just going by the book of numbers. He wants to start slow with the gel just to change one thing at a time and get a different baseline, and said that maybe my hot flashes will go away with just the gel, but that he'll fix it regardless. He asked if I wanted to get more of this work done and then he can refer me back to the Endo, but I said I'd rather stick with him of course!

One thing is that he said I already have some gyno that sucks but nothing I can do now other than make sure my E2 levels are in-check.

So, bottom line, is that if anyone is getting no-where with their PCP or their specialist, really do your homework and see if there's someone who specializes in this. It was a welcome relief. I'm already looking forward to my one-month visit.

glad youre happy and sorry about the gyno....i never heard of such a conservative anti age doc...they normally give you injectable...is the gel going to be from compounding pharm? what kind? what dose?

[subnet]

glad youre happy and sorry about the gyno....i never heard of such a conservative anti age doc...they normally give you injectable...is the gel going to be from compounding pharm? what kind? what dose?

thanks jpk - well I think that's part of my fault - I should have insisted on injections, which is what I wanted... He most-likely gave me gel because that's what my other prescription was for, even though I hadn't filled it yet. The gel for now is just Testim @ 5mg daily. Smells like I was putting hand sanitizer on - yuck. I also have another prescription for Androgel from my Endo so I might see what I like better. Still, i'm either going to wait my month so he can gauge my levels again, or go back sooner and ask for injectible like I should have in the first place. I am not sure he's that conservative, rather he just wants to see what my levels are in a month... hmmmm...

[zaggahamma]

thanks jpk - well I think that's part of my fault - I should have insisted on injections, which is what I wanted... He most-likely gave me gel because that's what my other prescription was for, even though I hadn't filled it yet. The gel for now is just Testim @ 5mg daily. Smells like I was putting hand sanitizer on - yuck. I also have another prescription for Androgel from my Endo so I might see what I like better. Still, i'm either going to wait my month so he can gauge my levels again, or go back sooner and ask for injectible like I should have in the first place. I am not sure he's that conservative, rather he just wants to see what my levels are in a month... hmmmm...

i know testim and androgel ....the testim smells a little more and is stickier imo....they both helped my in the beggining but graduated shortly thereafter

[subnet]

that seems to be the concensus around here, the gel might work for a while then they arne't enough. Think I should just call the guy back right away and ask for injections, instead of spending the month on the gel?

[zaggahamma]

that seems to be the concensus around here, the gel might work for a while then they arne't enough. Think I should just call the guy back right away and ask for injections, instead of spending the month on the gel?

not sure on that...i think the gels do work for some but geeeeeeeeeez...u wanna wipe that shiat on EVERY FVKIN day??????

i remember reading a post similar talking about gels and a couple posters were doing fine with it and speaking of levels being round 1000 on the shiat...it just aint for most

[subnet]

i hear you man - after jusst 2 days on this crap, I realize that this isn't going to work for me. Smells, is sticky and I'm worried about transfer. Just talked to the Dr. office and have made an appointment for next week where they'll inject me and show me how to self-inject, so that's good!

I also just found out this morning that after one week trying to get pre-authorized for my Androgel from my Endo, they've denied it - what a load of sh!t. Now we'll need an appeal from the Endo which could take a long time. No big deal I guess if I switch to the vial from the anti-aging Dr. I wonder how much more difficult it will be to obtain Test C or Test E vs the damn gel.

[CRACKER]

i dont know how familliar you are with that gel but ive read a forum on here about a guys chick getting sides from him being on the gel though skin on skin contact dont know if you have kids but that also could be a problem i would def try to stick with injections man but the gels do help with maintaing levels better

[subnet]

definitely read that too, and I also have kids so that was something I considered. Still the though of going through the rest of my life smearing that smelly crap on me every damn day doesn't sound too appealing... Next week I'll learn to do it myself and go from there.

[fm2002]

i get a kick out of doctors using the "range" as the only guide to make a decision. the Total T range is a joke and should only be used as a "reference".

when i first started having low T symptoms i was 36 years old and my Total T was close to 700! a few years later my symptoms got considerably worse and my Total T was 366. only then did a doc put me on TRT.

now i'm at 1250 on my shot day and feel like a new man.

some guys do fine on low TT while others need to be alot higher. there's only one way to find out...try it and see what happens.

i think it's time to find a new doctor. before you make an appointment, talk to the doc on the phone and ask him some questions about his procedures for administering TRT. any doc that's worth while will take the time to consult with you over the phone before making an appointment.

i'd love to be a doctor. it's one of the few occupations where your clients don't have to see any results but you still get paid.

Don't forget lawyers. Theyr'e even worse. They get paid even when they lose

[fm2002]

I would like to mention E2's affects to my libido. I found when my E2 levels were first high and than aftertaking a AI (Arimidex ), too low my libido and hardness of erection was lacking. That said after I reduced my Arimidex dose and got my E2 numbers where I wanted them "oh boy" did both come back

[subnet]

fm - what are your 'good' E2 numbers? I've read here and I think my Dr. said 20 to 25 (or there abouts) is a good range...

[fm2002]

fm - what are your 'good' E2 numbers? I've read here and I think my Dr. said 20 to 25 (or there abouts) is a good range...

For me it's around 27, but you'll need trial and error and blood tests to confirm to find your sweet spot.

[zaggahamma]

i hear you man - after jusst 2 days on this crap, I realize that this isn't going to work for me. Smells, is sticky and I'm worried about transfer. Just talked to the Dr. office and have made an appointment for next week where they'll inject me and show me how to self-inject, so that's good!

I also just found out this morning that after one week trying to get pre-authorized for my Androgel from my Endo, they've denied it - what a load of sh!t. Now we'll need an appeal from the Endo which could take a long time. No big deal I guess if I switch to the vial from the anti-aging Dr. I wonder how much more difficult it will be to obtain Test C or Test E vs the damn gel.

i started checking with my insurance FIRST to see what and how much they pay for all of it before TELLIING the fvking doctor WHAT to prescribe....saves time and energy

[subnet]

well I did check and they do cover the gel's etc., but apparently the Endo's office forgot to put the results of my blood work in their 3-page report they had to fill in (dumbasses). I'm positive we'll get it worked out thru appeal, but now that I'm going to get Test C or E through the other Dr. it doesn't really matter.

In fact, we'll have to see if insurance is even worth it depending on the price of the vial. Of course, if we ever have to do an AI or HCG (which I'm expecting), hopefully there won't be any insurance hassles. I'll try to check to see if there is any pre-auth needed on those too. I just realized that I went to my first Dr. appointment about 2 months ago - it's taken me this long to do all my rounds of bloodwork and finally get my 'trial' month supply of gel. I'd still be without TRT if I had to wait on the damn insurance

[subnet]

well, just got back from my first shot today of Test E. Dr. wants to put me on 200mg every 2 weeks. I said I'd rather do once a week but he said everyone is different, go for bloodwork next week to see what my level is and he might adjust to once a week or that plus change the dose. Have a 3-month prescription so at least I'll just start this program and continue. He also mentioned he's going for Nebido 'training' in December so sounds like it's coming out soon here. From what I've read, the longer half-life might make things better and require less frequent injections (can't remember the name it will be here in the US).

How long should it take for me to feel this first injection kicking in? A few days I'm guessing?

[ZonaDave]

well, just got back from my first shot today of Test E. Dr. wants to put me on 200mg every 2 weeks. I said I'd rather do once a week but he said everyone is different, go for bloodwork next week to see what my level is and he might adjust to once a week or that plus change the dose. Have a 3-month prescription so at least I'll just start this program and continue. He also mentioned he's going for Nebido 'training' in December so sounds like it's coming out soon here. From what I've read, the longer half-life might make things better and require less frequent injections (can't remember the name it will be here in the US).

How long should it take for me to feel this first injection kicking in? A few days I'm guessing?

is the doc going to give you shots or will he let you self-inject?

it should take a week or so to feel the affects but unfortunately it's possible that will deminish after the first week due to the half-life of T. most docs start their patients out with 100mg/week but they front load the first shot with 200mg to elevate T levels to compensate for the half-life.

[subnet]

self-inject! Showed me this morning how to do it, but I've been watching vids and reading every post here on it. He prefers Glutes and Delts and not quads, but I've been leaning towards quads just since I can see them easier.

Stoopid insurance will probably only give me a couple of 1ml vials though since they like to break things into one-month segments. Depending on the price, I might just buy it from the same place, but out of insurance to get the full vial... Walgreens should be comparable hopefully to other places.

I'm definitely thinking that I'll go on an EW schedule after everything I've read, but will do my bloodwork first just to follow his directions. I should be on day 12 or 13 when I get my blood checked so should be nice and low! I don't think he will really care though if I do EW vs. EOW, he just wanted to see EOW first. I've been on Testim for one week so do have a bit of T in my system already, although I don't really feel like I'm seeing/feeling any benefit yet (although my wife says I haven't been as grumpy lately).

[ZonaDave]

i've heard of some guys doing well on an EOW shot schedule but most shoot weekly or semi-weekly for more stabil levels.

it's a good idea to follow his instructions at first because you have to stroke their ego. when the results come back lower than expected, that's when you suggest trying weekly to see if that helps.

[subnet]

well, I have had some of my bloodwork come back, and just as I thought, my Total Test was low at 183 (241-827 range). This was on day 13 after a 200mg Test E injection. The last 4 or 5 days before the test were a b!tch - wanted to sleep all the time and felt worse than before I started the TRT. Self-injected .5ml of Test E for my very first time and it was a piece of cake! Did the glute but want to try the quad next.

I'm still waiting on the Estradiol result but since I was high before TRT, I'm still going to be high me thinks.

Final test was for Ferritin level (Iron) which was at a 28 out of a 20-380 range. Barely in the range... Might have to take Iron supplements but dont' know yet. Of course, when I look up Ferritin deficiency, some of the main symptoms are fatigue and irritiability which sound strangely familiar to also having low Test! Other symptoms are light-headedness, pale skin, stiff neck and headaches (I have all these).

Anyways, until I get the E2 results back and speak to the Dr., I'm not sure what's going to happen with my dosage. I know I definitely am going to inject once per week regardless of what he says (don't see him not agreeing with this), but am curious if he's going to up the dosage at all. I'm going to ask for an AI unless my E2 results come back low which again I doubt. Going to see what he thinks about Iron supplements and if he's concerned with the very low level...

So, as you all said, this is going to take a while to get things dialed-in but at least I think we're going in the right direction to learning what my body needs...

[zaggahamma]

well, I have had some of my bloodwork come back, and just as I thought, my Total Test was low at 183 (241-827 range). This was on day 13 after a 200mg Test E injection. The last 4 or 5 days before the test were a b!tch - wanted to sleep all the time and felt worse than before I started the TRT. Self-injected .5ml of Test E for my very first time and it was a piece of cake! Did the glute but want to try the quad next.

I'm still waiting on the Estradiol result but since I was high before TRT, I'm still going to be high me thinks.

Final test was for Ferritin level (Iron) which was at a 28 out of a 20-380 range. Barely in the range... Might have to take Iron supplements but dont' know yet. Of course, when I look up Ferritin deficiency, some of the main symptoms are fatigue and irritiability which sound strangely familiar to also having low Test! Other symptoms are light-headedness, pale skin, stiff neck and headaches (I have all these).

Anyways, until I get the E2 results back and speak to the Dr., I'm not sure what's going to happen with my dosage. I know I definitely am going to inject once per week regardless of what he says (don't see him not agreeing with this), but am curious if he's going to up the dosage at all. I'm going to ask for an AI unless my E2 results come back low which again I doubt. Going to see what he thinks about Iron supplements and if he's concerned with the very low level...

So, as you all said, this is going to take a while to get things dialed-in but at least I think we're going in the right direction to learning what my body needs...

maybe you can get enough iron in a modified diet...i always though that it was rare for men to be low in iron...wonder why yours is low maybe its not being absorbed?