34 yr old 255 total testosterone

Hi, I am a healthy 34 yr old male with low testosterone. There's so much information on the web to wade through and I'm hoping I can get some informative comments here so I know where to start.

I had my testosterone checked a few years ago and total testosterone was ~280 the first time and ~320 the second. Doc put me on 1% gel. I discontinued after two months because we were trying for kids.

I went to low T center today and my TT was 255 (at 9AM). The doc said this was enough for a low T diagnosis. However, I've been reading that free testosterone is what should be checked. So why are docs even testing for TT? Is it possible that I have average/normal FT but low TT?

Doc wants to run another TT test before starting me on HRT. He will put me on testosterone cyp once a week if this one comes back low also, which it probably will based on my past labs. The target TT will be ~600 since that's what would be considered "normal" for my age. Should I have him check my FT before starting HRT? Any other advice? Those that have been on HRT, what would you have done differently when you started?

Hello Patlet,

Step one is comprehensive blood work. You didn't mention full blood work so I'm assuming you received a hormone panel exclusively. That said, it's insufficient to diagnose what may be causing the low T. Yes, it's possible it's idiopathic but normally for someone your age there are contributing factors. Is it primary hypogonadism or secondary? Way to many questions without full blood work.

Many things can cause low T such as hypothyroidism, cortisol or prolactin issues, pathologies or even head or testicular trauma and varicoceles. Full blood work will help you determine where the issue lies and give you a logical path to address it. It may be fixable and you can avoid HRT for another 10 years or so, who knows, but I'd hate to enter into a protocol with reservations that I did not do enough to find the causative factor.

The issue with many doctors is that they don't know hormones as they are not trained in them in med school. It's basically an acquired skill unless they take on advanced training such as an A4M Certification, etc. Title of the doctor really doesn't matter, just that they understand hormones and will treat you based on how you feel, not as a number. The doc you mentioned is already treating you like a number.

Re free testosterone, yes, it's what evaluations should be based on as FT is what works for you. It's doubtful that your FT is adequate when your TT is that low. Even with a low SHBG level (it binds your testosterone in your blood) odds are your FT is inadequate.

Take a look in the Finding A Doc sticky thread at the top of this forum and get the first set of blood work listed. It will give you the opportunity to make an educated decision which path to take. I know it's hard to hold off when someone is offering this to you but it really is in your best interest.

And who wants to be "normal" for their age?

Welcome to the forum Patlet!

Kel