Do I need TRT?? Blood work Attached!

[Drip420]

Hey Guys, I just stumbled across this forum and thought maybe someone can give me some advice. I'll try to keep this post as concise as possible. Thanks in advance!

Starting from the beginning - I've had problems concentrating and maintaining focus, putting on muscle, night sweats, low energy levels, remembering things, etc since high school/college. My GP gave me a blood test back in 2015, and determined that I have low testosterone levels as well has elevated prolactin levels. Not sure what caused this - I did take accutane for acne when I was 15, 17 and 22 (6 months each course) and it eliminated my acne. I also partied a lot in college.

Ever since my initial labs, I've been trying to figure this out on my own. I have seen an endocrinologist that prescribed me cabergoline. The medication worked a bit initially but soon gave me headaches. I'd figured that the cabergoline was depleting my prolactin levels so I started to take a lower dosage - .25MG every 3 weeks instead of .5MG every week. My headaches were gone but my total testosterone stayed low..(all of this is reflected on my attached file) I also went in for a MRI to see if my pituitary gland has a tumor/abnormalities but the result came out negative. Since then, I have stopped taking cabergoline in 2018 and haven't done much to follow up with the endo.

I've recently been lurking the forums and completed some bloodwork referencing a lot of what other members test for. Some quick Bullet points:

• Total Testosterone, Serum - 463.7 (264-916 ng/dL)
• Testosterone, Free, Direct - 25 (9.3-26.5 pg/mL)
• Vitamin D, 25-Hydroxy - 36.5 (30- 100ng/mL)
• Prolactin - 27.8 (4-15.2 ng/mL)
• LH - 3.6 (1.7 ‐ 8.6 mIU/mL)
• FSH - 2.9 (1.5 ‐ 12.4 mIU/mL)
• TSH - 3 (0.450 ‐ 4.500 uIU/mL)
• SHBG - 15.8 (16.5 ‐ 55.9 nmol/L)
• (More results on the attached file)

Since my last follow up with my endo, I've been taking 4500IUs of Vitamin D3 and 15mg Zinc w/ 2mg Copper for the past 2 years and have felt a little better. My recent labs surprised me with my total t levels going up a bit to 463ng/dL(not nearly at optimal levels), but also my free testosterone is at 25pg/mL?? Not sure how that works, maybe because of the low SHBG? Is that normal?

Not sure if this can be fixed with just supplements/nutrition, I've been thinking about starting TRT/HCG following the best practices sticky thread method. I've attached a spreadsheet with my lab results that I've been tracking since 2015. Hopefully you guys can give me some input. Thanks again!!

Personal Stats:
27 y/o male, roughly 165lbs, 20-25% BF according to InBody 270 (US Navy Method - 17% BF), 5`8 - 5`9" // Lift weights 3 times weekly

Nutrition - mostly low carb/high protein diet. Lately, I've been eating more like a pescatarian, substituting fish for chicken/beef.

Supplements (everyday) - 4500IU Vitamin D3, 15mg Zinc Orotate w/ 2mg Copper Orotate, 500mg Chelated Magnesium Lysinate

(With these latest lab results: I will be increasing my intake of vitamin D3 to 6000IU's and will be intaking more fiber to lower LDL Cholesterol.)

[Youthful55guy]

Your Testosterone levels are excellent! Do not look at the Total T lab, it's worthless. It's Free T that matters and yours is in the excellent range for a man of any age. Your Total T is a bit lowish because your SHBG is a bit low. SHBG binds and protects T from liver metabolism. However, it also tightly binds T and prevents it from becoming Free T. only Free T can pass through the blood-brain barrier.

Yese, your prolactin is a bit high, but mine bounces around. In some labs it's within range an a couple of others it's slightly high. Since you are having consistently high prolactin, it's probably real. Since there is no pituitary tumor, I have no idea what's causing it. There are others here with more experience than I with dealing with high prolactin. perhaps they can provide some advice.

[Drip420]

Thanks for the input Youthful55guy! I'm planning to do another blood test next month to make sure this is not a fluke.. Still experiencing symptoms. Will report back soon.

Anyone have some input on how to combat elevated prolactin levels??

[Kyle1337]

Your LDL is absolutely fine. LDL increases with low carb diets, this is perfectly fine. Do some current research on LDL on low carb diets. We've been forced to believe LDL elevation is bad for us, yet it's in fact better. Research from 100 years ago is the same shit we regurgitate this day and age. It's not accurate anymore.

Also, your test levels are amazing.

[Drip420]

Got it, thanks for the input Kyle. I'll do some research in regards to LDL.

Hope my free test levels aren't a fluke.. it was at 10.6 pg/mL (9.3 - 26.5 pgmL) 4 years ago. Maybe the vitamin d3 and zinc did the trick??

[Drip420]

Hey Guys, I got some additional results from my recent labs. Please see below:

• Dihydrotestosterone - 25 (30 - 85 ng/dL) Low
• % Free Testosterone (Dialysis) - 2.9 (1.5 - 3.2%)
• Free Testosterone, Serum - 132 (52 - 280 pg/mL)
• Bioavailable Testosterone, % - 63.6%
• Bioavailable Testosterone, S - 289 (128 - 430 ng/dL)

Could it be that my body is not converting enough free T to DHT that are causing the symptoms that I'm experiencing? Thanks for the help and I appreciate the feedback!

[Youthful55guy]

Are you taking finasteride? The only way I've ever been able to my DHT down that low is with a whopping 5mg dose of finasteride. I've since backed off to 2.5mg and will have new results in a couple more weeks.

If you are not taking finasteride, then yes, you seem to have a conversion issue. Great for the hairline and for BPH prevention, but not so good for the libido.

[Drip420]

Are you taking finasteride? The only way I've ever been able to my DHT down that low is with a whopping 5mg dose of finasteride. I've since backed off to 2.5mg and will have new results in a couple more weeks.

If you are not taking finasteride, then yes, you seem to have a conversion issue. Great for the hairline and for BPH prevention, but not so good for the libido.

Hey Youthful, I'm not taking finasteride or anything else besides the supplements mentioned above. Any thoughts on how to increase the DHT levels?

[Youthful55guy]

Hey Youthful, I'm not taking finasteride or anything else besides the supplements mentioned above. Any thoughts on how to increase the DHT levels?

I don't, other than d@# they are low! Given that your Free T is pretty good, this is the first place I'd look for a possible root to your low T symptoms. I don't think there are any companies in the USA that sell DHT as a drug. I did read of one company in Europe that sells it as a cream, but I've not looked into it (no need for me). Another option for research and/or experimentation is to layer in a synthetic analog of DHT (in addition to TRT) to see if that helps you any. You would have to start TRT because the DHT analogs are all suppressive to the HPTA.

Your best option in the USA would be Anavar with a starting dose of around 10mg, which has been shown in studies (and my own experience with SHBG suppression) to have minimal liver toxicity. The biggest challenge would be convincing a doc to prescribe it, as it would be an off label use and docs are hesitant to do this with anabolic steroids . Alternatively, you could go to an overseas supplier and obtain it yourself. If you go that route, you might want to consider Stanozolol too. It's a lot less expensive and my experience with SHBG suppression is that you need half the dose. Don't know if this experience transfers to DHT supplementation.

[Drip420]

Seems like this is going to be a challenging one.. I'll do more research on figuring out how to increase DHT without negatively affecting my other metrics. Will report back after my next blood test in late-Feb. Thanks again!

[kelkel]

Interesting issue guys. I've been on fina (5mg) for years due to bph. Zero issues even with dht levels running low. About two months ago I pulled BW and my psa came back at 4.1. Slightly over scale. At the time I was on about 100 mgs per week of T and deca . After thinking about it for a while I decided to up my dose of Doxyzosin (alpha blocker - smooth muscle relaxer. Think prostate-penis) from 1 mg twice daily to a 4 mg extended release dose protocol.

After even more thought (accidents happen) I could only think of one change that may have caused my psa to spike. I normally run low dose nolvadex (serm) at 10 mgs daily. Studies show that serms can reduce prostatic inflammation as well as reduce prostate cancer risk. So i reintroduced the nolva and just now pulled BW again. About two months or less later. PSA dropped to 2.8. Interesting! At least to me. Also of note my test dosing is at 200 mgs weekly during the past two months.

I also pulled my DHT level which I haven't done in a while. Came back at 13 on a scale of 30-85. E2 at 61.2 on a scale of 8-35. Zero issues. Anyway, just a little sidebar conversation somewhat related to the topic of this thread. I know 55 will find it interesting....

[Youthful55guy]

Kel, My experience is that a sudden spike in PSA can be a sign of a prostate infection. Look at the graph below. My PSA normally is <1. Then it suddenly spiked. We started antibiotic therapy a couple days after the spike and the PSA came down dramatically after the 40-day antibiotic treatment was completed. Still not back to <1, but will hopefully get there.

[kelkel]

Kel, My experience is that a sudden spike in PSA can be a sign of a prostate infection. Look at the graph below. My PSA normally is <1. Then it suddenly spiked. We started antibiotic therapy a couple days after the spike and the PSA came down dramatically after the 40-day antibiotic treatment was completed. Still not back to <1, but will hopefully get there.

No doubt it can. Funny, when I first started fina I obviously didn't want to and after my psa dropped to an acceptable level I thought I try going without it. Shot back up to a 7 or so (scale tops out at 4) therefore I went back on and have stayed there.

Obviously I partake in more than TRT levels of T on occasion and the efficacy of Fina is quite impressive at handling the conversion of T to DHT.

[Youthful55guy]

Have you considered it could be a chronic prostate infection? I've been doing a lot of reading lately on prostate infections and they seem to divide them into acute and chronic categories (they have names and acronyms for each but I can't remember off hand). Chronic infections are harder to detect and often reoccur even when treated. Acute infections are often successfully treated with one course of antibiotics. I'm hoping for the latter and it seems that PSA is a good barometer for the infection.

[kelkel]

I have not considered that but will read up on it a bit.

[Drip420]

I found an interesting post on reddit about DHT and how it relates to prolactin, estrogen, etc. It also mentions zinc deficiency causes DHT / Prolactin levels to increase?? I'll include the link below:

https://www.reddit.com/r/steroids/co..._power_of_dht/

Guess I'll try increasing my dose of Zinc from 15mg to 30mg, and I heard Boron increases DHT as well.. might give that a shot. Any thoughts?

[kelkel]

You ran both Doxy and Nolvadex during that two months? Any idea which modified the PSA more? Probably hard to say but IDK if you have run similar experiments before.

Edit: would you consider the Nolvadex for long term use, like as a permanent part of your protocol or just as a short term thing?

Nolva probably moreso than the Doxy. Nolva reduces inflammation where Doxy mostly helps with nocturia and stream issues. Doxy works best when combined with Fina. I've been on 1 mg BID of Doxy for years. I just upped it yesterday to the 4 mg extended release version to see if there are any improvements.

Yes, I have no issues with low dose nolva long term. I'm on it more than off.