Help with Bloods

[Chickbock]

Hi

First off a bit about me

6’2
92kg (usually 90kg but I have just come back from holiday)

6 years ago I started complaining about erections and sexual desire energy etc. I went to my GP who did a blood test all was normal.

I have been given viagra, challis and another one I cannot remember. These help me with the erections but I feel robotic / going through the motions / unnatural. Also headaches / flushes.

I used to excersize a fair amount. I was a healthy weight. (Not toned or muscular) 34 inch waist.

I let myself go a little (after getting married) my erections and libido have not really changed. In the last 6 years. I have an understanding wife.

When researching strength training programs I came across testosterone levels. I match all of the symptoms apart from weight gain. (My diet was to blame for that). My diet is pretty decent now. I had a prick test for testosterone which came back as low. They prescribed Testim gel. I used this and felt better and libido was back however I was also on holiday in the Caribbean for two weeks during use so this could also have changed me.

I stopped the Testim after the first 30 day trial. Libido is back to. Or all (non existent). I stopped after researching the forum and finding that it could be a host of other things. I did another finger prick test 2 days after stopping Testim which came back high. I have then had full bloodwork done 2 weeks after stopping Testim.

2012 - 18.9nmol
November 2017 - 12.9nmol
December 2017 - above 52 nmol

Two days ago 13.8

Attached is the full bloodwork. Free T is low.

Any help would be appreciated

[Youthful55guy]

You Free T is definitely low, even though you SHBG is well within range. It appears to be driven more from low T production than SHBG binding of T. What the labs don't tell you is the root cause of the Low T. Basically, are you Primary hypogonadal (testicles not making T), or are you secondary hypogonadal (hypothalamus/pituitary not making LH/FSH). I suggest you dig deeper into that before messing up your normal endocrinology with TRT. It takes about 4 to 6 weeks for it to completely come off of TRT and get back to your normal steady state. Therefore, best to get the diagnosis early on.

You'll probably want at least one early morning LH/FSH labs to check you morning gonadotropin levels. Keep in mind that there hormones are highly episodic and can bounce around, depending on whether or not you happen to hit a peak or nadir. That's why they recommend an early morning test, as that's when these hormones are typically at their highest levels of the day. Even if your tests come back as low, you still need to figure out if the problem is at the hypothalamic or pituitary level. Ever have trauma to the head? Whiplash? This can sever the connection between the hypothalamus and the pituitary. A GnRH challenge test might help you sort out whether or not your pituitary is the problem, if not, then it points to the hypothalamus. Normal LH/FSH in combination with Low T usually indicates that the problem is with the testicles.

I'm not a proponent of topical T because it's expensive, messy, and the absorption is not always predicable. However, it seemed to work well for you in your trial, so you might want to consider it. I much prefer injectables and prefer T-cyp or T-eth with a 40-50 mg every 3 day dosing schedule. Since you are in Europe, you may wish to consider Nibido, some guys seem to like it, others do not. It's too new to get a complete story. I think some of the bad experiences are due to the docs still trying to figure out an optimal dosing schedule.

[Chickbock]

Thanks for your reply youthfulguy.

No head trauma or anything to report (other than bump as a child pre puberty). So if my LH/FSH come back as normal then it is the testes. (Or more likely to be the testes).

Can the cholesterol levels impact my T or free T negatively.

I am now kind of stuck on where to go from here.

1. Back to the GP with the medicheck results after LH/FSH test. To potentially be told you are in the normal range.
2. Lower cholesterol Lose weight, work out repeat tests in 12 weeks a
3. Start TRT (test cyp - Hcg) (subject to LH/FSH) now and rest again in 6 weeks.

Although with number 2 I am pretty that when I was active I’m sure I would have had low T then as my symptoms have not changed.

[kelkel]

Listen to YG55. Also Chick edit out your personal info from your post. You don't need that floating around the internet.

Welcome to the forum.

[Youthful55guy]

Can the cholesterol levels impact my T or free T negatively.

I am now kind of stuck on where to go from here.

1. Back to the GP with the medicheck results after LH/FSH test. To potentially be told you are in the normal range.
2. Lower cholesterol Lose weight, work out repeat tests in 12 weeks a
3. Start TRT (test cyp - Hcg) (subject to LH/FSH) now and rest again in 6 weeks.

Per kel's suggestion, he means on the PDF you attached. I noticed it too but didn't say anything. You should edit out everything at the top of the report.

Lowering cholesterol will in no way raise your T. It may have the opposite effect. T is indirectly made from cholesterol.

I would not restart TRT unless you are ready for a lifetime of commitment to treatment. It's not the kind of thing you can start and stop. You feel like $#!% for several weeks when you quite (worse than pre-treatment). You need to be off TRT (with T-cyp or T-eth) for at least 6 weeks before you can re-test. The recovery time for Nibido is MUCH MUCH longer (I actually have no idea how long). Once you introduce exogenous hormones into your system, there is a cascade effect in shifting the levels of dozens of hormones in the body and it takes that long to come back to a stable baseline.

This means, if you are going to pursue a more refined diagnosis (primary or secondary), or if you think simply living healthier will fix your problem, you should do that BEFORE you dive into TRT.