High total T, low free T

[Bobbies]

My total T is higher than normal, while my free T is actually lower than normal. That's a pretty extreme variation. I do have a lack of libido, energy, and motivation. I have read that when total T is low, but free T is fine, doctors will not likely prescribe TRT because "free T is the important part", but what about in this case?

They may think, "His total T is high enough, so let's not increase it even more". Although there's nothing wrong with high total T, doctors may assume there is. But I have symptoms of T deficiency that interfere with my life, despite high total T.

[theheat]

..........

[theheat]

I definitely wouldn't want to go on HRT if I had high total T naturally. Additional androgens do supress SHBG, but at the cost of your own natural T. You probably have high SHBG and E2. There's not much else you can do about the SHBG, except perhaps Proviron, but it would also suppress your T production. I heard "stinging nettle" may work, but I don't have much faith in herbs. You could take an AI like Arimidex if you have high E2, and that may bring down your SHBG somewhat, as high E2 usually elevates SHBG. Post your labs, that way we could get a better idea of what's going on.

[Bobbies]

I asked if doctors would prescribe TRT to me with this result. My natural production (from LH) is probably too high considering high total T and possible high E2. In fact, I have frequent testicular irritation. SHBG also binds E2, remember. An AI wouldn't reduce my natural production of T, but it would be a good idea to combine one with TRT.

[BallSak]

Post your labs so we know what you're talking about including thyroid and cortisol.

High SHBG usually tells you there's a problem somewhere.

[Bobbies]

My thyroid is normal, and my cortisol is a little high. I'm interested only in TRT at this point for the reason I outlined in the previous post.

My question is: Would a typical endo prescribe me TRT in this case, with symptoms of low T?

[theheat]

When you say your total T is higher than normal, what is it? 900? 1,200? No doctor is going to put you on TRT with a total T of 1,200. Why would you want to anyways? It would just take the place of your natural production and then it would still be bound by SHBG, so you'll end up with same #s. You wouldn't go up to an 1,800+ total T unless you took 500 IUs of HCG a week. Unless you find out what's causing the high SHBG, you'll be in the same boat with low free T, except for the fact that you'll be on TRT.

[BallSak]

My thyroid is normal, and my cortisol is a little high. I'm interested only in TRT at this point for the reason I outlined in the previous post.

My question is: Would a typical endo prescribe me TRT in this case, with symptoms of low T?

Well, being that the symptoms you describe are also symptoms of cortisol and thyroid deficiencies, you should be more interested in them.

"Normal" is a subjective term. Your T numbers probably also fall under "normal".

[Bobbies]

Well, being that the symptoms you describe are also symptoms of cortisol and thyroid deficiencies, you should be more interested in them.

"Normal" is a subjective term. Your T numbers probably also fall under "normal".

I don't know where my labs are, but thyroid and cortisol were both slightly on the high side on the number ranges. Total T was 900-something.

When you say your total T is higher than normal, what is it? 900? 1,200? No doctor is going to put you on TRT with a total T of 1,200. Why would you want to anyways? It would just take the place of your natural production and then it would still be bound by SHBG, so you'll end up with same #s. You wouldn't go up to an 1,800+ total T unless you took 500 IUs of HCG a week. Unless you find out what's causing the high SHBG, you'll be in the same boat with low free T, except for the fact that you'll be on TRT.

My testes are overworked, this is the issue. But slowing them down would worsen my free T even more. I don't know how else doctors could reduce natural T production, without reducing T. Hah, logic, right? If it won't solve my free testosterone issue, it'll solve my testicular pain issue.

HCG will not be necessary unless I take massive doses of T because testes are overworked by likely excessive LH.

[BallSak]

You need to do yourself a favor and find a competent doc to help you rather than trying to self diagnose. Most of the info above seems to be based on speculation.

[Bobbies]

"No, testicles can't be overworked, ever! That stuff about oxidative stress in the testes is all bollocks! And the fact that your testicles hurt, there's not a chance that it could be from excessive production of testosterone, which caused your higher-than-normal total T and probably E2. TRT is such a bad idea, lord forbid you give your testicles a break!"

All I asked is how doctors would respond. I'm still unaware of how doctors have treated men with low free T, and normal to high total T. I don't know much more than before. But if you claim a "competent" doctor wouldn't prescribe me TRT, I guess I better look for incompetent doctors.

[theheat]

So basically you want to go on TRT in order to put your nuts to sleep and give them a break? Most docs aren't that savy as far as HCG, Arimidex, Clomid, etc so don't expect anything other than going on TRT in order to replace your natural production with artificial T. That still won't do anything to increase your free T, unless you find out what's causing it (thyroid problems, high SHBG, etc?).

[BallSak]

"No, testicles can't be overworked, ever! That stuff about oxidative stress in the testes is all bollocks! And the fact that your testicles hurt, there's not a chance that it could be from excessive production of testosterone, which caused your higher-than-normal total T and probably E2. TRT is such a bad idea, lord forbid you give your testicles a break!"

Who are you quoting?

[kair0s]

I have an extremely similar problem. Similar symptoms, total test around 850, free never above 98 on Quest scale of 45-250 pg/ml. My SHBG is 43, Estradiol 28. Also in conversations with my doctor about treating symptoms and low free T number instead of total T. If I knew how to raise my free t without going on TRT I'd consider that option but I'd rather see how I feel on TRT with a higher free T (hopefully) than live with low free T and associated symptoms. Surprisingly I've searched for answers to this problem and haven't found as many threads about it as I would have thought (and no clear answers).

[17chester6]

You wrote:
All I asked is how doctors would respond. I'm still unaware of how doctors have treated men with low free T, and normal to high total T. I don't know much more than before. But if you claim a "competent" doctor wouldn't prescribe me TRT, I guess I better look for incompetent doctors.[/QUOTE]

It seems that you are hell bent to go on TRT and that you are looking for affirmation on this site. The site members are asking relevant questions and pointing out relevant issues and you seem to be resistant to hearing these raised issues.

I would just point out that any doctor that I know would refuse to put you on TRT as you are not T deficient. Starting TRT is not a picnic and it often entails multiple blood tests, changing doses, adding other medications as are needed (AI, HCG) not to mention some unwanted side effects such as water retention with resulting weight gain and swollen ankles among other symptoms.

You have not looked at all the parameters that could be causing your problems. Some other blood tests are warranted as has been pointed out. Also, are there other issues that might me causing or contributing to your symptoms such as depression, thyroid issues, stress, lack of sleep, over training, obesity, bad eating habits, poor nutrition, lack of exercise among others.

You wold do yourself a favour by stepping back and reassessing what is going on. Do the full work up, assess if there are remedial issues present and then move forward. You took the time to ask for input, don't turn your nose up at the suggestions without fully considering them.

[Low Testosterone]

If your free testosterone is low, you will have symptoms regardless of how high your total testosterone is. Your total testosterone could be 8,000,000 ng/dl and if your free levels were in the dirt you'd feel terrible. You're in a situation where you have stores of testosterone that you have no access to, which means those stores are doing you no good.

Outside of drugs you will not be prescribed in the U.S. for lowering SHBG there are things that can help but only moderately so. If you're truly low in Free you will probably need to consider TRT or at least explore the options.

[jump100]

I am having the same problem. My total T has been around 500nd but my free T has been below normal. Doctor placed me on TRT to increase total T so that free T also goes up. My SHBG was 32.33 (not too high) but my estrogen could be the problem. How do you guys think Free T should be raised?

[kelkel]

Look into Vit D, Stinging Nettle and avenacosides as an option to help reduce SHBG. Danazol is also an option as is Proviron. Do yourself a favor as well and do what Ballsack said in post #10.

[jump100]

KelKel - Is a SHGB of 32.33 too high, is that what is driving my free T down? Now that I am on TRT (Nebido) would I benefit from AI treatment? I guess two elements determine the drop in your free T, SHGH and high estrogen, right? I am good on vitamin D now, wasn't before. What I am concern about is having to run a total T of about 1200 to just be able to slightly increase my free T.

[kelkel]

No, it's not to high. Consider Labcorp's range of 19.3 - 76.4. Mine run's around 29. Benefiting from an AI depends on your E2 level and if it's even necessary. Yes, those elements impact Free T.

Startling Low Testosterone Blood Levels in Male Life Extension Members – Life Extension

My Free T tends to run low as well on my normal dose. A while back I upped my dose slightly to elevate it. Now it's around 22 with the scale going up to 24. Total T has been running in the 1400's or so to do so.

[jump100]

My free T is sitting at 8.32 (ref 8.80-27.00), that gives you an idea of how horrible I feel. I can't wait for Nebido to start releasing its testosterone into the blood stream. I just had my 2nd shot, five weeks after the first (one week too soon). I am desperate. I will ask for an estrogen test. If it is high, how does one take AI medication like Arimidex? I rely on you because doctors in Colombia don't have a clue about this treatment.

[kelkel]

Your booster should help you. Hopefully a lot. Try to get a sensitive assay for your E2. Standard estradiol is geared for women and not sensitive enough for males. If E2 is high, depending on how high, simply start with adex probably twice per week at .25mgs or even less. It's really a guessing game until we see your numbers. I think this booster shot will help you greatly!

Jump are you in the states? If so, how many mgs was the booster as the FDA reduced the amount by 25% from the European dosage when they approved it. 1000mgs down to 750...going from memory.

[jump100]

I am in Bogota, Colombia and on 1000mg of Nebido. I had my second shot after 5 weeks instead of 6 weeks (booster). The Doctor agreed with my recommendation. He wants to wait 8weeks to see what my levels are after 8 weeks. He is a general doctor who is not too knowledgable on TRT. It's why I frequent this website to get guidance. I had the booster (2 shot) about a week ago. Fingers crossed.