Low T Since Age 26 / Starting to Self-Dose

[Voyager1]

Hey Y55G - thanks for the thoughts! I do like that FT is high... but here it’s expressed as a percentage... meaning a have a high percent of super low total test... Right? I don’t think they can be looked at independently (IE Total T is in the tank but FT is high so all should be swell), right?

The prolactin is weird. And makes me feel... womanly. :-/

[Youthful55guy]

Hey Y55G - thanks for the thoughts! I do like that FT is high... but here it’s expressed as a percentage... meaning a have a high percent of super low total test... Right? I don’t think they can be looked at independently (IE Total T is in the tank but FT is high so all should be swell), right?

The prolactin is weird. And makes me feel... womanly. :-/

Very good point. I'm used to working with Free T being reported in pg/mL (normal range 9.3-26.5 for someone your age). When I saw such a high number, I instantly went to "there's nothing wrong". However, as a percent of an abysmally low Total T, yeah, I can see why you feel lick $#!%.

I'm also used to dealing with Total T in ng/dL, so I needed to do the conversion, your 6.85 nmol/L equates to 197.6 ng/dL. I don't know exactly what the range is for young guys like you, but for old farts like me, the range is 348-1197 ng/dL. Yours would be a little higher. Bottom line is that your total T is about half of the lower end of the range for a 50-60 year old man.

Ehen I plug the 197.6 ng/dL and your 8.9 nmol/L SHBG into a Free T calculator, and assuming your albumin is a normal 4.3 (or close), your Free T is about 6.44 ng/dL and your bioavailable is about 151 ng/dL (76.4%). Normal ranged for 50-60 year old men are 2-13.5 (Free) and 48-317 (Bioavailable). Younger guys would be slightly higher. So, while not being completely out of range (for an old man), your Free T is within the lower end of the range.

I don't see E2 in the labs, but I'm willing to bet that it is low, as there's not much T to convert. I suspect that if you do initiate TRT that the E2 will climb (best to get a baseline value first) and that may help drive up the SHBG, which would then increase your Total T. On the upside, SHBG acts to shield Total T from liver metabolism, so it gives it a longer half life in the body. On the flip side SHBG binds T tightly and prevents it from crossing the blood-brain barrier.

Finally, the prolactin and SSRI issues. Yes, SSRI usage can drive T down. This is pretty well documented in the literature. I have not researched much myself (b/c I don't use them), but I seem to remember that it is via increased prolactin. Perhaps others here with more knowledge on that topic can chime in. Also, note that the prolactin is not all that far out of range. I just discovered this week that I have very similar prolactin values of 17.8 (range 4.0-15.2 pg/mL). It disturbs me a little that it's not been measured before by any of my docs and I just happened onto it because it was a freebe in a larger hormone panel that I bought myself. However, I have had great success with TRT over the past 6 years, so it doesn't seem to be affecting me, and I had a pituitary MRI done for unrelated reasons about 4 years ago, so it rules out a tumor.

The bottom line here is that both you and I need to watch our E2 carefully to make sure it does not go out of range with TRT. E2 of and by itself is only a minor contributor to gynecomastia (contrary to popular belief), it's the combination of high E2 + High progesterone + High prolactin that cause rapid mammary development. However, even without high progesterone, high E2 + high prolactin should throw up a large yellow flag to do something. Fortunately, I have kept a close eye on E2 and always keep it in range and I have never had a gynecomastia problem.