30 yr old, Just got 2x labs done, Doc said i was on low side of normal

[Slick88]

Hi everyone, thanks in advance for the help. Over the past several years (from 25 till now) i have essentially not felt right. Started out with low libido and loss of random erections / morning wood. Slowly translated into lathergic spirts, brain fog, lack of energy, anxiety, mood swings, etc.

Decided about 5 years ago it must have been my lifestyle, so i got into lifting, go 4-5x per week and usually have 1 day in there of either cardio / mobility / yoga. Then added in proper diet, track all meals, macros, etc. Then decided it must have been a supplementation issue, so i added in multivitamins, vitamin d, ginger, magnesium, etc. Lastly i figured it must be sleep so i took all steps to get 8+ hours of undisturbed sleep in a blackout room. Basically, all of those things helped for a short period of time, then was right back where i started. Finally decided to talk to the doc about it as i suspected I might have low T levels. Doc ran labs and the results came back as follows:

Test #1 (just Test levels)
-Total Test: 305 (264-916)
-Free Test 10.1 (8.7-25.1)

Test#2
-Total Test: 336 (264-916)
-Free Test: 10.9 (8.7-25.1)
-LH: 5.2 (1.7-8.6)
-FSH: 3.5 (1.5-12.4)
-Hemoglobin: 14.9g/dL (13-17.7)
-Hematocrit: 43.7% (37.5-51%)
-TSH: 1.020 uIU/mL (.450-4.5)
There was literally about 30 more levels taken, not sure what the most pertinent ones are, i can add those in though

My primary doc said my levels were on the low end of fine, but couldn’t treat me. He said i could go to a urologist or endocrinologist (endo was backed up 1.5 months, so i got into the urologist first). My biggest concern is that I am still not certain if TRT is really what i need. I have spent the last few weeks reading this site, watching testimonials online, etc and it does seem like many people out there are in a very similar boat to me and have been helped by TRT. However, they do seem very confident that TRT was the treatment they needed as they knew they would likely have to battle a doc to get it. I am unsure at this point based on my results and i was hoping for some insight.

Thanks

[Ephemeral]

Yeah I was pretty much in the same boat, over 4-5 years I'd developed similar symptoms, I had the same T levels as well (a bit worse due to highish SHBG and albumin), and I was on the fence - tried the best I could before TRT but I didn't have the luxury of a few more years to hope that things will get better. TRT helped me a lot, but I'm still not 100% sure I want to pin for the rest of my life, and I wonder what would happen without it. However I don't really have the choice of getting off now, so I guess I just have to accept that I'll never know.

Your numbers are not extremely bad, but remember the ranges include 70 year old men too, so what docs usually consider low normal is not acceptable for a 30 yo dude in my opinion. Most docs also don't care much about symptoms and that's what's really important. I have a friend with your numbers (he's 40), and he feels alright, not as great when he was 20 but he can live with it.

Based on your pretty good LH level it's quite possible that you have a problem in your testicles, which is called primary hypogonadism. You might want to do an ultrasound to rule some things out, and in general try to find the cause. Did you maybe have an injury down there or been to a car accident or something like that?

If you're primary I doubt SERMS like Clomid would help, but you can give it a shot, it works for some people for some time.
Seems like you've nailed down the lifestyle/nutrition/sleep aspect, so I can't think of anything else you could try. If anxiety and mood swings are a serious problem then you could benefit from talk therapy, lowering stress, better coping strategies, things like that.

Good luck brother!

[Slick88]

Thanks for the reply man. So, just so i understand, are you saying most people who are type 2 (which seems to be the bulk of what i see on here) have low LH numbers?

[assguy22]

They are not optimal values but they are not so low as to start TRT. Logically you will get benefits from TRT but it would be preferable with these values to see possible other causes and address it naturally.

[Ephemeral]

Thanks for the reply man. So, just so i understand, are you saying most people who are type 2 (which seems to be the bulk of what i see on here) have low LH numbers?

Well yeah, that's the definition of secondary hypogonadism: deficiency in the release of LH and FSH.

[Slick88]

They are not optimal values but they are not so low as to start TRT. Logically you will get benefits from TRT but it would be preferable with these values to see possible other causes and address it naturally.

Thanks for the reply man. Can you give me a bit more context on what you mean though. For example, is there any specific tests you would recommend being run or levels to check out

[EDCG19]

Do you workout already?
You may need someone more experiences to look at your blood work so people usually go to a urologist rather than a primary care physician for these issues
I don't think its that low as well but you being 30 I would just start TRT at 50mgx2 and see how it works for you

If you don't want to do TRT at all than start working out and natural test enhancers like better quality sleep, more red meats, vitamin D (tons of it) and magnesium/zinc

[Slick88]

Do you workout already?
You may need someone more experiences to look at your blood work so people usually go to a urologist rather than a primary care physician for these issues
I don't think its that low as well but you being 30 I would just start TRT at 50mgx2 and see how it works for you

If you don't want to do TRT at all than start working out and natural test enhancers like better quality sleep, more red meats, vitamin D (tons of it) and magnesium/zinc

I do work out, usually 4-5 days a week and have been consistently sticking to that for years now. That’s why it’s a bit frustrating as I do a lot of the small things right but still feel shitty

[EDCG19]

I do work out, usually 4-5 days a week and have been consistently sticking to that for years now. That’s why it’s a bit frustrating as I do a lot of the small things right but still feel shitty

Some other guys may disagree or agree but man TRT is a life saver
It changed my life and only regret was not starting sooner

Talk to a doc I don't want to push anyone into making a decision and do some research before starting
Your current levels are low and not bad per say but still 50mgx2 a week is better than staying at that low range



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[Beetlegeuse]

The important thing to understand about TRT is that it is till death do us part. There are concurrent therapies that minimize the risks but there is no getting around the fact that despite the best of precautions TRT could permanently render your nards non-functional and you sterile. If you take exogenous testosterone with none of the customary precautions (particularly hCG) it is a virtual certainty that in time you will become sterile and your testicles will atrophy. If you start TRT even with all precautions and then at some future date decide you want to stop, there is no guarantee your testicular function will ever return to the even the less-than-adequate "normal" you were experiencing that compelled you to begin TRT to begin with. You could be worse off than you were before you began TRT.

So that's the broader implication of the decision you are considering. Don't start TRT if you aren't prepared to continue it (and deal with the consequences) for the next 50 or so years.

[TRTdrew]

I’m 41 and I just finished my first year of TRT. It’s been a good decision for me. I’m no expert so I won’t comment on your situation. Just READ ALL YOU CAN and make your decision. Good luck bro.

[Slick88]

Thanks for the replies guys. To me it really seems like it comes down to the decision of is it worse to deal with all of the issues this is causing me now with these levels... or... worse to deal with the potential implications down the road.

[HoldMyBeer]

Talk to a specialist if you're not sure. You do not want to have to pin yourself off the rest of your life because of uncertainty. There are other methods the specialist will have you try first

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[Slick88]

Talked in detail with my urologist yesterday and both him and I are in agreement that it makes sense to start.

Question for you guys: he did say that he highly recommends the pellets over injections and even went as far as to say that unless insurance won’t cover it (it’s likely they won’t for me) that he wants me on pellets. I brought up injections and he said I would need to come in once a week to the clinic (not happening). Any tips on which treatment option you prefer. Also, how you dealt with a doc who wanted you to come in for injections every week?

[HoldMyBeer]

Talked in detail with my urologist yesterday and both him and I are in agreement that it makes sense to start.

Question for you guys: he did say that he highly recommends the pellets over injections and even went as far as to say that unless insurance won’t cover it (it’s likely they won’t for me) that he wants me on pellets. I brought up injections and he said I would need to come in once a week to the clinic (not happening). Any tips on which treatment option you prefer. Also, how you dealt with a doc who wanted you to come in for injections every week?

That's odd the doc didn't want to try other options first. It is a life long commitment
My doc didn't have anything good to say about the pellets, and recommended injections
He also only made patients come in for injections if they were to squeamish to do it themselves (there was a quick instructional appointment on it w a nurse)
I, personally, would find another doctor. But that's just me

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[Slick88]

Yeah, there were some other things at play that I didn’t list. I had a 3rd test that came in at 280 this week as well as a few other long trem symptoms. So he felt pretty good that we would end up at this solution eventually

[Youthful55guy]

Talked in detail with my urologist yesterday and both him and I are in agreement that it makes sense to start.

Question for you guys: he did say that he highly recommends the pellets over injections and even went as far as to say that unless insurance won’t cover it (it’s likely they won’t for me) that he wants me on pellets. I brought up injections and he said I would need to come in once a week to the clinic (not happening). Any tips on which treatment option you prefer. Also, how you dealt with a doc who wanted you to come in for injections every week?

I'd walk away for a guy who only offers you pellets. He's in it for the money. Though there are some exceptions, most guys I've talked to who have tried pellets are very dissatisfied and they end up costing an arm and a leg for constant replacement.

Prescription T is dirt cheep in the scheme of drugs. I wouldn't worry about insurance. Simply pay out of pocket if they refuse to cover it. My 10 mL vial of 200 mg/mL branded Depotestosterone cost me $63.25 at last refill. At a dose of 0.2 mL E3D (equates to about 100 mg/week), this will last me about 150 days (21 weeks). That equates to about $0.42 pr day ($154 per year). I spend more on multivitamins than that.

If the doc tries to scare you away with needles, don't let him intimidate you. Chances are he hasn't a clue how to self-inject. With a dose of 0.2 mL E3D, you can easily draw up and inject the dose with a 28 mL insulin syringe, which feels like a small mosquito at worst. mostly, you just don't feel it. I'm sure he'll try to convince you that you need a harpoon sized needle and weekly or every other week injections of huge amounts. Again, he hasn't a clue as to how to properly administer TRT. PLEASE READ THE FIRST STICKY ON BEST PRACTICES IN TRT.

Another sign it's time to walk away is if he will not prescribe self-injections and that you'll need to come in for them to do it. That's just a ploy to squeeze money out of your insurance company (if they will even cover it) for weekly office visits. Also, weekly injections are just not frequent enough (again read the BEST PRACTICES sticky for a more in depth discussion).

Also, consider carefully before starting ANY TRT protocol whether or not you want to have kids someday. If so, you'll need to preserver the option for fertility with HCG. Your doc may or may not be willing to prescribe off label for this, and most insurance companies will not pay for it. It's also much more expensive than T-cyp or any other form of T. I am well beyond the age where I care about fertility, but I do want to preserve testicular function and size, so I use it. I am also not cost sensitive, so I use it at a dose that about double what you need for fertility preservation. At your age for preservation, you should consider 500 IU per week in at least 3 divided doses (about 200-250 IU E3D should be sufficient). My branded (Pregnyl) HCG from a local pharmacy costs about $125 per 10,000 IU, so that ends up being about $0.90 per day or about $325 per year. Still inexpensive in the scheme of drugs, but not as cheep as TRT and you need to add the two together for the total cost of protocol.