Need Help with Labs and TRT

[BlackGST5]

Hi everyone,
I am new to the forum so if this is the wrong place to post I am sorry. I am 27 and have had my testosterone levels checked several times the past couple months due to lack of energy and low sex drive. I was hoping someone could help me interpret these labs and suggest if I should try TRT, HCG, or if my levels are fine where they are at and leave it alone. I have already been prescribed Test Cypionate 100 mg/week for a few weeks and my sex drive has improved and my Total T came back at 750 ng/dl. My labs are as follows:

Testosterone, Total 416 ng/dl 240 - 950
Testosterone, Free 13.7 ng/dl 9 - 30
Testosterone, Bioavailabe 175 ng/dl 83 - 257
FSH 3.2 miu/ml 1.5 - 14.0
LH 3.8 miu/ml 1.0 - 9.0
SHBG 21 nmol/l 13 - 71

I don't have the E2 levels although I had them check previously on another lab and they were low 30's. Again, sorry if this isn't the correct place to post and thanks in advance for your help.

 

[goin on 4T]

If these labs are from before you got your script than they are not relevant other than to say your T is med/low and your free is med. What about progesterin and prolactin and your girl hormones?

 

[BlackGST5]

The labs are before I got the script. Not relevant? I am wanting to know if I should do something to raise them above this level and stay on TRT, go the HCG route, or do nothing. Prolactin levels were low normal, I had this done about a year ago and I am not sure on the progesterone. My free T is more on the low end right? The reference range starts at 9. I did prohormones a couple times in high doses right before being banned....not sure if that go give me any issues this far out. I did 6-OXO and ZMA for PCT afterward and my nuts came back and felt fine up until about a year ago.

 

[goin on 4T]

well its been a year, so i would get a new panel and get everything including IGF, there is a thread somewhere that says all of the test to get.
Ultimately the choice is yours most of the people in here are going to tell you HRT, I am on HRT so I am baised as well. I tried to come off for a month and man it was the shits. I just couldn't do it. I never wanted sex, was moody it was the shits.
Get the full panel and lets look at them. So stop the test and clear yourself so you get a good realistic idea of where you are at.
BTW I have been on HRT since 2005 I am 43 yo, as I am not the smartest guy here I have been around for a while and if I cant answer your question, I can direct you to some who can.
Happy Holidays!

 

[tical]

To be honest your pre-trt labwork isn't that bad. You might want to look into other things before heading the TRT route. You could be fatigued from a metabolism issue (cortisol and/or thyroid) which could in turn lower your sex natural sex hormones. A lot of us want to have T at the top of the range, but realistically, some of us just don't have the genetics for that.

If you're on T, having E2 in the 30s isn't exactly optimal. Ideally, you want your estrogen to be somewhere in the lower 20s. BUT - if you feel fine right now than don't mess with it, we're all different.

Definitely look into thyroid / adrenals before you decide you need TRT. I started TRT at 27 as well and it was great at first, but then other things fall out of place and you're stuck trying to manage all sorts of different hormones just to feel decent.

 

[BlackGST5]

Thanks for the info man! All the levels I posted were done a month ago or so. My prolactin and E2 was year ago. I think they checked the progesterone too and it was normal but I dont know the levels. What were your test levels before you started TRT? I was just wondering if HCG would be the better way to go since it apparently preserve fertility. I don't know if this is true or not, but my dr said in 93% of men will be able to have children after stopping TRT but 7% can't. I'll take my chances if this makes me feel better, but I guess if I could do it with HCG it might be a better option. I have read alot of people say it doesn't get most peoples levels to where they want them to be though.

 

[BlackGST5]

To be honest your pre-trt labwork isn't that bad. You might want to look into other things before heading the TRT route. You could be fatigued from a metabolism issue (cortisol and/or thyroid) which could in turn lower your sex natural sex hormones. A lot of us want to have T at the top of the range, but realistically, some of us just don't have the genetics for that.

If you're on T, having E2 in the 30s isn't exactly optimal. Ideally, you want your estrogen to be somewhere in the lower 20s. BUT - if you feel fine right now than don't mess with it, we're all different.

Definitely look into thyroid / adrenals before you decide you need TRT. I started TRT at 27 as well and it was great at first, but then other things fall out of place and you're stuck trying to manage all sorts of different hormones just to feel decent.

Hey tical,
I actually have been under alot of stress, not sleeping, and extreme fatigue. I had my thyroid and adrenals checked a month ago. Check out the results and let me know what you think. My cortisol is a little high for the 24/hr period. I am not really sure if my thyroid is good or not, it's it the middle from what it looks like. I am a pretty big guy even with my test levels where they are at and always have people asking me if I am on roids. Really I just want to feel better and if you don't think my T levels are causing this I'd just assume not do TRT regularly. I'll just keep getting the scripts and do an occasional cycle.

Cortisol, Urine Free 22.46 ug/g Normal is less than 32 ug/g
Cortisol, Urine Free 15.50 ug/L
Cortisol, Urine Free 60.4 ug/day Normal is up to 60.0 (this one was very slightly elevated)

TSH 1.870 0.300 - 5.100
Free T4 1.17 ng/dl 0.73 - 1.95

Another Thyroid from a few months ago:

TSH 1.770 uiu/ml 0.450 - 4.500
T4 1.29 ng/dl 0.82 - 1.77

 

[tical]

Stress will kill libido, easily. It's hard to comment on your thyroid labs because there are some very important markers left out. If you get a chance to get tested again, ask for at least TSH, Free T4, Free T3, Reverse T3. A decent measure of your metabolism can be done by just taking your temperature a few times a day (3 hours after you wake up, 3 hours after that, 3 hours later) and record the averages for a few days.

Optimal body temperature is 98.6 degrees. If your body temperature is steadily lower than this by a reasonable amount (>.4) then something is going on. This could contribute to daytime fatigue (it's basically hypothyroidism).

Not to oversimplify, but the reason you're most likely fatigued during the day is because of the poor sleep. If you're not getting restful, restorative sleep, it's probably reason for a lot of the issues you're dealing with. You need to figure out how to get better rest.

If you're cycling the testosterone, make sure you do a proper PCT to get those levels back up. Abruptly stopping the testosterone would leave you with low hormones for quite a while. 25mg of clomid is my sweet spot, gets my T into the 750s (range 200-800) and I don't seem to have any side effects at that dose. Larger doses kill my libido. 12.5mg is plenty for some, others need even more.

For example:

12.5mg of clomid after 6 weeks post TRT (2 years of TRT) had my T at 430
- increase dosage to 25mg
25mg of clomid after 4 weeks had my T at 750

I'd recommend anyone on here that cycles and uses SERMs for PCT to spend a little cash on labs and determine what the ideal dosage for you is, this way you can potentially avoid side effects and some may actually feel very good on it.

You have some choices and you should investigate them:

1. T therapy (with HCG) is okay however injections of T will require you to play the estrogen chasing game for a while to get things into place. It will also stop most of your LH/FSH production. This will in turn create problems converting pregnenolone from cholesterol, lowering cortisol and other sex hormones in the chain. After some time TRT typically leads to you needing to add more and more things to maintain the correct balance and feel good. If your testicles don't respond to LH then you might consider this route.

2. HCG monotherapy is good but will require frequent injections. Some people do well with this and the activation of the leydig cells via the HCG promotes the necessary enzyme activity for your body to produce pregnenolone from cholesterol.

3. SERM therapy for short term boosting of testosterone (an "endogenous cycle"). If you are patient and can find your "sweet spot" by incrementally dosing a drug like clomid (and taking bloodwork) you can achieve a reasonable boost of testosterone without suppressing your HPTA. From your labs, to have T in the 400s from LH of 1.0 your testicles seem to be working just fine, you would probably respond significantly to 12.5mg. Some doctors prefer this therapy for those patients that are concerned maintaining fertility, for instance Dr. Morgentaler (clinical professor at Harvard Medical School, author of the book Testosterone for Life). Some doctors don't approve of long term use due to potential side effects with vision (floaters). I personally feel that this is more of a concern at much larger doses.

 

[BlackGST5]

Hey man,
Thanks for all the info I really appreciate it. It's funny you say that about temperature because mine is always around 98.2 and sometimes even lower in the morning. I will definitely get my T3 checked as well now that you mentioned it.

Do you think my testosterone levels where they are at now are the cause of my problems or it's more related to stress and fatigue?

Would you recommend going the HCG route or Clomid route? I have read Nolvedex doesn't have the vision problems like Clomid can, is this correct? If so it it as useful for raising T levels like Clomid does?

 

[tical]

Hey man,
Thanks for all the info I really appreciate it. It's funny you say that about temperature because mine is always around 98.2 and sometimes even lower in the morning. I will definitely get my T3 checked as well now that you mentioned it.

Do you think my testosterone levels where they are at now are the cause of my problems or it's more related to stress and fatigue?

Would you recommend going the HCG route or Clomid route? I have read Nolvedex doesn't have the vision problems like Clomid can, is this correct? If so it it as useful for raising T levels like Clomid does?

Some people swear by nolvadex and some prefer clomid. I believe clomid is more effective than novladex. Nolvadex is formulated to act on breast tissue receptors whereas clomid isn't limited to that region.

I think before you start tinkering with anything, do your best to get your stress down and proper rest.

There are 2 steroidogenisis pathways that are relevant here:

1. Cholesterol->Pregnenolone->Progesterone->Cortisol
2. Cholesterol->Pregnenolone->DHEA->Sex Hormones

Continual stress increases the body's requirement for cortisol (which could explain your elevated cortisol levels). Stress doesn't necessary mean emotional stress. Infection, digestive, auto-immune, injury, etc. are all causes of stress to the body.

Now if your body is under extreme stress for a prolonged period of time, your sex hormones can suffer due to something referred to as the "pregnenolone steal."

As a survival mechanism your body will take preference to the pathway that best supports survival - the cortisol production pathway, not the sex hormone pathway. Basically "stealing" pregnenolone as a coping mechanism and leaving your body with less pregnenolone to produce sex hormones.

Remember, LH/FSH is responsible for stimulation of the leydig cells in the testicles resulting in the production of testosterone but also the stimulation of the P450scc enzyme that is responsible the conversion of pregnenolone from cholesterol.

Now, picture someone on steroids or TRT year round without HCG. LH/FSH will drop, now your pregnenolone drops below the range and you aren't able to produce sufficient amounts of cortisol or sex hormones. This will contribute to a downregulated metabolism as well because sufficient cortisol is required to get the active thyroid hormone, T3, into the cell.

I kind of went off on a tangent there, but you see what I'm saying.

If you're tired, at your age, it isn't likely because of T. It's because of a metabolic issue or a sleep disorder. I don't think you need TRT at this point, it's likely something else is the reason for you feeling so shitty.