Do I Need TRT? 25 Years Old - Very Low Testosterone

[authentic]

Hey all. New to this Forum. So a quick bit of background before my results.

I’m a healthy 25 year old male. I’ve not been not been training/exercising much in the last few months but I’m generally quite/very fit. And when I train hard (have done p90x a few times) I can get into great shape. Diet is pretty good, probably better than most and I don’t smoke or take any drugs. I don’t carry much fat around on me (I’m not as lean as I normally am though), and can put on muscle mass quite easily. In fact when I first started training at 17/18, some guys thought I may be on steroids! If I dedicate myself and lift heavy for a few weeks, I can put on good size.

I would describe myself as a confident person and ambitious - run an online business. I’m also assertive as an individual and a lot of people would describe me as having a masculine personality. Basically, I’m not effeminate character wise. Energy levels - pretty good. I work mostly from home, so as you can imagine pretty average during these hours. But when I’m out and about, with friends or at meetings, my energy levels tend to be high.

Taking the above into consideration, it really confuses me how I have such low testosterone. What triggered me to get tests done was basically inconsistent erectile strength and an inconsistent libido as well as general curiosity. I just thought both should be top notch at my age. With getting my results, I am shocked - I would have expected at least average testosterone results, and thought my actual issue would have been something else out of control (prolactin/cortisol) and not testosterone itself.

But the results speak for themselves. And I have to accept them and deal with them. Do I need TRT? I would rather not, but want to know your thoughts. Can I get to normal levels naturally or is TRT my only real option?

And does anyone think there could be a bigger issue behind all of this? (tumour/underlying condition) What, if anything, could be causing such low total testosterone and ridiculously low free testosterone? Are there any other tests I need to get done?

Finally - I’m surprised the free testosterone is so low. Total testosterone is low, but with low SHBG levels and average albumin levels, what can explain such low FT?

I’d really appreciate any thoughts. All my tests were paid for privately, and I spent quite a bit to get these results. I guess I should go see a specialist too, which I will be looking into.

Thanks - and look forward to interacting.

My Results

TSH: 4.08 mIU/L (0.27 - 4.2)
Prolactin: 364 mIU/L (86 - 324)
Testosterone: 13.4 nmol/L (7.6 - 31.4)
Free Testosterone: 2.77 pg/ml (4.0 - 30.0)
SHBG: 13 nmol/L (16 - 55)
Testosterone/SHBG Ratio: 102.3 (24 - 104)
Prostate Specific Ag(Total): 0.52 ug/l (0.00 - 1.40)
FSH: 2.5 IU/L (1.5 - 12.4)
LH: 4.4 IU/L (1.7 - 8.6)

Insulin: 11.9 mIU/L (2.6 - 24.9)
Cortisol: 402 nmol/l (9 am: 171 to 536)
Vitamin D: 27 nmol/L (50 – 200)
Albumin: 50 g/L (34 - 50)
Oestradiol: 117 pmol/L (44 - 156)

Random Blood Glucose (FL): 5.1 mmol/L (3.5 - 7.9)
Fasting Blood Glucose (FL): 5.1 mmol/L (3.5 – 5.8)
HbA1c: 40 mmol/mol (20 - 42)
Triglycerides: 1.3 mmol/L (< 2.3)
Cholesterol: 4.3 mmol/L Optimum (<5.0)
HDL Cholesterol: 1.6 mmol/L (0.9 - 1.5)
LDL Cholesterol: 2.1 mmol/L (Up to 3.0)
HDL % of total: 37 % (20 and over)

 

[Mprtz]

Welcome.

Good thing you're asking, definitely investigate before jumping on TRT.

A few initial impressions:

* Awesome lipids!
* Albumin is not "average" but top of range and could be responsible for lower free T.
* Prolactin is high, could be contributing to inconsistent erections.
* Vitamin D is low

I would definitely address these before considering TRT. Give Cialis a try and see how much it helps the erections.

EDIT: also keep in mind that free T doesn't tell the whole story, your bioavailable T calculates to 74%!

 

[halfwit]

You need to see a doctor regarding your thyroid; you're pushing hypothyroid levels, which can effect other systems in your body.

Once that (hopefully they look into WHY) has been resolved, everything else will fall into place. Keep in mind that HPTA issues with the hypothalamus and pituitary gland can affect this as well.

My .02c

 

[RR88]

Your just under 400 ng dl so for your age not very good but not awful. Everyone is different for a sweet spot on levels. I'd for sure start with diet and supplemental changes and see where you go. Next would be clomid or hcg. Better then staying on trt forever. For example. Clom iphone 50mg every other day for three months could easily get you to 600-800 steady. Try some other options before trt. Especially that your 25. Good luck

 

[Havasu]

Everything that was said above. Truly you are considered Hypothyroid. The American Association of Clinical Endocrinologists deemed that a TSH over 3 should be considered Hypo back in 2003. I'm looking into this myself as my TSH is 3.7

What Is a Normal Thyroid Stimulating Hormone Level?

 

[Alpin]

Hypothyroid bro. Get Free T4, Free T3 looked at...

 

[Alpin]

Your vit. D is low and your HBA1C is reaching the top of the range.

 

[authentic]

Thanks guys for the valuable feedback! Appreciate it

TRT is not really an option...I see this as a challenge to get my T levels super high naturally, so that is going to be my focus for now!

Some great points...

* Definitely am Vitamin D deficient so will be supplementing on that
* Need to bring the Prolactin down
* Noted the thyroid issues. Will look into this more and get some further testing done

Granted my Total T is not high (but not really low either) but what really threw me off was the low Free Testosterone. I got my Total T results, Albumin and SHBG results first...

So I used those online calculator, and my Free T and Bio T seemed fine

When I got the Free T results the day after from the lab (earlier today) it definitely got me very concerned!

So what can cause such low Free T like mine? It's below the normal range, which is wide ranging itself.

And isn't it important - since it's responsible for things like your mood, sexual health, confidence etc.? I really need to raise it.

 

[Alpin]

Thanks guys for the valuable feedback! Appreciate it

TRT is not really an option...I see this as a challenge to get my T levels super high naturally, so that is going to be my focus for now!

Some great points...

* Definitely am Vitamin D deficient so will be supplementing on that
* Need to bring the Prolactin down
* Noted the thyroid issues. Will look into this more and get some further testing done

Granted my Total T is not high (but not really low either) but what really threw me off was the low Free Testosterone. I got my Total T results, Albumin and SHBG results first...

So I used those online calculator, and my Free T and Bio T seemed fine

When I got the Free T results the day after from the lab (earlier today) it definitely got me very concerned!

So what can cause such low Free T like mine? It's below the normal range, which is wide ranging itself.

And isn't it important - since it's responsible for things like your mood, sexual health, confidence etc.? I really need to raise it.

You're Estradiol is up there too...117 pmol/l with13.4 nmol/l TT. You mentioned you're lean....
on any meds ?
I think if you fix that TSH things will change around for you.
Last i measured TT it was 14.3 nmol/l and estradiol 134 pmol/l...
Bio Avail.T is low normal. Basically Free Test.
i can relate.

 

[authentic]

You're Estradiol is up there too...117 pmol/l with13.4 nmol/l TT. You mentioned you're lean....
on any meds ?
I think if you fix that TSH things will change around for you.
Last i measured TT it was 14.3 nmol/l and estradiol 134 pmol/l...
Bio Avail.T is low normal. Basically Free Test.
i can relate.

Not on any meds - and yep, I'm pretty lean. Just some belly fat, and some fat here and there...but would be considered slim by almost everyone.

In the past, I've measured my eating to a single calorie and ate good clean foods only. I think it shows in my lipid results, which look really good.

Have you managed to sort out your TSH issues and are you noticing a difference? Definitely need to go see a doctor about that myself.

 

[3J]

yea his tsh is the first thing i noticed.. he needs to get on t4.. i think everything else will balanace out..

its not his total test that is the issue.. its his free test.. and his shbg isn't that high to say its the cause.. strange

 

[authentic]

Hey guys - so as you can imagine, I've been doing a lot of research in the past few days.

Also got a Thyroid Panel done. Here are the results:

TSH: 4.19 mIU/L (0.27 - 4.2)
Free T4: 19.5 pmol/l (12.0 - 22.0)
Total T4: 117 nmol/L ( 59 - 154 )
Free T3: 5.8 pmol/L (3.1 - 6.8)


What do you all think?


3J yep it's the FT which is really bothering me. Doesn't matter though - I'm determined to sort everything out naturally via diet/lifestyle and exercise! Results have pissed me off in a good way...

 

[AlanIRE]

I would be very careful about assuming that treating your subclinical hypothyroid problem is the panacea to all your ills.

After treatment with Testogel failed, I attempted to see if bringing down my TSH level (which was roughly comparable to yours) would boost my test naturally.

It did not. Even with a TSH below 1 mIU/L, my T levels stayed around 9-10 nmol/L.

Your issue seems to be an extremely unusual one. Can't understand why your Free T is so low when your SHBG level looks good.

Sorry I can't be of more help - but don't buy the hype about TSH like I did. You'll waste 6 months. The two systems are linked but not to as large an extent as users on these forums assume. Only a really high prolactin level can seriously impact gonadotropin production.

 

[halfwit]

I would be very careful about assuming that treating your subclinical hypothyroid problem is the panacea to all your ills.

After treatment with Testogel failed, I attempted to see if bringing down my TSH level (which was roughly comparable to yours) would boost my test naturally.

It did not. Even with a TSH below 1 mIU/L, my T levels stayed around 9-10 nmol/L.

Your issue seems to be an extremely unusual one. Can't understand why your Free T is so low when your SHBG level looks good.

Sorry I can't be of more help - but don't buy the hype about TSH like I did. You'll waste 6 months. The two systems are linked but not to as large an extent as users on these forums assume. Only a really high prolactin level can seriously impact gonadotropin production.

Nobody in here said Thyroid Stimulating Hormone has ANYTHING to do with his testosterone levels. However, an issue with the hypothalamus or pituitary gland most certainly can muck with both thyroid output and testosterone.

Furthermore, why on earth would you drive TSH down? Start chugging T3 to see if that helps? I brought up TSH as telling someone to ask their doctor for an MRI of the hypothalamus would likely end with deer in headlights looks and a dismissal. Have to provide enough information to get the doctors on the right track, and let them discover what you suspect.

Prolactin is not the only cause of secondary hypogonadism by a long shot. But the same place in the brain that controls dopamine also has a hand in T4 - > T3 conversion, which TSH is a marker for.

I could easily spend all day discussing how difficult it can be to ascertain the root cause of hypogonadism or other nasties we tend to encounter here. Doctors just prefer to use the term idiopathic.

 

[Havasu]

Welcome.

Good thing you're asking, definitely investigate before jumping on TRT.

A few initial impressions:

* Awesome lipids!
* Albumin is not "average" but top of range and could be responsible for lower free T.
* Prolactin is high, could be contributing to inconsistent erections.
* Vitamin D is low

I would definitely address these before considering TRT. Give Cialis a try and see how much it helps the erections.

EDIT: also keep in mind that free T doesn't tell the whole story, your bioavailable T calculates to 74%!

It's interesting, because I spoke with a TRT clinic and the way they manage their TRT they go ONLY by free T. They also said that the free t blood test is highly in inaccurate. There's one type of test specifically that uses a specific kind of equipment, and is expensive is accurate. However there is a formula they use to figure out actual free t that is accurate that uses the Albumin, SHBG, and Total Test. They said most of the time now they use the constant of 4.3 for the Albumin instead of actual Albumin numbers. You can see this equation in action in the app Bio T.

 

[Mprtz]

It's interesting, because I spoke with a TRT clinic and the way they manage their TRT they go ONLY by free T. They also said that the free t blood test is highly in inaccurate. There's one type of test specifically that uses a specific kind of equipment, and is expensive is accurate. However there is a formula they use to figure out actual free t that is accurate that uses the Albumin, SHBG, and Total Test. They said most of the time now they use the constant of 4.3 for the Albumin instead of actual Albumin numbers. You can see this equation in action in the app Bio T.

IDK I'm skeptical of this... The free T (direct) test is supposed to be less accurate than a calculation that includes an assumed value of Albumin?
The free T test is expensive and I think some clinics (including mine) sometimes test SHBG instead and choose to calculate it, but I think it's more about cost than accuracy.

 

[halfwit]

It's interesting, because I spoke with a TRT clinic and the way they manage their TRT they go ONLY by free T. They also said that the free t blood test is highly in inaccurate. There's one type of test specifically that uses a specific kind of equipment, and is expensive is accurate. However there is a formula they use to figure out actual free t that is accurate that uses the Albumin, SHBG, and Total Test. They said most of the time now they use the constant of 4.3 for the Albumin instead of actual Albumin numbers. You can see this equation in action in the app Bio T.

I'd like to know how it's more accurate considering that albumin-bound testosterone can easily become free test, and vice-versa. This is why I really only care about total, unless there is a problem with anabolic/androgenic benefits at a solid TT value.

But it not a doctor either.

 

[Havasu]

IDK I'm skeptical of this... The free T (direct) test is supposed to be less accurate than a calculation that includes an assumed value of Albumin?
The free T test is expensive and I think some clinics (including mine) sometimes test SHBG instead and choose to calculate it, but I think it's more about cost than accuracy.

Just passing along what they told me. I believe this is some background on it.

International Society for the Study of the Aging Male(ISSAM)

And here is the actual calculator

Free & Bioavailable Testosterone calculator

 

[authentic]

Interesting...

The free T test I paid for, wasn't that expensive. Came with other tests too - like a Male Hormone Profile.

If my bioavailable + Free T is calculated based on that calculator, my FT isn't that low. It's probably normal. So I guess that's expected, considering I've not done serious weight training/exercise in many months, and haven't really paid too much attention to my diet. Not to forget the high prolactin, insulin, Vitamin D and cortisol. All which affect T production.

I think if I address these issues, I can get to good T levels both TT and FT.

Though my TSH is high. Those results above look normal to me - anyone have any thoughts? Is it worth taking supplements like iodine?

Here they are for quick reference:

TSH: 4.19 mIU/L (0.27 - 4.2)
Free T4: 19.5 pmol/l (12.0 - 22.0)
Total T4: 117 nmol/L ( 59 - 154 )
Free T3: 5.8 pmol/L (3.1 - 6.8)

 

[Megatron28]

Interesting...

The free T test I paid for, wasn't that expensive. Came with other tests too - like a Male Hormone Profile.

If my bioavailable + Free T is calculated based on that calculator, my FT isn't that low. It's probably normal. So I guess that's expected, considering I've not done serious weight training/exercise in many months, and haven't really paid too much attention to my diet. Not to forget the high prolactin, insulin, Vitamin D and cortisol. All which affect T production.

I think if I address these issues, I can get to good T levels both TT and FT.

Though my TSH is high. Those results above look normal to me - anyone have any thoughts? Is it worth taking supplements like iodine?

Here they are for quick reference:

TSH: 4.19 mIU/L (0.27 - 4.2)
Free T4: 19.5 pmol/l (12.0 - 22.0)
Total T4: 117 nmol/L ( 59 - 154 )
Free T3: 5.8 pmol/L (3.1 - 6.8)

Your TSH being above 3.0 is indicative of hypothyroidism. Endocrinologists have changed the normal range, but many labs don't reflect it. Your Free T3 looks good though.