Lab Results Came Back- Give me your thoughts

[PresTex]

Alright guys,


Stats:

Age- 22
Weight-225
Height- 5'10"
Bf- 15%(rough estimate)


So to get started I have been on TRT for about 6 weeks now. I know I am way too young to be on TRT but somehow my test was crashed despite never messing with anabolics before and couldn't function anymore so I had to do something and going to a TRT clinic was the best possible option. I am not sure if I am primary or secondary hypogonadal but I plan to try a restart at some point to avoid being on TRT for life, but in the meantime I just want to get to a point where I can function and feel good again then make those long term decisions.

So here are my lab results before TRT:

TSH: 1.020 uIU/mL Ref Range .45-4.5
PSA: .3 ng/mL Ref Range 0.0-4.0

Total Test: 204 ng/dL Ref Range 348-1197
Free Test: 5.6 pg/mL Ref Range 9.4-26.5
Estradiol: 12.3 pg/mL Ref Range 7.6-42.6
Prolactin: 10.6 pg/mL Ref Range 4.0-15.2
Hematocrit: 47.4 Ref Range 37.5-51.0

Here are the results I received today after 6 weeks of TRT:

TSH: 2.950 uIU/mL Ref Range .45-4.5
PSA: .4 ng/mL Ref Range 0.0-4.0

Total Test: 313 ng/dL Ref Range 348-1197
Free Test: 16.3 pg/mL Ref Range 9.4-26.5
Estradiol: 11.7 pg/mL Ref Range 7.6-42.6
Prolactin: 9.7 pg/mL Ref Range 4.0-15.2
Hematocrit: 48.5 Ref Range 37.5-51.0


My doc is happy with this and wants to stick with the 100mg/wk test cyp protocol I've been on these past 6 weeks. I am not happy with this as my total test is low and I honestly do not feel that much better than before I started TRT. I can function now but still struggle with energy, sex drive, and mood. This is a typical TRT clinic doc though so I have come to expect a little incompetence(won't give me Hcg as part of my TRT) but figured if this at least got me feeling better I could deal with it. However, I do not want to keep spending the money for marginal improvements. So I'm wondering what you guys think lead to the total test being so low while showing improvements in free? What you think the proper protocol from here on out would be? And just looking for general advice before I go and make any decisions.

 

[Mprtz]

Ok, a few thoughts:

The time to investigate why your T is low at age 22 is really before you go on TRT, everything becomes more clouded after that. There is never going to be a time when going back to feeling like crap is going to be appealing.

Your test dose is obviously insufficient, you are still hypo at the end (presumably) of your week. The fact that your doc is happy with these values doesn't inspire confidence. The fact that he works for a clinic that supposedly specializes in treating this condition is doubly puzzling.

It looks like he's going more by free T. This is a controversial subject, with some saying free T is everything, some saying bioavailable is it, etc. In my opinion, the jury is still out as exactly what happens at various receptor sites does not seem to be well understood.

The bottom line is you are not feeling better... this should be a more important metric than any number on a lab test. I hope that you will succeed in helping your doctor understand this, or find someone more competent.

EDIT: two more things that I noticed:

1) either you are already extremely muscular, which would be weird given your low T, or something is wrong with your height/weight/bf numbers.
2) Your TSH took a big jump between these 2 tests, no real reason for that to happen on TRT

 

[49ER]

You have 6 months tops to live bro

JK!!!!

 

[PresTex]

Ok, a few thoughts:

The time to investigate why your T is low at age 22 is really before you go on TRT, everything becomes more clouded after that. There is never going to be a time when going back to feeling like crap is going to be appealing.

Your test dose is obviously insufficient, you are still hypo at the end (presumably) of your week. The fact that your doc is happy with these values doesn't inspire confidence. The fact that he works for a clinic that supposedly specializes in treating this condition is doubly puzzling.

It looks like he's going more by free T. This is a controversial subject, with some saying free T is everything, some saying bioavailable is it, etc. In my opinion, the jury is still out as exactly what happens at various receptor sites does not seem to be well understood.

The bottom line is you are not feeling better... this should be a more important metric than any number on a lab test. I hope that you will succeed in helping your doctor understand this, or find someone more competent.

EDIT: two more things that I noticed:

1) either you are already extremely muscular, which would be weird given your low T, or something is wrong with your height/weight/bf numbers.
2) Your TSH took a big jump between these 2 tests, no real reason for that to happen on TRT

Currently working on the underlying issues on my low T. I suspect I might have sleep apnea which would definitely compound the problem. Other than that it all I've come up with is that an OTC test boosting product(natural) might have messed something up.

My doc is definitely not the brightest guy out there. He had me on 200mg of test cyp every 2 weeks but I talked to him and got him to switch to weekly since test cyp has a relatively short half-life. Trying to find a new doc but it hasn't been easy as I don't want to have to pay out the ass for another doctor who is gonna play with my hormones without really knowing what he is doing. Im gonna talk to him and if he won't change the protocol ill treat myself or find a new doc. All that matters to me is that I feel good, screw the numbers. Plus, I have had multiple blood tests done in the past few years and I always feel better with higher total t so I want to get my total up and see how I feel.

To address your edit:

1) BF might be a little higher these days due to the struggle with my hormones but I definitely have some muscle because Ive been lifting consistently for a long time now. To give you an idea my lifts are as follows:

Squat: 435
Bench: 345
Deadlift:485

Definitely not crazy muscular but I'm no stranger to the gym. Lets say my bf is 20% as thats a more conservative estimate.

2) Yeah I noticed that and was not real sure why it spiked so much. Not sure if time of day or other external factors can affect the TSH results but I was hoping someone else would chime in on that.


One more thing, the only reason I'm postponing a restart and finding a quick fix(TRT) is because I am in my last semester of college and can't mess this up as I have a job waiting for me. So I can't afford to go off TRT and try a restart, have it fail, and potentially screw up my ability to function.

 

[PresTex]

You have 6 months tops to live bro

JK!!!!

 

[Chiefy]

I'd imagine that your SHBG is somewhat low which is causing your free T to show some improvement while your total T stays low. Without labs that's just a guess, but it seems likely.

How long after your injection were these labs drawn?

Either way, I'd say that a logical place to start would be to split your dose into 2 weekly injections just to keep things a little more stable, but you'll probably need a slightly higher dose of testosterone to get your numbers where you want them.

I've never heard of a clinic aiming for such a low total T before, seems odd for sure. I'd talk with your doctor about raising your dose a little bit and splitting your injections. If he's not into it, I'd probably think about taking your business elsewhere. There are many other clinics out there that would be ok with a protocol change. There's no point in paying the fees associated with most clinics if you're still going to be miserable.

 

[PresTex]

I'd imagine that your SHBG is somewhat low which is causing your free T to show some improvement while your total T stays low. Without labs that's just a guess, but it seems likely.

How long after your injection were these labs drawn?

Either way, I'd say that a logical place to start would be to split your dose into 2 weekly injections just to keep things a little more stable, but you'll probably need a slightly higher dose of testosterone to get your numbers where you want them.

I've never heard of a clinic aiming for such a low total T before, seems odd for sure. I'd talk with your doctor about raising your dose a little bit and splitting your injections. If he's not into it, I'd probably think about taking your business elsewhere. There are many other clinics out there that would be ok with a protocol change. There's no point in paying the fees associated with most clinics if you're still going to be miserable.

Yeah Ive been trying to find some information on SHBG and how it relates to free vs total test but haven't been able to find too much info. Ill get some labs done myself and see where its at since thats the only way to be sure.

The labs were done 4 days after injection.

Definitely going to have to find a new doc. He makes me come in for my injections and its a pain in the ass, especially considering the fact that he isn't even worried about how I feel and is happy with such a low total test. I have an order from PSL on the way so I'm going to increase frequency of injections and up the dosage a little and get bloodwork done again and see where I'm at. Its just too much trouble and not worth the cost of dealing with this doc.