GoliathOnline
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Introduction:
Hello All,
I could really use some of your collective expertise. I am writing my OP as comprehensive as possible to hopefully alleviate the back-and-forther and give you all as much up-front ammo as needed to potentially response...
Top level: I haven't been feeling myself for the last 2+ years and have essentially gone through seasons of feeling the effects of Low T (see more below).
Profile:
I'm 30 yrs old, 5'10" & 167lbs, lean body type, typically fairly active, good at keeping to a testosterone-friendly paleo diet, use all organic cleaning products and toiletries, but have a super stressful job and crappy sleep habits. I went through a cycle when I was 20 (stupid, I know) but felt recovered, I tried a prohormone when I was 24 but stopped after about 1 week as I didnt like the immediate sides. I haven't really touched anything else since.
Additionally, recently I underwent shoulder surgery which has kept me from being my usual active self (no gym in last 3+ months but I go to spin regularly; though, while in spin class I usually finish at the top of the leader-board so I guess my cardio is relatively okay). Note that my issues would happen even before the surgery, but exercising (read: lifting) at least seemed to provide a minimal break possibly due to increasing endorphins, muscle mass, test, etc. That said, these issues have plagued me for a while. Using various "natural testosterone boosting" resources, I have tried seemingly every combination of OTC testosterone/libido/mood/erection boosters with minimal gain. Also, no drugs, rarely drink, never smoke.
Symptoms:
Lethargy, Apathy, Depressed, Anxiety, Weak Erections, Long Refractory Period, Loss of Morning Wood, Poor Libido, Muscle wastes away in 1/10th of the time it takes to build it, weak results with Viagra/Cialis (due to limited desire and anxiety), smaller load volumes, etc...
Blood work:
I finally built up the courage to stop trying to fix this issue on my own and saw a Urologist at NYU-Langone last week (reputable doctor and organization). Upon describing my symptoms, he ordered a blood test on the spot and another one for next week during a morning follow-up appointment. The blood work was drawn at 3pm-ish and I was not in a fasted state, he said if the results were low then we would have me go through a more official and reliable morning fasted blood work process to corroborate the initial findings. Additionally, I had a doppler-ultrasound done to see if there is any damage to the testes (I have a minor variocele and he wanted to confirm the finding and rule out other issues, still waiting on the final radiology report). The first round of blood work is as follows:
Total Testosterone: 316 ng/dl (Range: 300 - 1080) - NEAR LOW
Bioavailable Testosterone: 107 ng/dl (Range: 131 - 682) - LOW
Testosterone Free: 36 pg/ml (Range: 47 - 244) - LOW
Testosterone Free Percent: 1.1% Range: (1.6 - 2.9) - LOW
FSH: 2.3 mIU/mL (Range: 1 - 12) - NEAR LOW
LH: 2.1mIU/mL (Range: 0.6-12) - NEAR LOW
SHBG: 65 nmol/L (Range: 11 - 80) - NEAR HIGH
Estradiol: 21 pg/ml (Range: 11 - 44) - NORMAL - however, the test says Adult Pre-Menopausal Female, still applicable?
Prolactin: 9.8 ng/ml (Range: 3.5 - 19) - NORMAL
Metabolic and CBC panel figures have plenty of NEAR LOW or NEAR HIGH values, but glucose and albumin - two of the more important ones regarding testosterone levels, I believe - are right smack in the middle of the normal ranges. That said, there are still some true LOW and HIGH values to note:
Creatinine: 1.64 mg/dl (Range: 0.7 - 1.3) - HIGH
Bilirubin: 1.3 mg/dL (Range: 0.2 - 1.2) - HIGH
EGFR MDRD (Non-African American): 49.6 ml/min/1.73m^2 (Range: >60) - LOW
White Blood Cell Count: 4.0 10*3/uL (Range: 4.2 - 9.1) - LOW
Mean Corpuscular Volume: 92.4 fL (Range: 79 - 92) - HIGH
I can provide the full CBC & Metabolic reports if you all think there may be more useful data to review...
Saliva Results:
I took a fasted morning saliva test in July, but the paperwork with the results said the lab didn't receive it until mid-August (approximately one month after I spit in the tube during a random morning). The Urologist said the results are still fine to look at from a trend aspect, but also that saliva samples can be more volatile than blood work and the delay between collection and reading could have certainly caused issue with some of the figures listed below:
Total Testosterone: 8pg/mL (Range: 44 - 148 - Age Dependent) - VERY LOW
Cortisol: <0.1 ng/ml (Range 3.7 - 9.5 - Morning) - VERY LOW
Estradiol: 1.1 pg/ml (Range 0.5 - 2.2) - NORMAL
Progesterone: 29 pg/ml (Range: 12 - 100) - LOW-NORMAL
DHEAS: 13.9 ng/ml (Range: 2 - 23 - Age Dependent) - NORMAL
Overall Impressions:
While I will go for another blood test for more details, it looks like between the saliva test and first blood test that my symptoms are corroborated by the test results. Specifically, it looks like my SHBG to Total Test level is quite skewed and I am unsure of what to make of the Low Cortisol. That said, if my Total Test was in the 600-700, with all else being equal, then my free testosterone levels would probably be in the normal range (albeit possibly on the lower side given the fact that the SHBG is on the higher side of average). FWIW, I am unsure on all of the testing methodologies (Standrd, Sensistive, LCMS, etc.). Are there specific versions of these tests I should insist on the doctor using for accuracy purposes?
That said, I prefer to stay off the injection path (either TRT shots, patches, HCG, etc.), as I want to keep my fertility options open being that I am still single and only 30 and would like to have a family one day. However,I obviously I first need to be able to get the plumbing up-and-running again. I know that Clomid is an option for an optimizer/restart but I believe that would also raise my SHBG levels, as well as my Estrogen and, potentially, my Prolactin levels. Thus potentially pushing them to an official HIGH level and still yielding the issues associated with Low T/Low Free T. Thankfully, as it appears to stand now, my Estrogen, Prolactin, Progesterone (via Saliva), and DHEAS (via saliva) seem to be okay; but I am sure the doctor will check all of those again via a morning fasted blood work.
Is there any way I can raise my test (free test, total, LH, etc.) without further raising my SHBG, potentially messing with my prolactin and estrogen levels, and keeping my fertility options intact? Aka, can I take Clomid with anything else to help right the ship?
Additionally, would doctors be able to prescribe Torem? Or is that not something doctors prescribe off-label for androgen deficiency? Are there any key distinctions to trying a restart for a situation like mine with either Clomid, Torem, Nolva, Tamox, etc.?
Also, understanding I'll be going for another round of blood work (and still have an ultrasound report pending) what other metrics should I insist on being tested? (e.g. DHT, DHEAS, TSH, T3, Neurotransmitters via urine/saliva, etc.) As of now, it seems like Clomid with an AI on-hand and a potential Variocele repair would be the most standard course of action, though I would appreciate all of your thoughts (also, thoughts on exemestane vs. arimidex?).
I apologize again for the long post, but hopefully it's comprehensive enough to not require as much back-and-forth as other OP messages on this topic. Of course I am working with a medical provider on this but I'd like to be armed with as many opinions, first-hand accounts, anecdotes, etc. when progressing with him so I leave no stone unturned (and, to be 100% certain that I am in good hands, I am going to go for a second opinion from another doctor at Columbia Medical who specializes in this, but the first appointment isn't until mid-Oct).
Thanks again in advance for any thoughts,
Goliath
Hello All,
I could really use some of your collective expertise. I am writing my OP as comprehensive as possible to hopefully alleviate the back-and-forther and give you all as much up-front ammo as needed to potentially response...
Top level: I haven't been feeling myself for the last 2+ years and have essentially gone through seasons of feeling the effects of Low T (see more below).
Profile:
I'm 30 yrs old, 5'10" & 167lbs, lean body type, typically fairly active, good at keeping to a testosterone-friendly paleo diet, use all organic cleaning products and toiletries, but have a super stressful job and crappy sleep habits. I went through a cycle when I was 20 (stupid, I know) but felt recovered, I tried a prohormone when I was 24 but stopped after about 1 week as I didnt like the immediate sides. I haven't really touched anything else since.
Additionally, recently I underwent shoulder surgery which has kept me from being my usual active self (no gym in last 3+ months but I go to spin regularly; though, while in spin class I usually finish at the top of the leader-board so I guess my cardio is relatively okay). Note that my issues would happen even before the surgery, but exercising (read: lifting) at least seemed to provide a minimal break possibly due to increasing endorphins, muscle mass, test, etc. That said, these issues have plagued me for a while. Using various "natural testosterone boosting" resources, I have tried seemingly every combination of OTC testosterone/libido/mood/erection boosters with minimal gain. Also, no drugs, rarely drink, never smoke.
Symptoms:
Lethargy, Apathy, Depressed, Anxiety, Weak Erections, Long Refractory Period, Loss of Morning Wood, Poor Libido, Muscle wastes away in 1/10th of the time it takes to build it, weak results with Viagra/Cialis (due to limited desire and anxiety), smaller load volumes, etc...
Blood work:
I finally built up the courage to stop trying to fix this issue on my own and saw a Urologist at NYU-Langone last week (reputable doctor and organization). Upon describing my symptoms, he ordered a blood test on the spot and another one for next week during a morning follow-up appointment. The blood work was drawn at 3pm-ish and I was not in a fasted state, he said if the results were low then we would have me go through a more official and reliable morning fasted blood work process to corroborate the initial findings. Additionally, I had a doppler-ultrasound done to see if there is any damage to the testes (I have a minor variocele and he wanted to confirm the finding and rule out other issues, still waiting on the final radiology report). The first round of blood work is as follows:
Total Testosterone: 316 ng/dl (Range: 300 - 1080) - NEAR LOW
Bioavailable Testosterone: 107 ng/dl (Range: 131 - 682) - LOW
Testosterone Free: 36 pg/ml (Range: 47 - 244) - LOW
Testosterone Free Percent: 1.1% Range: (1.6 - 2.9) - LOW
FSH: 2.3 mIU/mL (Range: 1 - 12) - NEAR LOW
LH: 2.1mIU/mL (Range: 0.6-12) - NEAR LOW
SHBG: 65 nmol/L (Range: 11 - 80) - NEAR HIGH
Estradiol: 21 pg/ml (Range: 11 - 44) - NORMAL - however, the test says Adult Pre-Menopausal Female, still applicable?
Prolactin: 9.8 ng/ml (Range: 3.5 - 19) - NORMAL
Metabolic and CBC panel figures have plenty of NEAR LOW or NEAR HIGH values, but glucose and albumin - two of the more important ones regarding testosterone levels, I believe - are right smack in the middle of the normal ranges. That said, there are still some true LOW and HIGH values to note:
Creatinine: 1.64 mg/dl (Range: 0.7 - 1.3) - HIGH
Bilirubin: 1.3 mg/dL (Range: 0.2 - 1.2) - HIGH
EGFR MDRD (Non-African American): 49.6 ml/min/1.73m^2 (Range: >60) - LOW
White Blood Cell Count: 4.0 10*3/uL (Range: 4.2 - 9.1) - LOW
Mean Corpuscular Volume: 92.4 fL (Range: 79 - 92) - HIGH
I can provide the full CBC & Metabolic reports if you all think there may be more useful data to review...
Saliva Results:
I took a fasted morning saliva test in July, but the paperwork with the results said the lab didn't receive it until mid-August (approximately one month after I spit in the tube during a random morning). The Urologist said the results are still fine to look at from a trend aspect, but also that saliva samples can be more volatile than blood work and the delay between collection and reading could have certainly caused issue with some of the figures listed below:
Total Testosterone: 8pg/mL (Range: 44 - 148 - Age Dependent) - VERY LOW
Cortisol: <0.1 ng/ml (Range 3.7 - 9.5 - Morning) - VERY LOW
Estradiol: 1.1 pg/ml (Range 0.5 - 2.2) - NORMAL
Progesterone: 29 pg/ml (Range: 12 - 100) - LOW-NORMAL
DHEAS: 13.9 ng/ml (Range: 2 - 23 - Age Dependent) - NORMAL
Overall Impressions:
While I will go for another blood test for more details, it looks like between the saliva test and first blood test that my symptoms are corroborated by the test results. Specifically, it looks like my SHBG to Total Test level is quite skewed and I am unsure of what to make of the Low Cortisol. That said, if my Total Test was in the 600-700, with all else being equal, then my free testosterone levels would probably be in the normal range (albeit possibly on the lower side given the fact that the SHBG is on the higher side of average). FWIW, I am unsure on all of the testing methodologies (Standrd, Sensistive, LCMS, etc.). Are there specific versions of these tests I should insist on the doctor using for accuracy purposes?
That said, I prefer to stay off the injection path (either TRT shots, patches, HCG, etc.), as I want to keep my fertility options open being that I am still single and only 30 and would like to have a family one day. However,I obviously I first need to be able to get the plumbing up-and-running again. I know that Clomid is an option for an optimizer/restart but I believe that would also raise my SHBG levels, as well as my Estrogen and, potentially, my Prolactin levels. Thus potentially pushing them to an official HIGH level and still yielding the issues associated with Low T/Low Free T. Thankfully, as it appears to stand now, my Estrogen, Prolactin, Progesterone (via Saliva), and DHEAS (via saliva) seem to be okay; but I am sure the doctor will check all of those again via a morning fasted blood work.
Is there any way I can raise my test (free test, total, LH, etc.) without further raising my SHBG, potentially messing with my prolactin and estrogen levels, and keeping my fertility options intact? Aka, can I take Clomid with anything else to help right the ship?
Additionally, would doctors be able to prescribe Torem? Or is that not something doctors prescribe off-label for androgen deficiency? Are there any key distinctions to trying a restart for a situation like mine with either Clomid, Torem, Nolva, Tamox, etc.?
Also, understanding I'll be going for another round of blood work (and still have an ultrasound report pending) what other metrics should I insist on being tested? (e.g. DHT, DHEAS, TSH, T3, Neurotransmitters via urine/saliva, etc.) As of now, it seems like Clomid with an AI on-hand and a potential Variocele repair would be the most standard course of action, though I would appreciate all of your thoughts (also, thoughts on exemestane vs. arimidex?).
I apologize again for the long post, but hopefully it's comprehensive enough to not require as much back-and-forth as other OP messages on this topic. Of course I am working with a medical provider on this but I'd like to be armed with as many opinions, first-hand accounts, anecdotes, etc. when progressing with him so I leave no stone unturned (and, to be 100% certain that I am in good hands, I am going to go for a second opinion from another doctor at Columbia Medical who specializes in this, but the first appointment isn't until mid-Oct).
Thanks again in advance for any thoughts,
Goliath
