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HRT Question....Free Test vs. Total Test

Pharm_Fed

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I had bloodwork done at my last physical and am now scheduled to see an endo for low test. I looked over the results and they read as follows:

Testosterone, serum - 629 ng/dL = [range = 249-836 ng/dL]
Free testosterone (Direct) - 7.8 pg/mL = [range = 9.3 - 26.5 pg/mL]

For the guys on HRT, did your endo base treatment off of total test, or free test? It seems to me that free test is the important one.

I've been reading more about it, just trying to get a feel for what to expect and figure out what questions I need to ask. All other bloodwork looks great, all other values are right in the middle of the range. BP was 97/58.

If total test is normal and free test is low, could there be another treatment to free up the bound test or is it more likely they will prescribe HRT?
 

brutale

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I had bloodwork done at my last physical and am now scheduled to see an endo for low test. I looked over the results and they read as follows:

Testosterone, serum - 629 ng/dL = [range = 249-836 ng/dL]
Free testosterone (Direct) - 7.8 pg/mL = [range = 9.3 - 26.5 pg/mL]

For the guys on HRT, did your endo base treatment off of total test, or free test? It seems to me that free test is the important one.

I've been reading more about it, just trying to get a feel for what to expect and figure out what questions I need to ask. All other bloodwork looks great, all other values are right in the middle of the range. BP was 97/58.

If total test is normal and free test is low, could there be another treatment to free up the bound test or is it more likely they will prescribe HRT?
You look at both and do a few tests since the numbers bounce around more than you'd think. You should also look at your SHBG - may be high, hence the high amount of bound test. Let's assume the numbers the numbers remain fairly consistent.

HRT could improve your numbers, but it seems like you would need to take test to the upper end to get free test to mid-range.

You could try targeting SHBG. As men age, SHBG's binding capacity tends to increase leading to declines in free test. Nettle root extract has been proposed as a way to reduce SHBG activity, as constituents of the root may bind to SHBG in place of test. I'm not sure how solid the evidence is. Proviron can increase free test by the same mechanism. (It is unclear however how much proviron shuts you down. So it is better with some supplemental test).
 

brutale

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Shbg

If you have elevated SHBG, the issue is pretty complicated.

Let me lay out what I've been able to learn. SHBG levels are regulated in the liver. So, liver disease and hepatotoxic drugs can raise levels. If your liver enzymes are good, then probably this is not an issue. You might try some liver tonics like milk thistle or liv52, and certainly make sure you are not taking any meds which impact the liver.

People report a correlation between elevated estradiol and elevated SHBG. So, make sure your E2 levels are good (<25).

There is some evidence (a japanese study i think) that omega3 fish oils can lower shbg.

So a reasonable game plan for you is:
- get more info with more testing, a full hormone panel w SHBG
- may benefit from low dose arimidex if E2 too high
- if SHBG too high: nettle root extract, liver tonics, fish or krill oil, no booze or liver toxic drugs
- HRT if needed
 

Pharm_Fed

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Thanks for the response. I'm only 27 so I would think high levels of SHBG would be unusual. My liver values were all right on target and I already take Milk Thistle so that should be under control AFAIK.

I have an appt with the endo on Thursday, just trying to gauge what to expect from others' experiences. I have read about many endos being reluctant to prescribe test because it's still fairly new and not quite mainstream treatment yet. Just want to be prepared with as much info and as many questions as possible.
 

maldorf

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I do not see them prescribing you test becaues your total test is great. My endo doesnt even test my free test levels. Most do not from what I have seen. Since you know its low though I would think that he will have some other way to treat that. Just pumping in more test is not the answer and would not be healthy.
 

napaulm

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I do not see them prescribing you test becaues your total test is great. My endo doesnt even test my free test levels. Most do not from what I have seen. Since you know its low though I would think that he will have some other way to treat that. Just pumping in more test is not the answer and would not be healthy.
same here, my trt was based on total, which was slighty above the lowest level. at 38 i had the test levels of a 65-70 yr old.
 

maldorf

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same here, my trt was based on total, which was slighty above the lowest level. at 38 i had the test levels of a 65-70 yr old.
Yeah, mine varied between 35-55 or so during the 10 months we looked at it. Another thing they really base HRT on is your LH level. LH level is probably more important than the total test. My LH level sometimes came back sayin "below measurable levels" on my labs! It never came up much and actually went back down at the end of 10 months.
 

brutale

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depends on the doc

I do not see them prescribing you test becaues your total test is great. My endo doesnt even test my free test levels. Most do not from what I have seen. Since you know its low though I would think that he will have some other way to treat that. Just pumping in more test is not the answer and would not be healthy.
Given your age, i think there may be some reluctance to go to HRT, understandably. For some reason I assumed you were a geezer like me.

My doc looks at free, as well as total, testosterone and estrogen. Looks at DHT too. He generally intervenes if either T or free T is low.

Next time I see him, I'll ask him what he'd do if T is good and free T is poor. Btw, your facts imply either that SHBG is high or that the binding efficiency of T to SHBG is high.
 

TeknoViking

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not trying to swoop this thread...

but i just got my blood work back and i was at 315..and i am 25 you think i am a candidate for hrt? I have so many symptoms of low test but i keep pressing forward.
 

Pharm_Fed

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I do not see them prescribing you test becaues your total test is great. My endo doesnt even test my free test levels. Most do not from what I have seen. Since you know its low though I would think that he will have some other way to treat that. Just pumping in more test is not the answer and would not be healthy.
I was told Proviron may be a viable option by someone on another board. What do you think about that, or are you aware of another treatment? Is it OK to take Proviron without anything else?

I have many symptoms of low test, so I know something needs to be done.
 

brutale

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not trying to swoop this thread...

but i just got my blood work back and i was at 315..and i am 25 you think i am a candidate for hrt? I have so many symptoms of low test but i keep pressing forward.
You need to post more info. Is your low T secondary to AAS? If so, how long have you been off? What was your pct? How are your other hormones: lh, fsh, etc.?

I'm concerned by all these young guys wanting HRT. Look, HRT is really great for older guys who already have kids and have to deal with declining T, increasing E, and all that. But it is inconvenient, sometimes expensive (depending on insurance), poses problems if you want kids, and is a long-term commitment. Also even steady HRT doses can elevate HCT - cyp being worse than transdermal in this regard. It is tempting to want a legal way to cruise. But cruising adds its own health issues to the list of HRT issues above. I don't mean to preach - just urging caution.

If I were young and had low T related to AAS, I'd try to find a way to restart my natural production over time ... and there are lots of things to try. I wouldn't jump into HRT unless my T stayed low for a long period even after interventions. Just my 2 cents.
 

TeknoViking

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i like that type of advise as i see the same cons to hrt as you do
 

Pharm_Fed

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You need to post more info. Is your low T secondary to AAS? If so, how long have you been off? What was your pct? How are your other hormones: lh, fsh, etc.?

I'm concerned by all these young guys wanting HRT. Look, HRT is really great for older guys who already have kids and have to deal with declining T, increasing E, and all that. But it is inconvenient, sometimes expensive (depending on insurance), poses problems if you want kids, and is a long-term commitment. Also even steady HRT doses can elevate HCT - cyp being worse than transdermal in this regard. It is tempting to want a legal way to cruise. But cruising adds its own health issues to the list of HRT issues above. I don't mean to preach - just urging caution.

If I were young and had low T related to AAS, I'd try to find a way to restart my natural production over time ... and there are lots of things to try. I wouldn't jump into HRT unless my T stayed low for a long period even after interventions. Just my 2 cents.
While I appreciate the concern, my low T is not due to AAS usage, as I'm natural. And I don't necessarily want HRT, I just want to feel better. If there is a safer/cheaper/more effective way to do that than test, I'm all for it. I see my the endo on Thurs. Just posted to try and gauge what I was facing from other people's experience. :)
 

brutale

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While I appreciate the concern, my low T is not due to AAS usage, as I'm natural. And I don't necessarily want HRT, I just want to feel better. If there is a safer/cheaper/more effective way to do that than test, I'm all for it. I see my the endo on Thurs. Just posted to try and gauge what I was facing from other people's experience. :)
Apologize for making blanket statements that do not necessarily apply to you.

I've seen a bunch of threads recently about hrt for young guys after unsuccessful cycle recovery and was thinking about that.

Good luck with your endo bro. And if he doesn't really listeni to your concerns, you can always find another doc who does. I have a great doc, but he wasn't the first person I saw. Let us know how it goes.
 

Pharm_Fed

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Thanks for the kind words. Will update when I know more.
 

Lymelight

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Great thread...Im 47 and have had a chronic illness for the past 10 yrs. I have been on a theraputic GH program for three months and am not feeling much better...though my weight has stabalized at around 180. My test level is over 800....Im considering to adding Nettles root to my program.
 

Pharm_Fed

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So, the endo did more blood work and found my LH level was low as well. I am being scheduled for an MRI to ensure there is not a tumor on my pituitary gland. I would appreciate any thoughts and prayers that this is not something serious.

Thanks.
 

Emery

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not trying to swoop this thread...

but i just got my blood work back and i was at 315..and i am 25 you think i am a candidate for hrt? I have so many symptoms of low test but i keep pressing forward.
It's the shits isn't it? did you recently come off cycle?
 

brutale

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So, the endo did more blood work and found my LH level was low as well. I am being scheduled for an MRI to ensure there is not a tumor on my pituitary gland. I would appreciate any thoughts and prayers that this is not something serious.

Thanks.
Good luck with your tests. Your endo is just being thorough -- don't freak out -- unlikely you have anything serious. Precautionary MRIs and CT scans are really common. Once in a rare while, they catch something (and then you're glad you caught the issue sooner rather than later). 99% it's nothing I'd guess.
 

Pharm_Fed

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Update: Just got a call from the endo and they said they didn't find anything abnormal on the MRI and we can proceed with treatment. They are calling in a prescription for test which I will pick up later this week and then I will have another appointment next week to discuss treatment and answer any questions I have. Praise God for this good news!
 

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