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Low Testosterone and struggling to get TRT

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roy2220

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Hi everyone !
(Sorry for writing in English, I don't speak Dutch.)

I'm 28 y/o, about 4 years ago I did one beginner cycle of steroids. For some reasons, I did not did a good PCT.
After I stopped the cycle I felt shit. My Test was very low since then ( I stopped training for some reasons since then ).
I feel down / deppressed all the time / low to zero libido / Erctile dysfunction / my penis has gotten smaller / no morning erection / back pain ( might be from osteoprosis related to low T ? )
my symptoms are killing me : I am not productive at all , I have no motivation of doing anything, I can't even go to the gym with this very low T , I gained a lot of fat
I am 100% sure that it is all low T related symptoms because of the cycle , before I did the cycle everything was fine.

Doctors are driving me crazy , they only look at numbers and ignore the history and the very clear symptoms .
a few days ago I went to a GP , she refer me to a Urologist . After a blood test :
Testosteron was 10.5 ( normal 10-29 ) ,
prolactine just above high : 305 ( normal until 300 )
He did the T test again in the morning and it was 13.5 (Testosteron peaks at the morning )

the Urologist said that my Testosteron is normal and he does not adivise TRT. He ignored all symptoms and history. He refer me to an endocrinologist and still waiting.
I just want your advice since I am new in the Netherlands .
I am absulotely convinced of doing a TRT but I don't know what should I do in case the endocrinologist refuse it.
what can I do to convince the doctor ? is there a dutch medical guidlines that I can show to him in case he does not know ?
What options do I have ?
can I / should I do TRT alone ? how much approximately would it cost ?



Appreciate your help !
 
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Galen

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He's right to state that your testosterone is normal. With a testosterone level of 13,5 nmol/L, it's unlikely that TRT might benefit you.

However, given your symptoms, and if they've persisted for a long period of time, one could perhaps make a case for a trial period with TRT to see if this alleviates (some of) your symptoms. A more detailed anamnesis would be required for this, and not all endocrinologists will do this for you as this is in fact not in line with the guidelines.

If possible, ask a referal to dr. Diederik Smit, he is a great endocrinologist at the ETZ hospital in Tilburg.
 

The Hoste

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He's right to state that your testosterone is normal. With a testosterone level of 13,5 nmol/L, it's unlikely that TRT might benefit you.

That is simply not true. At 28 you should not have the testosterone levels of a frail, old man. Just looking at reference ranges based on a population without considering age or health doesn’t make any sense.
 

Galen

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That is simply not true. At 28 you should not have the testosterone levels of a frail, old man. Just looking at reference ranges based on a population without considering age or health doesn’t make any sense.
The reference range for a healthy nonobese population between the age of 19 and 39 years old is 9.2 to 31.8 nmol/L: https://academic.oup.com/jcem/article/102/4/1161/2884621
His testosterone level falls within the reference range applicable to him (assuming he is, indeed, healthy and nonobese), thus his testosterone level is normal per definition.

However, this is for labs that are CDC certified. There are small differences from one lab to the other, hence the reference ranges provided by a lab sometimes slightly differ. Nevertheless, 13.5 nmol/L is always within these ranges too. A diagnosis of hypogonadism is made when a patient shows signs and symptoms consistent with hypogonadism and two subsequent fasted morning measurements fall below the reference range. In conditions where SHBG might be affected, a free testosterone measurement should be made. Additionally, when there are hallmark signs of hypogonadism, and no other identifiable causes, this might also be performed when T levels are below 14 nmol/L and/or a trial TRT run can be suggested. However, in many of such cases, TRT is unlikely to be of benefit.
 
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roy2220

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He's right to state that your testosterone is normal. With a testosterone level of 13,5 nmol/L, it's unlikely that TRT might benefit you.

However, given your symptoms, and if they've persisted for a long period of time, one could perhaps make a case for a trial period with TRT to see if this alleviates (some of) your symptoms. A more detailed anamnesis would be required for this, and not all endocrinologists will do this for you as this is in fact not in line with the guidelines.

If possible, ask a referal to dr. Diederik Smit, he is a great endocrinologist at the ETZ hospital in Tilburg.
Thanks for your reply. Actually 13.5 was only at the morning where T peaks, the rest of the day it is in the 10+- range.
So what if the endocrinologist refuse to do a trial TRT, what options do I have ?
I feel like they are ignoring my symptoms and just looking at values, which indeed could tell that there is a problem. ( low normal + those symptoms should tell sth ! )
BTW : those symptoms have been there since I stoped the cycle, which was 4 years ago !
 

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Thanks for your reply. Actually 13.5 was only at the morning where T peaks, the rest of the day it is in the 10+- range.
So what if the endocrinologist refuse to do a trial TRT, what options do I have ?
I feel like they are ignoring my symptoms and just looking at values, which indeed could tell that there is a problem. ( low normal + those symptoms should tell sth ! )
BTW : those symptoms have been there since I stoped the cycle, which was 4 years ago !
Testosterone should always be measured in the morning for that reason (the reference ranges are also based on fasted morning measurements). Measurements made later during the day should be considered invalid.

If the endocrinologist refuses a TRT trial, and doesn't come up with anything else to further investigate or deal with your symptoms, you can opt for a second opinion.
 

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