Doc says these lab results rule out low T causing my symptoms. True?

[SomeGuy]

I'm a 33 year old male, otherwise in good health. I'm in good shape, eat healthy food, and exercise regularly. I'm 6' and 180 pounds. Low cholesterol, blood sugar levels are fine, thyroid blood work is fine, and good blood pressure.

For the last few years I've had:
-Difficulty concentrating, poor memory, brain fog
-Borderline ED (things still work somewhat, but it's harder to get an erection, less firm than before, and usually goes limp part way through.)
-Irritability
-Poor motivation and follow through

I asked my doc to test my T levels and they came back as:

Total Testosterone: 502 NG/DL [range: 250-1100]
Free Testosterone: 69.4 PG/ML [range: 35.0-155.0]
SHBG: 35 NMOL/L [range: 10-50]
No testing was done for other hormone levels such as LH, estrogen, etc.

My doc says that with these levels there's no way that testosterone is causing my symptoms. My internet research shows that while my levels are within the lab reference ranges, they're way low for someone my age (33 years). According to one chart I found online my levels are normal for men age 65-74!

I'd love it if someone knowledgeable about this could tell me if these levels at my age could cause these symptoms and if I could benefit from treatment. I'm really having a rough time and don't want to go on like this for the rest of my life. But I don't want to waste more money going to another doc for a second opinion if the first doc is right and these levels are fine.

[PeakT]

Usually I don't get complaints of low testosterone symptoms from guys in the 500's.  However, every once in awhile a younger man like yourself will do so.  This is kind of a tough area, because there are other things that can cause fatigue-y kind of symptoms like you have.

Besides medical conditions, things like low vitamin d, high prolactin, high estrogen, nutritional deficiences, contaminant/toxin exposure, sleep disorders, medications and adrenal fatigue come to mind just for starters.

Did you get the read in the morning?

[SomeGuy]

They took the blood around 10am.  Although the Total Testosterone is in the 500's, my Free Testosterone seemed even lower on the "T levels by age" charts.  Does the Free T level look ok to you?

Thanks so much for your help!

[PeakT]

Yes, your free T is about 1.4% which is a little low as you probably know.  The free T measurements aren't the greatest though, but, yeah, that makes the whole picture look a little worse. 

If your pull was at 10 am, then your actual peak T was a little higher, but not by that much - maybe 10-15%.

Well, I would ask to get retested:  the T measurements can vary somewhat.  HRT involves a lot of time and money and lower fertility, etc.  So, for a young guy like yourself, it's often prudent to double check things.  And, then in the meantime, you can maybe ask about prolactin/estradiol/vitamin D reads as well.  Find a good doc and talk to him/her...

[PeakT]

Cortisol would be wise to get as well imo as it can cause some of these issues.

[SomeGuy]

Will do.  Thanks a lot!

It would be amazing if all of my seemingly separate symptoms could be cured with hormone therapy.  I'm trying not to get my hopes up too much, though.

I'm not worried about the fertility issues.  My wife and I have had out kids and we're done.  We've actually been discussing sterilization anyway.  The only side effect of TRT that worries me is the possible hair loss!  That would really suck.

[PeakT]

The only side effect of TRT that worries me is the possible hair loss!  That would really suck.

I cannot think of any guy complaining about hair loss due to testosterone treatment.  Of course, talk to your doc about that:  he/she is supposed to be the expert.

Also, do a lookup of tocotrienols:  they are probably protective against some types of hair loss...

[SomeGuy]

I've been Googling around a little more and found something potentially significant.  On my test results the % free testosterone isn't listed.  It says:

"The Testosterone %free result is no longer being reported or transmitted by the performing laboratory.  Its value is still being used to provide the result of the free testosterone, the more clinically significant result."

Now, when I calculate my %free by hand, I get just under 1.4%.  If I google up past results posted by others using the same lab and reference ranges as my lab, I find that their reference ranges for %free T are [1.5-2.2%].  So, according to my labs my %free T is below the reference range, although apparently the lab has recently decided to stop including the %free T reference ranges on their reports.

Is this significant?  Also, what might cause my %free T to be low, especially since my SHBG result seems to be exactly normal according to test by age charts, and the same as many other men's results where their %free T is normal.  Something besides SHBG is binding up my available T?

[PeakT]

I've got a page on this already that I think will answer a lot of your questions:

http://www.peaktestosterone.com/Free_Testosterone_SHBG

Let me know if that helps.