Considering TRT – Seeking Advice

[RBinLA]

I’m a 51 year old male considering TRT………any advice would be greatly appreciated! Several years ago I began to experience low mood, low energy/motivation, low libido, muscle pain and weakness, poor concentration and memory, irritability etc. I was prescribed anti-depressant and anti-anxiety meds. The meds didn’t help. I have now been off the meds for approx one year. I still have all my original symptoms. Was it low testosterone all along? I don’t know for sure but the lab work from my last physical in July 09 showed the following:
Testosterone Serum: 576 ng/dl
Free Test: 8.8 pg/ml
TSH: 2.659 mIU/L
T4 Free: 1.16 ng/dl
PSA Serum: 0.3

Although I felt like crap my doctor didn’t see any problems – everything looks ok. My symptoms continued so in Dec 09 I had additional lab work. The results are as follows:
Testosterone: 447 ng/dl
Free Test: 7.2 pg/ml
FSH: 5.6 mIU/ml
LH: 5.3 mIU/ml
T4 Free: 1.16 ng/dl
T3 Total: 105 ng/dl
Cortisol: 10.7 ug/dl
Prolactin: 8.6 ng/ml
DHEA-Sulfate: 103.8

What do you think….would TRT help with my symptoms?

[Downthelanetheycome]

I was on the low side. 488 total T and 5.9 free. My Dr let me try Androgel to see if it would help with my depression. SSRI’s were impossible for me to tolerate. Its been 5 months and although my T levels are great it has done nothing for my mood. It does help some people however. Testosterone raises dopamine levels in the brain which help some and it may help with the side effects of SSRI’s. For that reason I may try another one such as prozac. I am 55 years old. Maybe just adding in some DHEA would raise your levels enough to see if you might benefit from testosterone therapy. Next time also get your SHBG tested. Sorry you are going through this.

[DrMariano2]

Generally, a total testosterone over 400 ng/dL is not low.

I would look elsewhere in the system to determine where the problems may be occurring.

Suboptimal thyroid signaling can lead to a cascade of problems in the nervous system, endocrine system and immune system, as well as in metabolism. These problems can lead to depression, loss of libido, loss of motivation, impaired concentration, irritability, loss of energy, muscle pain, etc.

From a mental health point of view, I prefer a Total T4 between 8-12, Free T3 between 3.4 to 4.2, and a TSH of less than 1.0 as probably optimal levels.

Generally, I would consider a TSH > 2.0 as indicating suboptimal thyroid signaling within the nervous system.

TSH is a quirky measure in that it assumes that the nervous system is functioning well. However, this is not the case when one has mental health issues. Obviously, the nervous system is no functioning well in that case. When the nervous system is not functioning well, then the neurons monitoring thyroid hormone levels may not be doing so well or the neurons producing TSH may not be capable of producing enough. Thus, TSH may become low despite inadequate thyroid hormone levels.

Note that numerous conditions can lead to suppression of adrenal function. This includes stress, metabolic problems, nutritional problems, infections, immune system problems, etc. These can also lead to similar mental health issues such as depression, loss of libido, loss of motivation, impaired concentration, irritability, loss of energy, etc. The possible factors need to be teased out and addressed individually.

[Author]

Posts