@Cichlid MadMan: You are most welcome, I am glad you found them useful! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Cichlid MadMan what happened

if my doc won't prescribe testosterone for me although I have all the symptoms of low t...should I self administer testosterone....I had my levels checked it was 433ng/dl I'm in 33yrs old

@@zzzfresh3138 You have two choices. See a different doctor. (Always the MUCH better choice.) Or if that fails, see an online doc. (Beware of scams, they are numerous.) Don't forget you need Testosterone AND hCG! Lastly and most important: don't give up! (Easy to give up because fatigue is a symptom of Low-T!)

Glyn how is it going?

58 ng/dL for Total Testosterone? Ouch.

Thank you, @SM-ly7tn!

@Wezilla: We wish you the best of luck on your TRT journey! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed thank you. 👍

@Rick M: If you feel like you are not being heard by whoever is treating you, it is 100% within your right to seek another professional's opinion. Not all providers think through TRT the same way. Ultimately, if you are being seen by someone with a preconceived bias against a potential treatment, you will not be met with a balanced approach to your options. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Instructor alton: Honestly, if you are having to pry open the mindset of any provider to what TRT is all about, and the importance of the free hormone theory, it is probably best to seek another opinion. Your calculated free T is an integral piece of the puzzle. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

At the level of 345, I'd say ask your doctor for a referral to an endocrinologist. If he refuses, you're going to want to get a second opinion with another doctor. The most important thing is to not give up! 345 is low enough to care about improving it. Other people commenting on this video are basically bragging about their 750 testosterone levels. If you have qualitative symptoms (Google for Low Testosterone symptoms) make sure to bring those up to your doctor. Try to remember back to when you were 20 for a reference point in terms of sexual desire, fatigue, etc. Also, it's likely a genetic problem.

@Raj Mukhopadhyay: Numbers like those certainly point to a mixed hypogonadism picture, but needs to be correlated with repeat levels and a thorough history and phyiscal. We often see low normal TT levels with a below normal calculated free. That number would be very helpful in your case. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@m m: I don't disagree. The guidelines that exist need some work, but the stance that insurance has taken on TRT needs even more! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Probably doctors afraid of being sued. It's sad the patient has to suffer because of that. (And Low-T means you'll unlikely have the drive to get second/third opinions, see online docs, etc.) Fight for the best version of yourself!

@Nathan Kendrick: Yes, each lab and/or analyzer brand will have different reference ranges. Still, a total of 312 ng/dL likely yields a below-normal calculated free testosterone. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Eternal-zj5dg: Stay vigilant with it. If your PCP doesn't engage the possibility of TRT, I recommend seeking a second opinion from a practice specializing in it. I have seen many veterans gain improvement on TRT that eluded them when using conventional means of treating PTSD or depression. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@TCTmed that's what I've heard. I've been researching the benefits of trt for mental health, and it looks promising. I'd rather get off duloxetine and get my health back. I understand different places go off of different total and free testosterone levels. But is there anywhere I can search what seems to be the average? The va doesn't consider testosterone low until around 260. But I hope to use a private doctor to start and see if the va will take over. Since the treatment would be free for me at that point. Kind regards, Steven

@@Eternal-zj5dg Understandable. Best of luck to you! Thank you for your service; I hope the VA does its due diligence. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Aresene Remy: I am very glad you found the video helpful! I definitely see many patients with vitamin D deficiency who also have low testosterone. It's worth trying replacement, but I have also never seen Vitamin D supplementation correct testosterone deficiency. Given your numbers, as long as they are confirmed with a second test and draw before 10 AM and in a fasting state, it appears that you are a candidate for therapy. The numbness symptom isn't something I see a lot of, but if TRT is managed appropriately you can expect to see improvements in the classic symptoms you mentioned. I have found non-response to be very rare. I personally had improvement in brain fog and extreme fatigue after treating both my hypothyroidism alongside my low testosterone. Whoever you choose, make sure they are well versed in TRT. Endocrinologists and urologists often have their focus elsewhere, so while their knowledge base is vast, that doesn't always translate to optimal TRT management. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed Thanks for the reply. Before going for TRT therapy i would go tye natural route first. Should i see an endocrinologist to find out whe exact cause of whats causing my low t? My PC is completely clueless.

@Arsene Remy: Honestly, you are more likely to find help on this outside of a medical office. There is little focus on this in Endocrinology, and overall, the root cause is not found. Save a history of testicular or head trauma, chemotherapy, chromosomal disorder, or pituitary tumor the root cause often goes unlabeled. HIIT workouts, clean eating (with good fats), reduction/elimination of alcohol consumption, supplementing with zinc, magnesium, and vitamin D, and getting regular and high-quality sleep are good starting changes. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@Devlins 10: Those numbers indeed point in that direction. Just make sure that it makes sense with your symptoms, too! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Juan Tapia: Thank you for the feedback! The reference range we use, and the one adopted by Blue Cross Blue Shield, is 9-30 ng/dl. Keep in mind this is for a calculated free testosterone level. I strongly recommend against using a (direct) free T or analog assay, as this is an incredibly flawed test. Also, I find little clinical value in the measurement of % of total T and "bioavailable" testosterone levels. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Watching some other KZfaq videos make me think that sometimes they screw up on Free Testosterone tests. I'd go by Total Testosterone only.

@farooq farooq: That result appears to be within normal limits, according to what you have provided. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@ram kumar: Based on your numbers alone, it doesn't look like lowering your E2 would be a good idea. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

470 pretty low depending on ur age. Treat symptoms not numbers anyway. I wouldn't even mess with your estradiol. Get your testosterone to optimal levels. Most guys on trt don't even need an A.I.

@77ponch77: A total testosterone below 300 ng/dl, drawn in a fasting state and before 10 AM, on two separate days is what is necessary to confirm laboratory deficiency. Aside from that, symptoms consistent with low testosterone must be present for the formal diagnosis of hypogonadism to be valid. Now, if there is a reversible cause, like un/under-treated obstructive sleep apnea, that should definitely be assessed. On the other hand, many patients are potentially on antidepressants when testosterone deficiency may be a cause of their mood disturbance. All that said, I do believe that your number is low. There is likely more assessment needed, but a total of 262 (other criteria considered) is not normal. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@alkdklsdflkfds: They certainly will know how the disease process works, but that doesn't necessarily mean that they are well-versed in treating hypogonadism. In any specialty, you can find providers who keep their focus narrow and limit the extraneous issues they put effort into. Some urologists only deal with prostate, bladder, and vasectomy issues. Some endocrinologists primarily gear their practice toward diabetes. These are two specialties that should be champions of TRT, but not all providers in these fields are. Ask questions before your appointment. You may not need a referral to see the provider best suited to help you. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

At 195 you need help ASAP

@Anthony Smith: It's only something to worry about if you are significantly symptomatic. I never recommend treating based on numbers alone. That said, I have not found saliva tests to be as reliable as serum ones. I recommend having your levels checked by serum analysis done before 11 AM and in a fasting state. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@John Banacky: A total testosterone below 300 ng/dl, drawn in a fasting state and before 10 AM, on two separate days is what is necessary to confirm laboratory deficiency. Aside from that, symptoms consistent with low testosterone must be present for the formal diagnosis of hypogonadism to be valid. All that said, I do believe that your number is low. There is likely more assessment needed, but a total of 245 (other criteria considered) is not normal. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

John, any progress on this? I'm also 51 and free T is 250

@Joel Mcconnell: Hey, Joel! We have a slew of great articles on this at tctmed.com/trt-blog/. Essentially, the basics are getting plenty of uninterrupted (high-quality, and at least 7 hours) sleep nightly and using HIIT workouts with the appropriate balancing of intensity and rest. Also, avoid or eliminate alcohol, get the proper amounts of vitamin D, zinc, magnesium, and good fats in your diet, and control stress. Best regards, Augie Galindo, MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thanks!

@@Joel-McConnell You're welcome! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Silas0403: Reference ranges differ from lab to lab, not just country to country. To compare to the guidelines set forth by The Endocrine Society, which "is a professional, international medical organization in the field of endocrinology and metabolism", requires bias testing for labs with significantly variant reference ranges, or use of a lab which is more closely aligned with the reported standards. Furthermore, unless they used an calculated free testosterone or an equilibrium dialysis assay, the number for your free may also be suspect. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Fire your urologist.

@Necerbo: Unfortunately, I am hearing stories like yours more and more frequently. In the past, I was reluctant to start men younger than 25 on TRT. However, the fact is that our chemical environment has no shortage of endocrine disruptors in it, and therefore, we are bound to see the problem of low testosterone proliferate. Make sure you give your body its best chance to do things naturally before pulling the trigger on TRT. Get 8 hours of sound sleep nightly, decrease bad fats and increase good fats in your diet, limit or eliminate alcohol and/or illicit drugs (or recreational recently-legalized-drugs). Be sure to supplement with zinc, magnesium, optimal amounts of vitamin D, and use HIIT workouts 3-4 times weekly with structured rest days in between. Next, have levels tested before 10 AM, on two different days, after having fasted since midnight before. Your levels are dynamic day-to-day and week-to-week, so moving from 387 down to 375 over one year doesn't indicate any significant loss. If you are still low, then you need to take a long look at your symptoms and then decide for yourself whether or not the severity of those symptoms warrants engaging the potential risks and burden of therapy. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed i got even lower it was353ng/dl im17 nurses sad its normal range i got all the symptoms could i see a doctor?

@@metafizikosigiorga7964 Your total testosterone is in the normal range, but your calculated free may still be low, and given your age, I would expect a higher result if all other parameters are normal. You may want to consult a provider that specializes in hormone replacement. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed I am 23 and I have 240 ng/dl. I tried everything, I took boron, vitamin d3, exercised, made sure to get daily steps, ate enough protein, magnesium, zinc, and other stuff. I am planning to hop on trt, what do you think I should do? Btw I have no motivation, fatigue, skinny fat despite exercise and cant body recomp I just keep running on a circle, I cant concentrate, brains kinda fogged, I tried to fix my sleep using melatonin to make sure i am getting enough, Idk I just feel so bad all the time and my main priority is to be productivity or I will fail life, not building muscle even. Its so hard to get things done when I am physically tired all the time.

@@sushio4357: Despite your age, it certainly seems that you are suffering from a very typical conglomerate of symptoms that are consistent with Low T. With the behavior modifications that you have already tried and found unsuccessful, I think you are on the right track in considering TRT. Make sure to diligently think through the implication on fertility. While I have seen no evidence that TRT permanently suppresses normal sperm production after cessation, you should pursue sperm banking before beginning testosterone. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@rawad hanna: The best way, in my opinion, is to use a calculated free T. This can be done with an algorithm that can be found online (www.issam.ch/freetesto.htm), and requires your total testosterone, albumin, and sex hormone binding globulin (SHBG). This way you can calculate it yourself. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed thank you soo much you do not know how much you help me i live in Syria (the war country) too far from the USA this information is very helpful but in Syria i can't find some one who do the shbg test that means i can't have my free testosterone count...sadly i will have only total but thank you soo much again Doctors here do not know so much about trt

@@TCTmed i had a free testosterone test but it's not calculated and it's 10.8 pg/ml i could not have calculated yet... Is it fine

@@rawhan8602 I can't really hazard a guess here, as analog tests are just too unreliable and inaccurate. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@@TCTmed if the test is right would you consider it low free testosterone I will do my best to get the calculated test when i find some lap and i would not do anything tell i do it

@ FaithFilled1111: It should be a medical provider who discusses lab results with patients. There is too much to unpack, and the responsibility for that level of care belongs to the treating provider. Two things to consider, though: 1. Not all reference ranges are the same, so the lower limit of normal for some labs/analyzers can be in the 100s 2. If you still hit a wall of indifference, it's usually best to try to find a like-minded provider than to try to "convince" a naysayer of the benefits of TRT Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed Thanks for the feedback.

@@FaithFilled1111: You're welcome!

@Mak MakOA: 273 ng/dl would be considered low, 420 would not be. However, where your calculated free testosterone is also matters. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

​@@TCTmed im mid 30's. Because my doctor says its within range (eventhough low) i shouldnt consider therapy. But he is no TRT expert. Your thoughts? Testosterone: 9.2 nmol/l - SHBG: 26nmol/l - Free testosterone: 0.37 nmol/l - LH: 5.5 U/L - FSH: 4.9 U/L - Protactine: 199 mU/L

If you have numbers that are this different, make sure you're testing at consistent times of the day. Always as early morning as possible. 7:00am should be your target. Testosterone is the greatest in the morning.

@Jesse: Here are some things to think about before you answer that question. First, do you have symptoms consistent with testosterone deficiency like; fatigue that worsens throughout the day without cause, decreased libido, negative changes in the quality of your erections, difficulty maintaining sleep, trouble concentrating, irritability, difficulty keeping or building muscle, or trouble losing fat. If so, then you should review the potential risks and side effects associated with TRT (you can find videos on this on this KZfaq channel and more information on our website). If, at that point, you feel that the benefit of treating those symptoms outweigh the possible risks, then you are ready to look at levels. Meeting with an experienced provider who performs a thorough history and physical is very important. Your level of 500 is your total serum testosterone, but you will need to pay more attention to your calculated free T. Other labs will inform your provider if there may be other hormonal disorders leading to a low level. Remember that T levels are very dynamic, and do change daily. Also, remember that your levels should be increasing throughout your 20's. You could potentially have a high normal free T, even with a total of 500. So, a range on lab results tell us some things, but they are far from definitive. Answering all of these questions will answer your original question. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thank you very much for your answer. I do have low T symptoms, which is why I decided to get tested in the first place. Low libido, no erections, low energy, depression, hard time gaining muscle. I was referred to an endo. I will order more bloodtests for my free T now, since I heard from multiple sources that it's very important. If TrT will make me feel normal again then I'm willing to take the risks

@@Summerbrah: It sounds like you're taking a wise approach. Best of luck with everything! Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed doc i got all the symptoms 353ng/dl at17 can i get trt?

@Bilal Hamurabi: Natural testosterone production is, without a doubt, a much more dynamic beast than most give it credit for. I suppose the best answer to your question is, "response to a stimulus". However, there are limitations. In other words, even with a precisely maintained internal environment (stress reduction, healthy diet, avoidance/limitation of alcohol, consistent HIIT workouts, proper supplementation) the body may not respond the way you might expect it to. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

I am 82yo. Recently my T level was evaluated. The result showed my level to be in the low 600s. Is there any need for concern with this level at my age?

@mikeyoung1002: It is critically important to the development of secondary sexual characteristics during development but does play a vital role throughout life concerning overall hormonal balance. One can live without testosterone, so for a developed adult, there isn't necessarily an amount essential for life. However, the influence, or lack thereof, would definitely be felt. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@Al De La Cruz: Understand that I am biased, but I have seen the best results from practices that focus on hormone replacement. Like mine, most of these practices do not employ a urologist or endocrinologist. The current state of health care being what it is lends itself to practices getting bogged down and relegated to one primary focus. Many urologists are focused on prostate/bladder care and vasectomies. Many endocrinologists are overwhelmed with diabetes cases. Certainly, urologists and endocrinologists have the medical prowess in managing TRT, but it is rarely their focus. That said, if you don't have any symptoms, my recommendation is to wait on starting TRT. I avoid focusing only on numbers in my practice, so treatment becomes little more than an exercise in number manipulation without symptomatic improvement to target and measure. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed thank you so much!!!

@@aldelacruz5526 You're welcome!

@@TCTmed if I may ask 1 more question......I did both blood work back to back 3 months apart. I've been reading these tests should be done fasting b4 10am. My Dr didn't tell me this. I usually fast from 6pm till noon the next day. I did both tests 3 months apart while fasting 18 hours. So I didn't do them early in the morning. My question...if I'm scoring under 250 at noon labs what would be the difference in "numbers " vs doing it early like 7am? I understand my Dr isn't educated in this area or doesn't want to be but if the difference would be say like from under 250 to maybe 500+, that would be enough! Any feedback is appreciated 🙏

@@aldelacruz5526, It's rarely a giant swing. It is typically recommended to get two sets done within a week of each other, in a fasting state, and before 10 AM, but again, I wouldn't expect them to be more than 200 ng/dL higher. The difference is likely even smaller than that. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

Same 353ng/dl

@VympeL: Unfortunately, I hear that quite a lot. Don't let it deter you from seeking outside opinions from reputable providers experienced in the management of TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@surferjoe 5150: That could be ok based on your maturation trajectory, but if you are experiencing any delay in normal pubertal development, I would recommend digging deeper, perhaps with an endocrinologist. I wouldn't be too quick to turn to TRT at such a young age until the potential for other issues has been vetted. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@@TCTmed I have no motivation I'm depressed i have patchy sideburns I can't grow a beard I only have hair on my legs and pubes down there but I looked up and it said I should be at 600 ng

I also have poor appetite

@@Joe.8671 It sounds like it's worth looking into therapy. Just make sure you select a reputable practice that holds safety in the proper regard. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Managing Partner

@rawad hanna: Typically, with a calculated free testosterone, you won't see this scenario. However, the guidelines we adhere to state that it is "either/or". Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

@tpfmike1976: A testosterone level of 133 ng/dl is very low. ANY low level WITH symptoms should at least be considered for TRT. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

102 and I'm 18.

@@kristian420mua are you seeing a dr?

yea.

@Steve Tavares: You're free testosterone is really all that matters, but that does seem very low for a 44 year old. Best regards,Augie Galindo MPAS, PA-CTestosterone Centers of Texas | Founding Partner

Testosterone Centers of Texas free test levels are 42.1

If it's not a calculated free testosterone, I'd ignore it. Most practices order an analog (direct) free testosterone. This is clinically useless and cannot be relied upon. That being said, if your reported level is the result of a trustworthy assay, your numbers are low. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner

Testosterone Centers of Texas do you recommend me running testosterone

Well, more has to be evaluated before I could recommend anything. We monitor our patients very carefully, and diagnosis must meet strict standards. So, I would definitely recommend being seen by a reputable TRT expert. Best regards, Augie Galindo MPAS, PA-C Testosterone Centers of Texas | Founding Partner