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I'm 37. I went to a clinic with my complaints and a hormonal test was done: Fsh 2.69mIU/mL Lh 7.28mIU/mL Prolactin 3.95ng/mL Testosterone 18.0nmol/L Random blood sugar 4.3nmol/L These are my symptoms. I have chronic Ed, pe, weak erections, and very low libido. It's actually been like that for close to 2 decades now. My energy levels are low, I get tired and fatigued easily. I went bald in my early 20s and it takes a long time for hairs to grow back when I crop them. I've realised over time my ability to recall things have been declining and I'm no longer socially active and friendly as I used to be as I get anxious when I'm thrown into such situations. My metabolism is quite slow too so I've got a couple of fat, though I look slim. These got me really depressed and I see no sense to life at all. I know all these are signs of low T. But the doctors, including this recent one insist my levels are OK. What's really going on?

AlphaMD's Answer


Your doctors didn’t lie in saying your labs don’t show anything abnormal. But they won’t always because what is “normal” is based on population averages, not what is normal for you.

There is a new diagnostic criteria for hypogonadism known as relative hypogonadism. This is where when you were younger and healthier, your body’s set point for what it considers normal is set at the high end of the scale (35nmol/L). At 18nmol/L, you are at half of what your body considers normal, and you develop symptoms of hypogonadism.

Without knowing what your levels were 10-15 years ago when you were feeling healthy, the only other way to know is do a trial of TRT and get your levels back to the high end of the “normal” range. If your symptoms resolve, then that is what is known as a diagnostic/therapeutic trial. The diagnosis is revealed with the therapy making you feel better.

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