I’m a 51‑year‑old guy in good shape who trains hard (CrossFit + lifting + conditioning almost daily). I’ve dropped `20LBS over the past 4 months and sit around 215 lbs now. I eat clean, don’t drink, don’t smoke, and generally take care of myself, but I’ve been dealing with low libido, lower drive, slower recovery, and just not feeling like I’m firing on all cylinders.
I’ve been digging into my labs and trying to understand whether TRT makes sense for me, but the risk/reward feels complicated.
My recent biomarkers :
- Total Testosterone: 518 → 646 → 702 ng/dL (normal range)
- Free Testosterone: consistently low across multiple methods
- SHBG: 60–63 nmol/L (high)
- FSH: elevated
- LH: normal
- Estradiol: 35 pg/mL (normal)
- Prolactin: 3.2 ng/mL (normal)
- PSA: 3.0 → 2.39 (borderline but stable)
- Lp(a): 75.6 nmol/L (mildly elevated)
- Lipids, kidney, liver, thyroid, inflammation: all normal
- Sleep: 4–6 hours/night
- Training load: high
- Stress: high
So I’m in this weird spot:
Normal total T, low free T, high SHBG, elevated FSH.
Not classic hypogonadism - more like SHBG-driven low free T with partial age-related testicular decline.
My hesitation:
I’ve been researching TRT heavily. I understand the commitment, the suppression, the monitoring, and the potential risks (hematocrit, PSA, estradiol volatility, cardiovascular stuff). I’m not anti‑TRT - I just want to make a smart decision.
My Hone consultation this morning:
I had a remote consult with Hone. The doctor basically said:
- My total T is “falsely good” because SHBG is high
- Free T is what matters, and mine is low
- Estradiol is “high-normal” and should be lowered
- SHBG is “killing my free T”
- He recommended immediate TRT
- Dose: 0.4 mL (80 mg) twice weekly
- Plus anastrozole 1 mg twice weekly starting day one
- Said he’d “bet his career” my estradiol will go high without an AI
- Mentioned enclomiphene but clearly preferred TRT
- Said TRT would help libido, energy, gym performance, cognition
- Follow-up labs at 90 days
I’m not saying he’s wrong - just that this was a very aggressive plan compared to what I expected. Especially the AI at initiation.
Where I’m stuck:
I’m trying to weigh:
- The desire to feel better
- The fact that my free T is genuinely low
- The risks tied to PSA and Lp(a)
- The commitment of TRT
- Whether I should try enclomiphene first
- Whether lifestyle changes could lower SHBG
- Whether starting TRT at a lower dose and monitoring closely is a safer path
- Whether I’m overthinking this entirely
My question for the community:
For guys who’ve been in a similar biomarker situation — normal total T, low free T, high SHBG - how did you decide between TRT, enclomiphene, or waiting?
If you’ve gone the TRT route, how did you weigh the risks?
If you’ve tried enclomiphene, did it actually help free T and symptoms?
If you were in my shoes, what would you want to know before making the call?
I’m not looking for medical advice - just real-world experience and perspective.
This feels like a big decision, and I want to make it deliberately.
Thanks in advance.