Your total testosterone is not the issue—669 is solid. Free T is on the lower end, but with SHBG only at 47.5, it’s not pathologically high. What stands out more is your low IGF-1, sluggish DHEA-S, and a TSH creeping up toward 3. These aren’t isolated problems—they’re part of a broader downregulation in energy metabolism and circadian signaling. You’re not dealing with a testosterone deficiency—you’re dealing with a mitochondrial signaling issue, and your body’s pulling the brakes on growth pathways for a reason.
Before jumping to enclomiphene or chasing numbers with supplements, I’d recommend doing two things: (1) Test your iron/copper ratios (serum iron, ferritin, ceruloplasmin, zinc, copper) to rule out terrain-level dysfunction that could be suppressing your anabolic drive; and (2) Try a breath-hold test (like a BOLT score) to check your autonomic balance and CO₂ tolerance—you’ll learn a lot about how your system is handling baseline stress. You might find the issue isn’t “low testosterone,” but a system that’s preserving itself in a low-output mode. Fixing that gets your lean mass and energy back—without forcing it with external agents.
More labs and biometrics are needed but 40 yo men have low T for a reason and if there is no direct pathology the etiology is mitochondrial
Rick Cohen M.D.
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Thanks, that’s very helpful! I did find out I’m defficient in copper.
Sérum copper : 63 ug/dL, low
Sérum zinc: 90
Ceruloplasmin : 17.4
Coq10: 2.21 uf/mL, high
I’ve been supplementing with 2.5g copper daily in addition to my usual multivitamin/Multimineral. I’ll test again in about 3 weeks to see if levels have balanced. I’ll have to test sérum irons and ferritin on my next checkup.
It’s the first time I’ve heard about BOLT, and looks like I could use some improvement. I was able to hold my breath for only 15 seconds max. Are there any other labs you would recommend I get?
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My estradiol raised to ~50. T 900, Free T 16 (middle of range), 25mg twice per week. I tried a very low dose aromatase inhibitor which brought it down to ~30 with virtually no change in other hormones (thyroid, cortisol, testosterone, various binding globulins, etc) and no subjective changes, so I discontinued it.
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Yes you need a mitochondrial make over!
You’re already thinking in the right direction by looking upstream at root-level causes like iron saturation and metabolic shifts, rather than simply chasing hormone levels. But many of these issues—fatigue, loss of lean mass, low IGF-1, creeping TSH—often point to deeper terrain dysfunction, particularly involving magnesium loss, circadian misalignment, and redox imbalances. In our model (QMT), we use simple but powerful dynamic measurements—like breath-hold index (BHI), urine ORP and conductivity, and spectral analysis of cardiac rhythms (high/low frequency bands)—to detect functional blocks and help determine whether you’re in a depletion state or adaptive compensation.
We offer coaching for those who want to go deeper, including guidance on avoiding synthetic supplements, strategic use of light and temperature, and terrain-based interventions tailored to your patterns. One of our health coaches specializes in this kind of recovery mapping—if you’re interested, we can connect you.
Rick
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Interesting re seeing changes in personality using that drug. This happened to someone i know, female, who at 79 has been getting HRT via pellets. The testosterone is not only giving her a lot of energy but she says has changed her personality a bit, but in a good way. More confidence, not as needy. They have her at 200. When I finally asked to get mine checked after 7 years it was 220 - I never feel one bit different on or off HRT. She said she doesn’t care if anything she’s doing will shorten her life she’s never going off of it she feels so good. I suppose if she were 59 vs almost 80 she would feel differently but doubt there’s any reason it would shorten her life anyway.
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That’s great. As a guy TRT did the same for me.
Women need a certain level of testosterone to feel good. Just like men need a certain level of estrogen to feel good.
This guy I know, enclomiphene made him way more needy to the point he would denigrate himself continuously to get approval, but it would contrast with this weird disdain for everyone elses opinion.
I’ve seen a few people get strange reactions to it.
I can understand that. I’m certainly not going to get off TRT, it makes me feel too good. I can manage every other aspect of my health for longevity purposes. My blood work is better now than before I got on TRT in fact.
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So interesting I’d never heard of personality changes especially in an older women. When I went from sublingual to patch for estrogen the doc said now there was no way to get testosterone unless I do a pellet but I have since read about creams so will ask her for some, even if it doesn’t make me feel better it would be good for muscles especially with my fatigue and being in bed too much. This woman uses pellets some docs love them some stay away from them.
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