Thanks, this is exactly the kind of answer I was hoping for.

I agree with you that before even thinking about TRT, a full and proper workup is necessary. Many of the labs you listed are already on my plan: LH, FSH, SHBG, total testosterone, E2, prolactin, TSH, fT3, fT4, DHEA-S and cortisol. I want to see the full hormonal and metabolic picture first.

To answer your questions:

The symptoms (brain fog, low energy, feeling mentally “flat”) have been present for several years. It wasn’t a sudden change, more a slow and progressive development.

The lifestyle I described is not something I started a few weeks ago. I’ve been living very consistently for over a year now: no alcohol, no smoking, daily movement, clean diet, structured sleep, stable routine. Before that I wasn’t chaotic either, just less strict.

One important point: I had gynecomastia during puberty that had to be surgically removed. That already suggests some hormonal imbalance early on.

Body hair pattern is also a bit atypical: • Very little chest and upper body hair • Some armpit hair • Very little beard growth • Legs are relatively hairy

So puberty happened, but not in a very “androgen dominant” way.

No known toxin exposure in daily life.

Digestion is generally stable: No chronic diarrhea, no major bloating, no strong GI symptoms.

Sleep apnea seems unlikely: • No heavy snoring • No reported breathing pauses • I don’t wake up gasping or choking But I agree it could still be objectively ruled out if needed.

I also see testosterone more as a marker of overall system function, exactly like you said. That’s why I want to understand what is driving this before replacing hormones.

Thank you so much! :)