Hesitating on TRT, Does Anyone Have Regrets?

[ClashCityRocker]

I have two questions:

1. Can I "try" TRT long enough to see if it will work without risking the functionality I already have?

2. Does anybody have regrets for trying medically-supervised TRT when they were already pretty healthy and functional?

Background:

I'm 54 years old, 5'9", 150 lbs. I lift at the gym 4 days a week; eat 150 grams of protein a day; and walk or hike off-road 5 days a week. I don't take any prescription medications, other than Sumatriptan as needed for migraines.

An endocrinologist diagnosed me with primary hypogonadism based on high LH (19.3 mIU/mL) and FSH (49.9 mIU/mL), even though total T (465 ng/dl) and free T (68.4 pg/mL) were "normal." He basically said that midrange "normal" wasn't adequate in my case.

I have the golden ticket: a medical diagnosis by a specialist, with further office visits, lab work, medication, and supplies covered by insurance.

But I am hesitating because I don't want my balls to shrink, I don't like the idea of lifetime dependence, and my health is basically "good for a guy my age."

On the other hand, I am feeling "old," and my progress in the gym has all but stopped. I sleep poorly (3-7 hours a night in 3 or 4 increments) and am lacking motivation and initiative. Sometimes I feel depressed. I used to be involved in competitive sports, but I don't have the drive or energy for that these days.

What I would most like to see from TRT is increased muscle mass and strength; better sleep; and overall elevation in mood.

But my case is somewhat atypical, and that makes me think maybe I should just make due with the devil I know.

And feedback from guys who've faced a similar situation is appreciated.

 

[Systemlord]

1. Can I "try" TRT long enough to see if it will work without risking the functionality I already have?

You're going to eventually lose that functionality in the not so distant future. To answer your question, I was on TRT for 8-9 years and HPTA function returned within one week. I'm 53 years old. All this for you is a moot point considering you have primary hypogonadism.

There's no going back, better make it work.

An endocrinologist diagnosed me with primary hypogonadism based on high LH (19.3 mIU/mL) and FSH (49.9 mIU/mL), even though total T (465 ng/dl) and free T (68.4 pg/mL) were "normal."

TT is a function of SHBG, which inflates the TT. The TT doesn't define T deficiency. The FT is what matters.

On the other hand, I am feeling "old," and my progress in the gym has all but stopped. I sleep poorly (3-7 hours a night in 3 or 4 increments) and am lacking motivation and initiative. Sometimes I feel depressed. I used to be involved in competitive sports, but I don't have the drive or energy for that these days.

According to these listed symptoms your health will decline from this point forward if you take no action. Start TRT knowing the decision is already made for you as this is the hand you've been dealt.

 

[FunkOdyssey]

The free T is just shy of the "official" hypogonadal threshold set by multiple endocrinology associations of 65 pg/mL. If you've looked into this even superficially, you already know this is the better measurement of your testosterone status vs total T.

This seems like an absolute no brainer to me with your out-of-control LH and FSH. Your wish list for TRT benefits is also very reasonable and likely to be delivered. Get it done already.

 

[Systemlord]

The free T is just shy of the "official" hypogonadal threshold set by multiple endocrinology associations of 65 pg/mL.

Many experts would argue that the bottom 25% percentile of the FT ranges is a sign of hypogonadism if you take into account populational averages.

 

[Seagal]

I have two questions:

1. Can I "try" TRT long enough to see if it will work without risking the functionality I already have?

2. Does anybody have regrets for trying medically-supervised TRT when they were already pretty healthy and functional?

Background:

I'm 54 years old, 5'9", 150 lbs. I lift at the gym 4 days a week; eat 150 grams of protein a day; and walk or hike off-road 5 days a week. I don't take any prescription medications, other than Sumatriptan as needed for migraines.

An endocrinologist diagnosed me with primary hypogonadism based on high LH (19.3 mIU/mL) and FSH (49.9 mIU/mL), even though total T (465 ng/dl) and free T (68.4 pg/mL) were "normal." He basically said that midrange "normal" wasn't adequate in my case.

I have the golden ticket: a medical diagnosis by a specialist, with further office visits, lab work, medication, and supplies covered by insurance.

But I am hesitating because I don't want my balls to shrink, I don't like the idea of lifetime dependence, and my health is basically "good for a guy my age."

On the other hand, I am feeling "old," and my progress in the gym has all but stopped. I sleep poorly (3-7 hours a night in 3 or 4 increments) and am lacking motivation and initiative. Sometimes I feel depressed. I used to be involved in competitive sports, but I don't have the drive or energy for that these days.

What I would most like to see from TRT is increased muscle mass and strength; better sleep; and overall elevation in mood.

But my case is somewhat atypical, and that makes me think maybe I should just make due with the devil I know.

And feedback from guys who've faced a similar situation is appreciated.

Did you get an ultrasound of the testicles? Normally that's routine.

 

[DorianGray]

Looking at your description, if that were me, I would first try some OTC products to stimulate testosterone, gain some weight through slightly more but better eating (red meat, high density nutrition foods) and lift fewer reps but heavier weight as opposed to endurance type exercise. I'd give it six months of this and test again before you go out on a limb with TRT.

 

[Phil Goodman]

I started 4 and a half years ago(when I was 39). I don’t have any regrets. I’m stronger and have a better physique than I’ve ever had, and I’ve been lifting for 15 years. My well-being, mood, motivation, energy levels, and confidence have also all improved.

If you start then your muscle mass and mood will almost certainly improve. Sleep quality may be more difficult to nail down, and I’d say it’s probably likely that you’ll go through periods where it’s improved and also periods where it’s diminished(especially as your body adjusts to the new testosterone levels).

I have no regrets about starting, and don’t plan to stop. Feel free to ask any follow up questions your like.

 

[Guided_by_Voices]

While I don't regret TRT, if I had it to do over again and in situations like yours, I would take a much more staged and focused approach and try to address your issues with less invasive options to start with. Some thoughts:

- Consider starting with a SERM like clomid or enclomiphene at a low dose (e.g. 12mg every other day, or 25 mg twice weekly), or possibly HCG monotherapy.
- If that works well for you (or even if it doesn't) try to get a prescription for (or otherwise source) a low dose of oxandrolone, like 10mg pre-workout. Oxandrolone is much less suppressive that Testosterone and along with the SERM may keep your T levels about where they are.
- Consider growth hormone secretagouges and/or a small dose of HGH if you can get it, small being 2-3 IU before bed, 2 or 3 times a week. Either of these should improve sleep, and according to DR. Mark Gordon, my increase motivation with an anti-depressive affect.
- If I were doing it over, I would start T with as minimally suppressive a method as possible, likely a nasal or oral preparation (not Kyzratrex due to the proprietary lack of broad availability.)
- If your lifting protocol/progression is not sound, then you will stall on TRT as well, just at a somewhat higher level. Most people I see in the gym do not have a consistent, sensible progression based on gradually increasing volume at near-maximal (not maximal) weights, which is what I have found to work best over a long period of time.
- You didn't mention sexual function but the usual suspects (e.g. viagra, cialis, nitric oxide boosters, low dose PT-141) should be the first steps IMO. While some people can come off of TRT, there are a significant number who lose sexual function if they try to come off.
- Your issues also sound like what could be caused by under-eating.
- If you're on statins, try stopping them and see what improvements occur.
- Have you tried a low dose of thyroid supplement?

My major point here is to avoid going full-TRT as long as possible, knowing that it is always an option but it brings its own set of challenges. Start with low risk, easily reversible options that address your specific issues. At this point you don't even know if you are a high-aromatizer or not which introduces it own set of challenges. There are a lot of people who have a very hormone/testosterone-centric view of the world but the body is a complex system and I would take a holistic view.

 

[Cataceous]

I have two questions:

1. Can I "try" TRT long enough to see if it will work without risking the functionality I already have?
...

Unfortunately you're getting some mis-targeted advice—because primary hypogonadism is relatively rare. In some respects you are better off than those of us with secondary hypogonadism. Your malady is limited to testicular insufficiency, in contrast to the majority whose maladies involve poorly understood dysregulation of the hypothalamus or pituitary.

So the answer to your first question is an emphatic "yes", as long as it's handled correctly. When those of us with secondary hypogonadism use TRT to attain normal levels, it's pretty much a given that dozens of other hormones can be negatively affected. At a minimum we experience HPTA shutdown even with very conservative treatment. However, because your regulatory mechanisms are largely intact, you can slowly increase your dose of testosterone until your body tells you that you are at the correct level, evidenced by normalized levels of LH and FSH. I am aware of at least two or three guys who have done this with success. The low-and-slow approach is essential in these cases. If you stop raising the testosterone dose when LH is normal then there is little risk of losing the functionality you already have. Your testicles will not atrophy because they will continue to see normal LH and FSH levels—and the exogenous testosterone simply adds to what your body continues to produce.