Low Testosterone symptoms. 10 years of finding a solution

[Cataceous]

It's easy to get distracted by low-probability scenarios. You'd be hard-pressed to find many men actually suffering from hypogonadism with total testosterone over 500 ng/dL and normal SHBG. Maybe one in thousands, if not tens of thousands. Sure, you could be one of the unlucky ones. But odds are against it.

The risks of conventional TRT have also been glossed over. TRT has the potential to disrupt a dozen or more other hormones, which can cause additional symptoms. At a minimum kisspeptin, GnRH, LH and FSH are usually suppressed. These hormones all have functions beyond contributing to testosterone production. Changes in DHEA, pregnenolone and progesterone are also common and sometimes problematic. Fertility is usually compromised, and there is a small risk of experiencing long-term HPTA dysfunction when TRT is discontinued. In a number of cases libido gets worse over time with TRT.

... I've never had high prolactin but used to take antidepressants... I feel this is the cause of the dead libdio. Can antidepressants kill the receptors that would norm increase dopamine ??

I don't know about the mechanisms involved, but there are many anecdotal reports of long-term problems after SSRI use.

 

[00roast00]

It's easy to get distracted by low-probability scenarios. You'd be hard-pressed to find many men actually suffering from hypogonadism with total testosterone over 500 ng/dL and normal SHBG. Maybe one in thousands, if not tens of thousands. Sure, you could be one of the unlucky ones. But odds are against it.

The risks of conventional TRT have also been glossed over. TRT has the potential to disrupt a dozen or more other hormones, which can cause additional symptoms. At a minimum kisspeptin, GnRH, LH and FSH are usually suppressed. These hormones all have functions beyond contributing to testosterone production. Changes in DHEA, pregnenolone and progesterone are also common and sometimes problematic. Fertility is usually compromised, and there is a small risk of experiencing long-term HPTA dysfunction when TRT is discontinued. In a number of cases libido gets worse over time with TRT.


I don't know about the mechanisms involved, but there are many anecdotal reports of long-term problems after SSRI use.

What effects can the disruption of these other hormones have on someone on trt? Are the effects of these disruptions still worth the benefit of someone going on trt if it relieves their symptoms?

 

[Systemlord]

What effects can the disruption of these other hormones have on someone on trt?

LH induces pregnenolone production by modulating the expression of the LH receptor, so by supressing LH it may effect pregnenolone production down the road.

Also decreased semen volume and ejaculation force are common. Infertility is also a concern.

Are the effects of these disruptions still worth the benefit of someone going on trt if it relieves their symptoms?

It depends who were talking about here, someone with low-T as a direct result of uncontrolled type 2 diabetes, then yes TRT is worth it.

If we are talking about someone who just wants to put on extra muscle by running T levels in excess, then no TRT isn't worth it.

 

[Cataceous]

What effects can the disruption of these other hormones have on someone on trt? Are the effects of these disruptions still worth the benefit of someone going on trt if it relieves their symptoms?

Add testicular atrophy to the list of likely symptoms. More subtle problems can arise if adrenal and thyroid hormones are affected. The issue with LH, GnRH and kisspeptin is that there are receptors in many locations of the body whose functions are largely unexplored. So with TRT you're deactivating normal functions with no understanding of the long-term consequences. I found that over time my libido under TRT degraded to where it was not a lot better than pre-TRT, when total testosterone was in the 300s ng/dL and SHBG was in the 40s nMol/L. I now take GnRH with my TRT and that appears to have restored normal libido. A single anecdote in no way establishes causality, but it's still food for thought.

All of this could be seen as overstating the dangers, and indeed the likelihood of obvious and severe side effects from TRT is quite small. However, you're coming into this with a normally functioning HPTA. TRT would essentially break that, and probably for no good reason. Instead, follow @bixt's advice and try low doses of a SERM. With a long enough trial you'll be able to fairly evaluate if higher testosterone is doing much to resolve your symptoms.

 

[00roast00]

Add testicular atrophy to the list of likely symptoms. More subtle problems can arise if adrenal and thyroid hormones are affected. The issue with LH, GnRH and kisspeptin is that there are receptors in many locations of the body whose functions are largely unexplored. So with TRT you're deactivating normal functions with no understanding of the long-term consequences. I found that over time my libido under TRT degraded to where it was not a lot better than pre-TRT, when total testosterone was in the 300s ng/dL and SHBG was in the 40s nMol/L. I now take GnRH with my TRT and that appears to have restored normal libido. A single anecdote in no way establishes causality, but it's still food for thought.

All of this could be seen as overstating the dangers, and indeed the likelihood of obvious and severe side effects from TRT is quite small. However, you're coming into this with a normally functioning HPTA. TRT would essentially break that, and probably for no good reason. Instead, follow @bixt's advice and try low doses of a SERM. With a long enough trial you'll be able to fairly evaluate if higher testosterone is doing much to resolve your symptoms.

Thank you

 

[JmarkH]

My symptoms were mirrored to yours, except I'm 63. My numbers are more like someone in mid-40s. My total T 573 ng.dL, FT 14.4 pg/ml, Estradiol 19.6 pg/mL. I've had problems with high concept thinking as in data analysis. Mood swings, lack of motivation . . .
Many wouldn't think I'm a candidate for therapy, but a doc came up with a protocol for me. HCG 250 iu four times per week and 25mg Clomid on injection days. Tomorrow is my 4th injection day. I feel significantly better already and have regained 30% of my lost mental focus. I have high hopes and have labs at week 8.
You might look into the combination of HCG and Clomid.

 

[Cataceous]

...
You might look into the combination of HCG and Clomid.

Except for guys coming off of TRT, I don't see why this combination would be better than Clomid alone. HCG would tend to be suppressive of the HPTA, putting it in conflict with Clomid's stimulation. In addition, the protocol could be problematic for anyone with above-average estrogenic activity; the double-whammy of hCG and high LH can strongly stimulate intratesticular aromatization. Add that to the estrogenic activity of Clomid's zuclomiphene isomer and one can easily envision possible side effects.

 

[00roast00]

Seeing as you are all so knowledgeable here, could I have add an extra bit of information.

I would say I started feeling these symptoms gradually starting roughly about 10 years ago. 8 years ago I had a vasectomy. I didn't attribute any of the symptoms to this as they had started mildly before my vasectomy but continued to get worse since then (which I assumed was either my age or something else as they started prior). Could my vasectomy have had any impact on my current testosterone levels? Perhaps they were higher previously and this impacted them making my symptoms worse? Or could you see any other link to my symptoms and my vasectomy?

 

[00roast00]

Also one more thing on my most recent test my progesterone is 0.8 nmo/l where the range maximum is 0.474 nmol/l. Could this help identify anything?

 

[00roast00]

My symptoms are:

• Extreme brain fog to the point that I am forgetful and it takes a lot more effort to articulate my thoughts.
• Awful sleep. I never wake up feeling refreshed and wake up during the night multiple times.
• Low energy and mood
• Low libido/ED
• Overall I don't feel like myself anymore. I feel like an old man in a younger mans shell.

Hoping you had your blood work done between 7-10 am in a fasted state as we want to test at peak.

Let alone if you are training in the gym it would be better to take a week off before getting labs.

The causes of erectile dysfunction let alone decreased libido are complex and multifactorial.

Low libido/ED (lack of nocturnal/spontaneous daytime erections) are common symptoms of low-t.

Keep in mind dysfunction thyroid/adrenals can easily mimic low-t symptoms.

From your most recent labs, you were hitting a descent TT 17.7 nmol/L (510ng/dL).

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

FT 5-10 ng/dL would be considered low.

FT 16-31 ng/dL (high-end) is healthy.

Most men on trt will do well with FT 20-30 ng/dL and yes there are some who will do just fine with FT 15-20 ng/dL.

Comes down to the individual.




With a TT 510ng/dL SHBG 33.5 nmol/L (normal) and Albumin 4.2 g/dL, then your FT would be around 17 ng/dL (far from low).

TruT Free Testosterone Calculator by FPT

Free testosterone calculator by FPT. Improved accuracy of free T calculations.

tru-t.org

View attachment 19952


TT of 8-12 nmol/L would be considered the grey zone and even then many men with higher T levels can still suffer from low-T symptoms due to high/highish SHBG.

You are hitting a TT low 500s and you have normal SHBG so your FT is definitely not going to be borderline/low.

Even then no one can say that these levels are optimal for you let alone should not cause any symptoms.

Much more involved especially if we get into the sensitivity of the AR/polymorphism of the AR and CAG repeat length (short/long).

As others have stated would be wise to look into Natesto or clomiphene/EN before jumping into full-blown trt.

You stated that Natesto is not an option so if you are concerned about using clomiphene/EN and were dead set on using exogenous test then I see no harm in giving it a go as long as you have a decent understanding let alone realistic expectations.

Shutting down your HPGA is not something to take lightly!

Many men do well on trt whereas others may constantly struggle especially when it comes to libido/erectile function.

No harm in trying even short-term as you can always stop and you will eventually return to baseline levels.

PCT or cold turkey.

6 months would be a decent amount of time to put in.

The most sensible approach would be to find a doctor in the know who will work with/guide you.

Taking the UGL route and flying solo may not be your best move especially if you lack the understanding of how exogenous esterified T works.

Blood work using accurate assays is critical.

Do what you feel is best for you!

Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring

ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

www.excelmale.com

Figure 1. Threshold continuum to hypogonadism.
View attachment 19953
View attachment 19954




post #7

*No consensus has been reached regarding the lower TT threshold defining TD, and there is no generally accepted lower limits of normal TT. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not




post #8

AR CAG repeat lengths (short/long)

*The number of cytosine–adenine–guanine triplet (CAG) repeats in androgen receptors differ in men and influences the androgen receptor activity [88,89,90,91] (Figure 1). Hence testosterone sensitivity may vary in different individuals.

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]

*In general, it is currently speculated that variable phenotypes of androgen insensitivity exist, mainly owing to mutated androgen receptors. More subtle modulation of androgen effects is related to the CAG repeat polymorphism in exon 1 of the androgen receptor gene: transcription of androgen-dependent target genes are attenuated with the increasing length of triplets.

*As a clinical entity, the CAG repeat polymorphism can relate to variations of androgenicity in men in various tissues and psychological traits: The longer the CAG repeat polymorphism, the less prominent is the androgen effect when individuals with similar testosterone concentrations are compared.

*A strictly defined threshold to TD is likely to be replaced by a continuum spanned by genetics as well as symptom specificity. In addition, the effects of externally applied testosterone can be markedly influenced by the CAG repeats and respective pharmacogenetic implications are likely to influence indications as well as modalities of testosterone treatment of hypogonadal men. Investigation of CAG repeat polymorphism in exon 1 of the androgen receptor gene may be useful in testosterone treatment regimens adjustment

My symptoms are:

• Extreme brain fog to the point that I am forgetful and it takes a lot more effort to articulate my thoughts.
• Awful sleep. I never wake up feeling refreshed and wake up during the night multiple times.
• Low energy and mood
• Low libido/ED
• Overall I don't feel like myself anymore. I feel like an old man in a younger mans shell.

Hoping you had your blood work done between 7-10 am in a fasted state as we want to test at peak.

Let alone if you are training in the gym it would be better to take a week off before getting labs.

The causes of erectile dysfunction let alone decreased libido are complex and multifactorial.

Low libido/ED (lack of nocturnal/spontaneous daytime erections) are common symptoms of low-t.

Keep in mind dysfunction thyroid/adrenals can easily mimic low-t symptoms.

From your most recent labs, you were hitting a descent TT 17.7 nmol/L (510ng/dL).

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

FT 5-10 ng/dL would be considered low.

FT 16-31 ng/dL (high-end) is healthy.

Most men on trt will do well with FT 20-30 ng/dL and yes there are some who will do just fine with FT 15-20 ng/dL.

Comes down to the individual.




With a TT 510ng/dL SHBG 33.5 nmol/L (normal) and Albumin 4.2 g/dL, then your FT would be around 17 ng/dL (far from low).

TruT Free Testosterone Calculator by FPT

Free testosterone calculator by FPT. Improved accuracy of free T calculations.

tru-t.org

View attachment 19952


TT of 8-12 nmol/L would be considered the grey zone and even then many men with higher T levels can still suffer from low-T symptoms due to high/highish SHBG.

You are hitting a TT low 500s and you have normal SHBG so your FT is definitely not going to be borderline/low.

Even then no one can say that these levels are optimal for you let alone should not cause any symptoms.

Much more involved especially if we get into the sensitivity of the AR/polymorphism of the AR and CAG repeat length (short/long).

As others have stated would be wise to look into Natesto or clomiphene/EN before jumping into full-blown trt.

You stated that Natesto is not an option so if you are concerned about using clomiphene/EN and were dead set on using exogenous test then I see no harm in giving it a go as long as you have a decent understanding let alone realistic expectations.

Shutting down your HPGA is not something to take lightly!

Many men do well on trt whereas others may constantly struggle especially when it comes to libido/erectile function.

No harm in trying even short-term as you can always stop and you will eventually return to baseline levels.

PCT or cold turkey.

6 months would be a decent amount of time to put in.

The most sensible approach would be to find a doctor in the know who will work with/guide you.

Taking the UGL route and flying solo may not be your best move especially if you lack the understanding of how exogenous esterified T works.

Blood work using accurate assays is critical.

Do what you feel is best for you!

Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring

ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

www.excelmale.com

Figure 1. Threshold continuum to hypogonadism.
View attachment 19953
View attachment 19954




post #7

*No consensus has been reached regarding the lower TT threshold defining TD, and there is no generally accepted lower limits of normal TT. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not




post #8

AR CAG repeat lengths (short/long)

*The number of cytosine–adenine–guanine triplet (CAG) repeats in androgen receptors differ in men and influences the androgen receptor activity [88,89,90,91] (Figure 1). Hence testosterone sensitivity may vary in different individuals.

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]

*In general, it is currently speculated that variable phenotypes of androgen insensitivity exist, mainly owing to mutated androgen receptors. More subtle modulation of androgen effects is related to the CAG repeat polymorphism in exon 1 of the androgen receptor gene: transcription of androgen-dependent target genes are attenuated with the increasing length of triplets.

*As a clinical entity, the CAG repeat polymorphism can relate to variations of androgenicity in men in various tissues and psychological traits: The longer the CAG repeat polymorphism, the less prominent is the androgen effect when individuals with similar testosterone concentrations are compared.

*A strictly defined threshold to TD is likely to be replaced by a continuum spanned by genetics as well as symptom specificity. In addition, the effects of externally applied testosterone can be markedly influenced by the CAG repeats and respective pharmacogenetic implications are likely to influence indications as well as modalities of testosterone treatment of hypogonadal men. Investigation of CAG repeat polymorphism in exon 1 of the androgen receptor gene may be useful in testosterone treatment regimens adjustment

Thank you for this. I’ve been going through what you’ve said and been doing some research on it.

When I calculate my free testosterone using the TruT website you have used, I get the same result. Any other free testosterone calculator I use gives me a result at nearly half the TruT website calculates.

Free Testosterone Calculator gives me 0.373 nmol/l
Free & Bioavailable Testosterone Calculator gives me 0.373 nmol/l
Free & Bioavailable Testosterone calculator gives me 10 ng/dl

Does the TruT website calculates this differently to other websites or is it wrong? The TruT result would be good if true but if it’s not then my free T is showing as low?

If use use the balance my hormone free testosterone calculator, enter my figures but for total testosterone enter 17.7 nmol/dL rather than nmol/L then I get the same result from the TruT website. I think the TruT website is mistakenly calculating using /dL rather than /L when you enter a nmol/L figure.

 

[bixt]

Hello
I wanted to reach out & was wondering if you would be interested in a program that helped American men 20-60 years old who suffer from low testosterone levels feel more energetic, confident, & have higher libdo without having to go through therapy or take medications by dramatically increasing their testosterone levels naturally in less than 7 weeks

No we are not. 7 weeks is too long.