Should I do TRT?

[Vince]

Thanks for the reply Vince,
I don't see how this can help that much. Based on the research I have done it MAY help lower SHBG but it is not significant enough to alleviate the symptoms. (keyword is MAY not should).
I have never see or heard from anyone who have high SHBG being fixed only from this.

Here’s a good read

What is the Function of Sex Hormone Binding Globulin SHBG?

What is the function of SHBG?

www.excelmale.com

 

[Vince]

Proviron to lower SHBG?

Has anyone on here had success using proviron or any type of DHT analogue to lower SHBG without completely commiting to full blown TRT? I’ve heard success stories of some guys lowering SHBG using proviron without it shutting down their HPTA.

www.excelmale.com

 

[Cataceous]

Nasal gel, Natesto or equivalent, might be a reasonable option short of full-blown TRT. The relatively short testosterone pulses seem to avoid an HPTA shutdown, maintaining fertility, while augmenting natural production and providing the benefits of higher testosterone.

 

[Gman86]

F


Thank you for the reply!
Finally, someone who doesn't have a gatekeeping attitude towards TRT.
Just because I am young doesn't mean I should avoid the TRT like the plague while the same guy who said don't use TRT is enjoying a myriad of benefits from TRT itself. I am just tired of getting the same old reply of "oh you are too young" or thinking that I have not tried other methods of improving the symptoms.

I did try every trick in the book, magnesium, vitamin d, zinc,boron, etc. I also am a regular gym-goer at least 3 times a week and I do have a clean diet, I only eat processed food or sugary foods maybe 2 times at max per month but mostly I don't eat those stuff. I always sleep at least 7 hours every day and while I agree my sleep could be improved, I believe the cause of my sleep problems are the anxiety in the first place. I am a light sleeper and tend to be anxious and have racing thoughts before I go to bed making it harder for me to fall asleep. While it is not a daily occurrence but it is not that rare either.

So could I please get non-objective advice and none of that gatekeeping attitude on whether or not I should do TRT? I don't even think age should be considered as a variable here since at 21 I should be at my prime biologically and my bloodwork shows suboptimal levels and as I age it is unlikely that it will be better.

I am not saying that the advice has to be saying that I should do TRT, but if you say no please give a valid reason so that it can help me make the right decision. If you say that I shouldn't do TRT because there is a medicine that I can try first then this can help me weigh out my options, but if you are saying don't do TRT just because of my age even tough the bloodwork shows the suboptimal result and I am experiencing the symptoms and it can be fixed by "lifestyle changes" or "try vit d" please refrain from commenting. This is like saying that a new car with mechanical problems should not change the broken part and instead they should just try to drive the car more carefully and on less rocky roads just because the car is a new car hence you shouldn't replace the broken part and it should be functioning as normal while the diagnosis from a licensed mechanic(the doctor) says that the part should be replaced.

I couldn’t agree with u more. One of my biggest pet peeves is guys on TRT enjoying life because of its benefits telling other guys to only go on HRT as an absolute last resort, and if the person is too young they tell them they shouldn’t even consider it. I was 27 when I went on HRT, and it completely gave me my life back. It was hands down the best decision I’ve ever made. I lost my gf of 2 years because of low T, but luckily I was able to salvage everything else, including my job and my nursing license. Without HRT, I would of 100% eventually had to quit nursing and find another job that was pretty much all physical and didn’t require much mental energy. I was in a similar boat as u. Total T was around 600-700, but SHBG was mid 50’s, and free T was bottom of the barrel on one test, and the other it was actually slightly below the bottom of the range. I felt horrible. Had basically every symptom other than sexual issues, and some symptoms were pretty severe. Just felt like a shell of myself. No motivation, no energy, didn’t care about anything, slightly depressed (mostly just because of how I felt). Just felt like a lump on a log. Felt like the simplest things were like climbing mt Everest.

Anyways, ur only 6 years younger than me when I went on HRT, and like I said, going on HRT was hands down one of the best decisions of my life. Not one regret. It’s completely given me my life back. I even had a baby on accident 7 months ago. Wasn’t even trying. Was on HRT for over 6 years at that point. Being on HRT is easy. I inject EOD. It’s nothing. Doesn’t hinder my life even a little bit. Everyone will try to talk u out of going on HRT at ur age because of shutting down ur HPTA, and/ or risking conceiving a child, but what would u be shutting down, an already dysfunctional HPTA? Most likely if u don’t like being on HRT, u come off and ur HPTA will function just as it does currently. I tried to “restart” my natural levels with clomid. So after using Clomid, I stopped everything for a month, retested my levels, and they were identical to what they were prior to HRT. This was a bout a year after starting HRT. And as far as fertility, as long as ur fertile now, u should have no issues conceiving, even while on HRT. Like I said, I had a baby 7 months ago completely by accident, wasn’t even trying. Was on testosterone only at the time. Had been on HCG and test, but stopped the HCG completely 2 months prior to knocking up my ex gf. If u can’t conceive on test and HCG, there’s plenty of other options to improve fertility. More expensive options than HCG, but options nonetheless. Either way, what’s the point of having a somewhat functional HPTA, and being fertile, if u can’t enjoy life and can’t even get a girl to impregnate?

But I totally get what ur saying with ur anxiety causing sleep issues. I never really have sleep issues, but when my libido is high, I fall asleep insanely fast. All I think about is sex while I’m trying to go to sleep, and I pass out instantly. When my libido is low, or even moderate, I tend not to think about sex as much while I’m trying to go to sleep, and then I end up thinking about things I need to get done, or problems that need to be solved, or goals I want to accomplish, and I tend to have a more difficult time falling asleep. I don’t suffer from anxiety, but I’m sure if I had anxiety on top of that, falling asleep would be much more difficult.

Overall, I see nothing wrong with trying HRT. I would highly recommend freezing ur sperm tho, just to cover ur bases. I 100% foresee men having hormonal issues at younger and younger ages as time goes on. I’m not surprised one bit seeing men in their late teens/ early 20’s having hormone imbalances, that may or may not be able to be fixed through lifestyle modifications. I was just like u, I was the health freak out of my friends and family. Always ate healthy, always worked out, always was learning about health and longevity, and I still ended up with extremely low free T at 27. And I tried legit everything to avoid going on HRT. When I say everything, I mean everything. And I’m sure there was probably something out there that I could of done to fix my issue naturally, but I wasn’t able to ever figure it out, and I don’t think there’s anyone out there that currently knows either, unfortunately. High SHBG is a real conundrum. It goes up the more insulin sensitive u are. Which basically means that to lower it, u have to eat worse, and try to make urself insulin resistant. So it’s not like u can just eat healthier and fix the issue. Eating healthier can possibly make the issue worse, which is a real mind f*ck lol.

So again, if ur under the care of dr saya, ur in good hands. That’s my doctor as well. I see nothing wrong with at least trialing HRT. Even if u go on, ur symptoms mostly resolve, u can still come off and try to fix ur issue through lifestyle modifications. What trialing HRT would do, if it resolved ur symptoms that is, is it would at least let u know that low T was the cause of ur issues, so that ur not out trying to fix things that don’t need to be fixed. U at least will know the cause of ur symptoms. But obv if u go on HRT, and get symptom resolution, I’d probably just recommend staying on HRT. Even if u go on HRT, and get zero symptom resolution, that could also tell u that ur issues may not be related to low T. But with ur numbers, I’d be very shocked if going on HRT didn’t improve most of ur symptoms. Overall, if I were u I would trial HRT. That’s just me tho. Definitely do as much research as u can, and make ur owner informed decision. I just personally know that going on HRT and potentially getting ur life back, and being able to enjoy life again, is worth any risks associated with HRT, regardless of age. Again, imo.

 

[Rhino 2.0]

Nasal gel, Natesto or equivalent, might be a reasonable option short of full-blown TRT. The relatively short testosterone pulses seem to avoid an HPTA shutdown, maintaining fertility, while augmenting natural production and providing the benefits of higher testosterone.

How would one obtain Natesto? Does defy sell it yet?

 

[fifty]

It's 2020. There is no TRT gatekeeper mentality that's real anymore. You could pick up the phone and have testosterone, deca, anavar, hcg, arimidex, peptides, whatever at your door within a week.

Problems with using testosterone for TRT, off the top of my head, are:
1- infertility
-- may need to freeze sperm if that's a concern
2- increased hematocrit possibly requiring you to donate blood every few months
-- risk of low iron or ferritin symptoms from donating blood
-- risk of increased blood pressure
3- testicle shrinkage
4- reduced semen volume

HCG can help fix #1 & #3 but then your concerns are:
1- possible estrogen issues using hcg
2- worrying about keeping hcg stored in the refrigerator
-- managing that during any travel

 

[madman]

How would one obtain Natesto? Does defy sell it yet?

Prop vs Cypionate for E.O.D Injections..

If someone was swapping to more frequent injections (E.O.D) to help keep e2 from spiking as much, would it be better to swap to propionate? From my understanding most of the e2 conversion is from the part of the oil that helps give testosterone prop/eth is longer half life. I mean if you’re...

www.excelmale.com

 

[sammmy]

I am not taking DHEA as it is not the issue, and I am already supplementing with zinc and vit D as well.

DHEA gives a boost overrride to sexuality and endurance. You don't take it because of low DHEA levels.

 

[Vince]

DHEA gives a boost overrride to sexuality and endurance. You don't take it because of low DHEA levels.

Sammy, how much dhea are you supplementing with? What do you keep your levels at? How was your sexuality before DHEA? What do you mean by endurance, sex or physically?

 

[calmcalmcalm]

Nasal gel, Natesto or equivalent, might be a reasonable option short of full-blown TRT. The relatively short testosterone pulses seem to avoid an HPTA shutdown, maintaining fertility, while augmenting natural production and providing the benefits of higher testosterone.

This seems more like a temporary fix instead of fixing the main root of the problem. Also my location does not have Natesto available sadly.

 

[calmcalmcalm]

I couldn’t agree with u more. One of my biggest pet peeves is guys on TRT enjoying life because of its benefits telling other guys to only go on HRT as an absolute last resort, and if the person is too young they tell them they shouldn’t even consider it. I was 27 when I went on HRT, and it completely gave me my life back. It was hands down the best decision I’ve ever made. I lost my gf of 2 years because of low T, but luckily I was able to salvage everything else, including my job and my nursing license. Without HRT, I would of 100% eventually had to quit nursing and find another job that was pretty much all physical and didn’t require much mental energy. I was in a similar boat as u. Total T was around 600-700, but SHBG was mid 50’s, and free T was bottom of the barrel on one test, and the other it was actually slightly below the bottom of the range. I felt horrible. Had basically every symptom other than sexual issues, and some symptoms were pretty severe. Just felt like a shell of myself. No motivation, no energy, didn’t care about anything, slightly depressed (mostly just because of how I felt). Just felt like a lump on a log. Felt like the simplest things were like climbing mt Everest.

Anyways, ur only 6 years younger than me when I went on HRT, and like I said, going on HRT was hands down one of the best decisions of my life. Not one regret. It’s completely given me my life back. I even had a baby on accident 7 months ago. Wasn’t even trying. Was on HRT for over 6 years at that point. Being on HRT is easy. I inject EOD. It’s nothing. Doesn’t hinder my life even a little bit. Everyone will try to talk u out of going on HRT at ur age because of shutting down ur HPTA, and/ or risking conceiving a child, but what would u be shutting down, an already dysfunctional HPTA? Most likely if u don’t like being on HRT, u come off and ur HPTA will function just as it does currently. I tried to “restart” my natural levels with clomid. So after using Clomid, I stopped everything for a month, retested my levels, and they were identical to what they were prior to HRT. This was a bout a year after starting HRT. And as far as fertility, as long as ur fertile now, u should have no issues conceiving, even while on HRT. Like I said, I had a baby 7 months ago completely by accident, wasn’t even trying. Was on testosterone only at the time. Had been on HCG and test, but stopped the HCG completely 2 months prior to knocking up my ex gf. If u can’t conceive on test and HCG, there’s plenty of other options to improve fertility. More expensive options than HCG, but options nonetheless. Either way, what’s the point of having a somewhat functional HPTA, and being fertile, if u can’t enjoy life and can’t even get a girl to impregnate?

But I totally get what ur saying with ur anxiety causing sleep issues. I never really have sleep issues, but when my libido is high, I fall asleep insanely fast. All I think about is sex while I’m trying to go to sleep, and I pass out instantly. When my libido is low, or even moderate, I tend not to think about sex as much while I’m trying to go to sleep, and then I end up thinking about things I need to get done, or problems that need to be solved, or goals I want to accomplish, and I tend to have a more difficult time falling asleep. I don’t suffer from anxiety, but I’m sure if I had anxiety on top of that, falling asleep would be much more difficult.

Overall, I see nothing wrong with trying HRT. I would highly recommend freezing ur sperm tho, just to cover ur bases. I 100% foresee men having hormonal issues at younger and younger ages as time goes on. I’m not surprised one bit seeing men in their late teens/ early 20’s having hormone imbalances, that may or may not be able to be fixed through lifestyle modifications. I was just like u, I was the health freak out of my friends and family. Always ate healthy, always worked out, always was learning about health and longevity, and I still ended up with extremely low free T at 27. And I tried legit everything to avoid going on HRT. When I say everything, I mean everything. And I’m sure there was probably something out there that I could of done to fix my issue naturally, but I wasn’t able to ever figure it out, and I don’t think there’s anyone out there that currently knows either, unfortunately. High SHBG is a real conundrum. It goes up the more insulin sensitive u are. Which basically means that to lower it, u have to eat worse, and try to make urself insulin resistant. So it’s not like u can just eat healthier and fix the issue. Eating healthier can possibly make the issue worse, which is a real mind f*ck lol.

So again, if ur under the care of dr saya, ur in good hands. That’s my doctor as well. I see nothing wrong with at least trialing HRT. Even if u go on, ur symptoms mostly resolve, u can still come off and try to fix ur issue through lifestyle modifications. What trialing HRT would do, if it resolved ur symptoms that is, is it would at least let u know that low T was the cause of ur issues, so that ur not out trying to fix things that don’t need to be fixed. U at least will know the cause of ur symptoms. But obv if u go on HRT, and get symptom resolution, I’d probably just recommend staying on HRT. Even if u go on HRT, and get zero symptom resolution, that could also tell u that ur issues may not be related to low T. But with ur numbers, I’d be very shocked if going on HRT didn’t improve most of ur symptoms. Overall, if I were u I would trial HRT. That’s just me tho. Definitely do as much research as u can, and make ur owner informed decision. I just personally know that going on HRT and potentially getting ur life back, and being able to enjoy life again, is worth any risks associated with HRT, regardless of age. Again, imo.

I think we are more alike than we think, I was the "health nut" in my social circle as well. Initially, I only tested for my total testosterone and I was a little disappointed thinking that I would get a higher number than I expected since I follow everything in order to optimize my T. As I get to understand this topic further I was surprised my low free T and the high SHBG.

For the high libido before sleep, I am exactly the same as you as well. In my early to mid-teen years, I got mild sleeping issues but thinking about the sex part help me get to sleep real quick. It was not a problem and very manageable but now the anxiety and racing thoughts are getting more frequent.

Can I ask did it help you with your anxiety issues or making you calmer?
Did Dr Saya immediately suggest you start the TRT? What is your dose for EOD injection?
Dr Saya suggested that I start with MWF injection schedule but I think I am doing EOD injection. Have you tried using MWF injection in comparison to EOD injection? Is it the extra injection? Also, where is your injection site? With EoD injections, I assume we have to find a spot convenient enough since we will be injecting it more frequently. I am considering the deltoid muscle or love handle area, but is it okay to rotate only between 2 sites? so let's say only left and right love handles or only right deltoid and left deltoid?

Again thank you for your input man! This is the only helpful input so far

 

[calmcalmcalm]

It's 2020. There is no TRT gatekeeper mentality that's real anymore. You could pick up the phone and have testosterone, deca, anavar, hcg, arimidex, peptides, whatever at your door within a week.

Problems with using testosterone for TRT, off the top of my head, are:
1- infertility
-- may need to freeze sperm if that's a concern
2- increased hematocrit possibly requiring you to donate blood every few months
-- risk of low iron or ferritin symptoms from donating blood
-- risk of increased blood pressure
3- testicle shrinkage
4- reduced semen volume

HCG can help fix #1 & #3 but then your concerns are:
1- possible estrogen issues using hcg
2- worrying about keeping hcg stored in the refrigerator
-- managing that during any travel

Defy has prescribed the TRT so it is not an issue, I am talking about some guys in the forum having a gatekeeper mentality.

I read that hematocrit will stabilize around 1 year after starting the TRT? Is this true? I don't mind having phlebotomy or donating blood every few months for the first year.

 

[calmcalmcalm]

DHEA gives a boost overrride to sexuality and endurance. You don't take it because of low DHEA levels.

My recent bloodwork shows that my DHEA levels are in the mid-range, and Dr Saya has looked at my bloodwork and he didn't say anything about this.

Should I try it with the TRT?

 

[madman]

Defy has prescribed the TRT so it is not an issue, I am talking about some guys in the forum having a gatekeeper mentality.

I read that hematocrit will stabilize around 1 year after starting the TRT? Is this true? I don't mind having phlebotomy or donating blood every few months for the first year.

The biggest mistake you made was not using an accurate assay when testing your FT level.

You should have had it testing using the most accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

You stated your SHBG was 44 nmol/L which is far from being really high.

Sure your TT of 536 ng/dL may not be robust and with an SHBG of 44 nmol/L your FT is most likely far from optimal but doubtful it is as LOW as you seem to think.

If you truly are experiencing low-t symptoms at such levels than there is no harm in starting trt as long as you do not run into this headfirst with high expectations.

Sure it may very well work out for the best but do understand that there can be many bumps along the way and you may run into issues.

Trt is not the end all be all as other factors come into play especially having healthy thyroid/adrenals.

You are in good hands with Dr. Saya but be prepared as this may be a work in progress!

Also, be mindful about what some tout on these forums as trt being the saviour to all their miseries as some of these same individuals are running absurdly high TROUGH TT(1600+)/FT (60-80ng/dL) levels claiming they feel best when in fact they are just jacked up on T.

Although treating the symptoms is what truly matters the goal of trt is to relieve/improve low-t symptoms and improve overall well being while at the same time avoiding/minimizing any potential side-effects and keeping blood markers in a healthy range.

Even though TT is important FT is what truly matters as it is the unbound active fraction of testosterone responsible for the beneficial effects.

Achieving a healthy FT which results in improved overall well-being is what matters and highly doubtful one would ever need absurd levels to achieve such.

 

[madman]

This seems more like a temporary fix instead of fixing the main root of the problem. Also my location does not have Natesto available sadly.

Are you sure about that?

Defy does offer it.

So jumping on trt is not the same as in both cases we are replacing hormones through exogenous T and the kicker is Natesto will not shutdown the hpta!.....This seems more like a temporary fix instead of fixing the main root of the problem.

 

[madman]

Defy has prescribed the TRT so it is not an issue, I am talking about some guys in the forum having a gatekeeper mentality.

I read that hematocrit will stabilize around 1 year after starting the TRT? Is this true? I don't mind having phlebotomy or donating blood every few months for the first year.

Hematocrit will increase within 1-3 months and can take on average 9-12 months to stabilize
.
Trust me when I tell you that donating blood too frequently to control elevated hemoglobin/hematocrit is a bad move as you will surely just end up crashing your ferritin/iron which can lead to a host of other issues.

Even then weekly dose of T used and what overall TT/FT levels will have the biggest impact on increased RBCs/hemoglobin/hematocrit.

 

[madman]

Just spoke with Doctor Saya not too long ago. I showed him a more recent bloodwork and he said that my bloodwork have a pattern of High SHBG making my free T in the suboptimal range. He also said that SERMS(clomid,torem,enclomiphen,etc) will not work in my case since the problem is with the high SHBG, and SERMS can’t be used as a long term solution. I did try toremifene 60mg ED before the bloodwork, but lh stays pretty much the same and SHBG showing 44.

The way to lower SHBG is through TRT.

Should I do TRT? Right now I am still indecisive and leaning more towards TRT hoping that it would solve my anxiety for the main part. I am just getting cold feet about making the life changing decision.

Your advices are greatly appreciated

This is not a given for every individual!

 

[Rhino 2.0]

Just spoke with Doctor Saya not too long ago. I showed him a more recent bloodwork and he said that my bloodwork have a pattern of High SHBG making my free T in the suboptimal range. He also said that SERMS(clomid,torem,enclomiphen,etc) will not work in my case since the problem is with the high SHBG, and SERMS can’t be used as a long term solution. I did try toremifene 60mg ED before the bloodwork, but lh stays pretty much the same and SHBG showing 44.

The way to lower SHBG is through TRT.

Should I do TRT? Right now I am still indecisive and leaning more towards TRT hoping that it would solve my anxiety for the main part. I am just getting cold feet about making the life changing decision.

Your advices are greatly appreciated

Did Dr Saya offer you Natesto or did he offer the testosterone injections or both?

 

[Cataceous]

This seems more like a temporary fix instead of fixing the main root of the problem. Also my location does not have Natesto available sadly.

If you're using Defy Medical then they can prescribe Empower's nasal gel, which may be similar to Natesto. (@JayLay777)

Nothing TRT-related is "fixing the main root of the problem"; it's all about treating the symptom of lower testosterone. If you can do it with nasal gel then you're likely better off than if you need full-blown TRT, which suppresses a myriad of other hormones, including kisspeptin, GnRH, LH and FSH.

 

[calmcalmcalm]

The biggest mistake you made was not using an accurate assay when testing your FT level.

You should have had it testing using the most accurate assay such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

You stated your SHBG was 44 nmol/L which is far from being really high.

Sure your TT of 536 ng/dL may not be robust and with an SHBG of 44 nmol/L your FT is most likely far from optimal but doubtful it is as LOW as you seem to think.

If you truly are experiencing low-t symptoms at such levels than there is no harm in starting trt as long as you do not run into this headfirst with high expectations.

Sure it may very well work out for the best but do understand that there can be many bumps along the way and you may run into issues.

Trt is not the end all be all as other factors come into play especially having healthy thyroid/adrenals.

You are in good hands with Dr. Saya but be prepared as this may be a work in progress!

Also, be mindful about what some tout on these forums as trt being the saviour to all their miseries as some of these same individuals are running absurdly high TROUGH TT(1600+)/FT (60-80ng/dL) levels claiming they feel best when in fact they are just jacked up on T.

Although treating the symptoms is what truly matters the goal of trt is to relieve/improve low-t symptoms and improve overall well being while at the same time avoiding/minimizing any potential side-effects and keeping blood markers in a healthy range.

Even though TT is important FT is what truly matters as it is the unbound active fraction of testosterone responsible for the beneficial effects.

Achieving a healthy FT which results in improved overall well-being is what matters and highly doubtful one would ever need absurd levels to achieve such.

Appreciate the reply,
any tips for dialing in TRT doses? or any tips for TRT in general?