Thinking about TRT

[RCK73]

I also posted this in the labs section so sorry for double post.

Grateful for any help. 47 y/o. 6', 190lbs. Just starting to lift weights but have gained maybe 15 lbs in the past few years. Love handles and belly fat. Physically weak. Previously skinny fat. Cancer survivor. Workaholic. Stressful job that I like and can't/won't change. Increasingly negative, critical, angry, moody—getting much worse over the past 6 mos. Zero libido and weak erections. 5-10 drinks a week, never more than 2-3 per day. Eat decently. Poor sleep. Mental fog, although I perform a cognitively-demanding job at a high level. Used propecia for 6 years until 2014, but the libido issues predate that.

Testosterone 361 (250-1100 ng/dL)
Free Testosterone 43 (35.0-155.0 pg/mL)
FSH 4.7 (1.6-8.0 mIU/mL)
LH 1.4 (1.5-9.3 mIU/mL)
SHBG 48 (scale of 10-50 noml/L).
DHT 37 (12-65 ng/dL)
Vid D 26 (30-100 ng/ml)
DHEA 269 (70-495)
Estrogen 115 (60-190 pg/ml)
Cortisol 8.2 (4-22 mc/dl scale)
GH <.1 (< OR = 7.1 (ng/mL)
IGF 157 (52-328 (ng/mL), Z-score .2 (-2.0-2.0)
TSH W/REFLEX TO FT4 1.27 (0.40-4.50 mIU/L).
Total Cholesterol 149
HDL 80
LDL 55
Triglycerides 55
CHOL/HDLC RATIO 1.9
Progesterone 0.6
DHEA SULFATE 269
Prolactin 6.5
Estradiol 21
Insulin 23 (didn't fast so this might be inaccurate)

 

[DorianGray]

There is a lot going on to try and overcome by yourself it seems to me. TRT may not be the solution. Or, perhaps better to put it another way, addressing your lifestyle, job, stress, mental issues would solve a lot of physical symptoms. Consult a caring medical doctor to advise, lifestyle coach or psychologist to get some perspective on direction. Just my advice.

 

[Systemlord]

TRT may fix your problems initially, but if lifestyle factors remain, your body punish you in others areas.

Start with improving lifestyle parameters first, if you fail to do so TRT is always an option down the road.

 

[Cataceous]

If you haven't already, I would throw in some thyroid testing, at least free T3 and free T4. Also vitamin D and SHBG. I'd use the latter to confirm that your free testosterone is on the low end. Were your results from the early morning? They need to be to see peak testosterone. If AM testosterone is this low and other tests are ok then lifestyle improvements may not boost you enough to resolve symptoms. I would try a testosterone nasal gel such as Natesto. At a minimum this should tell you if higher testosterone is beneficial. The big advantage of this delivery method over conventional TRT is that you keep producing your own testosterone and don't experience significant hormonal disruption; regular TRT can suppress many important hormones.

 

[RCK73]

You guys are incredible, and I'm very grateful for your help and thoughtful replies.

I will request the additional tests from my doctor and follow up here. I've had clinically low vitamin D before.

Blood tests were first thing in AM.

I'd appreciate any additional insights on lifestyle changes. I'll lift weights and maybe try Holy Basil or melatonin to help with sleep. I can take more time off. But the mental symptoms really feel physical in nature—like they're imposed top down if that makes sense. Lifestyle coach is an interesting idea.

I'll also follow up with the nasal gel definitely. I wonder if my low LH is sufficient to get my doctor on board?

On that note, any thoughts about trying to fix the low LH? D-Aspartic Acid?

 

[seppuku]

You guys are incredible, and I'm very grateful for your help and thoughtful replies.

I will request the additional tests from my doctor and follow up here. I've had clinically low vitamin D before.

Blood tests were first thing in AM.

I'd appreciate any additional insights on lifestyle changes. I'll lift weights and maybe try Holy Basil or melatonin to help with sleep. I can take more time off. But the mental symptoms really feel physical in nature—like they're imposed top down if that makes sense. Lifestyle coach is an interesting idea.

I'll also follow up with the nasal gel definitely. I wonder if my low LH is sufficient to get my doctor on board?

On that note, any thoughts about trying to fix the low LH? D-Aspartic Acid?

I wouldn't touch d-aspartic acid unless you want even lower testosterone. I believed all the hype when it first came out, and after having had a low test result myself thought i'd try it. Well, two weeks later the doc tested me again. My total testosterone had dropped from 12 nmol/l down to 9 nmol/l (345 ng/dl down to 260 ng/dl). If you want to increase your LH, you need a serm like clomiphene (or better still enclompihene).

 

[RCK73]

I wouldn't touch d-aspartic acid unless you want even lower testosterone. I believed all the hype when it first came out, and after having had a low test result myself thought i'd try it. Well, two weeks later the doc tested me again. My total testosterone had dropped from 12 nmol/l down to 9 nmol/l (345 ng/dl down to 260 ng/dl). If you want to increase your LH, you need a serm like clomiphene (or better still enclompihene).

Thank you

 

[Systemlord]

Jatenzo (oral capsule) has also been shown to only supress FSH by only 65 percent and LH 75 percent leaving both in the low normal range.

 

[seppuku]

Jatenzo (oral capsule) has also been shown to only supress FSH by only 65 percent and LH 75 percent leaving both in the low normal range.

Is it known why? I thought any exogenous testosterone would cause shutdown, especially long ester ones like jatenzo uses

 

[Cataceous]

Is it known why? I thought any exogenous testosterone would cause shutdown, especially long ester ones like jatenzo uses

It may in part be related to the relatively low serum testosterone. In one of the trials it was averaging only in the mid 400s ng/dL. Injections can appear more suppressive because they make it so much easier and more likely to achieve high levels. In addition, Jatenzo does seem to create significant intra-day variation in levels. The substantial time spent with low serum testosterone presumably keeps the HPTA stimulated.

 

[Zibernet]

I also posted this in the labs section so sorry for double post.

Grateful for any help. 47 y/o. 6', 190lbs. Just starting to lift weights but have gained maybe 15 lbs in the past few years. Love handles and belly fat. Physically weak. Previously skinny fat. Cancer survivor. Workaholic. Stressful job that I like and can't/won't change. Increasingly negative, critical, angry, moody—getting much worse over the past 6 mos. Zero libido and weak erections. 5-10 drinks a week, never more than 2-3 per day. Eat decently. Poor sleep. Mental fog, although I perform a cognitively-demanding job at a high level. Used propecia for 6 years until 2014, but the libido issues predate that.

Testosterone 361 (250-1100 ng/dL)
Free Testosterone 43 (35.0-155.0 pg/mL)
FSH 4.7 (1.6-8.0 mIU/mL)
LH 1.4 (1.5-9.3 mIU/mL)
Total Cholesterol 149
HDL 80
LDL 55
Triglycerides 55
CHOL/HDLC RATIO 1.9
Progesterone 0.6
DHEA SULFATE 269
Prolactin 6.5
Estradiol 21
Insulin 23 (didn't fast so this might be inaccurate)

Don't necessarily listen to advice saying you should fix your personal issues before fixing your chemistry.
Both are very much intertwined, and you'd be surprised how chemistry influences your decisions.

There is no risk in trying.
Hop on testosterone, see how it changes your mood and your lifestyle.

If you are a man and alive in 2021, you most definitely need testosterone anyways given how many EDC are around.

 

[Systemlord]

especially long ester ones like jatenzo uses

Long ester you say, Total T levels are in the high 900's 1-2 hours after dosing and 250 12 hours later.

 

[madman]

I also posted this in the labs section so sorry for double post.

Grateful for any help. 47 y/o. 6', 190lbs. Just starting to lift weights but have gained maybe 15 lbs in the past few years. Love handles and belly fat. Physically weak. Previously skinny fat. Cancer survivor. Workaholic. Stressful job that I like and can't/won't change. Increasingly negative, critical, angry, moody—getting much worse over the past 6 mos. Zero libido and weak erections. 5-10 drinks a week, never more than 2-3 per day. Eat decently. Poor sleep. Mental fog, although I perform a cognitively-demanding job at a high level. Used propecia for 6 years until 2014, but the libido issues predate that.

Testosterone 361 (250-1100 ng/dL)
Free Testosterone 43 (35.0-155.0 pg/mL)
FSH 4.7 (1.6-8.0 mIU/mL)
LH 1.4 (1.5-9.3 mIU/mL)
Total Cholesterol 149
HDL 80
LDL 55
Triglycerides 55
CHOL/HDLC RATIO 1.9
Progesterone 0.6
DHEA SULFATE 269
Prolactin 6.5
Estradiol 21
Insulin 23 (didn't fast so this might be inaccurate)

Common symptoms of low/sub-par FT levels are low energy, depressed mood/anxiety, low libido, erectile dysfunction, lack of NPT/spontaneous erections, decrease in muscle/increased adipose.

Also, keep in mind that dysfunction thyroid/adrenals can mimic many of the low-t symptoms.

Your labs should have included a full thyroid panel/cortisol and SHBG.

Knowing where your SHBG sits is critical as it will have a significant impact on TT/FT let alone can dictate what injection frequency may suit one best.

As you can clearly see your TT 361 ng/dL is far from optimal and more importantly, your FT level is sub-par (well below mid-range) and it was tested using one of the most accurate assays the gold standard Equilibrium Dialysis.

Keep in mind that the low-end reference range for TT was 348 ng/dL up until mid-2017.

You would have been barely above that!

Even if you tried cleaning up some of your lifestyle habits it is doubtful that it would have any significant impact on bringing up your levels to make a difference, especially at your age.

As Cataceous stated in post #4.....If AM testosterone is this low and other tests are ok then lifestyle improvements may not boost you enough to resolve symptoms. I would try a testosterone nasal gel such as Natesto. At a minimum this should tell you if higher testosterone is beneficial. The big advantage of this delivery method over conventional TRT is that you keep producing your own testosterone and don't experience significant hormonal disruption; regular TRT CAN SUPPRESS MANY IMPORTANT HORMONES.

This is great advice and I would definitely look into trying out Natesto before jumping on full blow trt as shutting down your HPG-axis is a big move!

All other forms of exogenous testosterone will result in significant suppression of the HPG axis.

Most on trt are using injections (esterified T) and although very effective too many get caught up in driving TT/FT levels well beyond what would be needed/could ever produce endogenously let alone in their prime (early teens/the late 20s).

Too many get caught up one the more T is better mentality spewed on those bro forums.

Much more involved when using exogenous testosterone!

This can result in many getting caught up struggling on a protocol.

If you do decide to jump on injections then the best piece of advice would be to start low and go slow.

 

[Match]

Cholesterol is necessary for the formation of hormones in general and in this case is quite low.

Boosting good fats could help too, okay?

 

[RCK73]

Thanks, fellas. Bottom line is I feel like garbage mentally and physically, such that I'm a burden on my family.

My vid D is low too at 26 (30-100 ng/ml) even though I live in sunshine belt. Insulin was flagged at 23.0 (uIU/ml), but I did not fast beforehand (ad hoc test). DHEA was 269 (70-495). Estrogen was 115 (60-190 pg/ml). Cortisol was 8.2 (4-22 mc/dl scale). GH was <.1 (< OR = 7.1 (ng/mL), which seems low! IGF 157 (52-328 (ng/mL), Z-score .2 (-2.0-2.0)

TSH W/REFLEX TO FT4 was 1.27 (0.40-4.50 mIU/L).

Common symptoms of low/sub-par FT levels are low energy, depressed mood/anxiety, low libido, erectile dysfunction, lack of NPT/spontaneous erections, decrease in muscle/increased adipose.

Also, keep in mind that dysfunction thyroid/adrenals can mimic many of the low-t symptoms.

Your labs should have included a full thyroid panel/cortisol and SHBG.

Knowing where your SHBG sits is critical as it will have a significant impact on FT let alone can dictate what injection frequency may suit one best.

As you can clearly see your TT 361 ng/dL is far from optimal and more importantly, your FT level is sub-par (well below mid-range) and it was tested using one of the most accurate assays the gold standard Equilibrium Dialysis.

Keep in mind that the low-end reference range for TT was 348 ng/dL up until mid-2017.

You would have been barely above that!

View attachment 15412


Even if you tried cleaning up some of your lifestyle habits it is doubtful that it would have any significant impact on bringing up your levels to make a difference, especially at your age.

As Cataceous stated in post #4.....If AM testosterone is this low and other tests are ok then lifestyle improvements may not boost you enough to resolve symptoms. I would try a testosterone nasal gel such as Natesto. At a minimum this should tell you if higher testosterone is beneficial. The big advantage of this delivery method over conventional TRT is that you keep producing your own testosterone and don't experience significant hormonal disruption; regular TRT CAN SUPPRESS MANY IMPORTANT HORMONES.

This is great advice and I would definitely look into trying out Natesto before jumping on full blow trt as shutting down your HPG-axis is a big move!

All other forms of exogenous testosterone will result in significant suppression of the HPG axis.

Most on trt are using injections (esterified T) and although very effective too many get caught up in driving TT/FT levels well beyond what would be needed/could ever produce endogenously let alone in their prime (early teens/the late 20s).

Too many get caught up one the more T is better mentality spewed on those bro forums.

Much more involved when using exogenous testosterone!

This can result in many getting caught up struggling on a protocol.

If you do decide to jump on injections then the best piece of advice would be to start low and go slow.

 

[seppuku]

Long ester you say, Total T levels are in the high 900's 1-2 hours after dosing and 250 12 hours later.

Oh ok. Well i'm suprised at that as i thought test undecanoate was the longest acting (ie as in nebido). Maybe taken orally its effects are different then.

 

[RCK73]

Talking to my doctor on Friday. The PA he works with is a "anything about 250 is normal range" guy so I might have to see a TRT specialist. Any chance my insurance covers the nasal gel given my ranges?

 

[Systemlord]

Any chance my insurance covers the nasal gel given my ranges?

Depends on insurance, but not many cover the nasal gel.

 

[Systemlord]

The PA he works with is a "anything about 250 is normal range" guy so I might have to see a TRT specialist.

That's not the normal range, anything under 300 qualifies for TRT and even the up to date doctors are prescribing TRT with guys at higher numbers going against the guidelines because they know better.

 

[RCK73]

Guys, any thoughts on high SHBG given my other ranges (especially the low LH)? Mine is 48 (scale of 10-50). DHT is 37 (12-65 ng/dL). Liver and thyroid ranges are normal.