To start TRT or not?

[PaulKemp]

Hey everyone,

Ive been desparately scouring the forums in search for a little help without much success. So far I have read the other thread started by Elijah and the clomid thread to gain a little knowledge, but I am still a little lost.

Anyway, heres a little info I posted on another forum about the problem;

Im 32, about 85kg @ maybe 17% bf. I currently live in Thailand. Never done TRT or steroids.
Diet is Paleo-ish, Ive done a few programs recently like SS and 531, and have been working out since i was 18.

I went to an Endo in March bacause I was absolutely fried. I couldn't sleep, kept waking up at 2-3am on my workout days, even some of the off days, and could NOT fall asleep again. I thought it was adrenal fatigue, but my test results came back with "low test"

March:
Free T4 1.00 ng/dl (0.65 - 1.26)
TSH 1.299 uU/ml (0.340-5.6)
Cortisol 15.8 ug/dl
ACTH 27.4 pg/ml

Total T 438 ng/dl
SHBG 49. nmol/l (10-60)
Albumin 39 gm/l (38 - 50)
Free Androgen Index 30
Free Test. 72 pg/ml (90-300)
% Free Test. 1.63% (2-4.8)
Bioavailable Test. 153 ng/dl

LH 1.61 mIU/ml
Prolactin 7.05 ng/ml (3.4 - 19.4)

ALT 25 u/l (0 - 44)
FPG 82 mg/dl (70 - 99)


May
Total T 377 ng/dl
SHBG 37.2 nmol/l
Albumin 38 gm/l
Free androgen index 35
Free Test. 75 pg/ml (90-300)
% Free Test. 1.99 (2-4.8)
Bioavailable Test. 156 ng/dl

I did an MRI, no abnormalities.

This is where it gets frustrating;
-Doctor first says I have low test. Then, before prescribing Andriol (80mg/day), he says that my test isnt really that low. Wtf?
-Doctor did not test for DHEA, PSA, or E2.
-I asked if I needed an AI, or checking for liver and estrogen problems before taking the meds, he said that I would "probably" be ok.
-No real source of the low T was explained to me.

I had enough of that, and went to another endo. Other endo said I did not have low T. When I asked him about my low Free Test, Bioavailable test numbers he couldnt explain what they were or why they would be low, or how that impacted total Test.
-He then tells me I have to exercise and take vitamins! (I asked him how much I should squat a week, and tried to get his opinion on a decent strength traning program just for ****s and giggles. Then I showed him my protable vitamin container, stuffed to the brim...)
-He says that if I go on TRT, and I wanted to stop, all I have to do is stop. I dont need to take anything else to reactivate my own system.
-Did a test for PSA, and E2.
-He prescribed Nebido after sticking his finger in my bum. At least it was worth it...

June: (After three weeks on andriol @ 80mg a day)
PSA 0.651 ng/dl (0 - 4.0)
E2 15.6 pg/ml (7.6 - 42.6)


Questions:
1) Is my test low? Do I really need TRT?
2) What are the chances of trying TRT for a few months, then just stopping and being fine without having to take anything else to restart my own system?
3) Any idea what the problem might be? Alternative suggestions, the like?

I know the post was long, but honestly I have nowhere else to turn for my information because all the docs I have talked to here have their head in their a$$. Thanks for reading this far and any help you can offer!

[Elijah]

1) Yes, your testosterone is low, in particular your free testosterone, because of the high SHBG.

2) After two months, I believe you will get back to your current state on your own, but it may take some time. Preferrably, you help your system with clomiphene or something similar to get started. However, if you do feel great, I assume you will not want to go off.

3) I have no idea. Low testosterone can be a symptom of something else going on in your body, which I suspect may be the case for me. Have you tried a saliva cortisol test 4X daily? Iron panel? Hemachromatosis have the same symptoms as low testosterone and will depress your testosterone levels.

Your LH looks low, so you may have secondary hypogonadism. If so, you are a candidate for clomiphene monotherapy or HCG monotherapy. If you can get this to work for you, I think it is preferrable over regular TRT, since you are encouraging your body to produce it`s own testosterone. In terms of fertility, this is also preferrable.

Regards,

Elijah

[Jin Xie]

Elijah, how are you doing, mate?

[BigDawg]

Bro, try some DAA man. My boys have never been so full and hangin low since I started using it, my T numbers must be through the roof!

[DeniseXan]

Bro, try some DAA man. My boys have never been so full and hangin low since I started using it, my T numbers must be through the roof!

We should hang out together

[BigDawg]

We should hang out together

I need to check with my girl but she may be up for a threesome. ARF! ARF!

[Elijah]

Elijah, how are you doing, mate?

Not good, I`m afraid.

I have noticed no improvements from testosterone therapy beyond a slight strength increase in the gym. I thought I could be having issues with high E2 and I probably did early on, but it`s back low/lower now and I sitll feel the same.

I am strong in the gym and such, but on most days I have virtually zero energy or motivation. Brain fog is typically significant and my body aches at times. I`m not looking into my thyroid and waiting for a test on reverse T3. My thyroid have always been fine and even high, but I still gain fat easily. I`ve learned that if my RT3 is high, that may be blocking T3 from entering the cells and could explain why I feel so bad. I`m also looking to get a saliva and urinary cortisol test done. Cortisol in blood was elevated above the range on my last BW, but my doctor did not want to do anything about it or test further, which I agreed on since I was fairly certain that low testosterone was my real problem.

I have the occasional good day, but nothing more than prior to starting TRT.

[evanski]

Ive read some reports where people complain of worsening fatigue symptoms on TRT and the reasoning is that reduced stimulation of the testes results in diminished pregnenolone production and thus less conversion to other steroids. Ive seen bloods to support this theory with clomid therapy boosting levels into healthy range and TRT dropping them to nill. What does that mean for you? Low dose clomid on top of trt? I'm not sure. What are your DHT levels like?

[Jin Xie]

Ive read some reports where people complain of worsening fatigue symptoms on TRT and the reasoning is that reduced stimulation of the testes results in diminished pregnenolone production and thus less conversion to other steroids. Ive seen bloods to support this theory with clomid therapy boosting levels into healthy range and TRT dropping them to nill. What does that mean for you? Low dose clomid on top of trt? I'm not sure. What are your DHT levels like?

Test plus hCG (300 IUs BIW) would make more sense. And you can always take preg, ideally transdermally.

[Jin Xie]

Not good, I`m afraid.

I have noticed no improvements from testosterone therapy beyond a slight strength increase in the gym. I thought I could be having issues with high E2 and I probably did early on, but it`s back low/lower now and I sitll feel the same.

I am strong in the gym and such, but on most days I have virtually zero energy or motivation. Brain fog is typically significant and my body aches at times. I`m not looking into my thyroid and waiting for a test on reverse T3. My thyroid have always been fine and even high, but I still gain fat easily. I`ve learned that if my RT3 is high, that may be blocking T3 from entering the cells and could explain why I feel so bad. I`m also looking to get a saliva and urinary cortisol test done. Cortisol in blood was elevated above the range on my last BW, but my doctor did not want to do anything about it or test further, which I agreed on since I was fairly certain that low testosterone was my real problem.

I have the occasional good day, but nothing more than prior to starting TRT.

Really sorry to hear this. Are you practicing any form of meditation or mindfulness? And what about some therapy? May be a good idea. I hate to see people put all their eggs in finding a complete chemical solution to their problems.

[Elijah]

Really sorry to hear this. Are you practicing any form of meditation or mindfulness? And what about some therapy? May be a good idea. I hate to see people put all their eggs in finding a complete chemical solution to their problems.

Thanks, Jin.

I used to practice meditation and actually plan to make it a habit once again. I try to practice mindfulness as much as possible.

What kind of therapy are you suggesting? I have considered if my issues have a psychological angle, but I have been 90-100% sure they are not, since I`m truly a very positive guy. Solution oriented, always trying to make the best out of any situation and usually in a good mood. When I have my worst down days, it IS depressing, but I think that is more a function of feeling bad. Maybe there are some chemical processes in my brain that is out of order, considering that my libido is strongly affected as well. The only thing I know is that there are hours and even days where I feel GREAT and normal, without any logical explanation.

Since I had proven low testosterone, I have to say I`m very surprised that I noticed pretty much nothing from TRT and a proven doubled increase in testosterone.

I will get DHT and RT3 tomorrow. I`ve been told that if the thyroid is not working like it should, in the case of high RT3 blocking T3 to enter the cells, getting testosterone in range is not helpful. I am prepared that the test will come back normal, but who knows.

Adrenal fatigue is another option, I suppose.

[Elijah]

Ive read some reports where people complain of worsening fatigue symptoms on TRT and the reasoning is that reduced stimulation of the testes results in diminished pregnenolone production and thus less conversion to other steroids. Ive seen bloods to support this theory with clomid therapy boosting levels into healthy range and TRT dropping them to nill. What does that mean for you? Low dose clomid on top of trt? I'm not sure. What are your DHT levels like?

Hey, evanski.

Interesting. I did take HCG for a long while (a break now due to availability issues), so I was hoping that would help pregnenolone production among others.

I will most likely get my DHT tomorrow. Did not have the opportunity to test it until now.

[Elijah]

Follow these recommendations, and if you have reduced T3 and elevated RT3 its probably just euthyroid sick syndrome from a low carb diet, eat more carbs bro:

T3 is actually on top of the range and T4 is almost top range as well. Still, I periodically suffer from cold hands and feet and I seem to put on fat easily. I always thought my cold hands or feet was normal or possibly poor circulation. I have now learned that it is actually possible to have a good thyroid, but if RT3 is high, the T3 will not be able to enter the cells since RT3 is blocking the same receptors. RT3 may be increased during periods of stress and burnout and the conversion may in some cases be permantely "stuck". At least that`s the theory, but it is a controversial one.

The sad thing is that I can check off pretty much everything on your list including porn (believe it or not). Actually, for a period I tried to consciously expose myself to porn to get myself going again, but it did not help. I don`t like porn much at all anyway, even when I`m horny.

Sunlight exposure could be better, but we often have rainy days here in Norway, so it`s not always I can get it even if I want to. I used to work outdoors actually, but I still had issues then.

I tried tadalafil, but it did not do much for me. Truth be told, I think my valves and system works just fine, since I at times pack steel in my pants. It`s just that it`s very rare that I reach that state. Like an on/off switch. Not sure if Cialis impacts libido?

Regarding vitamins, I think I`m good in most of them, but I was actually low on vitamin K and copper. I never even heard about vitamin K until I went over my BW one more time.