T Nation

31, Very Low Testosterone. Dr. Wants TRT, I Don't

Hello Forum,

I’m 31 years old and my testosterone is EXTREMELY low. I recently found out 3 weeks ago after a bunch of bloodwork and testing that I have thyroid problems (subclinical hypothyroid/hashimoto’s thyroiditis) and extremely low testosterone .

I have been training hard 2 hours a day 5 days a week for the last 9+ months trying to put on some muscle, and have been completely 100% failing, I have a pristine/clean diet & really good supplementation plan, is this why?

My Dr. wants to put me on exogenous testosterone/cypionate , but I don’t know if I want to do this? I do not want to completely destroy my body’s natural ability to produce testosterone, nor do I want to be permanently infertile? Are the side effects of TRT the same for men with secondary hypogonadism? I’m already producing way less Testosterone than I should, so wouldn’t TRT completely destroy my body’s natural ability to produce permanently?

He did not mention PCT or cycling, he did not mention any aromatase inhibitors or anything, just 250mg testosterone cypionate indefinitely? Doesn’t this mean my balls will shrink, I will become infertile, and eventually my body’s natural ability to produce testosterone will shut down entirely and permanently? if I don’t cycle off of it from time to time?

Is there some better alternative like clomid or anavar that would allow me to build muscle without shutting down my natural testosterone production?

I upped my supplement game recently, and completely changed up my diet to only eat foods that boost testosterone, and started taking a few highly rated natural testosterone boosters, for someone with levels as low as mine, is it even possible to get to mid- or high-normal levels through diet and natural supplementation? or is TRT my only hope?

I’m really sick of putting this effort into my work outs and getting almost no results.

My levels from bloodwork follow:

TSH: 1.61 mUI/L

TSH: 1.29 mIU/L

TSH: 2.20 mIU/L
FT4: 1.34 ng/dL
Testosterone, Serum: 376 ng/dL
Free Testosterone: 5.3 pg/mL (REF: 8.7 - 25.1)

TSH: 4.54 mIU/L
FT4: 1.51 ng/dL

Testosterone, Serum: 324 ng/dL
Free Testosterone: 2.6 pg/mL (REF: 8.7 - 25.1)

Testosterone, Serum: 610 ng/dL
Free Testosterone: 7.7 (REF: 8.7 - 25.1)

TSH: 2.25 mUI/L
FT4: 1.10 ng/dL

Also, if TRT is the only practical solution for someone with levels as low as mine, how does steroid use fit in with someone like me who is very young to be on TRT (31 y.o)? What if I eventually wanted to cycle something like anavar or winstrol ? would I still have to take an AI, do PCT and cycle the anavar? would I cycle the testosterone too? (I have limited, almost no experience with steroids , but I’ve been trying to learn before starting TRT).

Thank You so much for your help, I’m really confused on the best course of action here.

My Dr. hasn’t run any tests on LH, FSH, DHT, SHBG, I don’t think he has a clue what is the cause of my hypogonadism? regarding if its primary or secondary? etc…

This idea of preserving suboptimal testosterone levels is irrational, why would you want to be unable to build muscle and risk all the diseases associated with low T? Guys worry about the side effects of TRT yet their already suffering horrible side effects of low T. The only way you’re going to experience side effects of TRT is if your doctor is failing you by not balancing your hormones or prescribes whopper of a dose of aromatase inhibitors therefore crashing your E2, if your doctors hasn’t mentioned anything about aromatase inhibitors it’s likely he doesn’t even know that at 250mg of T-cyp will drive your E2 through the roof! It sounds like with the dose of T he’s suggesting he plans on injections every 2-3 weeks because no doctor is going to prescribe more than 200mg per week which is the upper limit for weekly doses. If this turns out to be true you need to run from this doctor cause he sounds like an idiot! These 2-3 week injection protocols were some of the first protocols back when doctors were starting clinical trials back when little was known about what would happen to a guy injected with T-cyp. Testosterone cypionate has about an 8 day half life for most guys, I promise you be the second half of the second week you’ll be lower than you were before you started TRT and by the 3rd week you’ll be in a new kind of hell! Endocrinology is the only field of medicine where doctor never seem to consider the half life of the drug, a kind of tunnel vision.

Testosterone boosters are a scam plain and simple, if they truly worked it would put the TRT doctors out of business and big brother (FDA) would come in and regulate it all. Fascinating you would be concerned about side effects of TRT yet take Testosterone boosters which can have the worst long lasting side effects and can be dangerous. No SHBG tested, how’s your doctor supposed to set you up with a successful protocol without knowing where you SHBG is at? Those with high SHBG require large doses of T to drive it down, guys with low SHBG need smaller more frequent doses, it sounds like you’re doctor isn’t up to the task of balancing your hormones! Know that 80 percent of TRT doctors out their are living under a rock and don’t understand how to balance male hormones. TRT is the only solution to supplementing testosterone and have never known clomid to work out for anyone in the long term.

You need more data to make an accurate decision. Test your E2, LH, FSH, SHBG, fT3, rT3. Your TSH is high. Your free test is low (which will give you low-t symptoms) but your total test looks ok which probably means that your SHBG is high.

The protocol your doctor wants you on its dumb. You need T + hCG + AI (like anastrozole) twice per week.

Someone more knowledgeable than me should post better information shortly.

Thank You both so much.

This is exactly the type of information I needed to hear.

I made a mistake in my original post, my Dr.'s plan is actually 200mg IM weekly of depo-testosterone cypionate with weekly B12 injections and 100mcg T4 with 5mcg T3 for thyroid.

His exact words are: “You’re fatigue is caused by the perfect storm of clinical hypothyroidism fueled by autoimmune thyroiditis: exceptionally low vitamin D3, and subclinical EBV and CMV titers; and low testosterone levels.”

"Your TSH of 4.50 must be below 2.00 to be metabolically efficient. T levels must be >1000; and vitamin D3 must be in 60 range. "

“That’s the plan for three months. Your metabolism will balance, overcome the anti-thyroglobulin Ab effects; and the efficiency of the thyroid replacement with depo-testosterone cypionate will rebuild lean muscle mass.”

I understand that I’m pretty much wasting my time trying to fix my testosterone levels naturally through diet and supplements? but what about my thyroid levels? can these be fixed naturally if its only subclinical hypothyroidism? or should I just give in and take the thyroid meds for the rest of my life?

How does 200mg testosterone IM weekly sound? will I experience crashes on this cycle of test? I understand its kind of a moot point to worry about shutting down my natural production when it’s already so very low, but is there anything I can do to preserve the production I have left?

Thank You all so much,
Gary M.

Honestly unless you’re a hypermetabolizer and go through your T fast, you’re going to have high E2 problems. A sound protocol would be to start out low and go slow because you may not even need an AI at all, but if you start out high I guarantee you will suffer elevated E2 symptoms. Almost everyone (except hypermetabolizer) I’ve ever heard of starting out at 200mg weekly has always had to lower their dose in order to lower their E2, it would help to know what you’re baseline E2 was, this would basically give you some incite whether your E2 is going to be high after starting TRT. If one is already high in E2 while low T, then it’s a good indicator you’ll have E2 issues at any doses.

A lot of guys do require the use of an AI, but some like myself don’t as long as we’re not on a ridiculous amount of T. It’s becoming standard starting out most men at 100mg weekly and slowing increasing to bring levels up to the desired range and carefully monitoring E2 levels, most doctors expect guys to feel great at the top of the range, however not all do. I had low vitamin D3 when I was low T, not anymore. When one is already clinically low T in my opinion it’s already too late because you body is already showing it’s weak hand, if one is already low early in life it’s because that part is already failing otherwise you would be optimal.

Thanks for posting. I have the similar situation. I will have to give my treatment plan a little more time.