T Nation

34 Year Old w/ Low T for a while. Need Advice on TRT

First time poster but long time reader.

Age: 34
Height: 5’ 6"
Weight: 154 lbs
Bodyfat: 15-18%
Fat storage: Midsection, glutes, chest and upper legs
Facial hair: Normal
Body hair: Hairy legs, moderate chest & belly, little lower back, glutes
Lifestyle: Stressful couple of years
Workout: 4 times a week push/pull
Diet: Healthy 90% of the time
Supplements: Vit D 5000iu, Vit K2, Omega 3, Vitamin C 1000mg
Testicular pain: Nope
ED: Nope
Libido: Normal
Morning wood: Most days
Brain fog: Yes
Depression: No but been feeling a little bit low and lack of motivation
Irritability: Mild

It all began when I decided to check Testoterone in 2016 just for the hell of it. I had been working out consistently for about 4-5 years until then but with minimal results. It came out as 2.95 which was the lower end of the range. I rechecked in a couple of weeks and it came back as 3.95. About a year later it came out as 5.09 and today 3.35.

I was always hesitant to jump on TRT because I was worried about having fertility issues but that changed when my wife got pregnant 17 months ago and now enjoy two twin baby boys. Now it’s time to get my health on point.

No other issues beside low T. My test results are attached however I am missing Free T, DHT, GH, IGF-1, Cortisol, and SHBG which I should receive beginning of next week.

From all the tests it looks like I am secondary.

I know the protocol is best decided after seeing if low/high SHBG however I am not worried about doing shots every day. I might say that I kind of prefer SubQ than IM. I want to keep my fertility so I would like to run HCG as well. I’d rather skip AI if I can but seeing that my E2 is also low I believe it could be a possibility.

Questions for you all:

  • Is it worth attempting a restart?
  • Recommended starting dosage on T (SubQ or IM)
  • Recommended starting dosage on HCG
  • Any other recommendation since I am new to this game

Looking forward to any feedback and appreciate this community and all of the help you guys are handing out daily.

Edit: Forgot to mention there is no TRT clinic in my country and endocrinologists are as ignorant as they could get so I need to take matters in my own hand.



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I’d start with 150mg cypionate once a week.

Since you want to do SQ and use hCG, 35mg test MWF, 250IU hCG TThS.

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Unless you correct what’s causing the low testosterone (assuming you can), once clomid is withdrawn levels will return to baseline.

Starting TRT with microcytic anemia (low MCV) isn’t advised, you need an iron panel and ferritin as well. I started TRT and it took awhile to become iron deficient, it put me in the hospital.

Sometimes a lack of vitamin C in your diet can lead to iron deficiency because vitamin C is responsible for iron absorption in the small intestine.

What issues are you having exactly? It doesn’t sound like there are any from the details of your post (ignoring the lab tests)

Thanks for the reply. 35mg MWF and 250iu HCG TThS sounds like a solid plan. I could always increase the dosage by 5 mg after the first labs if not satisfied. However I will address the microcytic anaemia first as systemlord mentioned.

Thanks for all the help and information. I doubt I will be able to find the cause of low T given that it is clearly secondary and my prolactin levels are well within range so I guess TRT is the only option. I fully agree with addressing the anaemia first.

Looking at my labs a few years back the highest my MCV has been was around 85. I did two stomach endoscopies within the last 3 years and they came out as perfect. No ulcers and no bleeding. I took the occult blood stool test a couple of times and everytime it comes back negative. I would say my diet in the last 5 is leaned towards chicken and fish and very rarely eat red meat. I have been taking Vitamin C 1000mg everyday for the last two years. Maybe the brand isn’t that good?

I will get an iron panel and ferritin test on Monday however I am attaching the one from January since MCV was only marginally higher. I doubt this time they will come out much different. I can see that the lab changed the range from 80 to 84. I did consult doctors before but they all said that there is nothing to worry about and there is no need to do anything. I clearly don’t trust doctors in my country however.

What would you suggest? Should I start supplementing iron and what dosage?

Fatigue,
lack of energy,
lack of motivation,
brain fog,
used to be very social but now try to get out of activities,
get irritated easily,
feeling down but definitely not depressed,
lack of muscle given the amount of workout I’ve been doing the last 7 years,
more body fat than I should have given my diet,
everytime I try to cut body fat I end up loosing muscle,
no sexual issues thankfully

Sounds good. Keep in mind anemia is often seen in hypogonadism, and your hormone levels are low. I suspect TRT will help quite a bit and you’ll see significant improvement in your RBC indices.

Men only require 65-90mg of vitamin C daily, I’m sure you have the supplement industry very happy you’re taking more than 10 times as much as you need. Studies show people taking over the daily allowance of vitamin C have worsening arthritis, damaged and poor joint health.

Supplementation should be reserved for people who would otherwise become deficient if relying purely on dietary sources of vitamin C, most often people are causing harm and on rare occasion even death by being overly proactive on supplementation.

Your vitamin C absorption rates decrease 50% when supplementing doses over 180mg, 70-90% of vitamin C is absorbed at doses between 30-180mg. So by oversupplenting you are actually getting less.

It is worth a try. I could always keep on eye on my CBC and supplement iron as needed. Thank you.

I am one of those people that keep the industry alive :). My reasoning for the 1000mg started two years ago when I thought that I had adrenal fatigue and that was the cause of my low testosterone so I started supplementing with a lot of vitamins and minerals. I was basically taking a holistic approach which did nothing at all to be honest. So I would happily drop the amount of vitamin C to the lowest I need to get a better absorption.

What about iron? Given my ferritin and iron levels I believe that I could do around 90mg a day for 2-3 weeks and after that I could get away with a men’s multivitamin that includes iron. Usually in the 5-7mg range. I could up my red meat intake to twice a week as well. Right now I probably eat it once or twice a month.

Thank you

I take 2000mg vitamin C to help with the affects TRT has on my adrenals and to help with anemia. Works quite well. The resident endo here (though he is on hiatus) takes 2000mg as well.

At some point I used to take 2000-3000mg a day but I didn’t notice much difference when dropped to 1000mg. If I go a couple of days without taking the 1000mg I do feel a little bit more lethargic.

I saw in a another thread that we were around the same age. Let me ask if you ever did feel any regret going the TRT route? And how do you deal with traveling? Mostly worried about HCG since it needs to be refrigerated.

Thank you

I take 2000MG Vit C because physiolojik does it and touted it’s effectiveness at helping counteract the burden placed on the adrenals by TRT.

I don’t use HCG mainly because that same endo advises against it. Regardless, taking a little time off from it if needed isn’t going to create any big issues. I put seven 10ml bottles of T, two years worth of arimidex (both in my carry-on bag) & a hundred syringes (in my suitcase) when I flew to my new home in New Orleans from New York and security didn’t give two shits.

TRT is one of the best mistakes I’ve ever made. Technically I had decent T levels before TRT but had symptoms. Had I known anything about TRT I would have likely not gotten on it thinking it wouldn’t help. It has been life changing for me. I had a very hard first year figuring out how to make it work for me but once I got there it’s like I’m the person I’ve always wanted to be. It helps with depression, anemia, fat loss, muscle gain & the ability to retain it. I just feel like a better version of myself on it. If you told me it will take 10 years off my life I wouldn’t stop (I don’t think this is true for the record). For me quality of life has to be as important as longevity and I’m done living sub-optimally.

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Thanks for all the information buddy. Hearing your experience confirms my decision on going down this road. I expect to have a somewhat of a rough starting period as well until I get my protocol dialled in. However I am lucky at an extent that a lot of information is posted here and all of you guys are making this a lot easier on us newbies.

@dextermorgan Inspirational bro. Hope to experience something similar.
If it is how you describe it I prefer to live only 10 more years like that than 40 the way I live now…

I also received most of the updated labs. The only thing missing is cortisol as I believe the lab made a mistake and forgot to include it so I might have to take it again when I go the lab to get iron and ferritin checked as well.

I edited the first post for the new labs and I’m including them here.

New labs are: Free T, DHT, IGF-1, GH, SHBG

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I’ve read a lot on longevity and TRT since prostate cancer runs in my family. There has never been a study that proved that testosterone causes prostate cancer. It does fuel it once the cells mutate from regular to cancer ones and that is why those man a chemically castrated. I’ve seen a lot of men PC patients who are on TRT and not have a relapse.

In my opinion the only thing to worry is blood thickening which could be avoided by taking the right dosage or donating blood.

There is a lot of studies that suggest testosterone increases longevity by protecting the heart and other organs as well. This is one of the main reasons I want to get on TRT as well. Why wait till later in life while my levels are already way lower than average. All of these years deprived by testosterone will for sure do my body some damage.

So given SHBG=28 and the fact that I can only get Test E what protocol do you think I should follow?

The one suggested @highpull 35mg MWF and 250iu Hcg TThS looks good and convenient but if daily is better I could do it too.

As I said before I’d hate to take an AI so I would like E2 to stay stable since a lot of it would be converted to free E2 given my SHBG of 28.

Don’t make that assumption automatically. Some guys with single digit SHBG levels do fine on once weekly dosing and do not use an aromatase inhibitor.