T Nation

37 & Need Advice on Potentially Starting HRT - Blood Work Included

Hi All,

I could really use some help please. I was considering going on cycle (blast) then starting TRT, but after advice received here, if I need HRT, I will get that right first then consider a blast. Below is the key info.

BACKGROUND:
I am 37 and 6ft with average genetics at best. I was obese when I was 33 at 288lbs (133kg) . I went on a 2 year cut with hard training (mostly weight lifting) and went down to 173 (78kg) but I didn’t have enough muscle on my body and it make me look sick (face sucked in etc). I was probably around 14%bf.

From there I have been training hard and bulking for another 2 years. I am currently 244lbs (110kg) and am around 25%bf wearing 34” jeans. My current one rep maxs are:

  • 315kg (140kg) Bench (life long goal) and 100kg (220lbs) for 13 reps
  • 352lbs (160kg) Squat
  • 352lbs (160kg) Deadlift

I have also been doing BJJ for the last year and absolutely love jiu jitsu.

I did blood work one year ago and here are my results:
image
I will do another set of bloods at the 1 year mark.

SYMPTOMS:

  • I have low energy levels most of the time
  • Bad quality sleep (toss and turn and shallow)
  • My bench hasn’t progressed in 10 months. Tried high reps, low reps etc
  • I get brain fog quite often. Caffeine fixes it.
  • I get erections on demand but only wake up with wood 20% of the time.

MY GOAL:
My ultimate goal is to be lean and strong with a large athletic build, but not huge. Essentially, I want to look jacked but on the limits of natural for someone with good genetics. I would be very happy to be 95kg or 100kg at 12% BF.

I have accepted given my age that there will come a time in the near future when I will need to start HRT and this has made me consider starting now to keep me at the high end of the “normal range”.

ASSUMPTIONS:
Please assume I have a doctor that will give me access to any appropriate medical supplementation that would be recommend.

Please also assume I have the discipline to eat super clean when needed and train hard.

Sorry for the long write-up but I wanted to give an accurate picture of my history and my goals.

Thank you!

Before doing anything, I’d get up to date lab work. Make sure a complete thyroid work up is included. Plus, get the basics added, lipids, CMP, CBC, DHEA-S, etc. As of now, it appears your SHBG has you with a less than optimal free test level.

Thank you @highpull

I will get updated bloods including the added items you suggested when back home after the holidays.

Based on the bloods I posted do you think it warrants TRT and HGH or anything else?

Cannot say for certain, but yes, TRT.

I’ve been on TRT for almost four years now and kind of regret jumping into it. I would urge you to see if you can alleviate the symptoms without jumping on TRT. Your blood work is in different measurements than what I am used to seeing, but they all look normal to me - I may be missing something.

All of your symptoms could be related to weight. I know BMI is mostly bullshit, but you are not just overweight, but considered obese. Body fat of 25% isn’t horrible, but as you get older, body weight alone can influence health factors, regardless of composition.

And just based on past experience here, you are probably higher than 25%. I’m 6’1" and 180 pounds and am at 14% based on notoriously inaccurate BIA devices. And I wear 34" jeans.

Only you can make the determination - we’re all different, but I think you would be well served by losing weight again and getting more in depth blood testing.

Good luck.

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Why will you be starting TRT in the first place if your T value is normal.

TRT doesn’t provide any physical edge compared to naturally occurring normal T values. That is, if you take TRT and have a normal T level, you won’t have any leg up on the next guy in getting jacked or performing better.

Re: assumption

I consider a doctor willing to give TRT to those who don’t need it NOT the doctor one should go to.

TRT is medicine like any other medicine is classified for a condition. But many think it’s something to do simply because of desire.

And considering your symptoms list, considering your T value is normal, they likely have nothing to do with T at all.

A stalled bench press isn’t a symptom of low T. A 315 bench press is impressive for any gym rat, fat or not. It might be all you can bench or different trains might get you a higher bench. Regardless, this isn’t a “problem” docs care about. And considering your bench and and squat deadlift are close in poundage, perhaps something else is going on here.

Sleep
Yeah, tell me about it. I had insomnia so bad this past summer that I had to miss a day from work. And I have normal T values.

Brain fog
I suspect half or more of American adults are in a fog.

Erections
You likely get erections during your sleep. Most males don’t awaken with them everyday.

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I have had low TRT for a couple years or few and it got worse over 2018. Came here a couple weeks ago for help.

I got a blood test and it confirmed my levels. I can tell you that a caffeine fix does not fix my mornings. It gives me the caffeine that my body needs but doesn’t fix my mood or give me the positive outlook.

Regarding E2, many speak of not relying on the numbers in determining whether or not an AI should be used, instead, consider symptoms. Could the same approach be taken with testosterone?

His testosterone does not appear optimal, especially his free testosterone. Granted, there could be other, underlying issues here and he should get them checked, thyroid for example. Also, granted his lifts aren’t particularly a reason to jump on test, and I know from personal experience they do not increase forever, but he’s a big guy and if he has been lifting a long time, those numbers are no big deal.

I think he is a candidate for TRT at this point. I bet, if he bumps those numbers up to high normal and doubles his free test, he will feel better. Yeah, get an exam, check out some other things, go from there. It is definitely not a decision to be taken lightly.

Ya remove sugar, bad carbs, and anything else that is unnatural for a few weeks and it will help someone quite quickly with Fog issues.

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Yes, if the T is low normal and there are symptoms, it should be taken into account. I tested in the low 300’s and high 200’s when I was diagnosed as hypogonadal, along with having very low LH and FSH values. That told a story, but because I never used roids or had any other condition causing pituitary damage, it was diagnosed as idiopathic hypogonadism.

I don’t buy the optimization theory. Insignificant changes in the mid-to-high normal range, 500 to 1000 n/dl don’t effect function or well-being, and dare I sound jaded here, I don’t believe anyone who says otherwise. I don’t believe we are such delicate beings that are effected by insignificant hormonal changes.

That’s correct, however, as I pointed out, his deadlift, squat, and bench press are so similar in poundage that clearly something else is going on with his training. Men with a 315 pound bench press can have much higher deadlift and squat numbers.

Maybe you’re right, but this goes back to my point before: insignificant changes in the mid-to-high-normal range don’t effect people.

Thank you @The_Myth for taking the time to read my thread and give your opinion.

It is not my intention to stay this weight and I had the systems listed also when I was 178lbs. Keep in mind I have been bulking for 2 years and will start to cut down to around 100kg (225lbs soon). I actually went on the bulk because I thought my symptoms might be linked to my weight cut and I hated looking so small and skinny with my face sucked in.

Can you please go into more detail on the negatives you have experienced from TRT?

Thank you for the posts @BrickHead.

I was under the impression that if my T and other hormones were were at the top end of the natural range it could make a big difference in resolving some of my symptoms and make me stronger/improve my physique.

I always thought that “normal” T was a very loose and wide range. For example, I could have the T of a healthy 55 year old male and that could still be considered “normal”.

I am not too knowledgable and welcome any thoughts advice buddy.

Thanks again bud.

You’re welcome.

It doesn’t. Our bodies are just not that delicate.

It is. 300 to 1000 is a wide range. However there are men with low-normal values (<400) who have no symptoms or decrease in functioning. I have tested mostly at 700 to 900 all these years, but at the times I tested in the 500s I felt nothing different. Most docs who know what they’re doing consider 500 a fine number, as it is. And life doesn’t change at 800 compared to 500.

@highpull and @BrickHead regarding my numbers I should have mentioned, I injured my back two years ago (2 blushed discs) and have only been deadlifting for the last 4 months again.

I have also struggled with squatting for a long time. Bad mobility and finding the right stance and bar position (now found myself with a hybrid sumo low bar squat). I was box squatting 150kg for 10 reps this summer but that wasn’t to parallel and the numbers I listed were with at or below parallel.

The only lift that has stalled for a long time is my bench. Squat and Deadlift have not stalled yet.

To be honest, for how seriously I take my food and my training I am far from gifted at lifting. I just enjoy training and being strongish.

Man, that sure flys in the face of a lot of what I read here, with guys tweaking their dosing by 10mg here and there. I personally know a guy that tells me if his E2 goes over 30 his nipples get so sore it hurts to put on a shirt. He micro doses anastrozole daily with an eye dropper. I don’t get it, but who am I to question him and what works for him? Plus, I know many guys who have gone from 400-600 total levels to 800-1000 and feel much better.

Regarding “insignificant”, I think doubling free test levels is not insignificant.

You’re talking to a guy who snatched more than he bench pressed and could squat more than double the bench. But, I didn’t train the bench and I’m going to guess he is like most “weight trainees” and puts a disproportionate amount of time and effort into the “show” muscles. Maybe not, maybe there is an old football injury or something, who knows? Whatever, as long as he does something with weights, and does not get hurt, it’s good.

I’ll admit to some possible bias based on my personal experience with TRT and those of many I know. I know a lot of strength athletes and I’m old, been in it most of my life. I started TRT at 59, looking back, wish I would have in my 40s.

Well, doesn’t my shoe leather taste terrible………………

Sorry to hear that, hang in there. Be careful with box squats and bad discs. Good luck.

You’re welcome, and thank you for taking it in the spirit intended.

The only negative I’ve had with TRT is that I would rather not be on it. Hunting doctors, finding the right protocol, injecting E5D, just the hassle of it really.

I found a doctor that would let me self inject and that has been nice - but he doesn’t test E2 and doesn’t want to prescribe HCG. The HCG thing isn’t a big deal, but I wouldn’t mind being able to run it a few times a year. But, I would have to hunt a new doctor to do that, one that may not let me self inject (I’m in NY), or that may not let me run the HCG, so I just kind of go with the flow.

I’m actually coming off right now and am not looking forward to it - my last injection was eight days ago, so no sides as of yet.

When I was diagnosed, I wasn’t very healthy physically - skinny fat at 177 pounds, not sleeping well, not eating well, walking insane amounts to shed fat. I tested at 170 in the afternoon. I think it might have been more lifestyle related than secondary hypogonadism.

My diet is better now, I’m training more regularly, and my body composition is better, so I’m going to see what happens. I have been on continuously for at least four years, don’t remember exactly when I started, so I’m sure coming off is going to be a shit show.

Anyway, that’s it, just the hassle of finding doctors and dealing with appointments. Other than that, it’s been awesome, and, I expect I’ll be back on in a few months.

I’ve heard such stories, and jaded as this sounds, and although I don’t wish to disrespect anyone, I don’t believe them and suspect such men are hypochondriacs. Again, maybe I am wrong, but that’s what I suspect.

In that case, no, that’s not an insignificant change.

If you were hypogonadal all that time, then yes, you should have been taking TRT.

Overriding all I say is here is the premise that TRT is medicine and what I consider inappropriate is a view on TRT that it is non-medically-necessary option, simply because it involves taking a hormone that can provide physical advantages when taken above the clinical dose. Because of this, some people think they are going to experience advantages with clinical doses too!

I think this partly has to do with what seems like a current trend in super-wellbeing, a trend in which men seek to be some type of well-oiled bionic- man-cyborg. You see this stuff all over social media, people, especially fitness gurus taking such tender loving care of themselves hour by hour and in such yoda-like fine tune with every nook and cranny of their bodies.

Foam roll and stretch every night, take a special shower after every workout, never ingest any animal farm raised animals, eat only organic, go for a walk before or after every meal, take X supplement, get up or go for a walk for every 15 minutes of sitting, take TRT, remember everyone’s name, prep food for the whole week, read before bed, read before breakfast, have a steak-and-nut breakfast, “don’t let anyone tell you what to do”… (yawn). (Sorry for this rant that popped up, lol).