39, Low T, Medical Advice On TRT Needed

Hi there I’m new to the forum, looking for advice on TRT, as here in Edmonton is hard to find good doctor. Only one private clinic prescribe BHRT and HCG. I’m not sure if BHRT is better than TRT injections.I stil have no idea If I am primary or secondary hypo gonadal.
-age -39 -height - 5.09 -waist -38 -weight -214 lbs, married with one child
-live in alberta canada since 2012

  • hair on legs and thighs, some hair on belly,small hair on chest, sparse beard
    -carry fat - belly, love handles , chest
    -no smoking,no drugs, since 2004 drinking occasionally -once a week (sometimes once a month)a few beers or few shots
    -health conditions, symptoms [history]
    since Nov 2012 -truck driver working 6 nights ( mostly 8.30pm to 7 am) every week , very bad sleep deprivation, as I can’t sleep during the day
    -describe diet - in 2014 did extensive diet ( mostly salad, chicken, turkey, fish and apples, pretty much no sugar and no fat) over 6 mo lost 26lbs( from 216 to 190), no exercise just diet
    in 2017 did 10 day diet again, lost 10 lbs, in next 2 monts gained 15 lbs back
  • Oct 2015 - I had really bad sleep disorder - going on for 30 -36h without sleep at a time, then sleep for 2-3 hours. It continued about 2 mo. Went to doctor and asked for sleeping pills as ZZZquil and melatonin wouldn’t work anymore. Asked to check my test levels, test was low
  • nipple sensitivity - I had it since teenager, but had no idea waht it causes it till few years ago, last few years I have it once every few months
    -testes ache- had varicocelle surgery in 1997, was considering another one in 2010-2011 due to heaviness and pain in the left testicle. Never did it, since then I occasionally have pain
    -low motivation, no interest in anything, just don’t care about anything -I just “exist” no energy at all, no will to do anything, especially heavy lifting or running,
    Social withdrawal…90% of the time since 2010
    -December 2016 developed gout conditions - untreated
    mood - I am calm person, but sometimes get irritated for small stuff
    depression- heavy depression, thinking of death often,very low confidence, low self esteem, high anxiety
    get cold easily? a change? - warm body but cold feet and hands
    dry skin- yes
    use iodized salt-yes sea food- once 2 weeks
    exposure to chemicals - 3-4 times a week exposure to lower dose H2S gas( for about 40 min) since april 2017
    difficulty gaining muscle- hard to gain muscle
    concentration/focus/drive - hard to concentrate
  • no antibiotic treatments in past 4 years
    trouble urinating or awareness of prostate - did psa test - negative - frequent urinating, sometimes 2-3 time whithin 45 min, at least 2 times during night sleep
    morning erections- not every day- no problem maintaining erections , have normal sex life, can perform every day but only once
    current supplement/vitamin regimen - Optimum Nutrition Opti Men, VitD 2000ui, Rhodiolia, melatonin (2-3 times a week) and Zzzquil (once a week)
    normal sleep patterns - no sleep patterns, sleep whenever I can
    -Rx and OTC drugs- no hair loss or prostate drugs ever, mostly multivitamins, NOW Citrimax (Garcinia cambogia ) during diet period, after found out Low T was taking some test boosters -True GRIT Test Booster, AllMax-TestoFX
    -lab results with ranges
    29-Nov-2015 -
    Testosterone -am - 5.8 nmol/L
    TSH 3.12 mu/L
    14-Mar-2016 -
    LH 4.6
    Testosterone -am - 6.7 nmol/L
    03-Jul-2016 -
    LH 4.8
  • Testosterone -am - 5.4 nmol/
  • Estradiol-35 pmol/L
    no lab work after - my doctor refused to follow me If I don’t start TRT, I refused as he was ready to put me on TRT in November, as he had no idea of TRT side efffects or what kind of hypogonadisim I am.
    Doesn’t want to give me referral to endo.
    Don’t know from where to start, and what to do…

Please directly edit your post above and add lab ranges. See pencil icon above.
Need labs in list format, not prose.

Looks like the problem is your testes. LH/FSH are good.

TSH should be closer to 1.0, thyroid lab ranges are quite useless.
This is a big problem.
Thyroid function and T-status both have huge effects on energy and fat gain/loss.
Have you not been using iodized salt?
How much iodine and selenium in your vitamins?
With thyroid issues, you probably cannot absorb T gels or creams.

Seated in a truck - bad seats: Is your underwear strangling your testes?

Biol identical testosterone: This concept is hugely abused by people who should know better, in many cases, self-serving deception. Injected T is T+esters dissolved in oil that is slowly absorbed. As T+esters are absorbed, the ester groups are removed. Injected T is a time release bio-identical testosterone delivery system.

Please eval overall thyroid function via last paragraph in this post.

Eat healthy fats. Very low fat intake is dangerous.

You are most likely quite V-D deficient. Take 5000iu Vit-D3 per day, take 25,000iu for first 5 days. Find tiny oil based gel caps.

Sleep: Quite and fully darkened room? How much coffee do you drink. Can you find time release melatonin? If fast release, wears off in 4-5 hours and dropping melatonin levels are exactly the mechanism of waking up.

ZZZquil contains Diphenhydramine - Wikipedia which is available really cheap. If helps with sleep, but after a while is not effective. See if doc will Rx trazodone. 50mg may be effective, very cheap in USA. May need more over time as your body adjusts. Not addictive, but been able to sleep sort of is.

Sleep deprivation can affect your T levels.

Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.