T Nation

40 Y/O Debating TRT - Appreciate Advise

Been trying to do a lot of research on TRT before I commit, and this forum seems to have a lot of very knowledgeable folks on it so I thought I’d see if perhaps I’m missing anything I should discuss w/ my doctors or otherwise. Any thoughts or advice would be greatly appreciated.

40 Y/O
No Thyroid (Removed entirely, on Levothyroxine)
Vasectomy
No issues with the equipment working.
Don’t smoke. Rarely ever drink.
Athletic my entire life, in great shape, great diet, still able to put on muscle.
Roughly same weight as my college athletic days, and can still do nearly same weights.

I’ve had 11 Total Testosterone tests over the last 3 years, from newest to oldest:

304 (This month)
304 (This month… identical result a week apart)
297 (2018)
333 (2017)
349 (2017)
257 (2016)
397 (2016)
239 (2016)
292 (2016)
275 (2016)
227 (2015)

Latest other:

WHITE BLOOD CELL 7.1 3.9 - 11.1 K/ul
RED BLOOD CELL 5.03 4.20 - 6.00 M/ul
HEMOGLOBIN 16.1 13.2 - 18.0 g/dl
HEMATOCRIT 48.7 38.5 - 54.0 %
MCV 97 80.0 - 100.0 fl
MCH 32.0 26.0 - 34.0 pg
MCHC 33.1 31.0 - 37.0 g/dl
RDW 13.6 11.0 - 15.5 %
PLATELET COUNT 220 140 - 400 k/ul
MPV 9.3 7.5 - 11.6 fl

Free T4 1.12 ng/dL
TSH 0.934 mcIntl
LDL 81 mg/dL
HDL 45 mg/dL
Triglyceride 52mg/dL

A few years ago I went to the doctors just not feeling… right. Low energy, low libido, fatigued, etc. I had just had kids, a vasectomy, and thyroid removed so somewhat wrote it off to that and have been monitoring it since. However my TT results of ~220-240 at that time were flagged as low, thus I’ve been monitoring every ~6 months since.

Years later, I’m still feeling the same. Kids are older and I sleep a lot better now. I just can’t get a “constant” steady state. Some days I feel great, some days I feel like ass. Motivation down. Head fog. Low libido. It’s “easier” to get into a down state. Find myself forgetting things. Just don’t feel like myself. I feel old.

I’ve seen 2 Endo’s, and a TRT specialist and have another doctor appointment with someone new soon. Trying to make a very informed decision before I go onto a life long commitment with TRT.

One of my endos’ recognized my earlier lower results, but says I’m normal for my age now and the risks aren’t work it. The other endo (female) says I have no signs of hypergonadism and my results are fine. TRT specialist (understanding ultimately they want a sale) seems very informative, and said most of their patients who start are in my same TT 300 range and once they are on never want to go off. Also said about 20% of the patients end up not benefiting or finding it worth it.

Does anyone see anything in my results that raise any alarms? Or been in a similar situation and have input?

Really appreciate it. This is a big decision, and I really want to be around a long time for my kids and not do anything I later regret.

Testosterone levels this low you are at high risk for cardiovascular disease in the same way women are at risk for osteoporosis from low estrogen after menopause.

The ordinary doctors in managed healthcare are TRT ignorant and you are going to a doctor will almost no knowledge, most believe in range is normal, but nothing else beyond this is known because they don’t specialize in TRT.

You are better off paying for TRT out of pocket, endos are typically the worst at TRT and men are told they are normal when the endo has no clue and only cause more suffering. You’re better off going to a private TRT specialist.

Most doctors are taught in medical school TRT causes prostate cancer, only there are no studies that prove it, actually studies show men with low testosterone get more aggressive prostate cancer. I’m afraid your doctors are operating on old information and believe the low testosterone protects from prostate cancer, high testosterone protects from more aggressive prostate cancer.

This is why your doctor made the comment TRT is too risky, there is only risk remaining with low testosterone.

The locally weighted regression showed that total testosterone levels of 440 and 480 ng/dL were associated with increased Framingham CVD risk and an increased probability of increased hsCRP, respectively. Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk.

You are a prime candidate for TRT. It will make every better across the board

Very similar situation. I have been on TRT since February. Actually started last August with shots and then took a break and switched dr and switched to creams.

I would highly recommend a conversation with Defy Medical our of Tampa. They have been great to work with. I struck out with local urologist and even Endo.

Defy knows the space. Know how to help you dial in the protocol. Its out of pocket and you need to review costs, etc.

There is an initial honeymoon period and then takes some tweaking to get hormones balanced.

If you are looking for knowledgeable docs to have the fact based conversation with. They are the ones.

Does help with the symptoms you mention but it’s a lifelong commitment.

Forgot to post my other results:

ESTRADIOL (2) 30.6 Range 0.0 - 39.9 pg/mL
PSA< TOTAL 0.440 Range 0.000 - 4.000 ng/ml

Thanks for the feedback so far.

I’m not overly worried about costs, and based on everything I’ve learned thus far the TRT clinic I met with locally really appears to know their stuff. Even if my “regular” doctors all said I need it, I would likely still go to someone who specializes in it.

I think I’m hung up on the fact that I’m in shape and live a very healthy lifestyle, and I’m hovering around that ~300 range. The average of all my results is 297. I’m not a drastically low level, I can put on muscle… and I wonder if perhaps the rest is just in my head or something else. It’s that unknown. I find myself wondering if I’m missing a much better life or feeling a lot better and counter weighing that with this being a life-long commitment with some unknown long term health risks/benefits.

The thyroid medicine is so easy. Take it, or die. Easy decision there. :slight_smile: I’m finding this decision much harder.

Again, I appreciate the feedback.

Before committing to a life-long treatment; getting additional opinions from doctors and bloodwork as well as attempting some diet changes. Trying to see if I can shake these symptoms via alternative methods first.

Some additional test results:

Free T 99.7 pg/ml, normal 47-245
SHGB 22.5 nmol/L, normal 13.3 - 89.5
Vitamin D - came back low while supplementing; adding additional 5,000 IU daily now.

Had my Total T re-tested at the same time and it came back at 310.

Anyone able to help interpret those results? One of the frustrating things about some of the doctors I’ve spoken to is often when they deliver results its just a “Your fine” without explaining in detail the results.

Thanks!

Your results have already been interpreted and good advice was given with studies to back up the recommendations, only thing left if for you to accept that your levels are as low as old men and that the sick care system isn’t the place to go for hormonal treatments.

The problem is the doctor’s you’re going to are bound by sick care rules, <300 is where most doctors will prescribe TRT, not above which is terrible considering the consequences according to the provided studies and grim outcome.

Your problem is you are going to a sick care doctor who are not very knowledgeable on the subject of hormones and are asking to get quacked by going to an ordinary doctor for hormonal problems.

You can run around in circles with these clueless sick care doctors or seek out someone who has experience with hormonal problems outside of the sick care system.

The “you’re fine” has everything to do with a number, you doctors do not care about your symptoms, they only care if insurance will cover you for TRT and most will not <300. So really it’s about payment and insurance company says you are not approved for TRT, so your doctors turns around and says you’re normal when he has no clue about normal status himself.

It’s just a sick game and insurance companies denying medical coverage.

I actually discussed those studies w/ one Endo who has been prescribing Testosterone for almost 20 years now. His feedback was those studies are very limited in scope, and really should not be used in a decision making capacity.

He was also very upfront that indeed anything over 300 can’t be treated in the system where he currently works.

I felt he knew his stuff, was completely transparent, and his recommendation was to avoid TRT if possible at my current levels.

So while I suspect it’s often the case that sick-care doctors might not know what they are doing (I talked to one who resisted even running a total T test!), I don’t think a blanket statement can be made for all of them.

From a patient perspective, it’s really a tough situation. One one side you have a mixed bag of doctors, and then you have the for-profit T-clinics. Finding something in between to get good feedback from has been challenging. Trying to get multiple opinions from informed folks who don’t have a $$ incentive is challenging.

I’ve accepted my test results are what they are, and the symptoms I’m having - definitely no denying that. :slight_smile: I do however think going on T shots should be an absolutely last resort after exhausting all other options. IMHO I see far too many recommendations from folks to immediately just go on shots for the rest of your life without investigating other options/causes.

Again, appreciate it. Just trying to figure this all out. :smile:

Fair enough, why don’t you then listen to the harvard experts on the suggest of testosterone, Dr. Abraham Morgentaler, an expert in testosterone. He has a book called “Testosterone for Life” and in that book is all the latest info.

Fact is endo’s are the most uneducated on the matter of testosterone, to them in range is normal. The reference range consists of a wide variety of men who tested with LabCorp: 80-year-old men and 20-year-old men, obese men and super fit men, men with pituitary gland problems and men with glands that work like champs.

Hard to trust this logic. There is no explanation because they have no knowledge, that’s what the reference ranges are for, a lack of knowledge. Doctors are cross the world are all singing the same tune, you’re fine 300>.