T Nation

46 Year Old Male Considering TRT


46 years old
33 inch waist
165 pounds

Strength Train 4 to 5 days per week.
Carry fat around mid section aka love handles
Good Health. Two prior bouts with Kidney Stones in my twenties.

Take Multi Vitamin, 1000MG Vit C, 4K IU Vitamin D3, Fish Oil, and 25 MG DHEA.

Total T: 354 (250-827 ng)
Free T: 10.4 (6.8-21.5 pg)
TSH: 2.310 (0.450-4.500 uIu)
Pregnenologne: 66 (<151)
Dithydro: 49 (30 - 85 ng)
E: 19.8 (7.6 - 42.6 pg)
PSA: 0.3
SHBG: 39.1 (16.5 - 55.9)

Eat well balanced meals: Six meals per day and mostly drink water. No soda.
Rarely have morning wood. Libido below average. However, when I do engage in sex there are no issues with getting an erection or performance.

I do have low energy, tend to get irritable quickly, not my normal libido, and carry a little more body fat then I would like. My metabolism is not as fast as in the past.

I read a lot of publications from Life Extension and they are big proponents of maintaining youthful testosterone levels for overall health benefits, which is why I am considering TRT. However, in reading a lot of forums I am a little hesitant as it appears that many that take testosterone then have to take several other drugs such as something to reduce E, then HCG to keep testes from getting smaller, etc. Also, read that some develop erection issues when they never had erection issues, etc.

Some I am just wondering whether I should start this journey now or wait until I get older. If I was your good friend or family member what advice would you give me based on what I shared. Would you recommend I seek out treatment or tell me to consider at a later time in life?


I think that your low energy is mostly thyroid related.

TSH should be nearer to 1.0
The lab range for TSH covers a 10:1 range of levels. This is part of a collective medical stupidity.

This may be a result of not using iodized salt and becoming iodine deficient.

Your energy and metabolism are controlled by fT3 levels which control the metabolic rate of mitochondria inside your cells that make ATP and all of this is also how your body temperature is regulated. So your body temperatures may be low and body temperatures are a very good guide to overall thyroid function.

Check your oral body temperature:

  • when you first wake up, should be 97.7-97.8 and higher also good. 97.3 is way too low
  • you should also hit 98.6 mid-afternoon

Further reading:

  • thyroid basics
    Also see:
  • advice for new guys, note 1st paragraph
  • protocol for injections
  • finding a TRT doc
  • things that damage your hormones

LABS: - you have some now
LH/FSH [cannot be done after starting TRT]
hematocrit [HTC]
AST/ALT [liver function affects E2 and SHBG]
cholesterol [can be low]
vit-D25 [many need 5000iu vit-D3 to get near optimal levels]
AM cortisol

TRT now or later? Its all about quality of life. Low thyroid function sometimes causes lower T levels. So there might be some progress with interventions to improve thyroid function; which can sometimes be as easy as getting more iodine. First focus on thyroid issues. If cortisol is low, that is also a energy depressant. We have many guys here with thyroid problems. Less often with low cortisol. But we do have guys here with adrenal fatigue, T and thyroid problems, the three legs of the energy tripod.

Thyroid problems can lead to fat gain. So can low T levels. You probably are dealing with both. If you have thyroid/iodine problems, resolving those may improve T levels, which may not be all that you need.

If your iodine intake has been good or you replenish iodine levels and body temps stay low, one possibility is rT3 blocking fT3. And then there are degrees of thyroid autoimmune diseases, some of which may caused by selenium deficiency. You should have iodine+selenium in a daily multi-vit.

What’s the time line for loss of energy and fat gain? Any of that punctuated by stress events, blows to the head, accidents, illnesses?
What is the time line for use/non-use of iodized salt?