T Nation

About to Start TRT, Looking for Advice

Hello there, i have been reading through many threads for a few months now regarding TRT and i am about to take the plunge. Im hoping that some of you guys will be able to advise. Ill try to keep this as short as possible. Here is my backstory.

Current
26y/o
Height 6’
Weight 180
Living in Canada

In 2015 at 23 years old i had pain in my right testicle so i got checked by a urologist and was diagnosed with a varicocele. Went for a varicocelectomy a month later. I was knocked out on anesthetic i guess because when i woke up they told me that i was fine and it was no big deal so i was sent home. The pain subsided but over time the varicocele got bigger (like bulging out of the side of my sac) & a small one developed on the left side. I was naive and thought because it no longer caused pain that it was fine. I was also complaining of shitty erectile quality to my doctor at the time as well as less frequent nocturnal erections but he said it was all in my head and prescibed me viagra.
My testosterone was 19.2 nmol/L at that time

Over the next few years Erection quality/frequency had dramatically dropped in terms of ridgitidy (to the point where i cant have sex without a blue pill) nocturnal erections do not occur at all anymore even when i have a full bladder. Not only that but i feel as though my brain function has dramatically decreased within the past couple years especially in the memory category. I have been feeling very depressed as of late (have been getting depressed more often) about my situation as i have a gf of 7months and she has no idea i have these problems as i mask it with the dick pills. We have a healthy relationship other than this secret of mine.

It seems as though the varicocele shrunk dramatically in the past year and thats when i realized my testicles had atrophied ALOT. They used to be healthy and heavy. Now they are the size of grapes. So i went back to the doctors to bring up my issue and got some tests done.
Ultrasound test.
Current Testis Size
Left 12.3 ml
Right 14.2 ml

Hormone test

Testosterone - 10.4nmol/L range 8.4-28.8
Free T calculated - 259pmol/L range 115-577
Bio available T - 6.1nmol/L range 2.7-13.5
SHBG - 21 nmol/L range 10-70
T4 free - 12.3pmol/L range 10.6-19.7
TSH - 1.32mU/L range 0.32-5.04
Estradiol - 53 pmol/L
LH - 1.8 range 1.1-8.8IU/L
FSH - 4.6
Prolactin - 6.2 range 3.8-20.6ug/L

2nd test

Testosterone - 7.4nmol/L
Free T - 189pmol/L
Bio available T - 4.4nmol/L
SHBG - 18.7 nmol/L
FSH 4.3
LH - 1.9
Prolactin - 8.3

I am already in contact with a fertility clinic to freeze some sperm as i have read on T-Nation that if I pursue TRT it will probably make me infertile (my doctor had no clue about this) My Endo would not prescribe me Clomid because she thinks i am not “low enough” however my GP is willing to prescribe me testosterone.

My main concerns are my balls atrophying even more than they already have, and losing my hair as i am already balding/receding quite a bit. I have ALOT of body hair on chest and shoulders as well as everywhere else.

If someone/anyone could chime in with some advice or personal experience please do!

Thanks

TRT has a tenancy to lower SHBG, it’s usually just a little bit. The lower the SHBG, the higher the free hormones, high Free T almost always means high Free E2, so estrogen towards high normal usually spells trouble for low SHBG men, not always but most of the time.

Almost all low SHBG guy whether on this form or other forms seem to do much better on more frequent injections, smaller more frequent injections lowers the chance to aromatase, the conversion of testosterone into estrogen which may not be a problem for you because you’re not overweight at six foot 180 lbs.

You may be able to get away with two injections a week, more may or may not be needed, it all depends on how fast your body metabolizes testosterone.

Beware 200mg every 2 weeks or once monthly doesn’t work and you might have to fight your doctor to get you the right TRT protocol as TRT in Canada is known to be the worst place to get TRT.

Your testicles will atrophy while on TRT, HCG can make your testicles fuller again, expect getting TRT together with HCG understate healthcare will not happen. Going private would be your only recourse.

Stop by our poll we have going on to get an ideal what TRT protocols looks like, maybe you’ll find something that may work for you.

Have you had your semen analyzed? I’m wondering how fertile you are right now.

Thanks for the insight @systemlord i had no idea about low SHBG and requiring a more frequent injection schedule. As for pining i was hoping to not have to pin more than once a week, but of course if the best protocol requires twice or more i will as i want to do TRT as effective as possible.

Your spot on about the 200mg every two weeks which is what my doctor recommended he could do for me lmao. They really dont seem to have a clue up here in Canada as to what works for testosterone replacement. I am planning on fighting him to at least start with once a week until i can convince him to let me pin on my own or find a GP that is willing. I generally have a fast metabolism (difficult to gain weight but find it very easy to lose it).

Does anyone in Canada actually get prescription HCG? Or is that totally out of the question.

Im Sorry but i totally FORGOT to mention in originl post that i took pro-hormones ( i believe M1T ) at 16 years old for 4 weeks. Not sure if they were even real or not (no pct) because i was young and dumb and didnt read into it. Don’t believe my low T is a result of this as i had a good sex life years after the cycle & the presence of a very large varicocele years down the road. But who am i to know forsure.

@highpull i had semen analysis done 4 months ago when i started reading into Varicocele effects on testosterone and fertility.

Results
Total sperm count 150 million - Low is >36
Total sperm per/ml - 30mill - low is >15
Total motile -64%
Progressive motile 49%- low is in the 30’s

Everything came back Normal but my Endo said that these numbers arent very robust for a man of my age. Which i was sort of expecting. However i do know that it is not a good as when i was younger because the semen is alot less “white” than before and more clear. So i still have a decent ammount to work with for the freezing portion. GF is on board for the freezing and wants me to dump as much as possible.

Thank you @charlie12 fr those threads.

Any feedback or knowledge is much appreciated

A clinical study was published in 2005 that perhaps you could show your doctor to convince him, pay attention to figure 1 graph B, 6 days after an injection levels are below the therapeutic ranges.

Hormone profiles after intramuscular injection of 200mg testosterone enanthate every 2 weeks in patients with hypogonadism

TRT is lost on the majority of doctors and so called endocrinologists who specialize in endocrine glands and hormones, the reason is generic testosterone is dirt cheap to produce and isn’t as profitable as prescription drugs which raked in 820 billion dollars in 2018.

Without patents on testosterone cypionate, investors will never pay much attention to TRT. Doctors aren’t about to be re-educated and be re-trained in an area of medicine with so little return.

The FDA is attempting to make it more difficult for compounding pharmacies to manufacture testosterone cypionate in order to jack up prices, which doesn’t sound like a bad idea if doctors will pay attention if it becomes more profitable.

@systemlord I have found a doctor in my city who does try privately so I will be making an appointment with him for next week. I have some concerns being a low SHBG guy and how try will help me being as my SHBG was 17,21,24 on three diff tests.

How has it helped you on your protocol in terms of brain function, erectile quality, libido, overall well being?

I’ve had my SHBG fluctuate from 16-22 and I felt best on daily injections, EOD is second best. Me being overweight has prolonged my recovery, so until I lose weight, the libido and erections will have to wait do to high estrogen which affects my cognitive ability as well.

I noticed muscles getting firmer before the two week mark, veins started to pop as well.