T Nation

AF787's TRT Journey

I’ve been looking into possibly getting started on TRT for a few months now. Right now, I’m leaning toward it, but wanted to get some additional insights.

Background: I’m a 40 year old man and have begun to notice some symptoms of low testosterone. In particular, I have low sex drive, much fewer erections (though quality of them is still great), find that recovery is slower/I get tired more easily. I got my levels checked and am still within the normal range (415), but that’s a 33% drop from my first test two years ago.

Although overall, I live a healthy lifestyle (lift 4-5 times a week, plus 3 cardio sessions, no alcohol, clean diet). In addition, about 7 months ago I changed jobs to something much less stressful and with better hours so sleep quality and quantity is up quite a bit. As a result, I was a bit surprised to notice some of these symptoms worsening, particularly the fatigue/slower recovery. My most recent blood work did show that I’m pretty Vitamin D deficient, but other than that everything else is very healthy. I know that the Vitamin D issue could explain some of the fatigue and have started supplementing 5000 IUDs a day. However, I also did some rough math and if my T-levels keep dropping at this rate, I’ll be below the normal range in a little over a year. Is it worth waiting, or would you recommend just getting on TRT now?

Here are some of the most recent labs as well:

Total T - 415 ng / dL
Free T - 14.0 pg/ML
SHBG - 34.5 nmol/L

Thanks!

Might be worth looking into having a sleep study done. Poor sleep can have a hell of an effect on nearly every aspect of your health.

I suggest this simply because it can be difficult deciding if poor sleep is causal or a symptom.

I wouldn’t fight you if you wanted you do a 6 month to a year trial and see if you feel better. It can take a while for you to start feeling all the benefits so give it enough time to make a solid determination.

I may have misread your post there, sleep has improved you say. So maybe that’s not it. If your partner says you snore (not mentioned) I’d look at the sleep study anyway. Maybe it’s improved but still not great.

Thanks for the input. Yes, sleep has improved quite a bit over the past 7 months. I’m consistently sleeping through the night and getting 7-8 hours regularly.

You know good thyroid hormones are needed in order to metabolize testosterone. Low vitamin D could not only cause depression, low libido but also fatigue. I’ve been there myself.

If you are overtraining and not eating enough or the right diet, this could easily explain your symptoms. I wouldn’t recommend TRT without a complete set of labs, a complete mineral vitamins panel and other biomarkers listed below.

I would hate to recommend TRT and later find out you had a couple of deficiencies that could have been corrected without needing TRT. You need to cross your T’s and dot your I’s before going down the TRT path.

Also what time were these labs drawn?

  • Prolactin
  • Cortisol
  • Ferritin
  • Thyroid Panel -> TSH/Free T4/Free T3/Reverse T3/Thyroglobulin Antibodies/Peroxidase antibodies
  • CBC-complete blood count
  • Comprehensive Metabolic Panel
  • Lipid profile/panel
  • Vitamin and mineral panel

I’d agree with at least getting full labs before making a decision on how to proceed. Could be thyroid, could be vitamin D, etc. but it’s tough to say without more info.

That’s a lot of working out man. Some people can do that much, but not everyone can do it without overtraining. I’m not sure how intense your sessions are, so just a thought.

@systemlord
Thanks for the input! Labs were drawn at 8:30 AM. I’m still pending the full report (Reverse T3, Estradiol, and a few others), but the info I have so far doesn’t show anything out of range, aside from Vitamin D.

Prolactin - 15.8 ng/ML
TSH - 3.2 uIU/ML
T3 - 2.1 pg/ML
T4 - 1.35 ng/DL
DHEA - 204.0 ug/dL
LH - 2.8 mIU/mL

WBC - 3.6 x10E3/uL
RBC - 4.89 x10E/uL
Hemaglobin - 15.2 g/dL
Hematocrit - 45.4%

Glucose - 86 mg/dL
IGF-1 - 188 ng/mL

Vitamin D - a whopping 6.9 ng/mL (I don’t doubt this is a contributing factor. However, I haven’t made any significant diet/lifestyle changes in the past few years that would have sent my levels crashing downward.)

Thanks for the input! I’m seeing strength gains/visual changes, almost never get DOMS, and deload every 5 weeks, so I would be surprised if I’m significantly overtraining.

Based on your age, labwork and symptoms; I would go ahead and jump on TRT if you’re willing to spend a few hundred dollars every month and dedicate some time (few months to a year) to get dialed in. Just find a TRT specialist at an anti-aging/sport medicine clinic and consult with them. They’ll ask for a certain baseline of labwork, and then an MD will assess whether TRT may be worthwhile to you. You’ll then start a protocol and through trial and error you’ll feel much better once dialed in. I wouldn’t even wait as your levels/symptoms will only get worse as you age.

Yikes. Shouldn’t be that much.

Run the numbers. That’s how much it costs. 1) comprehensive bloodwork, 2) consultation fees, 3) testosterone, syringes, alcohol prep pads, other things like sport physicals, etc.

Don’t start TRT without preparing to pay $500 a month in the beginning. Eventually can cut costs to maybe $150 or so a month.

First month was pretty expensive for sure. It does average out to probably $150 a month.

$150-200 for consults, $200-300 for labs, Testosterone that is way way marked up through pharmacies that don’t take insurance, etc. It adds up but eventually once you get dialed in it goes down to consults and labs only being 2x a year so you’re mostly paying for T

Maybe I’m lucky. My clinic is $200 for consult + And includes lab work and first month of supplies and $125/month after. Includes everything.

Do you still pay for physicals? Just got contacted to do another one of these money-wasters.

Are you in the U.S? Comprehensive labwork alone is like $300 or so.

Yes. US. No physicals. Blood tests every 6 weeks until dialed in, then every 6 months.

Physical? No. I had to do one at a local doc before my first consult (over the phone) but haven’t had to do another. I just do consults every 6 months at this point and away I go

Thanks for the advice! This is what I have been leaning toward doing. I’ll keep everyone posted on how things go once I get the ball rolling.

Just realized I may need to switch providers lol! Where are you guys with?

Currently with Defy. They’re great as an online clinic and the medical director over there is really smart, but they go overboard on labwork and additional costs it seems.