T Nation

At a Crossroads - Help

I’ll try to make this as brief as possible, but it’s going to be lengthy just due to the nature of the post. I have read the stickies, multiple other threads from this site and others, and done as much research as possible.

I didn’t have any sexual problems (maybe lack of sex drive, but it’s hard to tell what’s normal for a dude who’s been married ten years and has a four year old that leaves you with little alone time!). I have no problem getting it up or performing though. I lost a little over 80 lbs four or five years ago after years of drinking too much beer and eating too much fast food and never touching a weight. Got into training and noticed that it was really hard to lose the fat around my lower back and chest. Thought it was hard to build muscle and all that so I decided to get my levels checked. I’m 32, around 190. Levels came back at 368 total, 12.8 free. Doc told me to do one packet of Androgel 1%. Came back two months later and total was at 567. Doc wouldn’t run any other tests or discuss long term game plan. Just said I could stop taking it and we’d see what would happen.

Went to a different general doc in July and she ran tons of blood work. Results were:

Test - 288
Free test - 7.2
DHEA Sulfate - 305
DHEA Unconjugated - 5.120
Estrone - 33
Estradiol - <20
Estrogen - <53
Ferritin - 115.5
Folate - 17.57
FSH - 9.1
HCT - 45.1
MCV - 90
MCHC - 34.3
LH - 4.46
Chol - 139
Trig - 28
HDL - 82
LDL - 51
Progesterone - .33
Prolactin - 15.3
PSA - .63
Free T3 - 3.7
Total T3 - 1.18
Free T4 - 1.55
Total T4 - 8.04
TSH - 2.180
B12 - 1260
D 25 Hydroxy - 52

Continued on Androgel and was referred to an endo.

Drew again two months later (September 2011). Not quite as comprehensive. Results were:

Total test - 09
FSH - 9.1
LH - 3.01
Prolactin - 8.3

Doc put me on Androgel 1.62 - two pumps a day. Drew again in January 2012.

Total T - 575

Doc ordered an MRI to rule out a growth on the pituitary. Came back fine.

Labs done June 2012.

Total T - 324

Went to a urologist and tried to get to the bottom of things. Ran more blood. That was this week. Results came back -

Total T - 371
Free T - 13.4
FSH - .02
LH - 0
Prolactin - 11.98

Did not run E2, which I’m pissed about. As you can see my nuts are now completely shut down. Fertility test came back in the dirt. So now he says he’ll do whatever I want to do and is telling me he wants to stop TRT and inject 500iu of HCG sub-Q 2x a week.

I’m very frustrated. My wife and family think I was stupid to start TRT because of “cosmetic” reasons. Which is true. I didn’t have any sexual issues, but I just didn’t feel like all the work I did in the gym and with my diet was getting me anywhere (I’m a trainer and do things the right way, not like a bunch of uneducated idiots, so I don’t think that was the problem). I’ve always had smallish testicles, and also have had issues with hematospermia. I occasionally have blood in my ejaculate. They have never found a reason for that. It just comes and goes. No infection has ever been found. No pain. I’ve had genital exams, so I don’t think a varicocele is to blame for all of this. Now I feel like I haven’t gotten any real noticeable benefit from the TRT and I’ve screwed up my fertility and health.

I’ve asked all four docs and they all basically say I’ll be on TRT for life. They’ve never given me a reason for the low T. They just say it’s early andropause. Anyway, I only really see two options here.

Stop taking TRT and inject the HCG at 500iu twice a week like the doc said. I’d actually like opinions on the Scally protocol and if you guys think that would be more effective. I could get Clomid and Nolva from a research site if necessary. Hopefully doing one of these options would bring my balls back to life. Then I could see if my levels remained steady after the protocol and hopefully just deal with my life without messing with any of this ever again.

Or switch to injections and insist on 250iu sub-Q 2x/week along with the TRT. Hopefully that would at least keep my fertility up in case my wife and I wanted any other children. I’m not a big fan of needles, but if that’s what I’ve got to do that’s fine.

So I guess my questions are…

Was I foolish for starting TRT in the first place? That level seemed low for a 30 (at the time) year old personal trainer who has a very good diet and lifestyle.

Do you think efforts to get off of TRT would work/be sustainable?

If not, do you think I should switch to injections with concurrent HCG?

I know this was extremely lengthy. Thank you very much for your help. I am really about to lose it over here!

Were you happy with a test of 288? I’m secondary and started at 150 and still decided to do TRT because my peak of 450 while on meds/after weight loss and diet just wasn’t enough. Now my trough is 500 and my peak 700 and I feel much better than I did at a peak of 450.

Some people feel good at 450…I feel better between 500-700. For me the TRT protocol is easy and I have no regrets. I feel better than I have in a long time.

[quote]wesmantooth wrote:
So I guess my questions are…

Was I foolish for starting TRT in the first place? That level seemed low for a 30 (at the time) year old personal trainer who has a very good diet and lifestyle.

Do you think efforts to get off of TRT would work/be sustainable?

If not, do you think I should switch to injections with concurrent HCG?

I know this was extremely lengthy. Thank you very much for your help. I am really about to lose it over here![/quote]

  1. I don’t think it was foolish to put your trust in a supposed “expert” at all. Getting burned by the docs is part of the process of dealing with hormone imbalances for many of us with testosterone/hormone issues. Was the doc foolish for putting you on TRT and then stopping it “to see what would happen?” Absolutely. You now know you are on your own in many ways with this problem of yours, so don’t bother asking questions like this. Concentrate on going forward.

  2. If you are really not interested in TRT, then you should give a restart a try. On the other hand, it doesn’t sound like you’ve had any competent medical assistance in the matter, so to say TRT has not given you any benefit is only true because it hasn’t been attempted correctly.

  3. Based only on my experience, I think you should give TRT a real try, especially considering you have a doc who says he will do what you want. If it were me, I’d start the standard protocol outlined in the stickies. I personally did not start there, but that is about where I am now in terms of medication. For me and many others, you’ll have to do a lot of research on your own. You’ll have to get labs done more frequently than twice a year. You’ll then have to interpret your own labs. You’ll have to fight your doc to get the treatment you need. You’ll have a few really shitty stretches of time where you try to get everything sorted out endocrinologically. If you can bear all of that, then strongly consider it. Otherwise, try the restart before embarking on TRT.

I agree. Who knows if the only reason I haven’t felt a real improvement on TRT is because I haven’t had things tweaked correctly. It’s hard to say if I felt happier before. Again, the side effects I noticed were mainly physical things like having a hard time losing fat, carrying fat in the lower back and chest, inability to gain much strength or muscle mass. It’s just really hard for me to say because I don’t know that I’ve had an accurate idea about what I should feel like at a normal level.

I kept changing docs and getting more and more frustrated with the process and that is what has really turned me off. I’m on my fourth doc now and he wants me to do the 500iu of HCG twice a week for six weeks without TRT. I’ll get my labs done and then if I do start back I will definitely be switching to injections and using the protocol in the stickies.

[quote]wesmantooth wrote:
I agree. Who knows if the only reason I haven’t felt a real improvement on TRT is because I haven’t had things tweaked correctly. It’s hard to say if I felt happier before. Again, the side effects I noticed were mainly physical things like having a hard time losing fat, carrying fat in the lower back and chest, inability to gain much strength or muscle mass. It’s just really hard for me to say because I don’t know that I’ve had an accurate idea about what I should feel like at a normal level.

I kept changing docs and getting more and more frustrated with the process and that is what has really turned me off. I’m on my fourth doc now and he wants me to do the 500iu of HCG twice a week for six weeks without TRT. I’ll get my labs done and then if I do start back I will definitely be switching to injections and using the protocol in the stickies. [/quote]

Look for factors for why you need it in the first place

Lifestyles and nutritional imbalances
Biological
neurological
psychological
environmental
genetic

answers will be found in one or more of those suggested above.

[quote]Hardasnails wrote:

[quote]wesmantooth wrote:
I agree. Who knows if the only reason I haven’t felt a real improvement on TRT is because I haven’t had things tweaked correctly. It’s hard to say if I felt happier before. Again, the side effects I noticed were mainly physical things like having a hard time losing fat, carrying fat in the lower back and chest, inability to gain much strength or muscle mass. It’s just really hard for me to say because I don’t know that I’ve had an accurate idea about what I should feel like at a normal level.

I kept changing docs and getting more and more frustrated with the process and that is what has really turned me off. I’m on my fourth doc now and he wants me to do the 500iu of HCG twice a week for six weeks without TRT. I’ll get my labs done and then if I do start back I will definitely be switching to injections and using the protocol in the stickies. [/quote]

Look for factors for why you need it in the first place

Lifestyles and nutritional imbalances
Biological
neurological
psychological
environmental
genetic

answers will be found in one or more of those suggested above.

[/quote]

Can you elaborate? I had an MRI that ruled out a growth on the pituitary. I have had genital exams which would have indicated a varicocele. I get plenty of sleep. Don’t overtrain. Eat adequate calories. Never drink out of plastic or heat things up in plastic. Anything I’m missing? Docs seem to think it’s just early andropause and I will see how I respond to the HCG. That should tell me a lot about whether my testicles will respond or not. Then I’ll know the best course of action to take going forward.