T Nation

Completely Lost 26 Year Old. Need Advice

I have read the new guy stickies the best I can and would just like the advice of others who may be able to shed some light on my situation. I have always been a very active person (playing sports, lifting weights, excising, etc). Last year I started buckling down on my fitness and nutrition and lost around 30 lbs while doing Crossfit and weight lifting. I got down to the leanest I had ever been by the end of the year. That’s when I started to notice symptoms of low T (fatigue, low libido, loss of morning erections). Then, around the first of this year, I started having sleep and anxiety issues and had my fears confirmed at my GP and did indeed have low T levels. He seemed to think there was no explanation as to why my levels were low and just said it happens to some people early, and suggested I start TRT. Obviously I was reluctant because I am still young, so I declined and figured I could fix the issues on my own. I assumed that I damaged my hormones by overtraining/undereating, even though I had upped my calories to around 3300-3400 a day and was slowly gaining mass at this point. I also figured the sleep issues just made it worse and I started having anxiety about sleeping which just made it worse each and every night worrying about sleep. After a few weeks of no progress trying to address my issues. I went back to my doctor and started TRT at his suggestion. I am now around a month in and have noticeable progress in sex drive and morning erections. Sleep has gotten slightly better; however, my weight has just significantly with most of it feeling as if it is added fat even though my diet and exercise are just as controlled as before. My anxiety has also stuck around. I guess my questions would be, did I make a mistake by trusting my doctor and starting TRT? Could it be possible for me to recover my hormones naturally even after I have been on TRT for as long as I have? What should my next move be? I will post the lab results that caused my GP to suggest TRT in the first place. Again, I am young, new, and scared so please help. Thanks to any advice in advance.

Let’s start by telling us what does your TRT protocol look like, how much and how often are you injecting testosterone?

If you’re injecting 200mg every two weeks which I’m sure is the case, you’ve just been quacked by a doctor that has no clue what he/she is doing and it’s time for another doctor. Testosterone cypionate on paper has a 12 days half life, in the real world it has a 7 day half life, so injecting every 14 days is stupid because that means your levels are going to be low again long before your next injection.

Everyone’s protocol is going to be unique to them, SHBG is a huge factor in what type of protocol is best for you. My SHBG is lower at 22 nmol/L and if I don’t inject T every 2 days, I have anxiety, feel exhausted and respond poorly to TRT. SHBG is the single most important test for evaluating a testosterone deficiency, Free T is all that matters as it’s the bioavailable portion of testosterone, Total T is bound to SHBG and not bioavailable.

TSH isn’t a thyroid hormone, Free T3 (not TSH) increases metabolism, body temperatures.

GP’s, endocrinologist and urologist are typically not very helpful and almost always are operating in the dark with no knowledge whatsoever. It’s not hard to understand why, there’s no standard of care for TRT, so doctors have no idea what they are supposed to do.

You need to seek a specialists out for your TRT, I did and it was a game changer!

Wow, your T is really low. I don’t see results for SHBG, that will be a necessity as to the frequency of your injections (low SHBG guys do better with multiple injections).

Given how low your levels are it may be months before you start to feel the full effects. I was nowhere near as low as you were and it took me about eight weeks to notice a difference.

My GP has me on 200mg test cyp once a week injected IM. No AI or HCG. I have asked him to refer me to a specialist such as an Endo, and he set me up an appointment with the urology office in my city which he says is who they send patients to who ask for a second opinion or other treatment options. It has taken a month, but the appointment will finally be next week. I asked my GP about trying a to restart my own natural production by using clomid or HCG and his office didn’t seemed informed on those treatment options. Given how low my T levels actually were, could that be an indication as to what the cause was? I am hoping I will get more insight from the urologist in my upcoming appointment, but was looking for advice on here because I have been reading a lot of different opinions on these discussion boards and I am just trying to explore all of my options. If the urologist is not the specialist I need as you suggested, where should I look for a specialist? What type of doctor would specialize in this?

I have come to terms with the fact that I may have had dropping levels over time and had finally just crashed and started feeling symptoms, but I also can’t get the thought out of my head that I did this to myself with hardcore training and dieting. I just want to know what the odds of me being able to restore myself to natural production or if I am in need of lifetime treatment. Also if I am in need of long term treatment, what the best coarse of treatment is for someone in my situation who hopefully has a lot of life left to live and would like to start a family in the near future and would like to start feeling like myself again (for myself and my wife who I am sure would like to have her old husband back). I know there are a lot of questions that may never get answers, but it can’t hurt to seek out advice. I’m sure I am not the first person to end up in my situation and won’t be the last.

I’m 30 in the same situation. My levels were 71 when i found out 2 months ago. With levels in the double digits its not worth thinking about natural production just get yourself right with TRT. Whats the point of living if you are miserable. I only wish I had found out at 26 why i felt the way i did.i I suppose doing some scans for tumors and stuff would be a good idea if you don’t think you know what caused your low t. I however know what did me in so I never thought twice about putting off treatment.

You require a private specialists, Defy Medical is a good option who has experienced doctors who have been doing this sort of thing for decades. Restarts using clomid are rare, your chances of retaining high normal levels after stopping clomid is very low.

There are chemicals in our environment thought to be causing endocrine disruption, testosterone and sperm counts are dropping at a faster rates than ever before, by 2040 men will become infertile. These endocrine disruptors are turning little boys into girls, little girls into boys. This isn’t natural, it’s man made.

My point is even if you somehow manage to have a successful restart, for reasons mentioned above your levels will not hold for long, some point in the future your levels will decline again.

That would be too much testosterone for most men to handle. A protocol for a low SHBG guy is very different than it is for a high SHBG guy, SHBG going from low normal to high normal can affect your Free T by 50%.

Once you’re on an optimal protocol I expect to see significant changes in 6-12 months. As it stands now your levels aren’t even stable yet which will take a total of 6 weeks, whenever you change dosages, it will take another 6 weeks for all levels to stabilize.

You need a private trt doc. Your wasting your time with endow and urologists. They don’t specialize in trt. They barely touch on it in med school. You might get lucky though.

Could my current protocol be causing problems such as excess weight gain, high estrogen, or other hormone problems? Should I adjust it or change anything while I seek a more specialized opinion?

Absolutely, estrogen in excess can cause water retention in the form of bloating. I get bloated in the stomach, everyone’s a little different and some get bloated in the face.

We really need to see your other biomarkers such as SHBG, Total T, Free T and estrogen, at this point you don’t have enough testing to make an informed decision. For now inject 50mg twice weekly.

Seek a competent doctor and you’ll be able to move forward with a plan.

Should these effects subside once estrogen is held in check if it does turn out to be elevated, or is it possible to be adding belly fat as long as it is elevated and it will stick around? There has been quite the weight jump over the last week or two and I figured it was mostly water retention since I am still working out and eating a solid diet; however I have read that high estrogen could still be causing fat gain even if diet and exercise are on point.

I intend to ask for a more thorough lab workup at my next appointment. Should I just forgo my urologist appointment and seek out an office that treats low T specifically or wait and see how knowledgeable this urologist is on the subject before making my decision. I don’t know exactly how time sensitive all of this is and it can take months to get appointments with doctors in my town I have found out.

Is injecting IM still the route to go? I have found a lot of people saying that injecting subq twice a week is the way to go for the most part.

SQ increased estrogen for me, it was like the entire shot converted over to estrogen. IM on the other hand works for everyone. Once you maintain estrogen not in excess, the water weight should subside, some find the kidneys responsible for some water gain caused by testosterone.

Large doses can cause estrogen spikes, injecting smaller doses more frequently can help lower estrogen and hematocrit.

Going with Defy Medical may only take a week to get started, it’s up to you if you want to play the doctor lottery. Chances are you will lose because important testing was already missed and it was do to lack of knowledge. If your doctor thought testing SHBG, Free T and estrogen was a good idea, he would have already done so already. These baseline tests are needed to determine a good protocol, testing only for Total T is a big red flag.

A lot of doctors only test for Total T and refuse all these other tests so to not upset insurance companies and get blacklisted which can ruin a career.

I unfortunately do not live close enough to Defy Medical for it to be an option. I could seek out a similar Dr. near me that specializes in Low T treatment though.

I just want to find someone who is knowledgeable enough to help give me some answers such as what could have caused this, proper treatment protocol, and be able to explain my numbers better to me. Surely there is a Dr. close to me who is capable of these tasks.

Defy Medical is a telemedicine clinic, I’m in california and receiving treatment through Defy Medical.

What would I be looking at cost wise to get started with them? The price of continuing services? Per month or Yearly I guess would be easiest to estimate?

Call and ask it’s cheap considering other clinics. I think 300 -500 upfront and then 150/200 monthly.

What all does that monthly price include? I will likely call and see.

Just call I’m not a patient but there the cheaper ones.

Would anyone have any guidance on my situation as far as could I have caused these issues with over training and overly restricting a diet? If so, could it be possible to repair? Or has the damage been done at this point? Or am I just overthinking it and just accept that maybe this was going to happen at some point and I just happened to feel the symptoms once I bottomed out for a lack of better terms? I guess I may never know, but it just helps me feel better the more I understand.

Pay as you go, $600-$700 to get started, first year is higher since initial consultant cost is waved continuing with treatment. Consultants after starting with Defy is $120 45min, $50 15 min and $35 10min.

You pay about 3 months for medicine, every 6 months for labs and consultants.

So I would be looking at $600-$700 to get started plus another couple of hundred dollars every three months for meds( which typically cost?), and then pay for labs (which typically cost?) and follow up consultations every 6 months which would cost what you quoted above depending on how long I wanted to talk to them?