Did I Jump on TRT to Fast?

Im 37, 6ft, 187 lbs.

Im skinny-fat, i.e thin legs and arms, and a “beer-belly”.Been struggling with fatigue over the last 4-5 years. Was diagnosed with sleep apnea in 2019, and this is under control now. Didnt do so much for my energy level.
Other relevant: Ive been using SSRI (panick attacks/ and a mild depression) for the last 10 years or so. This gave me ED, and I got taldafil 5mg daily for that. Which has made “things” work again. Currently been off SSRI for a year. But still needs the taldafil to have a boner long enough to finnish. Ive also have had high-ish Blood Pressure. Often measuring 140/95 at home. Been using propanlol (betablocker) from time to time, as it also calms my anxiety a bit.

During routine checkup i asked to do bloodwork for T. It came back with 7 mnol/L (range: 8- 35)
Doc didnt comment it until I asked if it was too low. He said we could do TRT, but then he needed some more bloodwork first, and a prostate check.

The following tests were done (im translating the test names to english)
ranges in paranteces

bloodwork_2

I was put on a TRT with some gel, 1 pump (21mg) on the shoulders each day.
So my T is low.
LH/FSH are low.

After reading here the last days, This means that i have a thyroid issue right?

I also was not informed by the doc, but it seems like TRT is much more complicated than just using the gel each day. I.e, I didnt know that my natural T production will be disabled. And that Estradiaol values also should be monitored.

So now after 1 week with TRT I am asking myself is this is something I want to commit for the rest of my life. The taldafil also lost its effect within the first two days on TRT. But Im hoping that this starts to work again as soon as my hormons has stabilized.

How was your sleep before getting your original bloodwork? How was your diet? Were you under an unusual amount of stress? All of these affect Total Testosterone significantly and can present as hypogonadism if they are not addressed before getting that bloodwork.

If you know these could be improved, you may want to do so and get new bloodwork in a couple months. If you don’t want to be on TRT unless absolutely necessary, this is your best bet to make sure it is actually needed. Of course, if your low T symptoms persist even after fixing sleep, stress, diet, etc. then you may want to pursue TRT if you wish to resolve your symptoms.

You LH and FSH are both indicating a pituitary problem likely caused by the SSRI and panic attacks/depression. SSRI’s can drop testosterone, some more than others.

You have secondary hypogonadism, a disease that needs treatment or your risk a grim health outcome if left untreated.

Your natural T is no longer able to sustain you. You can try to recover normal pituitary function through lifestyle modifications, but most guys that end up with T this low rarely recover normal natural healthy T production.

Men typically don’t absorb gels very well, I didn’t either. I even tried a T-cream with 20% concentration (compared to 1.62% for gels) from a compounding pharmacy and didn’t fare much better.

Injections is the most effective form of TRT, absorption is a non issue.

The LH and FSH will remain very low while on TRT.

ED drugs can’t overcome a low hormone state, you want erections, you need adequate T.

Sleep is good, never less than 6 hours, never more than 7.5hours.
I always fall a sleep within minutes. Always sleep the entire night without abruptions.

Diet is good, but perhaps I’m eating to few meals, not hungry in the morning. So mostly just a normal lunch, pasta, chicken, fish, rice vegetables. (what ever is the meal of the day at the office lunch room)

Dinner is also something like that, we eat out 1-2 times a month only. (5 kids and it’s expensive to eat out with the whole family)

Sometimes also a snack during the evening, fruit, youghurt, etc.

So to summarize, diet could for sure be improved a bit. Sleep I think is as good as it gets.

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Any unusual stressors? financial, relationship, work, etc.? You don’t have to be specific, but stress (cortisol) is kryptonite to T production

[Andrewgen_Receptors]
Any unusual stressors? financial, relationship, work, etc.? You don’t have to be specific, but stress (cortisol) is kryptonite to T production

No, not lately. Not unusual, I guess theres allways a certain ammount of stress involved when dealing with general anxiety, but this Ive learnt to live with, and is not really anything that bothers me. And financially, everything is gotten so expensive lately, but we still manage.

Been working alot lately, putting in 50-60 hours overtime in addition to the regular 8 hours a day last month.

The loss of taldafil effect was eminent within a few days of TRT. So I dont think that is stress related.

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So this pituitary problem, is this a permanent one caused by the SSRI`s? Is there tests I can ask the Doc to do, to confirm?
And treatment of hypogonadism, is only trt right? I dont think injections is a option here where I live, but I can ask.

Taldafil was working fine for years, right until last week when i started the T gel. Will starting with gel lower my T below what is was, to the level that taldafil cant do its thing anymore?

I have scheduled new tests in 2 weeks. Is there anything I should add to the tests? Like Cortisol, HCG, E2?

For the fact you didn’t recover normal pituitary function after stopping the SSRI, I mean if you were going to recover, it would have happened by now.

Your last set of labs at 202 ng/dL, that’s lower than most 80 year old men.

This is a disease state.

Your only recourse is replace what’s missing until something better comes along.

A few years ago there was a injection cocktail that stimulated the pituitary for those with secondary hypogonadism and it worked, but had side effects of causing diabetes and carpal tunnel and it was very expensive.

The last labs i posted in the first post was 11 (range 8-35) nmol/L (317 ng/Dl) This was the last bloodwork before starting TRT.
My first labwork was down to 202 NG.

In my country, as long as you are within the “range” they dont lift a eyebrow really. I had to ask if this was normal several times, and bring up TRT before the doc was going along with it.

So now im taking 21mg a day, and will do new blood samples in a few weeks. I want to be more prepared this time. So if the doc says that my T is now within range again, I guess he will either stop TRT, or keep the current protocol.
So, I ask here, what values should I be aiming for? The highest value in range her is 1009 ng/DL. I was at 200-300 at my base line.

Most guys feel optimal at the top end of the ranges whether on TRT or not.

This is due to a lack of knowledge.

That is what is taught so that is what they know. Insurance companies, and national health care, will not step away from that. This makes me very happy. This is why cash clinics exist.

Generally, guys towards the higher end of the ranges will feel pretty good. It is not unusual for guys to feel good, and be happy, with lower levels. However, most, if they feel good at 650-700, will want to move up and see if they feel better.

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So I received the latest bloodwork, after 3 weeks on TRT.

My protocol is 1 “pump” of gel a day. (7x20 = 140 mg a week)

Tot T is now 13 nmol/L (372 ng/dl) | range 8 - 35
SHBG is now 15 |(range 8 - 60)
PSA is now 1 | (range 0 - 2.5)

3 weeks ago my PSA was 0.85, so its up by 0.15 in 3 weeks.
The doc want to follow the guidelines from the manufactor of the testo gel im using, so as long as im below 17 nmol/L he wants me to double the dosage to 2 pumps a day, ( 280mg/week )

Im a bit concerned about the PSA levels though.

The libido and erections are both still lower than before i started.

You’re not supposed to test PSA this early in treatment because initially there can be a short-lived elevation which is normal. Your doctor comes across as clueless.

Nonsense, your PSA is normal.

This is stupid, below 490 is putting you at risk. You may not feel that great on TRT if your doctor is going to get cold feet. You may need levels near the top of the ranges to fully benefit from TRT and if your doctor doesn’t understand this, find another doctor.

Also topicals don’t offer a great deal of control over your levels. Also due to the nature of the very short half-life of gels, you’re going to need to have your levels peak high to benefit from treatment.

Meanwhile the number of CAG (cytosine–adenine–guanine triplet) repeats in androgen receptor differs in men and influences the androgen receptor activity. Hence testosterone sensitivity may vary in different individuals.

This is why you can’t target one number for everyone.

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I see, its the manufactors dosage description that says so. Start the TRT protocol with 1pump/20mg a day, do bloodwork after 3 weeks, then if you are still below 17 nmol, increase dosage with another pump/ (total 40mg) a day. Max safe dosage is described as 3 pumps a day.

I dont think the injections really is something I can ask for as long as the Doc sees my T value is responding to the gel. I also prefer not doing needles :smile:

Thanks for your answer. Ill try not to worry about the PSA levels for a while. We have had prostate cancer in my family with terminal outcome so I tend to be a bit concerned about this.

TRT doesn’t cause prostate cancer and the medical literature doesn’t support it. If you’re destined to get prostate cancer, then it’s going to happen no matter what and better to have high versus low testosterone.

Men with high testosterone get less aggressive prostate cancer and men with low testosterone get more aggressive forms of prostate cancer.

Testosterone Controversies in Men’s Health: Lecture by Dr. Khera

If the gel works, if it isn’t broke… The topicals has less impact on hematocrit and is one of the reasons it’s used first before injections. If you do ever need injections due to poor absorption on the gels, which is common, then you can always use 29 gauge insulin syringes (shallow IM) which are painless.

In the not so distant future there may be an oral option for T replacement in your country.

Lets hope so. I ve read about Jatenzo. But I guess your liver takes a hit by going the oral way.

Regarding injections, its only two types of testo undecanoate available by prescriptions, and from what I can read, it has to be injected IM, not Subq. You wrote “shallow IM”, i guess that still means muscular, like in my thigh or something.

Alot of questions running through here at the moment. Injections arent really on the table yet anyways. So thats something I can worry about later if it comes to that.

Going to try double dosage for a few weeks now and do new blood tests. (Actually, by reading leaflet that came with the T-gel, it says serum T can be measured allready 3 days after changing dose, because of the short halflife.)

That was true of other forms of oral T but not so with Jatenzo.

My ALT levels are 19.