T Nation

Did I Jump the Gun and Should I Stop TRT?

Hi all, wanted to post this here as this is the best community for this question. I am a 31 year old male. I got my levels checked out of curiosity at the GP back in September. Bloodwork showed

Testosterone - Total 277.6 ng/dL
Testosterone - Free 3.6 pg/mL (below low threshold)

I did not get any other hormones checked. I was surprised to say the least. I lift and eat relatively well. I generally feel fine but I have some significant energy issues. It seemed like even when I got 8 hours of sleep I was still exhausted and overall I feel run down. I have a normal sex drive I guess, but I have had issues getting it up. The doc did not seem to think any of this was a huge issue and offered me test if I wanted it. He basically said it was up to me and that it may or may not help. I accepted knowing full well what the potential benefits were. He stuck me with 100/mg the first time. Felt great for about 2 or 3 weeks but then crashed somewhat. I asked to move my appointment up and I saw him yesterday and he gave me 200/mg. I return in 3 weeks for another shot.

Reading the forums here I am just wondering whether or not I made a big mistake? Are my levels low enough to warrant TRT? I know I am pretty young for it. I do feel better but I don’t want to fuck up my natural production.

I think I should ask for a referral to an endo to check all my levels. I also think I should be on a different schedule if I decide to stay on TRT. Any input is appreciated.

I am no the most expert in here. In fact, my total T levels are just like yours, except highter free testosterone (from 8 to 25). I am not on TRT, but I know my levels are low since a few years ago.

However, if you take testosterone on a continuous basis which must be the case if you want permanent optimal levels that may relieve your symptoms, you will shut down your own production. Your natural levels will only get back to previous levels (at best) if you decide to stop the external testosterone injections now. Sometimes, it takes months to recover and it may never fully return to your previous levels, which were already low.

However, I don´t think you have caused major harm to your body with only those 2 injections. Someone else can provide a better opinion.
You can stop now at any moment before your endogenous productions is totally shut down. You´ll feel a crash 1-2 weeks after the last injection. Then, in a few weeks later you should slowly get back to your previous state (at best). But, you may end up with lower levels than before.

If you want to consider TRT seriously, in my opinion you should have a FULL hormone panel, bloodwork, thyroid, etc done. Do it along 1-2 years 2 to 3 times a year and study your body. Then you can see if your issue is testosterone and what you can expect from the replacement. More, you should focus more on symptoms rather than T levels. And, you should optimize your sleep/eat/train patterns before anything else. You probably already do that.

TRT is for life. It´s not a treatment that lasts 2-3 months and you´re cured. We all wish that was the case. TRT is a decision that will shut down anyone´s endogenous natural production of T and replace with an external but “physiologically correct” amount of T in your body. That´s why it should only be considered if you have symptoms that affect your normal life in many different areas. It has to be worth it !! Talk to your doctor. Good luck.

Cheers

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That train left the station, friend. Your levels are no longer natural, so any information gleaned will only tell you how the treatment is affecting said levels. Which of course you will get routine blood work and monitor everything while on trt, that is standard practice. But if you wanted to know your full hormone panel then that happens before you start taking testosterone.

And as you suspected, that schedule the doc has you on is unlikely to be ideal. Probably need to discuss having a prescription for at least weekly injection which you do at home.

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Thanks. I am not exactly sure what to do from here. From what I can tell my choices are

  1. Come off TRT completely, let my levels return to what they were or as close as I can get. Continue bloodwork, panels, etc, and keep an eye on things until I am certain I need TRT. (could take a few years)

  2. Continue TRT, change dosing schedule, monitor my levels, etc.

I am not going to lie, it is a tough choice. I feel a lot better on TRT. It is like a day and night difference. It is difficult for me to let go of that in exchange for feeling shitty again. That said I don’t know how I feel about taking shots for the rest of my life. I worry about some of the problems with TRT I have heard of (increased prostate cancer risk esp). I’m just thinking out loud here but I appreciate any input from anyone on what I should do (obviously I know its not medical advice). Thanks again.

There is no data showing an increase in prostate cancer. You say you feel a lot better, a day and night difference. Not sure why you would want to feel shitty again.

This.

I’d push for at home injections. You can likely use much smaller needles than they are using to make it less painful. I’d try once a week, see how that does, some people need more, some are fine with just once a week. Waiting 2-3 weeks is usually too long between injections and will have your levels constantly swinging up and down

He gave you ONE testosterone test and issues TRT? Christ.

There should be at least two tests confirming low T.

Borderline malpractice imo.

If that’s the real holdup then I’d say you have an easy decision ahead of you. By shot #3 you’re comfortable and by shot #8 you’re an expert. It’s easy and the benefits far outweigh the costs.

I think I could probably get used to it, I mean more my own stigmatization about using a needle once a week for the rest of my life. That said, I really feel so much better on test. I teach and I am in graduate school. It is so much easier for me to focus and be productive. My memory feels like it is back to normal, I have energy, I feel more confident, etc. I am definitely leaning towards asking for at home administration, and continuing to monitor my blood work.

What do you do with the guys with normal levels and have all the symptoms of low T? Do you only advise treatment for men under a given number? What about the men at 600 with every single symptom related to low testosterone and upon raising their levels their symptoms resolve?

Testosterone is not only for measurably deficient men.

Most places I deal with do one test to get a baseline. Running two tests is a waste of time and money. The goal is to see where they are starting from.

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Completely disagree Danny.

I recall seeing the Merck manual (perhaps another medical protocol guide sheet) at some point that list there should be numerous blood test confirming low T prior to prescribing test.

How does a dr confirm this isn’t just a script shopper who just ended a test cycle? Or there isn’t another issue occurring temporarily that is lowering T that can be addressed without lifelong treatment ?

I’m pretty sure medical protocol calls for numerous tests over a short period of time.

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If you want to be of the camp that you need to be below the bottom of the reference range to warrant treatment, you can be. Frankly you can do whatever you wish. Personally, I think it is silly.

Take my 60 something year old physician. Had T levels in the mid 700s. Had every single symptom of low T you can possibly imagine. He had been exposed to pesticides his entire life. His ‘normal’ levels weren’t doing anything for him whatsoever. He got on treatment, needed a ridiculously high dose, and his symptoms mostly went away. He’s a new man. He suffered for DECADES and can now live the rest of his life with some semblance of normality.

If a person has all the symptoms related to low testosterone, with clinically ‘normal’ levels, with no other explanation for the cause, a trial of testosterone to try to resolve low testosterone symptoms (crazy, right?) is attempted to determine outcome. If the treatment resolves the symptoms, then the issue is what exactly?

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I would speculate most men would feel good on testosterone just like your physician friend.

With his levels being into the 700s naturally, I would also speculate that “low T” wasnt his issue. The increase now in hormone
Levels is likely Just a mask for whatever issue was causing his “symptoms”.

It’s very hard for me to think that a male with TT into the 700s needs TRT.

Supra levels will make most men “feel” great.

Can pesticides etc be removed via fasting, along with discontinued exposure?

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At some point I am going to do an “EDC-induced hypogonadism” thread. I feel it taking shape. Would be fun to discuss the mechanistics aspects as to why a guy with mid-to high range TT/fT levels would need to go on TOT. If they are already at high end of range, then clearly they wouldn’t be doing TRT if they went above range to address their symptoms (I know, it’s a academic issue to many). Definitely not dismissing EDC impact and it is a difficult question to decouple whether the Doc above feels better because of true hypogonadism at the androgen receptor level or whether the T is masking the true cause. To Danny’s point, he would ask who the hell cares? Conventional medicine does this every day. But the truly “criminally insane” science people really do like to know the true root causes.

At this age and if he can handle these dosages without the sides that come with it, I’d say more power to him. Compression of morbidity and age at which you start treatment combined with benefit/risk (sides) all enter into the clinical decision making process as I understand it.

After running the math last night Danny, I am predicting within 6 months we will agree about 80% of the time and your starting mean weekly dosage equivalent will be 125 mg/week of testosterone ester. Given the wildcard and selection bias of the people you run into along with the EDC piece that’s not fully understood, I predict your recommended starting dose won’t drop much more than this over time and there will be a persistent gap between the 125 and the typical 75-100 mg/week used in “conventional” medicine.

I would be willing to bet a substantial amount of money that my ideal weekly starting dose won’t go below 150mg a week.

I’m serious.

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If you only new how many guys I’ve met with normal levels and literally wanted to kill themselves, you’d get it.

I had a guy find my business number and called me at my office. He was standing on a bridge preparing to jump and sobbing. Nobody would treat him because his levels were normal and something was clearly wrong with him. I got him help within ten minutes. He didn’t jump. The email he sent me weeks later still makes me cry to this day when I read it.

I have seen enough to know that serum levels are meaningless. They demonstrate nothing.

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The most important thing that seems forgotten is that people aren’t numbers. People have feelings and aches and pains and joy and heartbreak. Numbers are useful, but they don’t have any of the qualities that make us human. If numbers rules everything we wouldn’t be human, we’d be machines running on lines of code. But medicine works within a world where doctors get sued and thus a range for everything must be drawn up. In some cases those ranges are very helpful and important. In others they’re little more than a fig leaf for doctors and insurers.

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This was extremely well said. The Physicians and the medical boards need to find ways to quantify this to justify treatment in order to cover their asses. Things are oftentimes done in a non optimal way simply out of fear of getting sued. It’s sad when you think about it. I will say it again, the numbers are meaningless at the end of the day. I have seen too much to deny this fact.

In the US, it also depends on whether or not you want to be covered by insurance. Insurance requires two tests with levels roughly less than 300 total t both before something like 10am on different days. Now… that said… initially I WAS covered by insurance; but, I didn’t like the stipulations at all so I switched to private and out of pocket. For place number two, they ran one blood test and prescribed me before I was even able to tell them I was switching from another place. My levels were >1200. They leave me alone regardless of levels, which is great. Again, depends what you want.