T Nation

How to Decide If and When to Take the Plunge?

Hey guys,

First thanks again to everyone that responded in my other thread.

I’m struggling with the decision of whether to take the plunge or not, and what timeframe. Right now I’m thinking at least just get labs and then decide, but maybe someone has some feedback that may help.

I’m 41. Happily married, not planning to have kids. I’m 6’2", about 185, probably 12-14 % BF, somewhere between skinny fat and just skinny. Exercise regularly but not in a structured way.

I do have some symptoms that could be attributed to low T:

  • low energy and motivation, a general feeling of dragging
  • LOW libido to the point that it’s really starting to bother my wife how little we have sex. Like once a week at most, sometimes less, used to be 5x/wk at least
  • slow recovery after exercise, lots of soreness and tiredness
  • some depression, more anxiety. Not on meds and don’t want meds but sometimes it’s hard to cope
  • an overall feeling of being subpar, or at least suboptimal

I have some preexisting conditions that might be contributing:

  • I’ve had a varicocele since puberty but no doctor ever thought it was worth fixing. Now I learn that can contribute to low T
  • I’ve had a vasectomy about 5 yrs ago
  • Im in the process of quitting smoking right now, I’m sure that’s not helping anything
  • i was a big drinker in my 20s, don’t drink much now like once per month maybe
  • my diet could use work, right now I eat clean Paleo 50% of the time and the other 50% I eat junk.
  • could probably use more structured workout regimen, right now it’s inconsistent at best

So I’m well aware that I have a lot of room for optimization. The question I have is how to proceed. Should I do all the optimization I can on my own first, before even getting labs? My diet and habits could be changed right away, the varicocele is a much harder problem as my insurance sucks and I can’t afford to pay for surgery right now. I feel like ideally I’d get that fixed too before testing testosterone but I’m not sure I want to wait for that to become a possibility, it might be a year or more before that is a possibility.

Also I’m eager to feel better but I’m aware that part of that is wanting to feel good without doing the work, like wanting to have the cake and eat it too, so to speak.

So I guess my options are:

  • Get labs and proceed with TRT if indicated, and optimize along the way
  • Get labs, then optimize what I can before trying TRT
  • Optimize the things that are within my control now: diet, habits, exercise; before proceeding with labs and possibly TRT
  • Optimize everything, including getting the varicocele fixed, before proceeding. This might take a while, a year or more.

I feel like the last option might be the best, I’m just not sure if I have that level of patience.

I welcome any thoughts on my situation. I’m sure I’ll have some tough love coming and that’s ok, I deserve it I’m sure.

Thanks in advance.

Edited for formatting

At this point, you are overthinking things. Just get the labs. Start making all the necessary changes to your health that you mentioned…quitting smoking, better diet, etc. Whether you end up on TRT or not, making those health and lifestyle changes is a must. If after your initial labs your T numbers are reasonable(at least mid range). Stay the course with the healthy lifestyle and see if your symptoms improve. If after 4-6 months still low libido, energy, poor workout recovery, etc. Then retest blood and most likely initiate TRT. If your initial labs come back low(near bottom of the range or lower) then it’s less clear but likely advisable to initiate TRT immediately and of course commit to the already mentioned health and lifestyle changes. But it would be necessary to see the initial labs to confirm that there isn’t something glaring outside of T levels like thyroid or adrenal function that are causing your symptoms. So to summarize, go get labs ASAP. Get the full thyroid panel. And a cortisol test. Then see what’s up.

2 Likes

Yeah that makes sense, thanks man

All the items you mentioned to improve your health are automatic. Given your history and symptoms reported, I would see a doctor and get a full workup.

I know there can be more to this than physiology, but you said “happily married”. I’d look into everything.

Well yeah there can be more but… I do think that the problem is within myself. I used to be unable to get through the day without busting a nut one way or another. Now I go for weeks. Just lost interest somehow. Don’t want to spank it or anything, so weird.

I spent years in decline. Trying diet changes, supplements, etc. I finally asked to get my T checked and I was 177.

When I think of myself back then, it would have been an almost insurmountable task to make drastic lifestyle changes. I had no drive or motivation.

The turning point for me was on a gorgeous summer afternoon my son came to me and wanted me to go outside and kick a soccer ball around. I had no energy. I told him I couldn’t. I later picked myself up off the floor, walked past the window and saw my son out there kicking a soccer ball by himself against a chain link fence. I felt like the biggest piece of sh*t. I well up with tears just typing it out. I then looked around the house at all the unfinished projects that I told my wife I’d get to and was ashamed of myself. By that time I was in the process of getting blood work, taking tests for things like insulin resistance, etc ,etc at my endocrinologists office. I went into the doctor’s office that next week and said, “no more.” They said OK and I walked out with a script for Testosterone Cypionate. I was learning to stick a needle in my leg about a week after all of that. Since then, I haven’t turned down an offer to shoot baskets or go to the gym with my son (now 13). I’m as close to my wife as we’ve ever been. She absolutely loves the change. My sex drive is through the ceiling. Although hers isn’t up there with mine, she accomodates me very well, and in return I don’t let her lift a finger to do anything when I’m around. I do dishes, laundry, and still have the energy to go to social events, basketball games, etc.

I was literally being 25% of the man that I could be with a Total Testosterone of 177. I’ve run into some hiccups with my TRT protocol a couple times, but never have I said I want to quit. You could spend YEARS trying everything to figure it out (assuming you have the energy and motivation) without TRT. But then you also risk wasting those years on a solution you’ll never find.

Good luck.

2 Likes

Thank you for the heartfelt words man. That’s very inspiring

This is excellent, and it mirrors my own experience. I tried for 15 years to optimize naturally, with limited and inconsistent success. One of by big regrets is waiting so long. Get that bloodwork.

1 Like

TRT hasn’t helped much with this. Other areas yes.

Thanks man. Alright will do this at least, I’ll hopefully have some results soon.

@pyrosis
Get tested and if needed get on TRT. It’s a life changing experience and your quality of life will improve dramatically. My story is very similar to yours and when I think back on the time that was wasted feeling like ass and how different it would have been if I had TRT I get pissed at myself but then again I didn’t really know about TRT. You do.

Add LH & FSH to the list.

Getting tested tomorrow, we’ll see what the numbers are and then decide what to do about it. Thanks to everyone for the help and advice.

Hi again,

So I got labs done and I’m definitely out of whack although not in the way I expected. In fact I can’t make heads or tails of them, I can’t for the life of me figure out what the hell is going on. I’ll just post them up with some background and we’ll see.

So I’m 41, more or less lean, right now about 180# and probably 11-12% BF. I do exercise but no serious training right now. Diet is 50% keto/paleo and 50% junk food at different times. I’ve never used AAS.

Labs:

Testosterone total 614 ng/dl
SHBG 108 nmol/L H (16.5-55.9)
Free T 53.9 pg/ml (42.3-190.0)
Estradiol <5.0 pg/ml L (7.6-42.6)
IGF-1 125 ng/ml
T3 3.1 pg/ml
T4 1.52 ng/dl
TSH 2.35 uIU/ml
CBC completely normal
CMP completely normal except
Glucose 100 mg/dL H
A/G ratio 2.3 H
Lipids all normal except
LDL 121 mg/dl H

So what the heck. Why would my SHBG be so high? I had just gotten over the stomach flu when I had these labs drawn, could that be part of it? In any case, what is the next step, is there a way to decrease the SHBG naturally so that my free T would increase? What about the low estradiol?

I know you said you’re “in the process” of quitting smoking. I’m just here to tell you to get out of the process and do it already - that’s the next step. Don’t get stuck “in the process” for the rest of your (shortened) life. You cannot imagine how much better you will feel in three months and three years.

You know it’s time.

1 Like

You’re right man thanks for the reminder. Shit or get off the pot, so to speak.

1 Like

The body in response to low-T can increase SHBG. Your Total and Free T numbers aren’t that great, takeaway the high SHBG and now your Total drops considerably. Your SHBG can affect Free T by 50% going from low normal to high normal, but yours is twice the reference ranges compounding the problem.

I have never seen anyone decrease SHBG enough to matter when scoring at the top of the ranges, you are a lot higher than an average guy with high SHBG.

You have astronomically high SHBG, it’s also binding estrogen. To bad you don’t have LH labs, this would be a better indicator of T status. If LH were 1-3, this more than likely means you also have low-T as well as high SHBG.

Thanks man. That makes sense. So clearly quitting tobacco is priority #1. But then what? You seem to indicate that I can improve somewhat without exogenous T but not by a large amount, is that correct? If you were in my shoes what would your next step be?

Will TRT even help with this high of SHBG? Does exogenous T affect the SHBG level?

I haven’t seen a case where exogenous T didn’t affect SHBG, excess androgens suppresses SHBG in just about everyone, expect for those with insulin resistance where it is suppressing SHBG.

I see an increase in SHBG on exogenous T which is a good thing.

The way I see it is you are 41 years old, T delines as you age, you can slow this decline but you can’t stop it.

So in this case T replacement would likely lower my levels of SHBG? Seems like this would be doubly beneficial then. And probably increase my e2 as well which in my case would probably also be a good thing, seeing as I’m low to begin with.

Without a doubt.