T Nation

New to TRT. Looking for Some Thoughts

Hello all,

I have been working with an endocrinologist and due to my ongoing symptoms which have been present for well over 10 years. We have decided for me to start TRT. Testosterone gel, 30mg per day. I am 28 years old and started yesterday.

For information, my labs are;

FSH 2.08 IU/L (1.5 - 12.4)
LH 4.2 IU/L (1.7 - 8.6)
Oestradiol 54.8 pmol/L (41 - 159)
Testosterone 15.2 nmol/L (8.64 - 29)
Free Test - Calc 0.172 nmol/L (0.2 - 0.62)
DHEA-S 3.440 umol/L (4.34 - 12.2)
Cortisol 443 nmol/L (156 - 507)
TSH 2.63 mlU/L (0.27 - 4.2)
Free T3 3.48 pmol/L (3.1 - 6.8)
Free Thyroxine 18.200 pmol/L (12 - 22)
SHBG 113 nmol/L (18.3 - 54.1)
Albumin 50.9 nmol/L (35 - 50)
Insulin 1.73 mlU/L (2.6 - 24.9)
HbA1c 22.65 mmol/mol (20 - 42)
CRP HS 0.86 mg/L (<5)
IGF-1 25.9 nmol/L (10.9 - 33.7)
Growth Hormone 1.0 ug/L (test suggests normal)

MCV & MCH both always slightly above ref, but only very slightly.

Liver & kidney health good and all within ranges.

Cholesterol and HDL only slightly above ref.

I have also had a DUTCH test which showed Progesterone, Estrogens, Androgens and all Metabolites all at low end of range or below range. A poor sight to see to be honest.

My symptoms are all those associated with low testosterone, suspect it is because of my very high SHBG and low total T.

  • ED
  • No drive
  • Loss of muscle mass, difficult to gain muscle
  • No libido
  • Feel fragile, like an old man
  • Thin skin and poor wound healing
  • I feel as if I haven’t developed into an adult
    I could go on and on.

But I also have oily T-zone and facial acne. I have had acne since I was around 15/16 years old.
I don’t understand why, as my blood markers all seem to suggest my androgens are low, hence no acne.

I’m wondering if anyone has experienced anything like this before? My doctor is convinced that my acne is not related to my hormones and very high SHBG, but I think it could be, though research is not in my favour.

My sleep is also rock bottom. I wake up anywhere from 4-6 times a night to urinate. This started about 18 months ago, at this time of my life I was going through a very stressful period, I moved home and under the guidance of a functional medicine practitioner started supplementing with bio-identical hormones DHEA, Progesterone and Prognenolone - something at that time has triggered the sleep issues and I can’t help but think it was due to supplementing with the above. I stopped within a month of starting due to the sleep issues and sleep hasn’t never been back to normal since.

To top things off I have MTHFR gene.

I have had an pituitary MRI and it looks fine.

I’m wondering if I have genetic preposition which elevates my SHBG and starting TRT may lower it, then raise my Free T and balance my hormones, and potentially stop my acne. Seems backwards but I’m just not sure.

I don’t know if this is the best place for this, but I hope you can let me know your thoughts. Particularly on the acne and sleep issues. The acne is debilitating.

Thanks for your time all.

Are you a former steroid abuser? Do you snore? Are you overweight? Why did the doctor give you those hormones, based on a blood test? Did your prescribing doctor tell you about the loss of fertility while using TRT?

Hi. I have never used steroids. I don’t snore.

I am healthy, my body fat is around 12-15% i resistance train 5-6 times per week and my diet is very good. I keep to my diet very strictly as it worries me that my symptoms could get worse.

The endocrinologist started me on the TRT due to my symptoms and poor quality of life.

He mentioned the possibility of fertility loss. But he also explained that we will do testing in 4-6 weeks time to assess and he said that in a time frame of up to 4 months, he wouldn’t expect my fertility to be lost due to the low dose - is this accurate?

Please find a competent physician who will not waste your time with testosterone gel.

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I’m from the UK, the endocrinologist is an NHS physician. I guess gel isn’t going to do anything worth while?

Might as well rub your body with olive oil. Been there, done that. Gel is inherently useless and I have no idea whatsoever why physicians continue to prescribe it.

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Ok, thanks.

I think the gels are worth trying.

Many, many men use it with success. Most men don’t need to have levels outside of the reference ranges to succeed with TRT. Gels can get you well within range. It’s also applied daily, so it is a good mimic of natural production.

I used axiron, getting well into the 700 TT range. It’s definitely worth trying and seeing where your numbers land and how you feel.

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That’s reassuring, thank you! Did you take any ‘health’ supplements alongside the gel? I assume as such a low dose shouldn’t need to.

There are very few “supplements” that do anything in my opinion. A good multi and some whey protein are about all you need.

Good diet is where it’s at.

Try the gel for 6 weeks and get bloods. See how you feel.

My dad has been on androgel for well over a decade. Maybe closer to two. He’s now 80 and looks about 65ish. Still sharp. Still great shape. It’s like he hasn’t aged. I just wonder how much of that is attributable to the gel he’s been on.

Agreed on the diet front, many thanks for your help. Did you have any fertility issues on the low dose gel?

It will likely shut you down. Your sperm count will be greatly reduced, yes.

However, some men report conceiving while on TRT.

Any idea how long this usually takes? I guess it’s very individual? Apologies for all of the questions

How long what takes? You’ll be shut down very fast i’d say. Maybe a week?

Fertility. Thanks for that, appreciate your time.

I’m no Dr but its not rocket science to see that your Free T is in the basement and your SHBG is super high probably binding up all your Testosterone.

You need a Dr who recognizes this. Boron supplements reduce SHBG. That, coupled with twice weekly shots would make a huge difference in your life

Weed, porn, meth, alcohol? If so how often?

The NHS doesn’t have the best treatment protocols for TRT and generally I advise patients to look elsewhere for treatment (Balance My Hormones in Dorset). The T gels don’t really affect SHBG levels much, however the injectable testosterone does suppress overly high SHBG quite well in most cases which is what you want.

The gels work quickly and stable states are reached much faster than with the injectable testosterone.

It would appear your doc is not very well informed, but is nice to see he is at least willing to treat you where most docs would leave you out to dry.

As for the ance, normally ance is a problem when one’s hormone levels are high.

None of them. Alcohol once a month at the most

Watch porn here and there, but rarely

Thanks much appreciated.

Given my hormones are low I can’t understand the acne. Maybe it is totally unrelated