ok, my turn.
You can go after the workout and diet issues, but the success of your TRT is probably not at hand yet
Working out is inconsistent with transdermal(TD)T is you are going to sweat a loose it. Some simply don’t absorb TDs. Those who are hyperthyroid are well known non-responders. Some absorb ok to start, but the T changes their skin and after a while its a bust. Some do well. Some can’t stand rubbing a mess on their skin every day.
TD TRT can be a bad combo if you are in contact with the kids. A little transfer of T to your wife might be a good thing
If any TRT works, your HPTA, hypothalamus pituitary testicular axis, will shut down. The pituitary stops producing LH and your testes stop working. Then the testes shrink to a greater or lesser degree. A few will feel a 24x7 ache in their tests, most feel nothing. The scrotum will pull up tight. Some docs will prescribe HCG that you can inject under the skin. But it does not make sense to inject HCG then do TD TRT to avoid injecting T.
Many docs don’t want guys self injecting, for some reason. You may need to fight to save your testes. Many docs do 250iu SQ HCG twice a week, but EOD (every other day) is better. Many who have been on TRT then intro HCG report an improvement in mood.
If you don’t care about your testes, no problem, skip the HCG. Some will use HCG if they plan on having [more] kids. Your wife might have some thoughts about what your baggage looks and feels like too!
TRT that works well typically leads to increases in estradiol (E2). The testosterone is automatized, mostly in fat tissues, by the aromatase enzyme. For those that are fat, it happens more, and more E2 leads to more fat and more female butt-belly fat pattens. While TRT will often lead to fat loss and fat reapportionment, there is still the threat of E2. A guy can be on TRT and get high T levels, perhaps 1000pg/ml but feel like crap and have low energy and libido because of E2 that is elevated, even still in normal range.
Many docs are useless and will tell you that your E2 is normal and will ignore all of the symptoms that you describe… need a new doctor. You do not want a doctor that treats your lab work and ignores the patients symptoms.
To reduce E2, you can take an AI, aromatase inhibitor, Arimidex/anastrozole is the best, but costly. Typical starting dose is 1mg/week, not much but $9.00/1mg at the pharmacy. There are cheap alternative sources for this. Depending on weight and %BF you might start with more.
The lesson with E2 is that even with high T, elevated E can make you feel worse than when you started TRT. It can be the critical success factor.
So most probably need TRT+HCG+AI.
Costs: If you have, or can get, or can sign up under someone else’s, a Sam’s BUSINESS membership, injectable testosterone cypionate and HCG can be dirt cheap there, as well as syringes. Self injections are not a bad thing and many here who were needle phobic [me] went for injections because it simply works better. So don’t be closed minded to self-injecting. And you can use small insulin needles for injecting HCG and T. You don’t have to stick 1.5" needles in your butt!
TD TRT is way more costly than injected. Some insurance will not cover hormone replacement. Some will not cover injectables… things to find out. If you have to buy your own injectables, its no big deal.
So that is the condensed version… things for you to think about and research. If TRT is anything, it is learning.
Expect to see a major drop in LDL with almost no change in HDL. Some with high total cholesterol will get a major change and will not need to use any statin drugs.
Weight loss should be easier or spontaneous if E2 does not interfere.
If you still feel low energy when TRT levels are well up, have your thyroid levels checked, TSH, FT3, FT4.
If the TRT is working, libido can go through the roof. (I hope that your wife is understanding, perferrably enthusiastic.) As the body gets used to the new game, that will level off. But if libido crashes in 6-8 weeks, that is elevated E2 at work. Getting hyper-sexual then loosing it all can be a cruel joke. That is why I want to see guys start TRT with AI from the start.
If you are a non absorber of TD, now or after a while, all the more reason to check thyroid levels.
T can lower blood pressure by changing the tone and function of the muscles in the arterial walls. T also improves endothelial function. Arterial disease processes are driven by endothelial dysfunction.
You need blood tests that include PSA and have a DRE, digital rectal exam, once a year. Should be comparing pre and post PSA levels.
If you don’t have a lot of body hair, that can start to change.
If needing to loose weight, TRT will allow for gaining muscle that burns calories 24x7. The legs are the largest muscles and the easiest to build - work them. Low T is characterized by loss of muscle, perhaps with no net gain in weight as one replaces muscle mass with flab. You can see some huge improvement even if you don’t get bulk.
Some start to snore on TRT, this can pass. I had a few leg cramp issues, that passed. Expect to see some sorts of things that you were not looking for and ride them out.
Some will get acne. If you had that problem when young, might come back. Loosing hair? Expect to loose more.