T Nation

Raising TRT "Naturally" Without TRT?

TL;DR below

Just found this community and I’ve been reading a lot of helpful posts here so thanks for that. I’m right at the edge of considering going on TRT as I have been working for over a year with one of my doctors to raise my levels “naturally”. Looking for some advice on how realistic this is based on my current health state (I will post my labs below)

Just a quick background, 38 year old male, 5’7" currently 170-173lbs at about 19%BF. From 2012-2016 I worked a rotating swing shift working days/nights 12-14 hour shifts. During this time I gained about 30lbs (heaviest was 190lbs) over theses years while working a physically demanding job and watching my diet, was going through family stress as my wife was working full time, doing her masters degree and both of us taking care of our two young boys. I was experiencing mood swings, brain fog, up and down libido, pre hypertension and a lot of fat gain in the belly area specifically. I took a lot of brain support supplements, libido “herbs” and alcohol to try and maintain. I ended up researching hormone issues and went in to see a physicians assistant who begrudgingly ran a testosterone panel (only total T and Free T) which was low somewhere around 300 total T (i don’t have my records from that test) of course she said I was normal. By the end of 2016 I changed departments at my company and am on a 4 day, 10 hour shift schedule no nights, got fed up with this doctor and am currently at a private clinic that does “functional medicine”. There is a Naturepathic doctor and a regular doctor there that specializes in mens health and Testosterone optimization among other things. October 2016 I had the naturepath doctor run a very large panel, Total T and Free T were sub clinical, low vitamin D, sub clinical hypo-thyroid etc. He basically prescribed weight lifting and good diet including stopping the beer to raise my T.

Fast forward to this year, I checked back in with this doctor after almost 3 years since seeing him. Been regularly doing strength training 3xweek and some form of cardo/HIIT about 2xweek which is usually Krav Maga or HIIT class. Dropped weight from 190lbs to where i’m at bouncing between 167-173 lbs which I seem to plateau at this weigh. Been taking iodine, zinc, Ashwaganda, multi-vitamin etc. Still experiencing all my symptoms. Just have had an over 2 week period of Zero libido, couldn’t get it up even with the herbs that usually make me hard all day long, my dick actually felt numb to response. I have most of the stress out of my life and have cut back a lot from the alcohol. Got labs done again, things minimally better, vitamin D improved quite a bit.

TL;DR what do you guys think of the chances of naturally recovering my hormones and quality of life? I wanted to do this naturally and not be on medication for the rest of my life but I am getting closer to biting the bullet and going TRT route.

Labs 10/10/2016 (Huge panel, I’ll post relevant)

TSH 4.79 Ref. .450-4.50
T3 3.4 Ref. 2.0-4.4
T4 0.88 Ref. 0.82-1.77
Vitamin D 17.7 Ref. 30.0-100.0
Total T 369 Ref. 348-1197
Free T 15.6 Ref. 8.7-25.1
Estradiol 17.2 Ref. 7.6-42.6

Labs 2/12/2019

TSH 3.310
T4 1.11
T3 3.1
Vitamin D 32.6
Total T 430.1
Free T 16.2
DHT 26 Ref. 30-85
DHEA-Sulfate 426.8 Ref. 102.6-416.3
Cortisol 14.7 Ref. 6.2-19.4 (AM)
Estradiol 29.8 Ref. 7.6-42.6

This is a trend. Many general doctors do not seem to care about this issue, and many just think you are trying to get “juice”. Problem is that it really is damaging to be shamed for asking for testing for those who really need it.

Your Free T is not horrible. Your last two tests you averaged around 16. Many men on TRT don’t feel much better until they get to mid to late 20s. I think it is doubtful you will get there naturally.

Clomid could be an option. HCG is also an option. I would probably use HCG over Clomid (Clomid can raise SHBG, which lowers free T, but can increase total T so much that Free T increases). With one of those it is feasible that you could get to good Free T numbers since you are not totally in the gutter.

Your DHT is pretty low. That is related to libido. Are you a hairy person? Just curious mostly. My DHT was low, and no hair loss, but very little body or facial hair.

You’re not sub-clinic hypothyroid, your TSH indicates full blown hypothyroidism. Hypothyroidism starts out with elevated TSH and normal thyroid hormones, the problem is lab testing is not showing what’s going on under the surface.

Your previous doctor who said your testosterone was normal is clueless, endocrine society defines low testosterone below 300, if you do not fall below this geriatric level, you do not have low testosterone, in reality this is not necessarily true.

Men can increase their testosterone a little bit, but men almost never see testosterone increase from 300–>800 naturally, it’s a fantasy. Most men struggle to increase Free T to the optimal ranges as seen early in life, you’re 38 years old and seeing a natural decline.

Testosterone and the Heart

Testosterone (T) has a number of important effects on the cardiovascular system. In men, T levels begin to decrease after age 40, and this decrease has been associated with an increase in all-cause mortality and cardiovascular (CV) risk.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

The locally weighted regression showed that total testosterone levels of 440 and 480 ng/dL were associated with increased Framingham CVD risk and an increased probability of increased hsCRP, respectively. Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk.

The endocrine society according to these studies is wrong to choose the cutoff point to be considered low testosterone at <300. There are no studies showing 300 to be the place at which low testosterone is experienced, this number was chosen to restrict TRT usage do to bias and save on healthcare costs.

You’re at risk for cardiovascular disease at these testosterone levels. Your chances are increasing testosterone to the optimal ranges at a time when your natural production is on the decline do to age is next to impossible. Vitamin D is low, you need to supplement.

If you do not address your thyroid and optimize levels, TRT can not work.

TSH is high, but I think OP needs to test FT3, and RT3 to get a good picture. One case TSH is out of range, the other it is in range (but still high).

I’ve been reading some posts on here about some relationship between testosterone and thyroid, I’ll have to look into this more. I think it’s time to talk to the hormone specialist at the clinic I’m going to as my current doctor can’t prescribe Rx and is pro “natural” route

I have male pattern baldness/thinning going on but I’m pretty hairy overall, can grow a thick beard

Didn’t pan out. Head hair and body hair are impacted by DHT, but also are highly impacted by genetic predisposition.

A truer hormone specialized would never allow a TSH as high as yours to go without some form of action, hormone specialist gets thrown around a lot, most often the title is not justified and the person is anything but a hormone specialists.

The hormone specialist didn’t “allow” anything. I haven’t seen him yet , if you would have read the post or my replies. I was seeing a naturopath who doesn’t prescribe drugs. I’m in Alaska so there is only one private clinic I know about that will do TRT if you are not below the lab reference which we know is bs. I am planning on making an appointment this month to look at my Thyroid and hormones with the specialist.