T Nation

Should I Get on TRT?

Im 35 M and have noted a drastic change in the past few years. I’m 5’7, 165 around 15% body fat. I try to exercise at least 3-5 times per week and it includes lifting weights, boxing, yoga, and tennis. No kids. Not married. May consider freezing sperm- I guess.

Physical symptoms: fatigue, lack of energy, poor exercise tolerance, not much muscle tone nor results from working out. Erections are good (prob 70% of what they were but it takes me a while to get there and I do have to really be in the right state of mind- def takes time nothing like the immediate hard-ons I had in my 20’s). I really have to push myself beyond 20-30 minutes of lifting weights when I exercise.

Mental symptoms: lack of motivation, diminished libido but not bad, definitely much less assertive/confident, mild chronic depression and anxiety.

I decided to get some blood work:
Total Test 351
Free Test 41 (L)
Ultrasensitive Estrogen 7
TSH, T3, T4 all normal
CBC Normal
Liver, kidney creatinine normal
Cholesterol panel normal
ESR/CRP WNL
Vitamin D 15 (very low)

I did not get an FSH and LH.

I’m seeing a urologist next week- he briefly mentioned clomid which I am reluctant to take based on my research and on many of the posts on this site. I feel overall healthy but just tired, depressed and not very motivated. Been feeling this way for a few years and I have no history of depression. My dad is 70 and his total Testosterone is 301 and his free T was 51.

Any suggestions? Should I just take some zinc and vitamin D and see if lifestyle modifications can work? Bite the bullet and request TRT?

Some people on another forum have mentioned my estradiol is very low. This was from the ultra-sensitive Estradiol test.

This would be the logical choice given those labs.

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Avoid clomid, total waste of time. I seriously wonder if endos really think it helps people or if it just covers their ass

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It’s a tough call for some because it is for life. I had labs much worst than that before I finally bit the bullet. I tried every test booster and natural remedy I could but nothing worked. After 4 years at age 52 (I’m 61 now)I finally started trt and although its been a journey its been the best health decision so far that I have made. I wished I had started sooner.

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The labs ranges for estrogen per Labcorp for the sensitive method are 8-35 pg/mL, this is including the ranges for pre-puberty boys and adult men. A boy hits his teenage years, testosterone substantially increases along with estrogen.

As with testosterone reference ranges, age must be accounted for in every instance. Just talk to anyone on TRT who was prescribed an estrogen blocker right off the bat and had their estrogen reduced into the single digits.

Let me just say it’s not pleasant and I am amazed you don’t feel ten times worse. Most men can’t get an erection at all with estrogen at 15 let alone at 7 pg/mL and feel like they are dying.

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You’re on a TRT forum talking to a bunch of guys on TRT. Your levels are poor for someone in their 50s. At 35, it’s not like they’re ever going to be good, even if they improve some. This is optional, however, and plenty of guys simply live like this and accept it as part of the aging process. As you said, you’re not in your 20s anymore.

Clomid is fine, short term. But, it’s not as though you’ll go on it for three months, fix everything and have numbers stay in the 700-800s after stopping. I would not waste my time with it for other reasons as well.

You look like a perfect TRT candidate to me. I think you’ll find the benefits to be life changing. Good luck going forward.

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whats hard is that these symptoms are pretty general and non-specific. Perhaps its stress or diet or whatever who knows? I have always run a bit low on the Testosterone and Estrogen side. 2 years ago I checked it when I was 33 and it was around 400 with a regular estradiol (not ultra-sensitive) of 25. Im not as concerned even about the muscle tone and gym gains as I am about the fatigue and just lack of motivation. I used to be very competitive and ambitious and now I’m neither at all. Def much less decisive, depressed off and on as well as pretty anxious. Right now I am just using the whole economic mess caused by COVID to make sense of what is going on in my body- perhaps its stress.

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In combination with those numbers the symptoms are pretty clear and not general at all. Your testosterone and estradiol are terrible and you have the signs and symptoms of deficiency, as simple as that

I will say hello to you in old polish style:blessed be Jesus Christ

you should def. test fsh,lh, prolactine (beacuse you excersise a lot, so ithink it may be raised),progesterone, estradiol, testosterone,cortisol-all at once
without this, we dont know how to deal with problem and cant find solution

Just saw the urologist. He mentioned my level of 350 is lowish-normal for someone my age and he suggested an in-office injection of 200 mg of Test Cypionate to “see how I felt in a few days” to determine whether we should continue. This didn’t make much sense to me since most of the results of testosterone take time and you can’t rule out a placebo effect so I said I would think about it. what do you guys suggest? he also suggested that TRT doesn’t really improve erections or ED because “that is much more of a vascular issue.” thoughts?

Not with 35y/o, 165lb, normal lipid guys.

Oh boy.

What’s a “few” days?

You may have to tell him you feel better just to tell him. Get the prescription. Tell dr you would like to self inject.

Hopefully he gives the 200mg a week. Then you have enough to play with to get the right dose. I would take closer to 120 a week and reassess in 8 weeks.

He obviously does not know trt. You will not stabilize till about 6-8 weeks of a consistent protocol.

yeah I’m not sure this guy knows what he’s talking about. He mentioned that “200 mg once every 2 weeks is the standard dose.” I doubt he will understand AI’s- I showed him my labs with an estrogen of 7 (ultra-sensitive) and he made no mention of it. He didn’t comment on my free T at all which was low even by the lab’s standards. Im starting to realize finding someone who can even interpret your labs is hard. I don’t think traditional urologists or endocrinologists get trained in this.

According to what he has been taught, that is correct.

Which is fine as you do not need to use one.

Once again, they are not taught to look at it.

Yes on both counts. You’ll need to use a TRT specialty practice.

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What @highpull said. He’s going “By the book”, which is far from the worst thing. It may not be the best, but he’s at least open to it.

This is a red flag that your doc is inexperienced at prescribing hormones, it’s nice your doc wants to help, but his expectations are measured in days instead of weeks/months which is how long it takes for hormones to stabilize and for the body to adapt as your natural production is being shut down.

So you see progress takes longer than a couple of days, so your docs expectations are way off and unrealistic.

If ED issues are due to low-T, then your erections will improve. It all depend on what’s causing the ED.

Your doc is doing things by the book, sadly this almost always leads to suffering. I see many new members come here that were started on these every 2 week protocols and they don’t understand why TRT isn’t working.

The standard protocols are outdated, you need a doc that lives and breaths TRT, one that is more up to date or has a personal interest in learning how to prescribe TRT.

A lot of us have had to figure out our own dosing, some without the help of our docs. None of my endo’s are really well versed in prescribing TRT, one doc to the next are doing things drastically different and no one is on the same page.