T Nation

Start TRT or Not?


I am 29 years old, 6’1, 220lb, about 18% bf, I’ve had a visit to a TRT clinic due to some symptoms that i have been dealing with over years, after giving blood work my test level turned to be 213 only
LH 3.3 mIU/mL 2.8-6.8
FSH 1.8 mIU/mL 1.3-11.8

The clinic suggested that it is way too low and i should start a TRT, 200mg test, twice a week, and also HCG weekly. along with estrogen blocker pill, i think one per week.

I am a little bit concern whether i should start TRT or not, mostly because of risk of infertility in future.

The symptoms that i am having is mostly lack of energy, inability to build muscle mass even that i worked out for the past 4 years, and also weight gain issues and the round edges appearance (sucks), whenever i lose weight i end up recovering everything rapidly after the diet. the main concern here is my appearance. i don’t care a lot about the rest.

As for libido it is pretty high at all time, but some ED issues now and then, Viag usually solves it.

Thought about using TRT as a cycle for 6 months to change the body appearance but a lot are saying it is not going to work that way.

Would appreciate any advice on what to do at this point and whether its worth it and if infertility is really something that needs to be concerned. any advice is appreciated.



Your labs are inadequate, you simply need more labs. A low functioning thyroid can cause fat gain as well as low T, many who come here have hypothyroidism and low testosterone. Do you consume iodized salt? Thyroid requires iodine to function properly and can become diseased without it. Check oral body temps per thyroid sticky.

If this is all the labs this clinic ordered it is setting you up for failure, these T mills keep the real hormone specialists busy from screwing guys like you up. The dosages this clinic is suggesting is for someone with very high SHBG and I’m betting you don’t know your SHBG level.

These T mills like to over prescribe and go aggressive on protocols for everyone because of profit from selling drugs, you require individualized care and a protocol needs to be tailored extensive labs looking at all your biomarkers.

Most elderly healthy men have higher hormone levels than you do. If missing any of the labs below, you are about to descend into hormonal hell. You don’t take an estrogen blocker one weekly, this would result in varying estrogen levels during the week and would never reach a stable level. This T clinic screams inexperience.

It is very likely you won’t need Viagra anymore one you spend a couple months with your hormone levels in the 600-800 ranges. At your levels it’s amazing you have erections at all. Targeting an E2 levels of 22-30 pg/mL will be critical for erection quality using the E2 sensitive LC/MS/MS labs. Most clinics use the wrong E2 labs designed for females.

Total Testosterone
Free Testosterone
Estradiol (E2)
LH-Luteneizing Hormone
FSH-Folicle stimulating hormone
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel


I agree that some of TRT clinics are trying to make business. I’ve had two full blood work test, one was in a foreign country and the other was at the TRT clinic that i mentioned, both were full tests, not just Testosterone.

The one i had outside of US was with a primary doctor, it did included full thyroid test, and i was indeed concern about that too. the doc said “everything is normal” the Testosterone showed 340 there. I am sharing all details below.

The one i had in US at the TRT clinic was 3 months after (i dont have it handy right now), it also showed normal thyroid values, however i remember the cholesterol was high. and the clinic doc highlighted it. but didn’t commented much on it. maybe because i had breakfast before the blood work. not sure. I did research at time and found many articles advising that taking Niacin would balance the cholesterol level, i started taking them on daily bases for 2 months, still gained weight. no much difference. i also take multi vitamins every day. nothing seems helping and i look like chit.


You’re still missing the most important test of all, SHBG regulates and activates testosterone at receptor sites. You’re also missing estrogen labs. You don’t have it so it will be difficult to even to tell how your body holds onto testosterone, it dictates dosage and injection frequency. This one test would have allowed us to determine if the dosage is right for you and how many injections per week you will require.

None of these doctors understands male hormones if they are missing the most important test, it would like a mechanic not knowing what a ratchet is used for. You can’t start TRT blindfolded. You don’t even know where E2 levels are prior to starting TRT, you can’t determine AI dosing without this test.

It seems like the clinic is starting you out on a cookie cutter protocol designed for everyone. If everyone was a clone of the same person, this practice might not be so bad. No one injects HCG once weekly or takes an AI once a week, those that do find their way here wondering why they feel so terrible.


Yeah you’re absolutely right. Right now i live in Netherlands, and there is no TRT clinics here, and most of doctors do not have much experience with TRT. What i am planning to do is to order my injection packs from the US (the clinic has already said that they can ship them to me). meanwhile i will do a full blood work and post the results here, hopefully I can get some help here.

So beside Test, HCG and Estrogen Blocker, is there anything else i should ask the TRT clinic to send me in meanwhile?



I’d suggest you don’t order any TRT medicine at all.

You need to do the thorough blood tests first to see what the problem is & what solutions will suit you.


Alright, i will go for these blood work tomorrow:

Total Testosterone
Free Testosterone
Estradiol (E2)
LH-Luteneizing Hormone
FSH-Folicle stimulating hormone
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel

Will post the results here.


I was able to do a new blood test here in Netherlands last week, it was such a pain in the butt to find a clinic that is familiar with such tests, they done the test and somehow the result was missing the free and total testosterone level. they said that they somehow missed them. I however was lucky enough to get the blood test result that i had in US from the TRT clinic. they sent it to my email. so i am attaching both results, the new one without free/total testosterone and the older one with free/total testosterone.


US Test: https://www.dropbox.com/s/6k6tt03rur35hzn/US%20test.pdf?dl=0
New Test: https://www.dropbox.com/s/pj8rum8iybz16e9/New.pdf?dl=0


You’re still missing thyroid labs, you never ran a thyroid hormone panel. TSH is a poor indicator of thyroid status, it can appear normal when thyroid hormones are not. Anyhow TSH isn’t optimal. Test is very low and E2 labs are for females, you need the LC/MS/MS method which you must specify when ordering otherwise they will run the female E2 labs. No SHBG either.

Roche ECLIA methodology is for pre-menopausal women and children.


I gave them the list that you gave me:

Total Testosterone
Free Testosterone
Estradiol (E2)
LH-Luteneizing Hormone
FSH-Folicle stimulating hormone
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel

I see “thyroïd stimulerend hormoon” result on the results list that i sent here, but nothing else. Have you seen my first post test result? that one include a lot of thyroid tests, it is in my third reply in this post. do you see the thyroid results there?

I don’t know what else to do at this point man, doctors are retarded here.


HTC, hematocrit is quite high for low T.
You need to avoid high T doses as your HTC will be too high.
This is big problem.

TSH should be closer to 1.0
Forget “normal” as thyroid ranges are quite useless.
Get oral body temps, note that two sets are requested, see below.

When testing cortisol, get “AM Cortisol” done at 8AM or one hour after waking up. Results from later in day are mostly of no use.

Cholesterol and glucose need to be done ‘fasting’, in the morning with no food, just water.

DHEA Sulfate not shown, on a different page?

You need to test prolactin to see if that is the root cause of your problems. For a few days before the test you need to avoid things that cause prolactin release: orgasm, hugging {babies, puppies, kittens etc}

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


I admit I screwed the pooch on the the E2 recommendation, left out E2 “Sensitive”. If you had done the E2 Sensitive it would have showed even lower, so we know it’s low in your case because T is also low. You will have to donate blood on a regular basis while on TRT do to your hematocrit being high with low T.

It would be nice to know what SHBG sits at because if lower smaller injections EOD could help out with your high hematocrit versus larger doses less frequently. I don’t believe you have high SHBG, your Total T and E2 are both low so this might suggest SHBG is lower. I would inject 15-20mg EOD. We really prefer to use Total T and SHBG to get our free T percentages.

The half life is very short so free T measured directly has it’s problems. Sleep apnea could cause your hematocrit to be high, you should get a sleep study done.


Thanks for the info,

I think hematocrit is high because i am a smoker (about 10-15 cigarettes a day) probably i should stop if i start trt. most of the tests were done in morning and i don’t eat breakfast anyway.


Well, i can’t imagine myself donating blood. I was saying about that maybe hematocrit is high because i am a smoker?

What is the overall impression? would you start trt if you were in my situation? or you would live with some shitty symptoms? mainly lack of energy, a bit of overweight issues, ED problems.

I understand that i need to do these tests as well:

DHEA Sulfate
Checking oral body temperatures (not sure what is this exactly).
And preferably SHBG, LC/MS/MS

But is there any suggestion / impression that you guys can share with me right now based on the current results?


If you start TRT now hematocrit will shoot up and blood donation won’t become a choice, otherwise doctors will stop TRT. Your levels are low enough to cause heart problems, cardiovascular disease, dementia and alzheimer’s. You have some decisions to make regarding your health.

If I were you I would quit smoking, go on TRT and donate blood regularly. Checking oral body temps using a glass thermometer (not digital) upon waking an 2pm, you should get to 97.7 upon waking and 98.6 by 2pm.

I spent 10 months in 2015 withdrawing off Klonopin after 30 years so I know quitting smoking won’t be easy. My testosterone production never recovered and is why I’m need TRT.


Thanks man for sharing your thoughts. I think i need to make some decisions here.

Yeah i will find a glass thermometer, why is it useful? usually the body temperature is very warm at all time based on girlfriends comments.


Your body temps are directly connected to your free thyroid hormones, mainly Free T3. If body temps are off even a little, then Free T3 is not normal. Girlfriend could have hypothyroidism and lower body temps than you do making you feel warm to her when if in fact you’re low as well, just not as low as her.


What did affected your testosterone production in first place? smoking?


Withdrawing off of Klonopin damaged my pituitary gland.


Yeah i was wondering, because i remember i read that smoking actually increase the Testosterone in some people. not for me.

I used to smoke since age 17, now i am 30 almost, I quit smoking a few years ago for 2 full years, never easy, but started smoking again. should be easier this time i guess.