T Nation

Starting TRT When Obese

Over the last 15 years I’ve probably gained and lost 50lbs 10 or so times. I’m currently 280ish lbs. I fluctuate between 250-300lbs. Typically once I hit the 250 mark I stall out and lose all motivation to continue and fall off the wagon. I carry all of my weight in my chest and stomach.

To lose weight I use a keto/low carb approach.

Would trt help get over the hump?

Tt 330-568 3 tests over 3 years
Ft 55-88 same
E2 19 checked once
Shbg 36 same
Prolactin 13 same

It might. Loss of visceral fat is one of the more common benefits seen when increasing testosterone.

Free labs are useless without reference ranges. Thyroid problems can cause weight issues, I suggest you get some thyroid labs = Thyroid Panel -> TSH, Free T4, Free T3, Reverse T3 and antibodies.

Ft pg/ml range 35-155. Sorry about that. I will have to investigate thyroid labs because all I have ever gotten is tsh levels checked.

That’s alright, the ranges are not especially important in your case. You would be increasing testosterone to help you lose bodyfat. Based on the history you provided, I’m assuming you are middle age. Are there other lab tests, particularly lipids and glucose? Do you have any other symptoms relative to testosterone?

These labs are from September. I had an hba1c done in October and it was 5.5% but I was keto for most of that 3 month span.

Symptoms: brain fog, low energy/motivation, anxiety, concentration. I’ve dealt with anxiety my whole life, but the brain fog has been an issue for the past 4 plus years.

Maybe…you don’t mention your age. You will have to find a doctor that is willing to start you on TRT with a Test result of 568. Do you have morning erections on a regular basis? Have you heard of Resveratrol? Resveratrol is a natural Aromitase Inhibitor and may help to increase T levels by slowing its conversion to E2. There are other options (research chemicals) but not always the best for everyone.

Morning wood is hit or miss. No ed issues. I’m 43.

The 568 and ft of 88 was taken a couple weeks ago, by a urologist. He informed me based on those numbers he wouldn’t treat me. I normally titrate between a keto diet in a deficit or a wtf ever I want diet, which obviously derails me. My theory is, now that I’m on a caloric surplus my test levels go up. Which is great, but I’m gaining weight. Once I go into a deficit my levels tank, especially my ft. So the further I get into a diet, the worse I feel, which makes it easier for me to give up.

The urologist actually didn’t seem like he would treat me based on the September blood work either.

Based on what I’ve read ft is usually 2-3% of tt. Mine is around the 1% mark. Does this mean that my t is bound up or being converted to another hormone?

Probably, SHBG would be nice to see, but not mandatory given what we know. A few things:

It appears you’ve a reasonable approach to weight loss for a long time without results. While your testosterone levels are not horrible, they’re not great or even good either.

There are too many guys who lose the mid section after starting testosterone. It’s worth trying. Health wise, visceral fat is about the worst sign for men and women. TRT may improve your lipids. You will need to find a TRT practice as it is very unlikely a urologist or endocrinologist would treat you.

I’d still have my thyroid evaluated.

Also, I don’t know how you’re paying for the labs, going forward, you do not need free PSA tested. Your PSA is not high enough to make free PSA meaningful. We’re client bill with Quest and they charge quite a bit more for PSA/fPSA than just PSA.

Good luck.

Ok, thanks for the reply. I’ve only had my shbg checked once. It was 34 in a range 10-50.

I paid for the labs presented out of pocket.

You have some options available. Telemed clinics care much less about your numbers and they’re pretty good at focusing on symptoms and the presence of money with which to pay them. You can always go that route. You can make your numbers worse by taking a few simple steps and that will give you additional wiggle room.

But none of this solves the weight issue. Trt can help, sure, but you’ve got an unhealthy relationship with food and if you can’t sort that out then you’re going to spend the rest of your life with enhanced testosterone levels and sadly a ton of extra body fat that you don’t want.

Get on trt, yes, but do not for a moment think that it’s going to fix the underlying issue. Trt is a tool. Right now you’re trying to tear down the Berlin Wall with a rubber mallet. Trt will hand you a jack hammer. But you still have a shitload of work to do, even with the right tool in your hand. So get the tool but be prepared to work hard and find yourself frustrated at times. It’s ok, as long as you keep hammering away.

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Speaking from experience. Started trt April 2020.

No. Won’t get you over the hump. It won’t lift the weights. It won’t keep you in your deficit.

I know what to do, make great progress and just stop and fall off the wagon, trt can’t prevent that.

Paying for all of it out of pocket has motivated me to not waste my money.

Once I hit 250 this time with trt I look leaner and different than the last time I was 250 I want to see what 230 looks like and I have kept going.

200mg test cyp per week. 1000 mg injectable l carnitine per day. 3mg Rauwolscine per day.

April 2020 310lbs. Nov 2020 248lbs.

First off, congratulations. That’s a big deal and you should be proud of that. Second thing is everything else you said. You chose what to eat. You chose how hard to train. You made the decisions necessary to get where you wanted to be. Trt didn’t do it for you. That message cannot be stressed enough.

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Nice! Well done ejones!

Your points are well taken and my relationship with food and training need to change. I’m probably building up trt too much in the hopes that if I decide to do it it will be a permanent change. I’ve been trying to convince myself to start trt for the past 3 years, but can’t pull the trigger.

Brain fog, anxiety, more energy, ect are also things that I would like to see an improvement on If I decide the trt route.

Again, well done on the body recomp, I truly know how hard it is.

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My current numbers are Total T 1114, Free T 28.9, and my E2 is 8.9 The original Metabolic Diet is a carb cycling lifestyle-not diet. Five days a week carb intake is between 50 and 75 grams, and two days a week carb intake varies between 200 and 300 grams (depending on body weight) I have done this multiple times, lost a ton of fat/weight, had a ton of energy, and really leaned out. This is not a keto diet, and very easy to follow. You get to eat a boatload of food, just not carby food.

I will check out the metabolic diet. Sounds kinda what mark sisson preaches.

Dr Mauro DiPaolo was a competitive Power lifter, and really changed the sport. The Metabolic Diet book, IIRC, is around 400 pages and a great read. It has it’s technical spots, but it still makes a lot of sense.

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