T Nation

Things We Do BEFORE Rx Testosterone

Since so much stuff in this forum gets lost in multiple threads on people’s individual cases, banter back and forth, and all out BS said by “experts” here - I wanted to write a little about what we do in our practice BEFORE we ever write a script for testosterone therapy.

  1. first and foremost we run comprehensive labs - blood for thyroid, metabolic, lipid, etc (all your health markers). Urine for cortisol and sex hormones (about 99x more accurate and informational than blood as it gives you a four time look into every sex hormone as well as how each patients body is metabolizing them (this is EXTREMELY important as it tells us which detoxification pathway your body is preferring. I will attach a patients lab so you can see the kinds of reports we get.

  2. food / lifestyle logs. I want to see how each of my patients eats and lives.

  3. food and environmental allergens screen - food sensitivities and environmental allergens can play hell with your hormones. I want to see where my patients are having issues

  4. basic health inventory and bodyfat assessment - don’t need an explaination here.

Guys - if you go to a doctor with a hormone deficiency and you get a script without a root cause investigation, 9x out of 10 your therapy will fail. You will end up on a cycle of constantly crashing or jacking your estrogen out of a good ratio, raising and lowering your testosterone , and requiring ancillary drugs to counteract your side effects.

In my practice we address the underlying issues. If someone is overweight (.most guys with low t are) we address that first. I will not put anyone over 19% BF on testosterone. It won’t work well and in fact will end up worse than before they started. We make lifestyle changes first. We address sleep, fluid intake, recovery, stress, adrenal health, liver health, and emotional well being first. Once we treat these issues about half my patients don’t end up needing androgen therapy. When they do, their body is primed to use it. This is why we don’t need to script anti estrogens. My patients body’s are primed to use the drugs.

When I hear shit on here about “most people need an AI” or “shbg is the gold standard test” for therapy I want to scream. Shbg can change as much as 49% every single damn day based on a multitude of factors. What matters most is discovering someone’s underlying metabolic conditions and the ways in which their bodies eliminate hormones so that we can tailor a treatment protocol for them.

Attached are some sample labs from DUTCH. Try finding this info from some bs blood draws / pro tip - YOU CANT. Start taking your own health seriously. It isn’t about testosterone only. Or simply hormones. It’s your entire lifestyle that needs to be analyzed. I bet 50% of guys on this forum don’t need drugs at all. Also guys - If you can’t get your dick hard, have no sex drive, etc, don’t immediately assume “my protocol isn’t right”. It’s likely a combo of you stressing yourself out and environmental toxins and neurotransmitters being off. So stop chasing numbers. That is all for now.

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Does this mean I can get off TRT? what is the chance I’m one of these guys? High, low, moderate? I have no issue with being on testosterone replacement (esp because I want to be a competitive bodybuilder) however if I don’t need something I don’t see the point in staying on. I get the feeling I probably do require trt however what if I don’t? Is there any way I can figure it out? I’ll just give some bloods, from like five months ago (been on trt for like six months at this point) This was five days (or six?) after a 250mg shot of sustanon I believe

Total testosterone: 19.7nmol
Free testosterone: don’t remember
FSH: 4.7
LH: don’t remember
SHBH: also don’t remember something like 19

I’m gonna look for the bloods tomorrow, it’s late now.
@physioLojik

This is great info @physioLojik. But what about those of us who are older and have been on TRT for over 6 months. At this point if the doc didn’t do their job correctly aren’t we fucked? Haven’t we facilitated hypogonadism at this point? I mean maybe my doc was quick to allow this and didn’t get the proper tests. All I knew is that I felt way better and honestly testosterone saved my marriage because I was feeling so awful. I am a new man. The fat is slowly coming off and all I can do is put in my 4 heavy lifting days, 3 HIIT days, get sleep, cut down the booze, and concentrate on my food. Im down like 5 or 6 belt loops and the only thing different is my TRT. I mean my lifts are all up too and I hit two PRs last week in the gym…at 46 years old. Everything feels pretty good.

So with that being said all I can do is forge forward and try to make the best decisions for my treatment.

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Heck man that’s amazing progress! If you’re feeling good and things are getting better there’s zero reason to change a thing! @NH_Watts

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@physioLojik so should I go with tamoxifen over anastrozole?! :lol:

id rather see you use 10mg tamoxifen over an AI

@physioLojik thanks. Is that a daily dose?

I would like to say that if this was the case I still wouldn’t put the blame solely on the doctor. Doctors have to mesmorize a metric fuckton of information therefore one can’t expect anyone to make the right decision 100% of the time, everyone will make mistakes from time to time. However I’ve now gotten myself all anxious thinking what if I didn’t need TRT… Must… Nap it off, will be asleep for a few days (just kidding), I’ll resort to my anxiety relief antidote… Baklava

Given your history you do. @unreal24278

@NH_Watts yes

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This information is amazing, thank you for sharing.

Makes me feel a bit like @NH_Watts and wondering about the different path of investigation my urologist took before prescribing testosterone.

I was 40 when the problems started (42 now) and my main issue was ED, so it was 3 blood tests 3 months apart to look at total testosterone, LH, FSH and Prolactin. With an average total testosterone level of 244…LH, FSH, Prolactin all in range, he moved to a penile doppler which found I had a venous leakage. He referred me to a neurologist to have an MRI on my lower back to be sure my nerves were working correctly. After the MRI came back fine, he prescribed testosterone replacement.

Being 100% uniformed at the time, and seeming like the doctor did his due diligence, I just trusted the doctor and the prognosis. Now, being on testosterone for 9 months (feeling real good most of the time by the way, sometimes too affectionate for my wife’s liking though) I wonder if there is still time to get to the root cause of my low T?

@physioLojik, do you take insurance and offer remote analysis of people like what you’ve posted in this thread? I’ll send a jug of pee… Haha. Can’t hurt to ask.

Either way, thanks again for all the info you post here, much appreciated.

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So I should stop taking a pound of iodized salt and taking my temperature 12 times a day rectally? Blasphemy, don’t try to impress me with all that knowledge and thick thighs.

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I had Ed sporadically during a 6 month period. Never measured t. Then all of a sudden anxiety, mental breakdown, hot flashes, insomnia, heart paps, high BP, total Ed. At onset of these symptoms my t was measured at 440. Then 2 more times within 3 weeks below 300.
Endo prescribed t but not sure if right decision since the worst symptoms were sudden.

Sounded like andropause to me. Docs actually investigated me for carcinoid tumors.

@physioLojik

Salt and butter are my 2 favorite things…add another 1/2 lb salt for good measure.

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Do you still have those symptoms now that your on T? Those sound like terrifying things to have happen all of a sudden. Hope you are doing better man.

Yeah. They were getting better b4 trt. T went up to 380. Cardiologist gave me Xanax to help me sleep cause I didn’t sleep well for 1-2 weeks because of the symptoms. I never had a mental breakdown. Never took xanax but it took me out of that cycle I was I. I don’t take it anymore.

Symptoms started beg Oct injections early December. I have more hair growth in areas I already had hair. I feel really good. But felt really good a year ago too. So confusing.

One thing in addition. I had lower back pain since 20s am 41 now. The trt seems to have elimated it. Also when my t was below 300 my e2 was below 15

I had all those same symptoms Charlie. I would start sweating terribly for no reason, heart rate would spike, Anxiety would increase, then some of the ED symptoms as well. My T measured in the mid 200’s both times when the doc prescribed T for me. I had seen multiple docs, some were telling me it was depression, and trying to get me on anti-Dep drugs. I went with medical MJ instead. That helped sort of. It is crazy how similar all the symptoms are.

Do you get really bad heart burn too?

I don’t think I had stomach issues or heart burn. But who knows I was miserable. Basically I think I need trt but want confirmation I guess. I tried clomid right b4 trt got me to 500 t. Wasn’t feeling right.
When I think back now my dick never hung right you know it always crawled up. Mustache never really grew full. But I was always horny guy. Still am.
Did your symptoms start suddenly to?

Some of the symptoms popped out of no where. Like the sweating, heart palp, anxiety, a lot of the other stuff was building. I use to compare mine to a prairie dog popping its head out. I started to believe all the symptoms were related to heartburn and digestive issues. Then the Low T diagnosis helped. Heartburn is under control, weight is coming down, everything seems to be re-aligning.

The prevailing thing I keep seeing with patients as well as you guys is sympathetic nervous system dominance and likely excessive cortisol. Check the colleciton of symptoms.

Ill answer more in the next few days. Getting ready for our move :slight_smile: