T Nation

Thinking About Starting TRT

About me: Mid 30s male, married with children. I live in small town midwest USA. I’m 6’ 4" and roughly 240 lbs. Not sure my BF but I’m in decent shape and would not consider myself fat, my thighs are veiny (I have lean legs) and you can see all my abs, but its still a dad bod (love handles), maybe high teens on the BF?

My health problems: Long term sinus issues. I have had a chronic sinus headache lasting over 15 years. This is a long story but equates to me being on a heavy dose of antibiotics for years in my teens because of a bad doctor. Once I came off of them at roughly 18 yo I became sick for a few months and began developing headaches. They came and went so I ignored them. By the time they became constant and severe I was too broke to go to a doctor so I dealt with them. Once I had enough money to see some doctors, because I look healthy and fit, and because I had the sinus issues and headaches for so long the docs just laughed it off and offered more antibiotics to fix my “sinus infection”. I live in a small town so I didn’t have many options for a doctor and I was still too broke to travel to a specialist. Now I finally have a doctor out of state who is actually interested in my health I am hoping to get this under control soon enough. I even have my first appointment with an ENT next Wednesday. Wish me luck.

I also have had chronic plantar fasciitis for the last 10+ years. I was also too broke to have that looked into when it started but I have made some changes to my footwear and lifestyle and it is tolerable. Running is still totally off the table and standing or walking for long durations is a no go, but I manage well enough on this front.

Now on to my symptoms and my thoughts about TRT. The symptoms that I had that got my doctor into ordering my T test was long term fatigue (years), seasonal depression (many years), (I do take 10,000 iu per day D3 in the winter but still test low 20s), poor sleep quantity and quality (many years), and more recently (last 2 years) I have developed erection quality issues (once to the point of nearly full blown ED, which terrified me) and my libido is in the tank. I do not have low sex drive, I have absolutely no sex drive. Also, I have no spontaneous erections, and didn’t even know guys had that until I read the absence of them as a symptom of low T. Many years ago I would occasionally wake up with an erection but only if I had to pee really bad. Now that is not even an occurrence.

I have very low blood triglycerides and very low cholesterol usually in the 110 to 115 range, HDL 35-40 and LDL 60 to 80, and low blood pressure 110/70 range, and low normal thyroid function, high normal ferritin.

My diet is clean, I grow 90% of what I eat (I have a small organic farm). I eat no processed food and very little sugar, mostly from fruit. I eat a high fat diet, organic meat and eggs off the farm etc. Lots of vegetables, I don’t follow a meal plan, but my I’m fit enough and keep a general idea of macros in my head during the day. I run best on high quality fat but keep a roughly 40% fat 30% protein 30% carb ratio.

I lift weights only, I used to lift regularly before I had children (2009), then stopped due to time restraints. I started back up this last November five times a week because I felt like crap and I thought it would help. I cut back to 2x a week last week due to my fatigue (which is getting worse). I do a routine where I work up to a 3 rep max, then do a minimum of 21 reps at 70% of my 3 rep max. usually takes 3 sets to get to the 21+ range. Workouts last 45 minutes or so. Secondary lifts are 3 sets of 8ish reps. Legs are 3 sets of 12 reps, I can no longer go heavy on legs with my knees being in tough shape.

My first and only total T test result from last week was 200. That is obviously low enough to be a low T diagnosis. My DHEA sulfate was 345. Those were my only hormones tested.

Now, I do not want to just jump into T injections until I know it is the best and only option. For lifestyle changes about the only one I can think of at the moment is to change my day job. I have a very easy day job but like a fish out of water it is a terrible fit for my personality and is crazy stressful for me because of this. I am quitting as soon as I can, but these things take time and I am hoping to be out of there in no more than a month. I have likely had low to low normal T for a long time (now that I understand the symptoms) but I didn’t have the sexual problems I have now until I took my current job (two years ago) and I think the extra stress pushed me over the edge. Like I said, the job has to go as soon as I can make it happen. I also realize that until I get my sinuses under control so my headaches leave and my breathing gets better (I run a low o2 stat that seems like I should have COPD but don’t) that will continue to cause me problems.

I also struggle with cognitive function and focus (sometimes I cannot focus enough to even be able to read) which I am not sure if it is from the sinus pressure or low t related, probably both.

My plan is to get my sinuses treated as soon and aggressively as is possible. However, if cured sinuses (assuming they can be cured) and a new job (my old job that I loved) does not fix my issues I will likely have to start TRT. I want to make sure I start on the right foot. What baseline tests should I be getting now to be able to track and follow the effects of T injections if they become a necessity? I also have the occasional heart arrhythmia (hs-CRP and 24 hour EKG were all great) so I’m thinking potassium, because of my low sex drive E2, the full panel of testosterone, not just DHEA and total T, and do HCT to get a baseline, (I probably have old HCT levels from years ago, but I need a new baseline)

My other concern is that I would like to keep my fertility while on T if I have to go that route, so any tests I should add to get a baseline on that? As I’ll likely be stacking one of the pro fertility options with T.

I take no current medications of any kind, I have never smoked, I never drink more than a couple drinks a week tops (maybe 20 drinks per year total) , and only take a high quality multivitamin/mineral and some extra supplemental D3 gummies to get my D3 total up. And other than the bad stint of antibiotics as a child I have never taken any meds, drugs, or supplements of any kind except my one cup of coffee per day.

Appreciate any input. I am past the point of being able to just push through this. I feel like a leaky tire that is constantly going flat and I’m almost down to the rim. Again, my plan is to do sinus treatments asap, while formulating a T protocol to go on if the new (old) job and better sinuses can’t fix my symptoms.

Many thanks.

Your TT being that low, you’re likely a good candidate.

Before getting a script, test again, the following, for a better reference:

E2 sensitive
free T
TT
FSH
LH
Full thyroid panel
SHBG

I’m sure others will want you to check more. But get those done A) to have a good “off TRT” reference blood work, and B) to verify another low testosterone testing.

Unfortunately without proper lab testing (LH/FSH) we have no idea if you are secondary (pituitary problem) or have primary hypogonadism (testicular failure) and with the latter lifestyle changes will do nothing to correct.

Men below a certain point usually aren’t able to correct things if you are profoundly low, which you are. If your SHBG is on the high end, don’t waste time trying to change things through lifestyle.

This is not always possible, HCG can cause some issues that aren’t correctable at any dosage as some men just don’t do well on it. No worries as you can always start a fertility protocol while on TRT, this usually involves HCG and/or FSH injections.

Stopping TRT for a while and going on clomid can work as well.

Yeah sounds like you’re a prime candidate for TRT.
Saying that, if and when they fix your sinus issues, have a septoplasty say, it can make a night and day difference

Yeah start doing some kind of direct cardio/conditioning work, will suck for the first month but important for overall health and energy especially with all your issues.
This good for bad knees…

3RMs/ regular heavy low rep work not ideal in your situation -can leave you fried at the best of times.
Use the info on this site, try something submaximal like this for a while, can even act as a tonic…

(fine to spread out over 2 weeks)

RE plantar fascitis: look around this guys channel loads of outside the box tips…

Also in the mean time try adding ZMA and as a big guy crank the vit d further like 15000 one day a week. Alpha Male something to consider also

I would add prolactin and cbc, metabolic panel if not done already.

If you want a baby within next year. You can consider clomid route that would raise your t if your balls are working. Actually a good way to confirm if you are primary or secondary.

Yes you can still go on injections and add hcg when u want baby.

Thanks for the replies. So it looks like I should ask for:

E2
Free T
TT (first test last Friday at 200)
FSH
LH
Full thyroid (been a year)
SHGB
CBC (been a year)
and CMP (which will cover my potassium, I haven’t had this done for over a year, and it was basic, not a complete panel)

Any value to a cortisol test to further check adrenal function? Many of those on the list I’ve never had tested, so it seems like a good time to do that one too.

I will definitely check out the plantar fasciitis info on this site. I use to come here a lot in my powerlifting days but never thought to check for PF info here. Which is dumb because this site has always had a great sharing of knowledge and experience.

I had given up on cardio because I loved running but now with my feet as they are I just quit everything, but my wife does have a rowing machine that I will start using. I talked myself into my activity levels being ok due to the farm work, but it is not the same thing.

Again, hard to break old habits, but I can switch up my lifting routine. In the past I always did better on higher weights and fewer reps, but then I’ve been out a long time. I was making good progress on my strength (muscle memory and what not) but I can set my pride aside and do a routine more tailored to my current condition. Here I thought I was doing myself favors doing 3rm instead a an absolute max, haha, though I have not been doing any partner assisted reps (get through the sticky spots) to keep from over taxing myself, but my work capacity is still so low I need to focus on that more than total weight, this is probably a wise suggestion.

I will try the D3 15,000 IU once a week (I might even try twice). Even last summer (end of May) when I worked outside a lot and still taking 6,000 IU per day I only tested 33. So I probably have some room to increase, and I’ve never had the digestive issues with my current level of D3.

I’ll look into ZMA, my current zinc and magnesium supplementation from my multi is in the 180% daily recommended range, given my size and condition I may need to up that. What levels should I be looking at?

Some buddie suggested a nitric oxide booster. Any use? That said I’ll hold off on any supplements until I get my next round of bloods done so I have an accurate baseline. I see Alpha says it stimulates T and LH, so I don’t want to mess with those until after my bloods, but higher T and LH sounds like it could help.

Is there a proper amount of time to wait between TT tests. If my TT was 200 last Friday should I be waiting until next Friday to get my next round of bloods done to give me 2 weeks? or does it not matter?

I don’t know anything about a clomid treatment, can this be done stand alone or only stacked? Some cursory looks shows when used in men it blocks estrogen at the pituitary to increase LH and T. This makes sense. The expanded bloodwork should shine some light on the fitness of this as an option, but it looks promising. Maybe not enough of a T boost on its own, but as a stack, or if I am secondary it might be enough?

From the secondary or primary consideration, the question is if low T comes from the testes not working well (primary) or that they are not being signaled to produce enough T (secondary), in terms of hypogonadism. Correct?

I am really hoping getting the sinus problems fixed will be a game changer. Just going a day without a sinus headache fogging my brain would be a dream come true.

Again, really appreciate all the replies and insight. I have been writing what seems like books, but I want to make sure I paint an accurate picture of myself and the situation, and I appreciate you guys taking the time to read my posts and replying.

1 Like

One more thing I forgot to mention is that I also had an EBV test done as part of my fatigue issues and I do have an active EBV infection (it was my wife who first thought that I was having a mono infection again, I had mono very bad at 30). This would explain my rapid increase of fatigue the last two weeks, and the mild but constant sore throat and loss of apatite for the same two weeks. It also falls in line with my reduced immune function the last 15 or so years compared to when I was younger and rarely got sick. Does low T cause poor immune system function? If the sinus issues end up being a mold growth the imbedded mycotoxins could be the cause of my poor immune system. Can high mycotoxins cause low T? Mycotoxins was another blood test I think I need. It could help the ENT diagnose my sinus issues.

Mycotoxins can cause an immune deficiency.

That would explain a lot. Before I had my sinus issues I was never sick. Now I get the cold or sickness any time someone I’m around gets sick, and usually worse, plus I get strep throat a couple times a year, usually from what seems like nobody else who had it. My current primary doc told me that long term antibiotic treatment can cause fungal/candida infections in the sinuses when you come off of the antibiotics when your immune system is trying to get started back up again. That timing does work out for me. He did give me some anti fungal nasal sprays to read up on if the ENT doesn’t think I’ll need surgery to remove the infected tissues or a structural sinuplasty as mentioned by RampantBadger.

Can either just add 15 of zinc or taka zma product with minimum dose and gradually up it until feel weird/slight diuretic effect(from magnesium) and then drop down

NO booster and preworkouts usually just fluff or underdosed for the effective ingredients so best save your money

Sounds like you need to get some good bacteria back in your system. Dont know how to go about that, except ingesting bacterial cultures and interacting with more humans.

Ok guys, sorry I’ve been to busy to update but I’m back at work now with more free time to do the whole internet thing.

I ordered a ZMA sup from Amazon, should be here today, so we’ll see how that goes, I’ll start low and go up from there. How many days should I give each level before deciding to bump up?

I’ll skip the NOx sups, and I did try spiking my D3 to 15 for a day with no ill effects. I’ll add D3 to my next round of bloods, before the weather changes and I get more sun so I can check my supplement routine. A relative of mine gets injections for D3 as oral couldn’t keep up with demand, so I do have a family history of low D3. Also going to up my fish intake. I don’t normally buy food I don’t grow, but I’ll get some canned sardines shipped out to me. Maybe I need an aquaponics setup, haha.

I switched up my workout routine to be faster paced with lower weights (8 rep range upper body still at 12 for legs) 14 sets in 30 minutes. It’s way less fun, but it does hit a much weaker spot on me, my muscle endurance/conditioning is always much worse than my strength, so it’s a good change for me.

I did get a wearable spo2 monitor/tracker to make sure I don’t have sleep apnea. I keep reading about sleep apnea being dangerous if you start TRT and I wanted to eliminate that possibility before I started. I don’t snore much at all (according to my wife) but better to get some hard numbers. I’m only 2 nights in, but so far all looks good. O2 stays about 92 to 98 percent with no major o2 dips or heart rate spikes, which is about the same as my waking saturation. Not that o2 tracking alone replaces a proper sleep test, but I didn’t think I had it, so the o2 tracker is enough for me to confirm I probably don’t need a full sleep test and that I’m apnea free enough to start a TRT routine.

Still have my first ENT appointment tomorrow, so I’ll fill you guys in on how that goes.

Gonna try ordering my blood work today to be taken on Friday. Results likely the first part on next week if everything goes as planned.

I totally agree with the whole needing good bacteria idea. Years ago when I was not too far past coming off my antibiotics I had a bad candida problem in my gut, those were unpleasant symptoms, and I was put on an oral antifungal which helped a lot, but at the time I didn’t eat near as well as I do now and didn’t attempt to add good bacteria to replace the candida fungus. I make yogurt several times a week for the last couple years, which should be pretty high in probiotics, but it’s probably pretty hard to get the good stuff to survive the stomach acids and displace the bad stuff that might be established in there. I’ll ask my doctor about it.

As clomid is off label for men and harder to look up, what side affects are common and where might be a good place to read about it?

Again, thanks for everyone’s input who is following along. Once I get my second round of more complete bloods in, the TRT meat of this thread should really pick up.

1 Like

Boy, I could have written this letter. I have the same problems and I’m from a small town from the Midwest. Had constant sinus infections. Mine were from allergies. Managed the allergies with steroids and rarely have had one since. I also had planters fasciitis on both feet. Insurance insisted on therapy first. It was a year of waisted time and pain. I had surgery. 3 to 4 month recovery and was back to running and never had a problem since. It’s been 15 and 25 years respectively. I’ve also been on TRT for over 10 years. I’ve used every type of treatment except all the internet miracles. I’m on cypionate injections .45 ml every 5 days. It is a continual adjusting the amount and timing. Mine was from Mercury poisoning. It was 20 times over the maximum allowable levels. Mercury blocks the production of testosterone. It was 2 years of treatment. But now I’m in allowable standards and I now have to continue to cut the amount of testosterone I take to stay in a reasonable level. I doubt if I’ll ever be totally off.
Now some things you can do if you can afford it. I would get a total blood work. The best would be the Boston Heart. This does a very in-depth study of cholesterol, hormones, and many others, but you need a doctor that knows how to use all this information to help make a treatment plan. That will probably be a challenge. And it isn’t cheap either, but some insurances do cover it. I wish you the best.

Thanks farmboy. Hearing your success story gives me hope, that is funny how similar your story is. The fact that you are foot pain free after 25 years, and sinus problem free for 15 is really exciting to me. I would love to be able to run again, especially when out playing with the kids. Do you know exactly what the surgery was? Do they just cut the fascia to loosen it? I manage ok now, but I still have to think with each activity I do how much it will affect the next day by increasing the pain, which would be great to eliminate.

That is interesting that high mercury caused low testosterone levels. I looked up the Boston Heart panel, it was a huge list of tests. My insurance is not very good on testing, but I can look into it, that panel of test would be a huge wealth of information with the right doctor to interpret the results. I don’t know of any mercury exposure I’ve had, but you never know, and it does bring up the question other heavy metals. I have had some lead exposure over the years, could be another piece to the puzzle to test some of the heavy metals.

I had my ENT scope yesterday. There was no deviated septum or any polyps, but a lot of inflammation, he really had to shove to get the camera up and around in there. He put me on a steroidal saline rinse to do daily to help with the inflammation and scheduled me for a CT scan in a month. The right nostril really struggled to let any of the rinse in, but I had a little luck on my left side which unexpectedly drained what seemed like about an ounce of the solution about 3 hours later. It was an odd sensation but it was good to know some of the medicine stayed up in there for a few hours. Not sure if once the swelling goes down that will be less likely to drain later like that due to better drainage, or if it will happen more often because more fluid will be able to make it deeper into my sinuses. Either way it wasn’t that unpleasant, I look forward to seeing how much improvement the steroid will give with consistent use.

Next step is my second round of bloods, hopefully tomorrow or Saturday. I’ll let you know what the results are when I get them in.

As always, thanks to everyone following along and contributing.

Ok, long story short I made a mistake scheduling my blood draw and I now have a confirmation for this Friday. I wouldn’t expect any major news until I get the results which I will be sure to share them as soon as I get them. So basically for now it’s a whole bunch of hurry up and wait.

Good (or bad) news gentlemen, the results from my bloodwork are finally in. You will find the abbreviated results below. Test was taken non fasting.

Test total 180 (down from 200 three weeks ago) 250-1100
Free Test 38 35-155 (grey warning results, not red failure, but not
green normal either)
BUN 18 7-25
CREATININE 0.91 .6-1.35
FSH 7.9 1.6-8.0
LH 4.0 1.5-9.3
Red Blood Count 5.43 4.2-5.8
HEMOGLOBIN 15.2 13.2-17.1
HEMATOCRIT 44.9 38.5-50
SHBG 13 10-50
ESTRADIOL <15 (Not sure this is useful, I figured I was low, didn’t tell me how low, I forgot to request the sensitive test, sorry guys)
T-4 Free thyroid 1.1 0.8-1.8
T3 Free thyroid 3.4 2.3-4.2
TSH 1.38 0.4-4.5

All other electrolytes etc were smack in the middle of the recommended values. My Vit D3 came in at 55 (30-100) so 10,000 IU per day is about right for me, though I still do the 15,000 twice per week which I had been doing for the two weeks leading up to the test.

So TT is very low, lower than last time. Free T at 38 is also low, in the warning level according to the scale my lab gave me. FSH at was 7.9, right at the max of the normal scale, which is funny, because besides the hair on my head I have virtually no natural body hair. LH came in at 4.0, right mid reference range. I botched E2, sorry. SHBG was 13, which is just above warning level but technically normal range, everything else looked fine.

If anyone wants any of the other blood specifics just ask, I’ll be happy to to post them, but didn’t want to add statistic noise for the sake of it.

So I am going to start the T therapy as soon as I can coordinate with my doctor. Any ideas on dosing? How often should I get bloods to check up on dosage? What should I be shooting for on TT 400? 600? 1000? haha. And all the questions on delivery too. Frequency? once a week? every other week? best product to start is Test C? (pretty sure Test E is out of my price range) my buddy swears by the topical, but i’d rather try injections first. IM vs sub Q? Delts, glutes, qauds?

Another baby is likely in the cards pretty soon, so I would like to start with Clomid at the same time. Any ideas on dosing for that?

Also, what sides should I be looking for?

This is a bit scatterbrained of a post, but the results are in, so that’s good, my numbers are worse, which quickly made up my mind on the need for treatment, and now I am just looking for some anecdotal experiences and advice so that I can understand things a bit better when I talk to my doctor.

For our purposes I don’t think the sensitive test is needed. <15pg is enough to know you likely feel like shit.

Normal for a little boy before puberty, but not an adult male. Estradiol should be minimum 20, otherwise below this can cause osteoporosis. You need adequate estrogen levels for libido and erectile strength and I never heard a man that was able to achieve an erection at 13 pg/mL.

A lot of doctors believe technically in range is fine, and the moment you drop below range, now you suddenly become deficient, but that’s not how it works.

Hormones aren’t like a light switch where you’re either low or not low, hormones are like a dimmer switch and you raise the switch (levels) until the symptoms are gone.

You shoot for symptom resolution, not numbers. I would start out on twice weekly or EOD or you may find SHBG in the single digits.

Most report feeling worse than pre-treatment on an every 2 week protocol because your hormones are on a rollercoaster and it’s not an optimal way to replace testosterone and most report negative experiences.

Swoops, that got a good laugh out of me. Yes, I do feel like crap, haha. I take this a bit as good news though, If a side effect of T therapy is higher estrogen it would be well received. After this last blood test I have looked more into the symptoms of low estrogen and in many ways those are worse than my low T symptoms.

System, well, not sure if my higher end FSH helps or what, but while erection quality has fallen significantly, especially the last 2 years, I have never had complete sexual failure. I do have basically zero libido though. No spontaneous erections for a very long time.

I was reading a bunch last night and also saw where once per week or every other week can lower SHBG which as you mention would be a problem, and as you mention EOD or even every day seems like the best way to go to not drop further.

Looks like hCG and Clomid are both options to keep fertility. Doing a bit of reading the American Urology Society recommends hCG as the top option for fertility. I see several doctors recommending it. Not sure the benefits or consequences of one over the other, but I will be stacking one of those with the T. I am leaning towards doing hCG with Test C in an EOD schedule. I will have to work out an amount with my doctor, probably start slow and see where it goes.

Any thoughts on Sub Q vs IM? I understand the reasoning for both, but I am leaning towards Sub Q for myself for the same reasons as EOD or ED to slow uptake to keep SHBG from dropping.

How is hCG taken? That I haven’t looked at yet.

Again, thanks to everyone following along and commenting, it helps and is much appreciated.

Both subQ and IM work(are effective). However, results, and preference, vary from person to person. Given the same dosing and frequency, I personally feel better on IM.

As for QOD or QD…again, It’s personal. Back when I was on TRT doses, I felt best on QD. Smaller, more frequent dosing will also help keep your SHBG up. I noticed you mentioned that as a goal.

HCG(if you can still get your hands on it) is pinned subQ and is amazing! I always felt, and looked, my best after my HCG shot.