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.