Hello all. I'm new to the forum and this is my first post. I have been on TRT for just shy of 16 months but I am new to this whole science and wanted to get some experienced opinions to work in conjunction with my doctor's professional guidance as to my best course of action going forward. I look forward to being part of this forum.
About me. First, I am unemployed at the moment and pay for all of my medical expenses in cash.
I am a 5'9 172lbs 39yo active male with a healthy and very active lifestyle. I am primarily a cyclist but also do some running 6 days per week on average. I eat fairly clean - no dairy, lots of oatmeal, brown rice, chicken, fish, fresh fruits and veggies, (kale shakes everyday kind of guy). I don't drink alcohol or smoke . Currently, I take a multi, 6000iu of D3, and 1000mg of l-arganine daily. The preceeding may/may not be relevant, but I wanted to be as forthcoming as possible.
I have always been an athlete of sorts. Basketball and track were my thing until my early 30's when knee and ankle problems made is less reward and more risk than they were worth. I was very thin in HS in the 140's. Steady at the 160's through my 20's. Once I hit 30 it was like I skipped the 170's altogether into the high 180's. I'm thin but I've got a bit of a belly and I honestly don't know how. I've also got tree trunk quads/hams from the cycling making shopping for jeans a nightmare. I'm sure I'm not the only one.
I had been feeling less and less energetic since turning 34/35 or so but chalked it up to 'getting old'. Finally, I decided to go see a doctor when I began having symptoms of ED. This gentleman came very highly recommended and is easily the best doctor I have ever been to. I am very fortunate to have found him. I digress.
I was diagnosed with lowT (< 200 and my vit D was a 13). November of 2013 by my primary and and was immediately put on Androgel 1.62. After a few months of trial and error we got to where I felt great at 4 pumps per day. Fast forward a few months and I lost my job and could no longer afford it. We tried testosterone creams and starting with 100mg per day and the dosage increased until we got up to 300mg per day (2ml @ 150mg per ml) with little success up until this December 2014. I inquired about injections and pellets and he referred me to a Urologist colleague.
In January, I went to see the Urologist to discuss other options. He recommended Testopel but I could not afford them. He recommended I try compounded pellets that other patients have had success with. I don't have all of my results off the top of my head from that initial visit with the Urologist, but my total T was still in the low 200s. January 28th I was implanted with (what I was told were) 9 100mg compounded pellets (total cost $400) and recommended I take 1000mg of l-arganine daily. I felt lively by the end of week 3. By week 4 I had some strong morning erections. Week 7 I began getting the hot flashes and soft erections. Week 8 I am no longer waking with morning wood.
My 6 week blood work (3/11) was as follows:
Hemoglobin 14.9 13.5-18g/dL
Hematocrit 45 42-52 %
Estradiol 32.1 0.0-39.8 pg/mL
Testosterone Total 476 171-781 ng/dL
Testosterone Free 45 24.3-110.2 %
SHBG 37.1 13.2-89.6 nmol/L
I've also got the records from my primary that we took every 45-60 days from the various topical doses but felt this first post didn't warrant 'lab result' overload.
I just left to Urologists office for my first follow up visit. He is recommending I add a pellet (9 to 10) to raise my total T a little more. When I voiced concerns about how long this will last, he indicated that my lifestyle and the high volume cardio also effects how long the implants will last but feels confident that adding another pellet will help me get to 12 weeks before needing another procedure. Additionally, he mentioned that if I were to take a low dose AI, that should raise my total T and make the implants last longer by preventing some of that total T from aromatizing. I am scheduled to have the 10x100mg compounded pellets implanted this coming Monday 3/30 but I have yet to give an answer on the AI. At face value, telling me that this will lower the conversion of T to E (and in turn increasing the time between implants) sounds great, but I need to do some reading and ask some questions because I know nothing about AI's.
I placed a quick phone call over to my primary who recommended I try DIM but from everything I've read that simply aids in metabolizing the excess Estrogen (I'm paraphrasing of course) as opposed to an AI which would actually lower your Estrogen level (I think). I could say yes to an AI, but I don't know if my Estradiol level even warrants it.
I've just recently found a very inexpensive lab where I got the above work done for $125 so going forward, I will be getting my total and free testosterone and estradiol monthly just to keep track for myself of where I am as the Urologist is nowhere near as attentive to my needs and concerns as my primary.
I guess my first question is should I go on a low dose AI or not?
Any thoughts, advice, or insight is greatly appreciated. I thank you all in advance.