T Nation

TRT Cardiovascular Controversy


#1

It’s been a while since I posted.

I am obsessed with researching testosterone replacement therapy benefits/risks.

Light cycles on and off from ages 24-32 ish and the prescribed clomid for low T. After a couple years dropped clomid and Doctor prescribes testosterone gel. 4-5 months in started getting palpitations and weird sides. Stuck it out for another year until chest pains and random tachycardia events while jogging so I quit cold turkey.
1 year later started Clomid again due to low T and all the sides of low T.
Been on Clomid this last year and testosterone levels hover between 500-600 ng/dl with low range free T because of 50 SHBG. E2 is always around 20-30.
What’s disappointing is the sexual sides even before Clomid this last year. I want to be back to my “old self” for my wife.
Who here has been on T for a long time? Any sides? You take AI or hcg?


#2

Injectable testosterone is can be smoother than gels and sometimes gels can produce strange side effects in some men, mainly the ones you mentioned. You would want to inject testosterone twice weekly given your SHBG levels, I would then add HCG after 6 months, some guys don’t do well on HCG so it would be difficult to know what’s causing problems if you throw too much stuff at your system at once.

I have no reason to be on HCG at the moment, I feel fantastic without it. However I do need a low dose AI. You also need to know your garden variety GP, urologist and endocrinologist will fail miserably at TRT. Typically these type of doctors are seriously lacking in their knowledge which is why you were scripted the T-Gel, it eliminates the need to be skilled at reading a patient’s blood biomarkers.

The majority of endocrinologist were taught to treat diabetes and thyroid, not TRT so they are a little behind. You need an anti-aging doctor whose specialty is male/female hormones who doesn’t take insurance. Insurance doctors are going to fail at male hormones 9 times out of 10.


#3

I’ve been on TRT for over four years, 200mg injection once per week. I have used both cypionate and enathate. I have added hCG a couple of times for six weeks. Anastrozole is 1mg per week. Total test runs between 800-1000 and free test between 200-250. E2 between 18-28 with both types of tests. My SHBG was mid range, don’t recall the number. I have had no negative side effects.


#4

Not everyone can afford doctors without insurance. :confused: Both urologists iv had proscribe TRT. How are they shitty if they proscribe it? That seems so uninformativly generalized. I mean you no disrespect. Im taking all if this very seriously as iv been wrestling with the decision to leave clomid for trt for 4 years now. It just seems everyone talking about the success of TRT is contengent on these clinics. I just, i really dont get that. I have great insurance. Why would i opt to pay out of pocket? If trt success is really this way, then the system is severly broken.


#5

Between the problematic studies showing TRT causes prostate cancer, cardiovascular and stoke warning warning by the FDA a few years ago, it’s not hard to understand why mainstream medicine and the medical community has steered clear of TRT like the plague.

Slowly these studies have been shown to have very serious flaws, like the prostate cancer study that had all but 4 patents, two of which were female and one of the men had cancer, nobody ever determine how this man got cancer and doctors hung their hat on this study.

Add to this doctors are taught in medical school TRT causes cancer, is it really a shocker that the majority fail miserably at something with so much negativity?

Now you know why the majority say to these poor men, “you’re normal”, they don’t want to prescribe it because of fear.

You’re insurance is almost useless because of the culture within the medical community regarding TRT, sure it’s starting to change but slowly.

Private care is quite different from managed healthcare where someone else is footing the bill, everything is about reference ranges, practicing medicine is about treating the symptoms something managed healthcare doctors are trained to disregard.

This reference ranges have a ton of people within them who have undiagnosed subclinical hypothyroidism, so right there the reference ranges are seriously flawed.


#6

If your hypogonism is diagnosed at a super low number, say 112, is a insurance doctor still unrecommended? Like what about guys like this?

https://providers.ucsd.edu/details/12156/t_mike-hsieh-infertility-surgery-urology-la_jolla


#7

He’s a urologist, they’re surgeons and typically not experts in andrology. The urologist I saw had much of the same resume as the one you posted here. Mine was supposed to know andrology really well too.

Unfortunately he absolutely wrecked my life by telling me coming off of TRT cold-turkey would be just fine. My issue (high E2) could have probably been helped by just lowering my dosage or doing shots more often. I heard his practice did it to another young guy too and he never returned. Point being, this is not something you want to mess around with if you don’t have an expert to fall back on. The money aspect sucks, I get it, but things could get horrific for you if you go the wrong route with this.

Speaking from experience…


#8

You want to play the doctor lottery for the next several years and roll the dice with your health, you are going to go from doctor to doctor and the majority are going to be clueless.

I don’t think you’ll ever need an AI do to higher SHBG levels binding to all your androgens including estrogen.


#9

If the clinics dont take insurance i wonder if the prosciption is generally covered.


#10

If a doctor knows your hypogonadal and have really low base numbers then I can’t imagine a justification for taking you off TRT ever. Both of my urologist have both suggested that I optimize my AI to 1 mg per week instead of every other day like I’ve done in the past. They’ve never ever suggested taking me off my current medication. I’m not sure why or how a doctor could ever justify taking someone off the very medication that they need. Especially knowing full well that they will crash and burn and be miserable.

Were you hypogonadal?


#11

Well that’s the thing, their credentials say that they should know that, but some don’t.

Yes, I was hypergonadal, he thought I was young enough that I would bounce back to pre-TRT levels at least, he was wrong. My point is that unless you get someone with years of experience with this stuff then you’re bound to end up with a bad experience.


#12

So what you’re saying is clinic or urologist it doesn’t matter as long as they have experience over many years of prescribing TRT. That helps me I think because the first doctor I saw pushed TRT just about every year that I saw him and he was just so good at answering all my questions at the time. The only reason I switched was because I needed a doctor that was closer to where I live but I think I’m gonna go back to the other guy.

I’m 39 going on 40 so if he ever thought my shit could bounce back then they would be retards.

I’m not sure if it really matters but my doctors have said that they are friends with Abraham Morgentaler. I don’t know if you know who that is but he’s been the advocate of testosterone replacement therapy for the last 30 years.

Maybe a lot of this is geography dependent as well. I used to live in Texas and even though that was pre-diagnosis of my hypergonadism I can tell a difference between the type of doctors here in California versus there. The ones here in California seem to be more liberal out of the box thinking.


#13

Abraham Morgentaler is a miracle worker in the field of TRT, he has had men with prostate cancer on TRT for decades and some even seen their cancer gone while on TRT. Anyone who is connected to Abraham Morgentaler has got to be well informed.

I’ve notice some states and even some countries (UK) seem to have really hard headed, arrogant doctors. Any doctor pushing TRT should be well informed since the majority are afraid of TRT do to being uninformed.


#14

Abraham’s TRT for life book is mind changing. That’s what got me on this journey of hopefully switching soon. Not to mention this forum and the people on it have been beyond helpful

I watch videos of people saying that when They take jobs overseas, those countries tend to make them come off the drug just to crash just to measure true low numbers just to justify them going back on. It seems very barbaric. That’s probably why some people are saying that only doctors who are on TRT can truly understand the patient They are treating.


#15

It’s more beneficial to have a doctor that on TRT himself, he will know firsthand when you describe your symptoms what’s going on with you. When someone comes here and describe what they are feeling, if I have felt it myself I know exactly what their problems is, someone who isn’t on TRT will not.

I believe the government or state/health insurance is driving this barbaric practice of proving people actually need TRT so they don’t have to pay for life long treatment. When you go private and start paying for treatment, they will never force you off TRT.

I wonder what type of damage these practices are doing to the human body, it can’t be good.


#16

I guess I should just count my blessings that my insurance fed doctors so far have indicated to me that I would be on TRT for life. They themselves are not on TRT and to be completely fair neither is Abraham Morgentaler but I understand why having a doctor on it is so much more sympathetic and relational. I definitely wish that was the case with my current doctors


#17

Does injectable TRT harm the liver ever?


#18

No, TRT does not harm the liver unless you already have certain undiagnosed medical problems, understand injectable testosterone is bioidentical to the real deal, so much so that the body doesn’t even know the difference.


#19

Obviously the oral is a different story though.


#20

Realistically oral shouldn’t even be an option, it has low bioavailability and can be toxic on the liver.