T Nation

TRT Prescribed, But Afraid to Start

Hi, fellas.
I am really sorry for my long story down below and my broken English(i am far-far away from what u can call native, lol), but i cant seek help in such question in ru-talkative internet, because guys here is 20-30 years behind you and almost know no nothing about TRT treatment. It`s like everything you can find there about TRT is on broscience level.
So, my story of T problems are almost as long as all my life. First problems i got when i was 14 years old. At this age i was diagnosed with delayed physical and sexual development(delayed puberty, physical development of 10-11 years old), was treated with HCG (1000 two times/week) and tyroxine(50mcg once / everyday). Went through puberty with this treatment. Was fat before treatment and gained even more weight in following years. At 19 i weighted 105kg(~230lbs) at 170cm height(5’6), was depressed, started powerlifting training(i was thinking that will make me fit), but gained more weight in following 6 years — finally settled at 130kg at 25 years(~285lbs). Stopped powerlifting training and went for diet and weight control, now my weight is ~105kg again.
For all my adult life I am feeling fatigued all the time, sleeping 10-12 hours a day(still no energy after wake up) depressed, suicidal thoughts, feeling anxiety, mood changes, brain fog, a lot of body fat. Looks like a low T symptoms, huh? But i had no problems like ED or low libido ever. I can even say, that my erections(i can keep my d hard for like 2-3 hours long) and libido are way above average.
Finally, knowing my teen T-problems, i went to endo, did all bloodwork she wanted and got next results:
TSH: 2.32 mIU/L(range: 0.27-4.20)
FT4: 18.84 pmol (range: 12-22)
Prolactin: 28.46 ng/ml (range: 4.04-15.20) HIGH
Testosterone: 2.81 ng/ml (range: 2.49-8.36) LOW
FSH: 9.25 mIU/ml (range: 1.5-12.4) HIGH
LH: 8.43 mIU/ml (range: 1.7-8.6) HIGH
Estradiol: 7.89 pg/ml (range: 7.6-43.0) LOW
(My bloodwork is more detailed, but i think there is no need to copy all things like DHEA-S, progesterone, sugar level, etc)
Long story short, after bloodwork endo diagnosed(yesterday) me with primary hypogonadism and got prescribed with TRT(i can go to pharmacy and buy what i need to do it like RIGHT NOW), also she said, that after 3 month we will look into diagnosing hyperprolactinemia.
Guys, i really afraid of TRT, i afraid that when i start it, i will regret it and cant never come back. Could my testosterone and low life quality problems be based on hyperprolactinemia only? Maybe i should try treat it with cabergoline without my endo? Can it fix my problems somehow? I read some articles, but all it says, that high prolactin supress gonadotropin-releasing hormone, and so LH+FSH will be low, but mine are already high, so probably no way my ballz will produce more T.
Could you give me your opinion on my case, please?
Also, i now know all risks living with low-T but still afraid to start TRT.

Already did it, my friend.

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If you are primary, you def need trt from what I know.
I really don’t think lowering your prolactin will increase t. Though you should keep an eye on it. Cause when you start trt if e2 goes up and prolactin high I believe your are more susceptible to gyno.

If you really want to confirm your balls are the problem try clomid or novaldex. That should increase LH even more.

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In 2015 I was diagnosed with hyperprolactinemia. It was my body fat. Loose the fat hyperprolactinemia goes away on its own.
TRt will help you loose that fat but it is for life. You will have to inject T for the rest of your life.
I would start out with a very low dose like 60-80 mg/wk and give it 3 months to see how you are feeling. The first month of starting T injections really suck. Water weight mood swings heart issues the list is huge. I believe starting at a very low dose reduces these bad sideeffects.

You also need to look hard at your diet and you need to start exersizing even if it is just riding a bike 3-4 times a week to start. Weight lifting burns very little calories. Walk or bike for at least 1 hour 3-4 times a week or even more if you can. Once your body starts changing from the TRT you can add weight training the two will change your life.

Good luck

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You can always stop and go back. But you’ll be going back to the same shitty levels you had just before TRT.

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Are you sure that its possible to go back, if my TRT protocol doesnt have HCG in it?
As i know, my own T production will shutdown after 2-3 months on TRT, and then it`s will be like gambling, trying to restart HPTA with my shitty hormonal system.

All I can say is that I would LOVE to have a crazy sex drive like you have.

Starting TRT may affect that negatively.

You’re missing important tests need to successfully design a TRT protocol. SHBG binds sex hormones testosterone and estrogen, a protocol for a high SHBG man if can look different than it were for a high SHBG man.

I can tell you right now your endo probably doesn’t know how to design a protocol and likely has a cookie cutter protocol he gives everyone (200mg every 2 weeks), your protocol needs to be tailored to your biomarkers and not everyone else’s.

fT3 is the most potent thyroid hormone which increase body temperatures and metabolism, I see no testing for it. Free testosterone is the bioavailable portion of testosterone and we have idea where Free T sits and will be needed to balance your hormones while on TRT. Your hormone panel or lack thereof hints at your endo’s knowledge of endocrine disorders and based off your hormone panel, it doesn’t look good.

There are lots of members here not on HCG, it’s mainly used for fertility reasons, but your testicles are dead or dying. It may help with mood and libido but response to it is different for everyone. Your insurance may not cover fertility treatments and or your endo may not prescribe it as it’s off label use for men on TRT.

More concerning is your body weight, obese men who start TRT may require an estrogen blocker since testosterone is converted to estrogen through the aromatase enzymes that live in fat tissue, to higher fat content, the more aromatase enzyme and therefore higher your estrogen will be.

If your doctor is unwilling to prescribe an E blocker, you will have to locate a doctor privately. You should be using insulin syringes to inject T (shoulders and quads) and not those harpoons doctors like to prescribe.

  1. Yes. There is no SHBG and free-T bloodwork, because their clinic lab dont have it(it`s not TRT clinic, our country dont have TRT clinics at all actually). But i can go for private lab and do it there if needed.
  2. My prescribed protocol is Omnadren 250(1 ampoule/1 ml) every 10 days. As i read this forum a lot, i already decided to split this dose in 2(0.5ml/125mg every 5 days) and do it subQ in abdominal(belly) fat with insuling 29G syringe, if i gonna start it.
  3. I actually dont care about fertility much. Im not child free supporter, but i think i can adopt child, if i want to have kids someday. So no HCG is okay for me in terms of no fertility. Also HCG can rise estradiol levels on its own, which can be bad for me, as im fat.
  4. Our pharmacies are open to sell you almost anything without prescription, so it`s not a problem to buy AI(anastrozole) or SERM(clomifene, tamox) any time, any day, if i really need it. But as i read this forum, i see there is guys who are against using AIs and are okay with high estradiol levels.
  5. Almost no insurance exist in this country, i pay cash for everything(and it`s not cost a lot, actually).

So you too think my testicles are done and i should go for TRT?

Your testicles aren’t responding to LH and FSH stimulation, that’s why your pituitary has cranked up both to get your testiocles doing their job and that’s not happening. Your likely infertile already or will be on your way there now.

It’s difficult to recommend a protocol without SHBG testing, but I would aim for 50-60mg twice weekly as every 5 days isn’t optimal. If your response is less than optimal, more frequent injections may be necessary.

TRT is it for you, short of a testicle transplant there’s is no other option for you, there is no coming back for you because your testicles aren’t functioning properly and never will.

I understand it, comrade. Im just afraid of “what if”.
What if i was misdiagnosed? What if my problem is in something else and ill make my condition worse with TRT? What if testosterone treatment just would not work?
Im reading this forum and all i see is people who are so much struggling with TRT. It`s just look like no one enjoying it and everyone most of the time just trying to find right solution, but somehow cant do it.
I cant imagine mysefl handling both problems, with low quality of life and TRT, at a same time.

Alot of guys read into it too much and go way overboard trying to adjust numbers. You will be fine, if you are low then it will improve your quality of life. If you are at feel like you are operating at 25% right now wouldnt you rather be at 75% 3 days a week and 50% the other 4. Or how about 60% 7 days a week?

That’s the perspective you’re going to get on this forum brother. Most people that are posting here are here BECAUSE they are having trouble and are seeking help. You have to realize what you DON’T see here, and thats the millions of people in the world who are on TRT and doing just fine, and way better than when they started.

This is also spot on.

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I am guilty of chasing numbers in the beginning, I was always pushing high normal numbers and never felt good. So I started lowering the dosage of T and only ran lab tests when I was feeling good, if I started to feel bad, I decreased my dosage.

Sooner or later I learn I feel best in the 500-550 range. I was extremely wired and fidgety in the high normal ranges, too much mental overstimulation.

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You know the problem and have a couple solutions. Try the restart but that might not work now that your older. How old are you?

Trt is a good option. Why not do hcg and testasterone so that your natural production continues. Otherwise do T if you are in your 40s.

I would go start right away and stop the pain and misery. When I found out my issues were due to low T I was excited. I was motivated and optimistic that my life is about to level the f up… :slight_smile:

When we’re low T we think negatively. With t we will be more positive. Most of your fears will dissipate once the state of your mind is healthy again. You’ll be positive and no longer care. that’s how I feel now that it’s working for me. Before then I was worried and kept thinking of the worse case scenarios.

Just remember it will take time to work.

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Someone changed topic title, it was written there — i`m 27 y/o.

@systemlord

When you went daily dosing, did you ever try subq to keep the e2 down?

I may try daily, but just worried about the constant injections into the musculature. Subq would avoid that.

SQ worked maybe a little too well, I just didn’t like the way I felt.

My liver doesn’t like daily injections, the rest of my body (erections and libido) loved daily injections.

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At 27 If hcg works I would try heavy hcg and less T. You took it many years ago. How high did you free T get with that dosage