T Nation

Was My Endo Right?

When bloods were originally drawn I was working IT, worked out min of 3 times week, minimal alcohol, good social group. Married, no kids.

Now it’s mostly similar. I took a break from working out though. But now I’m back in the gym.

Diet is mostly chicken, rice, veggies. Pasta. Lots of Trader Joe’s.

No meds. I take Nexium for heartburn.

I’m not very in touch with my emotions, but I’m getting there. I don’t mean “I never cry”. I mostly mean that I don’t really think about my mood very often. I tend to just kind go with the flow. But I did have a very stressful job after bloods were drawn. But I moved to a new position that is slightly less stressful. BP is normal.

I sleep about 7 hours to 8 hours a night. But feel tired a lot.

I drink coffee, maybe 3 drinks of alcohol a week (time of blood draw I wasn’t drinking), slight marijuana usage (but was clean when I was getting blood drawn).

Unfortunately none of those blood tests. I have wbc, rbc, hgb, hct, mcv, mch. All within range.

My sense of smell I think is average. Although I’ve always assumed my wife had an amazing sense of smell, so maybe mine is just off, lol. But I would rate my sense of smell pretty average.

Yes, but keep in mind that there is plenty of data available regarding dosing from recent clinical studies. Especially in the last 5 years a number of dose response studies on subcutaneous application of eg T enanthate were published. There is a good reason that the suggested starting dose of eg Xyosted (which subq T enant) is 75 mg weekly.

Not at all saying that 200 mg is a bad dose, but you may want to approach your dose coming from the lower side rather than starting too high, even if this means that it might take longer to find ‚your‘ dose.

I couldn’t agree more with this. Guys like to start high and work backwards, but it is so much quicker to start low and titrate up to your level.

So you think the 80mg/week he suggested is a great starting place? I still think 150mg is the perfect starting dose.

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I like 100 as a starting place, but I think 80 is a safer start than 150mg. Of course, I’ll probably be bumping above 200 if the next labs say the same thing as last Thursday’s, so it’s pretty individual.

Fair enough. I started at 220mg, dropped the AI and went to 100mg. Then every 8-12 weeks went up by 20. Until I hit 160mg it was like I wasn’t taking anything. Had I just started at 150mg I’d know if it was too much or too little. I think 80mg would just lead to switching shit up before they know what it actually does and cause issues in the long run.

Haha, so many conflicting opinions, but I’m sure it’s just because we have multiple variables and everyone has a different combination of those variables.

I’m still reading and researching. I’m also scheduling more recent bloodwork just in case.

Once I have it all, I can come up with a good plan.

I’m leaning more toward 150mg a week. But I’d like to see more recent bloods and do some more research.

Welcome to TRT………………….

I get it. It just seems most that start out below 150mg end up there or higher anyway. I think starting with 80-100mg is a waste of time. I can see maybe 120mg as a starting point for some. I suppose part of the equation is (should be) the level and patience the patient has and where one draws the “more is better” line.

That is a problem with evidence based medicine. If I have ten guys telling me they started at 200mg once a week, still take that amount, feel great and are thrilled with TRT, I’m going to have a difficult time going, “but, according to a paper I read……………”

Please don’t misunderstand, I read a lot and appreciate the links to the many journal articles that you have provided.

You never really know how someone will respond to TRT, you can pay attention to those with similar biomarkers and still experience the unexpected. I have seen high SHBG men who usually do very well on once weekly dosing say that they feel best on a daily protocol, it’s the opposite of what you expect.

More often at least on these forums, the lower SHBG, the higher the injection frequency, the better they feel. There are a few exceptions though, TRT non-responders who only feel the effects of TRT when levels are in flux after dosing changes.

These guys have burnt out receptors and enzymes that convert to other hormones.

The guys who blast heavily for years on end then go back to say… 100-200mg/wk tend to not feel great at all as they have serious AR downregulation… it takes time, but things do eventually go back to normal

These are my latest results. Any recommendations?

Edit: next questions might be “How do you feel?”

Fatigued
Foggy
Low libido
Can’t gain muscle
Underweight

Your thyroid looks alright, TSH is barely elevated, maybe some very small level of resistance.

Your testosterone isn’t the best, your LH is a better indicator of testosterone production. The leading experts are seeing men with all the classic symptoms in the LH ranges of 1-3 with those diagnosed with secondary hypogonadism. If testicle stimulation and response is good, even at an LH of 4, levels could still be suboptimal and some symptoms still present.

Unless you are seeing a really knowledgeable doctor that can make the case for low testosterone to the insurance company, I doubt a doctor would prescribe TRT at these numbers. I will say your testicles are really responsive given the super low LH.

You want something more concrete than one random guys option, here you go.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men: A Locally Weighted Regression Analysis.

The locally weighted regression showed that total testosterone levels of 440 and 480 ng/dL were associated with increased Framingham CVD risk and an increased probability of increased hsCRP, respectively. Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk.

I can go telemedicine, but honestly I’d only be concerned about getting a script for traveling. Flying with test and no script would be a little scary for me.

I was slightly confused by your wording. Are you saying that my numbers are fine, but the low T could lead to heart issues?

Would you think trt would help me? I don’t mind self administering.

This isn’t a problem, simple insert the prescription label in the carrying case with the actual vial.

I think it’s safe to assume you will respond, to what degree your genes will determine. It all depends on what your body’s natural optimal levels is designed to function well. You’ve got all the classic symptoms, I don’t think a trial of TRT is unreasonable.

I have never seen a single guy stop TRT and not regain his baseline labs after stopping TRT and I’ve been here on these forums for years. Unless the guy was working towards primary hypogonadism while on TRT…

Some guys come here with more than one problem, it can be a s simple another hormone out of balance. I came here with low testosterone, diabetes and a diet primed for failure. I lacked vitamin C in my diet which lead to a iron deficiency.

What I meant was that I wouldn’t feel comfortable traveling without a prescription.

My levels have been the same for about 3 years now. So I think I’m pretty levels out.

I think I’ll give 150mg a week a shot.

Just tear the prescription label off the box the vial comes in and include that with the meds. Or keep the vial in its box. Every box will have the prescription on it.