T Nation

Worried About TRT

I know the answers have been given here, and all over the web, but I’m still kinda concerned about TRT so I thought I’d post my situation and get some feedback from you all.

Age: 40

My T levels from two different tests

Free: 9.7ng/dl (9-30 range) Total: 485 ng/dl (240-950 range)
Free: 10.6pg/ml (8.7 - 25.1 range) Total: 565 ng/dl (348-1197 range)

My problems:

Pretty serious depression for many years, erectile dysfunction, no libido, lack of motivation and confidence.

Other health issues:

I drink too much too often, but I’m otherwise very healthy (done all sorts of tests) and in pretty great physical shape.

Questions/Concerns:

  1. The doc was willing to put me on 1% androgel because I seem to fit the profile very well for TRT (low free T plus my symptoms). Do you all agree?

  2. What I’m looking for is help with depression and ED. Is 1% of andro right for me?

  3. I’m willing but nervous about TRT. If I start now, I’m looking at doing this for many, many years, long term anything like that seems risky to me. I could probably ‘get by’ another 5 years or so to reduce the longevity, but I’m probably being silly… am I?

  4. I don’t seem to have much trouble building muscle… how can that be if my T is low, and with my drinking?

  5. As I’m sure many of you know, alcohol and T don’t mix, so I’m guessing a good bit of my T problems probably stem from drinking every night. I’m attempting to reduce my drinking but that’s going to realistically take me a long time, am I crazy to take T to fix what I’m probably largely doing to myself with the drinking??

  6. If I go the TRT route for a while and go off it for whatever reason some time later, will my normal production eventually return?

I’d really appreciate any feedback you can provide, thanks a lot!

some more info

-age- 40
-height- 6’
-waist- 33"
-weight- 190lbs

-describe body and facial hair-
normal body hair, weekly beard, recently started losing hair at the front center of my head

-describe where you carry fat and how changed-
I don’t really carry much fat

-health conditions, symptoms-
depression for many years, erectile dysfunction, no libido, loss of motiviation/confidence.

-Rx and OTC drugs-
no RX, only OTC is plenty of D3, Zinc, Magnesium, and Multi vitamins

-lab results with ranges-
Free: 9.7ng/dl (9-30 range) Total: 485 ng/dl (240-950 range)
Free: 10.6pg/ml (8.7 - 25.1 range) Total: 565 ng/dl (348-1197 range)

  • What other lab info is helpful?

-describe diet-
3-4 meals a day, not a bodybuilder diet but pretty healthy. 1 protein shake after workouts. drink too much - 6 drinks a day 24/7/365 for 15yrs.

-describe training-
winter 6 days on 1 day off moderate lifting, summer lots of cardio. frequent gaps in training due to traveling, highly unlikely I’m overtraining.

-testes ache, ever, with a fever?-
nope

-how have morning wood and nocturnal erections changed-
for the most part I haven’t had wood without helping it along in years now.

Did your doctor test LH, FSH, E2 and Thyroid before deciding to put a guy with 565 TT on TRT? TRT is a last resort.

You should look at the advice for new guys sticky, perhaps again, and look at the things there other than low-T.

Hypothyroidism can lower T and otherwise has many symptoms [yours ] that are common to hypogonadism. Please look at the thyroid basics sticky.

  • check your oral waking body temperature, before you get out of bed, soon as possible

  • check to see if you get 98.6 mid-afternoon

  • have you been using iodized salt forever? If not, you probably are deficient.

  • is iodine listed in your vitamins?

Do not start TRT until you get the above labs at a minimum.
And add prolactin to the list

Get your lab reports and post everything here. Don’t tell us that something is normal, post.

Here’s the only other numbers I have that you’ve asked for so far.

Free T4 1.25 ng/dl (0.76-1.46ng/dl)
TSH 1.440 uiu/ml (0.358-3.740uiu/ml)

100mcg Iodine daily from my multi vitamin, and I regularly eat iodized salt.

I don’t have a thermometer to take my temp but I’ll get one soon.

My blood work so far was done by my GP and wasn’t done to figure out my Depression/ED issues. I just happened to notice the low free T and got a second test and it was low there too. In about 3 weeks I’ll be going to see an Endocrinologist and can get more numbers then. I’ll be asking for everything on your list

[quote]LH and FSH [LH/FSH]
-TT
-FT or bio-T
-E2
-Prolactin [optional in most cases]
-DHT [sort of a waist of time and blood if your testosterone levels are low]
-PSA
-DRE[/quote]

Is there anything else I should ask for?

What do you all think about my low free T? Would you agree TRT could be a possible solution to my issues or not?

Also, I’d REALLY like to know - if I end up on TRT and it doesn’t help, will I able able to return to normal T levels naturally when I stop?

Not gonna preach on the drinking, you acknowledge you drink too much, so you will get that figured out if the problem is that serious because only you can know this?

ED- does this only happen during sex? Are you able to achieve erections when you masturbate? if so, this is performance anxiety. If not, maybe physically related, either way this is a fixable issue and its not solely testosterone related.

Depression- how long has this been going on? Treatment methods you have tried?

I think T is part of your equation here, but I think if you have hopes TRT is gonna fix everything you might be disappointed. Also at 40, chances are a restart are gonna be the same level as now best case scenario, and probably lower.

All these issues are fixable my man.

Your T is fine. I think you’re wasting your time there. Have you lost interest in other activities? Low emotional intensity? Constant high stress? If so there is an answer and it’s Ketamine. Clinics are popping up everywhere for a reason. It’s basically a miracle.

I have seen Ketamine being used to treat highly depressed suicidal individuals, and in this sense its a miracle for sure but this only snaps them out of the depression temporarily, very confusing data regarding dosage of long term ketamine use. Also, if you thought HCG was hard to get try asking for ketamine. This would have to come from a Psychiatrist based on a serious diagnosis of major clinical depression. Brent, be curious to know where these “ketamine clinics” are? What part of the country? I would def agree this drug is an exciting possibility for the future of depression.

[quote]jkyle2179 wrote:
Not gonna preach on the drinking, you acknowledge you drink too much, so you will get that figured out if the problem is that serious because only you can know this?[/quote]

In terms of everyday life my drinking is not even remotely an issue, however I’m fully aware it’s not a good idea long term and that it’s likely hurting my T levels. I’m working at reducing my intake, but it’ll take time as I have to change my lifestyle quite a bit.

I only get an erection from direct stimulation, it’s never quite as hard as it should be, and it’s gone the instant the stimulation stops. I never get hard at any other time and pretty much have no libido.

Hard to say for sure… 10yrs possibly longer. I’m seeing a psychologist now, and briefly tried meds a few years back. I didn’t like taking meds.

It’s my free T that caught my attention. Low free T is leading suspect for many if not all of my symptoms according to my research (and my doctor). I do understand though that T may not fix me and there could be something else going on here.

My life is pretty low stress aside from being stressed about my health situation. I haven’t lost total interest in activities but my desire is less than it used to be.

Free T is not that bad based in relation to your total T numbers… You said you have been seeing a mental health professional for years, whats the diagnosis? Clinical Depression? Bipolar? Are you currently taking any meds?

As far as theED goes, it doesn’t sound like ED, sounds like you maintain an erection just fine during sex/masturbation etc… Just because you don’t stay hard all day or it takes physical stimulation for you to get an erection mean there a problem, this is more common place as we age. So I wouldn’t be too concerned about this. When you get the underlying emotional issues you have fixed, this will help in this area too because you will feel like pounding something, so you don’t have ED! get that out of your head.

I’m really surprised at these responses.

“6” drinks a day, 24/7/365, makes you an alcoholic.

under “other health issues” it should read “alcoholic.”

I’m not being harsh here, you and I said the same thing, I just used the word and you didn’t.

I’m not sure why you would even consider TRT if you think the alcohol consumption could have (it likely does) much to do with your situation. Drink if you want to, go on TRT if you want to, but to me it makes no sense to jump into something else in order to mask your symptoms of a separate issue.

Given those pre-TRT numbers, TRT doesn’t do anything for depression. And it may even worsen depression/anxiety-based ED and libido issues.

That is my experience.

Low free T alone can cause all of my symptoms. It may not be in my case, but low free T is a prime suspect with my symptoms.

Did I say years? I was diagnosed clinically depressed almost 10yrs ago and again recently but I’ve only recently started taking therapy seriously.

No meds. I did for a month or so years ago and they didn’t help enough to warrant taking them.

If it’s normal aging, I must be 80 :slight_smile: Seriously, I have zero natural erections, I have to fight to keep the few that I force, and have no libido. Been like this for 3 years or so now and my doc and wife are quite sure I have ED issues.

[quote]I’m really surprised at these responses.

“6” drinks a day, 24/7/365, makes you an alcoholic.

under “other health issues” it should read “alcoholic.”

I’m not being harsh here, you and I said the same thing, I just used the word and you didn’t.[/quote]

Yes it does which should be quite obvious. Not sure how your ‘clarification’ helps a thing here.

Thanks for answering one of my main questions. I agree with you - using TRT to help a situation that I might have a part in causing doesn’t make sense… That is, until I’m realistic about how long it’s going to take to deal with my drinking and how tired I am of being in this awful place.

[quote]Given those pre-TRT numbers, TRT doesn’t do anything for depression. And it may even worsen depression/anxiety-based ED and libido issues.

That is my experience.[/quote]

Thanks for letting me know your experience, I’ll keep it in mind for sure, but many people experience the opposite which is why testosterone is one of the first things they check if your depressed or have ED.

Fwiw, I got my appointment with my endo today, I go Nov 7th. I’d be thrilled for more feedback before then as I’d like to be armed to the teeth when I go in.

I really appreciate all the responses so far!

if you know the alcohol is likely a factor, but you aren’t ready to deal with that head-on, and just want the TRT…why even mention the alcohol? if you aren’t going to deal with that FIRST, it becomes irrelevant to your case. I’m not an expert here, but I have a feeling that even if TRT makes you feel better initially, eventually that constant alcohol is going to wreck you again.

If you’re injecting Testosterone in your body, then your body has no choice, that T is there. However, maybe the constant alcohol eventually screws you up so that your body can’t effectively use the T that’s there. I really don’t know, but it would be smart to figure these things out prior to starting anything.

I had a few years ago that was an alcoholic- my best friend in high school. After my first year in college (he didn’t go) I came home to find he drank a lot. Well, I did too so oh well…fast forward a few years, I’m out of college, he’s still been home bored and drinking, A LOT. This guy was in decent shape to look at him, 5’11" 185-190, but at 24-25 y/o he was on medicine for his blood pressure and had a Viagra script. I wouldn’t have been surprised if the chronic alcohol wrecked his T as well.

btw, my “clarification” was because you described an alcoholic, but didn’t just say “I’m an alcoholic.” Wasn’t sure if you were in denial or what.

[quote]fivepines wrote:

[quote]Given those pre-TRT numbers, TRT doesn’t do anything for depression. And it may even worsen depression/anxiety-based ED and libido issues.

That is my experience.[/quote]

Thanks for letting me know your experience, I’ll keep it in mind for sure, but many people experience the opposite which is why testosterone is one of the first things they check if your depressed or have ED.
[/quote]

Certainly you are right that T should be checked (although in practice most doctors DON’T check T levels given these symptoms - no psychiatrist or PCP has ever ordered T labs for me when I complained of these issues).

But my point was that the people who noticeably respond to TRT are generally the ones who test frankly hypogonadal, with total T under 300-350 ng/dL, not those of us who test well within the range, like you and me. (As for free T, it remains controversial whether it has much meaning, and you will find vehement arguments between experts for and against it.)

Still, it may be worth a trial to see if it helps, and I wish you luck.

About to get tested, finally, tomorrow. I noticed that my doc didn’t check off PSA on the test order so I’m just going to check it off myself :slight_smile: However, there are two options PSA Cancer, and PSA Free/Total. Which should I get? If PSA Cancer, that requires a second selection of Screening or Diagnostic, which I’d also need to know. Thanks!

[quote]fivepines wrote:
About to get tested, finally, tomorrow. I noticed that my doc didn’t check off PSA on the test order so I’m just going to check it off myself :slight_smile: However, there are two options PSA Cancer, and PSA Free/Total. Which should I get? If PSA Cancer, that requires a second selection of Screening or Diagnostic, which I’d also need to know. Thanks![/quote]

Call your doc in the AM and ask if the failure to order a PSA was an oversight, would it be OK for you to add it to the panel, and if it is, which one you should select.

Most doctors will ‘fire’ (ie, summarily dismiss from their practice) a pt who alters an order sheet.

[quote]EyeDentist wrote:

[quote]fivepines wrote:
About to get tested, finally, tomorrow. I noticed that my doc didn’t check off PSA on the test order so I’m just going to check it off myself :slight_smile: However, there are two options PSA Cancer, and PSA Free/Total. Which should I get? If PSA Cancer, that requires a second selection of Screening or Diagnostic, which I’d also need to know. Thanks![/quote]

Call your doc in the AM and ask if the failure to order a PSA was an oversight, would it be OK for you to add it to the panel, and if it is, which one you should select.

Most doctors will ‘fire’ (ie, summarily dismiss from their practice) a pt who alters an order sheet.[/quote]
I’ve added a lot of things they miss over the years with various doctors. None ever noticed lol

[quote]fivepines wrote:

-describe diet-
3-4 meals a day, not a bodybuilder diet but pretty healthy. 1 protein shake after workouts. drink too much - 6 drinks a day 24/7/365 for 15yrs.

-describe training-
winter 6 days on 1 day off moderate lifting, summer lots of cardio. frequent gaps in training due to traveling, highly unlikely I’m overtraining.
[/quote]

They often say, “You can’t outrun a bad diet.” This is definitely the case with you.

6 drinks on any given day isn’t a big deal. 40-50 drinks a week, every week for 15 years is a serious fucking problem. You gotta get that shit sorted. You’re an addict, albeit an functional one, and it’s controlling your life.

It sounds like you have already decided the outcome you want and you just want others to justify it, you’ve already answered your question with what may be wrong and you have a response for everyone. Your alcohol is a problem and that needs to be dealt with and quit being hung up on the T numbers. When people change Drs orders and want to manipulate their blood tests so they can get more than what’s needed it causes problems for a lot of people. Hey I hope you get your stuff worked out.