Which doc will the majority of this forum consult
- the one which brings your levels to a midrange of your age group - something like TT 550 to 650
- or the one who promises to ‚optimize, you and make you an alpha male?
I dont think anyone should consult a doctor obsessed and afraid of numbers. It should be about symptoms resolution
According to the Tru T calculator a men needs only 600 ng/dL with an SHGB value of 30 to bring your fT to almost 21.
Wasn’t it Morgentaler who mentioned that one should be above 15?
600 can easily be reached with the dosage recommended by the endocrine society.
And there is a ton of men out there who have TT levels of 400 with no symptoms of androgen deficiency. I linked those studies already before.
It should be evidence based medicine and symptoms alone can trick you big time. There are enough men here who report that normalizing their T levels did not resolve their issues.
@johann77 If normalizing your t levels means 500-700 of course. For some people this is enough but… For many people this is not enough and the endocrine society does not seem to understand that.
Many of the people being told they have “normal” testosterone levels of 300-500 start to feel much better when they increase it. A friend of mine for example started to feel better when he stuck enough time to 30mg per day protocol and his levels rose above 1000. Good for him he found a doctor that seems to understand that
That’s good for your friend.
But treatment recommendations should not be based on the minority but rather on the majority of subjects. If you don’t feel better after raising TT from 250 to 600 go and adjust - perfectly fair. But it’s always better to approach the optimum from the lower side than from the higher side.
And if you don’t achieve symptom relief at the upper range or even above its time to consider other factors.
Morgentaler is a bit too aggressively promoting TRT in my opinion, but I couldn’t agree more to this approach taken from one of his papers (except the gel):
‚From a clinical perspective, there is little justification for denying a trial of treatment to symptomatic men with testosterone greater than 300 ng/dl if they have evidence of low levels of bioavailable or free testosterone. Men with elevated SHBG may be truly androgen deficient yet their total T may appear “normal.” Prospective clinical trials are silent on the efficacy of treatment in men with testosterone greater than 300 ng/dl, because these men are generally excluded. Yet in one retrospective, uncontrolled study of men with sexual dysfunction and low free testosterone, 73.6% of men with total testosterone greater than 300 ng/dl reported improved erections (5). Conversely, there is no guarantee that men with “unequivocally low” testosterone will respond to treatment, since less than half of those with testosterone less than 200 ng/dl reported improved erections (5). The diagnosis of androgen deficiency clearly resists easy categorization by total testosterone values.
I usually begin testosterone treatment with transdermal gel, making sure that treatment levels reach the mid-normal range or higher. Raising testosterone only into the low-normal range will be subtherapeutic for most men. If there is no symptomatic benefit by 3 months, I discontinue treatment.‚
imagine you are a compounding pharmacy with referals from a few TRT docs who throw you a few hundred patients each…call it 1000 in total. if the doctor, on average, prescribes 50% more testosterone…that increases your revenue on testosterone prescriptions. Instead of 1 vial every 3 months…its 1 vial every 2 months. Its a straight top line revenue boost…and over a thousand patients a year that equals 6 figure levels of additional income.
A bit different approach from him, but I totally like this doctor. He is destroying in a very intelligent and scientific way all endocrinologists who deny TRT treatment to all men who are with low-normal total t levels.
My friend was proclaimed with normal testosterone for having 370 or something like that. For him the difference between that and 1000 is night and day or getting his life back. And he is not minority. This is the story of the vast majority of guys starting TRT.
However there are men like me who started at 560, although with relatively high SHBG(53). It is too early for me to say, but I already started to feel a bit better. Im very positive for how TRT will influence my life…and Im usually the negative guy.
However my younger brother has total testosterone around 380-400 and claims to feel awesome and not to have any symptoms. Ok, some people are like that. My problem with endocrinologists are they think ALL people should be like my brother and they should not have symptoms at those levels. This obsession with numbers is just absurd
How about all the guys in their 20’s being told 350 is normal? The average guy in his 20’s has testosterone close to the top of the ranges, yet a small percentage of men are significantly lower and told their levels are normal when the averages tell a different story.
Everyone has their own set point where symptoms are experienced, no one thought to consider androgen receptor sensitivity that some men are a little more resistant to androgens and needs a little more than the next guy.
Not everyone has short CAG repeat number.
@systemlord If they arent experiencing or complaining of symptoms then 350 for them is ok even tho less than the average. There is the conundrum a Dr. faces by not wanting to guide a patient…350 is on the low band of normal, but if a Dr. were to make a big deal about this in the absence of symptoms…they could start an unneccessary worry and focus on something that isnt a problem, in effect creating a problem. Tell a man he;s less than average enough and he’ll start to be less than average.
Almost approaching 7 weeks since starting TRT and i think its time for an update.
I’m still living in a canadian ski town and do not have easy access to bloodlabs so i’m basically going in the dark here. I’ve stuck to my new lowered dose protocol as suggested by @systemlord for 5 weeks going from 37.5mg to 30mg eod 130mg > 105mg.
I recently switched to a more reputable UGL lab as my old one was giving me strong post injection pain, this new lab is way better i now have zero pip.
My old symptoms have returned for the most part, first three weeks my libido was a lot stronger and it seems to have now lowered almost to pre trt levels. I’m still getting morning erections most days but not as often i did during the early weeks of TRT.
Brain fog is still bad, this is easily the worst symptom i have and the one im most keen to get rid of. I’ve noticed my anxiety is still quite high, haven’t experienced any of this high test confidence ive been reading about. I don’t want to blow smoke up my ass but ive been told i’m quite an attractive male, ive been told by a few of my co workers that i have various objectively attractive women interested in me, but i lack the confidence and the drive to persue any of these opportunities.
My energy levels have been pretty good, haven’t noticed any excessive fatigue which i used to get frequently. I’ve only noticed a bit more vascularity in my arms. and i’m seeming to retain my old muscle mass easily despite not being able to work out (tore ac joint snowboarding)
Probably also worth mentioning that i have been smoking quite a lot of weed lately. My roommates smoke daily and ive started to do the same. I’m not liking the effects its having on me mentally so ive decided to cut that out starting today. I’m drinking moderate-excessive amounts of alcohol usually once or twice a week. Keep in mind im living in a party town.
I’m thinking about increasing my dose to 37.5mg EOD. Would this be wise? I haven’t really had any high E2 symptoms other than a bit of bloating which subsided after a couple of days. And yes, i’m aware how important bloodwork is trying to dial in a dose, but thats not an option for me right now.
your responses are appreciated. thanks
You either want to feel good or you don’t, none of these activities are helping. You have other health problems going on and need someone who can work the problem. It could be as simple as a mineral or vitamin deficiency or some other hormone.
You would be surprised how one simple vitamin deficiency can wreak havoc on your mind. The vitamin C deficiency was bad enough to make me think I was about to die. The brain fog and fatigue is unbelievable.
I would always have the most problems after 6 weeks when I had these vitamin deficiencies because my test levels were higher using up more.
The first week you had your own production as well so it is normally to feel better then. When my production shut down I felt suiscidal for 4 days
If you feel bad now 7 weeks in most likely your protocol is not good, your gear or your dose
Hi all, thought i’d do an update. I need of some Advice too.
I’ve now been on my EOD 140mg subQ trt protocol for 5 months. I’ve recently returned home from my overseas working holiday and am now able to finally get access to bloodwork which i have yet to complete since starting.
Overall i’m feeling pretty good, not amazing. My libidio has improved and i’m getting consistant morning wood, i’ve also noticed my testicles haven’t atrophied much (maybe like 10%?). My body is noticably leaner and i have since put muscle mass quite easily. I’ve been very consistant with my protocol and have not added any variables other then the occasion multi vitamin and zinc. I have noticed i still have pretty intense brainfog, this could be correlated to the weed i was consuming in the afternoons/nights overseas as it was legal there and my roommates happened to be massive stoners. I have since completely stopped everything Alcohol/drugs for almost 4 weeks. I’m hoping this is the root of my brainfog but i have not noticed much improvement since stopping so there is a good chance its unrelated. maybe related to thyroid???
Anyway, My doctors appointment is Thursday. Could someone please advise me what bloodwork i should request? I’m already anticipating this doctor to grill me for self prescribing TRT but so be it.
thanks guys 
bump
@vonko1988
@systemlord
For a detailed blood work this is my opinion:
Mandatory:
- Total Testosterone
- SHBG
- Albumin
- Estradiol
- Prolactin
- CBP
- TSH
- FT4
- FT3
- Anti-TPO
- Anti-Tg
- Trigliceridi
- Lipid Profile
- Cortisol serum
- Glucose
- Liver Enzymes
- CRP
- PSA
Optional:
- Vitamin D
- Zinc
- Magnesium
- B12
- Na
- Ca
- Cl
- Iron
- Ferritin
- Creatinine
- Bilirubin
Thank you, I’ll report back most likely monday when i have the results
I’ve noticed you haven’t added free testosterone, is this a mistake or is it not neccessary?
cheers
I would throw it in, but some prefer to calculate it since the more common free T tests aren’t super accurate (though my measured and calculated have always been almost the same).
Okay thanks, I imagine it’s going to be quite difficult trying to convince my GP to test me for all those things. They’re very conservative in Australia and will often argue that its a waste of tax payers money getting all those lab values lol.
I’m going to have to go quite an assertive approach.