32 Going on 90 it Feels Like. Hoping to Start TRT Soon

Pharma TRT
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After almost coming to my wits end trying to figure out my health on my own I think I feel hope for once. Currently 32 year old male but have felt off in many ways for the last 3-5 years. Depression, fatigue, and now total lack of libido within the last year. Have been prescribe antidepressants but these never made anything better and usually worse. Most recently my overall mood and inability with erections was the tipping point. Decided it was time to figure this out on my own and after some time I ran across TRT. Have not started treatment yet but I do think it might be my saving grace or at least I am hoping that. Honestly, it just feels to good to share and put my thoughts out there with others maybe in a similar boat or have been in that boat. Would love any feedback on my current labs and look forward to hopefully posting some updates.

32 year old male
6’5"
185 lbs

Activity Level: weights, 3-4 x week, light cardio 2-3 x week. Have been consistent with this for quite a while but never really made any progress with muscle gains.

Diet: Been on a keto diet for about a year. I know keto can be a hot topic but it really helped at the time and continues to help. Even though i remained active I was still slowing putting on some fat weight, keto stopped this and did help slightly with energy. Completely realize keto is not great for muscle gain but that was not happening on a more traditional diet either. Drinking has been reduced to 2-3 drinks per week at max for about 6 months.

Medication:
Alprazolam 0.5mg as needed for anxiety. Don’t use it frequently but when i do its just to feel more “normal”. Just being honest, not something I wish to continue with.
Multivitamin
Fish Oil (higher omega 3)
Magnesium, Sodium, Potassium.: Mainly to due with the loss of these while on keto
Lucienne: 3G per day.

Current Program: Didn’t really know where to turn to so i reach out to a local TRT clinic that had good reviews. After reading on TRT for quite a bit it became pretty obvious I would need to be the expert and find a program that was up to date on knowledge, this never seemed to be a majority of GP docs. Wanted someone that would treat the symptoms and not the numbers. Have had my initial consult and blood work. Waiting on that set of blood work to come back still. Had other blood work taken as well which has already come back and I will share below. Would love any thoughts or comments on it. Hoping to get in early next week for my first injection and then do the remaining injections at home. This clinic accepts insurance which will help on my out of pocket cost slightly. Hard to qualify for insurance coverage on TRT I realize but think my numbers my justify it. Again, love to know your thoughts.

Don’t have all my labs and yes, they are not full of everything you will want to know. Hoping that the new labs I get back from this other clinic will be more in depth.

2017 TT: 358 (Range 250-900). GP doc thought this was fine

2019 Newest labs below so far but more to come. My draw time was around 2pm which is not ideal for peak TT levels as I understand. From the studies I have read it seems there is up to a 30% various maybe slightly more throughout the day. Still based on my current total T of 84 @ 2pm, I can’t believe my morning T would be even above clinically low. The new labs I am waiting on have a draw time of 9am so there should not be any confusion. Have been doing a ton of research and feel really excited about the possibilties here. Just want to feel me again, be a better husband (mostly in bed), better father (patience and mood), plus a whole host of other things that seem like could be improved with optimal TT, Free T, E2, and the other blood levels. Symptoms over numbers though right?

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The problem is doctors are taught in medical school in-range is normal, only with TRT this is not the case, young men score somewhere near the top of the ranges and old men on the bottom, so unless you’re and old man your levels are low.

Not that it changes your situation, you cannot draw testosterone labs at 2 p.m because levels decline later in the day and peak again in the morning requiring testing no later than 10 a.m, but those on TRT is doesn’t really matter when you draw labs.

No one thought to consider your age, add to the fact TRT is demonized in the medical community and most doctors refuse to even talk about TRT because most doctors still believe TRT causes prostate cancer based on anecdotal evidence.

These labs are inadequate, you have just traded a clueless doctor for another. Sex hormone binding globulin (SHBG) is a protein synthesized in the liver and secreted into the bloodstream where fulfills its biological function, which is the transport of sex steroids hormones.

Therefore, SHBG levels emerge as one of the most critical parameters that are implied in regulating the access of these hormones to their target tissues, where it can even regulate testosterone action and your doctor thought is was alright to skip this very important test.

TSH is a stimulating hormone and not a thyroid hormone, thyroid status usually requires actual thyroid hormone testing for which you have none. Your TSH is good and chances are your thyroid is fine.

A lot of these clinics force you to come in for weekly office visit to receive your injections, treatment needs to be tailored to the individual, you cannot just inject once weekly and expect good results in everyone. Your SHBG levels will dictate your next move, if SHBG were on the lower end (<20), ED or EOD injections is needed.

I think there is more than enough evidence to suggest that your SHBG is very low, since SHBG transports testosterone, a low Total T value would indicate SHBG is very low and weekly injections will fail creating estrogen dominance.

Men with mid-range SHBG levels are fine injecting twice weekly, but for those wanting to lower
estrogen, more frequent injections is needed. You should be using 27-29 gauge syringes to inject your Test, injecting in the shoulders and quads.

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Appreciate the response and information. I left out a lot of details to keep my post as short as possible. I see why that leads to a lot of confusion though.

Currents labs are definitely not adequate which is why I am looking into an different clinic. Just wanted to show what I currently had available. If I have to have labs done on my own then that is what I will do. Private md labs seems to be fairly well respected for things like this.

My thought is that there is enough info and resources ou here to manage mostly on my own. So even if I wind up with a crappy clinic giving out 200mg test C / week, AI, and 1000 IU HCG, then I have what I need to manage within my own protocol. Nothing says I would then need to take 200mg/week but it would be there if for some reason it was needed. I will only do injections at home and no way would go into a clinic for once a week for them to do it.

My mindset at the moment is just to begin some treatment. I truly feel like crap and it’s become a big problem for my family. Not a wordsmith so I lack the vocabulary to really put how I feel into words. Again, no magic bullets but a proper protocol of TRT seems to be the right step forward. Hopefully starting a protocol of my own will give me time to look for more up to speed GP or clinic.

I was already leaning towards EOD injections as that seemed like a pretty good sweet spot. Right now just deciding between SQ and IM which feels like another highly debated topic. IM with 27/29G doesn’t seem to be a bad route, especially if I am doing smaller doses due to an EOD or ED schedule.

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You’re undereating and are significantly underweight. Fix both of those issues before considering TRT, otherwise you’re building a castle on a sand foundation (is that how the saying goes?! I’m blanking at the moment).

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Assuming you are basing my caloric intake on my weight which I don’t blame you. Guess I did not mention that within my diet section. Eat 2400-2600 calories a day (160G Protein, 50G Carbs, 180G Fat). I don’t restrict my calories though so some days I may eat slightly more if I am hungry. While Keto is debatable depending on who you talk to, it has been a help to me. Quality of life is still piss poor but did help some. Still tracking all my food through myfitnesspal and mostly eat foods cooked at home.

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I’m glad you don’t blame me for making comments that were based on the information that was presented.

Do you stay keto on these days or are you doing a type of cyclical keto diet?

The fact remains you’re underweight for your height, which indicates that calorie restriction is in place and has been in place for quite a while. And I see a direct line between “been doing keto for a year” and “these symptoms have worsened in the last year.” Like I tend to say, just because your bloodwork comes back showing low T, it doesn’t mean you need TRT. Fix the obvious problems first before starting decades-worth of medication.

I suggest steering away from the keto plan (this discusses a potential connection between restricted carbs and low Test), put on at least 20 pounds of bodyweight, and retest your bloodwork.

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Don’t disagree that Keto may not be my long term nutrition plan. Symptoms started far before keto was ever implemented. Consuming a more traditional “balanced” diet had more fatigue and fatty/water weight gain. Typically consume half of my carbs (25G) 30 minutes or so before any workout. Had this weight gain been some muscle, fat, and water then I guess that would not be the end of the world. Unfortunately, I simply slowly put on fat and water even when at fewer calories.

Again, 100% not opposed to increasing carbs and moving away from Keto. Keto has been a big benefit to me though after the last 3-4 years of struggles so probably not ready to totally remove it.

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Have you done any thyroid testing? I didn’t see any but it’s possible I missed it

Specifically you need free t3, reverse t3 and free t4.

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Just TSH at this point. Will look at getting free t3 and t4 done as well. Have additional labs coming in today but i dont think they ordered those. Will do that on my own if needed.

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I think it would be worth doing. Be sure to get reverse t3 too. You will probably have to do these on your own

T3 controls the metabolism of every cell in your body, so needless to say it’s easy to put on weight if you aren’t getting enough of it

Reverse t3 is like an anti T3 that stops T3 from working, even when the tests show you have plenty of t3, so it’s important to check that out at the same time

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Everything I read about rT3 says it’s a useless test. My dr, who somewhat specializes in thyroid says the same.

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That is not true. But you still should get t3 tested regardless, I hope he at least agrees with that.

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Why does he say its useless? I’m curious as my last thyroid labs had my TSH above 5, free t4 0.02 above the bottom of the range and free t3 upper 3/4 of range. I know TSH is bad and t4 sucks but wasn’t sure where to go with good t3. I figured I would be told I need reverse T3 by guys here but do not want to spend the money if its not needed.

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Your TSH is above 5, that is a good reason. Thyroid labs are not always going to show thyroid problems, sometimes thyroid hormones may look normal while there is thyroid dysfunction underneath the surface.

TSH very high is like a screaming infant, something is going on or it wouldn’t be elevated.

I would also test T4, if low would explain high TSH.

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I figured the low free t4 was the issue causing the higher tsh.

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Got some additional labs back today. No T3, T4, or SHBG which I realize can play an important role. Just posting what has come back so far. Total T was higher but quite sub optimal when collected first thing in the morning. Free T is very low and Estradiol being on the rock bottom end as well.

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Started treatment with a clinic today. Started on 160mg Test C as a weekly injection. Stupid me did not realize until I paid that they provide it as preloaded 160mg (0.8ml) syringes. Not what I am looking for obviously but also not going to just waste it because of that either. I am thinking I could use some slin pins to at least pull out half of each syringe and do 2x weekly for the first month. Will find a new provider in the meantime.

Found another company that originally i really liked because it seemed like i could self protocol pretty easy. Talked to the doctor and they combine the Test C (200mg/ml) with 1mg of Anastrazole… yikes and no Thank You.

Probably will upset some people I am sure to have begun a TRT protocol without SHBG, T3, and T4. Either way this is a great forum and look forward to sharing any of the ups and downs along the way.

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Back load some additional syringes to split it into a few doses. 3x per week or so should be a lot better than weekly

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Twice weekly should do fine, your total T and free T ratios suggest SHBG is about mid range. This clinic does pre-loaded syringes so they can charge for pre-loading.

Interesting how they withheld this drawback. The CDC is going to be cracking down on this practice because it’s not sterile. The clinic also offers 1mg AI mixed in with the Test because they can charge extra for it.

Understand some of these clinics do not care about your health, they care about only on thing, money. Remember that when it comes time to pay up for continued service.

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The pituitary gland increases TSH when there aren’t sufficient thyroid hormones, I suspect T4 could be below midrange and I believe this is why Free T4 may be low.

I believe Free T3 isn’t always sufficient as seen in testing. Lab testing is not 100%, look at how inaccurate second generation TSH testing was, third generation TSH testing revealed many who were thought to be normal had hypothyroidism and yet doctors are still using those lab ranges to determine normal status.

How scary, I feel sorry for the uninformed being told they are normal. These people scour the internet wondering what’s wrong with them after being told their normal and find T-Nation.

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The CDC is going to be cracking down on this practice because it’s not sterile.
- This was literally my first thought out the door. Also, I accidentally bumped one of them and some leaked out, not much but it’s still an unnecessary problem to deal with.

I do understand most if not all these clinics are out for the profit. One of those buyer beware situations, my health is my responsibility in the end.

Knowing my Free T now do you think SHBG is still needed? Also, do my current Low T and Low E go hand in hand? I know they will sort of now that I have begun TRT but what about before starting? Just wondering if my Low E contributed to a lot of my libido issues. Seems I have read a lot on here about people crashing there Estrogen and losing libido. Not sure why mine was so slow naturally unless it was all based on my T levels.