Considering TRT. Please help!

Pharma / TRT Testosterone Replacement
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Facts: 46 year old male. 5’11 230 pounds, assume 25% body fat. Like lifting weights, hate cardio, and diet can be much better. Never been able to get my physique where I want it. High cholesterol so take 5mg of crestor daily.

Went to a doctor who practices men’s sexual health for ED and delayed ejaculation, he noted low T and recommends I go on TRT. Here are my results:

Testosterone: 6.4 normal range (8.4-28.8) nmol/L
Testosterone Free: 198 normal range (196-636)

I know nothing about TRT and this website has a lot of information but I don’t understand it all. I need help. Below I have listed some questions and I would be grateful for responses. Also, I don’t know the many acronyms on this site so please type the words out. Many Thanks.

  1. What is difference (in simple language/explanation) of Testosterone and Testosterone Free tests that I did? Are any of them SHBG? If not, what is SHBG?
  2. What does HCG mean?
  3. Generally who is best positioned to administer TRT and monitor?
    a. Endocrinologist?
    b. Urologist?
    c. Sports medicine doctor?
    d. Men’s sexual health clinic?
  4. Seems like injectables are the way to go over gel.
    a. Is there a certain type (best) medicine to inject, what’s it called?
    b. What dosage would you recommend, how is this determined? I know this may be different for everybody but can you provide me a range?
    c. Does the time of the day matter when you inject? First thing in the morning, before sleep, before gym? If I want to get a benefit when I am lifting weights at the gym, what is optimal time before my workout to maximize benefit?
    d. How often to inject?
    e. How much would you need to inject to be on a bodybuilder/steroid like cycle? Will recommended “normal” does of TRT help me get ripped? I’d ideally like to see changes in my body image.
  5. Where in the body do you inject?
    a. Can you change where to inject each time?
    b. Can I develop a rash or injection site, any recommendations to make the process easier?
  6. How often will I get my T levels tested?
  7. What other regular blood tests should I do / test for to make sure everything else in the body is okay?
  8. Side effects
    a. Hair loss?
    b. Acne?
    c. Burst of high energy and then low energy? Would I be tired when affects wear off?
    d. Depression?
    e. Raise estrogen levels?
    f. Develop female breasts?
    g. I have high cholesterol, any impact?
  9. Do I need to take an anti estrogen?
    a. If so, what is the name of the medication and what dosage?
  10. Once I start do I have to stay on rest of my life?
  11. How do you get off?
    a. Do you need to take any other medications when getting off? If so, which ones and dosage?
    b. Can somebody share their experience getting off TRT and how it made them feel? Strength? Energy level? Libido? ED?
    c. I assume some would be back to where they started low energy levels? Depression?
  12. If there are people that have stayed on this continuously for 5 plus years, I’m curious on your views?
  13. Should I take creatine during TRT or after I have stopped to get maintain some strength? Any other over the counter supplements I should take?
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Testosterone deficiency isn’t defined by total testosterone. The Free T is where the rubber meets the road, so this is the only lab test you should pay attention.

Free testosterone in the bottom 25 percentile increases your risk of developing prostate cancer by 53% and reoccurrence. All cause mortality increases, such as heart attacks, strokes, atherosclerosis, dementia, Alzheimer’s, PAD, etc.

Other tests include, hemoglobin, hematocrit, CBC and estrogen. Low ferritin can mimic the symptoms of low testosterone, therefore ferritin should be measured before initiating TRT and 3-6 months after starting TRT, since TRT can suppress ferritin in some individuals.

PSA will be measured after the first six months, usually at the one year mark.

SHBG is made in the liver which binds testosterone which inflates the total testosterone, so men with higher SHBG will have a higher total testosterone.

There have been dozens of men in here with high total testosterone and low free testosterone.

So based on your low total testosterone, you have low SHBG, which is strongly associated with metabolic syndrome, and cardiovascular disease.

Endocrinologists are typically the worst, urologist can be a little better, but it’s hit and miss with sick care doctors, who are trained in men’s diseases and not men’s health.

A private cash only sports medicine doctor or men’s health clinic would be a better fit for TRT.

Definitely, injections nets you more lean muscle mass in the lower extremities.

T cypionate or enanthate, the latter can offer less fluid retention.

Most men would even notice anything if they miss an injection once after reaching steady blood levels which takes 6 weeks or 42 days.

The optimal injection frequency will be different for everyone, you’ll have to experiment and find out what works best for you. Most men do well on weekly, but twice weekly is becoming common in order to maintain high trough levels.

The only thing that has worked for me is dosing daily or every other day on injections, but now I dose oral testosterone undecaonate twice daily.

Dosing will vary, depending upon the individual, typically 100-150 mg is common. Genetics, training, nutrition, all determined what your results will be. There have been guys that have gone on steroid cycles who can’t put on any muscle, which has more to do with them being an ectomorph (body type).

I am a mesomorph, so I can put on muscle easy but I’m limited on how big I can get. I already had an athletic build with some bulging muscles in arms and legs without ever having stepping foot in the gym.

An endomorph has the ability to get very fat, but also being able to gain a lot of muscle. Think of the fat big guys with calf muscles the size of your head!

Deltoids using 27 to 31 gauge insulin syringes for shallow IM injections.

Yes, and it’s recommended. You can alternate between your quads and deltoids.

My provider tests my hormone levels every 6 month. You are more than likely be testing more frequently until your dialed in.

That’s determined by your genetics.

TRT is not a panacea, your results may vary and will depend on your current medical problems and genetics.

Hi cholesterol is not a problem, high cholesterol is healthy. I’m on the carnivore diet and I have sky high cholesterol, (low triglycerides) which is the way it used to be before big food companies came into the picture.

I stopped TRT in 2019 cold turkey and my HPTA restarted in 4 1/2 weeks, I was expecting a huge crash but did not experience one.

Your mileage may very.

You can use daily Cialis as an anti-estrogen. I recently had to stop it because of symptoms of what believe is low estrogen.

Since stopping my muscles look bigger and feel fuller. Healthy estrogen levels will help you with muscle mass increases and fat mass decreases.

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Okay, I’m not going to answer the 20 some questions you have in here, but I’ll drop the basic advice.

6 problems here can be changed by fixing your diet, TRT will band aid the real problem.

Again, this may be able to be fixed by correcting your diet. Lower bodyfat is recommended for optimizing natural testosterone production.

That being said, your symptoms and levels both warrant TRT as it is currently. Still, I would address your diet and bodyfat levels first, or in combination with testosterone supplementation.

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Take advice from people who take full on roids and do blasts of testosterone in cycles, and don’t go on TRT.

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and they will tell you, “You’re too fat to do a cycle. Lose weight first.”

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I want to add something, anyone with chronic health problems, the carnivore diet is recommended! It cuts out all or most processed ingredients big food companies put in food to make you more hungry. Your body also switches over to fat for energy rather than carbs and as a result, your body when fasting burns fat and weight drops off like easy!

The second you eat carbs when on the carnivore diet, your body switches back over to carbs for energy and decreasing the ability to use fat for energy, decreasing the ability to lose weight/fat.

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I mean, there’s nothing inherently wrong with what you said here - but theres a lot of wordplay that makes carnivore sound like a more optimal solution than it is.

Whether you’re “fat adapted” or not has no bearing on your body’s ability to burn adipose tissue. Carbs are intended to be used for intense, short-term energy needs such as weight lifting or sprints.

My diet is inherently “carnivore” plus about 125g carbs, which are all timed pre-workout. This plays into their specific purpose as a short-term use energy source. The training session burns up most or all my glycogen reserves, putting me back to a glycogen depleted state… meaning i go back to using adipose tissue for energy needs.

Carnivore is fine, but it’s suboptimal for building muscle and i think it’s just another fad diet that will disappear in the years to come. The main benefit, IMO, is that it reduces additives - which you pointed to.

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Wow guys, thank your very much for all the detailed responses. I knew I would find help here. This will be a new journey for me, I am nervous and excited.

I am going to work on my diet and cardio. I lift weights about 3x a week and in my prime was 6x a week and could bench two plates a side (remember I am 46 not 26!)

My ferritin level is 255 and they said normal range is 15-275.

I didn’t even know oral existed: “I dose oral testosterone undecaonate twice daily.” Anybody have a view if this is better than injectables?

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Fad diet! Americans used to eat steak, eggs, and bacon. Then came along the process food companies, that paid the American Heart Association to say red meat, high cholesterol, causes heart disease based on nothing more than surveys and questionnaires and as we reduced our red meat intake by 33% and heart disease rates tripled.

Just take a look at Hong Kong, the highest red meat consumption per capita in the world. The average person eating 20 ounces of red meat per day and they ranked number one for longevity in the world!

If you want facts, our human based digestive system is acid based and is optimal for digesting animal fatty meat, fiber dilutes stomach acid and prevents absorption of macro nutrients, which is why vegans need to supplement so many vitamins.

You can say eat everything in moderation, yet in the animal kingdom, we don’t see that. We see animals eating their species specific diet that is pretty limited.

Want to add one last things, carbs is not an essential nutrient, fat is an essential nutrient and you’ll die without it!

I blame the big food companies for putting propaganda out there for the masses to consume, brainwashing Americans on nutrition. The 7th Day Adventist Church and Kellogg Corp are behind it!

Fatty red meat has every essential nutrient that a human body needs to nourish itself. I think the problem here is the way we were raised, food is cultural, a way of life, and an addiction.

I can’t understand your comment that the carnivore diet is not good for building muscle, I don’t know where you get that from. Take a look at Dr. Anthony Chaffee on YouTube, who is very muscular and has been on the carnivore diet for over 13 years!

I don’t want to go off on a tangent and derail the thread, but we have to agree to disagree.

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There’s Jatenzo, Orlando and Kyzatrex, the latter two can be cash only, no insurance.

I’m on Jatenzo at 237 mg twice daily, or 3318 mg per week and only a fraction (9-13%) is actually absorbed in the small intestines. Oral testosterone undecanoate has less side effects than injections, especially with regards to erythrocytosis!

Peak levels at 2 hours is 988 ng/dL, 489 ng/dL at 6 hours, days ago I tested at 5 hours (1 hour too early) and → 592 ng/dL, trough levels 289 ng/dL. I feel the same 24/7. Strong erections when at trough.

I have never seen such consistency in hormone levels that I have on Jatenzo! Injections never offered that level of consistency.

My estrogen levels when at 592 ng/dL was 18, a bit low.

I was taping off Cialis at the time due to what I believe is low estrogen symptoms, being that Cialis can low estrogen over several months of treatment. I continue to feel better the longer I’m off Cialis.

The PK profiles are different than injections.

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I wanted to share the extremely consistent results I’m getting with Jatenzo at 237 mg twice-daily. All tests were done at 4-4.75 hours after my morning dosage.

The first and fourth labs were done exactly at 12 p.m. The second and third set of labs were done at 12:30-12:45 p.m. due to arrival time or waiting in line longer.

TESTOSTERONE, TOTAL

Your value 652 ng/dL

Standard range 221 - 716 ng/dL

TESTOSTERONE, TOTAL

Your value 609 ng/dL

Standard range 221 - 716 ng/dL

TESTOSTERONE, TOTAL

Your value 628 ng/dL

Standard range 240 - 871 ng/dL

TESTOSTERONE, TOTAL

Your value 644 ng/dL

Standard range 240 - 871 ng/dL

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It is optimal. It’s a fact, plants have toxins in them, plant protein has very poor bioavailability. Animal fat has no equal.

You tell me a nutrient in plants that we can’t get in red meat.

The carnivore diet is stupid simple.

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And potatoes, corn, bread, oats, honey, all sorts of fruit and vegetables…

I agree the carnivore diet is a fad diet, it’s restrictive, makes most people miserable, even if you eat filet mignon 3x per day. And it’s suboptimal for going 100% in the gym.

And why does it do that?

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Most of those aren’t good for people with type 2 diabetes, too many carbs, starch and sugar. In other words inflammatory.

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Like I said, Americans are addicted to food, eating.

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Did they ever eat fruits and veggies?

Right, so it’s a fad diet.

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A moment in time where Americans did eat fruits and vegetables. There was a moment in our past where we only ate fatty red meat.

This doesn’t mean adding fruits and vegetables in addition to red meat is the optimal diet. Clearly, it is not.

I thought we were talking about what is an optimal diet.

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So we should all do this because at one brief point in history, this is all we ate? Lol

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I’m losing weight, getting leaner and gaining muscle eating 4 to 6 pounds of red meat per day!

I’m working on developing my pecks and they’re starting to develop in a short amount of time. No problems in the gym here.

I want to know where you get this from, that the carnivore diet is sub optimal for the gym.

Is this a bias or is it based on science?

A study perhaps looking at carnivore diets and muscle gain and comparing that to other diets?

What magical ingredient do plants and vegetables have that meat doesn’t?

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Our brains started shrinking within the last 80,000 years and our teeth started getting more crooked. Humans had perfect mouths 80,000 years ago, we didn’t need braces.

Our brain started shrinking because our diet changed. More plants and vegetables because of the animal population decline.

You just compare the animal population decline with the change in brain size. It paints a clear picture.