Hey guys my name is Johnny and i am new on here. This is such an awesome forum with so much knowledge from everyone, super cool and excited to be apart of this.
So im 28 and ive been struggling with low t since 2014, as thats the first time ive gotten it checked. Like most people here i ignored it thinking if i lose weight, eat better etc it will become normal and sure it did but not by much. I suffer from ocd/anxiety so i took an ssri daily and its been almost 3 years. I really want to get off of it and im hoping as i start to get to the root of the problem with things it helps me cut it out. So long story short my T is the lowest its been and i feel like crap and need to make a change as ive been feeling like this for too long now. No energy, hard to get out of bed, unmotivated for the day, sleepy/always yawning/ body composition is awful, sex drive is much lower then before but still get hard very easily lol, hope that never goes away.
Anyways my wife and i are currently trying right now to have a child, does taking trt significantly reduce my chances? That is a big concern for us of course and dont want to risk lessening the chances right now. From my research i would be starting 100mg cypionate once a week. Here is some blood work from the past 5 years and then the most recent last week that i got ordered from my naturopath that was a full spectrum one. Im in Canada so some measurments are taken different. Any input would be great. If i need other blood work done before making a decision please let me know.
2014 - 383.28
2015 - 409.22
2016 - 544.66 (Lost weight and cut out alcohol)
2018 - 463.97
2019 - Complete bloodwork
|Hematology|
|WBC||6.6|4.0-11.0|x109/L|
|RBC||5.28|4.30-5.90|x1012/L|
|Hemoglobin||148|135-180|g/L|
|Hematocrit||0.47|0.41-0.52|L/L|
|MCV||88|80-100|fL|
|Platelet Count||250|150-400|x109/L|
|Differential|
|Neutrophils||3.6|2.0-8.0|x109/L|
|Lymphocytes||2.3|1.0-4.0|x109/L|
|Monocytes||0.4|0.1-0.8|x109/L|
|Eosinophils||0.3|<0.6|x109/L|
|Basophils||0.1|<0.2|x109/L|
|Granulocytes Immature||< 0.1|0.0-0.1|x10*9/L|
|Biochemical Investigation of Anemias and Iron Overload|
|Ferritin||176|15-250|ug/L|
|General Chemistry|
|Hemoglobin A1C||5.5|4.2-6.0|%|
|Sodium||139|135-145|mmol/L|
|Potassium||4.3|3.5-5.0|mmol/L|
|Creatinine||85|45-110|umol/L|
|Estimated GFR||108|>60|mL/min|
|Lipids|
|Fasting Status||Fasting|
|Cholesterol|H|5.8|2.0-4.6|mmol/L|
||Cholesterol - At risk if >5.7 mmol/L|
|LDL Cholesterol|H|4.0|1.5-3.0|mmol/L|
||The optimal LDL cholesterol for intermediate and high risk
individuals is less than 2.1 mmol/L. If triglycerides are
greater than 1.4 mmol/L, consider monitoring of alternate
lipid targets nonHDL cholesterol or apoB. For low risk
individuals with LDL cholesterol greater than 4.9 mmol/L,
target a reduction of LDL cholesterol of at least 50
percent. See Can J Cardiol 2013 vol 29 pgs 151 to 167.|
|HDL Cholesterol||1.4|>0.9|mmol/L|
|Non HDL Cholesterol|H|4.4|<4.3|mmol/L|
||Non HDL-cholesterol is calculated from total cholesterol and
HDL-C and is not affected by the fasting status of the
patient. The optimal non HDL-cholesterol level for
intermediate and high risk individuals is less than 2.7
mmol/L. See Can J Cardiol 2013 vol 29 pgs 151 to 167.|
|Triglycerides||1.0|<2.3|mmol/L|
|Random Urine Chemistry|
|Urine ACR (Albumin/Creatinine Ratio)||< 0.2|<2.0|mg/mmol|
||NOTE: Ur ALB:CR Ratio Reference target based on
CDA Guidelines for Diabetic Care|
|Thyroid Function|
|TSH||1.23|0.30-5.50|mU/L|
Vitamin B12
363
153-655
pmol/L
Interpretation:
(Serum B12 Probability of symptomatic
deficiency)
Thyroid Function
TSH
1.07
0.32-5.04
mU/L
T4 Free
13.5
10.6-19.7
pmol/L
T3 Free
3.57
2.60-5.80
pmol/L
Reproductive and Gonadal
Testosterone
10.5 (302.59)
8.4-28.8
nmol/L
Testosterone Free Calculated
260
115-577
pmol/L
Method of Vermeulen
Testosterone Bioavailable Calculated
6.1
2.7-13.5
nmol/L
Method of Vermeulen Interpret BAT and cFT results with
caution in presence of significant
hypoalbuminemia.
Sex Hormone Binding Globulin
21.4
10.0-70.0
nmol/L
When assessing testosterone status,
testosterone and SHBG should be tested on
the same specimen.
Exogenous testosterone has been tested as a contraceptive. In about 80 - 90% cases it reduces the sperm count to below 5 Mil/ml (normal is >20 Mil/ml, ideal is >40Mil/ml). So you dont want to go there, unless you add hCG, that would give you a good chance to stay fertile.
Do you have any information on your sperm count/mobility/morphology?
If your LH is low than I would try Clomiphene, maybe 25 mg eod and see how things are developing. There is a lot of data out there that supports the conclusion that Clomiphene improves T and thereby sperm count.
I was in the same situation 7 years ago and improved sperm count significatly with injecting hCG and FSH, but nowadays I would definitly try Clomiphene.
Long term propably ‘standard’ TRT.
SSRIs can do quite some harm on your bones, especially in combination with low T. I would do a bone density check if I was you. Clomiphene and/or TRT are typically associated with an improved bone densitiy status.
Thank you for taking the time out for your response. Do you think SSRIs can decrease T? Maybe not solely but I’m sure it doesn’t help. My sex drive has definitely gone down and my ability to ejaculate during sex takes longer as well since starting it. I didn’t really think too much about the one two punch of SSRIs and low T combined.
I will look into the bone density scan for sure might be why my vitamin d levels are low. Currently taking 5000iu daily to get into a good range.
I was thinking of possibly starting test once we ensure she is pregnant? Maybe that’s a better call then having to take other things on top of the test? We are wanting 2 kids and when that time comes maybe then take clomiphene etc?
I am going to see a naturopath Monday and will get a sperm check done. Also what are my test levels saying as far as free t, bioavilabe and shbg? Thanks!
Yah totally it wasn’t as bad at all when I was on 10mg but at 20mg currently can definitely feel the difference. My anxiety/OCD was not good at all so I had to increase it. If I can get those managed I could slowly get off of it.
I did some research on clomiphene seems like perhaps a good start before looking to start test to see if it can get me into a higher range while improving fertility?
Start maybe slowly with 1g in the morning an 1g in the evening. Move up by 1g each day until 3 or 4g twice a day (so total 6 to 8g per day). It works pretty quickly, if you are not happy increase the dose after a week.
But thats only my personal experiecne, n=1.
Regarding T:
Yeah, I was in the same range for quite some time and judging now, my symptoms - although not all - were coming from low T.
Test the clomiphene, the beauty is that it increases T and if it has an effect on spermatogenesis than a positive one.
But not more than 12,5 or 25 mg eod. Too high of a dose can cause depression.
@elevated1
Getting on TRT will make conception harder but not impossible. I know quite a few folks that have had multiple kids while doing TRT (some blasting and cruising). If you are doing this bad it may be worth the risk to get on it and just deal with the fertility as it comes with hcg & hmg.
Yes same with me at 50 mg eod, really bad depression. Was much better already at 25 mg and at 12.5 mg i actually felt better than i do now on TRT. Increased by T from about 350 to 520 ng/dl.
Sleep apnea can cause low testosterone, do you snore or breath heavy while sleeping?
TRT can negatively affect fertility, the fact you are trying to conceive I would try HCG and FSH injections and assess fertility, Clomid is another option, clomid will increase LH and therefore testosterone, it has sides most unpleasant at the higher doses, 25mg EOD is a middle ground.
Some have found every 3-4 day dosing works. TRT is not a death sentence for fertility or a door closed on regaining your natural production, often TRT, HCG and FSH injections is enough to remain fertile while on TRT.
When you are ready for TRT you may need frequent smaller injections do to that fact TRT will decrease SHBG and SHBG is already on the bottom end of the ranges, lowering TT and increasing FT and therefore you will not need high TT levels to achieve healthy FT levels.
To keep levels in a midrange TT levels without levels declining too much between injections, daily or EOD enanthate dosing is needed. I don’t see estrogen was tested, if towards the higher end of the ranges, daily dosing may be needed, if estrogen is in the middle range EOD and maybe twice weekly dosing is fine.
If you find the Canadian health care system problematic, there is Dr. Lawrence D. Komer Burlington, Ontario who runs a private men’s/women’s hormone clinic.
Successful restarts are rare, unless the cause of low testosterone is addressed (poor sleep/starvation diets/overtraining), levels will decline to baseline. HCG mimics LH and can increase testosterone, but may not relieve all symptoms of low testosterone, it works perfect for some men.
Clomid is a short term solution, the side effects can be moderate to severe.