New member but not new to training; would TRT be a logical next step?

Pharma / TRT
1

Recent blood work received; the way it reads is the marker, the recommended range, and result.

To summarize -

  • 39 M
  • 5’10", 180lbs, reasonable body composition (~12%, veins in lower abs just about year round).
  • Diet is 90% on point; a little clean up in some small areas could realistically happen.
  • Consistent training since teens; competitive junior, collegiate, post-collegiate athlete.
  • Consistent blood work since mid 20’s for health; more comprehensive blood work the last few years as income has allowed.
  • Classic or typical “Low-T” symptoms over the last 18 months or so.
  • Last year’s total T was 281; this year down to 208.
  • Last year’s estradiol was 15; this year down to 8.
  • Low free T.
  • SHBG, LH seem to be low to mid normal range.
  • IGF-1 low end of normal (about -1 standard deviation from mean).
  • Blood glucose, fasting insulin, HemoA1C numbers good.
  • Blood lipid numbers in real good shape.
  • Blood pressure is always in check.

Last year, when results came back, I tried to have a conversation with my doctor about TRT / HRT as hormones were off and I was feeling it. Despite the practice being a bit more modern and open to these things, the numbers were in range (albeit bottom of the range. I was doing a lot of endurance training so we decided to make sure training was more balanced with endurance / cardio work and strength work. I’ve since moved to spending about 50% of total training time doing strength work and 50% of total time doing endurance / cardio work, average time per week is about 6 hours (roughly 6 days per week, 1 hour per day). I don’t think I am dealing with chronic overtraining per se as cortisol isn’t elevated and liver / kidney markers aren’t askew.

That said, I don’t know what else I could be looking to do to optimize hormone levels and, more importantly, how I feel. It seems like it’s about time to seriously consider or explore HRT / TRT. I know if I provide my labs to one of the many online clinics I would have no issue with getting prescribed, however wanted to see what everyone’s thoughts are on a few things.

  • Any suggestions on how to approach PCP? I have a follow up to review blood work this week. If I go the prescribed route, I would rather go through my doc than a clinic and potentially have insurance pick up costs as it would be cheaper. That said, if he is not open, is an “ultimatum” of I’m ready to seriously take the next step of addressing so if we can’t do that here I will find a place that will an actual course of action?
  • With the many online clinics that are out there, what are the reasons some are more well known than others? I’m sure some are mills that just prescribe, some are more white glove with handholding that others more self serve, some are probably just more cost effective and hands off for self management, etc.
  • Any recommended clinics or against forum rules?

|Testosterone (Total)|250 - 1000|208|
|Estradiol|<= 29|8|
|DHEA-Sulfate|95 - 415|170|
||||
|Free Testosterone|46.0 - 224.0|32.4|
|SHBG|10 - 50|24|
|Cortisol|2.0 - 22.0|12.3|
|FSH|1.4 - 12.8|5.7|
|IGF-1|53 - 331|93|
|IGF-1|-2.0 - +2.0 SD|-0.9|
|LH|1.5 - 9.3|4.3|
|Progesterone|< 1.4|< .5|
|Prolactin|2.0 - 18.0|5|
|PSA|<= 4.0|0.27|
||||
|TSH|.4 - 4.5|2.11|
|T4 Free, Direct|.8 - 1.8|1.1|
||||
|Fasting Insulin|< = 18.4|3.2|
|Glucose|65-99|90|
|Hemo A1C|< 5.7|5.3|
||||
|Cholesterol (Total)|< 200|210|
|HDL|> = 40|61|
|LDL|< = 150|149|
|VLDL|||
|Triglycerides|< = 150|42|
||||
|BUN|7-25|26|
|A/G Ratio|1.0-2.5|2.6|
|Albumin|3.6-5.1|4.9|
|Alkaline Phosphatase|36-130|24|
|ALT|9-46|36|
|AST|10-40|38|
|Bilirubin|.2-1.2|0.3|
|BUN / Creatinine|6-22|25|
|Calcium|8.6-10.3|10.1|
|Carbon Dioxide|20-32|28|
|Chloride|98-110|103|
|Creatinine|.6-1.26|1.03|
|eGFR|>60|95|
|Ferritin|38 - 380|186|
|Folates|> 5.4|>24.0|
|Globulin|1.9-3.7|1.9|
|Iron, Serum|50 - 180|112|
|Potassium|3.5 - 5.3|4.5|
|Protein|6.1-8.1|6.8|
|Sodium|135-146|139|
|Vitamin B12|200 - 1100|1023|
|Vitamin D, 25-Hydroxy|30.0 - 100|41|
||||
|BASO (Absolute)|0-200|40|
|BASOS|NA|0.9|
|EOS|NA|1.6|
|EOS (Absolute)|15-500|70|
|Hemocrit|38.5-50|40.8|
|Hemoglobin|13.2-17.1|13.6|
|Lymphs|NA|42.3|
|Lymphs (Absolute)|850-3900|1861|
|MCH|27-33|28.9|
|MCHC|32-36|33.3|
|MCV|80-100|86.8|
|Monocytes|NA|11.1|
|Monocytes (Absolute)|200-950|488|
|Neutrophils|NA|44.1|
|Neutrophils (Absolute)|1500-7800|1940|
|Platelets|140-400|224|
|RDW|11.0-15.0|12.7|
|RBC|4.2-5.8|4.7|
|WBC|3.8-10.8|4.4|
|MPV|7.5-12.5|10.2|

2

Yeah … don’t. PCPs don’t know how to administer a proper TRT protocol 90% of the time.

Yeah, some do it better and have been around a long time. My recommendation is Defy Medical but there are a couple others out there that are good too.

2 Likes
3

My experience has been like this. Last year I was feeling off (it’s progressed through this year) and total T numbers came back at 281. I mentioned to my PCP and his response was along the lines of “you’re within range, we can talk more if you’re outside of range”. This week’s follow up will be interesting.

Thank you! I have heard of them along with others but good to know they can be personally vouched for.

4

As a quick follow up -

Met with a new doctor at the same practice I have been going to; this person was recommended to me by my wife as he is a mid 40’s guy himself who actively trains and competes in BJJ.

He reviewed blood work in depth and didn’t think a combination of OTC supplements would do much and that a combined enclomiphene / HCG therapy would do much as other markers like LH, FSH, and SHBG were “normal”.

His recommendation was to pursue TRT for a period of time, get follow up blood work in 10-12 weeks, and keep a small journal of how I feel daily so we can have something to review with respect to effectiveness.

He prescribed so I could go through insurance and a local pharmacy as opposed to going the clinic route or other means. He was pretty generous with his prescription (IMO) and advised on a few different ways to dose, pros / cons of each, etc.

I should be starting my treatment in the next few days.