TRT Advice

Pharma / TRT Testosterone Replacement
1

Hi Everyone - New to the forum and have been reading pretty heavily for a while now as I’m on this journey of trying to figure out if I need TRT and how best to proceed. I had seen a few docs over the course of the last 6 months with some half assed blood work done and the typical “oh you’re just fine” More recently my urologist has been totally on board and strongly felt my T was low based on the bloodwork I brought in, but sent me to a male fertility specialist doc he works with for a consult because I still want to have another child or two and don’t want my balls to shrink.

Saw the fertility doc last week (outta pocket, he doesn’t take insurance), anyways he wasn’t as on board with the TRT but said lets take it one step at a time and do a full hormone panel first. He then performed a quick physical exam and has me “push” down while he felt my balls and the crevice between them and my thigh. Following this he said that I have varicoceles (varicose veins affecting the testes) and while TRT may treat my problem this is likely the root cause and we may want to look into repairing that. I’m a bit skeptical as it seemed like a quick and easy diagnoses which leads to surgery but I see my urologist again next week and will see what he has to say.

Also, at the end of our consult he said lets go ahead and give you 200mg T and see how you feel over the next week. I agreed and honestly, while I might have felt a minor improvement I would say it was VERY minor, possibly even just a placebo effect. I understand everyone is different & not feeling anything after just one shot doesn’t really mean anything.

My symptoms are just generally am often tired & sluggish. It is hard to lose weight, esp. around the gut. In the past and again more recently when I do work out the results are lacking. Libido is moderate as is morning wood, but ability to maintain erections is not too great.

Now down to my specifics:

-age: 32
-height: 5’7"
-waist: 34"
-weight: 175lbs
-describe body and facial hair: Very hairy (middle eastern & runs in the family)
-where you carry fat: My fat is primarily around the belly & stubborn to get rid of.
-health conditions, symptoms: None
-Rx and OTC drugs: None

-lab results with ranges:
Total Test. - 292 (241-827 ng/dL)
Free Test. - 7.10 (4.25 - 30.37 pg/mL)
E2 - 20.9 (0-39.8 pg/mL)
FSH - 1.8 (1.4-18.1 mIU/mL)
LH - 3.6 (Males 20-70yrs) 1.5-9.3 mIU.mL

(I have previous test results which only have TT and Free T which I can post if needed, but the results were low on those as well)

-describe diet: I’m on a lower carb diet which includes a lot of meats, veggies and plenty of water. I cheat a few days a week but generally stay away from carb heavy, sugary foods & drinks.
-describe training: I’m mostly recovered from a surgery I had 6 months ago and I am doing Physical Therapy 2-3 times a week. I get a pretty healthy work out there. No major lifting or weight training.
-testes ache, ever, with a fever?: A few years ago I had sore testes and saw a doc to no help. Problem went away, never had it with a fever.
-how have morning wood and nocturnal erections changed: Morning wood is moderate and libido is moderate. Main problem is maintaining erections.

I’d like to thank you in advance for your help, this forum is really awesome. If I left anything out or you need more info please let me know.

2

I can confirm that varicose veins with your boys is a legitimate cause…I had the same issue, both my fertility doc as well as the urologist he referee me too agreed.

I decided not to pursue the surgery as it seemed a bit too risky, and had only a low probility of solving my fertility (and low t) issues.

3

lowpost, thanks for your input. What were your concerns about the surgery? The doc I saw didn’t have anything negative to say risk wise. Luckily fertility doesn’t seem to be an issue for me as my wife just got pregnant with ease, so my only concern is really my T levels.

4

So whats up guys…tons of view no input? Is everyone here just looking for answers like me?

5

um, bump i guess lol

6

Ok, the vericosities will be a problem with delivery of hormones to the rest of the body which is fairly obvious. The other problem is with diffusion of substances across semi-permeable membranes because the levels outside the leydig cells will eventually be higher than inside the cell. At that point diffusion outward will cease and possibly reverse. It could be caused by venous insufficency, obstruction, or both. Note the clothes you wear and how you sit there could be blockage due to positioning. Venous return pressure is normally close to zero and requires no resistance or blood will pool. Sorting that out is probably wise.

Sadly, the doc giving you 200mg and asking you to see how you feel clearly doesn’t know enough about TRT to be advising you. Firstly that’s a big dose to start on, secondly it’ll keep your T elevated for about 5 days and you won’t notice anything in the first week(unless its an adverse reaction or coincidence).

On TRT your boys will shrink and your sperm count will go down. Libido will also likely go through a roller coaster ride. Starting TRT is not a light decision to make because it’s a long term treatment plan. You have to be willing to go through months of waiting for your body to adjust to minor changes in meds/doses/administration methods. Thinking a change can be valid a week later is premature.

Testes size and consistency as well as sperm production can be managed through the use of hCG, an LH analog. Using an aromatase inhibitor can help manage elevated estrogen(E2), and help maintain libido, gyno, and skin/bone dysfunction.

Getting a doc to just prescribe you a whole package at once is jumping the diagnostic gun in so many ways. A good doc will ease you into it unless of course you’ve had an orchidectomy. Again this means you’ll have to be patient as your doc figures out what works best for you. Also, it means that your libido and marriage may undergo stressors that you may not be prepared for. It’s a big decision and the more you can learn, the better.

7

Cali81,

I just joined the club today, though im not seeking answers on low-t. Im interested in body building, but I am currently in a TRT program and man I cant say I regret it one bit. Bottom line, if you’re having a testosterone deficiency, I strongly recommend seeking a TRT specialist. Once you are on a program, it is not just your t-levels that increase, things like your mood, depression, stamina, overall characteristics of your body that affect your liveliness are greatly impacted positively. It took me three trial clinics before landing with the RIGHT doctor. Most docs just want your money and don’t take the time to prove proper treatment. Was he prescribing you any other medications such as an estrogen blocker or anything to promote natural testosterone and shrinkage of the testes? Its CRITICALLY important you get the other proper medicines that way you get optimal results with the t treatments. The last clinic I went to, the doc didn’t give me any estrogen controller, mind you as my t levels rose, SO DID MY ESTROGEN. So my libido was still lacking along with my body weight, moods, and erections. If you need anymore recommendations about anything id be more than happy to refer you to my medical center. They have locations across the country, but bottom line, they are mens only clinic and specialize in TRT, and you really cant beat their prices. Ive tried. Good luck!