Need some help - I am at the crossroads of TRT, and I am lost...

So here is my story... I am a 37 year old male diagnosed with low T in May 2015. For years, I had all the classic symptoms of low T (but did nothing about it), and after a routine doctor's visit and another round of annual blood work, my blood work came in at a low T level 233 ng/dl.

My family doctor, who has experience in TRT, placed me on testim for 1 month to see if that made any difference. At the time, I knew nothing of testim (or TRT in general), but I was willing to try anything just to feel better.

I gave it a try. And after a few days on testim... I honestly felt like a brand new man. I felt better then I had in years. I loved it. I felt like is was 21 again.

At the time, I promised my doctor that I would go home and do some research about TRT. Which I did. And unfortunately, after some considerable time spent online researching TRT, my testim experiment came to an abrupt end.

I have two young daughters at home (9 months and 5 years old), and I immediately stopped taking testim in fear of the product coming into contact with my girls. I will not take the risk of impacting my daughters, or my wife.

I needed an alternative, and fast, ... because i truly thought TRT may still be the answer for me.

I immediately went back to the doctor to explain my concerns, and he allowed me to switch to testosterone cypionate injections, 100mg/week. He also allowed me to inject myself at home - which has been quite convenient for me.

After a 2 month follow up and blood work, we increased my dosage to 150mg/week, as my T count was only marginally increasing, and I actually felt worse than I did before the treatment.

Fast forward another 2 months later (to yesterday), and after another round of bi-monthly blood work, my doctor and I sat down to seriously discuss my future on TRT, and how the TRT is going overall.

I explained to him that after 4 months of testosterone cypionate, i honestly still felt no better than I did before I started TRT. And I felt nothing like the "testosterone high" I received I when I was on testim.

My blood work (last week) came back with a T count of 433ng/dl. So although the numbers are going in the right direction, I certainly don't feel that way.

I though to myself... "maybe it is my estrogen count", but that came back at 25pg/ml. All my blood work came back at mid-range right across the board. My doctor looked at every single number... with no concerns at all - except for one.

My hgh blood count (IGF count- I believe) dropped considerably. This number has dropped over half count since I started TRT. Something the doctor thought was a direct result of TRT - but I did not truly understand his rationale as to "why" it decreased.

Overall, I honestly feel no better on testosterone cypionate than I did before I started. I am starting to get heart palpitations (which I never had before), and on top of that, last week, I had my first ever experience with erectile dysfunction (WTF!).

Overall, I feel that over time my libido is slowly dwindling overall (understandably as I age), but my erections are not nearly as good as they were 6 months ago before TRT, and after not being able to "function" at all last week (due to ED), I am ready to make some drastic changes to what I am doing.

The problem... I really don't know what to do. I feel lost. So my doctor gave me four options:

1. Stop taking TRT and seek alternative/natural ways to monitor/increase my T counts.
2. Continue on with TRT at the current doses to see if my symptoms subside over a longer period of treatment.
3. Start taking doses of HCG alongside + testosterone cypionate
4. Consider supplementing TRT with a prescription HGH mouth spray (due to my lowered HGH levels).

His closing comment to me is that I will need to go home and think about it, but not to delay in a decision, as if I choose option #1 (getting off TRT completely), the sooner I get off TRT, the easier it will be on my body to recover, and the better chance I will have to get "the boys" (my balls) back working again.

I really need help. What should I do? Any suggestions here gentleman?

I am at the crossroads of TRT, and ready to throw in the towel.

Welcome to Excelmale.com. I'm sorry you are feeling frustrated. Can you post up your total bloodwork? Particularly your total and free testosterone, SHBG, estradiol, and thyroid values. Please include the ranges that your lab provides as their standard values. Your exposure to exogenous testosterone has surpressed your body's ability to produce its own. Stopping TRT and waiting for your system to regenerate natural production of testosterone (absent a restart protocol managed by a capable physician) is a fool's game. You will feel terrible, and there is no guarantee you'll succeed. You need a well-trained physician to help you through this. Are you in the States? If so, would you consider Defy Medical and their telehealth model?

I assume @ 150mg, you don't specify, is one injection and if so, is a major player in why you don't feel good and why your TT (assuming you tested in a 'trough') is barely breaking 400s. In fact I'd bet ya it's once a week inj as that's pretty obvious actually.
Even though you wrote a lot there, it's fairly devoid of details and there is so much more to than injecting TCyp, factors that dictate dosing frequency, like SHBG.
I can tell you straight away that while your Dr is working with you as some do (most don't) that they're not nearly as good or as experienced as you think.

CoastWatcher said:

Welcome to Excelmale.com. I'm sorry you are feeling frustrated. Can you post up your total bloodwork? Particularly your total and free testosterone, SHBG, estradiol, and thyroid values. Please include the ranges that your lab provides as their standard values. Your exposure to exogenous testosterone has surpressed your body's ability to produce its own. Stopping TRT and waiting for your system to regenerate natural production of testosterone (absent a restart protocol managed by a capable physician) is a fool's game. You will feel terrible, and there is no guarantee you'll succeed. You need a well-trained physician to help you through this. Are you in the States? If so, would you consider Defy Medical and their telehealth model?

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Thanks for your response. I truly appreciate the support of others with similar experiences, as I feel I currently have very limited options. And no, I am not in the States, I am in Canada. TRT clinics are very limited where I am, so a family physician is really all I have.

Here are the results of my blood work from last week:

total t: 15nmol/L (8.0-26.7) note: my Dr said that is the equivalent to 433 ng/DSL
free t: 348 pmol/L. (175-700)
shbg: 20 nmol/L. (6-65)
estradiol: 90 pmol/L. (<200) note: converts to 25pg/ml
IGF: 4.5 mg/L. (2.9-7.8)
dhea: 9.2 umol/L. (<14)

thyroid: not sure what values to look for?

Vince Carter said:

I assume @ 150mg, you don't specify, is one injection and if so, is a major player in why you don't feel good and why your TT (assuming you tested in a 'trough') is barely breaking 400s. In fact I'd bet ya it's once a week inj as that's pretty obvious actually.
Even though you wrote a lot there, it's fairly devoid of details and there is so much more to than injecting TCyp, factors that dictate dosing frequency, like SHBG.
I can tell you straight away that while your Dr is working with you as some do (most don't) that they're not nearly as good or as experienced as you think.

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You are correct. One injection of 150mg/week. I have debated going to 100mg E5D as I hear that some are doing. But I truly believe what you are saying, and if I choose to stay on trt, I will not be doing 150mg once a week. I know that this has contributed to my issues. Perhaps my biggest mistake thus far. Thanks for the advice.

O

canada said:

Thanks for your response. I truly appreciate the support of others with similar experiences, as I feel I currently have very limited options. And no, I am not in the States, I am in Canada. TRT clinics are very limited where I am, so a family physician is really all I have.

Here are the results of my blood work from last week:

total t: 15nmol/L (8.0-26.7) note: my Dr said that is the equivalent to 433 ng/DSL
free t: 348 pmol/L. (175-700)
shbg: 20 nmol/L. (6-65)
estradiol: 90 pmol/L. (<200) note: converts to 25pg/ml
IGF: 4.5 mg/L. (2.9-7.8)
dhea: 9.2 umol/L. (<14)

thyroid: not sure what values to look for?

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I, too, am in Canada; I understand the challenges of TRT in this country - but it can be done. It requires a different mindset, a more aggressive approach to managing our health than is usually found here. Your SHBG is on the low side, the reference range your lab provided is ridiculous. That is cause, in and of itself, for you to move at once to smaller injections done more frequently. You are clearing your testosterone injection too quickly. Try an injection of 50mg every 3.5 days to start (Tuesday morning/Friday evening, Wednesday morning/Saturday evening). I fully expect you will see a significant improvement in your sense of well-being and in your lab values. You will never get the sensitive estradiol test outside the U.S. - it is not offered. Forget the test you are posting - it is worthless, providing no useful clinical information. I travel to the States regularly and obtain self-tested results. If you are near the border, I would urge you to consider that. As for thyroid, post up your TSH, free T3 and T4, rT3.

100% agree with Coastwatcher,and as I have low SHBG myself, I too know how very poorly a once a week injection protocol works. Splitting the dose and injecting every 3.5 days doesn't sound like a big improvement over once a week 'on paper,' but it will likely make a world of difference to how you feel.

In regard to tests, I hope your doctor ordered a psa prior to therapy commencing. It is needed to serve as a baseline as prostate monitoring is a key part of TRT.

Seeing your SHBG my advice to you is EOD injections, divide up that 150 and inject EOD. This will also drop your E2 which is severely elevated.

CoastWatcher said:

O

I, too, am in Canada; I understand the challenges of TRT in this country - but it can be done. It requires a different mindset, a more aggressive approach to managing our health than is usually found here. Your SHBG is on the low side, the reference range your lab provided is ridiculous. That is cause, in and of itself, for you to move at once to smaller injections done more frequently. You are clearing your testosterone injection too quickly. Try an injection of 50mg every 3.5 days to start (Tuesday morning/Friday evening, Wednesday morning/Saturday evening). I fully expect you will see a significant improvement in your sense of well-being and in your lab values. You will never get the sensitive estradiol test outside the U.S. - it is not offered. Forget the test you are posting - it is worthless, providing no useful clinical information. I travel to the States regularly and obtain self-tested results. If you are near the border, I would urge you to consider that. As for thyroid, post up your TSH, free T3 and T4, rT3.

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Thanks for your feedback again. I will post my TSH, free T3 and T4, rT3 tonight when I get home. Seems like my first immediate (and logical) step would be move towards small and more frequent injections.

I will also check to see if PSA was included in the testing.

Any thoughts on my drop in growth hormone levels... IGF: 4.5 mg/L. (2.9-7.8) ?

The Dr expressed concern over this number dropping in half, as I went from a high 7 level to a 4.5. He said he could right me a prescription for a HGH mouth spray that is only sold in Ontario, and that I would need to fax the prescription and it would come in the mail. I declined - but still curious.

Any thoughts on this? is this legit?

I'd retest the IGF such a drastic change you'd want to retest and eliminate lab error.

UPDATE: I have been fully off TRT for over 3 months. And... I feel worse than I ever have before. Weight is coming on non stop. Energy is going down. ED is now becoming a huge issue. My libdo is there, but things aren't working as they used to. Sleep is disturbed. Hot flashes too. Can't concentrate worth shit.

I feel depressed. Starting drinking more often. Starting gambling more as well. All to make me feel better.

So frustrated. I went back to my Dr and he suggested going back on TRT. Got my bloodwork done, and my T is back to under 300. All other levels are in check. Perfect health across the board. Except, for T. Slowly tanking. The last T shot I took was in September.

I am seriously considering going back on TRT. I know it is going to help.

My hesitation... I don't want this to be the rest of my life. I am scared. Scared of the health risks. It gives me such anxiety to know that i will be on this forever. It is such a big mental hurdle for me.

Bottom line - I know in my heart that this will make me feel better than i do right now.

What to do?

Any thoughts?

Stopping TRT cold turkey with no re-start protocol is never the right option as you have found out. My 2 cents: Go back on TRT and inject twice a week instead of once a week.

Another option, if it is available in Canada, would be to try to re-start your natural T production. See this link: https://www.excelmale.com/forum/sho...olics-You-May-Want-to-Read-this-HPTA-protocol

canada said:

UPDATE: I have been fully off TRT for over 3 months. And... I feel worse than I ever have before. Weight is coming on non stop. Energy is going down. ED is now becoming a huge issue. My libdo is there, but things aren't working as they used to. Sleep is disturbed. Hot flashes too. Can't concentrate worth shit.

I feel depressed. Starting drinking more often. Starting gambling more as well. All to make me feel better.

So frustrated. I went back to my Dr and he suggested going back on TRT. Got my bloodwork done, and my T is back to under 300. All other levels are in check. Perfect health across the board. Except, for T. Slowly tanking. The last T shot I took was in September.

I am seriously considering going back on TRT. I know it is going to help.

My hesitation... I don't want this to be the rest of my life. I am scared. Scared of the health risks. It gives me such anxiety to know that i will be on this forever. It is such a big mental hurdle for me.

Bottom line - I know in my heart that this will make me feel better than i do right now.

What to do?

Any thoughts?

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Well you were given 3 options to continue treatment in one form or another but chose the nuclear option after most of in one way or another advised against that so I don't what to tell you from this point. Either get treatment or be miserable. Sorry that sounds harsh.

Harsh, but true. So true. I made the choice to feel this way.

I am having trouble accepting my body is declining. That this will be my ongoing reality. In order to feel better.

Over the last 3 months, I have tried to believe that I can turn this around naturally. The truth - at 37 years old and starting test levels of low 200's, i don't know what else I can do

canada said:

Harsh, but true. So true. I made the choice to feel this way.

I am having trouble accepting my body is declining. That this will be my ongoing reality. In order to feel better.

Over the last 3 months, I have tried to believe that I can turn this around naturally. The truth - at 37 years old and starting test levels of low 200's, i don't know what else I can do

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Why not switch back to a topical and apply to your inner thighs... Be very disciplined after application to simple put on a pair of shorts... I did this for 5 years and never had an issue and absorption was just fine...

canada said:

Over the last 3 months, I have tried to believe that I can turn this around naturally. The truth - at 37 years old and starting test levels of low 200's, i don't know what else I can do

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I know you're in Canada, but you can still get a consultation with Defy Medical on the phone. Dr. Saya or Crisler can look at your lab work, talk about your medical and past TRT history, and formulate a plan for you. Since your Doctor in Canada is willing to work with you, you can take this plan to him, and implement it.

Your Doctor sounds like a nice guy, but he's not a TRT expert. You really need the advice of professionals that specialize, and are experts in TRT. That is Defy Medical. Just do it, you won't be sorry.

canada said:

Harsh, but true. So true. I made the choice to feel this way.

I am having trouble accepting my body is declining. That this will be my ongoing reality. In order to feel better.

Over the last 3 months, I have tried to believe that I can turn this around naturally. The truth - at 37 years old and starting test levels of low 200's, i don't know what else I can do

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The ongoing reality is that with a properly managed TRT protocol there is an excellent chance you will feel markedly better. What made you think you could naturally do what you had been unable to naturally do in the past? What variable had changed that allowed you to conclude the results would be different? You are hypogonadal. That is the nature of the beast. All of us here at Excelmale have had to accept that reality. There are legitimate, medical responses to your condition. It is up to you to pursue health or not. As a Canadian, I understand the frustrations that our medical system can present a patient in need of TRT. They can be overcome. Defy Medical will offer a consultation. You,in turn, can bring that to your doctor.

canada said:

Harsh, but true. So true. I made the choice to feel this way.

I am having trouble accepting my body is declining. That this will be my ongoing reality. In order to feel better.

Over the last 3 months, I have tried to believe that I can turn this around naturally. The truth - at 37 years old and starting test levels of low 200's, i don't know what else I can do

Click to expand...

I'll offer my 2 cents since you asked for opinions. I am 42 and been on trt injections+hcg for my 4th month now. I remember how I felt before starting. Like dirt: losing strength, gaining fat, low energy and struggle to just get up and go to work. I spent some time thinking about trt after bloodwork came back and showed I was low. I didn't know a thing about needles and dreaded the thought of being on shots the rest of my life. But I also didn't want to go the rest of my life feeling like crap if I could do something about it. You are 5 yrs younger than me so not much difference. I commited to at least a 3month trial of trt and then judge if its worth it for me. I have a NP that prescribes my meds. After much studying on here and asking questions, I decided to try it. After being on 3months now, I can only say wow, I don't remember feeling much better ever. I actually look forward to injection day cause I know its for my health and well being. Everyone is different and some have more challenges getting dialed in as evidenced by all the threads asking for help/advice. If you have a doc that is willing to work with you, I say try it for at least a period of time then way the benefits against your dreading of being on something the rest of your life. Best of luck Canada

Lancealot said:

I'll offer my 2 cents since you asked for opinions. I am 42 and been on trt injections+hcg for my 4th month now. I remember how I felt before starting. Like dirt: losing strength, gaining fat, low energy and struggle to just get up and go to work. I spent some time thinking about trt after bloodwork came back and showed I was low. I didn't know a thing about needles and dreaded the thought of being on shots the rest of my life. But I also didn't want to go the rest of my life feeling like crap if I could do something about it. You are 5 yrs younger than me so not much difference. I commited to at least a 3month trial of trt and then judge if its worth it for me. I have a NP that prescribes my meds. After much studying on here and asking questions, I decided to try it. After being on 3months now, I can only say wow, I don't remember feeling much better ever. I actually look forward to injection day cause I know its for my health and well being. Everyone is different and some have more challenges getting dialed in as evidenced by all the threads asking for help/advice. If you have a doc that is willing to work with you, I say try it for at least a period of time then way the benefits against your dreading of being on something the rest of your life. Best of luck Canada

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Thanks for your input and opinion. It makes me feel so much better knowing that others have been through similar mental struggles and are now feeling better. Thanks again and good luck to you.