The lure and promises of Testosterone seem too good to be true , nothing ever is, as Nelson has said TRT is not a silver bullet.
I thought I would make a list of things that people could check for before going down the TRT route. I have read a lot about TRT not working well for others. (many of these do seem to be not very well informed about dosages, AI's, etc.) So before I go down the road, I like many others would like to feel that I looked into as many other possibilities as I can find . I don't want to go into TRT half hearted as it seems others do, and then pack it in and look for other causes after they have disturbed their natural hormone loop. If I do it I will be 100% commitment.
I have made a list of things men should check that could help with tiredness symptoms.
There is also this useful list here on this thread here
If anyone has any other tests, considerations please post and I will add to the list.
(Ps. I am not on TRT at this point)
1. Blood tests - B12 , vitamin D get a full blood test with fasting blood sugar.
- Electrolytes minerals, low minerals can cause fatigue.
- Testosterone, SHBG so you can calculate Free Testosterone. DHEAs Try and get your Free testoerone level, everyone keeps using Total Testosterone levels but really free testosterone is the one everyone should be using if your TT is just low-ish.
- Levels of LH LSH can help identify levels of secondary Hypogonadism (eg pitiuary may not be sending correct signals to the testes to make testosterone)
- Full blood panels to show a myriad of potential issues.
2. Heart function tests, Echocardiogram. ECG, Stress test. any other non-invasive tests, the only test for Coronary artery disease test is risky with an angiography look into non-invasive CT Angiogram v Coronary Computed Tomography Angiography (CCTA). I know a cyclist who was complaining of tiredness and managed to get a angiography and it located his problem. He was about 50yo.
3. Thyroid tests. Get a full thyroid test especially with free t3
4. Thyroid temperature tests? If you have issues with Thyroid gain more information with morning temp tests.
5. Adrenal fatigue test - a saliva test taken throughout the day to show levels of Cortisol druing the day. Should be highest in morning then level off during the day. If your body is stressed cortisol will be all over the place.
6. Sleep Apnea, Unbeknownst to you , you may not be getting adequate sleep, even if you are sleeping 9 hours or more the quality of the sleep may be poor. Will affect your T levels. Get a Sleep test to check.
General Sleep You may also not be sleeping enough for lifestyle reasons or shift work, Not sleeping enough will kill your T levels. I bought a samsung s3 smartwatch to track my sleeping habits, I use the samsung app to automatically track sleeping, but there are other apps to manually track sleeping too. Im not sure if there is one for the apple watch I'm sure there is.
7. DNA tests (eg. 23andme.com) for rare disorders eg Klinefelter's Syndrome, this one from pics looks a bit obvious but getting a DNA test could help find some issue.
23andme.com takes (currently) about 8 weeks once they get your sample for results to come back. You can download your genome from 23andme and run it through other services to check for genetic issues eg promethease.com
8. Lifestyle - Lifestyle check, is my diet poor? Do I live a high testosterone lifestyle (hitting the gym meaning lift heavy weights and eating plenty of protein, keeping sugar low, stress free as possible)
9. Body composition - Do you carry a lot of body fat? Body fat acts like an organ for making female type estrogens. If you are fat your body is working against you already from a testosterone point of view.
10. Candida, Candida Albicans is an overgrowth of yeast in the intestines can cause chronic fatigue and brain fog and can cause hormonal imbalances reportedly. The best way to check for it is to send a stool sample to a lab.
11. Gut dysbiosis this is an imbalance of the gut bacteria in the Gut, new evidence in the last few years suggests that the gut bacteria are a lot more important to our well being than thought of before. A stool sample can be sent to a lab to check for overgrowth of "bad" bacteria and lack of "good" if you end up with a diagnosis of dysbiosis. It is quite difficult to fix this dybiosis. Studies have shown that most commercial probiotics taken orally very few of them make it to the gut. Lowering sugar intake that feeds the bad bacteria is mentioned to get your gut in good shape. I found a good probiotic is called VSL#3 it seems to be the best but it is crazy expensive. A month of TRT would be cheaper! Other probiotics to look into that you can make are Kifir and kombucha.
I thought I would make a list of things that people could check for before going down the TRT route. I have read a lot about TRT not working well for others. (many of these do seem to be not very well informed about dosages, AI's, etc.) So before I go down the road, I like many others would like to feel that I looked into as many other possibilities as I can find . I don't want to go into TRT half hearted as it seems others do, and then pack it in and look for other causes after they have disturbed their natural hormone loop. If I do it I will be 100% commitment.
I have made a list of things men should check that could help with tiredness symptoms.
There is also this useful list here on this thread here
If anyone has any other tests, considerations please post and I will add to the list.
(Ps. I am not on TRT at this point)
1. Blood tests - B12 , vitamin D get a full blood test with fasting blood sugar.
- Electrolytes minerals, low minerals can cause fatigue.
- Testosterone, SHBG so you can calculate Free Testosterone. DHEAs Try and get your Free testoerone level, everyone keeps using Total Testosterone levels but really free testosterone is the one everyone should be using if your TT is just low-ish.
- Levels of LH LSH can help identify levels of secondary Hypogonadism (eg pitiuary may not be sending correct signals to the testes to make testosterone)
- Full blood panels to show a myriad of potential issues.
2. Heart function tests, Echocardiogram. ECG, Stress test. any other non-invasive tests, the only test for Coronary artery disease test is risky with an angiography look into non-invasive CT Angiogram v Coronary Computed Tomography Angiography (CCTA). I know a cyclist who was complaining of tiredness and managed to get a angiography and it located his problem. He was about 50yo.
3. Thyroid tests. Get a full thyroid test especially with free t3
4. Thyroid temperature tests? If you have issues with Thyroid gain more information with morning temp tests.
5. Adrenal fatigue test - a saliva test taken throughout the day to show levels of Cortisol druing the day. Should be highest in morning then level off during the day. If your body is stressed cortisol will be all over the place.
6. Sleep Apnea, Unbeknownst to you , you may not be getting adequate sleep, even if you are sleeping 9 hours or more the quality of the sleep may be poor. Will affect your T levels. Get a Sleep test to check.
General Sleep You may also not be sleeping enough for lifestyle reasons or shift work, Not sleeping enough will kill your T levels. I bought a samsung s3 smartwatch to track my sleeping habits, I use the samsung app to automatically track sleeping, but there are other apps to manually track sleeping too. Im not sure if there is one for the apple watch I'm sure there is.
7. DNA tests (eg. 23andme.com) for rare disorders eg Klinefelter's Syndrome, this one from pics looks a bit obvious but getting a DNA test could help find some issue.
23andme.com takes (currently) about 8 weeks once they get your sample for results to come back. You can download your genome from 23andme and run it through other services to check for genetic issues eg promethease.com
8. Lifestyle - Lifestyle check, is my diet poor? Do I live a high testosterone lifestyle (hitting the gym meaning lift heavy weights and eating plenty of protein, keeping sugar low, stress free as possible)
9. Body composition - Do you carry a lot of body fat? Body fat acts like an organ for making female type estrogens. If you are fat your body is working against you already from a testosterone point of view.
10. Candida, Candida Albicans is an overgrowth of yeast in the intestines can cause chronic fatigue and brain fog and can cause hormonal imbalances reportedly. The best way to check for it is to send a stool sample to a lab.
11. Gut dysbiosis this is an imbalance of the gut bacteria in the Gut, new evidence in the last few years suggests that the gut bacteria are a lot more important to our well being than thought of before. A stool sample can be sent to a lab to check for overgrowth of "bad" bacteria and lack of "good" if you end up with a diagnosis of dysbiosis. It is quite difficult to fix this dybiosis. Studies have shown that most commercial probiotics taken orally very few of them make it to the gut. Lowering sugar intake that feeds the bad bacteria is mentioned to get your gut in good shape. I found a good probiotic is called VSL#3 it seems to be the best but it is crazy expensive. A month of TRT would be cheaper! Other probiotics to look into that you can make are Kifir and kombucha.
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