About to start T therapy, would love some opinions on where to start?

[Weef]

So I've been putting off T therapy for years now. I'm finally feeling crappy enough to get something done. I'm 43 years old. Just had some labs done and here's the interesting ones. Cholesterol/CBC/CMP was unremarkable and all within range.

DHEA-S 260 range:102-416
LH 4.1 range:1.7-8.6
Estradiol, sensitive 10.7 range: 8-35
SHBG 21 range 16.5-56
*** DHT 26 LOW (range: 30-85)
Total Test 308 (i've been as low as 275 prev), range: 264-916
Free Test(direct) 8.7 range 6.8-21.5

I've never tested DHT before so that's interesting. I've been losing hair for years so assumed it would be high. Would I be a good candidate for scrotal cream instead of shots due to the low DHT?

Just wondering what sorts of things I should ask on my first appointment after speaking with the doc. Anything seriously bad in this?

Appreciate any help!

 

[Weef]

I also just punched my data into one of those free test calculators just now. They didnt run Albumin this time, so I took it from a prev test that is probably close from a few weeks before.

Free Testosterone 7.02 ng/dL = 2.28 % Bioavailable Testosterone 190 ng/dL = 61.7 %

 

[Cataceous]

Questions for Your First Visit with a Potential TRT Doctor.

I occasionally get asked on the Peak Testosterone Forum what questions I might ask if I was going to interview a doctor to handle my...

www.peaktestosterone.com

 

[Weef]

Thanks for that. I was more thinking specifically to my above numbers. i already have a good doc, just wanted some ideas to bounce off him

 

[Cataceous]

As an aside, Tru-T calculated free testosterone is about 9 ng/dL, well under the healthy normal range of 16-31. Seriously bad? You are certainly hypogonadal and the low estradiol could be hurting your bone health. Given the low total testosterone, the DHT and estradiol metabolites are not unusually low. Basically you're looking to at least double all values with treatment in order to be normal. Will the doctor offer a SERM like enclomiphene as a treatment option? You're young enough that it could be worth a try. Does he prescribe hCG with TRT? Other questions in the article I linked to are also relevant, e.g. what serum hormone levels would he target in your case?

 

[Weef]

I'm actually going to defy. I think they usually do HCG+TRT as well as clomid if I push.

I'm 43 and don't plan to have more kids, do you think its worth attempting clomid first? I've heard some nasty side effects like screwing up your vision etc. And also that it raises numbers but doesn't actually help symptoms much.

But thanks so much for the response, I'm going to start googling and reading more on Clom and see if its a route i should pursue. Losing fertility is scary even if no future plans, (plus having to stay on shots for life) so maybe I should explore that first.

 

[Cataceous]

I wouldn't bother with Clomid. Since you're using Defy you can ask them about a trial of enclomiphene. It's the non-estrogenic isomer of Clomid.

 

[Weef]

Oh, that's interesting! Great to know.

Same basic question though, am I setting myself up for not much in gains if I go the Enclomiphene route instead of just going straight to Test/HCG? Have you heard of anyone happy with their results on enclomiphene?

I read about Clomid a year or two ago before enclomiphine was available, and from what i read most people were not happy with their results (either screwed up their vision, or just raised their numbers on labs with no actual feeling of any benefit).

Also would there be any risk that Enclomiphine would lower my estradiol any lower? It seems fairly low already.

 

[Cataceous]

Enclomiphene is too new for there to be a lot of feedback about it. There are a couple recent threads with guys saying good things about it so far. If you're strictly looking for body composition gains then TRT is the ticket. But TRT is maybe riskier when you consider the subtle and less subtle effects of long-term HPTA shutdown. This school of thought says it's safer to keep your body working more naturally, as long as you reasonably can. It depends in part on testicular function. Personally, I wish enclomiphene had been available for me to try before I started TRT.

The hope regarding enclomiphene is that the lack of good results with Clomid is mainly due to the estrogenic zuclomiphene isomer.

Regarding estradiol, if enclomiphene raises testosterone then estradiol should rise proportionally.

 

[Weef]

Well, again thanks for this info and your decision making process really is giving me pause now. I was all gung ho obviously to begin shots. I guess I'll wait for my consult and maybe its a good idea to try the least risky alternative first.

I don't necessarily like the idea that I'm the guinea pig but I also don't like feeling like crap everyday!

Do you know if enclomiphene is basically cycled for a while to jumpstart things or if its something else I'll have to take for life?

Again thanks so much for giving me such great info to dive into!

 

[Cataceous]

At least with enclomiphene if you don't get reasonable results in two or three months then it's easy to start TRT at that time. Going the other direction is harder because of the time lag for HPTA restart.

Chances are you're looking at taking enclomiphene indefinitely to maintain your results. Actual jumpstarts are exceedingly rare. The usual result is a return to baseline when the treatment ends.

Regarding being a guinea pig, at least Clomid has been in use for many years now without discovery of extreme risks. At higher doses visual disturbances/floaters become more common. These are assumed to also be possible with enclomiphene, but I don't know if that's definitive.