About to start TRT - should I?

[FedUpAlready]

Glad u decided to take a chance and start TRT. Really looking forward to seeing how u do. Why are u not applying it all to ur scrotum? And why not apply twice per day to avoid any dip in the afternoon? Here’s all my labs on creams and different application sites. Maybe it will help u out on ur journey. I was also using empowers cream. And didn’t want to apply it all to myself scrotum because I was a little hesitant about sky rocketing my DHT

First rodeo for me, so I'm following Dr. Saya's instructions to the letter for the first several months until labs and follow-up.

Day 2 was also good, and the "feel good" window roughly mimicked day 1. My GF would testify that my libido was better than it has been. Also did a bunch of projects around the yard that I just haven't had the energy to do.

 

[Pacman]

Day 2 was also good, and the "feel good" window roughly mimicked day 1. My GF would testify that my libido was better than it has been. Also did a bunch of projects around the yard that I just haven't had the energy to do.

I don't understand why someone with T levels as high as yours would do TRT. There are a lot of reasons that you could be feeling the way you feel. If you go on TRT, your T levels won't be all that much different than they are now, and you'll shut down your own natural production on top of that. The efficacy of testosterone is measured in ranges, not precise numerical values. So if you have 869 ng/dL right now, and with TRT you get to 1047 ng/dL in 3 months, it's super unlikely that you'll feel any difference. Not to mention having to go do blood tests every 3-6 months, possibly needing AIs, being on this for life. Why be dependent on something external if you likely don't need it?

TRT gives you the same hormone you already produce naturally. What will you do once you pass the initial psychosomatic effects you feel now, and see that maybe the cause of your negative physical/mental experiences is something else? (i.e. and for example: could be chemical imbalance of the brain, depression, tumor, nutritional imbalance, etc etc)

I am not criticizing you, but I just don't understand why someone in your position would go on TRT. If I was in your position, I certainly wouldn't.

 

[FedUpAlready]

I don't understand why someone with T levels as high as yours would do TRT. There are a lot of reasons that you could be feeling the way you feel. If you go on TRT, your T levels won't be all that much different than they are now, and you'll shut down your own natural production on top of that. The efficacy of testosterone is measured in ranges, not precise numerical values. So if you have 869 ng/dL right now, and with TRT you get to 1047 ng/dL in 3 months, it's super unlikely that you'll feel any difference. Not to mention having to go do blood tests every 3-6 months, possibly needing AIs, being on this for life. Why be dependent on something external if you likely don't need it?

TRT gives you the same hormone you already produce naturally. What will you do once you pass the initial psychosomatic effects you feel now, and see that maybe the cause of your negative physical/mental experiences is something else? (i.e. and for example: could be chemical imbalance of the brain, depression, tumor, nutritional imbalance, etc etc)

I am not criticizing you, but I just don't understand why someone in your position would go on TRT. If I was in your position, I certainly wouldn't.

Fair question, and no offence taken. The whole point of being here is to discuss and learn.

Ignoring the overwhelming desire to feel normal again (which I did in so far as it's possible for a human to do), the data-driven factors to try TRT were 1) my LH level which is getting close to double the top of the range and 2) sub-optimal free T because of the high SHBG level. The latter has been a problem for a long time, in fact as I noted previously this was a low(ish) SHBG reading for me as I've clocked well into triple digits previously.

Regarding the LH level, and this was part of my consultation with Dr. Saya, my body is essentially asking my testes for more testosterone and putting them into overdrive, but it's not enough to get my free T into an optimal range - either numerically or symptomatically. We don't know why the SHBG is so high. It doesn't appear to be a liver problem, I'm not anorexic, no estrogen use, no signs of thyroid problems. That leaves the most likely explanation as genetics which isn't something that I can control.

So we try to get my levels up to a point where I experience relief from the symptoms.

That's probably a very simplistic response to what is a complex question, and an even more complex set of systems that are involved. It's the best one that I have for you though.

 

[sammmy]

I have very similar hormonal levels, except the high LH, including the high SHBG and out of normal range estradiol. I am also similar age and the same symptomatics - hard to put muscle mass in gym, fatigue/depression, sexual problems - in my case difficulty to reach orgasm and lack of libido.

First, forget all "methods" to decrease SHBG because they all decrease endogenous testosterone too so they are nearly pointless.

I've tried transdermal terstosterone gel in the past without the HCG. During the two initial weeks when the body hasn't shut off the endogenous testosterone production yet, it improved the orgasmic problem and increased the libido. It made me irritable and did not improve anything at the gym.

I've also tried only HCG and it increased my free testosterone, improved orgasm, but for the short period I tried it (2 weeks) I did not notice any benefit at the gym.

If your trial with TRT fails to improve all symptoms (which is very likely because you simply do not have a low testosterone, regardless of LH), I would suggest trying the following that works for me:

Beta Ecdysterone extract of Cyanotis Vaga- bulks up muscles slightly and vastly improves endurance at the gym and recovery, doesn't influence testosterone but works on the estrogen receptors

DHEA - improves libido and may improve energy during the day

Anastrozole - makes me tired and joints hurt but vastly improves libido and anorgasmia for me, I actually measured it boosts my free testosterone but Aromatize Inhibitors suppress estradiol too much which will make you feel bad so it is not a permanent solution.

I cannot use DHEA, Anastrozole, HCG or testosterone gel, anymore because they all crash my immunity (I'm hiv positive). This should not be a problem for you.

 

[Pacman]

my LH level which is getting close to double the top of the range

That is what strikes me as really odd, that your LH is double the normal amount when your total T levels are on the high end and your free T is still considered normal, at least within the normal range, even if it is on the lower-ish end.

When your hypothalamus gland detects insufficient levels of total T in your body, it sends a message to your pituitary gland to produce LH, which in turn makes your testicles produce testosterone. The conversion of total T to free T is affected (in large part) by your levels of SHBG, which admittedly are high.

I am not going to suggest that I know more than any doctor, and it may very well be that (maybe) TRT will benefit you. But remember that any specialist you consult will see your issues through the lens of his own specialty. Which is not a bad thing, but something important to keep in mind. Like if you go to a dietitian, they'll most likely say it is all due to diet. Go to a psychiatrist, he'll say you some medication. Most of the time, they will not consider the various other causes/solutions to your issue, that is what I have experienced.

And to be clear I am not making any claim at all that your doctor is wrong either, not in the least, but consider this:

I myself have primary hypogonadism (physical failure of the testicles), so when I first got tested my LH and FSH were skyhigh (like 5 times the normal amount). This was to be expected, because my total T levels were around 40 ng/dL (seriously!), so my system was on overdrive and my pituitary gland was putting in "overtime", so to speak. After I brought my T levels to the normal range, the LH+FSH levels dropped drastically, pretty much to 0. This is normal.

But in your case, your brain is producing very high levels of LH despite you having T levels in normal range. It does not make sense that your brain produces such a high amount when your blood test shows totally normal levels.

If I was in your position, I'd make a visit to a neurologist. Even if you don't think that there is any issue with the functioning of your brain, why not go to at least to rule it out? Sometimes, issues connected to the brain (such as a brain tumor) can cause your brain to be in overdrive, even though it does not need to be, like when certain parts of the brain are under constant physical pressure. These type of things happen. An endocrinologist will not be able to diagnose or detect those type of issues, but a neurologist would.

Worst case scenario, you ruled out what might be the most important thing in the world for you to take care of right now.

And the reason I recommend a neurologist specifically is because it appears that your brain is not responding how it should, so there might be an issue there and this might be just one of the earliest signs (in addition to the symptoms you are experiencing on the daily). If it is not related to some malfunction of your brain (let's hope not), then at the very least you can put that suspicion to rest. And if it is, then you can thank your lucky stars you detected it now when whatever it may be is not too far progressed.

Just my two cents. Prevention (or early detection) is a million times better than dealing with it after it is too late.