Doc wants to take me off TRT and not sure what to do next (29 yo guy)

[irishguy1989]

TLDR:
My urologist is refusing to keep treating me and I'm unsure if Testosterone is the answer to my symptoms. I would love advice from you guys on whether TRT is the right road for me.

Background:

I've had many blood tests over the past 2 years due to a list of symptoms (ED, lack of morning wood, anxiety, low mood, low energy, headache, random sweats, low confidence).

After some research (and having dabbled with steroids 5 years ago) I figured it might be good to try TRT.
I’m based in Ireland where it's incredibly difficult to get TRT. We don’t have TRT clinics.

After months of searching I eventually found a urologist who started treating me 3 months ago with Androgel.

He said it was a trial as Im ''not technically low T -- but have some symptoms.'' On the gel I felt great the first month (never felt better in years) and then reverted back to how I was feeling pre TRT.

Unfortunately because of this he wants to take me off TRT as he thinks its not the answer to my problems and he believes my issues are ''more mental than hormones''. He won’t prescribe injections either. I’m now coming off Testosterone and feel like crap.

My question to this forum:
While my total T is not textbook low I feel like my free T is and could be affecting my symptoms?
Question is do I keep pursuing TRT or follow docs advice and live life without?
—
Age: 29
BMI: 25 (cardio + weights 5 times per week)
Medication: none but was on anti-depressants last year and did use cycles of test and deca in the past (5+ years ago).
Symptoms: Social and performance anxiety, low mood, zero to low libido, ED, no morning wood, low motivation for past 1-2 years, random sweats.
All other bloods are ok.
—
Pre TRT numbers:
Total Testosterone: 450 ng/dl (300 - 950)
Free testosterone: 6.3 ng/dl (5 - 19)
SHBG: 51 nmol/L (18.3 - 54.1)
Oestradiol: 55.00 pmol/L (0 - 192.00) [14.98 pg/ml]
Albumin: 50 g/L (35-50)
Prolactin: 312 mU/L (86-324)
LH: 7.0 (1.7 - 8.6)
FSH: 1.9 (1.5 - 12.4)
—
TRT numbers:
Total Testosterone: 550 ng/dl (264-916)
Free testosterone: 10.6 ng/dl (5 - 19)
SHBG: 50.00 nmol/L (18.3 - 54.1)
Oestradiol: 43.00 pmol/L (0 - 192.00) [12 pg/ml]
Albumin: 52 g/L (35 - 50)
Prolactin: 248 mU/L (86-324)
LH: 4.9 (1.7 - 8.6)
FSH: 1.6 (1.5 - 12.4)

 

[xqfq]

I don’t have advice for your specific situation with the doctor, but hopefully others here can provide guidance on convincing skeptical physicians.

I do believe you would benefit from well-done TRT. Your total testosterone level was normal but your free testosterone, which is all that really matters, was below-range low.

Using the new Tru-T.com calculator (search “tru-t” on this forum for lots of information), your free T was 11.42 ng/dL, or below range (16-31 ng/dl, see https://www.excelmale.com/forum/threads/tru-t-calculator-what-is-the-range.19213/). Using the other calculators your free T is even more under range.

You may not have symptom relief because your testosterone levels aren’t high enough with your current protocol on the gel.

You might have felt good for the first month because your body’s own testosterone production wasn’t shut down, so you had your body + the gel, which may have been an adequate amount of testosterone for you!

 

[Sean Mosher]

Androgel is simply never going to be able to get you dialed in (dosed too low).
Need to go the compounded topical route or injections.
Your SHBG is on the higher on so you'll need a decent dose to come over the top of that and allow your FreeT to increase.

 

[Systemlord]

TRT numbers:
Total Testosterone: 550 ng/dl (264-916)
Free testosterone: 10.6 ng/dl (5 - 19)
SHBG: 50.00 nmol/L (18.3 - 54.1)
Oestradiol: 43.00 pmol/L (0 - 192.00) [12 pg/ml]
Albumin: 52 g/L (35 - 50)
Prolactin: 248 mU/L (86-324)
LH: 4.9 (1.7 - 8.6)
FSH: 1.6 (1.5 - 12.4)

These are not TRT numbers because your LH is not suppressed, when exogenous testosterone enters your bloodstream, LH is usually suppressed after a couple of weeks. Your labs that you ran were in fact your naturally low levels and this can be explained by the fact that men absorb T-gels poorly as your LH indicates.

You may very well need levels 1000> to see Free T levels high enough. You need to get on TRT, low estrogen can cause osteoporosis, low testosterone can cause cardiovascular/heart problems.

Your estrogen was low as well, in your case estrogen is low because Free T is low. Your doctor is operating in the dark and doesn't understand things very well, I'm sure he is doing the best that he can, but simply isn't knowledgeable enough to treat you.

You won't find many of us here on androgel, because it doesn't work for the majority of men. I'm mean you absorbed absolutely none of it, it didn't even suppresses LH.

Injections is the most effective, all of it is absorbed.

 

[irishguy1989]

These are not TRT numbers because your LH is not suppressed, when exogenous testosterone enters your bloodstream, LH is usually suppressed after a couple of weeks. Your labs that you ran were in fact your naturally low levels and this can be explained by the fact that men absorb T-gels poorly as your LH indicates.

You may very well need levels 1000> to see Free T levels high enough. You need to get on TRT, low estrogen can cause osteoporosis, low testosterone can cause cardiovascular/heart problems.

Your estrogen was low as well, in your case estrogen is low because Free T is low. Your doctor is operating in the dark and doesn't understand things very well, I'm sure he is doing the best that he can, but simply isn't knowledgeable enough to treat you.

You won't find many of us here on androgel, because it doesn't work for the majority of men. I'm mean you absorbed absolutely none of it, it didn't even suppresses LH.

Injections is the most effective, all of it is absorbed.

Thanks dude. You’re 100% correct. My LH reduced slightly but did not become suppressed.

If I cannot find a doc do you think its worth going the self medication route (eg 100-150 weeky) and should actual TRT help my symtoms?

 

[irishguy1989]

Androgel is simply never going to be able to get you dialed in (dosed too low).
Need to go the compounded topical route or injections.
Your SHBG is on the higher on so you'll need a decent dose to come over the top of that and allow your FreeT to increase.

Thanks man! If i was to go self med route how much would I need weekly to get good FT levels? I’ve read the norm starting is 100-150 test cyp weekly?

 

[Systemlord]

Thanks dude. You’re 100% correct. My LH reduced slightly but did not become suppressed.

If I cannot find a doc do you think its worth going the self medication route (eg 100-150 weeky) and should actual TRT help my symtoms?

You could always travel to get proper treatment, last resort is self treatment. You will need labs every 6 months to track progress and keep CBC levels in healthy ranges.