Suggestion based on blood work : TRT or not?

[isenita]

Hello Everyone,
I am a newbie and need your experience and opinion.

I am 38 years old male, I have been struggling with weight loss and motivation to go to the gym in the past 2 years. I feel energetic only from 8 am to 11 am (where I try to do most of my work done) and then the rest of the day I function out of coffee. I feel much more thirsty than what was used to, and feel also much hotter than what used to be. 5 years ago I got diagnosed with Non-alcoholic fatty liver, the liver was enlarged and fatty (to a mild status), at the time my ALT were at 160, after some milk thistle, NAC, dropping alcohol. Right now AST are in range and ALT are high but between 50 and 60. Losing weight will be beneficial. I am at 22-23% body fat, but I was always being used to be on the 14-15% range until a couple of years ago where I started getting fatter despite my effort and start to lose motivation to train. I never used drugs nor steroids or SARMS. I have no erectile dysfunction, but my libido is lower than what was used to be (not low at concerning level, I still have an ok sex life but for sure I have less desire than before).

I did a check-up at the end of the year and found:
ALT: 55 IU/L
Total Testosterone (only hormone I checked): 235 ng/dL

As follow-up, I got done my Estradiol, LH, FSH, PSA, Thyroid panel and Insuline, everything in the normal but LH and FSH that were above range at
LH:11 mIU/mL
FSH:15 mIU/mL

I did rest more and took another testo test earlier in the morning and got: 370 ng/dL

Now I am looking for suggestions. My main goal is to lose weight to come back to the 12-13% body fat with some decent (not huge) muscle size, to preserve my liver, regain better cardio performance (now I lose breath very easily and lose energy very easily), feel energized and more confident with my body.
My wife and I have a baby (I made her pregnant one year and half ago) and we don't want any other kid.

My ideal plan would have been diet and train hard to drop in body weight and increase strength to hopefully increase testo level naturally. However, it has been one year that I am trying so and being unsuccessful: I got crazy carvings every time I tried to diet and food is some kind of anti stress at the moment, I go to the gym and after I do two exercise I feel totally deprived of energies and I just leave. I did a keto diet for 1 month, the energy increased slightly during the day , however I was still very hungry and didn't lose any weight at all.

What are your suggestions?

 

[Systemlord]

I feel much more thirsty than what was used to, and feel also much hotter

This happens when estrogen is low. My sisters after menopause have hot flashes throughout the day, everyday and unable to retain water.

LH:11 mIU/mL
FSH:15 mIU/mL

My ideal plan would have been diet and train hard to drop in body weight and increase strength to hopefully increase testo level naturally.

I’m sorry, fixing the low-T naturally isn’t possible, because you have testicular failure. Your pituitary gland is pumping out the LH stimulating hormone in an attempt to stimulate your testicles to produce testosterone and estrogen, but your testicles aren’t responding, so the LH is high and will continue to rise.

Infertility is likely. TRT can improve liver function.

Testosterone treatment improves liver function and reduces cardiovascular risk: A long-term prospective study

Objectives: To report the association between testosterone treatment in hypogonadal men with hepatic steatosis, non-alcoholic fatty liver disease and cardiovascular disease (CVD). Methods: A prospective study was conducted to assess the physiological ...

www.ncbi.nlm.nih.gov

Primary hypogonadism​

Common causes of primary hypogonadism include:

• Klinefelter syndrome. This condition results from a congenital abnormality of the sex chromosomes, X and Y. A male normally has one X and one Y chromosome. In Klinefelter syndrome, two or more X chromosomes are present in addition to one Y chromosome.
  The Y chromosome contains the genetic material that determines the sex of a child and related development. The extra X chromosome that occurs in Klinefelter syndrome causes abnormal development of the testicles, which in turn results in underproduction of testosterone.
• Undescended testicles. Before birth, the testicles develop inside the abdomen and normally move down into their permanent place in the scrotum. Sometimes one or both of the testicles aren't descended at birth.
  This condition often corrects itself within the first few years of life without treatment. If not corrected in early childhood, it can lead to malfunction of the testicles and reduced production of testosterone.
• Mumps orchitis. A mumps infection involving the testicles that occurs during adolescence or adulthood can damage the testicles, affecting the function of the testicles and testosterone production.
• Hemochromatosis. Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production.
• Injury to the testicles. Because they're outside the abdomen, the testicles are prone to injury. Damage to both testicles can cause hypogonadism. Damage to one testicle might not impair total testosterone production.
• Cancer treatment. Chemotherapy or radiation therapy for the treatment of cancer can interfere with testosterone and sperm production. The effects of both treatments often are temporary, but permanent infertility may occur.

 

[isenita]

This happens when estrogen is low. My sisters after menopause have hot flashes throughout the day, everyday and unable to retain water.



I’m sorry, fixing the low-T naturally isn’t possible, because you have testicular failure. Your pituitary gland is pumping out the LH stimulating hormone in an attempt to stimulate your testicles to produce testosterone and estrogen, but your testicles aren’t responding, so the LH is high and will continue to rise.

Infertility is likely.

Primary hypogonadism​

Common causes of primary hypogonadism include:

• Klinefelter syndrome. This condition results from a congenital abnormality of the sex chromosomes, X and Y. A male normally has one X and one Y chromosome. In Klinefelter syndrome, two or more X chromosomes are present in addition to one Y chromosome.
  The Y chromosome contains the genetic material that determines the sex of a child and related development. The extra X chromosome that occurs in Klinefelter syndrome causes abnormal development of the testicles, which in turn results in underproduction of testosterone.
• Undescended testicles. Before birth, the testicles develop inside the abdomen and normally move down into their permanent place in the scrotum. Sometimes one or both of the testicles aren't descended at birth.
  This condition often corrects itself within the first few years of life without treatment. If not corrected in early childhood, it can lead to malfunction of the testicles and reduced production of testosterone.
• Mumps orchitis. A mumps infection involving the testicles that occurs during adolescence or adulthood can damage the testicles, affecting the function of the testicles and testosterone production.
• Hemochromatosis. Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production.
• Injury to the testicles. Because they're outside the abdomen, the testicles are prone to injury. Damage to both testicles can cause hypogonadism. Damage to one testicle might not impair total testosterone production.
• Cancer treatment. Chemotherapy or radiation therapy for the treatment of cancer can interfere with testosterone and sperm production. The effects of both treatments often are temporary, but permanent infertility may occur.

I see, thank you for your answer! Do you think despite the fact that after some rest the testo went to 370 values still my testis are failing?
I do have a baby, we conceived one year and half ago after 3-4 months of trying and my wife doesn't want to have other babies so it isn't a big deal the fertility, the important is that it works and keep libido. I never used any illegal substance (not even marujana) and not took any steroid/sarms in my life nor got any injury to my testies. It is a puzzle why they are not working properly.

So in your view TRT will be overall beneficial to my health than the current situation?

 

[Systemlord]

So in your view TRT will be overall beneficial to my health than the current situation?

Without a doubt. The libido is usually the first to go, then erections and things go downhill from there. You‘re also at risk for type 2 diabetes. I’m pretty sure your SHBG is low given your low TT value and is usually low in type 2 diabetics.

You’re actually where I was in my 30’s, fatty liver, SHBG decreasing, high triglycerides and type 2 diabetes came next and my T was declining as a result. I was 91 ng/dL and 120 ng/dL and SHBG at 11 nmol/L.

You could change lifestyle factors to improve your situation, but TRT is inevitable at this point.

Relevance of low testosterone to non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a condition where there is excess accumulation of triglycerides in the liver in the absence of excess alcohol consumption. It ranges from simple steatosis to non-alcoholic steatohepatitis (NASH), which can ...

www.ncbi.nlm.nih.gov

 

[isenita]

Without a doubt. The libido is usually the first to go, then erections and things go downhill from there. You‘re also at risk for type 2 diabetes. I’m pretty sure your SHBG is low given your low TT value and is usually low in type 2 diabetics.

You’re actually where I was in my 30’s, fatty liver, SHBG decreasing, high triglycerides and type 2 diabetes came next and my T was declining as a result. I was 91 ng/dL and 120 ng/dL and SHBG at 11 nmol/L.

You could change lifestyle factors to improve your situation, but TRT is inevitable at this point.

Relevance of low testosterone to non-alcoholic fatty liver disease

Non-alcoholic fatty liver disease (NAFLD) is a condition where there is excess accumulation of triglycerides in the liver in the absence of excess alcohol consumption. It ranges from simple steatosis to non-alcoholic steatohepatitis (NASH), which can ...

www.ncbi.nlm.nih.gov

Thansk for your reply. How did TRT improved your fatty liver and triglicerides?

 

[Systemlord]

How did TRT improved your fatty liver and triglicerides?

Not much happened until I corrected my vitamin D 3 months ago, since then I have lost 3” inches off my waist in 3 months.

 

[Drug350]

This happens when estrogen is low. My sisters after menopause have hot flashes throughout the day, everyday and unable to retain water.



I’m sorry, fixing the low-T naturally isn’t possible, because you have testicular failure. Your pituitary gland is pumping out the LH stimulating hormone in an attempt to stimulate your testicles to produce testosterone and estrogen, but your testicles aren’t responding, so the LH is high and will continue to rise.

Infertility is likely. TRT can improve liver function.

Testosterone treatment improves liver function and reduces cardiovascular risk: A long-term prospective study

Objectives: To report the association between testosterone treatment in hypogonadal men with hepatic steatosis, non-alcoholic fatty liver disease and cardiovascular disease (CVD). Methods: A prospective study was conducted to assess the physiological ...

www.ncbi.nlm.nih.gov

Primary hypogonadism​

Common causes of primary hypogonadism include:

• Klinefelter syndrome. This condition results from a congenital abnormality of the sex chromosomes, X and Y. A male normally has one X and one Y chromosome. In Klinefelter syndrome, two or more X chromosomes are present in addition to one Y chromosome.
  The Y chromosome contains the genetic material that determines the sex of a child and related development. The extra X chromosome that occurs in Klinefelter syndrome causes abnormal development of the testicles, which in turn results in underproduction of testosterone.
• Undescended testicles. Before birth, the testicles develop inside the abdomen and normally move down into their permanent place in the scrotum. Sometimes one or both of the testicles aren't descended at birth.
  This condition often corrects itself within the first few years of life without treatment. If not corrected in early childhood, it can lead to malfunction of the testicles and reduced production of testosterone.
• Mumps orchitis. A mumps infection involving the testicles that occurs during adolescence or adulthood can damage the testicles, affecting the function of the testicles and testosterone production.
• Hemochromatosis. Too much iron in the blood can cause testicular failure or pituitary gland dysfunction, affecting testosterone production.
• Injury to the testicles. Because they're outside the abdomen, the testicles are prone to injury. Damage to both testicles can cause hypogonadism. Damage to one testicle might not impair total testosterone production.
• Cancer treatment. Chemotherapy or radiation therapy for the treatment of cancer can interfere with testosterone and sperm production. The effects of both treatments often are temporary, but permanent infertility may occur.

Wow. If those LH & FSH numbers are low, than mine look terrible. My LH came back at 3 miU/ml and FSH @ 4 miU/ml, SHBG 34 nmol, Estradiol 21 pg/ml, Prolactin 14.6 ng/ml, Total 169 NGDL, Free 3.1 NGDL, Bioavailable 72.6 NGDL. Does this equate to "Primary" or "secondary" hypogonadism ??? My doctor notes "secondary hypogonadism". Thanks.

 

[Systemlord]

My LH came back at 3 miU/ml and FSH @ 4 miU/ml, SHBG 34 nmol, Estradiol 21 pg/ml, Prolactin 14.6 ng/ml, Total 169 NGDL

My LH was 3.6 and FSH 4.6 and TT 91, 120 ng/dL and FT below range.

Does this equate to "Primary" or "secondary" hypogonadism ??? My doctor notes "secondary hypogonadism".

Secondary.