I've posted on this forum before, and the feedback has been very helpful.

I'm at 3 months after a 110-day TRT trial earlier this year that was stopped mainly because of adverse sexual side effects (now improved somewhat off-therapy). The other symptoms that caused me to seek TRT in the first place have returned, however, and my labs are slightly worse than before (although in the same ballpark).

I have been down the Grok/ChatGPT rabbit hole, and they both agree I would likely do better on a low-dose daily regime, perhaps transdermal, maybe with an AI (my endocrinologist agreed to follow and respond to E2 this time but flatly refuses to prescribe hCG). I am skeptical, however, and don't want to make my situation worse.

As always, your thoughts and observations are appreciated.

The history, as concise as I could make it:

• 5'9"; 142.4 lb; muscle mass 115 lb; body fat 14.5%; fit but relatively high body fat in legs/glutes. Fertility not desired. No other prescription meds.

Clinical history

• Longstanding symptoms: depressed mood, poor sleep, generalized anxiety, low motivation, difficulty gaining/maintaining quality muscle, overall getting physically softer and psychologically less motivated, despite disciplined lifestyle.
• Very healthy lifestyle: high‑protein whole‑food diet, <3 drinks/month, strict sleep hygiene, resistance training 3×/week, daily walking.
• Remote prolonged prednisone and methotrexate use, stopped at age 40. No chemo/radiation. No history of mumps orchitis, testicular torsion, or cryptorchidism.

Relevant labs and findings (off TRT, ~3 months after discontinuation)

• Total testosterone 411 ng/dL (Reference Range: 250-1100 ng/dL)
• Free testosterone 56.8 pg/mL (Reference Range: 35.0-155.0 pg/mL)
• LH markedly elevated ~19.3 mIU/mL (prior) — FSH markedly elevated ~49.9 mIU/mL
• SHBG 51 nmol/L (slightly above RR 10–50)
• Hematocrit 46.8% (RR 38.5–50.0)
• Morning cortisol previously 23.1 mcg/dL (mildly high previously; nondiagnostic)
• Pre-TRT baseline labs similar (465 total T; 68.4 free T; high normal SHBG; sky-high LH/FSH)

Prior treatment attempt

• 110‑day trial of testosterone cypionate (IM/SC) with variable dosing/frequency:
  • Initial 80 mg IM weekly → immediate BP spike.
  • Average dose over trial ~86.16 mg/week; dosing frequency varied from daily to every 3 days
  • Labs at day 31 showed high serum T (78th percentile) and free T (84th percentile), SHBG ~50th percentile.
• Clinical response to TRT trial:
  • Muscle gained quickly but paradoxical increase in abdominal fat.
  • CNS overstimulation, poor sleep, emotional flattening (stable but blunted affect).
  • Marked variability and overall decline in libido and sexual function: decreased genital sensation and intermittent inability to climax.
  • BP spike temporally associated with higher initial dose; BP normalized with dose reduction.
• Discontinued TRT due to sexual dysfunction
• After discontinuation he reported feeling markedly better for ~3 weeks (rebound); after 3 month washout sexual function improved while other low‑T symptoms returned.

What went wrong? Can I expect better results with an improved protocol? That 3 week period after discontinuation was great, but therapy felt awful, even though labs and anabolic results were good.

ClashCityRocker said:

I've posted on this forum before, and the feedback has been very helpful.

I'm at 3 months after a 110-day TRT trial earlier this year that was stopped mainly because of adverse sexual side effects (now improved somewhat off-therapy). The other symptoms that caused me to seek TRT in the first place have returned, however, and my labs are slightly worse than before (although in the same ballpark).

I have been down the Grok/ChatGPT rabbit hole, and they both agree I would likely do better on a low-dose daily regime, perhaps transdermal, maybe with an AI (my endocrinologist agreed to follow and respond to E2 this time but flatly refuses to prescribe hCG). I am skeptical, however, and don't want to make my situation worse.

As always, your thoughts and observations are appreciated.

The history, as concise as I could make it:

• 5'9"; 142.4 lb; muscle mass 115 lb; body fat 14.5%; fit but relatively high body fat in legs/glutes. Fertility not desired. No other prescription meds.

Clinical history

• Longstanding symptoms: depressed mood, poor sleep, generalized anxiety, low motivation, difficulty gaining/maintaining quality muscle, overall getting physically softer and psychologically less motivated, despite disciplined lifestyle.
• Very healthy lifestyle: high‑protein whole‑food diet, <3 drinks/month, strict sleep hygiene, resistance training 3×/week, daily walking.
• Remote prolonged prednisone and methotrexate use, stopped at age 40. No chemo/radiation. No history of mumps orchitis, testicular torsion, or cryptorchidism.

Relevant labs and findings (off TRT, ~3 months after discontinuation)

• Total testosterone 411 ng/dL (Reference Range: 250-1100 ng/dL)
• Free testosterone 56.8 pg/mL (Reference Range: 35.0-155.0 pg/mL)
• LH markedly elevated ~19.3 mIU/mL (prior) — FSH markedly elevated ~49.9 mIU/mL
• SHBG 51 nmol/L (slightly above RR 10–50)
• Hematocrit 46.8% (RR 38.5–50.0)
• Morning cortisol previously 23.1 mcg/dL (mildly high previously; nondiagnostic)
• Pre-TRT baseline labs similar (465 total T; 68.4 free T; high normal SHBG; sky-high LH/FSH)

Prior treatment attempt

• 110‑day trial of testosterone cypionate (IM/SC) with variable dosing/frequency:
  • Initial 80 mg IM weekly → immediate BP spike.
  • Average dose over trial ~86.16 mg/week; dosing frequency varied from daily to every 3 days
  • Labs at day 31 showed high serum T (78th percentile) and free T (84th percentile), SHBG ~50th percentile.
• Clinical response to TRT trial:
  • Muscle gained quickly but paradoxical increase in abdominal fat.
  • CNS overstimulation, poor sleep, emotional flattening (stable but blunted affect).
  • Marked variability and overall decline in libido and sexual function: decreased genital sensation and intermittent inability to climax.
  • BP spike temporally associated with higher initial dose; BP normalized with dose reduction.
• Discontinued TRT due to sexual dysfunction
• After discontinuation he reported feeling markedly better for ~3 weeks (rebound); after 3 month washout sexual function improved while other low‑T symptoms returned.

What went wrong? Can I expect better results with an improved protocol? That 3 week period after discontinuation was great, but therapy felt awful, even though labs and anabolic results were good.

Click to expand...

This is just my two cents and I'm sure others will disagree with me.

For me to feel good, I need a higher dose of testosterone and HCG. We are all different. Because of your issues. I would just inject testosterone, a low dose. 10 mg daily and let it play out. I do daily injections. I pick six places shallow IM shoulders, VG and Sub-Q in love handles. Now after 9 years of dailies it's part of my daily routine.

You mentioned E2. Where was/is E2 on/off TRT?

Unfortunately it seems your doctor did not end up targeting normal LH/FSH as discussed in your previous thread:

This guy perhaps has a more savvy doctor:

Reiterating, in my opinion primary hypogonadism should at least initially be treated with very low doses of testosterone that are slowly increased until LH/FSH are normalized. The resulting testosterone levels should be close to what your body wants. Higher doses simply result in HPTA shutdown and attendant side effects—as you found out the hard way.

When using testosterone cypionate, two or three mg daily is a higher-end starting point as long as you don't mind occasional testing of LH to help you home in on the correct dose. Transdermal testosterone could work but is much harder to control. If you have variable absorption then it could end up being nothing but trouble.

Seagal said:

You mentioned E2. Where was/is E2 on/off TRT?

Click to expand...

My endo didn't follow it the first time around, unfortunately. I just had an ultra-sensitive E2 baseline drawn this morning in case I decide to try again.

I think I'm going to give it another few months and get my labs redrawn. I'm skinnier than when I was on TRT, but I feel better off it.

Cataceous said:

Unfortunately it seems your doctor did not end up targeting normal LH/FSH as discussed in your previous thread:

C

Post in thread 'Hesitating on TRT, Does Anyone Have Regrets?'

Apr 12, 2025

ClashCityRocker said:

I have two questions:

1. Can I "try" TRT long enough to see if it will work without risking the functionality I already have?
...

Click to expand...

Unfortunately you're getting some mis-targeted advice—because primary hypogonadism is relatively rare. In some respects you are better off than those of us with secondary hypogonadism. Your malady is limited to testicular insufficiency, in contrast to the majority whose maladies involve poorly understood dysregulation of the hypothalamus or pituitary.

So the answer to your first question is an emphatic "yes", as long as it's handled correctly. When...

• Cataceous

• 

This guy perhaps has a more savvy doctor:

C

Post in thread 'Primary Hypogonadism: Doctor wants to put me on 25mg of Testosterone enanthate per week'

Nov 10, 2025

You have a wise doctor. It's not common for guys with primary hypogonadism to get such good advice. All I would add is that dividing the dose into 2-3 injections per week is a good idea—if he didn't already suggest that.

It is correct that with primary hypogonadism, exogenous testosterone adds to natural production until you get close to normal levels of testosterone. You use LH/FSH measurements to tune your dose, just like he says. You're aiming to bring them down to normal from over-range/high-normal. The latter is a prominent feature of primary hypogonadism: It means that your brain is...

• Cataceous

• 

Reiterating, in my opinion primary hypogonadism should at least initially be treated with very low doses of testosterone that are slowly increased until LH/FSH are normalized. The resulting testosterone levels should be close to what your body wants. Higher doses simply result in HPTA shutdown and attendant side effects—as you found out the hard way.

When using testosterone cypionate, two or three mg daily is a higher-end starting point as long as you don't mind occasional testing of LH to help you home in on the correct dose. Transdermal testosterone could work but is much harder to control. If you have variable absorption then it could end up being nothing but trouble.

Click to expand...

I would love for this to be true. In my case, it seems exogenous T was good for anabolism and bad for other things. But the boost I got coming off (which I interpret as my natural production coming back on as the cypionate started to clear and maybe elevated E2 levels dropped) felt absolutely fantastic.

There does seem to be a lot of controversy about this, but I would absolutely try low dose if I ever went back on. Interestingly, even when I was at 811 total T on therapy, my FSH was still in the reference range and my LH was just below. There's certainly no harm in starting low, as I could always increase the dose.

ClashCityRocker said:

...
Interestingly, even when I was at 811 total T on therapy, my FSH was still in the reference range and my LH was just below. ...

Click to expand...

Was this at 31 days on TRT, or further along? If only a month then suppression would likely progress. Three months would be harder to explain, though it sounds like reduced levels of LH/FSH/GnRH/kisspeptin were still taking a toll on sexual function. I personally have found that restoring some GnRH activity under TRT ameliorates such symptoms. It's hard to estimate what fraction of men with HPTA suppression suffer from these side effects.

ClashCityRocker said:

• CNS overstimulation, poor sleep, emotional flattening (stable but blunted affect).
• Marked variability and overall decline in libido and sexual function: decreased genital sensation and intermittent inability to climax.
• BP spike temporally associated with higher initial dose; BP normalized with dose reduction.

Click to expand...

These can be fixed by things like lower dose and/or switch to daily test propionate. There are likely some benefits to maintaining normal HPTA function, but it wasn't necessary in my case to resolve your entire list of complaints.

Cataceous said:

Was this at 31 days on TRT, or further along? If only a month then suppression would likely progress. Three months would be harder to explain, though it sounds like reduced levels of LH/FSH/GnRH/kisspeptin were still taking a toll on sexual function. I personally have found that restoring some GnRH activity under TRT ameliorates such symptoms. It's hard to estimate what fraction of men with HPTA suppression suffer from these side effects.

Click to expand...

That was day 31 after starting TRT, and my doses only got higher after that. So further suppression almost certainly did occur.

That linked thread was very interesting, but it also underscores how complicated and nuanced this all gets.

I'm about 15 weeks after my last does of cypionate, and I'm assuming the exogenous T has completely cleared my system. I feel slightly worse than my pre-TRT baseline. That said, I don't know if this is the new baseline, or if I'm still on the way back up. If everything is optimized, lifestyle wise, I've been around 500 for total T, 80 free, in my "natural" state the last couple of years. I can at least get by on that.

My instinct is that E2 played a role, as I also gained belly fat on T, even though I was working out and eating as before, and also because I was getting headaches.

But things also got worse the longer I was on therapy. My last two weeks of 15 mg ED were brutal, even though I expected improvement with E2 symptoms on daily sub Q dosing. So that makes me think HPTA suppression could have played a role as well.

I'm in the process of getting a second opinion. I think my current endo is too "by the book" for someone looking to feel "optimized," as opposed to just getting good lab results. He leaves dosing frequency, route, and even amount (to an extent) up to me, but he is not into adjunct therapy at all. If there's not a double-blind, peer-reviewed published study to support something, he won't try it. I'm not knocking him, as that's the safe course. But it didn't work for me last time around.