Life after TRT - What now?

Hi Guys

Hope some of you can relate to this. Long story cut short. 33 year old male presenting most, if not all classic symptoms of low testosterone. Diagnosed with Secondary Hypogonadism. Testing was formally extensive including numerous blood tests, physical exam, MRI etc. Results showed a normal hormone profile (including thyroid) with the exception of a low LH output and, of course, low Testosterone (baseline 5.0-8.7nmol/L). MRI shows normal pituitary size, shape and structure with no tumor or mass present. No other abnormalities in other brain tissue or other body parts! Duration between first test and TRT - 1 year of investigation.

Subsequently, I was placed on an 8 month trial of TRT in the form of Tostran gel. After a few tweaks, my levels increased to a stable 15nmol/L - which proved the sweet spot for me - and in regards to the dose which I finally started to feel better with. That was obtained with 10 pumps per day of Tostran gel applied over my upper body. On paper, it translates to 100mg of testosterone applied to the skin daily.

Unfortunately, my RBC increased dramatically on the worthwhile dose - so much so it made me secondary Polycythemia Vera, with a RBC of 182 g/L. The risks were explained - I was placed on Asprin and 6 weeks ago - TRT was completely stopped without a taper. All of my symptoms have returned - although my baseline Testosterone level is 9.5 nmol/L on the latest test (higher than I expected) and importantly the RBC has come down 158 g/L.

Here's the thing. How an earth am I suppose to obtain adequate Testosterone levels if my Hemoglobin demonstrate they rise so easily? TRT has still been considered - but they explained I would need close monitoring and a blood drain on a regular basis for life. Not to mention the risks. That is a big deal. Not so much the procedure, but the bad side of TRT.

I also lift weights and have done for 5 years. Because of this - on paper, my weight looks too much - and was advised to lose weight - to encourage endogenous production of Testosterone. In reality though I was in great shape. I am 5ft'6 and in the peak of my training was 15 stone (210lbs) fit and healthy.

After some self investigation and research - I have traced the route cause of my Testosterone problem to chronic ongoing insomnia, anxiety and depression. The sleep issues would be massively responsible for a low to non existent LH, which, in theory you would assume equates to low testosterone. I've had sleep issues for years and as such, my natural Testosterone levels cannot be considered stable - because that is down to too many variables which unfortunately don't go in my favor. Since starting a supplementation of Tryptophan and ZMA - I am sleeping better. So what next if I consider against TRT?

I have been looking at the possibility of using an otc SERM, AI & Test booster - as you would think LH would be the component to target specifically. However - I am curious if stimulating LH would also increase RBC secondary to increasing Testosterone -like TRT did? Or is an increase in RBC a side effect of exogenous testosterone exclusively? Whatever the outcome, I have to hit that 15nmol/L mark at least to get any real benefit from TRT. Don't know what to do next.

Thoughts?

J

Since you said your weight as "stone" I take it you're not in the US? Regardless, the ticket to play in the TRT pool is blood donations. RBC/HCT rise goes hand-in-hand here, if you can't or are unwilling to donate a pint of blood every few months, TRT isn't for you. You could investigate much lower levels of Test in order to control RBC/HCT but its rather futile or has diminishing returns.

Welcome to Excelmale. Was a sleep study ever conducted to rule out apnea? Untreated apnea can, and will, undermine a TRT protocol. Rising Hct and Hgb are common, typical complications that arise during the course of TRT. They are easily treated with a therapeutic phlebotomy - a donation of blood where the blood bank disposes your blood rather than making it available for the community. It only requires a prescription from your doctor. Stopping TRT isn't necessary.

Hey guys thank's for the quick replies already!

Yes I'm outside the US. This is done on the NHS, and although a genuine case - even getting on TRT was difficult. They are very strict on their procedures. I have asked about donating blood - but because of the high RBC and being on TRT they said I can't. So it would have to be a therapeutic phlebotomy.

However, even with the mentioning of bringing the RBC under control - my doctor literally said today are the risks worth it? And we would need to fine tune a suitable dose. Fair enough. The thing is though, my symptoms only started improving at 15nmol/L with any real significance. That's still a mediocre level compared to some guys - but obviously right for me to get by on. I had tried various doses - but in my case anything under the mentioned I just did not find any benefit. Which is also why I don't want to go on low dose TRT for life without really getting anything from it. It's pointless.

That's why I wondered if there are any alternatives such as targeting the LH specifically? I haven't had an apnea study no, I suppose it would be well worth looking into - but because I have a history of chronic insomnia (sometimes 3 days without any sleep at all) and depression - this is why finding a stable level naturally is next to impossible. I swear down now that has something to do with it.

There are many, many men here at Excelmale who have to deal with the challenge of rising Hct and Hgb. It is, as Vince Carter mentioned, the ticket to ride the TRT Train for a lot of guys, though certainly not all. The risk that your doctor referenced is reduced to near zero if blood levels are monitored regularly and blood is donate regularly (as often as objective testing requires).

Hey Coastwatcher

Thank you for shedding light on that for me!

Certainly don't mean to appear feeling sorry for myself, like the majority I just want to feel better. Know what I mean?

I do understand my doctors concern, but as the saying goes there's nobody who know's you better than yourself. I will willingly accept the TRT protocol if it's offered including the phlebotomy. However if it's just a lower dose affair I feel personally better off looking elsewhere kind of thing. Certainly that's kind of where it felt like it was going anyway (awaiting outcome). That's my only concern really.

I do train like a beast so ideally sleeping is an issue which needs to be fixed too. As I said though I am responding well to tryptophan and zma. I know there's a lot of mixed opinion on zma but for overall health I think it's worth while for a start.

Interestingly I've just found some old blood work results pre-TRT (these ones I had done privately a year before) and even then without any TRT my RBC was high 178 g/L. So it has peaked and dipped at various times. I'm pretty sure if I had an underlying problem causing polycythemia it would remain increased? Like I mentioned recent one has come down to 158.

Not sure how Sleep Apnea impacts RBC, does it create peaks and dips then?

Apnea impacts RBC because you're starving of oxygen at night. Your body sees that and responds by created more RBC's. Fix the apnea and that will help. I'm coming on 5 years of TRT and I just put on my gel, take my hCG EOD and go about my business. No donations, no worries about blood, etc. My hemo/RBC has never moved in 5 years and a 1300 total T level.

Smoking effects it too. Again, oxygen starving creates more RBC's.

Also, on other forums, I've seen the people who have to donate regularly have to deal with low iron/ferratin problems.

Henry said:

Apnea impacts RBC because you're starving of oxygen at night. Your body sees that and responds by created more RBC's. Fix the apnea and that will help. I'm coming on 5 years of TRT and I just put on my gel, take my hCG EOD and go about my business. No donations, no worries about blood, etc. My hemo/RBC has never moved in 5 years and a 1300 total T level.

Smoking effects it too. Again, oxygen starving creates more RBC's.

Also, on other forums, I've seen the people who have to donate regularly have to deal with low iron/ferratin problems.

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Hey bud thank you for the reply.

Glad to hear your TRT is working well for you. Regarding sleep apnea I haven't been diagnosed yet, but as suggested it's a possibility. I mean it does exist in my family. Both my parents have it. It's not something I have thought about much. Might explain the raised cell count a year prior to trialling TRT. I neither smoke or drink much.

I suppose an injection would take my slightly higher (that would be a single nebido shot every so often) so best to get it ironed out now kinda thing. I felt great on TRT towards the end so I know it can and does work. I suppose my post is merely frustration really at what to do next.

Having said that suppose I know what I need to do - so if it's offered I'll take it. Jumping the gun.

I know some of the guys here do daily injections. Have you thought about that? I'm guessing that the small doses help keep the spike in RBC's down and that's what helps.

Henry said:

I know some of the guys here do daily injections. Have you thought about that? I'm guessing that the small doses help keep the spike in RBC's down and that's what helps.

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Don't think that will be an option. Here on the nhs I believe once you progress from gel, their choice of TRT is Nebido - as it is suppose to be long acting.

I'm in the UK, and experiencing similar issues.

Donating too often can tank your iron, and it can be a PITA to get them back up (especially if you have absorption issues - Tip: vit c aids absorption).

If I can afford it, I'm gonna try a sleep study (not cheap!), as elevated RBC/HCT are usual symptoms.

JP84,

The readings of RBC in g/L do not translate for me so hard to tell just how far along your blood issue is. However, one thing to consider is that there are guys on the forum who used to have to donate blood regularly and claim that after some time (up to 2 years for some) their hematocrit stabilized and they no longer need to donate.

With that in mind - again no idea how severe your blood issues are - if the docs are willing to continue TRT with you under close monitoring and you're ok with whatever risks they have presented to you, you might consider doing that to see if your blood might also stabilize after a while. Doubtless some of the guys who have experienced this will read this, and hopefully they can chime in.