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galaxy

Member
Hi All - First off I want to say this forum has been a hugely invaluable resource in getting me educated on TRT. I've spent a good amount of time reading and absorbing all there is on this site, and the recommended books/videos. So thank you to all the moderators, contributors, and doctors who put their time into making this forum so great.

This is a very long winded post, so apologies for that ahead of time, and if people aren't concerned with my specific story they can skip to question section as I'm primarily concerned with Question #2.

Thanks

Background

I'm an early 30s male and in 2015 I started to notice I was feeling fairly fatigued and never fully rested. I would sleep 9-10 hours and still have brain fog. I was diagnosed with hypogonadism (labs below) and it's been a long journey since then.

Upon getting diagnosed I dove deep into reading everything I could (this forum, PeakT, Nelson's Book, TOT book, and anything else I could get my hands on), then I went to an endocrinologist, integrative medicine specialists, functional medicine practitioner, psychiatrist, two sleep specialists, pulmonalogist (i have asthma), acupuncturist, chiropractor, and probably a couple more doctors I'm forgetting. Needless to say I've spent a bucket load of money.

My endo at the time had me try out low dose Clomid (25mg ED) two different times due to my age and the fact that other than my fatigue I had no other symptoms pertaining to low T (no ED, no anxiety.....). As you can see from the labs below, the Clomid worked and popped my T, but I felt no resolution in my fatigue. As a result, my endo said that the low T may be due to an underlying illness, and to explore that before committing to lifelong TRT and the potential side effects / hit to fertilitiy.

So i spent the next couple years exploring various issues ranging from Lyme and potential sleep issues (going as far as to get a deviated septum corrected, getting an in lab sleep study conducted which came back ever so slightly positive, trying out cpap which wrecked my sleep, and trying out a dental appliance, only to retest in an in lab sleep study to have my new sleep doctor say there was no issue), to gut health, nutrition, and a bunch of additional lab tests.

After spending the better part of two years chasing every potential fatigue related issue down a rabbit hole, and trying a clomid restart twice. I've decided to give TRT a go. I plan on progressing down the TRT spectrum as follows:

I've been prescribed Androgel so will start there, if that doesn't work move to 20% compounded formulation probably from EmpowerRx, and if that doesn't work move to subQ 2-3x/week injections, then IM injections if that doesn't work. During all this I plan on monitoring all key labs.

I'd prefer to stay away from AIs (due to potential bone density loss per the research referenced in TOT) and so will try and lower the dosage of test accordingly. My endo isn't a big believer in using HCG at the moment, even though I'd like to retain my fertility (no kids), so I'm getting a sperm count down ahead of time as well as banking.

My insurance doesn't seem to cover fertility issues for TRT as the mainstream consensus seems to be that fertility can be restarted so that's all coming out of pocket (sperm testing/consult/banking). I at the very minimum want the safety of knowing that I have banked some sperm in the off chance I turn out to be one of the 1-2% of men who fail to regain their fertility. While on the TRT I'll monitor my sperm count, and if I'm not feeling fully resolved from a fatigue perspective I may find another practitioner who would prescribe me HCG.

I'm also getting a Dexa bone scan ahead of time to monitor my bone density, in addition to establishing all other key lab baselines.

Questions
1) I'd love feed back or thoughts on anything I may be missing.

2) Every time I would read something related to TRT i would store it in my evernote, and I can't recall where I found this quote, but I found it stored the other day wanted to get people's thoughts on it now that I'm about to start on the gels:

"Gels cause higher risk of cardiovascular disease due to rise in DHT rise in capillary testosterone" - ZRT labs, who apparently has built an extensive database of testosterone measurements and usage for a wide variety of products, came to an alarming conclusion: capillary testosterone in the extremities is 30-50 times higher in the capillary and small vessels of the extremities than that seen in healthy young men or men on testosterone via injections or pellets. [2] For reasons not yet understood, the topical application of testosterone allows testosterone to "pool" in the small vessels. Thus, plasma levels can appear to be reasonable, the testosterone in end point extemities is "through the roof" and estradiol as well. ZRT labs believes these ultrahigh estradiol levels could be responsible for the adverse events.

Labs

2015 Pre Clomid Labs (all at LabCorp):
Total T: 300
Free T: 7
Estradiol-S: 16.4
SHBG: 21.1
DHEA-S: 260.6
LH: 6.1
FSH: 3.9
Prolactin: 10.6
Thyroid Panel (TSH, Free T4, Free T3, Reverse T3, Thyroid Antibodies) all fine
Weight/Blood Pressure/Metabolic Panels all fine

2016 On Clomid 25mg /day (all at labcorp) - even though saw a pop didn't feel any better
Total T: 610
Free T: 18.3
Estradiol-S: 44.6
LH: 15.9
FSH: 7.9
SHBG: 26.8
DHEA-S: 316.7

2016 Off Clomid for 3 months (all at labcorp) - you'll see the restart didn't work
Total T: 317
Free T: 11.1
Estradiol-S: 22.3
LH: 6.2
FSH: 3.4
SHBG: 18.4
Prolactin: 11.7
DHEA-S: 298.6

2017 On Clomid 25mg/day
Total T: 590
Free T: 14.43
Estradiol-S: 42.4
SHBG: 26
DHT: 46
Progesterone: 0.19

2018 Off Clomid 4 months
Total T: 391
Free T: 14.74
Estradiol-S: 20.1
LH: 9.8
FSH: 3.9
SHBG: 32.6
Prolactin: 7.1
DHEA-S: 229.9
DHT: 30
 
Defy Medical TRT clinic doctor

CoastWatcher

Moderator
Welcome to Excelmale. ZRT deals in saliva and single, blood-spot testing - an utterly unreliable method of assessing hormone levels. I know of no single doctor working at the leading edge of androgen management who relies on hormone levels obtained from saliva samples...with the exception of the four-point cortisol test (that is the standard method of determining cortisol levels over the course of the day). I have no faith in anything they may have studied or stated.

This Forum is certainly heavily oriented toward injections, but topical TRT is a rational approach to consider. Drs. Saya and Crisler regularly prescribe compounded, testosterone cream.
 
Last edited:

Re-Ride

Member
Well written intro, informed approach. I'd skip the Dexascan for sure. If you were to later develop bone loss for some reason Dexascan won't pick it up in the neck for instance as in my case. Had many over the years with the only benefit being that my bed sheets bring in big bucks on ebay as Shroud of Turin.
 
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