Is TRT My Best First Option...

Hello Guys, looking for advice from multiple sources since I have not started TRT yet and want to do what's best from the get-go.

I am 54 y/o, 5'9", 169lbs and have been into health/fitness my whole life, take no medications, and no steroid use.
My cholesterol, insulin and glucose are creeping up.


Here are my lab values, want to see if I need to start TRT or if I should take another path initially to stimulate my system to produce. I am not seeing a Doctor at this time for my hormones, had blood work done on my own.
Test - 307 (264-916)
Free T - 39.2 (50.0-210.0)
SHBG - 95.7 (19.3-76.4)
Estradiol, sensitive - 8.9 (8.0-35.0)
DHEA-S - 267.5 (44.3-331.0)
LH - 2.8 (1.7-8.6)
FSH - 3.8 (1.5-12.4)
Prolactin - 5.2 (4.0-15.2)
PSA - 0.3

Thanks, Rich

Hey, your numbers look a lot like mine. I started on TRT a few months ago and I feel fantastic now. What kind of symptoms are you experiencing, besides elevated cholesterol and glucose? I am also in that boat too. Guess what, the common factor for testosterone decline, insulin sensitivity, and heart disease is ... AGE.

What are your HDL, LDL, and Triglyceride numbers, out of curiosity?

Hey Dave,

I feel pretty good, certainly not optimum, the good is probably because of my overall health, conditioning and diet. I am noticing a diminished outlook on life and being less decisive on most days. As well as ups and downs in sexual performance-eating liver daily seems to help.
I have read several books and listened to many podcast on Cholesterol and think my numbers are a "little" high. Requested numbers, may alarm some that I choose not to be on statins:
Total Cholesterol - 459
Direct LDL-C - 371
HDL-C - 68
Triglycerides - 80

Your LDL is terrible, you definitely need Improvement in your diet. Have you thought about getting a complete thyroid panel with reverse T3. Improvements in free T3 should help your testosterone levels and also activate more LDL receptors in your liver, if your levels are low.

I'm no fan of statins either but you can't safely ignore LDL that high. Have you gone to get a heart scan or at least a carotid artery scan? You should find out your calcium load and Agatston score.

I highly doubt eating animal protein at all is helping your LDL by the way.

Dave B. said:

I'm no fan of statins either but you can't safely ignore LDL that high. Have you gone to get a heart scan or at least a carotid artery scan? You should find out your calcium load and Agatston score.

I highly doubt eating animal protein at all is helping your LDL by the way.

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What happens to the carbs?
https://www.excelmale.com/forum/showthread.php?4276-What-happens-to-the-carbs

I have had 3 calcium scoring test performed in the last 10 year wirh a score of zero each time, with the last one being about 18 months ago.

I have been Paleo for 5 years and Keto for 6 months.
My numbers weren't this high prior to Keto so I believe my body is still adjusting.

RPellerin said:

Hey Dave,

I feel pretty good, certainly not optimum, the good is probably because of my overall health, conditioning and diet. I am noticing a diminished outlook on life and being less decisive on most days. As well as ups and downs in sexual performance-eating liver daily seems to help.
I have read several books and listened to many podcast on Cholesterol and think my numbers are a "little" high. Requested numbers, may alarm some that I choose not to be on statins:
Total Cholesterol - 459
Direct LDL-C - 371
HDL-C - 68
Triglycerides - 80

Click to expand...

A little high?! Don't know what books are podcasts you listen to but that's wayyyyyyyy past a little high, unless that was intended as sarcasm and I missed it. I'd say you're a good candidate for TRT, but you need to address those lipid levels. Mine run higher than I'd like for sure, and it can be a battle, but you need to address that asap. Seen many people with elevated lipids on paleo and or keto diets. 6 months is well passed keto adjustment period, Eating liver aint helping either....

Okay Gents,
I can go to other forums to discuss diet and lipids, I came to this one to discuss hormones - which the others don't know much about.

My Test, Free Test, Estradiol, LH, FSH and Prolactin are on the low end of the spectrum while my SHBG is on the upper end. Is there a pre Test treatment protocol or medication to help my situation, or would Test be the way to effectively treat these hormone deficiencies?

RPellerin said:

Okay Gents,
I can go to other forums to discuss diet and lipids, I came to this one to discuss hormones - which the others don't know much about.

My Test, Free Test, Estradiol, LH, FSH and Prolactin are on the low end of the spectrum while my SHBG is on the upper end. Is there a pre Test treatment protocol or medication to help my situation, or would Test be the way to effectively treat these hormone deficiencies?

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I think you are looking for a simple answer to a complicated question.

Taking testosterone will suppress your natural production of test and decrease your fertility. HCG is used to counteract this shutdown.

HCG by itself will likely increase your natural testosterone, but will that be enough, maybe or maybe not. Clomid could also increase your natural level of testosterone.

I took 6 mg of boron a day, my free T increased 36%, significant but my testosterone is still only 7.5 pg/do. (6.6-18.1 range). Not enough to make a big difference for me, but none the less significant.

IMO nothing will be as effective as exogenous testosterone at raising testosterone,but you really need to understand what you are getting into and the ramifications of different ways of getting testosterone, gel, creams, injections?

You should do some sort of thyroid check as well.

I am well aware of what I am considering with TRT, which is why I am asking question before pulling the trigger.

TSH: 1.51 (0.27-4.2)
Free T4: 1.17 (0.93-1.70)
Free T3: 2.4 (2.0-4.4)

*I am hoping one of the Doctors on this forum will see my post and be able to provide feedback.
*I initially entered incorrect value of SHBG on my original post and have since updated.

RPellerin said:

I am well aware of what I am considering with TRT, which is why I am asking question before pulling the trigger.

TSH: 1.51 (0.27-4.2)
Free T4: 1.17 (0.93-1.70)
Free T3: 2.4 (2.0-4.4)

*I am hoping one of the Doctors on this forum will see my post and be able to provide feedback.
*I initially entered incorrect value of SHBG on my original post and have since updated.

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Regards pulling the trigger, it isn't an irreversible decision. You can give it a try and stop, most likely even without taking HCG you can restart your natural production of testosterone simply by stopping exogenous testosterone.


I took Nebido for 5 years and stopped, my production of sperm was zero. I took nothing else, but likely my testos never got above the top of the range. Once I stopped after a few months, my natural testos measured 326 ng/dl (348-1197)/ Then I took clomid for 3 months, my testos went up to 478 ng/dl. Clomid also increased my sperm production to normal levels.

I think the restart protocols,clomid, hcg, etc, certainly speed things up, but I suspect you end up the same assuming you don't keep taking clomid or hcg, it just takes longer.

(During those 5 years I pretty much only measured total and free testos, so I can't say what was going on with all the other indicators. I felt pretty good, though it did vary. My TT varied from 635-902 ng/dl, I certainly could feel the difference between 600 and 900 TT. I was self administrating.)

Now my testos sans any medications was 390 ng/dl in Jan and 348 ng/dl (264-916 ng/dL) in April. While the boron appeared to have lowered my shbg, it also lowered my TT, the net effect was higher FT. Or maybe it was some other reason for the fall in TT, a bit hard to tell, these things do fluctuate.

But I am not sure what a doctor on here can tell you, there are general guidelines, many people react the same way, but a significant number of men don't get the same results with the same protocols, so your individual response will vary.


Perhaps a doctor will respond to your general question, or you could also start the process, pay Defy for an evaluation, and discuss your concerns with one of their doctors or some other TRT doctor specialist. Or like I said, give it a try and stop.

Whatever your decision, take care and good luck.

DragonBits said:

Regards pulling the trigger, it isn't an irreversible decision. You can give it a try and stop, most likely even without taking HCG you can restart your natural production of testosterone simply by stopping exogenous testosterone.
.

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While technically true, I feel most should view it as a life long commitment. He may better off attempting the HPTA reboot protocol first and of that does not work, go with TRT with the expectation it's a permanent thing.

Will Brink said:

While technically true, I feel most should view it as a life long commitment. He may better off attempting the HPTA reboot protocol first and of that does not work, go with TRT with the expectation it's a permanent thing.

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Technically, is it a reboot protocol if the OP has never been on TRT?


I would expect that if something like HCG or clomid worked for him, then he would have to be on those drugs for a life time. His natural production of testos isn't high enough for his goal, and once he stopped HCG/Clomid his testos would return to current baseline.


BTW: It appears the OP knows why his cholesterol ldl is so high, he should volunteer what is causing that.


Since his cholesterol / ldl is quite high, I would suggest doing a NMR LipoProfile® test, and an inflammation panel that includes some of the following.

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C-Reactive Protein (high sensitivity)

The CRP blood test measures your level of systemic inflammation and is used to evaluate your risk of developing coronary artery disease.

Myeloperoxidase (MPO)
MPO is a vascular specific marker that measures your body's response to damage in your artery walls and the subsequent formation of vulnerable plaque which is prone to rupture.

Homocysteine
Elevated blood levels of homocysteine may directly damage the delicate endothelial cells that line the inside of arteries and result in vascular inflammation, blood clot formation, heart attack, and stroke.

Fibrinogen
Fibrinogen plays a role in the development of atherosclerotic plaque. It can also cause acute blood clot formation that may block a coronary artery (causing a heart attack) or a cerebral artery (causing an ischemic stroke).

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If he expects that his cholesterol to return to more normal levels, why not take a statin in the short term then discontinue ?

Though I think for some of us we tend to over test have too many blood tests, the costs do start to add up. Insurance won't cover all these tests.

But one would expect his HS c-reactive protein test to be high.

DragonBits said:

Technically, is it a reboot protocol if the OP has never been on TRT?

.

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Yes, some docs have done a reboot on people with low T who have not done TRT in an attempt to "reboot" their HPTA, with varying success long term. Tends to work better on younger men as one might expect. Whether he was a candidate depends on what a competent doc concludes after a full workup. A man with low T, going on TRT, should view it as a life time commitment in my view and there would be no reason to stop other than some specific medical reason.

Thanks for the discussion Dragon and Will.
I do not exactly know why my LDL is high, genetics I suspect.
I follow a low inflammatory, keto diet; quality fats, grass-fed and organic.

Great point regarding short-term statin use, I recently started taking red yeast rice.
Here are recent results of a couple of the labs you mentioned:
hsCRP - 0.8 /WTN Within normal limits
MPO - 224 /WNL
Homocysteine - 6.2 /WNL
A few calcium scoring test in last 10 years, all ZERO.
Recent caroid ultrasound, unremarkable

Personally I would never recommend somebody with a zero plaque score, to go on a Statin. Plus I've never heard of preventative doctor recommending a Statin for somebody with a zero score.

RPellerin said:

Thanks for the discussion Dragon and Will.
I do not exactly know why my LDL is high, genetics I suspect.
I follow a low inflammatory, keto diet; quality fats, grass-fed and organic.

Great point regarding short-term statin use, I recently started taking red yeast rice.
Here are recent results of a couple of the labs you mentioned:
hsCRP - 0.8 /WTN Within normal limits
MPO - 224 /WNL
Homocysteine - 6.2 /WNL
A few calcium scoring test in last 10 years, all ZERO.
Recent caroid ultrasound, unremarkable

Click to expand...

Seen many where keto diets, Paleo, etc have seen people's lipids skyrocket. I fail to see a value in them, but that's up to you. Just FYI, it may be genetic, or it may be the nutritional approach, or bit of both.