Im 38 years old with an active lifestyle and after experiencing the usual symptoms and talking to some others who have gone through the TRT route I decided to have my levels checked through an online clinic. They only ordered total T which came back at 305, it was just a finger prick that got mailed off, not a blood draw. Previously I asked a doctor to do a blood draw several months ago which cam back at 329, this was unfasted and after a morning workout, whether that makes a difference or not. This doc told me it was normal so I brushed it off, and hadn't thought about it until recently when I began searching deeper for answers to my symptoms so I reached out to the online clinic. They came back and recommended a 3 times per week injection of test cypionate and an AI.
Im not concerned about fertility, my wife and I have 3 kids and cannot possibly have more. A big concern is hairloss because I do not have a good bald head, but there is no way I would take finasteride and I understand the risks with test. I also do not want my testes to shrink but Ive read there is something I can take along with the test to prevent that so I need to do more digging there. Finally I do not want to destroy by bodys ability to produce natural test, but it sounds like it will rebound back to baseline of what im producing now if I did decide to start and then stop?
My wife and I have a good sex life when we aren't interrupted by work and kids but my erections don't feel as strong as they used to and sometimes im just too worn out for it. This coupled with other symptoms is what is making me pursue options with test injections.
Assuming a full test panel is recommended, even with low (for 38) total T numbers?
Is test cypiomate and AI the most recommended stack or are there other things I can take to minimize negative side effects?
Thanks for reading
Be very wary of those dime a dozen run of the mill T-clinics as they are notorious for overmedicating T from the get-go let alone many of them thrown in an aromatase inhibitor which for most would never be needed.
The standard cookie cutter protocol is usually the high-end therapeutic dose 200 mg T with an AI thrown in to boot.
Even if they try and start you on 150 mg T/weekl.....RUN!
Standard starting dose by those in the know is 100 mg T/week or better yet 50 mg T twice-weekly.
Most men on therapy are injecting 100-200 mg/week whether once weekly or split into more frequent injections.
What is critical here is the majority of men can easily hit a healthy or better yet high trough FT (lowest point) before your next injection injecting 100-150 mg T/week especially when split into more frequent injections.
Some men can achieve a robust trough FT injecting <100 mg T/week especially when split into more frequent injections.
Yes there are those outliers who may need the high-end therapeutic dose 200 mg T/week but it is far from common as in rare!
Such dose is overkill for most!
All that should really matter here is the dose one needs to achieve a healthy trough FT which will result in relief/improvement of low-T symptoms and overall well-being.
Yes symptom relief is what truly matters but when it comes to what FT level is needed one needs to keep in mind the overall goal would be to use the least amount in order to feel well while at the same time minimizing sides and keep blood markers healthy long-term.
If anything you would be far better off seeking out a urologist or andrologist or finding a reputable T-clinic that is well versed in this game.
Forget the finger prick test that is not going to cut it let alone you need to have your T levels checked in the early am in a fasted state otherwise your result will be skewed.
When testing testosterone (TT, FT, and BAT) blood work needs to be done in the early AM in a fasted state as we want to test at the peak.
Even then you need a thorough set of labs before even considering jumping on T!
Should get a thorough set of labs to rule out low testosterone let alone any dysfunction thyroid/adrenals.
Blood work should be done for TT, FT, estradiol, SHBG, DHT, prolactin, Vit D DHEA-S, LH/FSH, PSA, full thyroid panel (TSH, Free T3, Free T4, Reverse T3, antibodies), salivary cortisol (Four Specimens), lipids, CMP, CBC, and CRP.
Always need to make sure you test critical blood markers RBCs, hemoglobin and hematocrit (CBC panel) as it is a given said blood markers will be driven up when using exogenous T especially when you push your trough/steady-state FT level too high!
The cutoff for hematocrit is 54%.
I know it may seem overwhelming but blood work is critical in order to see if you truly have low or low/normal free testosterone let alone where your overall baseline health markers sit!
Judging by your symptoms and where your blood tested TT 329 ng/dL (not fasted) chances are your FT is low/subpar.
Keep in mind although TT is important to know FT is what truly matters as it is the active unbound fraction of T responsible for the positive effects.
No way to avoid accelerated hairless when using exogenous T if you are genetically prone other than use of a 5-AR inhibitor which is a bad move as this can easily cause sexual dysfunction let alone numerous other issues.
I would steer clear here.
I would tread lightly when it comes to manipulating T metabolites DHT and estradiol through use of AIs/5-ARs as these metabolites are critical to your overall health.
Ts metabolites estradiol and DHT are needed in healthy amounts to experience the full spectrum of testosterones beneficial effects on (cardiovascular health, brain health, libido, erectile function, bone health, tendon health, immune system, lipids, and body composition).
*Natural testosterone is viewed as the best androgen for substitution in hypogonadal men. The reason behind the selection is that testosterone can be converted to DHT and E2, thus developing the full spectrum of testosterone activities in long-term substitution
*Preparations of native testosterone or its esters (aromatizable T) should be used for TTh
The addition of an LH mimetic (hCG) would be your only option when it comes to maintaining some degree of intra-testicular testosterone (ITT) to minimize/prevent testicular atrophy and maintain fertility but even then your hpta will still be shut-down.
If you end up going on therapy and decide to come off in the near future you will go back to baseline.
Some that abuse T/AAS long-term usually end up worse off.
