I appreciate the words of caution! Have you stopped it at this point or are you still on? I am naturally a pretty cautious person and want to seek out information on positives and the negatives of something, especially something like this that messes with hormones.
To give a little more background. I started all of this in March (really not that long ago). For a while prior to that, honestly hard to quantify, likely years, I noticed a buildup in anxiety, exhaustion, irritability, lack of motivation and focus, occasional issues with ED but not often. I gained weight, up to 193 lbs and a size 36 jeans, this was the biggest I have been even at almost 6' tall. I noticed my blood pressure was creeping up, my heart rate was creeping up, exercise was horrible to do, and I generally just felt miserable, everything hurt all of the time.
I got COVID in Feb, I had such bad brain fog after that I was forgetting things that I should not have, it scared the hell out of me. Then the ED issue got worse. These things are always indicative of another issue. I decided to make changes and sort this out. Got a script for tadafil, awesome, it works like a charm even at a 2.5 mg dose, not sure I would want to stop taking it honestly. I changed my diet (somewhat to a fault, I just really didn't realize how low my calories were), I ate clean, low carb, essentially keto, so lots of veggies and good protein sources. Cut out sweets, stopped all alcohol (maybe a beer or two a day kinda guy before). Started making progress with weight loss. I added in exercise and while it sucked at first I was able to do more over time.
Got my labs checked as noted above. Despite being overweight (which I understand usually suppresses SHBG) I had a higher SHBG, low Free testosterone, and lower E2. Talked to the clinic doc, he thought it was genetic and thought to fix it I should start TRT. I declined saying I wanted to optimize my weight first and recheck things. He prescribed clomid, I was concerned about that and did not start it.
Things got better over the summer, I got the weight off, exercise tolerance up. By today I'm 152 lbs (too light), down to a 32 jeans, and overall feel better. I'm not as irritable as I used to be, I like being able to run essentially a 5K three days a week, rock climb weekly, do martial arts 2-3 x a week. Brain fog has improved a lot too, I'll forget things occasionally, but who doesn't. Blood pressure, amazing, 100/60. Heart rate, 40's-50's now resting. The libido, ehhh, I don't know, not really better. ED, no problems now with tadalafil, but that's with medicine, it is a bandaid. Anxiety and confidence is better too.
The symptoms I'm still having, tired, joints and back hurt like hell most of the time, the other issues I mentioned above. So overall, yes many symptoms improved, some still exist and are significant. I still can't really build muscle and seem to have hit a plateau with the exercise a while back, yep I can crank out a run, but not any further than that 5K. Still can't kick the last tiny bit of belly fat, but it is mostly flat.
The things I'm worried about, the long term health impacts of what my labs are telling me. SHBG being high could be genetic, it could be a sign of another problem. If it is indeed genetic TRT should help with that, and it will fix my low Free testosterone. Why do I care about the SHBG being high, and please, you guys correct me if I'm wrong, it leads to less bone density and is correlated with vertebral fractures in older men, loss of libido, ED, along with other longer term health issues. I do believe as system lord noted, just chasing that number will not fix the problem, lower the SHBG at best may result in a temporary improvement in numbers, but not long lasting (if what I'm reading is accurate). I also think since it was high when I first got labs, not in a calorie deficit I won't fix it with supplements or diet adjustment. It may very well be what Systemlord mentioned about the low free testosterone leading to the SHBG higher.
I also have pretty low estrogen, it dropped though this too, my understanding is that could also contribute to the libido issues. Besides that, it also contributes to other functions and overall health. I may be one of those people who doesn't aromatize enough to need anastrozole. The doctor didn't think I would, but gave me the AI with a (don't use it unless things get bad, and he did let me know we could change the testosterone dose). It would be good to have it a little higher though.
Will I start TRT? At this point you all have given me a lot of good things to think about, positive and negative, and I really do appreciate it.
I probably will, but first I'm checking a full Iron panel, and thyroid panel, along with a salivary cortisol, these things were not checked before other than a TSH. I'm also rechecking the free testosterone with dialysis as suggested so I know. If I have something up with my thyroid, or if I have hemochromatosis (I doubt either), I would want to know this before I start, as treating either of these could mean things do get better without TRT. In which case I re-evaluate where my testosterone numbers are after treatment. Again, I don't suspect I have these, but I want the initial numbers before starting TRT.
Since I finally started tracking calories about a month ago and figured out how little I was getting in, I have added more calories, a few more carbs, pushed the protein up to 1 gram/lb at a minimum. Still nutrient dense food and not crap, I rarely eat out, and even then will get a salad.
I completely agree. Not going to fix it naturally. The free T also does warrant treatment. Beyond just for a hope in improvement of symptoms and to build muscle (because that would be nice), but for the downstream health impacts, I don't want the bone density of an 80 y/o in my 40s.
I want to verify that something else isn't happening.
I am glad you all have been so willing to give advice and opinions. I am under no illusion that if I do go forward things will not always be great and it will take time to get right. I also understand that it might make things worse, and I might not tolerate it and have to stop.
I am questioning the need for HCG. I'm not having anymore kids and it would add another factor to figuring out what's helping/not helping. The testosterone dose of 200 mg/week (divided in two), he explained was to overcome the relatively high total levels I have. I do wonder if it is too much with what I have learned here.
Thank you all again, I'm pretty new to this stuff, so I'm still learning. If there something I'm not understanding quite right let me know!
