Considering starting TRT although levels are not "clinically low" Feedback would be appreciated

[lancelot]

I'm new to the forum and would like to possibly get some opinions on my situation. I am 58 years old and have considered going on TRT for several years. Between reading lots of information, talking to several highly knowledgeable people and researching this forum for many years, I feel like I am well informed. I have worked out since I was in my early teens (competed in bodybuilding in the 80's but didn't abuse steroids) and have always ate very healthy. Here are some of the reasons I am considering TRT: I have been showing signs of insulin resistance the last 5 or 6 years and my morning blood sugar is averaging between 105-115 even while eating a fairly low carb diet. Many studies show TRT helps with metabolic syndrome. Also new research shows high glucose levels contribute to alzheimer's through the buildup of beta amyloid plaque in the brain. Almost everone on my father's side of the family(including him) has gotten Alzheimers. I take some metformin but it does little at a low dose and I read higher doses lower testosterone..which I don't want.

I am putting on fat easily lately and seeing virtually no results from my training. I also get irritable easily, especially after a hard workout. I've always had a very good physique and I'm not happy with how I'm looking although this isn't a huge factor in my decision. However, I would like to see more results from my diet and training efforts. I am sure I would respond well to TRT for this. In the 80's, I was a super responder to tiny amounts of testosterone and would blow up in a month or so.

My ldl and hdl, due to the glucose issues, have been off for several years. I did do some scans for arterial plaque recently and it didn't show any buildup yet..but that could change. I also think my drive, motivation and focus could be better..even though I get some results from cognitive enhancing nutrients and nootropics. I think testosterone would also be helpful for that. My libido is inconsistent. It's good for a few weeks, then times when it wanes. Not a huge concern since my longtime girlfriend has a very low libido. I get morning wood on some days and then go through periods of none for a few weeks.
I order my own bloodwork a few times a year. I do the comprehensive ones and add in total and free test. My last one in December showed my total to be 476 ng/dl and free 80 pg/ml. My PSA is 1.0 and most all values,except lipids, are in normal range except blood platelets which the last two times are slightly under range.

So..although my testosterone numbers aren't real low, and I don't feel overly lethargic or depressed..I feel some of the issues I described would be helped by going on TRT. I know most guys are usually under 300 when they decide to do it with many other classic "low T" symptoms. It seems the idea is to wait until your levels decline to the lowest range and then start. But while those levels are declining..aren't you also physically losing ground? Wouldn't it be better to intervene at the level I'm at ..at 58 years old..instead of waiting till I'm at a 200 test level?
I have some fears, especially when I see all the problems people have on the forums. Should I shut down my hpta while it still has halfway decent function in order to get the benefits I seek? Will I ever be as healthy on a synthetic form of my own hormone as I am now? I know me, and only me,..can make that decision, but I'd love to hear some feedback. I've struggled with this decision for at least 4 years now.
Thanks

 

[Cataceous]

I would continue to avoid TRT as long as possible. It's a lot more disruptive than most guys realize. Investigate Natesto—or generic testosterone nasal gel, which can give you a testosterone boost without shutting off your natural production.

You should also get a better idea of your free testosterone. Unless the test you had used equilibrium dialysis or ultrafiltration it is not accurate enough to have any value. If you measure your SHBG, which should be done anyway, then total testosterone can be used to calculate free testosterone approximately.

 

[lancelot]

I would continue to avoid TRT as long as possible. It's a lot more disruptive than most guys realize. Investigate Natesto—or generic testosterone nasal gel, which can give you a testosterone boost without shutting off your natural production.

You should also get a better idea of your free testosterone. Unless the test you had used equilibrium dialysis or ultrafiltration it is not accurate enough to have any value. If you measure your SHBG, which should be done anyway, then total testosterone can be used to calculate free testosterone approximately.

Thank you for your answer. And I agree. I've been avoiding getting on for at least 5 years because I understand completely the ramifications of going on it. I am not sure if the free testosterone blood test utilizes what you mentioned. As far as the Nasal gel, Natesto..I would be surprised if it didn't suppress natural production. That would be great but I was under the impression that any endogenous source of testosterone, regardless of delivery system, would shut down hpta function.
When you say TRT is more disruptive than people imagine, do you mean it's because it's so difficult to try and replicate what the body does naturally and that trying to balance all your hormones while on it is extremely difficult?

 

[lancelot]

I would continue to avoid TRT as long as possible. It's a lot more disruptive than most guys realize. Investigate Natesto—or generic testosterone nasal gel, which can give you a testosterone boost without shutting off your natural production.

You should also get a better idea of your free testosterone. Unless the test you had used equilibrium dialysis or ultrafiltration it is not accurate enough to have any value. If you measure your SHBG, which should be done anyway, then total testosterone can be used to calculate free testosterone approximately.

Did some reading up on Natesto and it sounds very interesting. Thank you for suggesting that.

 

[Mountain Man]

I'm new to the forum and would like to possibly get some opinions on my situation. I am 58 years old and have considered going on TRT for several years. Between reading lots of information, talking to several highly knowledgeable people and researching this forum for many years, I feel like I am well informed. I have worked out since I was in my early teens (competed in bodybuilding in the 80's but didn't abuse steroids) and have always ate very healthy. Here are some of the reasons I am considering TRT: I have been showing signs of insulin resistance the last 5 or 6 years and my morning blood sugar is averaging between 105-115 even while eating a fairly low carb diet. Many studies show TRT helps with metabolic syndrome. Also new research shows high glucose levels contribute to alzheimer's through the buildup of beta amyloid plaque in the brain. Almost everone on my father's side of the family(including him) has gotten Alzheimers. I take some metformin but it does little at a low dose and I read higher doses lower testosterone..which I don't want.

I am putting on fat easily lately and seeing virtually no results from my training. I also get irritable easily, especially after a hard workout. I've always had a very good physique and I'm not happy with how I'm looking although this isn't a huge factor in my decision. However, I would like to see more results from my diet and training efforts. I am sure I would respond well to TRT for this. In the 80's, I was a super responder to tiny amounts of testosterone and would blow up in a month or so.

My ldl and hdl, due to the glucose issues, have been off for several years. I did do some scans for arterial plaque recently and it didn't show any buildup yet..but that could change. I also think my drive, motivation and focus could be better..even though I get some results from cognitive enhancing nutrients and nootropics. I think testosterone would also be helpful for that. My libido is inconsistent. It's good for a few weeks, then times when it wanes. Not a huge concern since my longtime girlfriend has a very low libido. I get morning wood on some days and then go through periods of none for a few weeks.
I order my own bloodwork a few times a year. I do the comprehensive ones and add in total and free test. My last one in December showed my total to be 476 ng/dl and free 80 pg/ml. My PSA is 1.0 and most all values,except lipids, are in normal range except blood platelets which the last two times are slightly under range.

So..although my testosterone numbers aren't real low, and I don't feel overly lethargic or depressed..I feel some of the issues I described would be helped by going on TRT. I know most guys are usually under 300 when they decide to do it with many other classic "low T" symptoms. It seems the idea is to wait until your levels decline to the lowest range and then start. But while those levels are declining..aren't you also physically losing ground? Wouldn't it be better to intervene at the level I'm at ..at 58 years old..instead of waiting till I'm at a 200 test level?
I have some fears, especially when I see all the problems people have on the forums. Should I shut down my hpta while it still has halfway decent function in order to get the benefits I seek? Will I ever be as healthy on a synthetic form of my own hormone as I am now? I know me, and only me,..can make that decision, but I'd love to hear some feedback. I've struggled with this decision for at least 4 years now.
Thanks

I was in a similar spot at age 62 when I got on. I was also in range. Unlike you, I wanted to get back a better physique. I did not have any metabolic issues and looked fit. Muscle tone had regressed to nothing special. I was working full time and wanted to have a last burst of trying to get back to feeling good before retirement age.

Best decision I could have made. Got the physique back I had at age 40, sex life came back as a result of my wife’s interest being sparked by my progress and more affectionate nature to her. She also got in shape and weighs what she weighed on our wedding day. While I do have orthopedic issues with knees and hips, I do work out every other day with bands and still kind of shock people when I take of my shirt, which is great for my aging ego. Great sex 3 times per week is also a quality of life booster as well.

You have to realize that you hear about guys having problems with TRT on this forum because that is one of the reasons guys get on the forum, to get answers. It is by no means reflective of the reality of guys on TRT, the exception rather than the norm. Start with just testosterone, keep the protocol simple and adjust and add only if you need to. I believe guys have problems when they start right out of the gate with testosterone and an AI. Makes it difficult to get it right. It ain’t that complicated. Start at 100mg one time per week. Get your diet, sleep, workouts, and stress levels in order before you start tinkering with your medications. It works, but you have to put in the effort.

 

[Vtail]

Have you checked your thyroid levels? In a nutshell - I started TRT a few years ago at 56yrs old due to fatigue and brain fog. After a few months on TRT I still wasn't feeling great and luckily found a doctor that understood the thyroid. All my thyroid lab levels were "within range" but barely. I started supplementing with T3 and within days started to improve. In hindsight if I had started with the thyroid I may not have needed TRT. Although for me the physical benefits of TRT are undeniable, there are some annoying negatives as well that would have been nice to avoid. At this point I feel good, so if it ain't broke I'm not going to fix it - so TRT and thyroid meds for me forever. Good luck to you. This forum will get you up to speed on all aspects of TRT and thyroid support (as well as a bunch of other stuff).

 

[Cataceous]

... As far as the Nasal gel, Natesto..I would be surprised if it didn't suppress natural production. That would be great but I was under the impression that any endogenous source of testosterone, regardless of delivery system, would shut down hpta function.
When you say TRT is more disruptive than people imagine, do you mean it's because it's so difficult to try and replicate what the body does naturally and that trying to balance all your hormones while on it is extremely difficult?

As you may have read, what sets Natesto apart is its short half-life. The three daily pulses of testosterone do not cause significant HPTA suppression; there is sufficient time at lower levels to keep the axis functional.

Regarding the disruption caused by conventional TRT, it is virtually impossible to "replicate what the body does naturally". At a minimum TRT suppresses upstream hormones, which include LH, FSH, GnRH and kisspeptin. Progesterone, DHEA and pregenolone are sometimes affected. There may also be secondary effects on ACTH and the thyroid hormones. There is a lot of potential for introducing new problems. And that doesn't even get into the dosing issues. We see stories here daily of men taking too much testosterone and having problems with hematocrit, estradiol, etc. All too often, instead of reducing the dose they try to manage the side effects with blood donations and aromatase inhibitors, which makes things even more complicated.

It's true that guys with problems are overrepresented in the forums. Nonetheless, I recall seeing some statistics about the overall "churn" rates for various forms of TRT, and it was surprisingly high—suggesting that overall satisfaction is marginal.

 

[Charliebizz]

I was in a similar spot at age 62 when I got on. I was also in range. Unlike you, I wanted to get back a better physique. I did not have any metabolic issues and looked fit. Muscle tone had regressed to nothing special. I was working full time and wanted to have a last burst of trying to get back to feeling good before retirement age.

Best decision I could have made. Got the physique back I had at age 40, sex life came back as a result of my wife’s interest being sparked by my progress and more affectionate nature to her. She also got in shape and weighs what she weighed on our wedding day. While I do have orthopedic issues with knees and hips, I do work out every other day with bands and still kind of shock people when I take of my shirt, which is great for my aging ego. Great sex 3 times per week is also a quality of life booster as well.

You have to realize that you hear about guys having problems with TRT on this forum because that is one of the reasons guys get on the forum, to get answers. It is by no means reflective of the reality of guys on TRT, the exception rather than the norm. Start with just testosterone, keep the protocol simple and adjust and add only if you need to. I believe guys have problems when they start right out of the gate with testosterone and an AI. Makes it difficult to get it right. It ain’t that complicated. Start at 100mg one time per week. Get your diet, sleep, workouts, and stress levels in order before you start tinkering with your medications. It works, but you have to put in the effort.

I'm not trying to start an argument but how do you really know guys are doing great cause they aren't on the forums ? That's just an assumption. I personally know many guys who do not use forums and we're on trt and got off. I don't know many people that are on that are doing well. That said it doesn't mean everyone on trt is telling people they are using it either.

And yes trt works at boosting t levels. But at what cost. It disrupts hpta and in a lot of guys the body has lowered t for a reason. Now your just ramping it back up and it exposes all the other issues you have going on. I personally believe trt should be one of the last interventions tried.

I'm also glad your doing well and I wish it worked that way for me. But I think it works a lot better for men when low t is caused by age related decline. Us younger guys seem to have a lot more issues with it.

 

[lancelot]

I was in a similar spot at age 62 when I got on. I was also in range. Unlike you, I wanted to get back a better physique. I did not have any metabolic issues and looked fit. Muscle tone had regressed to nothing special. I was working full time and wanted to have a last burst of trying to get back to feeling good before retirement age.

Best decision I could have made. Got the physique back I had at age 40, sex life came back as a result of my wife’s interest being sparked by my progress and more affectionate nature to her. She also got in shape and weighs what she weighed on our wedding day. While I do have orthopedic issues with knees and hips, I do work out every other day with bands and still kind of shock people when I take of my shirt, which is great for my aging ego. Great sex 3 times per week is also a quality of life booster as well.

You have to realize that you hear about guys having problems with TRT on this forum because that is one of the reasons guys get on the forum, to get answers. It is by no means reflective of the reality of guys on TRT, the exception rather than the norm. Start with just testosterone, keep the protocol simple and adjust and add only if you need to. I believe guys have problems when they start right out of the gate with testosterone and an AI. Makes it difficult to get it right. It ain’t that complicated. Start at 100mg one time per week. Get your diet, sleep, workouts, and stress levels in order before you start tinkering with your medications. It works, but you have to put in the effort.

Thank you for your answer. It's always good to hear some positive stories on TRT. I have some friends who have had very good experiences as well. And although it's not my main reason, my training is important to me as well.

 

[lancelot]

Have you checked your thyroid levels? In a nutshell - I started TRT a few years ago at 56yrs old due to fatigue and brain fog. After a few months on TRT I still wasn't feeling great and luckily found a doctor that understood the thyroid. All my thyroid lab levels were "within range" but barely. I started supplementing with T3 and within days started to improve. In hindsight if I had started with the thyroid I may not have needed TRT. Although for me the physical benefits of TRT are undeniable, there are some annoying negatives as well that would have been nice to avoid. At this point I feel good, so if it ain't broke I'm not going to fix it - so TRT and thyroid meds for me forever. Good luck to you. This forum will get you up to speed on all aspects of TRT and thyroid support (as well as a bunch of other stuff).

My blood panels always seem to show my thyroid values in good range. I think I'm ok there. Thanks for the suggestion.

 

[lancelot]

As you may have read, what sets Natesto apart is its short half-life. The three daily pulses of testosterone do not cause significant HPTA suppression; there is sufficient time at lower levels to keep the axis functional.

Regarding the disruption caused by conventional TRT, it is virtually impossible to "replicate what the body does naturally". At a minimum TRT suppresses upstream hormones, which include LH, FSH, GnRH and kisspeptin. Progesterone, DHEA and pregenolone are sometimes affected. There may also be secondary effects on ACTH and the thyroid hormones. There is a lot of potential for introducing new problems. And that doesn't even get into the dosing issues. We see stories here daily of men taking too much testosterone and having problems with hematocrit, estradiol, etc. All too often, instead of reducing the dose they try to manage the side effects with blood donations and aromatase inhibitors, which makes things even more complicated.

It's true that guys with problems are overrepresented in the forums. Nonetheless, I recall seeing some statistics about the overall "churn" rates for various forms of TRT, and it was surprisingly high—suggesting that overall satisfaction is marginal.

Thanks for your answer. One of the main reasons I am considering it is due to the positive effects of testosterone on insulin resistance. I eat well and exercise and my morning blood sugars have been rising for the last 5 years or so to where they are often 115 or so. A positive diabetic diagnosis is fasting glucose of 120..so I am drifting towards that. I use metformin but if I take the doses that lowers my blood sugar even slightly, I feel lousy..fatigued.. nauseated. Plus those doses lower my libido most likely since it lowers testosterone. High glucose levels are a factor in Alzheimers which as I also said is unusually prevalent in my family. Since my diet and exercise are not the cause of this issue, it's quite possibly genetic, which would explain why so many in my family got dementia. I want to avoid that at all costs. Plus the sugar issue is giving me terrible lipid values for several years and I'm not interested in Statin drugs.
From the research I have done for over 10 years, I believe many of the side effects incurred are from people taking large doses of testosterone at one time. I feel lower daily doses such as 10 mg or so of a fairly fast acting ester like propionate eliminates some of the bigger DHT and estrogen spikes you get from 100mg or so all at once. i also read some research where small frequent doses do not cause the same hematocrit elevations.
The Natesto sounds good but would it help the insulin resistance as much as something a bit longer lasting?. That is what I am concerned with. In the anti-aging philosophy of this, it seems at my age of 58, my levels are most likely going to keep declining and other issues will accompany that decline. Part of me feels that if I start now, while I'm in the mid 400's, I can avoid that decline to some degree. I certainly wouldn't be the type of guy that goes to some uninformed doctor and get stuck on 200 mg every two weeks with arimidex. I would do the daily short ester types and avoid ai's unless it was absolutely necessary.
Again, I agree with everything you are saying because I absolutely hate the idea of shutting myself down. I'm very much into letting the body do what it is supposed to naturally, which is why I've hardly ever taken any meds..except metformin briefly. But again I'm not some 30 year old guy who boozes it up, gets no sleep, is stressed and is told they have low T. I'm 58, do most everything right, but might have a genetic issue that I'd preferably use test for life instead of insulin for life. I guess it comes down to risk/reward and that's why I like getting feedback from experienced people such as yourself. Thank you.

 

[Charliebizz]

Thanks for your answer. One of the main reasons I am considering it is due to the positive effects of testosterone on insulin resistance. I eat well and exercise and my morning blood sugars have been rising for the last 5 years or so to where they are often 115 or so. A positive diabetic diagnosis is fasting glucose of 120..so I am drifting towards that. I use metformin but if I take the doses that lowers my blood sugar even slightly, I feel lousy..fatigued.. nauseated. Plus those doses lower my libido most likely since it lowers testosterone. High glucose levels are a factor in Alzheimers which as I also said is unusually prevalent in my family. Since my diet and exercise are not the cause of this issue, it's quite possibly genetic, which would explain why so many in my family got dementia. I want to avoid that at all costs. Plus the sugar issue is giving me terrible lipid values for several years and I'm not interested in Statin drugs.
From the research I have done for over 10 years, I believe many of the side effects incurred are from people taking large doses of testosterone at one time. I feel lower daily doses such as 10 mg or so of a fairly fast acting ester like propionate eliminates some of the bigger DHT and estrogen spikes you get from 100mg or so all at once. i also read some research where small frequent doses do not cause the same hematocrit elevations.
The Natesto sounds good but would it help the insulin resistance as much as something a bit longer lasting?. That is what I am concerned with. In the anti-aging philosophy of this, it seems at my age of 58, my levels are most likely going to keep declining and other issues will accompany that decline. Part of me feels that if I start now, while I'm in the mid 400's, I can avoid that decline to some degree. I certainly wouldn't be the type of guy that goes to some uninformed doctor and get stuck on 200 mg every two weeks with arimidex. I would do the daily short ester types and avoid ai's unless it was absolutely necessary.
Again, I agree with everything you are saying because I absolutely hate the idea of shutting myself down. I'm very much into letting the body do what it is supposed to naturally, which is why I've hardly ever taken any meds..except metformin briefly. But again I'm not some 30 year old guy who boozes it up, gets no sleep, is stressed and is told they have low T. I'm 58, do most everything right, but might have a genetic issue that I'd preferably use test for life instead of insulin for life. I guess it comes down to risk/reward and that's why I like getting feedback from experienced people such as yourself. Thank you.

I will say despite my blood glucose and a1c always being good. I have hypoglycemic like issues when I don't eat every 3 hours. Since starting trt it's gone. I can go long stretches with out eating if I want.

 

[madman]

I'm new to the forum and would like to possibly get some opinions on my situation. I am 58 years old and have considered going on TRT for several years. Between reading lots of information, talking to several highly knowledgeable people and researching this forum for many years, I feel like I am well informed. I have worked out since I was in my early teens (competed in bodybuilding in the 80's but didn't abuse steroids) and have always ate very healthy. Here are some of the reasons I am considering TRT: I have been showing signs of insulin resistance the last 5 or 6 years and my morning blood sugar is averaging between 105-115 even while eating a fairly low carb diet. Many studies show TRT helps with metabolic syndrome. Also new research shows high glucose levels contribute to alzheimer's through the buildup of beta amyloid plaque in the brain. Almost everone on my father's side of the family(including him) has gotten Alzheimers. I take some metformin but it does little at a low dose and I read higher doses lower testosterone..which I don't want.

I am putting on fat easily lately and seeing virtually no results from my training. I also get irritable easily, especially after a hard workout. I've always had a very good physique and I'm not happy with how I'm looking although this isn't a huge factor in my decision. However, I would like to see more results from my diet and training efforts. I am sure I would respond well to TRT for this. In the 80's, I was a super responder to tiny amounts of testosterone and would blow up in a month or so.
My ldl and hdl, due to the glucose issues, have been off for several years. I did do some scans for arterial plaque recently and it didn't show any buildup yet..but that could change. I also think my drive, motivation and focus could be better..even though I get some results from cognitive enhancing nutrients and nootropics. I think testosterone would also be helpful for that. My libido is inconsistent. It's good for a few weeks, then times when it wanes. Not a huge concern since my longtime girlfriend has a very low libido. I get morning wood on some days and then go through periods of none for a few weeks.

I order my own bloodwork a few times a year. I do the comprehensive ones and add in total and free test. My last one in December showed my total to be 476 ng/dl and free 80 pg/ml. My PSA is 1.0 and most all values,except lipids, are in normal range except blood platelets which the last two times are slightly under range.

So..although my testosterone numbers aren't real low, and I don't feel overly lethargic or depressed..I feel some of the issues I described would be helped by going on TRT. I know most guys are usually under 300 when they decide to do it with many other classic "low T" symptoms. It seems the idea is to wait until your levels decline to the lowest range and then start. But while those levels are declining..aren't you also physically losing ground? Wouldn't it be better to intervene at the level I'm at ..at 58 years old..instead of waiting till I'm at a 200 test level?
I have some fears, especially when I see all the problems people have on the forums. Should I shut down my hpta while it still has halfway decent function in order to get the benefits I seek? Will I ever be as healthy on a synthetic form of my own hormone as I am now? I know me, and only me,..can make that decision, but I'd love to hear some feedback. I've struggled with this decision for at least 4 years now.
Thanks

I order my own bloodwork a few times a year. I do the comprehensive ones and add in total and free test. My last one in December showed my total to be 476 ng/dl and free 80 pg/ml.

So..although my testosterone numbers aren't real low, and I don't feel overly lethargic or depressed..I feel some of the issues I described would be helped by going on TRT.


Judging by all the symptoms you state let alone having a TT 476 ng/dL your FT level is most likely sub-par/low depending on where your SHBG sits.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

Even though your TT 476 ng/dL is far from low we have no idea where your SHBG let alone FT truly sits as unfortunately it was most likely tested using an inaccurate assay (direct).

SHBG will have a significant impact on TT/FT.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

I would definitely look into getting a full pre-trt panel done which includes the most accurate assays for TT/estradiol (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration) before jumping to any conclusions!




You can use Nelsons discountedlabs to purchase such panels.

Many options available depending on what you are willing to spend.

Pre Testosterone Replacement Blood Test Panel

Blood Tests Before Starting Testosterone Replacement Therapy TRT

www.discountedlabs.com

 

[Mountain Man]

I'm not trying to start an argument but how do you really know guys are doing great cause they aren't on the forums ? That's just an assumption. I personally know many guys who do not use forums and we're on trt and got off. I don't know many people that are on that are doing well. That said it doesn't mean everyone on trt is telling people they are using it either.

And yes trt works at boosting t levels. But at what cost. It disrupts hpta and in a lot of guys the body has lowered t for a reason. Now your just ramping it back up and it exposes all the other issues you have going on. I personally believe trt should be one of the last interventions tried.

I'm also glad your doing well and I wish it worked that way for me. But I think it works a lot better for men when low t is caused by age related decline. Us younger guys seem to have a lot more issues with it.

I fully agree. Older guys, and this is just my opinion, tend to do better. I waited until 62 for the same reasons you have cited. Ultimately, every medication or procedure comes with a risk and if you are not comfortable, then don’t do it.

How old are you charliebizz?

 

[Charliebizz]

I fully agree. Older guys, and this is just my opinion, tend to do better. I waited until 62 for the same reasons you have cited. Ultimately, every medication or procedure comes with a risk and if you are not comfortable, then don’t do it.

How old are you charliebizz?

I'm 39 now but been dealing with low t since I'm 27. And that's the other thing. Trying to find the root cause in some of us is almost impossible lol.

 

[lancelot]

I order my own bloodwork a few times a year. I do the comprehensive ones and add in total and free test. My last one in December showed my total to be 476 ng/dl and free 80 pg/ml.

So..although my testosterone numbers aren't real low, and I don't feel overly lethargic or depressed..I feel some of the issues I described would be helped by going on TRT.


Judging by all the symptoms you state let alone having a TT 476 ng/dL your FT level is most likely sub-par/low depending on where your SHBG sits.

Although TT is important to know FT is what truly matters as it is the active unbound fraction of testosterone responsible for the positive effects.

Even though your TT 476 ng/dL is far from low we have no idea where your SHBG let alone FT truly sits as unfortunately it was most likely tested using an inaccurate assay (direct).

SHBG will have a significant impact on FT.

The only way to know where your FT level truly sits is to have it tested using the most accurate assays such as the gold standard Equilibrium Dialysis or Ultrafiltration (next best).

I would definitely look into getting a full pre-trt panel done which includes the most accurate assays for TT/estradiol (LC/MS-MS) and FT (Equilibrium Dialysis or Ultrafiltration) before jumping to any conclusions!




You can use Nelsons discountedlabs to purchase such panels.

Many options available depending on what you are willing to spend.

Pre Testosterone Replacement Blood Test Panel

Blood Tests Before Starting Testosterone Replacement Therapy TRT

www.discountedlabs.com

Thank you very much. I will definitely try to get my Free test and SHBG through the proper assays.

 

[Cataceous]

...I feel lower daily doses such as 10 mg or so of a fairly fast acting ester like propionate eliminates some of the bigger DHT and estrogen spikes you get from 100mg or so all at once. i also read some research where small frequent doses do not cause the same hematocrit elevations.

I follow the general principle, but would point out that the short half-life of propionate can lead to excessive variation in serum testosterone. I was measuring around +/-50% variation about the mean with daily use, whereas healthy young men naturally top out at around +/-25%. It's possible to blend propionate with a longer ester to tune the amount of variation.

...
The Natesto sounds good but would it help the insulin resistance as much as something a bit longer lasting?. ...

The prescribing information for Natesto doesn't address whether this product specifically has been shown to help with insulin resistance. But it notes that androgens in general can do this:

Changes in insulin sensitivity or glycemic conrol may occur in patients treated with androgens. In diabetic patients, the metabolic effects of androgens may decrease blood glucose and, therefore, may necessitate a decrease in the dose of anti-diabetic medication.​

I think you'd just need to try it. I don't see much to lose in doing this before going with conventional TRT.

 

[lancelot]

I follow the general principle, but would point out that the short half-life of propionate can lead to excessive variation in serum testosterone. I was measuring around +/-50% variation about the mean with daily use, whereas healthy young men naturally top out at around +/-25%. It's possible to blend propionate with a longer ester to tune the amount of variation.


The prescribing information for Natesto doesn't address whether this product specifically has been shown to help with insulin resistance. But it notes that androgens in general can do this:

Changes in insulin sensitivity or glycemic conrol may occur in patients treated with androgens. In diabetic patients, the metabolic effects of androgens may decrease blood glucose and, therefore, may necessitate a decrease in the dose of anti-diabetic medication.​

I think you'd just need to try it. I don't see much to lose in doing this before going with conventional TRT.

Thank you. I will really look into considering the Natesto. As far as the shorter half life of propionate, I thought that might be a good thing as far as not raising hematocrit to the degree that longer esters seem to do..which may explain why studies show the cream and gels forms of testosterone seem to not raise hematocrit much.

 

[madman]

Thank you. I will really look into considering the Natesto. As far as the shorter half life of propionate, I thought that might be a good thing as far as not raising hematocrit to the degree that longer esters seem to do..which may explain why studies show the cream and gels forms of testosterone seem to not raise hematocrit much.

Injectable T has been shown to have a greater impact on increasing HCT compared to transdermal T.

3–18% with transdermal administration and up to 44% with injection.

In most cases when using injectable T high supra-physiological peaks post-injection and overall T levels (running too high TT/FT level) will have a big impact on increasing HCT.

Manipulating injection frequency by injecting more frequently using lower doses of T resulting in minimizing the peak--->trough and maintaining more stable levels may lessen the impact on HCT but it is not a given.

As again running very high TT/FT levels will have a stronger impact on driving up HCT.

T formulation, the dose of T, genetics (polymorphism of the AR), age all play a role in the impact a trt protocol will have on blood markers (RBCs/hemoglobin/hematocrit).

Does hematocrit keep increasing after testosterone steady state? How often to check?

Hello guys, I’ve been on TRT for about 4 months and I just recently got my blood lab results. Everything looks good, but I did noticed my hemoglobin and hematocrit did increase to 15 and 45 respectively. Are they going to keep increasing? My doctor wants to check me at 6 month intervals now and...

www.excelmale.com

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Erythrocytosis Following Testosterone Therapy

Effects of T formulation

Of the available T formulations, short-acting IM injections (TC and TE) have the highest incidence of erythrocytosis (approaching 40%).14 Recent studies support a unified hypothesis in which T formulation, dose, and pharmacokinetics collectively determine the risk of erythrocytosis by establishing the DURATION OF SUPRAPHYSIOLOGIC T LEVELS.52 T formulations that result in stable serum concentrations (pellets, transdermal gels and patches, and extended-release IM TU) result in a low incidence of erythrocytosis that is dependent on dose and serum level and independent of the duration of therapy.11, 52, 67 The relation of individual T formulations and associated effects on average T levels and incidence of erythrocytosis are presented in Table 1.


Conclusions

Erythrocytosis is often a limiting variable in patients on TTh. Direct and indirect effects related to supraphysiologic T levels are believed to mediate the effects on erythrocytosis. The true mechanism of erythrocytosis and its role in thromboembolic events remains unclear, although some data support an increased risk of CV events resulting from T-induced erythrocytosis. Large multicenter randomized controlled trials are required to study TTh, its effects on Hb and Hct, and the clinical significance of treatment-induced increases in red blood cell mass.

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Although injectables have been shown to have a greater impact on HCT.

You can see even when using a transdermal formulation that maintains stable serum concentrations that the impact it has on HCT is DEPENDANT ON THE DOSE AND SERUM LEVEL OF T.

Using higher doses of transdermal T and achieving higher TT/FT levels will have a great impact on HCT levels.

 

[lancelot]

Injectable T has been shown to have a greater impact on increasing HCT compared to transdermal T.

3–18% with transdermal administration and up to 44% with injection.

In most cases when using injectable T high supra-physiological peaks post-injection and overall T levels (running too high TT/FT level) will have a big impact on increasing HCT.

Manipulating injection frequency by injecting more frequently using lower doses of T resulting in minimizing the peak--->trough and maintaining more stable levels may lessen the impact on HCT but it is not a given.

As again running very high TT/FT levels will have a stronger impact on driving up HCT.

T formulation, the dose of T, genetics (polymorphism of the AR), age all play a role in the impact a trt protocol will have on blood markers (RBCs/hemoglobin/hematocrit).

Does hematocrit keep increasing after testosterone steady state? How often to check?

Hello guys, I’ve been on TRT for about 4 months and I just recently got my blood lab results. Everything looks good, but I did noticed my hemoglobin and hematocrit did increase to 15 and 45 respectively. Are they going to keep increasing? My doctor wants to check me at 6 month intervals now and...

www.excelmale.com

-------------------------------------------------------------------------------------------------


Erythrocytosis Following Testosterone Therapy
View attachment 14166


Effects of T formulation

Of the available T formulations, short-acting IM injections (TC and TE) have the highest incidence of erythrocytosis (approaching 40%).14 Recent studies support a unified hypothesis in which T formulation, dose, and pharmacokinetics collectively determine the risk of erythrocytosis by establishing the DURATION OF SUPRAPHYSIOLOGIC T LEVELS.52 T formulations that result in stable serum concentrations (pellets, transdermal gels and patches, and extended-release IM TU) result in a low incidence of erythrocytosis that is dependent on dose and serum level and independent of the duration of therapy.11, 52, 67 The relation of individual T formulations and associated effects on average T levels and incidence of erythrocytosis are presented in Table 1.


Conclusions

Erythrocytosis is often a limiting variable in patients on TTh. Direct and indirect effects related to supraphysiologic T levels are believed to mediate the effects on erythrocytosis. The true mechanism of erythrocytosis and its role in thromboembolic events remains unclear, although some data support an increased risk of CV events resulting from T-induced erythrocytosis. Large multicenter randomized controlled trials are required to study TTh, its effects on Hb and Hct, and the clinical significance of treatment-induced increases in red blood cell mass.

-------------------------------------------------------------------------------------------------




Although injectables have been shown to have a greater impact on HCT.

You can see even when using a transdermal formulation that maintains stable serum concentrations that the impact it has on HCT is DEPENDANT ON THE DOSE AND SERUM LEVEL OF T.

Using higher doses of transdermal T and achieving higher TT/FT levels will have a great impact on HCT levels.

Thanks. Very good info. I read a study a few month ago on the use of about 10 mg a day of testosterone propionate. Along with getting good total and free levels, it appeared to have little hematocrit elevation..which probably would worsen with higher doses. That was one of the methods I was considering..and hoping it would lessen dht spikes and concurrent hair loss. I still have fairly good hair at 58 and would like to not lose a lot if I go on TRT. I've heard of people microdosing finasteride to prevent it..but not sure I want to do that either.