Having Second Thoughts

[BBaller]

Hey everyone,

You can see my posting history to get a little more context of me. Short version:
31- Low T verified via bloodwork for the last 15 months- had some success naturally raising it, but it was transient. Am set to visit Defy soon.

Over the last few days reading some of the struggle stories of men here, and grappling with the enormity of this decision, I'm wondering whether I should go forward.

Here are my causes for concern:
- T went up recently from 337-->395 in two weeks. Granted, this could be transient (and my rec league team won our first game of the season so it' entirely plausible that contributed). But maybe this is the beginning of an upward trend

- Over the last couple of years I've been under a lot of stress. Work, finances, relationships, moving, etc. I've been able to manage for the most part, but I do wonder whether that has tanked my T. Recently I've felt a bit of renewed optimism and clarity, and wonder whether I should continue to ride that out, dedicate myself to getting my affairs in order, and see if some of my T related issues sort themselves out if those external factors improve. Then I can reassess whether TRT is right for me.

- Hearing some of the struggles and complications for guys here puts my current relatively good health on stark relief. My low-T symptoms are medicore energy levels, poor gym recovery, difficulty losing stubborn fat and gaining muscle, brain fog and poor concentration. No major impact on libido and sexual performance, and for the most part I'm still a productive, functional adult. I do wonder whether healthy T levels will help me feel really robust, energetic, focused and strong, but in comparison to guys who have crippling issues, I have it pretty light.

- I'm still very concerned about fertility and am young so am also concerned about the long term commitment involved in TRT

- I'm also very concerned about other side effects. I hear stories here of guys who seem to be an a treadmill of side effect management, trying new drugs to mitigate the effects of other drugs or serve as adjuncts. And while I'm not opposed to pharmaceuticals, the fewer the better in my book. Some members of my family are on lots of drugs and the list of new adjuncts seems to keep growing even as their health doesn't. I want to avoid that path of continual escalation as much as possible and for as long as possible.

I welcome any of your thoughts. Thanks guys

 

[CoastWatcher]

TRT is a commitment if time and energy. Some men struggle to find relief on the appropriate protocol (and almost all of us work for a period of time to find that point where things are locked in). However, in my case, it gave me back my life. Without a doubt, TRT was worth the effort it took. You wrote that "you want to avoid the path of continual escalation (of drugs) if at all possible," and you commented on your relative youth and hope for children. If that's the case, why start testosterone therapy now? It reads as if you want to be talked into it. Step back and see how you feel six months or a year from now.

 

[ERO]

Poor or not enough sleep is a huge contributor of Low T, so perhaps explore a sleep study or make an effort (if possible) to get more and better sleep and your T levels may rise to healthy levels. However, if you do that for, say another 6 months and you are still low, I'd look to work with Defy on a useful TRT protocol.

It is ideal to avoid TRT if at all possible, but if you have tried everything and you are still low after that, it is likely that you will feel a lot better on than off. Also, please note that many if not most of the guys that are struggling with TRT are working with a Doc that just doesn't properly understand how it works. I am not trying to talk you into TRT, but I don't want you to totally write it off either if you are still low in another 6 months or a year.

 

[CoastWatcher]

ERO is correct when he points out that the worst struggles you read of here are, typically, working wi a doctor who doesn't understand contemporary TRT managment, or fails to treat them as a partner in the pursuit of better health. A good doctor, working with a well-informed patient, makes TRT success far more likely. But Defy will be there six or twelve months from now. If hesitant...wait.

 

[xr88]

I'm fairly new on trt (26). I've been struggling with it, but as ERO and CoastWatcher said, it's because I have been dealing with a doctor that doesn't really understand trt and all that goes along with it. Now that I'm making some changes for the better, I feel like trt will help give me back a normal life. Not pushing you towards trt, but if you choose trt, you should have much better luck than I have. A lot of guys have great things to say about defy. There is also a list of recommended doctors on here if that is more of the route you're looking for. Good luck with your decision.

 

[Vince Carter]

At 31 I'd be much more concerned for finding the reason behind your low T. I'd go full thyroid, adrenal, serious testing in those areas along with all the major bloods and then diet/exercise considerations, ruling out problems in other areas.

 

[BBaller]

Poor or not enough sleep is a huge contributor of Low T, so perhaps explore a sleep study or make an effort (if possible) to get more and better sleep and your T levels may rise to healthy levels. However, if you do that for, say another 6 months and you are still low, I'd look to work with Defy on a useful TRT protocol.

It is ideal to avoid TRT if at all possible, but if you have tried everything and you are still low after that, it is likely that you will feel a lot better on than off. Also, please note that many if not most of the guys that are struggling with TRT are working with a Doc that just doesn't properly understand how it works. I am not trying to talk you into TRT, but I don't want you to totally write it off either if you are still low in another 6 months or a year.

Thanks ERO- good point about the importance of a skilled clinician. I know guys here have great things to say about Defy, so maybe it makes sense to just follow through and discuss these concerns with them.

Sleep definitely seems to impact me heavily. I understand it can be a bit of a chicken and egg thing. Low T can make restful sleep harder, and poor sleep can lower T. So if I'm having trouble with one, the other might help and vice versa.

 

[BBaller]

I'm fairly new on trt (26). I've been struggling with it, but as ERO and CoastWatcher said, it's because I have been dealing with a doctor that doesn't really understand trt and all that goes along with it. Now that I'm making some changes for the better, I feel like trt will help give me back a normal life. Not pushing you towards trt, but if you choose trt, you should have much better luck than I have. A lot of guys have great things to say about defy. There is also a list of recommended doctors on here if that is more of the route you're looking for. Good luck with your decision.

Thanks xr88- I hope you're able to dial things in and find the improvements you're looking for.

 

[BBaller]

ERO is correct when he points out that the worst struggles you read of here are, typically, working wi a doctor who doesn't understand contemporary TRT managment, or fails to treat them as a partner in the pursuit of better health. A good doctor, working with a well-informed patient, makes TRT success far more likely. But Defy will be there six or twelve months from now. If hesitant...wait.

Thanks Coastwatcher- as mentioned above, I think I will go forward with my appointment and discuss these concerns. If Defy docs are as open-minded and sensitive to individual needs and concerns as many members here report, I'm confident that they can advise me appropriately. And I do always have the option to wait if I'm still on the fence after consultation.

 

[BBaller]

At 31 I'd be much more concerned for finding the reason behind your low T. I'd go full thyroid, adrenal, serious testing in those areas along with all the major bloods and then diet/exercise considerations, ruling out problems in other areas.

Thanks Vince Carter- I have some speculations, but no clear sense of why my T is low. I do suspect, based on patterns going back to my youth, that my T has been habitually low for most of my life, though I have no blood work prior to last year to verify as much. I just know that I've long had issues with decisiveness and assertiveness, my strength has always been low or low-average, and have a propensity for fat gain over muscle gain when in calorie surplus.

My lifestyle is overall quite healthy. Primarily whole foods based macronutrient-balanced diet, weight training 3-4x/week, recreational basketball 8-12 hours a week, very good lipid panel, supposedly normal thyroid panel according to my primary care doc, etc. Endocrinology is a complicated field though and I suppose thyroid or adrenal issues could be at play.

What are other reasons why a male's T would be low? Physical trauma, environmental pollutants, pharmaceutical side effects?

 

[Vitamin_C]

BBaller your symptoms are exactly like mine, I am only 2 years older than you and have seen my test as low as 199 and hangout in the 300's. Recently, I have raised it into the high 400's and low 500's by doing some lifestyle moderation, but I would really love to be into the 600-700's naturally in a perfect world ( I am 33 years old). I ran Test Cyp 100mg bi weekly and felt very anxious on it so I quit and got back to baseline and am currently sitting in the low 500's.

Libido or erections were never an issue, even in the 300's for me, but recovery from workouts, gaining strength, and putting on fat have been problems. I have ZERO room for error if I don't eat well, absolutely none. Believe it or not, I have been able to put on decent size for someone who has had lowish Test, I can't imagine what I could do with healthy T levels.

My TRT doc wrote me a script for hcg and t-gel. I am on the fence if I should give it one last shot. I do have anxiety and panic disorder, but I can manage them well without pharmaceuticals, however test made me pretty anxious so I got off. I have had all sorts of blood work done, SHGB, free test, thyroid, ACTH, cortisol etc. Only thing that red flagged was my 24 hour urine cortisol is elevated, it may be because I am a night shift worker?

 

[BBaller]

BBaller your symptoms are exactly like mine, I am only 2 years older than you and have seen my test as low as 199 and hangout in the 300's. Recently, I have raised it into the high 400's and low 500's by doing some lifestyle moderation, but I would really love to be into the 600-700's naturally in a perfect world ( I am 33 years old). I ran Test Cyp 100mg bi weekly and felt very anxious on it so I quit and got back to baseline and am currently sitting in the low 500's.

Libido or erections were never an issue, even in the 300's for me, but recovery from workouts, gaining strength, and putting on fat have been problems. I have ZERO room for error if I don't eat well, absolutely none. Believe it or not, I have been able to put on decent size for someone who has had lowish Test, I can't imagine what I could do with healthy T levels.

My TRT doc wrote me a script for hcg and t-gel. I am on the fence if I should give it one last shot. I do have anxiety and panic disorder, but I can manage them well without pharmaceuticals, however test made me pretty anxious so I got off. I have had all sorts of blood work done, SHGB, free test, thyroid, ACTH, cortisol etc. Only thing that red flagged was my 24 hour urine cortisol is elevated, it may be because I am a night shift worker?

Vitamin_C- thanks for your response, and it's great to hear from someone with a similar constellation of symptoms.

Congrats on your T level improvements and gym gains. What sort of lifestyle modifications have you made that have brought you some success?

And congrats too on your discipline. I'm fortunate that I seem to have greater margin for error than you when it comes to weight stability. I can maintain fairly easily, and on generous calorie levels (probably because of my activity level), but muscle or strength gains are as you describe: zero margin for error, maybe several pounds of fat for every fraction of a pound of muscle.

I'm sorry to hear that you found yourself anxious on T. Can you describe your experience a bit more? In what ways would it interact with your disorder? Did you find yourself sleeping poorly? Having disproportionate reactions to external stimuli? Heart palpitations? Etc.

Despite a fair number of family members with mental health issues, that's thankfully never been a big issue in my life.

 

[Vitamin_C]

//What sort of lifestyle modifications have you made that have brought you some success?//

cut out a lot of alcohol, intermittent fasting, lots of deadlifts, liver cleanse etc.

strength gains have been so-so, its a lot harder to do it in your 30's with declining t-levels.

// Can you describe your experience a bit more? //

I would always get really anxious a couple hours after my injection (50mg) and for the next day or two, then it would subside the longer it was away from the injection day. I did read that exogenous testosterone can cause anxiety, panic attacks, derealization/depseronalization (just fancy words for panic attacks) so maybe since I already have intermittent anxiety I just thought the testosterone would give me them in a psychosomatic fashion, but testosterone can alleviate anxiety with some people, or it can cause it with others, and I'm not sure anyone knows the mechanism for it causing anxiety, only theoretical to be honest. The anxiety I got from the testosterone was not unbearable, but to be honest I felt better before I started TRT . I ran it 5 weeks and decided to come off, get back to baseline, and see how high I can raise it naturally. The highest I've seen my total test naturally since then has been 519, not desirable but not undesirable at the same time. As others have stated in your early 30's, something in the endocrine system is most likely is causing the lower output of testosterone and sometimes its really hard and expensive to find out . I go see my TRT doc next Wednesday, he has written me a script for t-gel and hcg that I get from a compounding pharmacy. I may give it one last shot, if I still feel the anxiety I will just get off and get back to baseline and keep trying to raise it naturally.

 

[BBaller]

Vitamin C,

Thanks for the follow up here. I already do much of what you're describing. i would say that sleep and stress are my next major areas of lifestyle focus.

Interesting that you mention dead-lifts specifically; that's definitely strongest of the major lifts. Haven't done 1RM testing recently, but last I checked I was capable of about ~2.25x body weight.

Sorry to hear about your panic attacks and I wish you well in this next round of experimentation.

I did speak with Dr Saya at Defy and had a good experience. I feel more open to moving forward, though I am going to sleep on it for a bit and continue to mull the option. It's there when and if I'm ready.

Anyway, thanks again and good vibes your way.

 

[Encore]

BBaller,

Not to say that TRT would be the wrong decision for you at this time, but I feel like I would spend a couple months working on controlling stress and improving sleep "hygiene" and then come back to this decision later.

Have you considered the possibility that you are overtraining as well? In my 20s and early 30s, I exercised about as much as you, playing soccer, basketball, and doing heavy lifting (double bodyweight deadlifts, 1.5x BW bench, etc.). There were times when I know I was run down from doing too much, at least for a guy with a full time job.

Your levels aren't too low, and if you start TRT now, you might not have the same incentive to work on optimizing your stress, sleep, and exercise intensity/frequency, etc.

 

[BBaller]

Hi Encore,

Appreciate the comment. I'm not especially concerned about dis-incentivizing myself to continue with other self-care practices. I think of myself as a reasonably attentive guy who has approaches my own health seriously without being fanastical.

It is possible that I am over-training; that's occurred to me. Recently I've been scaling back a little bit and being responsive to my own biofeedback. As work and other obligations have pressed upon me, I've moderated either the weight training or basketball, or both, as makes sense. It is tricky though, as athletics and staying active are pretty central to my life, and what I enjoy doing when I have the chance.

Part of my hope with TRT would be improved recovery in general. Ultimately, the goal would to be as active as I desire (within reason) and be able to sustain it without burnout. That would be a strong contributor to a high quality of life for me. I'm not a pro athlete and don't anticipate I ever would be. But the experiential benefits of staying active are important to me.

Anyway, I do agree with you that a focus on mitigating stress and improving sleep hygiene are valuable goals, and things I will continue to emphasize. TRT is a log-term strategy so I don't feel rushed about it. I'm eager to see what it's like, but also willing to sit on it for a while to see whether I can make do without it for a while longer.

Thanks again for your insight.

 

[Vitamin_C]

Vitamin C,

Thanks for the follow up here. I already do much of what you're describing. i would say that sleep and stress are my next major areas of lifestyle focus.

Interesting that you mention dead-lifts specifically; that's definitely strongest of the major lifts. Haven't done 1RM testing recently, but last I checked I was capable of about ~2.25x body weight.

Sorry to hear about your panic attacks and I wish you well in this next round of experimentation.

I did speak with Dr Saya at Defy and had a good experience. I feel more open to moving forward, though I am going to sleep on it for a bit and continue to mull the option. It's there when and if I'm ready.

Anyway, thanks again and good vibes your way.

I appreciate it man. I am 33 years old and it seems like my current natural limit is high 400's to low 500's. I do get low TRT symptoms such as lack of motivation, brain fog, mediocre gains in the gym, easy fat/weight gain, lack of assertiveness etc. When I was on Test Cyp for 5 weeks, the anxiety was there, but it wasn't unbearable, It may have just been psychosocial. My TRT doc wrote me a script for 10% compounded gel and HCG with P5P that I filled today and will pick up next week. Thinking of starting out hcg at 250 iu bi weekly and going from there. My other labs were fine, my E2 always stays normal to low, SHGB normal range, cortisol is elevated but I am a night shift worker and I suspect this is causing elevated cortisol. ACTH came back in normal range despite elevated Cortisol. Squats and deadlifts have definitely helped raising my T-levels back to my normal range after I quit Test Cyp, but my celing is about 400-500 naturally. I'll give the T-gel and hcg a shot, if I don't like it I'll simply get off and get back to my baseline and go from there.