Just Started TrT and am Very Confused

[EasyCompany]

Hi, new guy here. After years of trying to combat declining T with diet, fat loss, weightlifting, etc. I finally decided to give TrT a try. At 73 years of age my T had been slowly declining to where I recently got the following report: T=328, SHBG=54.7, Free T = 4.63, Albumin 4.4. In addition, I have been experiencing sluggishness, unreasonable procrastination, ragged sleep patterns, loss of strength when lifting and very slow gains with the weights, loss of libido, and ED. This is such a contrast to what I was in my thirties when I was benching 300+, sleeping soundly for 8 1/2 hours a night, extremely focused and instantly aroused by a nice set of legs, ta-tas or whatever and having marathon sex sessions. I realize that some aspects of aging are inevitable, but surely there is something I can do to combat what's happened to me.

I'm a natural lifter, and the only medication I take is a calcium channel blocker for pre-hypertension. My health is excellent and I want to keep it that way.

I told my urologist that I was interested in discussing TrT with someone and he recommended that I see someone in their affiliated Men's Clinic. Made an appointment and was looking forward to it. It turned out to be the exact opposite of what I wanted.

I told the PA in the Men's Clinic that I didn't want just TrT, that I wanted to keep squeezing my body to produce as much T as possible and wanted to do whatever I could to get more out of my aging gonads. He just shook his head and said, "ain't gonna happen at your age." I asked him why and he just said "because its not." He was one of these guys who is always in a hurry, doesn't really listen, and thinks he knows everything.

He offered me TrT in a pelletized form that is placed in a small incision in my upper buttock and is supposed to last for 4 months. I told him that I was extremely interested in not having my genitals atrophy and he said, "well, you need to take clomid then." I didn't like this guy, but I was there and decided I'd go ahead with the pellets and clomid and see what happened. He said to take one 50 mg tab of clomid twice a week, Monday and Thursday. To me it would've made sense to take 1/2 of that dosage five or even seven days a week, but he said no, just twice a week, the full dosage.

I've read a lot about the body's feedback loops, the conversion of Test to Estrogen and the resultant signal to the brain to shut down T production, etc. and it seems like, to my very unlearned mind, that it would've made sense to take both clomid and HCG along with the Test, as that would keep my body's T production mechanisms operating. I always thought that clomid influenced sperm production with a side benefit of more T and HCG influenced T production with a side benefit of a slight increase in sperm production. This dude said no, they both did the same thing. That just doesn't seem to make sense.

My question is, given my desire to squeeze every last drop of T production possible out of this aging body, does a better protocol make sense? And if so, where do I go to find a doc who is actually interested in hearing what I'm saying and providing the services I want?

If you made it to the end of this epistle and have some helpful advice, thank you very much in advance.

 

[FunkOdyssey]

I would suggest a telemedicine consult with Defy medical if you can't find a good local provider. They are very responsive to the patient's wishes and they would have probably started you on enclomiphene (without any TRT) based on your expressed desire to "get more out of your aging gonads".

 

[Guided_by_Voices]

First of all, congratulations on making it to where you are and on doing your homework on basic hormone systems in the body. I don't think you're confused at all. You sound like you're on a good path with your thinking. Like Funk above, I have also been with Defy for many years and have found them to be very reasonable (I have no financial affiliation with them.) Several things...I think @Cataceous is closer to this topic than I am, but I thought enclomiphene was a bit of a dud and the first step was now (back to ) clomid, but I could be out of date there. Either way, Defy would know. Also, the leading edge for the first step of TRT from what I've heard is intermittent dosing of fast-clearing testosterone such as in a cream (this apparently creates minimal suppression of your own production, and MAY improve symptoms.) That is leading edge and not yet common, but is something to consider if supporting your own production alone does not do the job. Also, note that other things besides T can be involved in your symptoms so a work-up from a good holistic practitioner may be in order, although Defy will look at common risks like thyroid. Finally, there are things that don't affect your own hormones as much as T that many of us find to be just as important. DHEA, PT-141, Ipamorelin/ModGRF and something in the viagra family are four big ones that I would consider first line therapies and if I had it to do over again I would have started with those in conjunction with clomid and/or HCG instead of jumping straight to T. They provide overlapping benefits and don't seem to have nearly the number of issues with getting dialed-in as T does. Since you still have your natural production you have options that many of us on here don't have.

 

[Cataceous]

... Also, the leading edge for the first step of TRT from what I've heard is intermittent dosing of fast-clearing testosterone such as in a cream (this apparently creates minimal suppression of your own production, and MAY improve symptoms.) That is leading edge and not yet common, but is something to consider if supporting your own production alone does not do the job. ...

Unfortunately topical testosterone doesn't qualify as fast-acting with respect to the HPTA. The skin acts as a reservoir and ensures a relatively long half-life. Instead we have testosterone nasal gel or troches delivered bucally. There is direct research showing that the HPTA continues to function when Natesto is used. Buccal troches provide similar pharmacokinetics, so it's inferred that results should be similar if the amount of testosterone absorbed is similar.

I think fast-acting testosterone is a better starting point than Clomid or enclomiphene. These latter drugs work for some men, but they introduce complexity and sometimes do as much harm as good. Clomid may be thought of as a mixture of enclomiphene and a long-acting estrogen (zuclomiphene). If the anti-estrogenic activity of enclomiphene happens to properly balance against the pro-estrogenic activity of zuclomiphene — and the added HPTA activity — then there may be decent results. If not, well some guys report feeling awful on Clomid. With enclomiphene alone it's hypothesized that there's insufficient estrogenic activity in certain regions of the brain in some cases, leading to poor subjective outcomes even when lab work looks fine.

 

[EasyCompany]

Thank you all. I’ll give Defy a call.

 

[Guided_by_Voices]

Unfortunately topical testosterone doesn't qualify as fast-acting with respect to the HPTA. The skin acts as a reservoir and ensures a relatively long half-life. Instead we have testosterone nasal gel or troches delivered bucally. There is direct research showing that the HPTA continues to function when Natesto is used. Buccal troches provide similar pharmacokinetics, so it's inferred that results should be similar if the amount of testosterone absorbed is similar.

I think fast-acting testosterone is a better starting point than Clomid or enclomiphene. These latter drugs work for some men, but they introduce complexity and sometimes do as much harm as good. Clomid may be thought of as a mixture of enclomiphene and a long-acting estrogen (zuclomiphene). If the anti-estrogenic activity of enclomiphene happens to properly balance against the pro-estrogenic activity of zuclomiphene — and the added HPTA activity — then there may be decent results. If not, well some guys report feeling awful on Clomid. With enclomiphene alone it's hypothesized that there's insufficient estrogenic activity in certain regions of the brain in some cases, leading to poor subjective outcomes even when lab work looks fine.

Thanks for clarifying, very helpful. I'll add two things. I was someone who did "ok" on clomid for the first 2 years or so of my hormone journey, but it only helped symptom-wise at a very low dosage of 12mg every other day. Most people report starting at a higher dose than that so I think some of the negative reports are due to excessive dosing, but I agree that chances of long-term success are not good.

Also for the OP, starting with the ancillaries I listed first (and possibly other things also) may reduce your list of symptoms, and what's left could have very different options depending on what it is. For example, poor sleep (which could cause everything else on the list) is one thing to address, whereas if gym performance (which I prefer to think of as vigor and having an excess of youthful physical abilities, IOW not being frail) is the remaining issue, then that is a different set of options.