Looking for input on TRT + Tirzepatide stack

[scrappymalloy]

Hi all... I just joined recently, and looking for some direction.

I let myself and my health slide and want to get back on track ASAP.

Stats:

• 50 yrs old, 5'10", 235 lbs
• BMI 33.7, body fat ~33% (Renpho)
• Lean mass ~148 lbs, lift 3-4x/week (push/pull/legs) for years
• 10K+ steps daily, Peloton, hikes when I can
• Hip resurfacing 15 months ago, not performing well. Significant knee issue. Want to do more but limited.

The T story (tracked weight daily since 2016):

Inverse correlation with weight gain has been near-perfect:

• Dec 2018: 444 ng/dL @ 207 lbs (felt good)
• Dec 2025: 353.8 ng/dL @ 232 lbs
• Apr 2026: 359 ng/dL @ 235 lbs

LH 2.0, FSH 4.8, E2 <30, Prolactin 6.5, SHBG 21. Low LH with low T tells me this is functional/secondary, not primary.

Symptoms: Low drive, brain fog, low energy, low libido (not gone, just low). Brain fog and lack of motivation are the worst. Stuck on weight loss despite hitting calories and macros. General "blah" about life for a while now.

Other relevant:

• CPAP compliant ~8 hrs, AHI 1.26. Apnea is not the issue.
• 20 years of nightly THC for sleep, cut from 10mg to 5mg, working toward zero. Know it suppresses LH.
• Oura sleep score ~79, deep sleep around an hour.
• TPO antibodies 209 (way out of range), TSH 2.12.
• Cardiac markers are mostly out of range as well.

My read: Obesity-induced secondary hypogonadism. Weight gain caused the T drop, not the other way around. But now I'm in the loop where low T makes losing weight harder and the weight keeps T suppressed.

Three paths I'm weighing:

1. TRT only. Fixes brain fog fast, drives recomp, helps metabolically. Hesitant on the lifelong commitment. Also concerned about having 25-year-old hormones when my 50-year-old wife doesn't.
2. Tirzepatide only. Strips fat, fixes the root cause, T rebounds naturally, lipids clean up. But "eventually" could be 6-12 months before brain fog lifts.
3. Both concurrently. TRT handles brain fog and muscle preservation immediately, tirz handles appetite and insulin sensitivity. No pharmacological contraindication that I've seen. Looks synergistic on paper.

I don't want to go on TRT if I don't need to. I also can't keep grinding on this alone. I need an intervention.

Questions:

• Anyone been in a similar spot?
• Anyone run TRT + GLP-1 concurrently? Did TRT actually preserve muscle during the cut? Any pushback from your doc on combining?

Happy to share more data if useful. Thanks.