Low Testosterone symptoms. 10 years of finding a solution

[00roast00]

Over the last 10 years I’ve gradually been getting a list of increasing symptoms which I now believe might be low testosterone.

My symptoms are:

• Extreme brain fog to the point that I am forgetful and it takes a lot more effort to articulate my thoughts.
• Awful sleep. I never wake up feeling refreshed and wake up during the night multiple times.
• Low energy and mood
• Low libido/ED
• Overall I don't feel like myself anymore. I feel like an old man in a younger mans shell.

A bit about me:

I'm 38, an avid gym goer for the majority of my life and live a healthy lifestyle. I rarely drink, don't do drugs and I am conscious about what I eat. I have muscle mass but I have average body fat at 19% body fat. I used to have a lower body fat but I’m finding it increasingly difficult to lose it due to my energy levels and recovery. I reduced the amount of days I work out in case I am overtraining and I’m now only working out 3 days a week and I’m struggling with that.

What I have ruled out so far:

• Initially I thought I was depressed and went on SSRIs for a few years. Came off when it didn’t improve more symptoms
• Sleep apnea test - came back negative
• Improved my general sleep hygiene, earlier nights, consistent 8 hours, blue light blocking glasses a few hours before sleeping
• High levels of vitamin D, K, B’s, magnesium
• Boron and Zinc (this lead to my E2 dropping and causing problems with joints which you’ll see in my 2nd hormone test below
• Gave up caffeine and alcohol - no improvement
• Various supplements and Nootropics to help with my brain fog. Nothing worked.
• Had allergy tests - nothing
• Increased healthy fats. Also tried low carb then keto diets.Energy improved slightly on keto and low carb

2017:
Test 16.30 nmol/l (range 8.64 - 29nmol/l)
Free T 0.346 nmol/l (range 0.2 - 0.62nmol/l)
Oestrodiol 76 pmol/l (range 41 - 159pmol/l)
SHBG 29 nmol/l (range 18.3 - 54.1nmol/l)
Albumin 46 g/L (range 35 - 50 g/L)
FSH 3.0 (range 1.5 - 12.4)
LH 3.1 (range 1.7 - 8.6)
TSH 1.59 (range 0.27 - 4.20)
Free T4 14.4 (range 12.0 to 22.0)
Free T3 4.55 (range 3.1 - 6.8)

My hormone levels aren't great but within clinical levels. My FSH and LH show my balls are working. My thyroid results rule out any thyroid issues.

You’ll see on my second set of results from this year below that my testosterone is slightly higher from the boron and zinc experiment but it reduced my E2 and left me with painful joints. The extra testosterone was unnoticeable.

2022:
Test 17.7 nmol/l (range 8.64 - 29nmol/l)
Free T 0.373 nmol/l (range 0.2 to 0.62nmol/l)
Oestradial 64.8 pmol/l (range 41 - 159pmol/l)
SHBG 33.5 nmol/l (range 18.3 - 54.1 nmol/l)
Albumin 42.6 g/L (range 35 - 50 g/L)

Given everything I’ve tried and that my levels are on the lower side of the scale do you think i would benefit from trialing TRT. I’ve spent over 10 years investigating and trying different solutions without any luck. Could it be that my levels have decreased over time due to my age and even though they’re not low low, they’re too low for me?

I’m at a point where I feel like I’ve tried so many things but without a solution and the only option I can think left to try is TRT? Do you think it’s worth trialing?

 

[bixt]

Clomid 12.5mg twice or thrice a week. Or enclomiphene if you can get that.

 

[Cataceous]

Given your fairly normal hormones, I'm wondering if your issues could in part be dopamine-related. Have you tried any dopaminergic supplements, such as L-tyrosine of NALT? There are stronger options available, including macuna pruriens and wild green oat extract. Pharmaceutical options include bupropion and selegiline.

I would not recommend TRT, but a SERM as suggested by @bixt is a reasonable way to see if higher testosterone makes a difference. Another option along these lines is a nasal gel, such as Natesto. This boosts your testosterone without crushing your own production.

Edit: Have you tested prolactin? Higher levels independently reduce libido and also correlate inversely with dopamine.

 

[nippy]

Given your fairly normal hormones, I'm wondering if your issues could in part be dopamine-related. Have you tried any dopaminergic supplements, such as L-tyrosine of NALT? There are stronger options available, including macuna pruriens and wild green oat extract. Pharmaceutical options include bupropion and selegiline.

I would not recommend TRT, but a SERM as suggested by @bixt is a reasonable way to see if higher testosterone makes a difference. Another option along these lines is a nasal gel, such as Natesto. This boosts your testosterone without crushing your own production.

Edit: Have you tested prolactin? Higher levels independently reduce libido and also correlate inversely with dopamine.

Hi may I jump on this thread...

I've had low testosterone for a while now so was given the chance to go onto trt. 3 years I've been on it high doses low doses cream gels i and injections. Malavida is actually worse than ever I had a better sex life before trt.. a few months ago I had changed injections from IM to subq .. for a week I felt amazing I had sex drive I was happy I was sleeping better I felt normal like I used to before trt. I did some research on to why this may be and a few people said changing injections can increase dopamine. As testosterone is absorbed differently. Obviously the dopamine rush last of the week and it's never been seen since lolol. I've tried l-dopa. L-tyrosine. Macruna prurians... . . Nothing helps the libdio... I've never had high prolactin but used to take antidepressants... I feel this is the cause of the dead libdio. Can antidepressants kill the receptors that would norm increase dopamine ??

 

[00roast00]

Given your fairly normal hormones, I'm wondering if your issues could in part be dopamine-related. Have you tried any dopaminergic supplements, such as L-tyrosine of NALT? There are stronger options available, including macuna pruriens and wild green oat extract. Pharmaceutical options include bupropion and selegiline.

I would not recommend TRT, but a SERM as suggested by @bixt is a reasonable way to see if higher testosterone makes a difference. Another option along these lines is a nasal gel, such as Natesto. This boosts your testosterone without crushing your own production.

Edit: Have you tested prolactin? Higher levels independently reduce libido and also correlate inversely with dopamine.

Thanks for this. I was looking up the side effects of clomid which are a bit concerning. Also have have said it raises their levels but doesn’t improve the symptoms sometimes. I don’t have access to the nasal gels unfortunately.

My prolactin came back as normal.

I’ve got access to to test and pct to trial but won’t do it if you guys think it won’t be worth trialing?

 

[Vince]

Thanks for this. I was looking up the side effects of clomid which are a bit concerning. Also have have said it raises their levels but doesn’t improve the symptoms sometimes. I don’t have access to the nasal gels unfortunately.

My prolactin came back as normal.

I’ve got access to to test and pct to trial but won’t do it if you guys think it won’t be worth trialing?

Are guys that do well on low dose clomid unicorns...or do they really exist?

They actually EXIST!!! There are certainly some challenges in treating with low dose clomid, specifically in dealing with the varying effect (estrogen antagonist/agonist) of the two isomers enclomiphene and zuclomiphene. However, as I (and Dr Crisler) have said many times...I DO ACHIEVE SUCCESS...

www.excelmale.com

 

[bixt]

Thanks for this. I was looking up the side effects of clomid which are a bit concerning

My suggested dose will give you no side effects I am 99% sure. IF you are getting "emotional" etc, then just discontinue it..... Clomid has zero permanent side effects. Unless you did something silly like 300mg for 2 months and clouded up your cornea.

If you are one of those people who are going to read too much into side effects, you will never do TRT either, or any kind of treatment besides herbs and vitamins. I don't know of any medication with no side effects. I suggested to you the least invasive and almost riskless approach to increasing your T.

I few years ago I overheard a senior doctor telling someone, "If there are no side effects, then that medicine doesn't work". Its not entirely true, but its food for thought...

Read the above link posted by @Vince and see what Dr Saya has to say.

 

[Systemlord]

My hormone levels aren't great but within clinical levels.

No consensus has been reached regarding the lower TT threshold defining testosterone deficiency, and there are no generally accepted lower limits of normal TT. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or Free T that distinguishes men who will respond to treatment from those who will not.

The number of triplet CAG repeats in androgen receptors differ in men and influences the androgen receptor activity, hence testosterone sensitivity may vary in different individuals.

The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of testosterone deficiency.

So don't be fooled by "within clinical levels" and think you are all good just because your TT and Free T levels are within normal ranges. The presence of symptoms might suggest you do have a testosterone deficiency.

A trial of TRT on an appropriate protocol will answer your question as to whether your issues are T related.

 

[Systemlord]

My FSH and LH show my balls are working.

My brother's 15 year old chevy truck has 180,000 miles on it, it doesn't have the power it once had when brand new, and has days where it doesn't want to start, but it's working.

If anything, your LH levels show a problem with the pituitary gland or somewhere upstream. There are chemicals in the environment which can downregulate the HPTA by fooling it into thinking the body is producing too much testosterone and that is what thought to be why most secondary cases of hypogonadism and testing show no problems with the pituitary gland other than the low normal LH.

 

[MIP1950]

I agree with @Cataceous about enhancing or upregulating dopamine. Another possible ancillary is PT-141, which can be purchased online or prescribed by a doctor. Never used it, but it's on my list. Not a dopamine enhancer, but related to dopamine.

"PT-141 is a nonselective agonist that binds to melanocortin receptors. PT-141 peptide therapy activates your dopamine hormones which enhance your sexual performance and stimulate sexual motivation. PT-141 works directly on your nervous system, bypassing the vascular system entirely."

Peptide Therapy for Erectile Dysfunction - Truong ...​

https://truongrehab.com › peptide-therapy-for-erectile-dys...

 

[00roast00]

Are guys that do well on low dose clomid unicorns...or do they really exist?

They actually EXIST!!! There are certainly some challenges in treating with low dose clomid, specifically in dealing with the varying effect (estrogen antagonist/agonist) of the two isomers enclomiphene and zuclomiphene. However, as I (and Dr Crisler) have said many times...I DO ACHIEVE SUCCESS...

www.excelmale.com

My suggested dose will give you no side effects I am 99% sure. IF you are getting "emotional" etc, then just discontinue it..... Clomid has zero permanent side effects. Unless you did something silly like 300mg for 2 months and clouded up your cornea.

If you are one of those people who are going to read too much into side effects, you will never do TRT either, or any kind of treatment besides herbs and vitamins. I don't know of any medication with no side effects. I suggested to you the least invasive and almost riskless approach to increasing your T.

I few years ago I overheard a senior doctor telling someone, "If there are no side effects, then that medicine doesn't work". Its not entirely true, but its food for thought...

Read the above link posted by @Vince and see what Dr Saya has to say.

Thanks I will give it a trial then. How long should I wait before I should notice effects?

Is clomid good for long term or is this just to see if higher test helps, then move over to trt?

 

[bixt]

Thanks I will give it a trial then. How long should I wait before I should notice effects

This tiny dose will bump your levels up within days in my experience - as your balls are fully functioning currently. How long the higher levels subjectively then take fix your symptoms (or not), I cant say. 8 -12 weeks is what people say you should do, to assess.

You will read all over the net that clomid takes weeks or months to raise levels - that's because all those posts are from bodybuilders or TRT guys who's nuts and pituitary were not working for a long while. They need to be "woken up" and regain size etc. That's not the case with you. Also those guys use doses such as 50mg a day (minimum), and can potentially get estrogenic side effects from such doses. Extremely unlikely to be the case with 12.5mg 2-3 times a week.

Is clomid good for long term or is this just to see if higher test helps, then move over to trt?

Lets first see how well you do on this dose and how high your levels are after a couple weeks.

If you feel better, and levels are good - then you can make a decision to stick on clomid long term or hop onto TRT (arguably "more natural" but requires much more commitment than taking a pill).

Or maybe you feel "nothing different", yet bloods show double your T and FT. Then you can simply hop off and carry on with life, looking for other solutions. If you "trial" TRT on the other hand, if it doesn't work, there's no guarantee your natural levels will return. Then, in addition to solving your original problem, you are now needlessly stuck with dialling in TRT, forever. That's the beauty of this low dose clomid plan, you can stop anytime, risk free. Your nuts appear to be in good condition, they are responsive to low LH. You therefore appear to be a good candidate for clomid therapy.

 

[00roast00]

This tiny dose will bump your levels up within days in my experience - as your balls are fully functioning currently. How long the higher levels subjectively then take fix your symptoms (or not), I cant say. 8 -12 weeks is what people say you should do, to assess.

You will read all over the net that clomid takes weeks or months to raise levels - that's because all those posts are from bodybuilders or TRT guys who's nuts and pituitary were not working for a long while. They need to be "woken up" and regain size etc. That's not the case with you. Also those guys use doses such as 50mg a day (minimum), and can potentially get estrogenic side effects from such doses. Extremely unlikely to be the case with 12.5mg 2-3 times a week.




Lets first see how well you do on this dose and how high your levels are after a couple weeks.

If you feel better, and levels are good - then you can make a decision to stick on clomid long term or hop onto TRT (arguably "more natural" but requires much more commitment than taking a pill).

Or maybe you feel "nothing different", yet bloods show double your T and FT. Then you can simply hop off and carry on with life, looking for other solutions. If you "trial" TRT on the other hand, if it doesn't work, there's no guarantee your natural levels will return. Then, in addition to solving your original problem, you are now needlessly stuck with dialling in TRT, forever. That's the beauty of this low dose clomid plan, you can stop anytime, risk free. Your nuts appear to be in good condition, they are responsive to low LH. You therefore appear to be a good candidate for clomid therapy.

Thank you, this makes sense and is good advice.

 

[madman]

Over the last 10 years I’ve gradually been getting a list of increasing symptoms which I now believe might be low testosterone.

My symptoms are:

• Extreme brain fog to the point that I am forgetful and it takes a lot more effort to articulate my thoughts.
• Awful sleep. I never wake up feeling refreshed and wake up during the night multiple times.
• Low energy and mood
• Low libido/ED
• Overall I don't feel like myself anymore. I feel like an old man in a younger mans shell.

A bit about me:

I'm 38, an avid gym goer for the majority of my life and live a healthy lifestyle. I rarely drink, don't do drugs and I am conscious about what I eat. I have muscle mass but I have average body fat at 19% body fat. I used to have a lower body fat but I’m finding it increasingly difficult to lose it due to my energy levels and recovery. I reduced the amount of days I work out in case I am overtraining and I’m now only working out 3 days a week and I’m struggling with that.

What I have ruled out so far:

• Initially I thought I was depressed and went on SSRIs for a few years. Came off when it didn’t improve more symptoms
• Sleep apnea test - came back negative
• Improved my general sleep hygiene, earlier nights, consistent 8 hours, blue light blocking glasses a few hours before sleeping
• High levels of vitamin D, K, B’s, magnesium
• Boron and Zinc (this lead to my E2 dropping and causing problems with joints which you’ll see in my 2nd hormone test below
• Gave up caffeine and alcohol - no improvement
• Various supplements and Nootropics to help with my brain fog. Nothing worked.
• Had allergy tests - nothing
• Increased healthy fats. Also tried low carb then keto diets.Energy improved slightly on keto and low carb

2017:
Test 16.30 nmol/l (range 8.64 - 29nmol/l)
Free T 0.346 nmol/l (range 0.2 - 0.62nmol/l)
Oestrodiol 76 pmol/l (range 41 - 159pmol/l)
SHBG 29 nmol/l (range 18.3 - 54.1nmol/l)
Albumin 46 g/L (range 35 - 50 g/L)
FSH 3.0 (range 1.5 - 12.4)
LH 3.1 (range 1.7 - 8.6)
TSH 1.59 (range 0.27 - 4.20)
Free T4 14.4 (range 12.0 to 22.0)
Free T3 4.55 (range 3.1 - 6.8)

My hormone levels aren't great but within clinical levels. My FSH and LH show my balls are working. My thyroid results rule out any thyroid issues.

You’ll see on my second set of results from this year below that my testosterone is slightly higher from the boron and zinc experiment but it reduced my E2 and left me with painful joints. The extra testosterone was unnoticeable.

2022:
Test 17.7 nmol/l (range 8.64 - 29nmol/l)
Free T 0.373 nmol/l (range 0.2 to 0.62nmol/l)
Oestradial 64.8 pmol/l (range 41 - 159pmol/l)
SHBG 33.5 nmol/l (range 18.3 - 54.1 nmol/l)
Albumin 42.6 g/L (range 35 - 50 g/L)

Given everything I’ve tried and that my levels are on the lower side of the scale do you think i would benefit from trialing TRT. I’ve spent over 10 years investigating and trying different solutions without any luck. Could it be that my levels have decreased over time due to my age and even though they’re not low low, they’re too low for me?

I’m at a point where I feel like I’ve tried so many things but without a solution and the only option I can think left to try is TRT? Do you think it’s worth trialing?

My symptoms are:

• Extreme brain fog to the point that I am forgetful and it takes a lot more effort to articulate my thoughts.
• Awful sleep. I never wake up feeling refreshed and wake up during the night multiple times.
• Low energy and mood
• Low libido/ED
• Overall I don't feel like myself anymore. I feel like an old man in a younger mans shell.

Hoping you had your blood work done between 7-10 am in a fasted state as we want to test at peak.

Let alone if you are training in the gym it would be better to take a week off before getting labs.

The causes of erectile dysfunction let alone decreased libido are complex and multifactorial.

Low libido/ED (lack of nocturnal/spontaneous daytime erections) are common symptoms of low-t.

Keep in mind dysfunction thyroid/adrenals can easily mimic low-t symptoms.

From your most recent labs, you were hitting a descent TT 17.7 nmol/L (510ng/dL).

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.

FT 5-10 ng/dL would be considered low.

FT 16-31 ng/dL (high-end) is healthy.

Most men on trt will do well with FT 20-30 ng/dL and yes there are some who will do just fine with FT 15-20 ng/dL.

Comes down to the individual.




With a TT 510ng/dL SHBG 33.5 nmol/L (normal) and Albumin 4.2 g/dL, then your FT would be around 17 ng/dL (far from low).

TruT Free Testosterone Calculator by FPT

Free testosterone calculator by FPT. Improved accuracy of free T calculations.

tru-t.org

TT of 8-12 nmol/L would be considered the grey zone and even then many men with higher T levels can still suffer from low-T symptoms due to high/highish SHBG.

You are hitting a TT low 500s and you have normal SHBG so your FT is definitely not going to be borderline/low.

Even then no one can say that these levels are optimal for you let alone should not cause any symptoms.

Much more involved especially if we get into the sensitivity of the AR/polymorphism of the AR and CAG repeat length (short/long).

As others have stated would be wise to look into Natesto or clomiphene/EN before jumping into full-blown trt.

You stated that Natesto is not an option so if you are concerned about using clomiphene/EN and were dead set on using exogenous test then I see no harm in giving it a go as long as you have a decent understanding let alone realistic expectations.

Shutting down your HPGA is not something to take lightly!

Many men do well on trt whereas others may constantly struggle especially when it comes to libido/erectile function.

No harm in trying even short-term as you can always stop and you will eventually return to baseline levels.

PCT or cold turkey.

6 months would be a decent amount of time to put in.

The most sensible approach would be to find a doctor in the know who will work with/guide you.

Taking the UGL route and flying solo may not be your best move especially if you lack the understanding of how exogenous esterified T works.

Blood work using accurate assays is critical.

Do what you feel is best for you!

Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring

ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

www.excelmale.com

Figure 1. Threshold continuum to hypogonadism.

post #7

*No consensus has been reached regarding the lower TT threshold defining TD, and there is no generally accepted lower limits of normal TT. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not




post #8

AR CAG repeat lengths (short/long)

*The number of cytosine–adenine–guanine triplet (CAG) repeats in androgen receptors differ in men and influences the androgen receptor activity [88,89,90,91] (Figure 1). Hence testosterone sensitivity may vary in different individuals.

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]

*In general, it is currently speculated that variable phenotypes of androgen insensitivity exist, mainly owing to mutated androgen receptors. More subtle modulation of androgen effects is related to the CAG repeat polymorphism in exon 1 of the androgen receptor gene: transcription of androgen-dependent target genes are attenuated with the increasing length of triplets.

*As a clinical entity, the CAG repeat polymorphism can relate to variations of androgenicity in men in various tissues and psychological traits: The longer the CAG repeat polymorphism, the less prominent is the androgen effect when individuals with similar testosterone concentrations are compared.

*A strictly defined threshold to TD is likely to be replaced by a continuum spanned by genetics as well as symptom specificity. In addition, the effects of externally applied testosterone can be markedly influenced by the CAG repeats and respective pharmacogenetic implications are likely to influence indications as well as modalities of testosterone treatment of hypogonadal men. Investigation of CAG repeat polymorphism in exon 1 of the androgen receptor gene may be useful in testosterone treatment regimens adjustment

 

[madman]

No consensus has been reached regarding the lower TT threshold defining testosterone deficiency, and there are no generally accepted lower limits of normal TT. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or Free T that distinguishes men who will respond to treatment from those who will not.

The number of triplet CAG repeats in androgen receptors differ in men and influences the androgen receptor activity, hence testosterone sensitivity may vary in different individuals.

The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of testosterone deficiency.

So don't be fooled by "within clinical levels" and think you are all good just because your TT and Free T levels are within normal ranges. The presence of symptoms might suggest you do have a testosterone deficiency.

A trial of TRT on an appropriate protocol will answer your question as to whether your issues are T related.

Interesting!

Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring

ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

www.excelmale.com

*No consensus has been reached regarding the lower TT threshold defining TD, and there is no generally accepted lower limits of normal TT. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not

*The number of cytosine–adenine–guanine triplet (CAG) repeats in androgen receptors differ in men and influences the androgen receptor activity [88,89,90,91] (Figure 1). Hence testosterone sensitivity may vary in different individuals.

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]

 

[00roast00]

My symptoms are:

• Extreme brain fog to the point that I am forgetful and it takes a lot more effort to articulate my thoughts.
• Awful sleep. I never wake up feeling refreshed and wake up during the night multiple times.
• Low energy and mood
• Low libido/ED
• Overall I don't feel like myself anymore. I feel like an old man in a younger mans shell.

Hoping you had your blood work done between 7-10 am in a fasted state as we want to test at peak.

Let alone if you are training in the gym it would be better to take a week off before getting labs.

The causes of erectile dysfunction let alone decreased libido are complex and multifactorial.

Low libido/ED (lack of nocturnal/spontaneous daytime erections) are common symptoms of low-t.

Keep in mind dysfunction thyroid/adrenals can easily mimic low-t symptoms.

From your most recent labs, you were hitting a descent TT 17.7 nmol/L (510ng/dL).

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.

FT 5-10 ng/dL would be considered low.

FT 16-31 ng/dL (high-end) is healthy.

Most men on trt will do well with FT 20-30 ng/dL and yes there are some who will do just fine with FT 15-20 ng/dL.

Comes down to the individual.




With a TT 510ng/dL SHBG 33.5 nmol/L (normal) and Albumin 4.2 g/dL, then your FT would be around 17 ng/dL (far from low).View attachment 19952


FT of 8-12 nmol/L would be considered the grey zone and even then many men with higher T levels can still suffer from low-T symptoms due to high/highish SHBG.

You are hitting a TT low 500s and you have normal SHBG so your FT is definitely not going to be borderline/low.

Even then no one can say that these levels are optimal for you let alone should not cause any symptoms.

Much more involved especially if we get into the sensitivity of the AR/polymorphism of the AR and CAG repeat length (short/long).

As others have stated would be wise to look into Natesto or clomiphene/EN before jumping into full-blown trt.

You stated that Natesto is not an option so if you are concerned about using clomiphene/EN and were dead set on using exogenous test then I see no harm in giving it a go as long as you have a decent understanding let alone realistic expectations.

Shutting down your HPGA is not something to take lightly!

Many men do well on trt whereas others may constantly struggle especially when it comes to libido/erectile function.

No harm in trying even short-term as you can always stop and you will eventually return to baseline levels.

PCT or cold turkey.

6 months would be a decent amount of time to put in.

The most sensible approach would be to find a doctor in the know who will work with/guide you.

Taking the UGL route and flying solo may not be your best move especially if you lack the understanding of how exogenous esterified T works.

Blood work using accurate assays is critical.

Do what you feel is best for you!

Low Testosterone in Men: Recommendations on the diagnosis, treatment and monitoring

ABSTRACT The relative proportional increase of the elderly population within many countries will become one of the most significant social transformations of the twenty-first century and, for the first time in history, persons aged 65 or above outnumbered children under five years of age...

www.excelmale.com

Figure 1. Threshold continuum to hypogonadism.
View attachment 19953
View attachment 19954




post #7

*No consensus has been reached regarding the lower TT threshold defining TD, and there is no generally accepted lower limits of normal TT. This lack of consensus follows from the fact that no studies have shown a clear threshold for TT or free T that distinguishes men who will respond to treatment from those who will not




post #8

AR CAG repeat lengths (short/long)

*The number of cytosine–adenine–guanine triplet (CAG) repeats in androgen receptors differ in men and influences the androgen receptor activity [88,89,90,91] (Figure 1). Hence testosterone sensitivity may vary in different individuals.

*The same applies to androgen receptor gene CAG repeat lengths >24 in the presence of symptoms and normal testosterone levels may be considered as a state of preclinical TD [93]

*In general, it is currently speculated that variable phenotypes of androgen insensitivity exist, mainly owing to mutated androgen receptors. More subtle modulation of androgen effects is related to the CAG repeat polymorphism in exon 1 of the androgen receptor gene: transcription of androgen-dependent target genes are attenuated with the increasing length of triplets.

*As a clinical entity, the CAG repeat polymorphism can relate to variations of androgenicity in men in various tissues and psychological traits: The longer the CAG repeat polymorphism, the less prominent is the androgen effect when individuals with similar testosterone concentrations are compared.

*A strictly defined threshold to TD is likely to be replaced by a continuum spanned by genetics as well as symptom specificity. In addition, the effects of externally applied testosterone can be markedly influenced by the CAG repeats and respective pharmacogenetic implications are likely to influence indications as well as modalities of testosterone treatment of hypogonadal men. Investigation of CAG repeat polymorphism in exon 1 of the androgen receptor gene may be useful in testosterone treatment regimens adjustment

Thanks that’s a really detailed breakdown and good advice. I’m going to do 4/8 weeks clomid then if my symptoms significantly improve I’ll consider trt. Thanks again

 

[00roast00]

My brother's 15 year old chevy truck has 180,000 miles on it, it doesn't have the power it once had when brand new, and has days where it doesn't want to start, but it's working.

If anything, your LH levels show a problem with the pituitary gland or somewhere upstream. There are chemicals in the environment which can downregulate the HPTA by fooling it into thinking the body is producing too much testosterone and that is what thought to be why most secondary cases of hypogonadism and testing show no problems with the pituitary gland other than the low normal LH.

That’s really interesting, thank you. What do you think is the best course of action?

 

[00roast00]

I have have to say this is the most level headed educated advice I’ve ever received on this topic. Thank you all.

 

[Systemlord]

Thanks I will give it a trial then. How long should I wait before I should notice effects?

Due to differences in CAG repeats and current health problems, the time it takes to start feeling improvements is going to be unique to the individual.

We are talking anywhere from days, weeks or months. The time until maximum benefits are achieved is 1 year with minor improvements continuing for years.

 

[Systemlord]

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Interesting

My apologies @madman I forgot to include the link and properly quote the post as I was time constrained.