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Scoot2300

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Hi All - I am going to be as brief as possible but would appreciate the feedback. I have done almost a year's worth of research on TRT. Talked to people who have been on it for years, at the beginning of their journey and samples of everyone in between. I have watched and read hundreds of hours of articles, videos, etc. See, I am not considering TRT because I have low T. As a matter of fact, I had my blood work done through a clinic and my levels are normal (On the lower end but still normal) but I still have the option to start. Let me explain.

I am a 47 year old male. I was a pretty good athlete throughout my youth. I have always been a gym rat, not body building per se but have a decent physique and have never waivered. My cardio could be better but I will get to that in a few minutes. After leaving high school, I went to college for a spell but it wasn't for me. I started working at a factory that involved a lot of heavy lifting. 9 years later (age 27) I was in rough shape. I had pretty much destroyed my lower back and was in extreme spasm and pain. I was given the choice of a 3-level fusion where they would fuse my L-5, L-4 and L-3 both anterior & posterior as well as 6 titanium screws with bone graphs taken from my hips to complete the fusion. I had an 11-hour surgery January 4, 2001 and was put on massive doses of Oxycontin and Percocet for as long as I wanted. I was told my recovery would take 10-12 months. Since I was a younger guy and previous athlete, I did everything they told me to do and ultimately tested my fusion early and walked, walked, walked. However, I got severely addicted to the pain killers (This was before they knew Oxycontin was literally turning people into zombies) and eventually, I needed to surrender and go to rehab where they told me that I was lucky I had a strong heart as the doses I was taking should have killed me months earlier. So, I kicked the habit successfully, along with any alcohol and never looked back. I have been sober for almost 18 years. During this time period, I got into the weight lifting again but realized I needed to change the way I exercised. I started cycling longer distances and eventually worked my way up to 40 mile bike rides. About 3 years ago, I was playing indoor soccer and felt some discomfort in my thoracic region. I got nervous and after 17 years of not seeing my original surgeons, I made an appointment and went back. They were stunned. The surgery that I had done had a lifespan of 11 years. They told me that after 11 years, the upper discs start to degrade as they are now bearing the brunt of the fused vertebrae. They took some x-rays and said my fusion was still holding very well and that what I was doing, I should keep doing it.

About a year and half ago, I noticed quite a dramatic reduction in my motivation, strength, energy, libido reduction. What I was used to lifting began to decline and I find myself in a situation that has caused me to research TRT. I had my blood work done and like I mentioned, in the normal ranges. But, I wasn't investigating TRT for this reason. I was investigating this is a potential alternative to any further surgery as I feel that if I ever need a second surgery to fuse more of my spine, my quality of life would be dramatically reduced and I could possibly become incapacitated. I am experiencing muscle issues where the graphs were taken and that also has me concerned.

So, here is my thought after all this research. If I were to pursue TRT it would be to potentially alleviate all of the reasons/symptoms I mentioned above but also, I would be "experimenting" with being able to increase bone density while being able to add, or continue to maintain, muscle growth which will translate into my never (hopefully) or at least for the foreseeable future, needing further spine surgery. I don't smoke, my BP is fine, I have slightly elevated Cholesterol (hereditary) but that is about it. Pretty healthy diet, I eat some shit on the weekends but nothing outrageous. The only medication I take is Naproxen. The clinic I am engaged in is willing to work with me for the protocol I would like (smaller more frequent dosing, etc. trust me, I have done the research on dose, HCG attempt to never use an AI unless if absolutely needed, etc.) and they will provide me with PCT should the first 6-months either not work for me or things go wrong and I need to come off. I understand that I would be messing with healthy hormones. I understand that even if I did come off, my normal production may not return to my normal levels. I understand the risks, at least on paper, and I am still leaning towards moving forward because again, this route for me, knowing what I went through 20 years ago, could be the tool that I need to essentially hold or even possibly completely stave off any further surgery. Mind you, there are a few studies (just a few) that I found which does support the bone density results I would be hoping to benefit from. I do have the other symptoms of low T but knowing my levels are normal, I don't have another explanation.

I guess what I am asking the forum is this, as the present trajectory, this could become problematic or worse within the next 5 or 10 years for me. Right now, the lesser of two evils is for me to experiment with testosterone and get my levels up to benefit from the increased bone density, muscle growth and the other residual symptoms (low libido, motivation, energy, etc.) and go down this path. I know my body well. I am losing this battle albeit slowly and the thought of another back surgery and opiates are something I am simply not willing to accept and scares me enough to try Testosterone. I am trying to think of any pertinent information that might help folks comment but that's all I got at the moment.

Thank you in advance and I appreciate any forthcoming comments.
 
Defy Medical TRT clinic doctor
I think you are putting too much hope into testosterone alone. It can be one piece of the puzzle, but there are a lot of other things going on as we age. Have you had comprehensive lab work? Can you post your results? With testosterone there can be a big difference between low-normal and normal. If you have high SHBG then normal total testosterone can still translate to low free testosterone and symptoms.

Even if your testosterone is on the low side I suggest a couple safer options instead of full TRT. First, low doses of enclomiphene can boost your natural testosterone production. Second, the Natesto testosterone nasal gel provides a short-acting boost in testosterone, giving the benefits of higher levels without the complete HPTA disruption of regular TRT.

Tests to consider:
 
Thanks for your reply Cataceous. Labs below. Cholesterol is a bit high but it is hereditary. The rest is "normal". I do appreciate your other suggestions, however, I would be getting the TRT treatment through a mens clinic and options are limited.

Testosterone, Serum 475 (NORMAL 264-916 ng/dL)

Free Testosterone(Direct) 13.0 (NORMAL 6.8-21.5 pg/mL)

Test Name Result Flag Reference Range Lab
Thyroid Panel with TSH
TSH 1.770 NORMAL 0.450-4.500 uIU/mL 01
Thyroxine (T4) 7.7 NORMAL 4.5-12.0 ug/dL 01
T3 Uptake 28 NORMAL 24-39 % 01
Free Thyroxine Index 2.2 NORMAL 1.2-4.9 01
Estradiol
Estradiol 30.8 NORMAL 7.6-42.6 pg/mL 01
Roche ECLIA methodology
Complete Blood Count (CBC) With Differential
WBC 4.1 NORMAL 3.4-10.8 x10E3/uL 01
RBC 5.14 NORMAL 4.14-5.80 x10E6/uL 01
Hemoglobin 15.5 NORMAL 13.0-17.7 g/dL 01
Hematocrit 46.2 NORMAL 37.5-51.0 % 01
MCV 90 NORMAL 79-97 fL 01
MCH 30.2 NORMAL 26.6-33.0 pg 01
MCHC 33.5 NORMAL 31.5-35.7 g/dL 01
RDW 13.1 NORMAL 11.6-15.4 % 01
Platelets 259 NORMAL 150-450 x10E3/uL 01
Neutrophils 51 NORMAL Not Estab. % 01
Lymphs 37 NORMAL Not Estab. % 01
Monocytes 9 NORMAL Not Estab. % 01
Eos 2 NORMAL Not Estab. % 01
Basos 1 NORMAL Not Estab. % 01
Immature Cells NORMAL 01
Neutrophils (Absolute) 2.1 NORMAL 1.4-7.0 x10E3/uL 01
Lymphs (Absolute) 1.5 NORMAL 0.7-3.1 x10E3/uL 01
Monocytes(Absolute) 0.4 NORMAL 0.1-0.9 x10E3/uL 01
Eos (Absolute) 0.1 NORMAL 0.0-0.4 x10E3/uL 01
Baso (Absolute) 0.0 NORMAL 0.0-0.2 x10E3/uL 01
Immature Granulocytes 0 NORMAL Not Estab. % 01
Immature Grans (Abs) 0.0 NORMAL 0.0-0.1 x10E3/uL 01
NRBC NORMAL 01
Hematology Comments: NORMAL 01
Prostate-specific Antigen (PSA), Serum
Prostate Specific Ag, Serum 0.9 NORMAL 0.0-4.0 ng/mL 01
Roche ECLIA methodology.

Insulin-like Growth Factor 1 (IGF-1)
Insulin-Like Growth Factor I 176 NORMAL 81-263 ng/mL 02
Testosterone, Free and Total
Testosterone, Serum 475 NORMAL 264-916 ng/dL 01
Free Testosterone(Direct) 13.0 NORMAL 6.8-21.5 pg/mL 01
Lipid Panel
Cholesterol, Total 275 HIGH 100-199 mg/dL 01
Triglycerides 167 HIGH 0-149 mg/dL 01
HDL Cholesterol 60 NORMAL >39 mg/dL 01
VLDL Cholesterol Cal 31 NORMAL 5-40 mg/dL 01
LDL Chol Calc (NIH) 184 HIGH 0-99 mg/dL 01
Comment: NORMAL 01
Metabolic Panel (14), Comprehensive
Glucose 93 NORMAL 65-99 mg/dL 01
BUN 15 NORMAL 6-24 mg/dL 01
Creatinine 1.14 NORMAL 0.76-1.27 mg/dL 01
eGFR If NonAfricn Am 76 NORMAL >59 mL/min/1.73 01
eGFR If Africn Am 88 NORMAL >59 mL/min/1.73 01
BUN/Creatinine Ratio 13 NORMAL 9-20 01
Sodium 140 NORMAL 134-144 mmol/L 01
Potassium 4.0 NORMAL 3.5-5.2 mmol/L 01
Chloride 97 NORMAL 96-106 mmol/L 01
Carbon Dioxide, Total 25 NORMAL 20-29 mmol/L 01
Calcium 10.0 NORMAL 8.7-10.2 mg/dL 01
Protein, Total 7.5 NORMAL 6.0-8.5 g/dL 01
Albumin 4.8 NORMAL 4.0-5.0 g/dL 01
Globulin, Total 2.7 NORMAL 1.5-4.5 g/dL 01
A/G Ratio 1.8 NORMAL 1.2-2.2 01
Bilirubin, Total 0.6 NORMAL 0.0-1.2 mg/dL 01
Alkaline Phosphatase 67 NORMAL 39-117 IU/L 01
AST (SGOT) 25 NORMAL 0-40 IU/L 01
ALT (SGPT) 28 NORMAL 0-44 IU/L 01
 
Ok, some lab work to fill in: SHBG, zinc status, vitamin D, prolactin, LH, FSH, sensitive estradiol, DHEA-S.

Regarding estradiol, what's concerning is your highish E2/T ratio, about 0.65%. However, it's not necessarily real unless confirmed by a sensitive estradiol measurement. The standard estradiol test you had is very reliable, more so than the sensitive test. However, the standard test can mistakenly count some other molecules as estradiol. It's good to calibrate it against the sensitive test at least once.

If the clinic is willing to work with you then I'd at least ask about enclomiphene. You can mention that Defy Medical is a viable alternative for you, and they do prescribe it. I believe that an HPTA shutdown is best avoided, except as a last resort. HCG can ameliorate some shutdown symptoms, but your higher level of aromatization means you could have some of the same problems I did. With hCG I never found a protocol that gave consistently good results over longer periods of time.
 
Testosterone, Serum 475 (NORMAL 264-916 ng/dL)

Free Testosterone(Direct) 13.0 (NORMAL 6.8-21.5 pg/mL)

Your Free T levels aren't great, anyone on TRT with these Free T levels with steady hormone levels would be complaining of symptoms (low libido, motivation, energy, etc.) you are describing.
 
Your Free T levels aren't great, anyone on TRT with these Free T levels with steady hormone levels would be complaining of symptoms (low libido, motivation, energy, etc.) you are describing.

At first glance.....true!

2 critical pieces missing.....SHBG let alone FT tested using an accurate assay (Equilibrium Dialysis or Ultrafiltration).

I would not rely on the piss poor direct immunoassay for FT!

Either way with a TT 475 ng/dL then his FT level would be far from optimal.
 
How can you tell it was the direct immunoassay?

post #3

Testosterone, Serum 475 (NORMAL 264-916 ng/dL)

Free Testosterone(Direct) 13.0 (NORMAL 6.8-21.5 pg/mL)







Screenshot (3398).png
 
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