Second Opinion on Restarting TRT (Primary Hypogandism)

ClashCityRocker

New Member
I've posted on this forum before, and the feedback has been very helpful.

I'm at 3 months after a 110-day TRT trial earlier this year that was stopped mainly because of adverse sexual side effects (now improved somewhat off-therapy). The other symptoms that caused me to seek TRT in the first place have returned, however, and my labs are slightly worse than before (although in the same ballpark).

I have been down the Grok/ChatGPT rabbit hole, and they both agree I would likely do better on a low-dose daily regime, perhaps transdermal, maybe with an AI (my endocrinologist agreed to follow and respond to E2 this time but flatly refuses to prescribe hCG). I am skeptical, however, and don't want to make my situation worse.

As always, your thoughts and observations are appreciated.

The history, as concise as I could make it:
  • 5'9"; 142.4 lb; muscle mass 115 lb; body fat 14.5%; fit but relatively high body fat in legs/glutes. Fertility not desired. No other prescription meds.
Clinical history
  • Longstanding symptoms: depressed mood, poor sleep, generalized anxiety, low motivation, difficulty gaining/maintaining quality muscle, overall getting physically softer and psychologically less motivated, despite disciplined lifestyle.
  • Very healthy lifestyle: high‑protein whole‑food diet, <3 drinks/month, strict sleep hygiene, resistance training 3×/week, daily walking.
  • Remote prolonged prednisone and methotrexate use, stopped at age 40. No chemo/radiation. No history of mumps orchitis, testicular torsion, or cryptorchidism.
Relevant labs and findings (off TRT, ~3 months after discontinuation)
  • Total testosterone 411 ng/dL (Reference Range: 250-1100 ng/dL)
  • Free testosterone 56.8 pg/mL (Reference Range: 35.0-155.0 pg/mL)
  • LH markedly elevated ~19.3 mIU/mL (prior) — FSH markedly elevated ~49.9 mIU/mL
  • SHBG 51 nmol/L (slightly above RR 10–50)
  • Hematocrit 46.8% (RR 38.5–50.0)
  • Morning cortisol previously 23.1 mcg/dL (mildly high previously; nondiagnostic)
  • Pre-TRT baseline labs similar (465 total T; 68.4 free T; high normal SHBG; sky-high LH/FSH)
Prior treatment attempt
  • 110‑day trial of testosterone cypionate (IM/SC) with variable dosing/frequency:
    • Initial 80 mg IM weekly → immediate BP spike.
    • Average dose over trial ~86.16 mg/week; dosing frequency varied from daily to every 3 days
    • Labs at day 31 showed high serum T (78th percentile) and free T (84th percentile), SHBG ~50th percentile.
  • Clinical response to TRT trial:
    • Muscle gained quickly but paradoxical increase in abdominal fat.
    • CNS overstimulation, poor sleep, emotional flattening (stable but blunted affect).
    • Marked variability and overall decline in libido and sexual function: decreased genital sensation and intermittent inability to climax.
    • BP spike temporally associated with higher initial dose; BP normalized with dose reduction.
  • Discontinued TRT due to sexual dysfunction
  • After discontinuation he reported feeling markedly better for ~3 weeks (rebound); after 3 month washout sexual function improved while other low‑T symptoms returned.
What went wrong? Can I expect better results with an improved protocol? That 3 week period after discontinuation was great, but therapy felt awful, even though labs and anabolic results were good.
 
Last edited:
I've posted on this forum before, and the feedback has been very helpful.

I'm at 3 months after a 110-day TRT trial earlier this year that was stopped mainly because of adverse sexual side effects (now improved somewhat off-therapy). The other symptoms that caused me to seek TRT in the first place have returned, however, and my labs are slightly worse than before (although in the same ballpark).

I have been down the Grok/ChatGPT rabbit hole, and they both agree I would likely do better on a low-dose daily regime, perhaps transdermal, maybe with an AI (my endocrinologist agreed to follow and respond to E2 this time but flatly refuses to prescribe hCG). I am skeptical, however, and don't want to make my situation worse.

As always, your thoughts and observations are appreciated.

The history, as concise as I could make it:
  • 5'9"; 142.4 lb; muscle mass 115 lb; body fat 14.5%; fit but relatively high body fat in legs/glutes. Fertility not desired. No other prescription meds.
Clinical history
  • Longstanding symptoms: depressed mood, poor sleep, generalized anxiety, low motivation, difficulty gaining/maintaining quality muscle, overall getting physically softer and psychologically less motivated, despite disciplined lifestyle.
  • Very healthy lifestyle: high‑protein whole‑food diet, <3 drinks/month, strict sleep hygiene, resistance training 3×/week, daily walking.
  • Remote prolonged prednisone and methotrexate use, stopped at age 40. No chemo/radiation. No history of mumps orchitis, testicular torsion, or cryptorchidism.
Relevant labs and findings (off TRT, ~3 months after discontinuation)
  • Total testosterone 411 ng/dL (Reference Range: 250-1100 ng/dL)
  • Free testosterone 56.8 pg/mL (Reference Range: 35.0-155.0 pg/mL)
  • LH markedly elevated ~19.3 mIU/mL (prior) — FSH markedly elevated ~49.9 mIU/mL
  • SHBG 51 nmol/L (slightly above RR 10–50)
  • Hematocrit 46.8% (RR 38.5–50.0)
  • Morning cortisol previously 23.1 mcg/dL (mildly high previously; nondiagnostic)
  • Pre-TRT baseline labs similar (465 total T; 68.4 free T; high normal SHBG; sky-high LH/FSH)
Prior treatment attempt
  • 110‑day trial of testosterone cypionate (IM/SC) with variable dosing/frequency:
    • Initial 80 mg IM weekly → immediate BP spike.
    • Average dose over trial ~86.16 mg/week; dosing frequency varied from daily to every 3 days
    • Labs at day 31 showed high serum T (78th percentile) and free T (84th percentile), SHBG ~50th percentile.
  • Clinical response to TRT trial:
    • Muscle gained quickly but paradoxical increase in abdominal fat.
    • CNS overstimulation, poor sleep, emotional flattening (stable but blunted affect).
    • Marked variability and overall decline in libido and sexual function: decreased genital sensation and intermittent inability to climax.
    • BP spike temporally associated with higher initial dose; BP normalized with dose reduction.
  • Discontinued TRT due to sexual dysfunction
  • After discontinuation he reported feeling markedly better for ~3 weeks (rebound); after 3 month washout sexual function improved while other low‑T symptoms returned.
What went wrong? Can I expect better results with an improved protocol? That 3 week period after discontinuation was great, but therapy felt awful, even though labs and anabolic results were good.
This is just my two cents and I'm sure others will disagree with me.

For me to feel good, I need a higher dose of testosterone and HCG. We are all different. Because of your issues. I would just inject testosterone, a low dose. 10 mg daily and let it play out. I do daily injections. I pick six places shallow IM shoulders, VG and Sub-Q in love handles. Now after 9 years of dailies it's part of my daily routine.
 

hCG Mixing Calculator

HCG Mixing Protocol Calculator

TRT Hormone Predictor Widget

TRT Hormone Predictor

Predict estradiol, DHT, and free testosterone levels based on total testosterone

⚠️ Medical Disclaimer

This tool provides predictions based on statistical models and should NOT replace professional medical advice. Always consult with your healthcare provider before making any changes to your TRT protocol.

ℹ️ Input Parameters

Normal range: 300-1000 ng/dL

Predicted Hormone Levels

Enter your total testosterone value to see predictions

Results will appear here after calculation

Understanding Your Hormones

Estradiol (E2)

A form of estrogen produced from testosterone. Important for bone health, mood, and libido. Too high can cause side effects; too low can affect well-being.

DHT

Dihydrotestosterone is a potent androgen derived from testosterone. Affects hair growth, prostate health, and masculinization effects.

Free Testosterone

The biologically active form of testosterone not bound to proteins. Directly available for cellular uptake and biological effects.

Scientific Reference

Lakshman KM, Kaplan B, Travison TG, Basaria S, Knapp PE, Singh AB, LaValley MP, Mazer NA, Bhasin S. The effects of injected testosterone dose and age on the conversion of testosterone to estradiol and dihydrotestosterone in young and older men. J Clin Endocrinol Metab. 2010 Aug;95(8):3955-64.

DOI: 10.1210/jc.2010-0102 | PMID: 20534765 | PMCID: PMC2913038

Online statistics

Members online
4
Guests online
247
Total visitors
251

Latest posts

Beyond Testosterone Podcast

Back
Top