Should I do TRT?

[calmcalmcalm]

I am 21 years old, and the main symptoms that I am experiencing are low mood, anxiety and mild depression.
difficulty maintaining erection. I think I might have secondary hypogonadism.
Can you guys give me some input?

Free T is 36.61 pmol/L range is (30.88-147.50)

 

[Cataceous]

Those numbers are not sufficient to clearly suggest hypogonadism. The inexpensive direct free T tests should not be used, as they are unreliable. Instead, you should measure AM testosterone again, along with SHBG—and ideally albumin too. With these you can get a pretty good estimate of free testosterone (healthy normal range 16-31 ng/dL). Basically, if your SHBG is in the 40s nMol/L or higher then your free testosterone is at the low end of normal. But even then, I personally would be hesitant to start TRT with testosterone in the 500s ng/dL.

 

[fifty]

Treat your low LH

 

[Vince]

I agree you’re not a candidate for TRT. You would be very disappointed if you did. You could try enclomiphene to increase your lh and fsh.

 

[Systemlord]

The SHBG needs testing and I expect it to be on the higher end which would validate the Free T results. You should use the more accurate testing methods, the Equilibrium Dialysis or Ultrafiltration for further testing.

If more testing reveals very low LH and Free T on each subsequent testing on the more reliable testing methods, this just adds validation and is more than likely pointing towards low-T. It will be difficult to get the diagnoses of low-T with mainstream docs with these numbers.

A reason for elevated SHBG can be due to having low-T.

 

[calmcalmcalm]

Just spoke with Doctor Saya not too long ago. I showed him a more recent bloodwork and he said that my bloodwork have a pattern of High SHBG making my free T in the suboptimal range. He also said that SERMS(clomid,torem,enclomiphen,etc) will not work in my case since the problem is with the high SHBG, and SERMS can’t be used as a long term solution. I did try toremifene 60mg ED before the bloodwork, but lh stays pretty much the same and SHBG showing 44.

The way to lower SHBG is through TRT.

Should I do TRT? Right now I am still indecisive and leaning more towards TRT hoping that it would solve my anxiety for the main part. I am just getting cold feet about making the life changing decision.

Your advices are greatly appreciated

 

[Mountain Man]

No. You’re way to young. Get in shape and start seeing a therapist. Everything you are dealing with is very fixable, even the ED. Workout, eat right and start working with a therapist.

 

[calmcalmcalm]

No. You’re way to young. Get in shape and start seeing a therapist. Everything you are dealing with is very fixable, even the ED. Workout, eat right and start working with a therapist.

I am in shape and I do workout. I believe diet wise I am also doing fine, no processed food and only sugars are from food. I eat a high protein diet. Dr.Saya also mentioned that high SHBG can be a sign of a good diet. So I believe these are not the issues.

 

[sammmy]

Try DHEA, Zinc, and Vit D before you commit to injecting yourself for life, which may or many not address your desired goals.

 

[Mountain Man]

I am in shape and I do workout. I believe diet wise I am also doing fine, no processed food and only sugars are from food. I eat a high protein diet. Dr.Saya also mentioned that high SHBG can be a sign of a good diet. So I believe these are not the issues.

Then take a good look at treating the anxiety and the depression. Do not take any medications for it. Medications for anxiety are typically addictive, and medications for depression have a side effect of ED. You need a good therapist who is going to utilize behavioral interventions and cognitive therapy. Also, finding a relationship that is healthy will be the best cure for the ED that one can get. You have to get rid of the anxiety before you can do that. and the fact that you are in good shape is a huge plus. The physical condition is good, now work on your emotional wellness. Nothing builds confidence more than being in shape and having your mind and body in sync.

 

[Gman86]

Very interesting that u seem to have both secondary and tertiary hypogonadism. We tend to see one or the other. Primary is when ur pituitary is sending out plenty of LH, but ur testicles just aren’t working properly and will not make enough total testosterone, regardless of how much LH is being sent. Secondary is when ur pituitary fails to put out enough LH, which u clearly have. Tertiary is when there’s enough total T, but u have very high SHBG, which causes free T to be too low, and causes hypogonadism symptoms that way.

Tertiary hyponadism is extremely hard to cure through diet and lifestyle changes, from my experience and understanding. Almost always has to be treated via HRT. But ur hope lies in the fact that ur also experiencing secondary hypogonadism. That can be fixed via lifestyle changes much much easier. So I would exhaust all options in regards to getting ur pituitary to release more LH, before even considering going on HRT at ur age.

The first thing u should always start with is sleep. Sleep is, and always will be, the number one aspect of human health. So go out and get some blue/green light blocking glasses. Best tip I can give anyone, hands down. I recommend blublox, specifically their onyx sleep glasses. Put them on 2-3 hours before ur going to go to bed. Next thing to do is try to get as much sunlight in ur eyes as u can first thing when u wake up. The earlier the better. Try to go to bed around 10pm, and try to get 7-9 hours of uninterrupted sleep. Make sure ur room is blacked out, and keep it as cool as u can tolerate. Around 60 degrees is preferable. Also try to get some form of activity in each day. Whether it be lifting weights or light cardio. Also make sure to finish eating at least 2-3 hours prior to going to bed. If ur not taking magnesium, definitely start. I take it all throughout the day, in a liquid form I put in my water, but if u don’t want to take it throughout the day, at least take some before bed. I’ll link a good video on sleep tips that I watched recently. There’s obv a ton of other lifestyle changes that might need to be worked on, but I would get sleep down first, and then work on the others.

 

[Vince]

I am in shape and I do workout. I believe diet wise I am also doing fine, no processed food and only sugars are from food. I eat a high protein diet. Dr.Saya also mentioned that high SHBG can be a sign of a good diet. So I believe these are not the issues.

Have you considered trying a high fat low carb diet. With no cheating.? no spike in blood sugar . I would consider that before trying trt.

 

[Cataceous]

Very interesting that u seem to have both secondary and tertiary hypogonadism. We tend to see one or the other. Primary is when ur pituitary is sending out plenty of LH, but ur testicles just aren’t working properly and will not make enough total testosterone, regardless of how much LH is being sent. Secondary is when ur pituitary fails to put out enough LH, which u clearly have. Tertiary is when there’s enough total T, but u have very high SHBG, which causes free T to be too low, and causes hypogonadism symptoms that way.
...

My understanding is that secondary hypogonadism relates to issues at the pituitary while tertiary stems from the hypothalamus. Even if the OP is into hypogonadal territory, which is debatable, there is not sufficient information to say if it is secondary or tertiary in nature. A GnRH stimulation test could narrow it down.

 

[Gman86]

My understanding is that secondary hypogonadism relates to issues at the pituitary while tertiary stems from the hypothalamus. Even if the OP is into hypogonadal territory, which is debatable, there is not sufficient information to say if it is secondary or tertiary in nature. A GnRH stimulation test could narrow it down.

I think ur right, as usual lol. So looks like he possibly has secondary or tertiary hypogonadism, as well as let’s call it quaternary hypogonadism lol

 

[calmcalmcalm]

Try DHEA, Zinc, and Vit D before you commit to injecting yourself for life, which may or many not address your desired goals.

I am not taking DHEA as it is not the issue, and I am already supplementing with zinc and vit D as well.

TSH T3 and T4 also shows that thyroid is not the problem

 

[Cataceous]

... So looks like he possibly has secondary or tertiary hypogonadism, as well as let’s call it quaternary hypogonadism lol

I don't think the concept of "quaternary hypogonadism" works. For elevated SHBG to be identified as a unique cause of hypogonadism it would need to be so high that other parts of the system are maxed out at reasonable physiological limits. For example, if the hypothalamus were at it's limit of GnRH production, or the pituitary were at its limit of LH production, and the hormone levels were either high in-range or over-range.

That's certainly not the case here, with LH being low in-range. And SHBG of 44 nMol/L is not excessive.

@calmcalmcalm: Low doses of mesterolone (Proviron) or ostarine are mentioned as possible ways to reduce SHBG without a lot of HPTA suppression, perhaps in conjunction with a SERM. You'd need to determine if these are legal where you are and find a doctor to supervise.

 

[calmcalmcalm]

F

Very interesting that u seem to have both secondary and tertiary hypogonadism. We tend to see one or the other. Primary is when ur pituitary is sending out plenty of LH, but ur testicles just aren’t working properly and will not make enough total testosterone, regardless of how much LH is being sent. Secondary is when ur pituitary fails to put out enough LH, which u clearly have. Tertiary is when there’s enough total T, but u have very high SHBG, which causes free T to be too low, and causes hypogonadism symptoms that way.

Tertiary hyponadism is extremely hard to cure through diet and lifestyle changes, from my experience and understanding. Almost always has to be treated via HRT. But ur hope lies in the fact that ur also experiencing secondary hypogonadism. That can be fixed via lifestyle changes much much easier. So I would exhaust all options in regards to getting ur pituitary to release more LH, before even considering going on HRT at ur age.

The first thing u should always start with is sleep. Sleep is, and always will be, the number one aspect of human health. So go out and get some blue/green light blocking glasses. Best tip I can give anyone, hands down. I recommend blublox, specifically their onyx sleep glasses. Put them on 2-3 hours before ur going to go to bed. Next thing to do is try to get as much sunlight in ur eyes as u can first thing when u wake up. The earlier the better. Try to go to bed around 10pm, and try to get 7-9 hours of uninterrupted sleep. Make sure ur room is blacked out, and keep it as cool as u can tolerate. Around 60 degrees is preferable. Also try to get some form of activity in each day. Whether it be lifting weights or light cardio. Also make sure to finish eating at least 2-3 hours prior to going to bed. If ur not taking magnesium, definitely start. I take it all throughout the day, in a liquid form I put in my water, but if u don’t want to take it throughout the day, at least take some before bed. I’ll link a good video on sleep tips that I watched recently. There’s obv a ton of other lifestyle changes that might need to be worked on, but I would get sleep down first, and then work on the others.

Thank you for the reply!
Finally, someone who doesn't have a gatekeeping attitude towards TRT.
Just because I am young doesn't mean I should avoid the TRT like the plague while the same guy who said don't use TRT is enjoying a myriad of benefits from TRT itself. I am just tired of getting the same old reply of "oh you are too young" or thinking that I have not tried other methods of improving the symptoms.

I did try every trick in the book, magnesium, vitamin d, zinc,boron, etc. I also am a regular gym-goer at least 3 times a week and I do have a clean diet, I only eat processed food or sugary foods maybe 2 times at max per month but mostly I don't eat those stuff. I always sleep at least 7 hours every day and while I agree my sleep could be improved, I believe the cause of my sleep problems are the anxiety in the first place. I am a light sleeper and tend to be anxious and have racing thoughts before I go to bed making it harder for me to fall asleep. While it is not a daily occurrence but it is not that rare either.

So could I please get non-objective advice and none of that gatekeeping attitude on whether or not I should do TRT? I don't even think age should be considered as a variable here since at 21 I should be at my prime biologically and my bloodwork shows suboptimal levels and as I age it is unlikely that it will be better.

I am not saying that the advice has to be saying that I should do TRT, but if you say no please give a valid reason so that it can help me make the right decision. If you say that I shouldn't do TRT because there is a medicine that I can try first then this can help me weigh out my options, but if you are saying don't do TRT just because of my age even tough the bloodwork shows the suboptimal result and I am experiencing the symptoms and it can be fixed by "lifestyle changes" or "try vit d" please refrain from commenting. This is like saying that a new car with mechanical problems should not change the broken part and instead they should just try to drive the car more carefully and on less rocky roads just because the car is a new car hence you shouldn't replace the broken part and it should be functioning as normal while the diagnosis from a licensed mechanic(the doctor) says that the part should be replaced.

 

[calmcalmcalm]

Have you considered trying a high fat low carb diet. With no cheating.? no spike in blood sugar . I would consider that before trying trt.

Thanks for the reply Vince,
I don't see how this can help that much. Based on the research I have done it MAY help lower SHBG but it is not significant enough to alleviate the symptoms. (keyword is MAY not should).
I have never see or heard from anyone who have high SHBG being fixed only from this.

 

[calmcalmcalm]

I don't think the concept of "quaternary hypogonadism" works. For elevated SHBG to be identified as a unique cause of hypogonadism it would need to be so high that other parts of the system are maxed out at reasonable physiological limits. For example, if the hypothalamus were at it's limit of GnRH production, or the pituitary were at its limit of LH production, and the hormone levels were either high in-range or over-range.

That's certainly not the case here, with LH being low in-range. And SHBG of 44 nMol/L is not excessive.

@calmcalmcalm: Low doses of mesterolone (Proviron) or ostarine are mentioned as possible ways to reduce SHBG without a lot of HPTA suppression, perhaps in conjunction with a SERM. You'd need to determine if these are legal where you are and find a doctor to supervise.

While the SHBG and the LH is technically in range, it places my free T on the lower end of the range. My thinking is like this if you are buying a car on a price range of $30k to $100k, will there be a major difference between a car priced $35k like Honda CRV compared to ~$100k like Mercedes Benz S class? while if you compare a car on the $65k range like a Lexus to a mercedes S class, there will still be a difference however the Lexus will still be a nice car compared to the S class.

Based on my understanding Proviron or ostrarine will suppress your HPTA, even if this works it will lower my Testosterone level. Dr Saya said he is willing to prescribe me with TRT as SERMS treatment are not designed for long term solution, it should only be used as a kickstart to your HPTA system. Also, I don't think SERM will help for my case since the Testosterone is not the only issue, the low LH and high SHBG will make the SERM not optimal for my case.

 

[Gman86]

Thanks for the reply Vince,
I don't see how this can help that much. Based on the research I have done it MAY help lower SHBG but it is not significant enough to alleviate the symptoms. (keyword is MAY not should).
I have never see or heard from anyone who have high SHBG being fixed only from this.

It’s actually the opposite. Doing low carb will improve insulin sensitivity, and therefore theoretically ur SHBG should stay the same or increase doing low carb