Should I try Testosterone

[Tinman]

I have been on this site for several years and really appreciate all the info and opinions. Posted once several years ago about how “Gene’s Stack” helped me with some sexual function issues. I think increasing NO has helped my overall health in the years since. But the sexual issues have lingered and I've strongly considered TRT for years. I am pretty healthy and overall feel pretty good. Mood and energy is good, eat pretty healthy and workout 4-5 days per week. Play basketball twice a week and mix in weight training and yoga other days. My most recent numbers are…

57 years old
190 lbs

453 ng/dL total t
65.5 pg/dL free t
30 nmol/L shbg
132.2 ng/dL bio available t

My current doctor will not consider TRT at those numbers. But I recently met and talked to some guys locally who highly recommend I get on it. They suggested pellets or injections. From my research I would like to start with cream and see how it goes from there.

I have read many suggestions to newbies and people on the fence like me but curious to get opinions and suggestions from some of you about my specific numbers and situation.

Thank you in advance for your feedback.

 

[Mr_Fusion]

It's definitely time to get another doctor and take charge of your health...

 

[sammmy]

In medicine you have to treat the root cause if you want success. If you have erectile problems, best is to take cialis/viagra.

The free T calculator shows you have a normal free testosterone of 9.9 ng/dL so testosterone cannot be blamed for your sexual problems.

You can try TRT of course for a few months. It will boost sexuality in the first few weeks because the increased T levels modulate the neurotransmitters in the brain (this is known as the honeymoon period) but then your brain will adapt and the effect will go away.

 

[Guided_by_Voices]

If you're going to try it, I recommend you try a protocol that won't significantly shut down your natural production. A low dose of clomid or enclomiphene, or one of the oral/nasal types that cataceous has talked about would be a good start. If you're looking for gym benefits, I would start with the GH secretagogues since they do not shut down natural T production. IME, 12mg of clomid every other day is low risk and can help. Full-blown TRT is non-trivial to manage. I do agree that getting in contact with a medical coach (I use Defy) who is fluent in these things is desirable. Your doctor should have been bringing these ideas to you.

 

[DixieWrecked]

Give it a whirl.

 

[Systemlord]

In medicine you have to treat the root cause if you want success.

I agree with this hole heartedly.

The free T calculator shows you have a normal free testosterone of 9.9 ng/dL so testosterone cannot be blamed for your sexual problems.

You don't know this is normal Free T for him. If you group everyone together as a population and calculate the averages, it's normal. Also, it seems no one considers the impact of endocrine disruption going on in modern society.

Normal averages 30 years ago was 720 ng/dL, now it's 420 ng/dL. Everyone keeps saying your hormone levels are normal even as testosterone continues to decline every 10 years as men become more feminine.

 

[Vince]

I agree with this hole heartedly.


You don't know this is normal Free T for him. If you group everyone together as a population and calculate the averages, it's normal. Also, it seems no one considers the impact of endocrine disruption going on in modern society.

Normal averages 30 years ago was 720 ng/dL, now it's 420 ng/dL. Everyone keeps saying your hormone levels are normal even as testosterone continues to decline every 10 years as men become more feminine.

I started TRT at age 60, it's the best thing I ever did. Turning 70 soon.

 

[sammmy]

TRT does NOT improve sexual function, unless your FREE testosterone is very low (the OP's isn't). Most endocrinologists know that and that is why his doctor will not put him on TRT.

The rest is lack of logical thinking, but again the quickest way to see that TRT is not that "magical" is to try it and be disappointed like numerous cases on this forum that had normal FREE testosterone but got on TRT and are constantly looking for ways to improve libido and sexual function.

 

[Phil Goodman]

TRT does NOT improve sexual function, unless your FREE testosterone is very low (the OP's isn't). Most endocrinologists know that and that is why his doctor will not put him on TRT.

The rest is lack of logical thinking, but again the quickest way to see that TRT is not that "magical" is to try it and be disappointed like numerous cases on this forum that had normal FREE testosterone but got on TRT and are constantly looking for ways to improve libido and sexual function.

• Total Testosterone: 453 ng/dL (normal range for adult males is approximately 300-1,000 ng/dL).
• Free Testosterone: 65.5 pg/dL (normal range for adult males is about 50-210 pg/dL).

Looks like his free is pretty low. Also, you’ve been here long enough to know that most endocrinologists avoid prescribing trt because they have very outdated views on it and are hamstrung by insurance, not because it is ineffective. Lastly, there are also many users here and elsewhere who have started trt and seen great improvements. Not telling OP what he should or shouldn’t do, but your post seems a little(or lot) flawed.

 

[sammmy]

You may have been here long enough but you haven't learned much ...

Total testosterone does not matter.

Free testosterone matters, and since the test used by him is probably unreliable with an unknown range, I calculated it with the calculator: it's about 10 ng/dL with a normal range for males 5-25 ng/dL.

This is NOT LOW and does NOT explain his sexual dysfunction. Endocrinologists know that because there are studies that free testosterone must drop much lower to manifest as a sexual dysfunction. His problem is most likely vascular or nerve damage, to which the TRT will do nothing.

Last, where are the "many users here and elsewhere" that got on TRT with a previously NORMAL free testosterone and have seen a "great improvement" in sexual functioning?

Broscience is one thing, medical logic reality quite another.

 

[sammmy]

I hope this is not too complicated for the broscience inclined here:

Does Low Testosterone Cause Erectile Dysfunction?

A lot of different issues can cause erectile dysfunction, but — despite assumptions — low testosterone isn’t at the top of the list. Here’s what to know.

health.clevelandclinic.org

 

[Phil Goodman]

You may have been here long enough but you haven't learned much ...

Total testosterone does not matter.

Free testosterone matters, and since the test used by him is probably unreliable with an unknown range, I calculated it with the calculator: it's about 10 ng/dL with a normal range for males 5-25 ng/dL.

This is NOT LOW and does NOT explain his sexual dysfunction. Endocrinologists know that because there are studies that free testosterone must drop much lower to manifest as a sexual dysfunction. His problem is most likely vascular or nerve damage, to which the TRT will do nothing.

Last, where are the "many users here and elsewhere" that got on TRT with a previously NORMAL free testosterone and have seen a "great improvement" in sexual functioning?

Broscience is one thing, medical logic reality quite another.

Well what’s “normal” for one person may result in issues for another. If 10 on a scale of 5-25 isn’t low then what would you say is low? And that’s even assuming the test he used was inaccurate, which you are assuming. Just like you are assuming what his issue likely is. You may be right, and actually I’d say you probably are at least partly right that there are other factors at play here. What I don’t agree with is how you make a lot of assumptions and then act like you have the ultimate answer based on very limited knowledge and accuse anyone who disagrees with you of throwing around “broscience”.

He didn’t even say it was specifically an ED issue, though we can likely infer that’s at least part of it due to his mention of improving NO. But then again, that didn’t resolve it. He may be overtraining for his age, which trt would absolutely help with, in addition to lowering overall inflammation which helps with erection quality. But out of curiosity, can you share these studies that show testosterone has to drop much lower than 10 on a scale of 5-25 before it results in sexual issues?




And again, I’m not saying you aren’t correct or at least partly correct. I’m saying it’s quite possible trt could help him(and again not telling him he should or shouldn’t start).

 

[sammmy]

And I say it is rather improbable that TRT will help him simply because he does NOT have low free testosterone and I don't know a single case here of someone like him with normal testosterone before TRT that was helped by TRT sexually.

Now, assuming someone with ED is necessarily low on testosterone and denying the fact his free testosterone is actually normal, because it is not in the upper part of the range, to me is raging broscience that leads to nowhere.

Every Endocrinologist or Urologist knows that, as the link that I posted. Regarding how low the free testosterone must get to present as sexual dysfunction, there is Google.

 

[sammmy]

No correlation between sexual functioning and testosterone level, as long as it is in the normal range, so "low normal" or "high normal" is the same sexually:

Sexual function does not change when serum testosterone levels are pharmacologically varied within the normal male range - PubMed

These data indicate that erectile function and sexual activity and feelings are restored by relatively low T levels. These data may help explain why some partially hypogonadal men continue to have normal sexual function and the absence of good correlation between serum T levels in the normal...

pubmed.ncbi.nlm.nih.gov

 

[Systemlord]

And I say it is rather improbable that TRT will help him simply because he does NOT have low free testosterone and I don't know a single case here of someone like him with normal testosterone before TRT that was helped by TRT sexually.

Now, assuming someone with ED is necessarily low on testosterone and denying the fact his free testosterone is actually normal, because it is not in the upper part of the range, to me is raging broscience that leads to nowhere.

Every Endocrinologist or Urologist knows that, as the link that I posted. Regarding how low the free testosterone must get to present as sexual dysfunction, there is Google.

You're not either deficient or not deficient, there's no hard line, it's a spectrum. You can have an insufficiency where only minor symptoms are present at first, such as lower libido and a degree of ED.

It's also been suggested by many experts in the field of testosterone that Free T in the bottom 25% percentile to be a sign of hypogonadism.

You can exclude me.

 

[Seagal]

Testosterone Therapy Improves Erectile Function and Libido in Hypogonadal Men - PMC

Erectile dysfunction (ED) and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play in men with low testosterone levels. The aim of this review is to provide ...

pmc.ncbi.nlm.nih.gov

In early 2017, Corona et al. performed meta-analysis of 14 RCTs that studied the effect of TTh on erectile function in men with late onset hypogonadism, and compared pre- and post-IIEF scores [25]. Overall, when compared to placebo, TTh provided only a modest improvement in IIEF-EF, as the mean difference between groups was 2.31 points. The mean change in IIEF-EF, however, was greater when data were stratified by baseline testosterone level. In primary studies using a testosterone threshold <8 nM (231 ng/dL), IIEF-EF increased by 2.95 points, whereas in primary studies with testosterone threshold of <12 nM (346 ng/dL), only a 1.47 point increase in IIEF-EF was observed [25]. Given that a greater improvement in erectile function was observed in studies using a lower testosterone threshold, this supports the theory that once a threshold of “normal” testosterone level is achieved, higher testosterone levels do not further improve erectile function [26]. This definitive study by Corona et al. also suggests that TTh may be a useful monotherapy in men with mild ED.

 

[Phil Goodman]

Testosterone Therapy Improves Erectile Function and Libido in Hypogonadal Men - PMC

Erectile dysfunction (ED) and decreased libido are common complaints in the older male population. Recent studies have elucidated the role testosterone therapy (TTh) can play in men with low testosterone levels. The aim of this review is to provide ...

pmc.ncbi.nlm.nih.gov

In early 2017, Corona et al. performed meta-analysis of 14 RCTs that studied the effect of TTh on erectile function in men with late onset hypogonadism, and compared pre- and post-IIEF scores [25]. Overall, when compared to placebo, TTh provided only a modest improvement in IIEF-EF, as the mean difference between groups was 2.31 points. The mean change in IIEF-EF, however, was greater when data were stratified by baseline testosterone level. In primary studies using a testosterone threshold <8 nM (231 ng/dL), IIEF-EF increased by 2.95 points, whereas in primary studies with testosterone threshold of <12 nM (346 ng/dL), only a 1.47 point increase in IIEF-EF was observed [25]. Given that a greater improvement in erectile function was observed in studies using a lower testosterone threshold, this supports the theory that once a threshold of “normal” testosterone level is achieved, higher testosterone levels do not further improve erectile function [26]. This definitive study by Corona et al. also suggests that TTh may be a useful monotherapy in men with mild ED.

Summary:

The available literature supports a role for TTh in men with low testosterone levels, ED, and low libido, with symptomatic improvement in these men.


Also, for the one you referenced, it says it does not further improve symptoms, there was an improvement in the higher group… it just wasn’t as pronounced as the results from the lower group. So it’s not as simple as some imply that if you are low you see improvements but anything above that results in no improvements. There isn’t some magical cutoff where a person sitting at 9 will see results but someone with a level of 10 will see no benefits.


But we’d honestly need more info from OP to offer more detailed insights. We’re kind of getting sucked into the rabbit hole of whether or not trt can help with ED, and if so what levels it can provide relief for. There is a lot more to it when it comes to sexual performance like energy, confidence, libido, etc.

 

[Seagal]

Summary:

The available literature supports a role for TTh in men with low testosterone levels, ED, and low libido, with symptomatic improvement in these men.


Also, for the one you referenced, it says it does not further improve symptoms, there was an improvement in the higher group… it just wasn’t as pronounced as the results from the lower group. So it’s not as simple as some imply that if you are low you see improvements but anything above that results in no improvements. There isn’t some magical cutoff where a person sitting at 9 will see results but someone with a level of 10 will see no benefits.


But we’d honestly need more info from OP to offer more detailed insights. We’re kind of getting sucked into the rabbit hole of whether or not trt can help with ED, and if so what levels it can provide relief for. There is a lot more to it when it comes to sexual performance like energy, confidence, libido, etc.

I understand... I just wanted to provide more nuanced scientific information. I hoped the cited paragraph would be a motivation to read further.
I'm confident that more anecdotal reports will come soon.

 

[Phil Goodman]

I understand... I just wanted to provide more nuanced scientific information. I hoped the cited paragraph would be a motivation to read further.
I'm confident that more anecdotal reports will come soon.

Oh yeah, that’s how I took it and thanks for the resource. Things are almost always more nuanced than people tend to think. Like the saying goes… a conclusion is usually just where you end up when you’re tired of thinking about something.

I do think Sammy has a good point about trt not being terribly effective at resolving severe(and maybe not even moderate in a good bit of cases) ED. But that isn’t the end of the discussion, and it isn’t as cut and dry as he has seemed to imply in this thread(or at least as cut and dry as I’ve interpreted his responses). And I’d say a study where they take 11 people, artificially crash their test levels, elevate them at two different doses, then follow up after 30 days is certainly not a conclusive study(or even a very good study).

 

[FunkOdyssey]

A couple things no one has mentioned yet:

He wants to try cream, which among all TRT modalities is most strongly associated with improved libido and erectile function. Supraphysiologic DHT is certainly a factor here and perhaps also the shorter half-life and less HPTA suppression. I think it is possible that even sexually healthy men with normal testosterone levels would see enhancement in some areas with the use of scrotal cream.

CAG repeats. If you want to state with certainty that someone at a given testosterone level is not functionally hypogonadal, you need to know the number of CAG repeats on their androgen receptor genes. If you don't have that information, you have no basis to confidently declare them eugonadal. If you think this throws the entire concept of diagnosing hypogonadism based on levels alone out the window, you're right.