Start TRT with "Normal" Levels?

[jimmydiesel]

First post here: Been trying to make the jump for a year to start TRT.

6'0 height, 160 lb weight, Total T crashed down to about 275 ng/dl after losing about 50 lbs a little over a year ago. The numbers improved but the symptoms got worse.

Doctor (anti-aging clinic) suggests I start TRT for symptom relief. I started to experience virtually every "Low T" symptom over the past few years. It was tolerable until the mental stuff recently hit, bad anxiety, depression, brain fog, etc. Very nervous to start this therapy as I don't think I could handle feeling worse at the moment.

Last Year I had a total T @ about 280 ng/dl (range 280-1100)
This year I had other labs come back at total T between 400-660.Most recent was total t @581 ng/dl.
Free T has been between 6 and 10.46 ng/dl (range 1.9-27)
SHBG has been between 43 and 67 nmol/l (range 14.55-94.6)
LH is 3.4 mIU/ml (range 1.5-9.3)
E2 is 22.5 (range <40) non sensitive i believe

I've never used steroids, or been any type of hormones.

Absolutely no endurance, zero libido, and the opposite of a “sense of well being” that you often hear TRT patients say they get.

Not looking to increase gym gains or anything like that as I don’t even have to stamina to complete a workout.
I was told that it’s less about levels and more about symptom relief- and also that I had a higher shbg which could attribute to symptoms.

Doctor says he'd like to see me double my free and total t numbers, but specifically he said he wants free t about 20 ng/dl at least.

I know I'm not extremely low, and most people would call this in the normal range. Has anyone had these types of levels and had success with TRT?

Any advice, opinions and expertise welcome

Also wondering if I can just start with T and add HcG Later if needed. Doctor wants to start me on both, but I'm pretty freaked out about the HcG because theres so many differing experiences and opinions on it. Not trying to ever have any more kids- but I understand it can help with mood and libido?

Thanks

 

[Jiu Jitsu Dude]

In my opinion I would not go on trt with your numbers. It can be emotionally gruelling to get this dialed in. I started trt 12 weeks ago with T levels between 154 -300ng/dl. My bio available T was under the range of acceptable levels (i.e. not even on the range scale). The anxiety I've experienced can be horrible at times. But with that being said I have also experienced great benefits of trt too. But it is still an emotional roller coaster for me but I do believe we will get it dialed in and be successful. It is common for those who don't need trt for trt to make things even worse. You may simply be depressed or struggle with anxiety. That could also cause your symptoms.

I could be totally wrong but I've read about scenarios like yours many times and wonder why did they even start trt? Be careful, messing with hormones is a very serious matter and should only be undertaken if you definitely need the intervention. Be careful Jimmy

 

[Systemlord]

It seems as if SHBG is choking your Free T and as SHBG fluctuates your Free T is also fluctuating as you see in your labs. I would start TRT in isolation so you have only one variable to adjust at a time and add HCG later after you dial in your TRT protocol, this way if you experience symptoms you'll know the HCG is the cause.

Two injections per week is best given your SHBG level.

 

[Vince]

Have you ever had a complete thyroid panel, TSH, free T4, free T3, reverse T3 and both antibodies? Bad thyroid levels can have the same symptoms as low testosterone, also low free T3 or high reverse T3, will also lower your testosterone.

 

[jimmydiesel]

Have you ever had a complete thyroid panel, TSH, free T4, free T3, reverse T3 and both antibodies? Bad thyroid levels can have the same symptoms as low testosterone, also low free T3 or high reverse T3, will also lower your testosterone.

The testing I have does the , T3 free, T4 FREE and TSH.
FWIW, most recent:
T3 Free: 3.7 pg/ml (range 2.3-4.2)
T4 Free: 1.26 ng/dl (range 0.89-1.76)
TSH: 0.960 uIU/ml (range 0.55-4.78)
Doc said thyroid looked "fine." I don't know what these numbers mean, but I do run a average low oral temp, which i've read might mean something? always under 98.6, rarely over 98.0 unless feverish.

 

[jimmydiesel]

It seems as if SHBG is choking your Free T and as SHBG fluctuates your Free T is also fluctuating as you see in your labs. I would start TRT in isolation so you have only one variable to adjust at a time and add HCG later after you dial in your TRT protocol, this way if you experience symptoms you'll know the HCG is the cause.

Two injections per week is best given your SHBG level.

A higher shbg warrants more frequents injections? This I did not know. can you explain a little more about that?

I would much rather start TRT without HCG for the specific reason of only adding one variable at a time. Especially since everything I have read suggests wildly different HCG experiences.

 

[jimmydiesel]

In my opinion I would not go on trt with your numbers. It can be emotionally gruelling to get this dialed in. I started trt 12 weeks ago with T levels between 154 -300ng/dl. My bio available T was under the range of acceptable levels (i.e. not even on the range scale). The anxiety I've experienced can be horrible at times. But with that being said I have also experienced great benefits of trt too. But it is still an emotional roller coaster for me but I do believe we will get it dialed in and be successful. It is common for those who don't need trt for trt to make things even worse. You may simply be depressed or struggle with anxiety. That could also cause your symptoms.

I could be totally wrong but I've read about scenarios like yours many times and wonder why did they even start trt? Be careful, messing with hormones is a very serious matter and should only be undertaken if you definitely need the intervention. Be careful Jimmy

Thanks for your response. I'm well aware the commitment and risk involved which is why I posted here and am so hesitant to jump on board. I know replacing T isn't a cure all especially for those with anxiety and depression. It really seems like a "chicken or the egg" type of scenario when mood issues are present with low normal T levels. What causes what? I would like to believe that regardless of cause of these mood issues, T would be helpful at my age and my scenario for a few reasons. Here they are

1. My natural levels are not going to get any higher.
2. Depression and Anxiety are always idiopathic to physicians. They always want you to take some anti-depressants. I believe chemical imbalance theory is not the only game in town and most studies show antidepressants being as effective as placebo. I took anti-depressants as a teen and early 20's for GAD, and will never go down that road again. Therapy alway works better.
3. I'm seeing a lot more info over the past few years about inflammation being a cause of Depression and anxiety/brain fog. Higher levels of T= less inflammation in brain and body, and Low T is correlated with higher inflammatory markers. So another "chicken or the egg."

 

[Systemlord]

A higher shbg warrants more frequents injections? This I did not know. can you explain a little more about that?

I would much rather start TRT without HCG for the specific reason of only adding one variable at a time. Especially since everything I have read suggests wildly different HCG experiences.

Your SHBG isn't high enough to warrant once weekly injections, twice weekly is fine for most high SHBG men.

 

[Jiu Jitsu Dude]

Thanks for your response. I'm well aware the commitment and risk involved which is why I posted here and am so hesitant to jump on board. I know replacing T isn't a cure all especially for those with anxiety and depression. It really seems like a "chicken or the egg" type of scenario when mood issues are present with low normal T levels. What causes what? I would like to believe that regardless of cause of these mood issues, T would be helpful at my age and my scenario for a few reasons. Here they are

1. My natural levels are not going to get any higher.
2. Depression and Anxiety are always idiopathic to physicians. They always want you to take some anti-depressants. I believe chemical imbalance theory is not the only game in town and most studies show antidepressants being as effective as placebo. I took anti-depressants as a teen and early 20's for GAD, and will never go down that road again. Therapy alway works better.
3. I'm seeing a lot more info over the past few years about inflammation being a cause of Depression and anxiety/brain fog. Higher levels of T= less inflammation in brain and body, and Low T is correlated with higher inflammatory markers. So another "chicken or the egg."

I had/do struggle with depression and some anxiety and 50mg of Zoloft was a life saver for 18 years. And Gabapentin worked like a charm for anxiety. I still take low doses of both. It has really helped. But it cannot overcome Low T.

I thought the Zoloft was pooping out but then the low T the symptoms can mimic that identically. But I had all the classic signs of low T also. I may find out that both are true. But I'm hoping that fixing the low T will put me back where I was and no Rx med change.

My brain is so sensitive to any outside chemicals. It's a little daunting to strike a good chemical balance for me. Like I had for 18 years.

I understand your thinking. And I hope and pray that it works for you (and me too God! lol). Just tread carefully. I guess you (and me for that matter) could get off in 6 months if it takes you down a rabbit trail. Take care Jimmy.