TRT for obese guy

[maxrebo]

I weigh 250lbs @ 5'6, down from 300lbs. At my highest weight had a TT between 250ng/dl and 320ng/dl. I'm now up to 380ng/dl. My SHBG increased as well from 22 to 29. However, I've been noticing my symptoms getting worse as I've lost weight. For one, I'm a more depressed, apathetic and fatigued than I was before but also I've been having more issues with ED and libido as well as penile sensitivity. I'm guessing that even though my TT is a bit higher, because my SHBG is higher my FT is lower now which is causing these issues. Also my e2 dropped from the weight loss from ~36pg/ml to around 21pg/ml - though with the non-sensitive test.

I would like to give TRT a try. I'm in Germany so my main options are Nebido (1000mg undecanoate every 8-12 weeks) or gels. Given my weight I would probably prefer the gels so my E2 doesn't spike as it probably would with the massive dose of the Nebido. However from what I read, with gels there can be issues with bad absorption and possibly increased DHT conversion. Also I could try to see if my uro would be willing to split up the Nebido dose - maybe 250mg every 3 weeks?

Any recommendations?

 

[Systemlord]

Thyroid testing is needed, rapid weight loss can increase Reverse T3 which can block Free T3, the most potent thyroid hormone. Insulin resistance and high body fat can lower SHBG, now that you have lost weight SHBG has increased. I got a small increase in SHBG after losing 10 pounds.

Nebido will not work for everyone, especially those who metabolize testosterone quickly, those men will not feel well on Nebido. I would try the T-Gel first before starting the Nebido because it might take a long time for Nebido to start showing results if at all.

If T-Gel works well for you, you should know very soon. When I applied Axiron and Androgel together it only took a couple of hours to feel amazing. It just shows you how poorly I absorb T-Gels if I needed two different T-Gels applications get results that surely would have faded given more time as my natural production shut down.

 

[maxrebo]

Thanks for the response! I didn't lose the weight quickly, it took me 2 years to lose those 50lbs. My thyroid has been tested regularly over the last 4 years, according to my endocrinologist there's nothing wrong with it.

 

[Vince Carter]

Thanks for the response! I didn't lose the weight quickly, it took me 2 years to lose those 50lbs. My thyroid has been tested regularly over the last 4 years, according to my endocrinologist there's nothing wrong with it.

Saying there is nothing wrong doesn't mean anything. We deal with numbers and lab reports not "it's in range", etc etc

 

[maxrebo]

True, my bad! Here's the latest thyroid panel I had on the 4th of October:

fT3 - 3.37pg/ml [2 - 4.4]
fT4 - 1.27ng/dl [0.93 - 1.7]
TSH - 1.7 uIU/ml [0.27 - 4.2]

 

[Systemlord]

True, my bad! Here's the latest thyroid panel I had on the 4th of October:

fT3 - 3.37pg/ml [2 - 4.4]
fT4 - 1.27ng/dl [0.93 - 1.7]
TSH - 1.7 uIU/ml [0.27 - 4.2]

While those results look good, in the absence of Reverse T3 testing it doesn't provide the full picture. A lot of doctors don't look at Reverse T3 until TSH is elevated, yet my TSH is 1.0 which looks optimal on the surface until you check my Reverse T3 which is high and blocks a portion of my Free T3 at the receptors since they compete for the same receptor.

So now my Free T3 levels don't look so great anymore. Now that I know it's elevated perhaps there's something in my diet or lifestyle I can do to lower it now that I'm aware of it. In my case insulin resistance and high body fat percentage is the cause.

Whenever the body is under stress whether mental or physical, Reverse T3 will be elevated.

Other than the lack of Reverse T3 testing, thyroid looks good.