Whether to go on TRT or not while obese

[maxrebo]

Hi all,

I've been quite overweight / obese for years. At my highest I weighed in a 300lbs at 5'6. Only in the last 2 or so years I've managed to lose about 50lbs. From my highest weight until now my TT has fluctuated between 250ng/dl and 385ng/dl. SHBG is low-ish at around 25nmol/L. My E2 (though with non-sensitive testing) is usually in the high 20s, low 30s.

My symptoms are:

• Depression / Inability to enjoy anything
• Low motivation, low self-confidence
• Anxiety
• Difficulty concentrating, brain fog
• Little facial hair growth (all other men in my family can grow a full beard)
• Constant fatigue
• Low libido
• Reduced penile sensitivity

Now on the one hand, I'd like to see if I can improve my TT with further weight loss, on the other hand, I feel like complete garbage with low T. Would you recommend going on TRT to improve quality of life and possibly help with fat loss? Can anyone share some experiences getting on TRT while obese or even share your protocol? I'm also quite worried about exacerbated side effects from TRT due to obesity (high e2 and all that).

 

[Vince Carter]

Though you should lose the weight and good on you for dropping 50 so far, it's could be a real stretch that that is going to reverse some low T condition. Where's your Free T lab? I can presume it wasn't all that low with your SHBG @ ~25.

 

[maxrebo]

My last blood panel didn't include Free T but my calculated Free T would be 9.1ng/dL or 2.36% based on a TT of 385ng/dl and SHBG of 25nmol/L. My previous free T labs were low-normal, unfortunately I don't have the exact values with me right now.

 

[blackebob]

If you warrant it, take it.

 

[You Gonna Learn Today]

I will give my personal experience with TRT. I myself was/am considered obese. At my highest I was at 245 and also 5'6" like you. It is a constant circle you deal with. Low energy, low libido, low self-esteem, and all of the other standard low T symptoms. I got on TRT and it has helped me with all of the mental symptoms that were causing a lot of the issues. It's also helped with energy, libido, and overall mental awareness. If I were to go back in time the only thing I would change is finding this forum a LOT sooner. I wasted about a year and a half doing it all wrong. This site has helped a ton with doing things right and giving me a better understanding of TRT.

As far as the weight goes, you need to change your diet. Unless you have major thyroid or hormonal issues causing other issues, your diet will change so many things for you. Doing TRT alone will not solve all of your problems. I thought it would for about a year and then I decided to finally change my diet. Since removing sugar, bread, tortillas, and all off the processed junk food I've dropped 39 lbs. As of this morning I weighed in at 206. I'm pushing to get to my goal weight of 185 and it's not far off. It will take time and that's the main thing you have to understand. Regardless of the energy, motivation, and all other excuses we sometimes make (because I made them all the time so I know about them), the diet is what is going to get you to lose the weight. Take it from someone your height who was/is also obese. Get on the Keto diet or something similar that cuts carbs and you will get the weight down. Even if you don't get on TRT, doing that alone may make a difference for you. But again, the only things I would change about starting TRT is not doing it sooner and not finding this site sooner.

Good luck! PM me if you ever need any advice on the diet part. I'm no expert, but I can probably help you out and I'm sure you can visit the other parts of this forum for nutrition. I'm 100% certain there are plenty of posts on here regarding the topic. I have a friend of mine that I convinced to get on keto with me. He's 5'10" and was at 306 when he started. Today he weighed in at 281 after 6 weeks. It works, but it takes time and commitment.

 

[maxrebo]

Thank you for sharing your experiences! The mental issues are what makes me want to go on TRT the most, I think that's what's been holding me back for the most part.

I think I have a pretty good grip on nutrition. I do intermittent fasting and keto (sometimes even zero carb) and I've managed to lose some weight on that. Most of my meals are basically meat and veggies/salad. I stay below 1800 kcal on most days.

However what gets me are the days where I feel so depressed and fatigued that I won't care about my nutrition anymore and I get pretty bad cravings. Some days I can power my way through it, some days I fail. Maybe this is what TRT could help me with? Even out my mood a bit and make me feel a bit more energetic and motivated.

 

[You Gonna Learn Today]

Just to add to my previous response, I am also a low SHBG (20.5nmol/l on my lastest charts) and inject ED. I've tried between 10-40mg per day and I honestly feel the best at 40mg per day (840ng/dl on my latest charts). Each of these I tried for 5 weeks while increasing it 5mg each 5 week cycle. I know that amount is a bit on the high side, but my labs are good and that's where I personally feel my best. I know others will say a lower amount will work, but everyone is different. This is what I've tried over the past 9 months or so and 40mg is where I feel my best. I have constant wood all of the time and don't have any issues with my hematocrit levels (43.6%) or any other labs (E2 40 PG/ML - I don't think this is the right E2 test, but this is what my doc uses). I don't take any AI's either.

Luckily, my doctor is amazing and open with me on this dosage as long as I feel great and my numbers come back ok. To be honest, I see it sometimes like a mental boost that I'm "juicing" everyday to keep me motivated with working out and eating well. Hahahaha I know I'm not, but whatever works, right?!?!

 

[maxrebo]

That is awesome! Have you used HCG? Did you get any E2 issues with that?

 

[You Gonna Learn Today]

Thank you for sharing your experiences! The mental issues are what makes me want to go on TRT the most, I think that's what's been holding me back for the most part.

I think I have a pretty good grip on nutrition. I do intermittent fasting and keto (sometimes even zero carb) and I've managed to lose some weight on that. Most of my meals are basically meat and veggies/salad. I stay below 1800 kcal on most days.

However what gets me are the days where I feel so depressed and fatigued that I won't care about my nutrition anymore and I get pretty bad cravings. Some days I can power my way through it, some days I fail. Maybe this is what TRT could help me with? Even out my mood a bit and make me feel a bit more energetic and motivated.

Great job on the current weight loss! We both know it's not easy, but we have to stay committed and keep pushing forward. I completely agree with you on the mental concerns. Personally, if this is the case, I highly recommend you consider starting TRT. It definitely helped me with the same exact issues you have going on. Find the right doctor in your area or if possible, even go with Defy. I'm good with my doctor or I would switch to them myself.

Good luck!

 

[You Gonna Learn Today]

That is awesome! Have you used HCG? Did you get any E2 issues with that?

I tried HCG at the beginning with my current doctor, but I didn't notice any changes with it. If anything it was raising my E2 too much which caused me to use an AI. I've had a vasectomy for a while, 42yrs old right now, and don't plan on having any more kids. I just don't see a need for HCG myself. I'm staying on TRT as long as it takes, so I'm good where I am right now and don't plan on changing anything.

 

[Tad1979]

Check out Jay Campbell’s “Definitive Testosterone Replacement Therapy Manual”... it may have some useful information for your specific situation. Though I warn you, the author speaks pretty strongly about the idea of losing as much weight as possible prior to beginning TRT, if for not other reason than more adipose/fat tissue leads to testosterone being more readily converted into estradiol, which causes problems all on its own. On a personal note, if you’re like I was, NOTHING helped me to be successful with fat lose until I started on TRT, then all of a sudden my body started responding in the expected way to weight loss strategies. Keep up with the diet and don’t forget to pay attention to your other macronutrients as there is a heavy fat component that is vital to the true ketogenic diet.

As far as whether or not TRT will help with your mood/energy, I can only share my own experience. I was having horrible insomnia, fatigue, and continued fat gain despite proper diet and time at the gym at least three times a week - but every little thing was one more weight on my shoulders that I couldn’t find the energy to crawl out from under. Within a week of starting TRT that changed - things felt like work, but didn’t feel like they were crushing me. My kids were annoying still, but I was able to take their antics with more humor and patience than before. Your labs seem incomplete without mentioning your thyroid function, so I do hope this has been tested as hypothyroidism mimics low testosterone and vice versa.

 

[maxrebo]

My thyroid has been tested multiple times. Initially, my endo suspected hypothyroidism because I had one slightly elevated TSH lab of 3.53µU/ml, but it went down again and I've had two sonograms of my thyroid since - one year apart - and they were both negative.

Thanks for sharing!

 

[You Gonna Learn Today]

One other thing I would recommend is a sleep study. Sometimes, as Tad1979 mentions in part of his post, there could be underlying issues with sleep. I am actually doing an at home sleep study this week to see if I need an APAP machine during sleep. I've been told that could also help tremendously with the fatigue and other issues I have going on (and you might too). Like others have mentioned on this board, TRT is not a magic pill. It treats some areas that it's supposed to treat, but you need to look at everything in your specific situation to see what areas need to be addressed.

 

[maxrebo]

I probably should have been more detailed in my initial post. I've had multiple sleep studies, first one showed an AHI of 16 but the other two since then have been ~5 AHI since I lost weight. It's borderline but my doc said it's not necessary to treat and with a bit more weight loss that number will go down even further.

I think for now I'm going to keep losing weight and see about getting on TRT next year if my T and my symptoms don't improve. Thanks again.

 

[Tdizzle]

One other thing I would recommend is a sleep study. Sometimes, as Tad1979 mentions in part of his post, there could be underlying issues with sleep. I am actually doing an at home sleep study this week to see if I need an APAP machine during sleep. I've been told that could also help tremendously with the fatigue and other issues I have going on (and you might too). Like others have mentioned on this board, TRT is not a magic pill. It treats some areas that it's supposed to treat, but you need to look at everything in your specific situation to see what areas need to be addressed.

I would have to agree with the possible sleep issue causing fatigue. I was diagnosed with sleep apnea about 6 years ago. Once I got my CPAP machine, what a difference !!

 

[Dr Justin Saya MD]

I would have to agree with the possible sleep issue causing fatigue. I was diagnosed with sleep apnea about 6 years ago. Once I got my CPAP machine, what a difference !!

Indeed a night and day difference for many guys.