Should I wait for symptoms before starting TRT

[TRTNewbie]

Hello,
I'm James and I'm 37 years old, 5'11.5" and 211lbs. I work out regularly, mainly focusing on compund lifts (bench, deadlift, squats). During one of my annual checkups, I asked the doc to check my testosterone because I just saw the commercial. He said that he's sure it won't be a problem but he checked anyway.

The results came back at:
LH = 4.1 Ref (1.5-9.3 mIU/mL)
FSH = 3.9 Ref (1.6-8.0 mIU/mL)
Prolactin = 11.6 Ref (2.0-18.0 ng/mL)
Estradiol = 23 Ref (< or = 39pg/mL)
Testosterone , Total, Males = 290 Ref (241-827 ng/dL)

We were both shocked so I tested again a month later:
Testosterone, Total, 277 Ref 241-827
Testosterone, Free, 59.8 REF 47-244 pg/mL
SHBG 27 REF 13-71nmol/L
PSA: 0.89 Ref 0.00 - 4.00
Vitamin B12 - 802 Ref - 211-911

I don't have any of the problems I see in the commercials. My libido is fine (I always want sex and I'm a chronic masterbater), my erections are fine, my memory is good, I have energy, I sleep well, my mind is sharp, I work out well and add weight to the bar. I feel great so it's kind of disappointing to see the test numbers so low. I eat well, getting in at least 200g of protein, take Orange Triad multivitamins, fish oil and 6,000iu's of Vitamin D. I work out consistently. I'm pretty bummed out over these numbers.

My regular doc wants to put me on Androgel. Another doc wants to put me on test cyp 200mg a week. I'm wondering if I should do it.

Here are some other labs:
Glucose, fasting 88 REF 65-99 mg/dL
Sodium 141 Ref 135-146mmol/L
Potassium 4.9 Ref 3.5-5.3 mmol/L
Chloride 105 Ref 98-110 mmol/L
Carbon dioxide 27 ref 21-33 mmol/L
urea nitrogen 15 ref 7-25 mg/dL
Creatinine 1.13 ref 0.60-1.35 mg/dL
BUN/Creatinine Ratio None ref 6-22
Uric Acid 5.1 Ref 4.0-8.0 mg/dL
Phosphorus 3.2 ref 2.5-4.5 mg/dL
Calcium 9.6 REF 8.6-10.3mg/dl
Cholesterol, total 151 Ref 125/200mg/dL
HDL Cholesterol 67 ref >=40 mg/dL
Cholesterol/HDL Ratio 2.3 ref <= 5.0
LDL Cholesterol, calculated 75 ref <130mg/dL
Triglycerides 43 ref <150 mg/dL
Protein, total 7.4 ref 6.2-8.3 g/dL
albumin 4.6 ref 3.6-5.1g/dL
Globulin, Calculated 2.8 ref 2.1-3.7 g/dL
A/G ratio 1.6 ref 1.0-2.1
Bilirubin, total 0.5 ref 0.2-1.2 mg/dL
Bilrubin, direct 0.1 ref <=0.2 mg/dL
Alkaline Phosphatase 60 ref 40-115 U/L
GGT 24 ref 3-90 U/L
AST 18 ref 10-40 U/L
ALT 16 ref 9-60 U/L
LD 137 ref 100-220 U/L
Iron, total 115 ref 45-170mcg/dL
TIBC 328 ref 250-425 mcg/dL
Transferrin saturation 35 ref 20-50%
EGFR NON AFR American 83 ref >60 mL/min/1.73m2
EGFR AFR American 96 ref >60 mL/min/1.73m2
OSMOLALITY, serum 286 ref 275-295 mOsm/kg H2O
MICROALBUMIN, RANDOM
MICROALBUMIN 0.2 ref NOT ESTABLISHED mg/dL
MICROALBUMIN, RANDOM URINE 0.2 ref < 30 mcg/mg Creat
CREATININE, RANDOM URINE
Creatinine Random Urine 108 ref 20-370 mg/dL
TSH 1.00 ref 0.40 - 4.50 mIU/L
T4, Total 5.7 ref 4.5-12.0 mcg/dL
T3 Uptake 35 ref 22-35 percent
T4, free, calculated 2.0 ref 1.4-3.8 units
CK TOTAL 102 ref 44-196
Amylase, Serum 64 ref 21-101 U/L
CBC INCLUDES DIFF/PLT
WBC 5.4 ref 3.8-10.8 Thous/mcL
RBC 5.52 ref 4.20-5.80 Mill/mcL
Hemoglobin 14.4 ref 13.2-17.1 g/dL
Hematocrit 47.2 ref 38.5-50%
MCV 85.6 ref 80.0-100.0 fL
MCH 26.1 ref 27.0-33.0 pg OUT OF RANGE
MCHC 30.5 ref 32.0-36.0 g/dL OUT OF RANGE
RDW 13.6 ref 11.0-15.0%
Platelet count 248 ref 140-400 Thous/mcL
MPV 8.8 ref 7.5-11.5 fL
Total neotrophils,% 49.6 ref 38-80%
Total lymphocytes,% 40.2 ref 15-49%
Moonocytes,% 8.1 ref 0-13%
eosinophils,% 2.0 ref 0-8%
Basophils,% 0.1 ref 0-2%
Neutrophils, Absolute 2678 ref 1500-7800 Cell/mcL
Lymphocytes, Absolute 2171 ref 850-3900 Cells/mcL
Monocytes, Absolute 437 ref 200-950 Cells/mcL
EOSINOPHILS, Absolute 108 ref 15-500 Cells/mcL
Basophils, Absolute 5 ref 0-200 cells/mcL

DIFFERENTIAL - An instrument differential was performed.
Urinalysis, Complete
Color Yellow Ref Yellow
Appearance Clear Ref Clear
Glucose, QL Negative ref Negative mg/dL
Bilirubin, Urine Negative ref Negative
Ketones Negative ref Negative mg/DL
Specific Gravity 1.015 ref 1.001 - 1.035
Blood Negative ref Negative
PH 6.0 ref 5.0-8.0
Protein, Total QL Negative ref Negative mg/dL
Nitrite Negative ref Negative
Leukocyte Esterase Negative ref negative
Squamous Epithelial Cells None Seen ref <or =5 cells/hpf
WBC None Seen ref <or =5 cells/hpf
Bacteria None seen ref none seen/hpf
RBC None seen ref <or =3 cells/hpf
Hyaline Casts None seen ref None seen /lpf
Cardio CRP (R) 0.5 ref <1.0 Lower relative cardiovascular risk
RPR w/titer + Conf RFX
RPR Screen Nonreactive ref non reactive
Vitamin D, 25-OH,LC/MS/MS
Vitamin D, 25-OH, TOTAL 85 ref 30-100ng/mL
Vitamin D, 25-OH, D3: 85
Vitamin D, 25-OH, D2: <4
Heomglobin A1C: 6.0 - Increased risk of diabetes Ref: <5.7 - decreased risk of diabetes, 5.7-6.0 - increased risk of diabetes, 6.1-6.4 - higher risk of diabetes, > or = 6.5 - consistent with diabetes

Sperm count 102M/ml ref 20-250M/ml
Motility 69% ref >30
Fructose Assay: Progression 3 ref 2-3
Semen volume 2.3 ref 1.5-5ml
viscosity 1 ref 1-1.5
pH 7.9 ref 7.0-8.3
Total sperm in ejaculate 234.6 million
Total motile sperm in ejacualte: 161.9 million

 

[TRTNewbie]

The reason why I'm contemplating going on TRT is I've been reading about the increased risk for diabetes and it runs in my family. My A1C numbers are scaring me too. My mindset is to fix this low number before it does become a problem. Am I wrong for thinking that way?

I forgot to add in the other post, I'm 20% bodyfat. It's very hard to lose weight now and I've gained most of it in my belly. My waist is now a 38 when it was a 32 for years. It's like I gained 6 inches around there in a year and a half's time. When I was in my 20's I would eat like a pig (whole pizzas for dinner) and I would stay at 160lbs.

The doc gave me a script for androgel. He said to give it a try for a month and note any changes. I do get tired in the afternoon sometimes and I sometimes lack motivation to go to the gym but from reading any forums, it's not as bad as some experiences that I've read.

Another doctor (the one that wants to do the injections) asked me to compare my moods, strength, energy, etc to when I was in my early 20's. He asked questions like: Were you more energetic in your 20's or were you stronger in your 20's? Of course I was. He asked about the quality of my erections (were you harder in your 20's, did you want more sex in your 20's? Of course I did! I was happier too (that's because I was single and living at home with little to no bills). He said that my change in attitude and outlook was due to low t. Basically, getting on TRT would give me the strength, vitality and vigor I had back in my early 20's.

Thanks

 

[zkt]

Now THATS what I call a set of labs!
Acccording to the numbers you are healtier that a whole herd of ox.
But as to the HbA1c; it does indicate a potential problem and studies have shown that TRT is beneficial in heading off insulin resistance and T2D.
BUT, understand that TRT will shut down your natural production and you seem to be doing fine as it is. Also, TRT is a long term treatment. Altho TRT can be stopped at some time in the future and pre TRT baseline values will return.
You might want to consider dietary changes to lower insulin, glucose and subsequently HbA1c rather that TRT.

 

[TRTNewbie]

I find it weird that my glucose is fine at 88 and my A1C is borderline.

I was loking at some labs from May of this year (the labs I posted are from September of this year) and my A1C was 5.2. I wonder what happened to cause that .8 jump? Diabetes does run in my family though.

 

[Bucky]

IMO, If it aint broke don't try to fix it. Go by how you feel, not how the numbers say you should be. If it wasn't for the commercial, would you have requested the T to be checked?

 

[TRTNewbie]

IMO, If it aint broke don't try to fix it. Go by how you feel, not how the numbers say you should be. If it wasn't for the commercial, would you have requested the T to be checked?

To be honest, I wouldn't have even considered it.

 

[zkt]

I find it weird that my glucose is fine at 88 and my A1C is borderline.
I was loking at some labs from May of this year (the labs I posted are from September of this year) and my A1C was 5.2. I wonder what happened to cause that .8 jump? Diabetes does run in my family though.

A familial Hx is a strong predictor of T2D.
;A1c gives a bigger picture of the general trend. But the jump of .8 ? perhaps you ate more sugars and simple carbs thatn usual for a while.
What is your diet like?

 

[toolman]

To be honest, I wouldn't have even considered it.

Just the pharmaceutical company convincing a healthy person they area sick. If I did not have all the classic symptoms, low libido, no energy, etc., then I would never have started a drug you have to take for life. My life is much better, but not without a shitload of blood work, bi weekly injections, etc. Diet and exercise can absolutely help you stave off your diabetes concerns way better than T and with far fewer sides and complications.

 

[TRTNewbie]

Breakfast is usually eggs, cereals, milk, bacon, etc. Pretty simple stuff. I usually grab some fruit for snacks and I throw in some tuna fish from the can or some other protein. Lunch will be a grilled chicken salad, a sandwich from the deli or maybe leftovers from the dinner last night. After lunch, I'd grab one of those protein shakes because I try to get between 180-200g of protein a day. Dinner will be chicken or steak, some vegetables and whatever else I need to meet my macro numbers. I have an app on my phone that I use to chase my macro numbers.

I also try to get no less than 10 glasses of water in a day. Ever since the labwork, I've agressively been cutting sugar out of my diet. I want to head off diabetes.

 

[TRTNewbie]

Just the pharmaceutical company convincing a healthy person they area sick. If I did not have all the classic symptoms, low libido, no energy, etc., then I would never have started a drug you have to take for life. My life is much better, but not without a shitload of blood work, bi weekly injections, etc. Diet and exercise can absolutely help you stave off your diabetes concerns way better than T and with far fewer sides and complications.

Thanks for sharing your experience. I have a question though. Would you be able to use a gel or cream so you can avoid the injections? From what I've been reading so far, it looks like the gels and creams are easier to deal with than the injections (I could be wrong though).

 

[cvictorg]

Hello,
I'm James and I'm 37 years old, 5'11.5" and 211lbs. I work out regularly, mainly focusing on compund lifts (bench, deadlift, squats). During one of my annual checkups, I asked the doc to check my testosterone because I just saw the commercial. He said that he's sure it won't be a problem but he checked anyway.

The results came back at:
LH = 4.1 Ref (1.5-9.3 mIU/mL)
FSH = 3.9 Ref (1.6-8.0 mIU/mL)
Prolactin = 11.6 Ref (2.0-18.0 ng/mL)
Estradiol = 23 Ref (< or = 39pg/mL)
Testosterone , Total, Males = 290 Ref (241-827 ng/dL)

We were both shocked so I tested again a month later:
Testosterone, Total, 277 Ref 241-827
Testosterone, Free, 59.8 REF 47-244 pg/mL
SHBG 27 REF 13-71nmol/L
PSA: 0.89 Ref 0.00 - 4.00
Vitamin B12 - 802 Ref - 211-911

I don't have any of the problems I see in the commercials. My libido is fine (I always want sex and I'm a chronic masterbater), my erections are fine, my memory is good, I have energy, I sleep well, my mind is sharp, I work out well and add weight to the bar. I feel great

I see no need to do anything other than what you're doing now. You have NO SYMPTOMS of low T at all [)]

 

[TRTNewbie]

So should I even worry about the numbers? Man, they are really freaking me out. I'm on tons of forums and I'm reading about guys with numbers in the 300's and 400's and reading their stories are freaking scary. I know it sounds stupid but I'm wondering if some of that stuff is going to be in my future and should I do something now to head that off.

 

[bax]

Maybe you have really good thyroid/adrenals or whatever and so are able to get by on a much lower level of test? I know for me when my test gets below even 400 I feel like death. Consider yourself lucky and don't fuck with it unless you begin having issues.

 

[TheWall]

So should I even worry about the numbers? Man, they are really freaking me out. I'm on tons of forums and I'm reading about guys with numbers in the 300's and 400's and reading their stories are freaking scary. I know it sounds stupid but I'm wondering if some of that stuff is going to be in my future and should I do something now to head that off.

We're the same age and relatively the same height and weight. I am now 38, 5'10" and 170pds. About a year ago, I started having fatigue, weight gain, low libido and then ED. My TT came in at 230. My doctor says this cannot happen overnight, so theory is for me (and probably you) my ideal TT is around 300. Once you go over the wall (for me 250) that is when the symptoms start.

I've been on TRT for about 6 months and my best days of the week are Thursday and Friday (I get my shot on Friday) when my TT is around 400.

I'd recommend waiting until you have symptoms. TRT is not perfect, I'm better than I was in the past 10 years but issues with absorption and monitoring your bloodwork 1/2 year to yearly can be a bit of a drag.

 

[TRTNewbie]

Thanks everybody for sharing your experiences. I thought TRT was easy. I was under the impression that all I had to do was put on some gel every morning after I showered and take a shot of HcG twice a week.

I'm going to continue working out and do more cardio to get rid of the bellyfat and help chase down the A1C.

 

[TRTNewbie]

I have a question though:

What would happen if I started TRT? Is it true what my other doctor said? Would I have the strength and stamina I used to have in my 20's? Would I be able to run 3 miles in 18 minutes or 2 miles in 12 like I used to? For reference, I run 3 miles in 30 minutes now. Would I be able to go to the gym and workout the same bodyparts every 3 days without getting exhaused? For reference, I have to workout the same bodypart 5-7 days. Would I be able to go out and run 7-10 miles like it was nothing? Would I be able to do 75 pushups in 2 minutes and 100 situps in 2 minutes like I used to?

Thanks

 

[TheWall]

I have a question though:

What would happen if I started TRT? Is it true what my other doctor said? Would I have the strength and stamina I used to have in my 20's? Would I be able to run 3 miles in 18 minutes or 2 miles in 12 like I used to? For reference, I run 3 miles in 30 minutes now. Would I be able to go to the gym and workout the same bodyparts every 3 days without getting exhaused? For reference, I have to workout the same bodypart 5-7 days. Would I be able to go out and run 7-10 miles like it was nothing? Would I be able to do 75 pushups in 2 minutes and 100 situps in 2 minutes like I used to?

Thanks

It depends. Everyone reacts differently.

When I started, I still had my normal supply of 230 TT added to the TRT I was at about 700 - 1000 TT my first few weeks. I did not notice a difference and although my ED was resolved I did not feel like superman. At my 6 months the natural supply had stopped and I leveled at 400 - 700 TT.

I had a very weird reaction to only the first shot. I had a burst of energy about 2 hours after that shot that lasted about 24 hours. I experienced "runners high" and I have never had that before or since. Optimism through the roof...felt like I could conquer the world. 3 days later most of my symptoms returned. I'm sure I had other imbalances (very low SHBG, etc) that allowed that particular shot to absorb and distribute quickly. I was pretty low at that point. It never happened again after that shot. I now feel like I did about 10 years ago.

My long term gains were things I was not aware were happening:

High Normal BP went to normal/low normal.
Weak eye muscle requiring reading glasses returned vision to almost 20/20 vision.
Metabolism and general digestion improved
Clarity of thinking improved greatly
Mood improved greatly (I was moody the year before but not depressed)
5 to 7 pds of muscle gained with very little effort
Generally more energy (I go walking everyday and ride a bike 8 miles on the weekend)

Now, how much of this is due directly to TRT and how much to improved digestion I cannot say...but for me you can see how necessary normal levels of TT are needed. Normal being relative only to the individual. If I could have fixed this naturally (and I tried everything for 6 months) I would have. There are so many considerations. I use T Cyp so I have to get a shot at an office so I don't have needles/T in the house with my young kids. Creams were not an option because it could affect my kids or wife. Creams sometimes do not absorb after a period of time for some people. I would not start TRT until you feel the effects rather than going for gains.

 

[TRTNewbie]

Thanks again for sharing and for the advice.

 

[TRTNewbie]

A quick update.

I found a new doctor that prescribed test c, hcg and let me inject at home. He prescribed 200mg (1cc) once a week and I decided to split that up to 60mg (.3cc) every Tuesday morning and Thursday night. I also take 250iu's of hcg on M, W, and F. I know I didn't follow his protocol but, based on my research, 200mg's was too high of a dose to start on. I also want to avoid an AI. Also, I read that twice a week injections are better than once a week so I decided to do twice a week since I'm injecting at home anyway.

I've been on 6 weeks now and noticed that within 2 weeks, my erections were firmer and harder and I lasted longer in bed. No more 2 minute man problems. Within 5 weeks, I felt more endurance and stronger in the gym. My weight is still the same and my general mood has gotten better. I've had a lot of people tell me that I'm calmer and easier to deal with. Little things that used to bother me don't. I have a better outlook on things. Also, I've had chronic epididymitis and chronic prostatitis since 2002 and I've been living with pain from that since then. The pain is usually a 3 (on a scale of 10) and I sometimes (maybe once a year) get flare-ups that are 6-7 in pain. Since I started TRT, the pain is zero. I can actually squeeze my right nut and it doesn't hurt. Before, any squeezing of it would cause a painful flare up that would last a couple of weeks. It feels good to not have that nut pain anymore.

I'm trying to decide if I should continue with the treatment. I always felt fine and never thought I had any problems but now that I started TRT, I just feel better.

 

[LW64]

Any recent labs with the protocol you're using? Taking T twice a week and HCG three times a week has the potential to run your estradiol too high. You can try injecting HCG twice a week instead.

There are more than a few posters here who have dealt with prostatitis. Do some research on it and you will find it can be related to too much tension in the pelvic floor muscles. T can help but if the muscles have been constantly in tension (lots of pressure at work or at home? tense personality type?) you can try supplementing with magnesium (acts as a mild muscle relaxant; take 300 mg/day), green tea/pomegranate/broccoli/curcumin extract supplements, hot baths, lower body stretches, and just trying to relax more.