Newb potentially starting TRT in the next few months. Advice?

[ChronosOceanus]

Hi Steroidology,

My journey here started about year ago when my wife and I first started trying to get pregnant (we are both 33 now, I'm 6', 190 lbs, estimating 15-16% BF). After the first few months of nothing happening we were still hopeful, but thought it may be something going on with her fertility since her older sister had issues, too. After about 9 months we went to a fertility specialist, and her initial tests went fine. I had a semen analysis and bloodwork done and found out that my sperm count was 0. Test levels came back at 214 ng/dL (FSH: 35.9 mIU/mL, LH: 8.1 mIU/mL). The second semen analysis came back with 0 sperm, as well, answering our questions about why she wasn't getting pregnant. My hormone levels the second time around are:

Testosterone Total: 425 ng/dL
Estradiol: 10.7 pg/mL
LH: 13.9 mIU/mL
FSH: 29.4 mIU/mL

After finding out out that I was azoospermic we decided to have our urologist perform a surgery called micro-TESE in which he dissects the testicles and uses a microscope to basically look for sperm, and extract any that are found to use in IVF. Unfortunately, none were found which was a disappointment - but we are moving on.

My urologist did advise that this procedure sometimes causes a severe drop in testosterone production due to testicle damage. Because of this, I'm going to get another hormone panel done in about a month (3 months post-surgery) to determine if there have been any changes. If so, he said we can discuss TRT. At my post-surgery follow up appointment I tried to ask him about the TRT process, but he was in a rush and I didn't get to ask all that I needed (kind of rude). I did ask if there was a "cut-off" and he said that Testosterone levels need to be below 300 ng/dL with symptoms.

My questions:
1) If I don't have a severe drop in testosterone in my next panel do you guys think ~400 ng/dL is still low for my age?

2) Would low-normal levels still justify seeking out other sources for TRT therapy (Defy Medical, IMT) if my urologist won't go down that road? I've been a low-energy person ever since high school, have mild depression and anxiety, irritable a lot of the time, and lack motivation/focus. Libido is usually fine, usually have morning erections, but some days it's non-existent/no morning wood. I feel like I'm decently successful in life DESPITE these things, but that I could be doing so much better (i.e. "I have so much potential..."). I did have a trainer for ~2 years several years ago which helped put on some muscle (I was always decently athletic), but eventually plateued both in strength and physique. I basically have a layer of fat on my stomach/chest/love handles that would not go away despite my best efforts (heavy lifting, HIIT) and very clean diet.

3) Is it strange that now that I've been researching it that I WANT to go on TRT? I know once I start it's for life. But, I don't think I'd mind doing injections, and I'm infertile anyway - so who the fuck cares about that now?

Thanks for any advice for this newb!

 

[Milton]

Welcome! Looks like you need to get in touch with 3J http://www.3jsdiet.com/ and here in the forums and get his advice on how to get started. You all are still young and if you attack this from a diet base perhaps your count will go up.

 

[ChronosOceanus]

Thanks for the welcome post! I'll see if I can find 3J.

If anyone knows about a diet that can boost my testosterone by several hundred points I'm all for it, but haven't heard of such a thing throughout my weightlifting/fitness time. It's been very dialed in in the past, and currently 80% "good", whole food. I stick mostly to chicken, eggs, lots of veggies, some rice, fish every few days. Avoid sugar/breads as much as possible.

Weekends aren't great all of the time with the dessert and pasta though. I usually have a few drinks on Fri/Sat, too, but don't overdo it.

 

[Milton]

I hope at least one of you likes to cook since there are so many good foods like shrimp, tuna, strawberries to name a few, to prepare that are loaded with vitamins and minerals that boost Testosterone levels naturally. Above all things make sure to get your meats and vegetables from organic sources to get the most out of your tasty meal.

 

[ChronosOceanus]

I love to cook, and she is getting better. All meats and butter are organic, if not grass-fed/finished, too. Some veggies we do organic, some not.

I usually have some canned tuna once or twice a week on a big ass salad w/ olive oil & vinegar. I'll look into shrimp since they are tasty. I'm semi-allergic to strawberries, though. I get a little rash whenever I eat them.

 

[PrinceDianabol]

Thanks for the welcome post! I'll see if I can find 3J.

If anyone knows about a diet that can boost my testosterone by several hundred points I'm all for it, but haven't heard of such a thing throughout my weightlifting/fitness time. It's been very dialed in in the past, and currently 80% "good", whole food. I stick mostly to chicken, eggs, lots of veggies, some rice, fish every few days. Avoid sugar/breads as much as possible.

Weekends aren't great all of the time with the dessert and pasta though. I usually have a few drinks on Fri/Sat, too, but don't overdo it.

There is none. A healthy diet certainly will help, but simple dietary changes are not and will never push you several hundred points on the scale unless you were seriously undernourished to begin with.
Ensure you are getting plenty of micronutrients (especially the fat-soluble vitamins A, D, E and K) and some essential fatty acids (avocados, fish oil, fatty fish, peanut butter, etc.) All that and calories set at maintenance or above + good hydration and that's the best you can do with diet.

Other things to ensure is adequate sleep on a fairly consistent basis and regular exercise, which you seem to already be doing. You will need follow up bloodwork to be sure, but honestly at your age I'd probably opt for TRT if I got that same value back consistently and you've checked all the boxes above.

Of course, all this is depending on you fully understanding the commitment:
*inject twice per week with 23-25g pins (Test)
*inject twice per week with slin pins (hCG - if you choose to go that route, might not need to in your case.)
*take a pill anywhere from twice per week to every day (Aromatase inhibitor to keep estrogens within healthy ranges.)
*donate blood every three months (if needed to keep RBC/hematocrit down, I don't but a lot of guys do.)
*bloodwork every 1-3 months for the first year or so (dialing in.)
*bloodwork every 3-6months for the rest of your life thereafter (constant check ups. Not such a bad thing as you get to keep a constant eye on your overall health, something most other people miss out on.)



I believe I've already answered your first question, as to the second yes if you feel you need it. Just try other GPs until you find someone worthwhile. What country are you in btw?

 

[ChronosOceanus]

Thanks for the reply, PrinceDianabol. I'm in the US (NJ).

I do take 4,000 IU of Vit D3 every day, but haven't looked into A, K, or E. I also take ~5g of high quality fish oil every day, too. I eat almonds and avocados. Sleep is at least 7-9 hours every night (except some weekends). Drink plenty of water, and I'd estimate like 2,600-3,000 calories per day, but haven't counted calories in years. I do BJJ twice a week and supplement with lifting (usually 1-2x/week, and some sprinting/HIIT).

So pretty decent job on that type of stuff. Is it perfect? No, but probably better than a lot of people.

I'm also concerned about my strength. The most I've ever squatted was 215 lbs., which is nothing for my size - especially after working on increasing this weight for months. I should be able to bench that much. Deadlift max is a little better at 285 max, but I still feel that I should be able to do MUCH more. That's on a hex bar, too, which is supposedly easier than traditional. And in BJJ, I do get my ass beat a lot for my size, but that could be technique since I'm still a white belt, but who knows.

I'd say if I knew that TRT made my energy levels increase to that of a "normal" person, gave me more focus at work, better mood on a daily basis, and increased sex drive, I would do all of the injections/pills/bloodwork/checkups in a heartbeat.

 

[PrinceDianabol]

Thanks for the reply, PrinceDianabol. I'm in the US (NJ).

I do take 4,000 IU of Vit D3 every day, but haven't looked into A, K, or E. I also take ~5g of high quality fish oil every day, too. I eat almonds and avocados. Sleep is at least 7-9 hours every night (except some weekends). Drink plenty of water, and I'd estimate like 2,600-3,000 calories per day, but haven't counted calories in years. I do BJJ twice a week and supplement with lifting (usually 1-2x/week, and some sprinting/HIIT).

So pretty decent job on that type of stuff. Is it perfect? No, but probably better than a lot of people.

I'm also concerned about my strength. The most I've ever squatted was 215 lbs., which is nothing for my size - especially after working on increasing this weight for months. I should be able to bench that much. Deadlift max is a little better at 285 max, but I still feel that I should be able to do MUCH more. That's on a hex bar, too, which is supposedly easier than traditional. And in BJJ, I do get my ass beat a lot for my size, but that could be technique since I'm still a white belt, but who knows.

I'd say if I knew that TRT made my energy levels increase to that of a "normal" person, gave me more focus at work, better mood on a daily basis, and increased sex drive, I would do all of the injections/pills/bloodwork/checkups in a heartbeat.

Well I'd say you've got your bases pretty well covered already mate. Don't bother supplementing with A, K or E, they won't anything significant. The main one there was vit D actually - but you're already supplementing it. In fact between that, your fish oil & diet choices you've pretty much already got an optimal diet for T production. Plus the sleep, water and exercise. Honestly, you're doing more to benefit your natural T production than 90% of the other guys that come here with low values...

IMO you would very likely benefit a lot from TRT. My levels pre-TRT were roughly the same as yours, I can't even tell you how much better I feel. I'm cutting at the moment and this being my first cut since starting TRT and it has gone insanely better than before. Hunger control is soo much easier, fat is melting off much quicker, recover much better from work outs. The biggest change for me was in my energy and mood. Not saying this is ENTIRELY from TRT but I did get promoted twice in the last 8months since starting TRT. Several co-workers said they noticed I'm much more energetic/motivated and happier these days. I do believe it had a big contribution to my recent 'successes.'

I can't stress enough though that you definitely need to confirm via repeated blood tests, as it's possible (although unlikely) that value was a one-off. And looking into restarts or trying AI monotherapy first would be another option to consider. However, if bloodwork confirms and you are prepared and ready for it, TRT would reign supreme over the other options.

 

[PrinceDianabol]

Also, keep in mind TRT is for life. Some people have the notion they can go on and see how it is, bail out if they don't like it or just do it for a year or two. Not a good choice, as your levels will almost ALWAYS be lower than when you started. If you go on, you never go back off. Or if you try you'll get kicked in the face with hypogonadism and never want to again

 

[ChronosOceanus]

Thanks, PD. I'll definitely wait to confirm with a third blood panel next month, and go over everything with my urologist. If it does turn out to be the same low level and he wants to move forward with TRT, but doesn't want to do HCG or AI's (if needed), should I still consider going through him, or do you think it's better to go through a Defy or IMT to get the best all around therapy? He's a young guy (late 30's/early 40's) so he should be up with recent research, but I guess you never know. Our health insurance is pretty comprehensive in network, so that's a plus, but we aren't hurting financially so going to an outside clinic isn't out of the question. I am concerned about the 6 month wait time that Defy has for the first blood panel follow up after the first injection. I haven't looked too much into IMT's procedures, though.

Funny you mention that your co-workers noticed those changes. My manager has made comments directed at me to be more energetic and enthusiastic when presenting, and how we could use more energy in our group (when we were looking through candidates to fill an open position).

And cutting...yeah...it works great for my face/arms/legs, but does nothing for belly/chest fat.

 

[christianbber]

I'm in your exact same shoes.

I'm 30 years old, my total testosterone ranged between 192ng/dl - 434ng/dl.

Younger 20's... had tons of energy... very smart... loved the gym...

Past few years just went downhill. No energy, brain fog, low sex drive, moody, etc..

TRT is very opinionated... VERY. Everyone has an opinion on TRT and on very long ends of the spectrum.

Personally, I just did not want to go the rest of my life with low levels.... Injections ? Blood work ? Donate blood ? That is a very small cost in return for my younger self back. Is it a pain at first ? Yes but once you form a habit it's second nature and you don't even think about it.

 

[halfwit]

Wow. Looks like textbook primary hypogonadism to me. Your LH and FSH being so high is your pituitary SCREAMING at your testes to make sperm and testosterone. This will not likely improve, especially after having invasive surgery done. (I am surprised that your baseline went up though, possibly an early morning blood draw vs afternoon?)

TRT is for life, but once you see the difference - you will be thankful for that fact. Oh, and it's certainly worth looking into guys like IMT; they easily know more about TRT than any PCP will.

My .02c

 

[Megatron28]

Wow. Looks like textbook primary hypogonadism to me. Your LH and FSH being so high is your pituitary SCREAMING at your testes to make sperm and testosterone. This will not likely improve, especially after having invasive surgery done. (I am surprised that your baseline went up though, possibly an early morning blood draw vs afternoon?)

TRT is for life, but once you see the difference - you will be thankful for that fact. Oh, and it's certainly worth looking into guys like IMT; they easily know more about TRT than any PCP will.

My .02c

Wow indeed! That is the most clear cut case of Primary I have ever seen on here.

 

[ChronosOceanus]

I'm in your exact same shoes.

I'm 30 years old, my total testosterone ranged between 192ng/dl - 434ng/dl.

Younger 20's... had tons of energy... very smart... loved the gym...

Past few years just went downhill. No energy, brain fog, low sex drive, moody, etc..

TRT is very opinionated... VERY. Everyone has an opinion on TRT and on very long ends of the spectrum.

Personally, I just did not want to go the rest of my life with low levels.... Injections ? Blood work ? Donate blood ? That is a very small cost in return for my younger self back. Is it a pain at first ? Yes but once you form a habit it's second nature and you don't even think about it.

How is TRT going for you now? How long have you been on?

 

[ChronosOceanus]

Wow. Looks like textbook primary hypogonadism to me. Your LH and FSH being so high is your pituitary SCREAMING at your testes to make sperm and testosterone. This will not likely improve, especially after having invasive surgery done. (I am surprised that your baseline went up though, possibly an early morning blood draw vs afternoon?)

TRT is for life, but once you see the difference - you will be thankful for that fact. Oh, and it's certainly worth looking into guys like IMT; they easily know more about TRT than any PCP will.

My .02c

Yep, that's pretty much what my urologist told me about my LH and FSH levels. And that I'll most likely need to go on HRT at some point.

You're right - the first blood panel that showed 214 ng/dl was in the afternoon when my first urologist had me do a blood test, which is one of many reasons we changed urologists to the guy I go to now, and who did the surgery. The ~425 was around 8:30 AM, and it was prior to the surgery that I had. I'm still waiting to see what my levels will be like post-surgery, but my urologist wanted me to wait 3 months for things to settle down hormone-wise.

 

[ChronosOceanus]

Wow indeed! That is the most clear cut case of Primary I have ever seen on here.

Yeah, I have something called Sertoli Cell Only (SCO) syndrome which is when only sertoli cells line the seminiferous tubules, which basically means I can't produce sperm. Cause is unknown, but most likely a random gene mutation. No treatment other than trying to find pockets of sperm for reproductive purposes using the surgery that I had, or a similar one. Often times low testosterone levels are present in men with SCO.

Is it uncommon for men with primary hypogonadism to have normal testosterone levels?

 

[Megatron28]

Yeah, I have something called Sertoli Cell Only (SCO) syndrome which is when only sertoli cells line the seminiferous tubules, which basically means I can't produce sperm. Cause is unknown, but most likely a random gene mutation. No treatment other than trying to find pockets of sperm for reproductive purposes using the surgery that I had, or a similar one. Often times low testosterone levels are present in men with SCO.

Is it uncommon for men with primary hypogonadism to have normal testosterone levels?

By definition, Primary Hypogonadism means you have below normal TT. You have not gotten to Hypogonadal levels yet however.

Here is more info on Hypogonadism if you are interested.

http://www.steroidology.com/forum/testosterone-replacement-therapy/662394-basic-trt-overview.html

 

[IMT staff]

Looks like your vitamin D is bumping your pituitary and the testes can't keep up with the workload. I am curious to see what your free T, it sounds like your symptoms are from low SHBG or estradiol deficiency.

 

[ChronosOceanus]

Looks like your vitamin D is bumping your pituitary and the testes can't keep up with the workload. I am curious to see what your free T, it sounds like your symptoms are from low SHBG or estradiol deficiency.

Should I consider not supplementing with Vitamin D, or is that ok?

Free T from my first panel (the one I did in afternoon) was 5.1 (Ref: 4-29 ng/dl). Bio available Test was 96 (Ref: 77-357 ng/dl). I don't have that info for the second test I did in the morning, but I could get it. I'd assume it's slightly higher.

What would be some treatments to balance Estradiol or SHBG if they are deficient?

 

[ChronosOceanus]

By definition, Primary Hypogonadism means you have below normal TT. You have not gotten to Hypogonadal levels yet however.

Here is more info on Hypogonadism if you are interested.

steroidology.com/forum/testosterone-replacement-therapy/662394-basic-trt-overview.html

Thanks for the info Megatron. I read through the TRT overview. I guess my questions boil down to: if my hormone panel next month shows that I'm low-normal Test (~400), would your recommendation as someone who has experience with TRT be to avoid therapy and wait until my levels inevitably drop in X number of years? Or should I get started now if I'm already comfortable doing that?

I'm aware this isn't a black or white issue. Just looking for some perspective and guidance as I deal with this in the next few months.

Thanks again.