Seeking Advice: Starting TRT as a Diabetic?

[blmaxxx26]

Hello All, first just wanted to say what a tremendous resource this forum is thanks!

I am a 50yo male with an over 10 year history of extrememly low energy, low libido, insomnia, depression. I almost feel like a walking billboard for low T lol.

3 years ago I was diagnosed with Type II diabetes and have been on 500mg metformin 2x day since then and able to maintain good blood sugar so far.

Late last year my partner at the time asked if I had ever had my t level checked and I never had. But a light went off and thought maybe that's what's been wrong for all these years. So I went to my GP and got blood work was as follows:

TESTOSTERONE, FREE AND TOTAL BY LC-MS/S 12/02/2013 07:15
SEX HORMONE BINDING GLOBULIN 20 11-80
TESTOSTERONE, FREE LC-MS/MS 53.1 47.0-244.0
TESTOSTERONE, LC-MS/MS 238 L 300-890

On the one hand it was shocking to see a 238 but on the other it seemed to explain why I feel like crap 90% of the time. The doc didn't seem to think it was "that low" and ordered another round of testing to see if this was just an aberration. Results were:

FSH 1.73
LH .3
Prolactin 5.6
TESTOSTERONE, FREE AND TOTAL BY LC-MS/S 07:09
SEX HORMONE BINDING GLOBULIN 20 11-80
TESTOSTERONE, FREE LC-MS/MS 73.9 47.0-244.0
TESTOSTERONE, LC-MS/MS 324 300-890

My GP said based on these results my body was perfectly happy with the amount of testosterone I had. Needless to say, I was not convinced and said I wanted to see a specialist so he referred me to an endocrinologist. Endo fully explained how the entire system works, negative feedback loops, etc. He explained the pros and cons of TRT. His main concern was that I am already at a very increased risk of heart issues being diabetic. He then talked about the newer study showing possible heart issues with TRT. He then wanted to do his own tests. Results were:

FSH 1.69
LH .1
TSH 1.150
HCT 45.7
HGB 15.7
Insulin-Like Growth Factor I 164
T4, Free 1.21
TESTOSTERONE, FREE AND TOTAL BY LC-MS/S 07:15
SEX HORMONE BINDING GLOBULIN 16 11-80
TESTOSTERONE, FREE LC-MS/MS 54.2 47.0-244.0
TESTOSTERONE, LC-MS/MS 224 300-890

I now have followup appointment with him to discuss and decide if I want to start TRT.

My main questions for people here is mainly about the fact that I am diabetic and how that would play into possible negative consequences of TRT. If I wasn't diabetic starting TRT would be a no-brainer for me. The quality of my life for the past 10 years has really sucked. I literally have no energy after work, have terrible mood issues, irritability, insomnia, bouts of depression, and the low libido. So the question in my mind is, is the risk of getting a heart attack, stroke, etc worth it?

So I'm wondering if there are any other diabetics here on TRT? Also just general thoughts from those in the know? I really appreciate it thanks!

 

[IMT staff]

Its been a while but there was a study showing diabetic men needed half the insulin once they started TRT, you should give it try! Start at a very moderate dose, it may be tougher for you to titrate your dosages. Diabetes if very closely related to lowT.

 

[Megatron28]

This is anecdotal, but some guys I have talked to have seen improvements with their diabetes after getting on TRT. I think they were all Type II.

 

[Daniel_IMT_Staff]

Testosterone Replacement in Hypogonadal Men With Type 2 Diabetes and/or Metabolic Syndrome (the TIMES2 Study)
Testosterone Replacement in Hypogonadal Men With Type 2 Diabetes and/or Metabolic Syndrome (the TIMES2 Study)

CONCLUSIONS Over a 6-month period, transdermal TRT was associated with beneficial effects on insulin resistance, total and LDL-cholesterol, Lpa, and sexual health in hypogonadal men with type 2 diabetes and/or MetS.

Low serum testosterone is common in men with type 2 diabetes and/or metabolic syndrome (MetS) and numerous studies have reported an association between testosterone deficiency and visceral obesity, insulin resistance (IR) and dyslipidemia (1***8211;4). In men with type 2 diabetes, low testosterone is associated with a high prevalence of symptomatic hypogonadism (3), frequently due to hypogonadotrophic hypogonadism (5).

 

[halfape211]

My main questions for people here is mainly about the fact that I am diabetic and how that would play into possible negative consequences of TRT. If I wasn't diabetic starting TRT would be a no-brainer for me. The quality of my life for the past 10 years has really sucked. I literally have no energy after work, have terrible mood issues, irritability, insomnia, bouts of depression, and the low libido. So the question in my mind is, is the risk of getting a heart attack, stroke, etc worth it?

So I'm wondering if there are any other diabetics here on TRT? Also just general thoughts from those in the know? I really appreciate it thanks![/QUOTE]



To BLMAXXX26:
Diabetics are 2.5 times more likely to have low T, so there should be others here that are diabetic. I've been a diabetic for about 6 years, started on Metformin and am now on insulin, and have been on TRT for about 7 months. I see no negative consequences for a diabetic to go on TRT. None, only good things. So I think it's still a no-brainer. I suffered from much of what you speak and quality of life is improving. Diabetes is easier to control, weight loss is now possible. If you control the high the E2, the foggy brain and other effects of high E2 will go away. I'm not dialed in yet, but it's made a huge difference in my life.

It's good to educate yourself on a matter of this importance, however heart problems, prostate problems, etc are more likely on LOW T, not on normal amounts of T. There are others here with more knowledge than I, but from everything I read and from all the info I got from my anti-aging Dr., I strongly suggest you jump at the TRT. I wish you good luck getting a good Dr. and proper treatment

 

[halfwit]

I'm type II and currently on insulin after many years of orals. TRT probably would have made a bigger difference for me with regards to my insulin resistance, but I pretty much let it go for way too long as I was hypogonadal for a very long time and didn't realize that was why I was slowly starting to shut down. Testosterone plays a HUGE role in our metabolism and in our quality of life. If anything, you should notice an improvement and the possibility of being able to drop the metformin as you appear to be still quite early in the stages of diabetes. (I was on 2g of metformin, 45mg of actos, and 50mg of glipizide when I started TRT, so I was much further than you with the disease.)

However, with all that said - I would strongly urge you look into WHY your pituitary gland is producing such small quantities of LH and FSH. This screams to me (.1 LH) secondary hypogonadism which may or may not be caused by the diabetes, but I'm betting that there's something going on elsewhere. Oddly, diabetes can cause hypogonadism and hypogonadism can cause diabetes; so it's a matter of hoping for the latter in your case in my non-MD opinion.

Either way, I do think you're on the right path and you're on the road to acquiring a far superior quality of life. Best wishes to you and hopefully you can get this straightened out quickly and painlessly.

My .02c

 

[Rida5d]

Halfwit is back

 

[halfwit]

Halfwit is back

Never left brother, just finding almost all my free time being gobbled up by school.

<3

 

[IMT staff]

Testosterone Replacement in Hypogonadal Men With Type 2 Diabetes and/or Metabolic Syndrome (the TIMES2 Study)
Testosterone Replacement in Hypogonadal Men With Type 2 Diabetes and/or Metabolic Syndrome (the TIMES2 Study)

CONCLUSIONS Over a 6-month period, transdermal TRT was associated with beneficial effects on insulin resistance, total and LDL-cholesterol, Lpa, and sexual health in hypogonadal men with type 2 diabetes and/or MetS.

Low serum testosterone is common in men with type 2 diabetes and/or metabolic syndrome (MetS) and numerous studies have reported an association between testosterone deficiency and visceral obesity, insulin resistance (IR) and dyslipidemia (1***8211;4). In men with type 2 diabetes, low testosterone is associated with a high prevalence of symptomatic hypogonadism (3), frequently due to hypogonadotrophic hypogonadism (5).

Reps for this one, great post!

 

[THE-DET-OAK]

I agree great post. reps.

 

[blmaxxx26]

UPDATE:

First, thanks for all the replies especially the link to that study.

I had the followup appointment with the endo and it was basically your worst nightmare. First the good news: He said I definitely fit the criteria for low T and am a candidate for TRT. And he agreed to let me self inject. Now all the bad news.

He will prescribe 100mg test c every 2 weeks and that is it.

When I asked about HCG he said that is an off-label use and "beyond his comfort level" and I would need to see someone else for that. I was like who? He said a reproductive endocrinologist.

When I asked about testing for estrogen levels and possibly needing an AI he said he never tests for estrogen levels in men there are no good baseline levels to go by so there is no use in testing it.

When I asked about starting on a 50mg every 3.5 days he said he never heard of such a thing and had no idea how I could possibly accurately do an injection on such a schedule, i.e. how could I possibly know what every 3.5 days is? Yes he actually said this.

Then the kicker. He literally said if it were up to him "he would never treat anyone for TRT. He doesn't believe in it." Those are actual quotes. I just wish he had said that the first time we met. It would've saved me getting another useless round of tests, waiting a month for the second appointment, and another $25 copay. When I said how about quality of life? What about the fact that I feel like absolute utter crap 95% of the time? He basically said yeah but is it worth the risk of mortality?

So now I have to figure out what's next...see if I can find another doctor around here who lives in the 21st century...figure out if I can afford going out on my own...

 

[Daniel_IMT_Staff]

Hello,

I am really sorry to hear that! Fortunately there are other options out there, look around and settle for nothing but the best.

You can also start by inquiring with us at IMT. Email or call at your convenience.

Also, it's good that you are out on the boards looking after your own health. Imagine the people that just listen to their doctor and assume(which they should) that he knows best.

 

[GreenCoffeeBeans]

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