Testosterone replacement therapy (TRT) - Conflicting Advice

[harlington]

TRT - Conflicting Advice

recently i saw my local gp due to feeling extremely tired, sluggish etc (had been for some time too)

blood tests came back with low testosterone, we ran a second test which also came in low and doctor prescribed testogel daily to treat it

having read a lot of articles, this forum plus training at a powerlifting gym.. i'd seen a lot of info and was concerned that doc didn't seem to believe testosterone replacement therapy (TRT) would be a lifetime treatment and didn't talk about testosterone production shutting down

with that in mind i went to see another doctor just to seek a second opinion... hers is that young males shouldn't ever really be given testosterone replacement therapy (TRT) because it will stop production and make them infertile. she said it may actually be insulin resistance instead and i should get tested for that as well as some other chromasome bits and pieces which will take 2 - 4 weeks to test. at that point she may put me on metformin to treat insuling resistance if it is that

i suppose part of me is a bit disappointed as i had psyched myself up to the testosterone replacement therapy (TRT) and was quite looking forward to feeling good as early as next week. if i go the latter approach it looks like at least 4 weeks to even get a treatment and that treatment may take some time to really show any effect

i suppose my question is does the 2nd doctors point have merit? Should i be pursuing this insulin resistance theory before starting any TRT?

while kids etc aren't high on my priority list i guess i would like the option just in case too

 

[MOEGREEN]

You didnt say what your age and test levels were so it will be hard for anyone to tell you or give you advice on that..I am not a doctor but I am on testosterone replacement therapy (TRT) therapy and took a while to find the right place to treat me correctly.

 

[harlington]

Apologies..

Age 29
testosterone 8.9 nmol/l
SHBG 12 nmol/l
Free Test 244 pmol/l
FAI 59.3
FSH 2 (2 - 12)
LH 3 (2 - 9)

 

[harlington]

just thinking more about the 2nd doc... she also said if metformin does not work to treat insulin resistance they use HGH

my brief research just now has thrown up a heap of articles that seem to indicate the total opposite, that HGH causes insulin resistance?

 

[Megatron28]

just thinking more about the 2nd doc... she also said if metformin does not work to treat insulin resistance they use HGH

my brief research just now has thrown up a heap of articles that seem to indicate the total opposite, that HGH causes insulin resistance?

I don't feel like I know your whole situation, but given your age I like that the second doc is trying to work with you to see if you can restore your natural T production. That is definitely worth pursuing in an effort to avoid being on testosterone replacement therapy (TRT) for the rest of your life. I don't know if your problem is with insulin, but run the labs and see.

Some other things that should be checked which can affect your T are:

Have a sleep study performed
Review your diet with a nutritionist
Thyroid panel
Vitamin D
Complete medical history (e.g. long-term pain medication use?)
MRI of pituitary
Prolactin
Lifestyle changes (e.g. alcohol, exercise, etc)
Estradiol

TRT doesn't make you infertile. Lots of guys have had kids while on testosterone replacement therapy (TRT). Some temporarily pause testosterone replacement therapy (TRT) to have kids too.

Something else to consider. You may want to look into trying a restart of your HPTA. You might be able to get your pituitary working again and signal your body to produce more test. Sometimes you will hear it referred to as post cycle therapy (pct) on this forum. It is basically what guys done with a cycle do to fire up their natural T production again.

Good luck. Keep learning as much as you can and let us know how things go.

 

[harlington]

thanks for the response

out of the above:
thyroid was checked and normal
vitamin d slightly low (but only just)
no long term painkiller use
lifestyle pretty good - lift weights on the regular etc


i agree it's good to consider other options, guess i'm just frustrated as i was looking forward to fixing myself up, thought i'd better do my due diligence and now there is this prospect that i might still feel like crap for a few months to come.

also still find it weird to have insulin resistance and normal blood pressure, cholesterol and blood sugar...

 

[MOEGREEN]

Yes listen to megatron he is correct, you are low but it is safe to see "WHY" first and than you are more inclined to determine your next protocol as I did all kinds of test first to determine what was right for me....Good luck

 

[totalburnout]

thanks for the response

out of the above:
thyroid was checked and normal
vitamin d slightly low (but only just)
no long term painkiller use
lifestyle pretty good - lift weights on the regular etc

If vitamin D was 'slightly low' as in "out of range", that's what most all progressive doctors would consider EXTREMELY low. Ideally vitamin D should be around 60-70. Its a cheap supplement and easy to take.

Have you done a cortisol test?

i agree it's good to consider other options, guess i'm just frustrated as i was looking forward to fixing myself up, thought i'd better do my due diligence and now there is this prospect that i might still feel like crap for a few months to come.

also still find it weird to have insulin resistance and normal blood pressure, cholesterol and blood sugar...

Some more questions.

What was your fasted glucose level?

What your height, body weight, and body fat approximately?

What constitutes a good diet and what constitutes a good workout routine?

It wouldn't be out of the realm of possibility to be insulin resistant and still have a normal glucose level. After all the standard glucose test is performed after you've fasted. You're not getting a snap shot of how insulin is managing blood sugar after ingesting food.

I have no idea if insulin resistance would make sense in your case without having some more information.

Also are you sure she said to treat insulin resistance with HGH and not possibly hCG? Often time people get the two acronyms confused.

 

[THE-DET-OAK]

If vitamin D was 'slightly low' as in "out of range", that's what most all progressive doctors would consider EXTREMELY low. Ideally vitamin D should be around 60-70.

This is not always the case, sometimes that is too high and can cause inflammation that can lead to some pretty serious health problems. It just depends on the individual, but that could easily be too high, this can cause your body to convert more 25 OHD to 1,25 dihydroxy. It is more about the ratio than the total.

Again, when you parrot information, thats the type of end result you get.

 

[totalburnout]

This is not always the case, sometimes that is too high and can cause inflammation that can lead to some pretty serious health problems. It just depends on the individual, but that could easily be too high, this can cause your body to convert more 25 OHD to 1,25 dihydroxy. It is more about the ratio than the total.

Again, when you parrot information, thats the type of end result you get.

Going with the exception instead of the general rule again, are we?

Read what I wrote. I have no context of what his Vit D level is and other factors. I said what MOST all consider low is less than the 60-70. Obviously it will vary from individual to individual. There's a study that someone posted here or on another board (maybe even IMT posted it) that showed overall that the 60-70 figure was generally the most beneficial.

But congratulations on pointing out a situation where that doesn't always prove true!

 

[harlington]

If vitamin D was 'slightly low' as in "out of range", that's what most all progressive doctors would consider EXTREMELY low. Ideally vitamin D should be around 60-70. Its a cheap supplement and easy to take.

Have you done a cortisol test?



Some more questions.

What was your fasted glucose level?

What your height, body weight, and body fat approximately?

What constitutes a good diet and what constitutes a good workout routine?

It wouldn't be out of the realm of possibility to be insulin resistant and still have a normal glucose level. After all the standard glucose test is performed after you've fasted. You're not getting a snap shot of how insulin is managing blood sugar after ingesting food.

I have no idea if insulin resistance would make sense in your case without having some more information.

Also are you sure she said to treat insulin resistance with HGH and not possibly hCG? Often time people get the two acronyms confused.

haven't done cortisol

height 178cm, weight 108kg.

good diet typically low-ish carbs, mostly meats and vegetables with 1 - 2 'cheat' type meals in a week.
workout is either press/squat + accessories or bench/deadlift + accessories.

definitely said HGH, and was referring to the insulin resistance not the test.

vit. d result was 64 nmol/l ( test result looking for >74)

fasting glucose was 4.5nmol ( normal <5.5)

 

[harlington]

presumably even if it is insulin resistance related, testosterone replacement therapy (TRT) improves insulin resistance... if that factor is then eliminated through loss of abdominal fat i could then do a HPTA restart and see if the problem still exists


it's frustrating because it's all very 'which came first the chicken or the egg'

some articles say low test leads to insulin resistance and some say insulin resistance leads to low test!

all i know is i have a script for test gel and i want to stop feeling like crap

 

[Megatron28]

presumably even if it is insulin resistance related, testosterone replacement therapy (TRT) improves insulin resistance... if that factor is then eliminated through loss of abdominal fat i could then do a HPTA restart and see if the problem still exists


it's frustrating because it's all very 'which came first the chicken or the egg'

some articles say low test leads to insulin resistance and some say insulin resistance leads to low test!

all i know is i have a script for test gel and i want to stop feeling like crap

For what it is worth, I can share my glucose experience. I was always borderline high. Normal range for fasting glucose is 65-99 mg/dL. I used routinely come in around 99-103. I have definitely improved since going on TRT. I got labs done yesterday and my glucose was 77. I had another one from a couple of months ago that was in the low 80's. testosterone replacement therapy (TRT) definitely seems to have helped my glucose. I don't know how it works, but I am glad it has.

 

[Good.2.Go]

Going with the exception instead of the general rule again, are we?

Read what I wrote. I have no context of what his Vit D level is and other factors. I said what MOST all consider low is less than the 60-70. Obviously it will vary from individual to individual. There's a study that someone posted here or on another board (maybe even IMT posted it) that showed overall that the 60-70 figure was generally the most beneficial.



But congratulations on pointing out a situation where that doesn't always prove true!

Isn't it lovely when you "Genuinely" try to help some one & then are critiqued. It's happened to us all including Hi-jacking. My apologies...as we were....