Started Testim

[DrMariano2]

I found out I have Low T about 6 mos. ago and have been researching the area as
much as I can.

I just started 5 grams of Testim daily last week.

Should I see an endo Dr to see if there is a chance to get my own body to produce more T or should I just accept
the fact that I will need TRT for life.?

Also, should I be taking anything else other than Testim based on my labs?

So far after a week I do feel like I have a little more energy but also feel a little more aggitated and aggressive.

Also, I have some insomnia which may just because I have a lot on my mind.

Here are my labs: (Before Starting on Testim)

Test Total: 212 (Ref Range: 250-1100)
Test Free: 58 (Ref Range: 46.0-224.0)
Test Bio: 131.9 (Ref Range: 110.0-575.0)
Test SHBG 17 (Ref Range: 8-48)
Test Albumin: 5.0 (Ref Range: 3.6-5.1)

Dihydrotest: 23 (Ref Range: 25-75)
Estradiol: 26 (Ref Range: 11.6-41.2)
FSH: 2.3 (Ref Range: 1.4-18.1)
LH: 3.5 (Ref Range: 1.5-9.3)

Cortisol: 13.8 (Ref Range: 4.3-22.4)
DHEA: 390 (Ref Range: 61-1636)

TSH: 1.65 (Ref Range:0.35-5.50)

Total PSA: 0.4
Free PSA 0.1
% Free PSA 25

Based on these labs am I a good candidate for TRT and if so should I be taking
anything else besides the Testim?

Infertility at this point is a non-issue since I don’t want anymore kids.

Generally, one can consider testosterone replacement therapy when total testosterone becomes significantly low (e.g. < 300 ng/dL) or if one develops symptoms or signs of hypogonadism even with a total testosterone that is mildly higher than 300. When replacing testosterone, a good target is to achieve 650 ng/dL of total testosterone. Once this is done, any remaining problem is with the other hormones, neurotransmitters, cytokines, metabolism, nutrition, etc. A single lab indicating low testosterone does not always tell the story. I have seen testosterone bouncing around from 170 to 800 ng/dL between labs in some patients, for example. Thus, multiple labs may need to be done to help clear up the situation. There may be metabolic issues or other issues with the nervous system, endocrine system, and immune system which from time to time impair production of testosterone. Evaluating for and considering treatment of those other problems may help improve and stabilize one’s own testosterone production. This can be considered before adding testosterone. When one has diabetes type, for example, there are numerous factors which may lead to low testosterone production. Addressing these factors – which are also what may contribute to diabetes, may help restore testosterone production. On the other hand, insulin resistance with high insulin levels may be involved in diabetes in a positive feedback loop with low testosterone, which may increase insulin resistance. Thus, adding testosterone can be done in order to reduce insulin resistance, breaking the positive feedback loop with insulin resistance. Adding testosterone can reduce thyroid binding globulin, helping increase free thyroid hormone. Testosterone can also help reduce inflammatory cytokine signaling. Reducing insulin resistance also helps reduce inflammatory signaling. These and other changes due to additional testosterone can help improve energy. However, adding testosterone can also reduce thyroid releasing hormone (TRH) produced by the testes. This can, in some men, reduce thyroid hormone signaling significantly, promoting fatigue. Estrogens are hormones which promote aggression in men. Testosterone is calming. The increase in estradiol formation from the addition of testosterone may promote irritability and aggression. Estrogens can also increase thyroid binding globulin formation from the liver. This reduces free-thyroid hormone activity. This may be compensated by an increase in sympathetic nervous system norepinephrine production. This may promote anxiety, irritability, aggression, and insomnia. Low cortisol signaling may indicate an increase in immune system inflammatory signaling. The inflammatory signaling may lead to sickness behaviors including fatigue, loss of libido, impaired concentration, social isolativeness, etc. Inflammatory signaling may also lead to an increase in stress/norepinephrine signaling, leading to insomnia, irritability, etc. TSH > 1.0 may indicate the presence of hypothyroidism. With age, thyroid hormone decreases gradually. Low thyroid hormone signaling may reduce testosterone production.

When men have low testosterone levels, they tend to die young of various conditions. Thus, when one has low testosterone, it is useful to examine for other health problems which may contribute not only to low testosterone but to other serious illnesses.

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