Trying to figure out if/what HRT I need

[r75]

I'm 37, and have been having trouble with low libido and ED, and low energy for 5 years or more. When I have sex, I usually lose my ability for a day or two, and my drive for like a week. I thought it was due to psychological issues, but I think that at least part of my trouble has been due to hormonal problems. I finally saw a doctor about it 6 months ago, and the first thing the PA recommended was a Thyroid test. I also had a T test done, at my request. I didn't know much about it, so I didn't ask for other tests like E2, or LH/FSH.

My TSH levels were at 7.6, so I started taking levothyroxine, and they're down to normal (I didn't see that lab, but I think it was around 2).

my latest labs show

Serum T: 387 ng/dL (348-1197)
Free T: 9.1 pg/mL (8.7-25.1)
Prolactin: 4.3 ng/mL (4.0 - 15.2)

I had sex the night before the lab, too, so my prolactin might have been elevated from baseline... not sure.

My PCP said he would prescribe TRT if I wanted to see if it helped with my symptoms, and I actually asked for Striant, which is a ridiculously expensive buccal tab that keeps your levels really even.

Since I'm relatively young, and I still want to have kids, I'm kind of nervous about screwing with my androgens. I asked my PCP about using HCG to keep my testes producing, and he said he was not aware of that therapy, but he would refer me to an endo.

I have no interest in gaining muscle weight, although I wouldn't mind. I'm purely in it for health reasons.

So, I would really appreciate any advice you all have on:

1) What baseline tests I should do before starting TRT.
2) Experience with clomid, especially long term
3) Opinion about whether its even worth doing HRT with levels that are within "normal," even though they're right on the edge.

Thanks a lot for your advice.

Edit: Also, I practice Aikido, a self defense martial art, bike to work, and eat a balanced diet, with plenty of nuts, some meat. I'm pretty skinny. Stress might be part of the issue, but I don't think its the whole story.

 

[kisaj]

TSH doesn't show a whole picture, and according to the endos I was working with, shouldn't be used to verify thyroid. It should include T3, T4, and free T3.

Yeah, your numbers are low, so it could be an issue. I don't know a lot about Clomid other than I didn't consider it when it was brought to my attention as a possible option. I didn't like the mixed results and the vision problems the endo mentioned. To me, it wasn't worth it. As far as should you even consider it being in "normal" range? Hell yes. That is not normal for a 3 year old and that range they determine normal in takes all guys into factor. Fat, 90 years old, poor diet, no fitness, etc- and you are at the low range of these people.

I am 38 and at my best around 800-900.

 

[The Matrix]

1. Focus on lifestyle, stress management, balanced eating, Sleep hygiene
2. Get proper evaluations of thyroid, adrenals, and other parameters done by a good Dr.
3. Isolate where the imbalances are in your life, and chemistry.

 

[r75]

Ok, thanks. I got an appointment with an endo for November. Any advice on which tests I should make sure he does, besides the thyroid ones you mentioned (e.g. androgen labs).

 

[The Matrix]

Majority of endos are not up on TRT or thyroid. They are diabetic drs most of the time.
Buccal kills your liver, which is probably already compromised more ways then one...

 

[r75]

Thanks Matrix,

The endo seems to have quite a bit of experience with thyroid issues, and talks about HRT on his website, FWIW. The buccal tabs that I ordered are absorbed directly into the blood, so the T is not processed by the liver. According to the literature at least, the amount that is swallowed is very low. Why do you suspect my liver is having issues?