Need Advice on Low T

Uncle_E

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I am about to turn 36 and I’ve finally confronted the classic low-t symptoms I’ve been battling. I honestly think that it has been a lifelong issue - I think that I was so malnourished in my teens and early 20’s that puberty didn’t fully happen. I’ve got somewhat of a beard, and I’ve fathered a child, but I still look like a skinny 18 year old kid.

I lifted in high school and college then took a few years off. I started training again around 30, and have had a good diet for the past 3-4 years. I’ve tried all the basics of eating right, sleeping right and trying to raise T the natural way.

In February I got bloods drawn hoping that they would come back normal but the test confirmed what I had suspected.
Total T - 294 ng/dl (241-827 range)
Free T - 44 pg/ml (47-244)
Albumin - 5.0 g/dL (3.5 - 5.1)
SHBG - 46.3 nmol/L (17.3 - 65.8)
TSH - 1.54 mIU/L (0.28 - 4.1)
Didn’t get and E #’s

My GP said that “he wouldn’t touch it with a 10 foot pole” and that I should never “open that can of worms” as there is too great a risk of cancer, heart disease, and a bunch of other scare tactics.

I went back recently for a physical and demanded a referral to an endocrinologist. Finally got that referral, it’s about 8 weeks away.

I have a couple questions I’m looking for feed back on:


1 - the test was completed at 2pm, I woke up at 4:30am that day and worked an 8 hour shift. Should I expect a dramatically higher number at the next test, assuming it is at 8am?

2 - could these numbers be a fluke, and the next test show that I’m normal?

3 - the wife wants me to resume self medicating with test boosters and dermacrine. If I do this to alleviate symptoms, could I potentially risk temporarily raising my T out of the treatment zone? Should be just try to ride it out for the next few weeks?

4 - will I regret going on TRT at 36?

5 - could this be a self inflicted issue due to my poor eating habits early on?
 
bad rad

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Questions:
1) It could have but I don't believe you would have had decent levels earlier in the day
2) Possibly but based on your details unlikely
3) Maybe but I didn't have good luck with OTC test boosters
4) That's for you to answer but I started earlier and don't regret it
5) Yes, nutrition early in life is under rated.
 
TheBigJS

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From your language (GP, demanded etc) I'm guessing you're in the UK?

The NHS isn't always that hot on TRT, trying it and just stopping, crazy long gaps between pins (very few are "allowed" to self pin), no AI etc. So keep us informed, keep posting here, there is a LOT more knowledge here.

I will pretty much guarantee if you were to pin 70mg Test E twice a week, sub Q with an insulin pin (a tiny needle, Test goes into subcutaneous fat not deep into the muscle, it's totally painless but not NHS protocol) and treat E with an AI if required it would absolutely change your life.
 
kenpoengineer

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What were your FSH and LH levels?
 

Uncle_E

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What were your FSH and LH levels?
No, I have not had those tested yet. I posted all of the results I’ve received to date. I will for sure get FSH and LH and E checked when I go to the endo.
kenpoengineer - I’ve read a lot of your posts, really interested in what your thoughts are.
 

Uncle_E

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From your language (GP, demanded etc) I'm guessing you're in the UK?

The NHS isn't always that hot on TRT, trying it and just stopping, crazy long gaps between pins (very few are "allowed" to self pin), no AI etc. So keep us informed, keep posting here, there is a LOT more knowledge here.

I will pretty much guarantee if you were to pin 70mg Test E twice a week, sub Q with an insulin pin (a tiny needle, Test goes into subcutaneous fat not deep into the muscle, it's totally painless but not NHS protocol) and treat E with an AI if required it would absolutely change your life.
LOL, I sound like a Brit? I’m in the US, but I am in New England...I guess I should have said PCP. The world of regular doctors and specialists is all new to me.

I scheduled the appointment with the doctor for the specific reason of testing my T. He talked in circles and found creative ways to try and talk me out of it. He wanted me to leave without taking the test. I had to tell him to cut the BS, I paid the co-pay and there was no way that I was leaving without the test. I felt like I was trying to convince a religious hospital to proceed with an abortion.

Thanks for the tip on the 70mg dose - helps me realize that there is hope for a better situation.
 
kenpoengineer

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Going on TRT is a lifetime of injections and bloodwork. Looking at your responses to other threads it appears you have used anabolics. Is it possible that you never fully recovered from past cycles, SARMS or AAS use? Have you thought about a HPTA Restart protocol as a trial before jumping into injections?
 
trn450

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1. You'd likely see upwards of a 30% increase in test levels in the AM relative to the PM. That full drop may not manifest by 2PM, but I'd expect it will be higher and that you'll be in the "normal" range per standard reference ranges.

2. Numbers could absolutely be a "fluke" or just lifestyle associate. If you're not sleeping well, if you're drinking a lot, if you're not exercising well, or staying hydrated you can end up with lower than normal numbers.

3. That's a flimsy question.

4. That's impossible to answer. But, there is a good chance you've got relatively normal T levels and/or that they can be optimized with lifestyle adjustments. And, there are certainly complications that come with TRT. If you're truly hypogonadal, you won't regret it. If you're not actually hypogonadal and you're fixated on this inappropriately, then you definitely could.

5. That's hard to say. But, I doubt it.

Qs:
1. How do you sleep?
2. How much do you drink?
3. Do you stay well hydrated?
4. What is your body fat percentage (estimate conservatively)?
5. Have you previously used PH's, AAS', SARM's, etc?

P.S. Your GP is definitely wrong about the dangers. Print this study for him and educate him: https://academic.oup.com/eurheartj/article/36/40/2706/2293361

*NOTE: the above study applies to truly hypogonadal individuals. It's essential that a proper diagnosis is made, as frustrating as it is.
 

Uncle_E

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Going on TRT is a lifetime of injections and bloodwork. Looking at your responses to other threads it appears you have used anabolics. Is it possible that you never fully recovered from past cycles, SARMS or AAS use? Have you thought about a HPTA Restart protocol as a trial before jumping into injections?
I appreciate you looking into that and raising the question. But the symptoms were present before and are what led me to experiment. IMO, I’ve only done two very mild cycles, both followed by PCT with SERM.

1st - 14 months ago I used RAD-140 for 3 weeks at 15mg/day. Used cycle support and test base (dermacrine). Experienced a spike in BP, so stopped at 3 weeks and jumped into PCT - Clomid 50/50/25/25. BP went back to normal and any signs of suppression returned to pre-cycle conditions.

2nd - 10 months ago I ran Epiandro at 200mg/day for 7 weeks with test base. Intended to run for 8 weeks total, but unexpectedly needed to travel and chose to stop a week early. Again, immediately went into PCT, clomid at 50/50/25/25.

After that PCT, I used a popular ‘natural’ anabolic and MK 677. At this time I first started using pre-work outs with DMAA for a few weeks - that seemed to be the most disruptive product in my opinion.

I did not get bloods before so I cannot scientifically compare where I was before to where I am now. I know that I should have, and regret that I didn’t. I think that I was in denial about my symptoms and wanted to remain blissfully ignorant until I hit my 40’s.
 

Uncle_E

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1. You'd likely see upwards of a 30% increase in test levels in the AM relative to the PM. That full drop may not manifest by 2PM, but I'd expect it will be higher and that you'll be in the "normal" range per standard reference ranges.

2. Numbers could absolutely be a "fluke" or just lifestyle associate. If you're not sleeping well, if you're drinking a lot, if you're not exercising well, or staying hydrated you can end up with lower than normal numbers.

3. That's a flimsy question.

4. That's impossible to answer. But, there is a good chance you've got relatively normal T levels and/or that they can be optimized with lifestyle adjustments. And, there are certainly complications that come with TRT. If you're truly hypogonadal, you won't regret it. If you're not actually hypogonadal and you're fixated on this inappropriately, then you definitely could.

5. That's hard to say. But, I doubt it.

Qs:
1. How do you sleep?
2. How much do you drink?
3. Do you stay well hydrated?
4. What is your body fat percentage (estimate conservatively)?
5. Have you previously used PH's, AAS', SARM's, etc?

P.S. Your GP is definitely wrong about the dangers. Print this study for him and educate him:
*NOTE: the above study applies to truly hypogonadal individuals. It's essential that a proper diagnosis is made, as frustrating as it is.
1 - 7-8 hours a night. I have a 1 year old child, so there have been several tough nights of 4-6 hours over the past year. However symptoms were present before.

2 - a beer or two with dinner during the week, a coupe more on Saturday night. Nothing excessive.

3 - yes, drinking plenty of water and taking basic vitamins - fish oil, multi, zinc and 5,000 IU vitamin D.

4 - I am a small hard gainer. At 5’8”, best measured numbers I achieved was 165 lb at 10% body fat. Fattest numbers were 155 lb at 15% fat. Right now I’m around 145 lb and lean with visible abs. The body fat scale at my gym broke, but you have an idea where I’m at.

5 - see my post above with details on 2 mild cycles followed by PCT with SERM.

Thanks for the link too.
 

Uncle_E

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I also want to note that I took the allergy drug Zyrtec, daily from age 18-32. I started realizing the low T symptoms and found info suggesting that the allergy drug could be lowering my T and spiking E. That’s what lead me down this road to begin with. I was so horrified, I stopped taking that medication and just suffer through the allergy symptoms.
 
trn450

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1 - 7-8 hours a night. I have a 1 year old child, so there have been several tough nights of 4-6 hours over the past year. However symptoms were present before.

2 - a beer or two with dinner during the week, a coupe more on Saturday night. Nothing excessive.

3 - yes, drinking plenty of water and taking basic vitamins - fish oil, multi, zinc and 5,000 IU vitamin D.

4 - I am a small hard gainer. At 5’8”, best measured numbers I achieved was 165 lb at 10% body fat. Fattest numbers were 155 lb at 15% fat. Right now I’m around 145 lb and lean with visible abs. The body fat scale at my gym broke, but you have an idea where I’m at.

5 - see my post above with details on 2 mild cycles followed by PCT with SERM.

Thanks for the link too.
I'd honestly stop drinking alcohol altogether and see how you respond. It negative impacts sleep quality and testosterone values. I know you were worried about the anti-histamine, but it's a much less likely culprit than the booze. One is a a hypothetical link between rats and humans, the other is a well established link. I know it's not "huge volumes" but, for some people any is enough to kill the T levels.
 

Uncle_E

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I'd honestly stop drinking alcohol altogether and see how you respond. It negative impacts sleep quality and testosterone values. I know you were worried about the anti-histamine, but it's a much less likely culprit than the booze. One is a a hypothetical link between rats and humans, the other is a well established link. I know it's not "huge volumes" but, for some people any is enough to kill the T levels.
Hmm, I hope it is not alcohol causing low-t levels/symptoms. I’d be taking the term ‘light-weight’ to another level of a couple light beers a week are destroying my t levels.

From what I’ve been reading up on, heavy drinkers with low t levels will have high SHBG levels. My SHBG appears to be in the middle of the the range, so I didn’t think alcohol consumption was an issue for me.

That being said, you are a medical professional with experience in this area so I listening to your advice. Being a few weeks out from an appointment with the endo, I will spend the time living as clean and healthy as possible and see what the next test says. Continue with a healthy diet, strive for quality sleep, maintenance work outs 3-4x per week, and eliminate unnecessary supplements and alcohol.

I should have an accurate assessment of of my situation at that point, and a much better idea of what to to next.
 

Uncle_E

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Update: I setup some appointments with a gastroenterologist to look into some digestive issues. I went through the tests and confirmed that I do not have Chron’s or UC or celiac issues. I was diagnosed with IBS though.

I’m thinking that this could be contributing to my symptoms in two ways. 1 - the food I eat passes through me too quickly and my body fails to absorb fuel necessary for T-production and optimal function. 2 - this is a stress/anxiety related issues, could also be contributing/causing symptoms.

I have a follow up with the gastroenterologist next week, and then my appointment with the endo in 2 weeks.
 

Uncle_E

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IBS Would NOT cause low T
No, I didn’t say that it CAUSED low T. I said I think it may contribute to T being low in my situation.

If the proteins, fats, carbs, vitamins and nutrients that I consume to facilitate a healthy T level are just passing through me and not being absorbed properly.

Just a theory I’m looking into to improve my symptoms.
 

Uncle_E

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Update: I met with the endo last week. My previous low score was drawn in February at 2pm, so I had bloods drawn again at 7:30AM yesterday. They said that it will take a couple of days to get the testosterone results, but some of the other results will post sooner. From what I've received so far, everything is in range but LH is on the borderline.

PROLACTIN - 6.08 ng/mL (2.10 - 17.70)
THYROXINE (T4) - 5.5 ug/dL (4.5 - 12.8)
T3 UPTAKE - 44 %Uptake (32 - 48 %Uptake)
TSH - 0.94 uIU/mL (0.28 - 4.10)
FREE THYROXINE INDEX (FTI) - 6.05 ug/dL (4.50 - 13.13)
FSH - 5.16 mIU/mL (1.27 - 19.26)
LUTEINIZING HORMONE 1.32 mIU/mL (1.24 - 8.62)

I'll update again with more results when they come in.

Edit: The results of my testosterone test just came in:

Total Test - 259 ng/dL Range: 250 - 1100 ng/dL
Free Test - 48.2 pg/mL Range: 35.0 - 155.0 pg/mL

Fantastic results, waiting on the rest of the results to figure out what to do next.
 
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Uncle_E

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My endo called me back on Friday afternoon. He was very excited to tell me that my results came back "great". I disagree that a total test level of 259 is great for a 36 year old man. His stance is that all the numbers are above the minimum acceptable range, so not treatment should be administered.

The test that I took in February indicated that free test was below range. The recent test by the endo supposedly used a more accurate testing method and showed that free test is actually within range. This is how the endo is looking at it - the first test was inaccurate, his new test proves that there is no deficiency - therefore there is no problem to treat.

The symptoms that I have been experiencing haven't been as bad in the past few weeks, so I do think that my free t levels have improved. I think this is from cutting beer consumption and perhaps getting more natural vitamin D?

Total Test - 259 ng/dL (250 - 1100 ng/dL)
Free Test - 48.2 pg/mL (35.0 - 155.0 pg/mL)
LH - 1.32 mIU/mL (1.24 - 8.62)
FSH - 5.16 mIU/mL (1.27 - 19.26)
PROLACTIN - 6.08 ng/mL (2.10 - 17.70)
THYROXINE (T4) - 5.5 ug/dL (4.5 - 12.8)
T3 UPTAKE - 44 %Uptake (32 - 48 %Uptake)
TSH - 0.94 uIU/mL (0.28 - 4.10)
FREE THYROXINE INDEX (FTI) - 6.05 ug/dL (4.50 - 13.13)

I expected Estradiol and SHBG test results, but did not receive them. LH and total T are at the bottom of the acceptable range, and if they drop throughout the day that would mean that I drop out of range as the day goes on.

The endo told me that if I wanted, I could come back and he would write me a script for SSRI's and viagra. I will not be taking him up on that offer.
 

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My endo called me back on Friday afternoon. He was very excited to tell me that my results came back "great". I disagree that a total test level of 259 is great for a 36 year old man. His stance is that all the numbers are above the minimum acceptable range, so not treatment should be administered.

The test that I took in February indicated that free test was below range. The recent test by the endo supposedly used a more accurate testing method and showed that free test is actually within range. This is how the endo is looking at it - the first test was inaccurate, his new test proves that there is no deficiency - therefore there is no problem to treat.

The symptoms that I have been experiencing haven't been as bad in the past few weeks, so I do think that my free t levels have improved. I think this is from cutting beer consumption and perhaps getting more natural vitamin D?

Total Test - 259 ng/dL (250 - 1100 ng/dL)
Free Test - 48.2 pg/mL (35.0 - 155.0 pg/mL)
LH - 1.32 mIU/mL (1.24 - 8.62)
FSH - 5.16 mIU/mL (1.27 - 19.26)
PROLACTIN - 6.08 ng/mL (2.10 - 17.70)
THYROXINE (T4) - 5.5 ug/dL (4.5 - 12.8)
T3 UPTAKE - 44 %Uptake (32 - 48 %Uptake)
TSH - 0.94 uIU/mL (0.28 - 4.10)
FREE THYROXINE INDEX (FTI) - 6.05 ug/dL (4.50 - 13.13)

I expected Estradiol and SHBG test results, but did not receive them. LH and total T are at the bottom of the acceptable range, and if they drop throughout the day that would mean that I drop out of range as the day goes on.

The endo told me that if I wanted, I could come back and he would write me a script for SSRI's and viagra. I will not be taking him up on that offer.
that sucks.

personally, I'd deal with your IBS stuff first, but maybe consult with Dr Henry at Entourage or a nearby TRT you have available.

I tried to raise my testosterone levels for about a year, and got nowhere. regular Dr's told me the same thing, that my levels were "good," but in all honesty, pretty crappy. since I've gotten on TRT I feel great and have made a ton of improvements.
 
kenpoengineer

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Let’s check your testosterone age with this chart
IMG_4376.JPG
 
kenpoengineer

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Uncle_E

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Thanks for the feedback. I’ve been too busy with work and traveling to come back to this. I am looking to get a second opinion, and I’m considering Entourage or a local clinic in my area. My wife is very apprehensive of the situation. She thinks any symptoms she notices is me choosing to be a jerk. She thinks that if the first doctor said that I’m fine, that I should just listen to him and stop ‘choosing’ to have these symptoms. She agreed that I should look into a second opinion, but the thing is, I can pretty much guarantee the outcome based on where I seek the second opinion. If I go to Entourage or a local clinic, I will get prescribed TRT. If I go to another endo or urologist in the healthcare system, it will waste a lot of my time and lead to another offer of prozac and viagra.
Anyone else on TRT ever have to deal with a skeptical wife?
 

jdm23

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Yeah my wife was really skeptical at first. Same thing as you.

I convinced her to give it a chance by taking RAD140 at a low dose and dermacrine. Those helped my mood immensely. Now she’s completely on board. RAD140 can’t replace testosterone but for me it was a good way to test the water and show my wife the benefits of HRT.
 

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You need to Research TRT clinics in your area and go see one. I'm doing TRT from a clinic out of Texas and yes it cost money but I rather pay for my health to be right than go to a Urologist that hasn't been trained what to look for in someone that has low T or Low or High Estrogen levels. I did go to a urologist after the PA on a military post prescribed androgel that didn't work after a yr. Then the urologist prescribed 1 shot a month 400mg of cypionate. It took me about a yr to figure out after the 7-10 day after the shot I felt like crap again. Did you know Test has a life of 7 days, so after the 7th day that when your T starts going down. The TRT protocol I'm on now is .3ml twice a week along with 1/2 pill of anastrazole and tomorrow I start HCG along with my Test twice a week.
 

Uncle_E

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You need to Research TRT clinics in your area and go see one. I'm doing TRT from a clinic out of Texas and yes it cost money but I rather pay for my health to be right than go to a Urologist that hasn't been trained what to look for in someone that has low T or Low or High Estrogen levels. I did go to a urologist after the PA on a military post prescribed androgel that didn't work after a yr. Then the urologist prescribed 1 shot a month 400mg of cypionate. It took me about a yr to figure out after the 7-10 day after the shot I felt like crap again. Did you know Test has a life of 7 days, so after the 7th day that when your T starts going down. The TRT protocol I'm on now is .3ml twice a week along with 1/2 pill of anastrazole and tomorrow I start HCG along with my Test twice a week.
And that’s exactly what I’ve been working in the past few weeks. I found a local clinic and tested again about 3 weeks ago. I had my e2 tested for the first time and it came back at 10.2 on a range of 7.6-42.6 pg/ml. All other labs were all comparable to my previous tests so they agreed to begin treatment.
I should be starting a test/hcg/ai regime next week. I’ll post updates.
 

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And that’s exactly what I’ve been working in the past few weeks. I found a local clinic and tested again about 3 weeks ago. I had my e2 tested for the first time and it came back at 10.2 on a range of 7.6-42.6 pg/ml. All other labs were all comparable to my previous tests so they agreed to begin treatment.
I should be starting a test/hcg/ai regime next week. I’ll post updates.
Your E2 is really low. If you’re taking an AI, stop now. And retest in 4-6 weeks.
 

Uncle_E

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Officially started TRT this week. I am on a test cyp/HCG/AI regime. I didn’t take the AI this week, might wait until I see symptoms or just take a reduced dose to avoid them.
 
Beau

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Your wife has never been a man. She has no way of knowing what normal hormonal feelings - for you - are.

Although, many women try to be the man - or at least "share" their opinions, which are "based in their feelings", about what you should do with your body - and yet they feel qualified/entitled to do so. Even though they have no clue - about your body.

She cannot comment on your hormonal situation any more that you can intelligently offer first hand experience on her menstruation.

Maybe when she goes through menopause, you can tell her that any symptoms you notice is her choosing to be a bitch, and she should just stop ‘choosing’ to have her symptoms, you know like night sweats and hot flashes. She can just ignore the beard she grows after menopause; the beard is just something she has chosen the grow.

Apparently all of these things are choices. Good to know.

If you try the menopause advice thing -- make sure to tell us.
 
bad rad

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Officially started TRT this week. I am on a test cyp/HCG/AI regime. I didn’t take the AI this week, might wait until I see symptoms or just take a reduced dose to avoid them.
I'd wait about a month to re-test your hormones before jumping on an AI immediately. I can't use them since my E2 stays so low. Low E2 is pretty crappy.

As for being a jerk low T causes anger issues in most men. That was the symptom that made me seek treatment.
 

Uncle_E

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I'd wait about a month to re-test your hormones before jumping on an AI immediately. I can't use them since my E2 stays so low. Low E2 is pretty crappy.

As for being a jerk low T causes anger issues in most men. That was the symptom that made me seek treatment.
What are your low E2 symptoms?

I held off on the AI for the first week, but I was feeling a lot of nipple sensitivity and tingling so I decided to start the AI half way through week 2. I’m on week 3 now.
 

Uncle_E

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Your wife has never been a man. She has no way of knowing what normal hormonal feelings - for you - are.

Although, many women try to be the man - or at least "share" their opinions, which are "based in their feelings", about what you should do with your body - and yet they feel qualified/entitled to do so. Even though they have no clue - about your body.

She cannot comment on your hormonal situation any more that you can intelligently offer first hand experience on her menstruation.

Maybe when she goes through menopause, you can tell her that any symptoms you notice is her choosing to be a bitch, and she should just stop ‘choosing’ to have her symptoms, you know like night sweats and hot flashes. She can just ignore the beard she grows after menopause; the beard is just something she has chosen the grow.

Apparently all of these things are choices. Good to know.

If you try the menopause advice thing -- make sure to tell us.
Haha Beau your a savage! You make some good points, I’m not old enough or crazy enough to try that menopause thing! She is pregnant now, so that’s a whole different ball of wax!

Fortunately she seems to be happy with the improvement so far even if it is placebo at this point.
 
bad rad

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I get extreme joint pain, bad erections, poor sleep, etc. The normal ones really. I tend to do better with "high" E2 in the 35-40 range on standard testing. I over respond to AI and have E2 below 6 for months.
 

Uncle_E

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So I have been on TRT for just over a year now, and I feel great with no regrets. My protocol is 200mg Test Cyp per week, HCG and .25mg AI 2x per week. I didn’t specify the HCG dosage as I try to take it as little as possible. The prescribed dose is 330iu 3x per week - I take more like 250iu 2x per week and take a few weeks off here and there. I can really feel it spike my E.
Prior to TRT:
Test: 259 ng/dl (250-1100)
Test: 294.3 ng/dl (241-827)
Free T: 44 pg/ml (47-244)
Estradiol: 10.2 pg/ml (7.6-42.6)
PSA 1.4: ng/ml (0.0-4.0)

After 1 year
Test: 869 ng/dl (264-916)
Free T: 26.9 pg/ml (8.7-25.1)
Estradiol: 18.3 pg/ml (7.6-42.6)
PSA: 1.1 ng/dl (0.0-4.0)
 

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