Should I start with T gel ot T shots?

[louie2400]

I'm wondering if you guys think I should start my TRT journey with T gel or T shots? Either option my Dr is also willing to prescribe HCG . A little background I am 30, tried everything over the past 1.5 yrs to try to raise levels naturally through diet, supplements and vitamins, exercise etc. I gave clomid a try for 40 days and it raised my levels in the 550 range, but sides were too much. I was going to give HCG monotherapy a try, but I have read that it just doesn't yield the results that T + HCG gives. I was going to try HCG mono in order to preserve fertility, but read a study that looked at spermatogenesis in men that were on T + HCG and no decline in sperm parameters were found. It was a small study, but promising. I am currently in a very challenging grad school program and am at the point that I need relief of symptoms ASAP as I am kind of at my breaking point. That is why I am not sure if I even want to give HCG mono a try. I have a script for HCG, but am waiting for insurance to hurry up and decide if they will cover it.

So as far as T gel or shots? I am leaning towards shots because I have read that gels don't work for a good population of those that try it and if they can lose effectiveness over time. But T gels are obviously more convenient and if they do work yield more consistent levels. Would I be able to raise my T levels as high with gels though? So what kind of advice do you guys have as what you would start with gels, or shots?

[lovbyts]

How about trying a doctor such as an Endocrinologist so instead of treating the symptoms you can treat the problem, once you find out what it is. TRT is a last choice.

[>Good Luck<]

So do you have low t to begin with? Show some bw results and so proper history.

[louie2400]

Thanks for the replys. This is my third Dr. now and he specializes in TRT and fertility.

No direct diagnosis as to why I’m secondary hypogonadism (low T). As far as head injury I got into a car accident and rolled my car on its side when I was in high school, no seat belt, smashed my face on the steaing wheel, but no broken bones. I didn't go to the hospital, but most likely had a concussion. Also got into a fight in early high school where I probably had a mild concussion, other than that no head injuries. Never used any performance or AAS. I smoked weed growing up, but always stayed in shape- lifting and working out, and wasn't your typical stoner. I haven't touched the stuff in like 5 years. I have varicoceles grade 2 and 3 on both testicles found via palpation and ultrasound, but Dr said they shouldn’t cause that much of an issue.

I have a pituitary MRI scheduled in a week. I put it off for a while because my dad had one and had a very bad reaction to the gadolinium dye. My dad was also diagnosed with secondary hypogonadism (low T) about a year ago. As far as I know now, my secondary has a BIG genetic component. I eat ridiculously healthy and have for a long time. Virtually no processed foods with lots of veggies, fruits, quality meats, and fats. I have always stayed in shape whether it was lifting weights, or running or a mix of both. I have teetered back and forth between running distance and lifting weights through the years. I currently don’t take and meds. My sister was diagnosed hypothyroid, but my levels have been checked numerous times and all came back fine.

I definitely didn’t want to have to resort to TRT if possible, but at this point it seems like the only option. I have already wasted (literally) years of my life just getting by in life and going through the motions. Sometimes I am amazed at how much I have accomplished in this state that I have been in, but know if I felt better and was healthy (hormone wise) my life would change dramatically. One of my biggest concerns is my mental performance and memory issues, they are pretty bad. But I also have NO libido and haven’t had any for about years. I just had a semen analysis that came back good. I have pretty bad sleep issues, but had a sleep study done that ruled out sleep apnea. I also am always fatigued and am at the point where I can not even work out anymore. If I do I will be shot for like a week. My mood is usually kind of off too even though I always try to stay as positive as possible. Here is most of my lab work for the past year plus while I tried to naturally get my levels to normal and most importantly feel better.

Nov. 11 2011:
TSH: 2.136 (0.358 - 3.740)
Testosterone : 129.0 (241 – 827)

Nov. 22 2011:
Testosterone: 153.0 (241 – 827)

Dec. 2011:

Test: 203 (280-800);
T Free 5.8 (9.3-26.5);
TSH 2.136 (.358-3.740);
Prolactin 4.8 (2.1-17.7);
FSH 3.0 (1.4-18.1);
LH 1.4 (1.5-9.3);
IGF-1 320 (63-373);
Morning blood cortisol 15.7 (4.3-22.4);
T4 Free .87 (.76-1.46)

March 2012:

Test 360 (280-800);
T Free 12.0 (9.3-26.5);
LH 4.4 (1.5-9.3);
FSH 3.7 (1.4-18.1);
Folic Acid,
RBC 675 (280-791;
Vit. B12 749 (211-911);
Trioiodothyronine total, TT3 .97 (.70-1.90);
Iron 92 (65-175);
% iron saturation 24 (15-50);
Ferritin 168 (26-388);
Celiac Test: IgA 5 (<20) IgG 4 (<20) IGA 1 (<4) IgA 123 (70-400);
Vit. D 44.3 (32-100);
Estradial 17b 15.8;
Thyroglobulin antibodies <20 (<40);
TPO antibodies 11 (<35)

May 24 2012:

TESTOSTERONE, TOTAL: 293 (250 – 1100)
TESTOSTERONE, FREE: 60.8 (35.0 - 155.0)

August 15, 2012(New Urologist):

FSH 4.1 (1.4 - 18.1)
LH 2.7 (1.5 - 9.3)
TSH 3.12 (0.36 - 4.20)
Prolactin 9.0 (0.2 - 13.0)
Estradiol 32 (11 – 40)
Testosterone 528 (300 – 1080)
SHBG 20 (11 – 80)
Testosterone, Bioavail 348 (131 – 682)
Testosterone, Free 130.0 (47 – 244)
Testosterone, % Free 2.5 (1.6 - 2.9)
Hematocrit 44 (40 – 52)

*not sure what increased total T at this time. I didn't change anything. For all I know it was a testing error. I still felt like complete crap at this time.

Nov. 12 2012:

Testosterone 82 (300 – 1080) *82 not a typo, VERY low
SHBG 22 (11 – 80)
Testosterone, Bioavail 47 (131 – 682)
Testosterone, Free 17.0 (47 – 244)
Testosterone, % Free 2.1 (1.6 - 2.9)
Estradiol 21(11 – 40)
TSH 1.97 (0.47 - 5.00)
FREE T4 1.2 (0.8 - 1.8)
TOTAL T3 0.92 (0.80 - 2.00)
25 OH Vitamin D, Total D2+D3 35 (23 – 65)
GLUCOSE 93 (70 – 99)mg/dL
BUN 15 (8 – 23)mg/dL
CREATININE 0.87 (0.50 - 1.20) mg/dL
EGFR (MDRD CALC)103>60

*not sure what caused the 82 total T at this time. I didn't change anything besides taking low dose 50mg of 5-htp before bed to help sleep and also took 3mg of melatonin a hand full to help sleep.

So after a month of clomid of 25mg EOD here are my labs:

Testosterone ,Adult Male 568 (300 - 1080) ng/dL

SHBG 25 (11 - 80) nmol/L

Testosterone, Bioavail 345 (131 - 682) ng/dL

Testosterone, Free 129.0 (47 - 244) pg/mL

Testosterone, % Free 2.3 (1.6 - 2.9) %

Estradiol- 34 (11-40)

[kelkel]

Louie it sounds like you're on the right track with a competent doc. Good for you. Very curious about what your upcoming MRI reveals. Please update this thread.

When it comes to the type of treatment you choose, you need to evaluate your lifestyle and discuss it with your family as well. You can always start with one and switch later if need be.

[EverettCD]

I am currently on Axiron, this is what I started TRT with. I am going to switch to injections soon as I am concerned about transferring it to my wife. The Axiron has worked well so far.

[steroid.com 1]

Your Doctor is wrong, Varicocele DOES cause low testosterone serum levels.

Read:
http://www.ncbi.nlm.nih.gov/pubmed/21435152
http://www.sciencedaily.com/releases...0616142726.htm
http://www.modernmedicine.com/modern....jsp?id=728993

These "Doctors" just amaze me...

[kelkel]

Good catch G. Doc's terminology "shouldn't" is not appropriate.

[letsfixit]

Your Doctor is wrong, Varicocele DOES cause low testosterone serum levels.

Read:


These "Doctors" just amaze me...

I had labs done before and after my surgery. My pcp would not consider me for trt unless I got this varicocele fixed. My test neither dropped or raised. But my balls sure do look better!

[lovbyts]

I always get confused between Varicocele and spermatocele but I see the difference now.

Any more test planed for the future? I would hope you do with that 82# It may have been an oddball hopefully and come back up. Try not to take anything before bed the day before if possible and especially dont drink any alcohol. Hopefully they can find out what is wrong and not just start you on TRT. Maybe they will try to jump start you, not with test but clomid or ???

[louie2400]

Louie it sounds like you're on the right track with a competent doc. Good for you. Very curious about what your upcoming MRI reveals. Please update this thread.
When it comes to the type of treatment you choose, you need to evaluate your lifestyle and discuss it with your family as well. You can always start with one and switch later if need be.

Thanks Kel! I will definitely keep you updated about MRI info. As far as shots vs gel and lifestyle, I'm single so family isn't an issue right now. I am more concerned about the effectiveness between gels vs shots. I have read about so many guys that had to switch to shots from gels due to them not working or eventually stopped working. I am leaning toward shots as to skip the whole 3 month process finding out that gels don't work. I just don't think I can take another 3 months of feeling like garbage. I figure I will already be injecting HCG , what is a couple more shots a week. The only thing swaying me toward gels is that I have seen Dr. Crisler say that daily gel and daily HCG is the best therapy.

I am currently on Axiron, this is what I started TRT with. I am going to switch to injections soon as I am concerned about transferring it to my wife. The Axiron has worked well so far.

Thanks for the info!

Your Doctor is wrong, Varicocele DOES cause low testosterone serum levels.

Read:
http://www.ncbi.nlm.nih.gov/pubmed/21435152
http://www.sciencedaily.com/releases...0616142726.htm
http://www.modernmedicine.com/modern....jsp?id=728993

These "Doctors" just amaze me...

Thanks for the links Gdevine. Yeah I read those studies previously. And they basically say that a varicocele reversal can increase T levels minimally. Me and my Dr talked about this, but for the 150 point increase I don't feel the surgery is worth it in my case. If I was sitting at 500 and it could bump me up to 650 that would be a different story.

I had labs done before and after my surgery. My pcp would not consider me for trt unless I got this varicocele fixed. My test neither dropped or raised. But my balls sure do look better!

So are you going to start TRT now?

I always get confused between Varicocele and spermatocele but I see the difference now.

Any more test planed for the future? I would hope you do with that 82# It may have been an oddball hopefully and come back up. Try not to take anything before bed the day before if possible and especially dont drink any alcohol. Hopefully they can find out what is wrong and not just start you on TRT. Maybe they will try to jump start you, not with test but clomid or ???

I'm not sure what other tests I can get. I have thoroughly looked at my thyroid. I have had a sleep study. My T levels have been consistently low for the past year besides that one 500ish value, which I have no idea what the deal there was because I still felt like garbage at that time. What else should I look into? WHat other tests should I have done?

I just got done taking clomid 25mg EOD and my results are posted above. It raised my T levels, but the moody/depressive sides were way too much to handle. I had to stop. Since stopping clomid I feel like my energy is less and less everyday (as the clomid is leaving my body due to clomids long half life).


If anyone else has any insight/advice I'd love to hear it!

[Rusty11]

I'm 51,so going on trt was a no-brainer. However, at 30, thats a whole different ballgame-really young. Anyway, testim is doing me good. When I added 100iu hcg each day, things really improved. So much, that I've cut back on the gel. Will this continue? Who knows. But for now, the combo has made me feel your age again. .
Good luck with your decision and it's great that ypu are weighing all options before taking the plunge. 30 is young.

[EverettCD]

I'm 51,so going on trt was a no-brainer. However, at 30, thats a whole different ballgame-really young. Anyway, testim is doing me good. When I added 100iu hcg each day, things really improved. So much, that I've cut back on the gel. Will this continue? Who knows. But for now, the combo has made me feel your age again. .
Good luck with your decision and it's great that ypu are weighing all options before taking the plunge. 30 is young.

This is great to hear a fellow gel trt user state that the addition of daily hcg has really improved things. I am adding hcg to my routine in a few days when it comes in.


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[Rusty11]

I'm doing 100iu/day. I read online and on here that this is the recommended dose for guys on gels.

[EverettCD]

Good deal, that my plan as well.

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[louie2400]

Just an update: So I have my MRI early next week. I was prescribed HCG @ 1500iu 3 days a week, about 3 weeks ago, but insurance was taking forever to get back to me and just found out they won't cover it. I don't have my next appointment with my doc for about 2 weeks, so I decided to fill my HCG prescription, but it was expensive ~$200 for 10,000iu. So I did an injection last night of 1000ius and don't feel any different (I'm sure it will take a while to feel anything). From here on out I plan to inject 500 ius 3 times a week until my Dr appointment. (I couldn't afford 1500ius 3 times a week and it seems like to high a dose anyway). Does 500ius 3 times a week seem like a good dose for HCG monotherapy? I figure I should give HCG mono a try for at least a few weeks and talk to my dr and see what he says. At this point I don't really have any other options until my appointment anyways. WHat do you guys think? As far as gels vs injections if I do go that route I have been leaning toward giving gels a try.

Speaking of shots, last night was the first time I have ever injected anything. I used an insulin needle in my butt (I have lower body fat) and literally could not feel it.

[steroid.com 1]

Read the sticky on HCG at the top of the forum...I wish I had a dollar for how many times I have to write that...

Any dosage amount over 350 iu daily has consequences like increased E2 levels and down regulation of leydig cell receptors.

[louie2400]

Update: I had my MRI yesterday and it wasn't as bad as I expected. I did feel a little weird when they injected the contrast dye, but did ok. The MRI came back relatively normal except for a mild heterogeneity of my pituitary with no masses. I also started HCG monotherapy last wednesday @ 500 iu three times a week. My doctor prescribed 1500 ius three times a week, but a)that seemed like way too high of a dose (even though I haven't seen any direct studies indicating a certain dose of HCG will lead to higher aromatization and thus higher E2, although many say that 350 ius is the theshold as Gdevine states above) and b) HCG is expensive without insurance covering it, ~$210 for 10,000 ius. I have injected HCG 3 times thus far and haven't noticed anything substantial yet. Should I feel something already? So I have my next appointment with my Dr next week. At this point I think I am going to give HCG mono a try for atleast 4 weeks, get labs and see what happens. But I am most likely going to lean toward trying a gel along with low dose HCG. I actually found a study that showed that T shots/gel along with low dose HCG lead to no decline in speramatogenesis. It was just published. Here is the gist:


Concomitant Intramuscular Human Chorionic Gonadotropin
Preserves Spermatogenesis in Men Undergoing Testosterone
Replacement Therapy

Results: A total of 26 men with a mean age of 35.9 years were included in the
study. Mean followup was 6.2 months. Of the men 19 were treated with injectable
testosterone and 7 were treated with transdermal gel. Mean serum hormone
levels before vs during treatment were testosterone 207.2 vs 1,055.5 ng/dl
(p 0.0001), free testosterone 8.1 vs 20.4 pg/ml (p 0.02) and estradiol 2.2 vs 3.7
pg/ml (p 0.11). Pretreatment semen parameters were volume 2.9 ml, density
35.2 million per ml, motility 49.0% and forward progression 2.3. No differences in
semen parameters were observed during greater than 1 year of followup. No
impact on semen parameters was observed as a function of testosterone formulation.
No patient became azoospermic during concomitant testosterone replacement
and human chorionic gonadotropin therapy. Nine of 26 men contributed to
pregnancy with the partner during followup.

Conclusions: Low dose human chorionic gonadotropin appears to maintain semen
parameters in hypogonadal men on testosterone replacement therapy. Concurrent
testosterone replacement and human chorionic gonadotropin use may
preserve fertility in hypogonadal males who desire fertility preservation while on
testosterone replacement therapy.