Advice on Quitting TRT (VERY long read)

[kelkel]

Xtitan you're quickly becoming an asset to this board!

kel

[xtitan1]

Xtitan you're quickly becoming an asset to this board!

kel

Oh thanks man I appreciate that

[PSFinAL]

Thank you guys for answering so quickly and providing advice. Below is my follow-up:

From kelkel: It would have been helpful if you were on HCG throughout TRT. If you were, I missed it.

I wish I had found this forum before even being put on TRT but I was ignorant. I was unaware that HCG could be helpful so no, you didn’t miss it. I thought I read somewhere that HCG can be expensive too but I’ll look into it.

From Vettester: One of the concerns I would have had is wondering why your testosterone was low to begin with? Your baseline labs were not all that good for the total serum (definitely low end for your age), but worse yet you had a 1.26% free test, indicating your SHBG must be highly elevated. Your free test should ideally be between 2% to 3%; right in the middle would be great!

The reading of the results was by a urologist and his response regarding my numbers was something to the effect of “some men have high testosterone while some have less but you’re within range.” What else could explain the fact that I seemingly had a good libido still with such low values? Was it just enough to keep me sputtering along?

From Vettester: This should have (IMO) prompted an MRI. Other pituitary related labs should have been taken (and still should be), including ACTH, prolactin, and at the time they should have also taken your LH/FSH.

Sounds like good advice on the MRI and I’ll ask the doctor about it. Would you suggest an MRI following a blood test to include ACTH and Prolactin depending on the values?

From Vettester: 2) Even if your HPTA responds, what does it do, go back to where it was before? I would only be guessing that you were slightly suppressed before starting, so all you might be doing is going back to that.

I know that I need to determine first if I have primary or secondary hypogonadism but let’s assume that I can go back to where I was. Since I had no noticeable symptoms at the time, what’s the harm? Would I be teetering between feeling good and not so good? Would I be medically too low?

From Vettester: Your SHBG is probably in the 50's or 60's, it needs to come down, maybe in the 20's. Check your B12 as well, and a Cortisol AM/PM test. The ACTH lab will help give us an idea with the feedback of cortisol, and will also be a factor if there's a condition with the pituitary. Would also like to see your lipids and metabolic panels, and definitely want to know if your kidneys and liver enzyme functions are normal.

I’ve wondered if I was on the low end of normal and my SHBG was high if I could be treated to lower it and get the same effect. As mentioned, I’ll ask about ACTH as well as getting Cortisol AM/PM. As far as my lipid profile, I only had one and that was in Dec 2011 and it was off the charts awful! I updated my original post with the values. I attributed it to diet, lack of exercise, and a thyroid that seemed to go south. As I understood it, once properly medicated on thyroid, cholesterol usually normalizes. I probably should ask for another lipid panel again. Back to Cortisol, the doctor put me on Adrenal Cortex and stated that anyone being medicated for hypothyroidism needs to take it and mentioned that the test for it was a waste of money since he would put me on it anyway.

From Vettester: Thanks for sharing a little historical information about yourself. If you can also tell us a little more about yourself, stats, medications, any notable family predisposition for disease, and a little bit about your lifestyle and levels of stress.

No problem. See paragraph 2 in the original post as I updated it with this information.

From xtitan1: Now for the part that I'm not getting: you're wanting to quit TRT therapy after never re-testing your testosterone levels after starting. TRT is a dial-in process and it seems like your doctor keeps changing your testosterone dose without checking your levels (unless you didn't write them down in your post). What's with that?

I’m not sure why my doctor hasn’t looked at my numbers again except that he’s the type that will listen to the symptoms and make a judgment regarding whether or not to request blood work. I can see where this can be good and bad. He upped my testosterone because I told him that I was feeling better but I wasn’t my old self so he increased my dose from 100 mg to 150 mg without a blood test. I must also mention that I take 0.25 mg of Arimidex every 4 days.

Lastly, I’d like to elaborate more on why I want to quit TRT. For starters, I don’t want to be dependent on medication unless it’s absolutely necessary. Second, my wife and I aren’t trying to get pregnant but we’re not preventing. We’re basically letting nature take its course but the problem is that my sperm count is probably minimal or zero. Last, if I can get to the root cause, then maybe there’s a more suitable treatment options available. If not, then I’m fine with being on TRT for life but I’d rather find out what’s going on first…even if it means an attempt at HPTA restart in order to really find out. I also wanted to mention that I still have no noticeable testicular atrophy. My testes are about the same size and they always were. I measured them at 2.25" long by 1.25" wide but I'm not sure that the size matters except to say there's no noticeable size change.