Originally Posted by
Will Morris
I don't wish to hijack this thread, but I did wish to say a thing or two before this thread gets lost to the abyss of the rest of the Q&A forum:
First things first, I cannot overstate how important it is to find a provider who has actually studied hormone replacement therapy, its optimization, and indications for treatment more than the "UP TO DATE RECOMMENDATIONS". When you fail to do this, you will have a much greater threat of finding yourself on the dark side of TRT treatment. At the age of 34, I finally made my first complaint to my PCM about feeling less energetic, somnolent, and basically just feeling like hell even though I was doing all the right things to take care of myself. I train frequently, I watch virtually everything I eat, and I have no vices. I figured, at that time, that it had to be something hormonal since I have had abnormal endocrinology panels since I was a young child (delayed onset puberty, constitutional growth delay, etc). At first, my PCM wanted to force a SSRI (selective serotonin reuptake inhibitor) on me, to which I pled my case that I was not depressed. Instead, I was sent for a sleep study. The sleep study confirmed mild to moderate Central Sleep Apnea with some obstructive sleep apnea, as well. I was treated with an auto-titrating PAP machine. That led to some marked improvement in daytime somnolence, but it did not shake the constant feeling of just feeling old and crappy. After that year, I was finally sent for a comprehensive blood panel, which included all the typical labs for testosterone. I ended up testing with something to the tune of 180 for total testosterone. After some wrangling with trying patches and gels, I was finally placed on TRT at a dose of 50mg / week. That was increased to 100/week after about six months. I felt much better. I can't say for certain that it was absolutely life-changing, but I did feel much better. My mood, my affect, my energy levels, etc all improved enough for me to notice. I felt much better. Fast forward two more years and I had a new PCM assigned. He retook my labs and my total testosterone was in the mid 400s. In our system, most providers will only treat enough to get you into the lower bounds of normal. He looked me up and down and said, "I don't really feel comfortable with you being on TRT because you don't look like you need it." His clinical decision making was relegated to looking at my appearance, and instead of chalking my physique up to over twenty years of training and eating well, his pudgy ass decided I needed to be taken off because I was "too muscular" to be on it. To top that off, everyone from the PCM to the pharmacists always treated me like a criminal when I would pick up my refills. I had numerous pharmacists ask me point blank, "Why do you need testosterone?"
Now the dark side part: I did not realize how much better I felt until I was taken off "cold turkey" like this. What transpired next was the worst 9 months, or so, of my entire life. Starting about 4 weeks after that appointment, I had a pretty precipitous decline in my overall mood, energy, and general feelings of well-being. I felt worse than I ever had before, but, with my line of work, I had no recourse to seek treatment elsewhere. Further, a superior officer several levels up authored a policy memorandum that prohibited anyone from being able to travel overseas for their job while being on TRT.
It took about 9 months to get back to some semblance of feeling better. I'm now about 2.5 years out from being taken off, and I feel okay, but I do admit that it is probably because I have now forgotten how much better I felt when I was on it. Interestingly enough, and it shouldn't come as any surprise to Dr. Nichols, but the TRT I was on had absolutely zero effect on me in the gym. I set zero PRs, and I did not have any appreciable improvement in my physique.
My most recent labs I had my total testosterone at 165. Luckily, I think I will be in a position where I can now seek the care of a physician who will consider more than just the fact that I have a relatively low bodyfat percentage for my age. I know spending money on something that you think should be covered by insurance sucks, but, I cannot overstate that "free medical care" oftentimes comes at a great cost. Certainly, insurance may pay for treatment, but, I've known my fair share of providers who will find any excuse to end treatment for someone because they don't want to be held liable if a patient abuses their prescription for TRT. Find a clinic that specializes in this field, and just be okay with paying the fee to have treatment. It is worth the fee to not be perpetually under the threat of having treatment stopped, and you don't have to worry about being treated like you are Greg Valentino when you go to the pharmacy to pick up your refill. Also, the time to diagnosis was measured in tens of months, with quite a bit of additional time wasted trying other forms of the medication that are far less effective. It leaves me curious as to how much of my 30s and into my 40s I have wasted feeling like shit.