testosterone--forum best practices

[tompaynter]

It's come to my attention that Rip and other experts here are addressing hormone issues medically if necessary, and not taking your doctor's word for it that you are ok just because your hormone levels are in some arbitrary normal range. I just turned 48 and while I am generally healthy, I can't say that I am brimming with motivation and vigor. Given that testosterone levels are falling society-wide*, I think it could be worth getting checked out. But it's complicated, so I'd like to get advice on how to go about it.

From various forum posts, it sounds like:
1) Don't take a general-practice doctor's word for it, seek a referral to an endocrinologist or even a doctor who specializes in men's issues (what would that be called, what should I search for?).
2) It's not a matter of just testing one hormone level. I'll quote from a forum post from a few years ago:
You need to get your "free and available" testosterone number as well, and your SHBG number. Testosterone attached to sex hormone binding globule (SHBG) is not available to your body to use, but it gets measured as part of the total. You also need to know your estradiol, and that ABSOLUTELY HAS TO BE measured using "sensitive assay." The estrogen test for women is useless to you, you must specify "sensitive assay." That tells you if you have too much estrogen, which indicates that too much of your testosterone is being converted to estrogen.
3) There are measures short of testosterone replacement--the drug Clomid was mentioned.

I could pay for tests but if it can be covered by insurance, I'd prefer it. The recommendation I've seen is to go to the doctor with a complaint suggesting low T (and not "my squat isn't going up as fast as I'd like"). Get a referral to an endocrinologist and go from there. Is that about right? Is it worth doing for someone like me who doesn't so much have specific symptoms as a suspicion that things could be better? (I actually saw an endocrinologist years ago because I had a general malaise that I thought might be low T but was told I was hormonally fine.)

Thanks.

Tom

P.S. I'm also considering doing SpectraCell's micronutrient testing...posted a question about that in the Nutrition forum.

*I think the overall decline in testosterone in males might explain a lot more about society nowadays than it is given credit for.

[crc]

If you're honestly trying to address your general malaise and not just looking for online validation to get a TRT prescription, examine your sleep and stress level first, then take it from there. Those affect everything.

[Cheesepuff]

I had thoughts down that line some time ago, but figured it is better to fix this more naturally if possible.

What CRC says above plus this video
How to Increase Testosterone Naturally | The Art of Manliness

I found taking D3 with fat, along with LP helped quite a bit. Don't over train or under train.

For sleep I found that earplugs and Afrin made a huge difference. (Rip says he does that so worth a try I figured)
I also clean out my nose with soap and a cup of water (no there are no videos), twice a day. I snore a lot less, and could have gotten insurance to pay for a CPAP machine. (I'm 64)
But again, more natural, if it works is better imo.

I'd investigate "going off TRT" before deciding to "go on TRT". But, that is just me.

Last line, and I never got here, I'd pay someone who knows what they're doing for advice.
There are doctors on these boards. I'd bet they would make recommendations that would be worth the money.

Good luck.

[Mark Rippetoe]

Soap???

[Cheesepuff]

A drop of anti bacterial hand soap in a glass of warm water.
It gets pretty nasty in there quickly apparently. And my breathing is better all the time.
Plain warm water wasn't gittin 'er dun.

I've had several broken noses. Talking when I should have been listening.

Now I do not inhale the water into my sinuses, if I were to do that, I figure I'd follow the Nette pot type salt and distilled water.
The water is going no further in than during a typical shower, just a little more volume and gentle scrubbing.

Clearly I require constant supervision!

[jfsully]

Yes, if you use a Neti pot, use sterile water! Tap water may rarely carry a brain-eating amoeba (safe to swallow but deadly if it moves from your sinuses to your brain).

Very unlikely, but totally avoidable.

[Masher]

The scenario you described was exactly my situation.

1. Be mid-40s, like me. Felt like crap, low energy, growing a gut despite exercise and good lifestyle.
2. General Practitioner tested me twice, only for "overall T" numbers -- came back low in 300-400 range.
3. Referred me to endocrinologist. Numbers were low, SHBG was HIGH. Result, no free T for my body to make use of.
4. Injecting 100mg/wk straightened me right out.
5. Realize I should have done this 5 years sooner ...

[tompaynter]

The scenario you described was exactly my situation.

1. Be mid-40s, like me. Felt like crap, low energy, growing a gut despite exercise and good lifestyle.
2. General Practitioner tested me twice, only for "overall T" numbers -- came back low in 300-400 range.
3. Referred me to endocrinologist. Numbers were low, SHBG was HIGH. Result, no free T for my body to make use of.
4. Injecting 100mg/wk straightened me right out.
5. Realize I should have done this 5 years sooner ...

Interesting. So does that mean you've more or less committed to testosterone replacement for life? Did you try or consider trying something like Clomid first, which if I understand correctly doesn't shut down one's own testosterone production?

[Richard Seaman]

Interesting. So does that mean you've more or less committed to testosterone replacement for life? Did you try or consider trying something like Clomid first, which if I understand correctly doesn't shut down one's own testosterone production?

I have no medical credentials, and only think I know from what I have read, so take these comments with the appropriate "grain of salt". My understanding is that low T can have any number of causes, and that fixes can take several forms depending on the cause. Broadly, and overly simplistically, there is primary and and secondary hypogonadism (low T). Luteinizing Hormone (LH), made in the pituitary gland, stimulates the gonads to produce T. (GNRH produced in the hypothalamus, stimulates production of LH). If LH is low and T is low (or LH is possibly normal -- an abnormal normal since LH should be high if T is low), that is secondary hypogonadism. In this case, I understand that clomid is sometimes useful since it can stimulate more production of LH. It may or may not work in this case. And, I've read that sometimes taking clomid for a period of a month or few months can jumpstart production of LH so that clomid can be discontinued.

However, if LH is high and T is low, that is primary hypogonadism. Clomid would not be useful since LH is already high. (This is me, sky high LH, low T). In rare cases if you have a deficiency of some essential nutrients or micronutrients, your gonads might have trouble making enough T. But in most cases the gonads are just not up to the job. In this case exogenous T is about the only solution.

Thats my understanding anyway.

[hondotbt]

Now I do not inhale the water into my sinuses, if I were to do that, I figure I'd follow the Nette pot type salt and distilled water.
The water is going no further in than during a typical shower, just a little more volume and gentle scrubbing.

I use the squirt bottle type of nette pot with salt daily after surgery 2 years ago to fix deviated septum and it's been of great help in reducing regular URI's.