Apologies in advance for the long life story. Not in the US.
The History (skip this if you like!)
I presented 12yrs ago as I hit 40, with life-altering fatigue, irritability and unable to control emotions, social anxiety, poor libido, poor sleep, weight gain. Diagnoses included sleep apnoea, T2 diabetes, major depression & general anxiety disorder, obesity (BMI 34.7), high cholesterol, high LDL, high Trygs, low HDL. But my blood pressure was good! Various Doctors started patching me up with CPAP, Metformin, a thousand different SSRI/SNRIs and 50mg Androgel daily, along with plenty of stern warnings to exercise more, eat less, and eat healthy. I muddled along with not much change until covid hit, and I was forced to see new Doctors in early 2020 in my adopted country (was previously still visiting my home Drs every three months).
Endos here basically test for total T and not much else. I was at 7.11nmol/L or 205ng/dL. I was prescribed Nebido (T-Undecanoate, 1000mg every 13wks aka Aveed). At the same time my diabetes was out of control (hospitalised for DKA) and I was started on insulin (BMI now 37.9). Depression was worse and a whole new raft of drugs administered. Blood Glucose came down, bloods started to get better, a little weight loss, not much change in the quality of life, still very low energy and depressive including a couple of three-month stints off work due to brain fog, lack of energy and all that depression jazz. Blood Pressure still good!
By mid 2021, my troughs were still measuring at 7.4nmol/L (213ng/dL). Following a very severe depressive episode in late 2021, my shrink put me on Spravato (basically ketamine) and like a miracle, the depression and anxiety was vastly reduced overnight, although still taking the SSRI/SNRI/Benzo cocktails. I've have mental ups and downs since then but mostly doing OK on that front.
But physically, still fatigued all the time, lethargic, low libido etc. I got as high as 10.6nmol/L (305ng/dL) in January this year, immediately before my next injection. Dr left practice, switch to new Endo with Nebido every 13wks. Occasionally felt a bit more normal, but still sleeping ridiculous amounts and napping at every opportunity. Sleep apnea well controlled. Despite 10yrs of Androgel then Nebido, this is when I noticed my testicular atrophy, wherein my Endo just shrugged. I was placed on Ozempic in Feb 23 and have followed the protocol since then, now 1mg every week. Mysteriously, my Blood Pressure remained good.
The Present
Male, Early 50s. 178cm (5'10"), 89kg(195lbs), BMI 28.1 (all in the belly), reasonable diet five days out of seven, walking approx 8-10,000 steps a day and occasionally swimming a couple of km. Still hate exercising. Atrophied raisins. Still brain fogged, weak & fatigued all the time, low libido and poor sleep. Good BG control, still losing weight.
Meds: Lexa/Pristiq/Spravato (mental health), Vyvanse (ADHD/wakefulness); Ozempic/Metformin (T2); Nebido @13wks TRT.
Test: I tested Total-T this month at 13.08nmol(376.9 ng/dL), my highest reading to date, having not had Nebido in 21weeks (New Endo again!). But I am in my worst bout of fatigue in a long time.
Bloods: are good, mostly. A1c is 6.2% (fasting 102mg/dL), Lipids are mostly good, although could do with higher HDL and Trigs are borderline. Only concern is Haematocrit at 51%. No markers for PSA, CHD, AHF; Liver and Kidneys all OK. Thyroid apparently OK.
So huge strides both mentally and physically this year - so how come I feel like crap more than ever?!
Where am I now?
I went down a rabbit hole about my nuts (partner and I both loved them low hangers!), read up on hCG, which led me to read more on TRT for older men, then learn more about all the other hormones that affect hypogonadal middle-age men. I then came across a ton of great articles here on ASF in the TRT section, as most other sources were focussed on gainz.
Realising I needed to do something I eventually found a lab able to do a full hormone screen (US$750! ouch!), so at least I have more than a Total-T readings to influence my decisions. I should know more in a week or so.
At the same time, my shrink(!) has given me blood orders for Total-T so I can test monthly to see what is happening between Nebido injections, try to establish a pattern. I was also thinking I wanted to ask my Endo to increase frequency to every 10weeks - the problem I face is that the reference range here is 6.7-25.7nmol/L (193-916ng/dL). So of course, with my readings I am fine. And my blood pressure is still normal!
The link between obesity-diabetes-low T-sleep apnoea-depression is well established, but as my mental health, weight, BG and apnoea are resolved/resolving, all I am left with is wondering about the last variable: my hormones.
What I would like to do, and my questions.
Chwist.
The History (skip this if you like!)
I presented 12yrs ago as I hit 40, with life-altering fatigue, irritability and unable to control emotions, social anxiety, poor libido, poor sleep, weight gain. Diagnoses included sleep apnoea, T2 diabetes, major depression & general anxiety disorder, obesity (BMI 34.7), high cholesterol, high LDL, high Trygs, low HDL. But my blood pressure was good! Various Doctors started patching me up with CPAP, Metformin, a thousand different SSRI/SNRIs and 50mg Androgel daily, along with plenty of stern warnings to exercise more, eat less, and eat healthy. I muddled along with not much change until covid hit, and I was forced to see new Doctors in early 2020 in my adopted country (was previously still visiting my home Drs every three months).
Endos here basically test for total T and not much else. I was at 7.11nmol/L or 205ng/dL. I was prescribed Nebido (T-Undecanoate, 1000mg every 13wks aka Aveed). At the same time my diabetes was out of control (hospitalised for DKA) and I was started on insulin (BMI now 37.9). Depression was worse and a whole new raft of drugs administered. Blood Glucose came down, bloods started to get better, a little weight loss, not much change in the quality of life, still very low energy and depressive including a couple of three-month stints off work due to brain fog, lack of energy and all that depression jazz. Blood Pressure still good!
By mid 2021, my troughs were still measuring at 7.4nmol/L (213ng/dL). Following a very severe depressive episode in late 2021, my shrink put me on Spravato (basically ketamine) and like a miracle, the depression and anxiety was vastly reduced overnight, although still taking the SSRI/SNRI/Benzo cocktails. I've have mental ups and downs since then but mostly doing OK on that front.
But physically, still fatigued all the time, lethargic, low libido etc. I got as high as 10.6nmol/L (305ng/dL) in January this year, immediately before my next injection. Dr left practice, switch to new Endo with Nebido every 13wks. Occasionally felt a bit more normal, but still sleeping ridiculous amounts and napping at every opportunity. Sleep apnea well controlled. Despite 10yrs of Androgel then Nebido, this is when I noticed my testicular atrophy, wherein my Endo just shrugged. I was placed on Ozempic in Feb 23 and have followed the protocol since then, now 1mg every week. Mysteriously, my Blood Pressure remained good.
The Present
Male, Early 50s. 178cm (5'10"), 89kg(195lbs), BMI 28.1 (all in the belly), reasonable diet five days out of seven, walking approx 8-10,000 steps a day and occasionally swimming a couple of km. Still hate exercising. Atrophied raisins. Still brain fogged, weak & fatigued all the time, low libido and poor sleep. Good BG control, still losing weight.
Meds: Lexa/Pristiq/Spravato (mental health), Vyvanse (ADHD/wakefulness); Ozempic/Metformin (T2); Nebido @13wks TRT.
Test: I tested Total-T this month at 13.08nmol(376.9 ng/dL), my highest reading to date, having not had Nebido in 21weeks (New Endo again!). But I am in my worst bout of fatigue in a long time.
Bloods: are good, mostly. A1c is 6.2% (fasting 102mg/dL), Lipids are mostly good, although could do with higher HDL and Trigs are borderline. Only concern is Haematocrit at 51%. No markers for PSA, CHD, AHF; Liver and Kidneys all OK. Thyroid apparently OK.
So huge strides both mentally and physically this year - so how come I feel like crap more than ever?!
Where am I now?
I went down a rabbit hole about my nuts (partner and I both loved them low hangers!), read up on hCG, which led me to read more on TRT for older men, then learn more about all the other hormones that affect hypogonadal middle-age men. I then came across a ton of great articles here on ASF in the TRT section, as most other sources were focussed on gainz.
Realising I needed to do something I eventually found a lab able to do a full hormone screen (US$750! ouch!), so at least I have more than a Total-T readings to influence my decisions. I should know more in a week or so.
At the same time, my shrink(!) has given me blood orders for Total-T so I can test monthly to see what is happening between Nebido injections, try to establish a pattern. I was also thinking I wanted to ask my Endo to increase frequency to every 10weeks - the problem I face is that the reference range here is 6.7-25.7nmol/L (193-916ng/dL). So of course, with my readings I am fine. And my blood pressure is still normal!
The link between obesity-diabetes-low T-sleep apnoea-depression is well established, but as my mental health, weight, BG and apnoea are resolved/resolving, all I am left with is wondering about the last variable: my hormones.
What I would like to do, and my questions.
- I was planning on hGC 500iu 2xWk SC to see if my marbles would recover size any. But after 12yrs on TRT they might be a lost cause. Do you think I need to blast first? This is purely vanity, kids not an option.
- I suspect I need to aim for more consistent T-levels. I'd like to aim for something median like 550-650ng/dL (19-22.5nmol/L) for my age, see how I feel. It depends on my full hormone results (Cortisol/DHEA/E2/FSH/LH/Free-T/Progesterone/TSH/T3/T4/Total-T/SHBG), and what I can learn from Total-T readings every month for the next three month before next Nebido shot.
- Pharmacies here take prescriptions as merely recommendations so I can get Testoviron (250mg Test-e) or Sustanon 250 quite easily. If I wanted to supplement the Nebido to get my levels up, what would be a good protocol? I was thinking around 50mg Test-E 2Xwk and start from there. (And what do I need to monitor apart from titties, E2, Hemacrit, BP?). Assume I'd need to stop a couple of weeks before my Endo blood draw?
- Anything else I should test for, add to my regimen that could help?
- Is it worth doing anything until my weight comes down further? I just feel like I need energy to do more at this stage. Not looking for aesthetics, just feeling normal. And a sex life would be nice.
Chwist.
Dont even worry about that brother.
So jealous of your lab prices. I have to depend on a friendly Dr for blood referrals outside of my usual Endo testing.
