Let me ask about the TRT. You’re young - are you taking any measures to preserve your fertility, knowing that long-term TRT use will shut down LH and FSH and they can be tricky to “reboot” when you’re older.
I agree about the ALT, and I’ve had the same situation with high ALT and normal everything else. I think that when a person is simply skinny/average, ALT mostly reflects the liver status. But once you carry above-average muscle mass, and you can lift heavy and effectively, you will see ALT spike more. In my years of training and taking breaks, that’s been pretty consistent, that when I’m more muscular and working harder, ALT will generally rise in blood tests. (I’ve had liver ultrasounds, a CT scan etc, and it’s in perfect health). But, if you want to really know, just take a week or so off from lifting.
There’s always the off-chance that the ALT is from somewhere else - like one of the supplements, medications or natural products you’re taking.
There are pretty reliable fertility protocols you can implement while on TRT. Even men who don’t use any fertility protocols can still impregnate a woman quite often.
The best fertility protocol I’ve seen other than stopping TRT for a while is to start using HCG. Some men may also need to add in FSH, or HMG.
Yeah of course, but nothing is for sure. Some guys bounce back with no effort, or get girls pregnant while on TRT, but others never bounce back. Back when I was a young trainee scientist I worked in a clinic which provided anonymised blood tests for guys using illegal drugs - many of which were steroids. They’d send in the blood with their age and a list of what they were taking, so I got to see a huge amount of different responses to things.
HCG is pretty expensive, last time I looked (though I haven’t used steroids or had to restart the HPTA for 15+ years now). Clomid is a weird drug too. I think having kids is one of the most important decisions a person can make, and I think you can’t always predict the future. I’m not pushing any ideology here, but if you’re young and think “I never want them” there is still a decent chance IMO that you change your mind in the future. I certainly did. So on that basis, I would always be a bit careful about making a potentially life-altering decision affecting fertility. I did use steroids, SARMs and all sorts of stuff, shut down and restarted my HPTA multiple times, and my wife got pregnant every time we wanted to. But I consider that as blind luck, and it could have gone horribly wrong.
It is important to differentiate between testosterone (especially normal or high normal doses) vs the whole gamut of steroids + other drugs bodybuilders tend to use.
You can get it pretty cheap just like you can get other pharma meds cheap if you get it from India or China.
I don’t like clomid. Enclomiphene is a little better but I also don’t like that. Has weird effects on the brain.
I think if a guy needs TRT to get energy and live a full life then he is more likely to have the energy to attract a partner in the first place. That’s where I’d consider TRT appropriate.
Some guys that are in the low end of the reference range (but still in the range) can still have strong symptoms of low testosterone that are resolved with TRT. The range itself has been lowered a number of times which I think isn’t useful.
Some guys can improve diet/lifestyle and get the numbers up and they feel great. Some guys do everything right consistently and still feel bad. Some guys have low numbers but feel fine.
I don’t focus on testosterone levels as much as the experience. There is a lot we don’t know such as androgen receptor density and sensitivity that causes different men to respond to the same level of androgens differently.
It would be great if something like enclomiphene (but better) was invented that went upstream and solved the issue without impacting fertility. I’m sure someone somewhere is working on that.
There is a new oral testosterone undecanoate that is out that they are claiming doesn’t have liver toxicity like other oral forms due to some mechanism and mimics the diurnal function of endogenous testosterone so that it doesn’t impact LH and FSH but if that is true or not I don’t know.
I started with 5mg and increased in a matter of months. A have absolutely no side effects so I planned to stay on this dosage. It helped my pump at the gym but now I’m not even sure if I feel it.
I don’t cycle modafinil. At this dosage it’s quite subtil and don’t interact with my sleep. I didn’t order a lot of it, it was to give it a try. Not sure I’m going to continue it.
I don’t try to maintain my fertility currently. I definitely want kids, just not right now. Matter of facts, I’m still virgin and don’t have a girlfriend so it is definitely not for soon. I could order rHCG (even an Ovitrelle pen is like 6500Ui for 25€ I think in France, so not costly), but what is mainly stopping me is the increase in aromatase enzymes creating more estradiol. Mine is already really high, wich could explain my BP (115 in systolic), and some water in my anckles. HMG is to expansive for a biweekly injection for months/years right now.
Meds like clomifene, tamoxifene etc. doesn’t work to imcrease LH/FSH while taking testosterone, especially at my dose, and their side effects are a no-go : eyes toxicity, blood clots, mood swing…
The idea is you use it 3 times a week, separated at least 1 day apart. You slowly titrate the dose up until you reach a point of overexcitement then start titrating downward. During this process you do mental exercises (also in the link I gave) and this drives up brain development.
I noticed by doing this for one month I gained a lot of mental benefits. I’m just starting this process up again.
Did you test your estradiol before and after starting tadalafil? Supposedly tadalafil slightly modulates estrogen metabolism.
Best to implement only if needed, and when you are trying to conceive.
Ok, so I guess all I’m saying is that it’s something to bear in mind. Some guys can conceive on TRT. Some guys can bounce back from years of TRT with no problems. Others need a lot of help to become fertile again. And others never regain fertility. You don’t know which group you’re in until the time comes. So if you definitely do want kids, at some point, you might want to think about preserving fertility, freezing sperm, or something to increase the chances in the future.
When I mentioned Clomid etc, I was meaning for when you came off, not to use them simultaneously with TRT, which would be dumb!
Totally agree. You see this in the trials of injections, gels, clomid, enclomiphene etc where the numbers on paper and the reported symptoms (qADAM etc) don’t necessarily line up.
For me personally there is a bit of a correlation with numbers and feel, but it’s hard to say which direction the correlation is. When everything is good, my normal total T is around 450-500, which isn’t a high boast-worthy number, but I feel good and function well. During a very stressful (work, study, life) period I measured my total T as around 150, and I felt horrible - but is that because I was stressed or because T was low. I’m not sure that boosting my T to 800 would have made me feel better, but maybe it would.
Anyway, with my stupid history of using prohomrones, oral steroids etc, I am just grateful that everything functions properly, my fertility was no problem, and mood etc is all good. I’ll periodically check, and if the numbers are dropping without cause, I’ll still keep an open mind to considering TRT.
I’ve had my testosterone higher than 1000 and I did feel great. Slight sleep interruption but it really felt good.
I’ve swapped from injection to cream. Lower testosterone overall I am presuming. Slightly higher DHT to test ratio. I feel a different mental quality in a good way on this.
I’m interested to increase the dosage but I will wait until my next blood test and see what the clinic thinks.
I’ve seen reports from men stating the same testosterone numbers on enclomiphene vs TRT injections feel totally different.
Same in the literature. Problem is, most studies are quite short, so the guys on Clomid get a big bump in T and free T and feel good. Longer term, that’s when the effects of blocking oestrogen happen, and when SHBG starts to creep up.
Personally, I would be curious to go for something like 12.5 mg Enclomiphene 3x per week, just as a “boost”, and see how the numbers and symptoms move.
Dr Fraser thanks that’s clomid still works on TRT and from my experience I believe so to. I take 25mg once weekly. Here you find it discussed (enclom. Vs Hcg);