HRT Evaluation Reveals Low T

[AlisonWood]

I've been researching this and know there have been a few posts from a while back on this topic...but wondering if anybody has any more advice/insight...

In getting evaluated for HRT my initial (pre-HRT) bloodwork revealed that for a male in their early 40's (or any age, for that matter) my testosterone serum is crazy low: 164 ng/dL (reference range = 348-1197 ng/dL)

My estradiol number is in the normal male range: 27 pg/mL (reference range 7.6-42.6 pg/mL)

From my layman's analysis - liver function looks ok

I have been experiencing symptoms of low T: sluggishness, brain fog, insomnia...though, at the same time, my gender dysphoria is very much alive and well

I'm pretty sure my doctor is going to say I should consider taking testosterone - but that's the exact opposite direction I'm trying to go, of course! Started exploring HRT in the hope of maybe trying a very low dose to relieve dysphoria - but now that I've got this low T reading, I'm not sure what to think.

Know there are a lot of health ramifications for having low T, and that if I don't have a high enough level of T then I probably need a higher level of E...

Then of course, some of the side effects of supplementing T (breast growth, reduced fertility, shrunken testes) are very similar to the side effects of supplementing E....even if one takes T it may just aromatise right back into E

I've never had much body hair (any, really) and have pretty tame facial hair - I suspect I've always had a low level of T (though must have had some because I know my sperm count has always been good, resulting in being able to have a family). But the thought of now supplementing T and taking on any more male characteristics is a little horrifying.

If/when my doctor suggests T, what do I tell them? Do I ask for E instead? Anybody else been faced with this choice?

Thanks so much in advance for reading this and any thoughts you have....

[Barbara Dugan]

A few years ago I had pretty much the same numbers and I choose the T route. and it was awful to me I felt miserable had all of the side effects of the T that you mention and elevated DHT numbers too my testosterone never went up actually went even lower.
I am on my 5th month of HRT and my T levels are with in the female range but now I feel great and physically and mentally balanced.

[Melissa Rose]

Why not discuss your complete situation with your doctor? If you have been seriously contemplating starting HRT, low dose or not, why complicate things by starting testosterone treatment? Hormones are a serious matter and withholding information from your health care providers is not a wise course of action. Your doctor's recommendation may be different once they have all of the information.

[Eryn]

From my point of view your testosterone level is a happy coincidence. You'll likely need a smaller dose of Spiro than folks with "normal" T.

You should really be completely open with your endo. This is the person who is going to help you reach your goal and the more info they have the more they can help you. It would be silly to try to pump up your T level just to knock it down again.

[phylis anne]

Hi Alison ,
like the others have posted tell the dr everything don't be concerned to how he feels about your journey may here have posted cautionaries r/e hormones they are not joking you may pleasantly be surprised once he has the facts and knows which direction you are going
hugs phylis anne

[AlisonWood]

Thanks so much ladies...actually my doctor knows the full story - it's actually an informed consent clinic I originally approached because of dysphoria.

My next appointment is next week - will report back about how it goes. Seems like either way though, I'll be going on some kind of hormone replacement before long - not sure which is harder, the dysphoria or just the fatigue/low drive - but willing to try either route if it makes things better.

Love this board - thanks for all your advice!

[Lauri K]

A few years ago I had pretty much the same numbers and I choose the T route. and it was awful to me I felt miserable had all of the side effects of the T

I had the same results as Barb, TRT was totally miserable event other than it did help the fatigue. After a year or so of my PCP guessing around around at doses etc. turns out she/ PCP has no clue how to deal with GD patients.

So I am off TRT going on 6 months now and hoping to figure all this out sometime soon, my T must be very low as I am weak as heck and fatigued terribly.

I am amazed at how few doctors have credentials or experience with these ailments, which is sad in 2016.

My advice is to find a PCP that had experience dealing with this, but if it were me I would decline the T

[Kate T]

Alison

If you are unsure as to whether you should be receiving Testosterone supplementation or Oestrogen supplementation then you aren't ready for transition. Get you're head sorted with a counsellor / psych.

I've said this in another thread, no one other than yourself can tell you if you are trans. Not a doctor, a counsellor or a psych. They can help you to ask the questions to understand yourself but you must take the responsibility for saying "yep, I'm trans, I need to transition". Once you have taken that responsibility then your question as to whether you should take Testosterone or Oestrogen is meaningless, no woman would put her hand up to take testosterone.

[StarrOfDelite]

I'm not sure why you're "pretty sure my doctor is going to say I should consider taking testosterone," if she/he is already aware of the full story, and is aware that the reason you had your hormone levels tested was for gender dysphoria. If you were describing body dysphoria, then I'm sorry for assuming something I shouldn't have.

You seem to have a good layman's concept of the basic principles involved with HRT, and I would suggest that before your next appointment with you sit down and prepare a list of written questions which you want to discuss. I'd probably organize it as one set to be asked if Estrogen is prescribed, and one set if Testosterone is prescribed. Office visits with doctors are stressful, and no one ever remembers all the questions they wanted to ask their doctor merely from memory.

Anyway, if testosterone is recommended you have every right as a patient to refuse it. You also have the right to get a second opinion. It's your body, and you have the right to question and refuse any treatment or prescription which doesn't seem right for your situation.

[I Am Paula]

I'm not a Doctor. The low T would probably be fine with the addition of E. It is when both sex hormones are defficient that you can develop problems. My T is at an unmeasurable level ie- they can't find any.

[Dana44]

If you are low on T but have good sperm, that is similar to me. But in my case where I am a DES kid, My Progesterone was at eighty percent. He basically said I was female in hormones. But he gave me T and I was off of it in two weeks as it was pushing my prostrate BTH or whatever its called up dramatically. In further research on me they said that the route out is estrogen as our bodies are basically female but we are males LOL what a life. That synthetic estrogen really did a number on us DES Kids.

[Sami]

Oh gosh I thought I was the only nut job diagnosed with low T so I ended up on T injections every 2 weeks for 7 months at age 45 and for me I felt terrible aggressive and just generally bad. Like you I have always had very little body hair puberty was slow when I was young and hellish I have never been able to grow any kind of full beard etc just never very masculine to be honest. Since a young age I knew I was different and wandered through life pretending I must admit when I was diagnosed with low T I did think we'll perhaps it's been low my whole life this is why I am so effeminate this is why I think I am trans this is why a lot of things but it didn't solve anything and just made me more miserable with who I was. In the end a year ago I told my doctor my feelings that I have been the same my entire life and how miserable I was she was very understanding and put me on a low dose of HRT within a week or two I felt fantastic my mind was clearing I felt nice to say the least. I have been on HRT for a year I am on a full dose now my body is changing my mind has just changed so much I am so much happier life isn't foggy I enjoy almost every day my hormone levels are female it was the best thing I ever did to go onto HRT I am still in male ish mode and under going electrolysis and I will transition to a certain extent but at the moment I am just happy being who I am on the inside if that makes sense. I watch my body change and look at it every day I use to hate looking at my body but now I like what I see I am really under construction but I am getting to where I need to be.

Anyway my advice don't waste your time thinking T will sort it out that it may have been thie issue all along like I thought it's a waste of time if you are trans then that is what you are T will make you miserable don't waste your time like I did x

[MonicaJean]

Before my first dose of E, my T was at 200, E was very low. The reversal of those two numbers after starting E made all the difference in the world. All the symptoms you mention vanished on day 1 of E. It was the most amazing moment of my life. When I experienced it, I knew which direction was right.

[AlisonWood]

So, I have an update...

Wound up talking to my doctor, who basically gave me a choice about how to deal with my low T combined with dysphoria. He was like, "well, you can go one way, or the other" offering to start me on testosterone to get my T levels up (and thereby hopefully just have more energy) OR start me on spiro to get my T levels all the way down (and thereby hopefully address my dysphoria).

On the way to the doctor's office I felt like an hold man, my joints hurt and it was just altogether depressing. I'm in my early 40s and knew I shouldn't feel that way. The thought of making that worse by dropping the bottom out of my T was hard to fathom. So I opted to go on beginning dose TRT injections (self injected, weekly).

I have to say, the testosterone actually made me feel better, sharper - not so especially anxious. HOWEVER - I very much experienced the crash over the course of the week. Weirdly, my dysphoria actually vanished on the days I took the injection, and as it wore off during the week the dysphoria rose. At the same time, I started to feel physically like crap.

After three weeks I went in for a blood test and my T serum level came back as...wait for it, a whopping 139 ng/dl (down from 164) and my estradiol serum level was 11 pg/ml (down from 27). At the same time, though I was feeling physically better at the start of the week, I just worried I was headed in the wrong direction. At one point, the thought of more T in my system started to make my skin crawl a little bit.

Several months ago I had made an appointment with an endo, which I had kept, so I might get a second opinion of sorts about my low T issue by itself. Intended to mention that I was grappling with gender dysphoria in passing, but main reason for the visit was to learn more about why I might have such low T naturally.

So, I start talking with my endo and he asked me to talk more about the dysphoria. He reviews my history, examines me, looks at my lab results. Then, to my great surprise, he says: "look, you are clearly transgender - the low T is probably just because you're heavy right now - but do you want to start HRT?" The word "yes" came out of my mouth so fast I couldn't believe it.

So I'm starting out on a crazy low dose of estradiol + sprio because, like many others on this Forum, I don't want/expect/intend to socially transition. My life is incredibly blessed with family and career stuff and I don't want to mess it up. Part of my thinking (perhaps a rationalization I suppose) is that I'm trying to deal with my dysphoria proactively so I don't erupt and need to go full transition later down the road (at least anytime soon).

It's been almost a week now and, though it's probably all placebo, I feel very different but increasingly, also very good. I can tell my already low T is now even lower, but surprisingly, the aches and pains I felt have completely vanished. I can only guess that it's the estrogen, even though its a small dose, coming to rescue and doing its part.

Compared to being on supplemental T, it feels like I'm running in a slightly lower gear, but it's such a smoother ride.

My family doesn't know exactly what is going on but knows that I'm trying to get my hormone levels right...that I tried injectible T, and am now trying something that will keep my T levels low, but steadier. In the last couple of days my wife even said, "I'm so proud of you for taking medicine/getting help you need - you're like a new person" She said that she loved me all the time but this new version is so much better and I'm so much better with our kids/less grumpy all the time." This was incredibly reassuring.

So - while I have my doubts and fears, I also have lots of hope and excitement. Sometimes when I take my pills I ask "is this really what I want to do?" But have taken a lot of inspiration from the ladies on this forum and take comfort in knowing, while MMV, that I'm starting on such a low dose that I ought to be able to slow things down if I want to.

Sorry this is so long; but I had a lot to share! TY for being here, Alison

[PretzelGirl]

I am glad you are feeling better Alison. Take care on your path forward. I always view taking HRT and not transitioning as a tough balance to maintain in life. I hope you are able to balance life on your terms.