I've been on TRT replacement for about 21 years. I thought it might be worthwhile to share my experience and thoughts for anyone who is interested.
I was diagnosed with hypogonadal disorder in my late 20s. My total testosterone was below 150 even though I had a normal puberty. I was also diagnosed with a non-secreting pituitary adenoma. Of course, I had symptoms for several years and it wasn't until I saw an endo who specialized in male testosterone issues that I was finally diagnosed and treated.
For many years, I took Androgel and was happy with the results. Then I got married and wanted to have kids. I was on hCG for 10 years at crazy high doses (2,400 iu, 3x per week). Had 4 kids and felt good until the last few years when my E2 got out of hand (curiously, my doc had not measured my E2 over the years and only started when I asked). I had gyno and corrective surgery. Tried AI, which worked but was tricky to titrate. Libido was great on hCG. Test levels were around 700.
Then decided to switch to testosterone shots. Had elevated hematocrit and had to go on therapeutic phlebotomy. I was also irritable. Libido was good. Phlebotomy resulted in iron deficiency. Overall, I didn't like the test shots. I found it difficult to accurately draw .25 ccs of fluid and the irritability was a serious downside.
Switched back to Androgel about 3 years ago. B/c it's a daily dose, less up and down. BUT libido is low even with Test around 600. But I'm also older now, late 40s, but still feel libido is low. Strength is good - I go to the gym 3x week. I was diagnosed with hypothyroid about 3 years ago as well, but replacement therapy has my levels in normal range. Also, as a side note, I've been on keto (the real deal keto) for about 2 years. I've lost a lot of weight and all of my cardio and fasting glucose labs are much improved (LDL particle size went from 2200 ->1200; fasting glucose from 99 ->82).
1. When you've been on TRT as long as I have been, it's difficult to know what is "normal." Is low libido normal for a man in his late 40s? What even is a low libido for a man in his late 40s?
2. It's easy to fall into the trap that something is not right if you're pulling labs all the time. Variations happen and that's normal.
3. Even really smart, highly trained docs sometimes don't know b/c there's a dearth of info. I don't blame the docs but it's important to find a doc that's open to suggestions. I'm lucky that mine is very open minded.
4. I do believe that carbs are serious problem for the US population and while keto might not be for everyone, it's worked wonders for me.
Hope someone finds this info helpful.