Is TRT suggested for low testosterone levels, low libido, and ED in a 47-year-old?

Question

Hello doctor,

I am a 47-year-old man. I went to my primary doctor with low libido and poor-quality erections eight years ago. Blood work came back with total testosterone 381 ng/dL and A1c 6.9 %. I started exercising and lost weight from 198 lbs to 178 lbs and inches from 38 inches waist to 32 inches. But the symptoms still persisted. My doctor started me on Clomid 50 mg thrice per week. Testosterone shot up to 900 ng/dL, but symptoms persisted although Cialis helped with erection quality, still I have low libido. So I stopped taking Clomid three months ago and had my physical last week. The doctor says my testosterone is 570 ng/dL, A1c is 6.0 %, and everything else looks good. He says that I have testosterone resistance since I still have symptoms. His analogy was that, for diabetics, bodies produce insulin but just do not know what to do with it. So his treatment recommendation is TRT testosterone replacement therapy along with Clomid. I will attach the note with the test and A1c results during this time. I am hesitant because I feel this therapy is overused nowadays, and I feel pretty good except for my libido. I sought a second opinion today from my urologist, he seemed disinterested in me doing that but said if I try a few injections it would not hurt me, then he advised me to run this by an endocrinologist. So I guess in summary:

1) Do you believe that testosterone resistance is a valid diagnosis?

2) If I do try the TRT, can I stop after a few weeks or a few injections and get back to the way I am right now with no permanent issues?

3) Or should I just start the Clomid again, or keep using the Cialis and keep working out and trying to clean up my diet more?

Any other thoughts and advice would be appreciated. Thanks.

Answer 1

Hello,

Welcome to icliniq.com.

I just read your query, and the following are answers to your queries:

1) I think testosterone resistance does present this way, and there is no harm in taking them. In fact, it is the definitive treatment for yourself if you are deficient in it.

2) Yes, you can get back to life as before if you discontinue it. It has been shown to be beneficial in preventing osteoporosis in men who are prematurely deficient in testosterone as well.

3) You can continue your previous treatment, but you said it was still ineffective as you did have low libido and mild erectile dysfunction. A healthy diet will be good but will not help much. You can go for those testosterone injections and see for yourself whether you feel better or not. There is no harm in taking treatment doses in persons who need them actually.

Hope you find my advice beneficial.

Good luck.

Answer 2

Hello,

Welcome back to icliniq.com.

I understand your concern.

What your doctor meant to say was that your body is gradually not producing enough testosterone for yourself, and whatever is present is not being utilized because they are not being sensed by the body so, the resultant symptoms you have. Now testosterone replacement will be like boosting up your testosterone in addition to what your body is producing, albeit in a lesser quantity. So to help your body, synthetic testosterone is given. Ultimately the aim is symptom resolution, not your testosterone levels correction. We treat the symptoms, not the laboratory results. If you had not complained about erectile dysfunction and low libido, all this would not be necessary. It is ultimately your decision whether you are currently happy with your situation or need help.

Hope you get my point.

Regards.

Is TRT suggested for low testosterone levels, low libido, and ED in a 47-year-old?

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