[DamnYuppie]

I am in my mid 40's and recently really noticed this. It felt like some of the teeth in the gears of my mind were worn down and things were slipping.

After complaining about it to some peers I was informed this could be due to low testosterone so I went and had that tested. Apparently my testosterone level was that of a 70 year old man so I started testosterone replacement therapy. I can say that it is a complete game changer! Yes I feel like a shill saying/typing it but it is true. My energy has gone way up and my mind is feels much sharper than it previously was.

To be honest at 30 this may not be an issue for you but I put this out there for others who maybe older I definitely recommend getting tested at a clinic that specializes in testosterone replacement therapy.

[fnordpiglet]

You should investigate clomiphene citrate instead of testosterone directly. Clomid mutes the brains response to estrogen, the final feedback product of the testosterone cycle. This causes the body to produce more testosterone in the testes rather than front loading the cycle. The primary impact is your testes continue to function, while testosterone over time will chemically castrate you.

This has been in use for 60 or so years but isn’t an FDA approved use of clomid. The primary reason is clomid is cheap to produce and not patented. It’s extremely safe and if you shop around you’ll find a urologist that’s aware of it and will prescribe it - but most urologists get marketing benefits from the rather expensive testosterone replacement products so not all are either aware or are willing to forego the lucrative marketing funds.

I switch to this about 10 years ago after starting testosterone for a few months. I wanted to have kids and I was very worried. I researched the biological processes for testosterone and stumbled on clomid as a relatively well known but unmarketed low T therapy. I went to a top urologist at NYU and he ranted about urologists that don’t use clomid. He gave me a prescription and it worked like magic. Two years later I had my first kid. I still take it at a low dose because I feel great. My testosterone levels are high normal range.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182219/

https://en.m.wikipedia.org/wiki/Clomifene (other uses section)

[adamhearn]

Suggesting long term SERM use in replacement of a bio identical testosterone does not seem like the brightest idea. There have been reports of blurred vision, floaters in the eyes, and more (look on pubmed under just about any SERM, but specifically clomid).

In my opinion it would be much safer to suggest recombinant FSH and LH. The brain testes axis seems to have the least amount of atrophy over time from anecdotal experiences of those online and in a few case reports. I do not think HCG should be used long term due to the non-bio identical nature, but it is a good short term LH mimic if my memory serves me correctly. Would be a great addition to a TRT protocol.

[fnordpiglet]

Research indicates blurred vision happens but is rare.

I thought LH/FSH is usually increased using HCG injections? Is there an oral route for LH//FSH? One of the benefits of clomiphene is it’s orally administered so no complex refrigeration / injectable requirements.

https://pubmed.ncbi.nlm.nih.gov/31216250/

[tootie]

I'm pretty sure the FDA has never denied a drug use application because it's not patentable and that's just a conspiracy theory used by people pushing bogus treatments. If there's peer-reviewed research that it works, it would be prescribed without doctor shopping.

[Enginerrrd]

>I'm pretty sure the FDA has never denied a drug use application because it's not patentable and that's just a conspiracy theory used by people pushing bogus treatments.

No, that's not it, that's a very uncharitable interpretation and is unnecessarily dismissive . The real issue is that no one wants to pay for studies to turn off-label uses to on-label uses if there isn't money in it because the process is expensive, and so won't be done when there are better returns on investment.

[tootie]

Apologies for the wrong interpretation, but I'm still skeptical. The generic drug market is huge, this drug in particular is already approved and in wide use for fertility treatment meaning that it's already passed safety trials. Getting approval for a secondary usage would be less costly than starting from scratch and there would likely be a huge market for this. There is absolutely money to be made from anyone who wants to get in this market.

[fnordpiglet]

Unfortunately I’ve been unable to dig up the details and citations but there have been companies that have tried. It isn’t as straight forward as it seems. See my other comment in this thread about one that tried. I even owned their stock for a while hoping it’ll work out but in the end the FDA didn’t want to encourage safer TRT’s. I was floored when I read their justification and my stock went to zero, and it looks like the company is dead now. I wish I could dig it up, the FDA memo on their decision changed my view of medicine forever.

[fnordpiglet]

That’s not my point. It’s not patentable so it’s not commercially viable to go through the clinical trials process for something that’s basically free to produce.

There is plenty of peer reviewed research, but not all doctors are aware of all research and testosterone replacement is widely marketed with very lucrative contracts to urologists.

Feel free to read the research yourself

https://www.ncbi.nlm.nih.gov/pmc/?term=Clomiphene+testostero...

[mattkrause]

That's not entirely true.

The FDA has a "new clinical investigation" program that is supposed to reward people running clinical trials. If you collect data showing efficacy of a new use of a previously-approved drug, you can "earn" the exclusive right to market it for that condition. Of course, someone has to actually do it...and the numbers don't always pan out.

[fnordpiglet]

I think a part of this is also the FDA has been really reluctant to touch testosterone producing substances - there was a company trying to get approval for a patented isomer of clomiphene and they took it through phase 3 and the fda indicated they wouldn’t approve it because they viewed the primary benefit of not being castrating as not compelling enough for a new treatment for low T. Their reasoning to my memory was mostly elderly men suffer from low T and they wanted to discourage what they viewed as a growing trend of lifestyle testosterone treatment. As a clomid user I bought the companies stock and followed it closely through the process and was terribly discouraged about the FDAs processes as a result (and my wallet too!). I’ve been trying to dig that stuff up but it appears the company died as a result and googles not finding the FDA communications. This was like almost 10 years ago.

[zemptime]

If the cost of providing this research is high, who would fund this peer-reviewed research which wouldn't make them any money?

For example, who would fund more studies on ginger? https://nutritionfacts.org/video/ginger-for-migraines/

[riekus]

What is your current dose and frequency? Researching this at the moment while I wait fory T test results

[vsareto]

>The primary impact is your testes continue to function, while testosterone over time will chemically castrate you.

Anastrozole or HCG (I forget which) should have prevented that

[fnordpiglet]

My understanding is anastrozole works in a similar way to clomiphene, but has heart and bone concerns.

HCG is an injectable. Others may think differently but I’d rather take a once a day tablet than introduce an injectable to my life.

[pstuart]

I'm intrigued and am going to "do my own research". Thanks for the lead!

[300bps]

I am in my mid 40's and recently really noticed this

Honest question - how much exercise were you getting before you went to testosterone therapy?

The reason I ask is because of the studies that have shown that the decline in testosterone associated with aging is because of poor health, not age. Example:

https://www.sciencedaily.com/releases/2011/06/110607121129.h...

I am in the next decade after you and have noticed no decline. I do heavy weight lifting three days per week and burn about 1,000 calories per day with cardio. That seems to be a sweet spot - too little exercise or too much and your testosterone will take a hit. Rubbish diet will not help though either.

[teaearlgraycold]

As someone that only recently started exercising after a lifetime of being sedentary - everything they say about exercise is true. If it was a pill it would be the greatest medical discovery of all time and worth trillions of dollars.

[fnordpiglet]

I’m in the same situation! I’ve always been sedentary but recently started relatively intense training and the improvement in literally everything is remarkable.

[teaearlgraycold]

No longer moderately depressed! I think I’m well north of neutral almost every day now. I feel better, look better, my knees don’t hurt as much.

[DamnYuppie]

I have been very active my entire adult life.

Part of what really tipped me off was my energy before and after the gym was much lower than it used to be. Also I would be tired starting around 2 PM in the afternoon, this isn't sleep related as I sleep like a baby, which I am grateful for. Also I never drank coffee or took lots of caffeine so I was perplexed as to why I would just crater in the afternoons.

After starting the treatment I am no longer tired in the afternoons, my mind feels sharper and I can tell I am recalling processing info better. The energy at the gym has improved as well.

[fnordpiglet]

Are you under extreme stress? This is what induced mine, I was working at a very stressful Wall Street quant trading job at a major firm at the time.

[worker_person]

Had a sleep study? Solved my testosterone problem.

[sillysaurusx]

How do you measure testosterone? You make it sound like you just step on a testosterone scale each morning and take note of the value. If that’s the case, I need to get me one.

[DamnYuppie]

I went to a clinic that specializes in it. They take several blood samples and send them off to the lab, the test for overall testosterone levels, free testosterone, estrogen and one other I am not 100% certain of.

There is a range that is considered normal testosterone except that range is HUGE, my results were at the very low end of that spectrum.

Part of the plan I am on I get tested every month for the first 3 months then every 3 months there after.

[teaearlgraycold]

You can get home kits. You just give them a couple drops of blood and send it back.

[300bps]

It's even easier than that - there are even saliva tests:

https://www.everlywell.com/products/testosterone-test/

(No affiliation, not an affiliate link)

[bengy5959]

Careful with the Saliva tests. They are much less accurate. I had one done and it said I was way above the normal range. I went to the doctor and had a blood test and it was normal.

[radicalbyte]

Thanks for posting this - I'm having this problem, but I've put it down to having small children, the chronic lack of sleep and the rarely having more than 1 hour time in a week where it's quiet and I can focus. That combined with being totally out of shape (covid + terrible two's).

[magicalist]

> I'm having this problem, but I've put it down to having small children, the chronic lack of sleep and the rarely having more than 1 hour time in a week where it's quiet and I can focus.

Evidence of testosterone supplementation improving cognitive performance is weak despite many studies.

Evidence of sleep associated with cognitive performance is extensive and well documented.

The (not that helpful in the moment) good news is that kids get older and will eventually sleep more and more independently.

[hathawsh]

Indeed, there is a light at the end of the tunnel. With young kids, problems that need an immediate solution are frequent. (When the toilet overflows, you can't just leave it for later.) Now that my kids are a bit older, the problems are more complex, but we generally have more time to work on them. (Kid needs to be convinced to clean their room so they can find their wallet.)

[DamnYuppie]

I would recommend trying to work on diet/exercise before I would go down the TRT path. If you get those squared away and stress at home is reduced and you still are having the same issues then it maybe something to look into.

[radicalbyte]

That's the plan - I was lifting before we had our youngest (2.5) and fairly fit (dad bod but I was working on it). Last 2.5 years ruined that. Will be happy when I can get back to regular training but for that to happen we need to be over this current period.

[pstuart]

And quality sleep.

[blindmute]

Testosterone has been declining in the population for decades. The reference levels for "normal" 20 year old now include what were, 60 years ago, levels considered too low for a ~60 year old man. It's not an exaggeration to say that at least a third of men have never experienced a normal hormonal level of testosterone. Testosterone affects nearly everything about the male physical and mental state; not only the stereotypical aggression and lust, but also mental clarity, happiness, even health.

[ivandenysov]

That is fascinating. Where can I read more about this subject?

[blindmute]

You can just search for 'american male testosterone decline' to find many articles and studies. For the benefits of testosterone, I'm sure similar articles exist, but I'm speaking from the experience of talking to men who have started TRT.

[guenthert]

Uh, did the doc mention why the testosterone levels could be low to begin with? Diet / "life style choices" / stress / lack of exercise? At mid 40s simply 'age' isn't all that convincing.

What about side / ill effects?

[dominotw]

> I can say that it is a complete game changer!

Could this be a placebo effect. I have low testosterone too. I've been doing "natural" ways by changing diet, cardio/weights, sleeping in a lot, trying to have sex regularly. But my numbers just don't seem to budge.

I think my only options now are TRT or just accept and make peace with it. If I do TRT, my impression is that you have stay on it for life. I am not sure i am ready for that kind of commitment.

[DamnYuppie]

I 100% feel you as the fear of having to do it forever was a big hold up for me as well. The reality is you can stop whenever you want you will just go back to having less energy etc.

Having done it I can see myself doing it until my late 50's at which point I should have the majority of my adventuring done as well as be out of the workforce so I will probably not be too concerned about lack of energy.

[dominotw]

>The reality is you can stop whenever you want you will just go back to having less energy etc.

I am not sure if you go back to your previous baseline. I know athletes who do this have forever left with way lower testosterone than their previous baseline.

[fnordpiglet]

See my reply above about clomiphene citrate. I had that same worry. While I still take it I could stop at any time and my body will produce testosterone naturally. TRT is castrating and there are medical alternatives that work.

[blindmute]

Once you experience a normal level of testosterone, you would not consider for a moment returning to "baseline". The commitment would be like your commitment to having a roof.

[bjourne]

But there are also many drawbacks to TRT. Some have speculated that the reason for womens' longevity relative to men is related to lower testosterone levels.