thanks for the advice
As other pointed out your T levels are not "terrible". However, how you feel is a metric that you should not be forgetting. What is normal for one person, could be low or high for another. There have been plenty of guys who go on TRT with similar levels as you and report feeling much better.
Correct, I've come across many people who've had similar numbers to mine and seen improvement and it's not like I've been suffering from these symptoms for a few weeks or a few months and then just jumped on Test....it's been years. I think individual genetics and receptor sensitivity play a role as to why people feel normal at different levels.
As a first step, I strongly suggest you see a good functional medicine doctor who understands hormones and a Urologist. Low libido and poor erections could be caused by more than just Low T. Make sure you see someone who has a good track record for treating these symptoms.
Yes I'm in the UK and there aren't really that many good functional/integrative medicine docs who have an interest in Men's Health/hormones. There are a few decent TRT clinics here now but I wouldn't call them functional/integrative medicine docs/clinics, they mostly just prescribe TRT and most ‘TRT docs’ are usually against using hair loss meds like Fin and Dut, most of them will just tell you to 'just shave it bro'. Dr Kyle Gillett and James O’Hara at Gillette Heath in the US are the only two that I've come across on YT/online that actually seem kind of pro Finasteride/Dutasteride and they are both on TRT + oral Dutasteride although I would say they are more functional/integrative medicine docs than just 'TRT docs' (they've made a few hair loss videos on their YT channel)
Have already seen a Urologist/Andrologist, had a physical exam (said I had a varicocele but shouldn't effect my levels) and even had Doppler ultrasound which came back normal which I was expecting anyway as my symptoms feel more Hormonal/neurotransmitter related but most Urologists don't seem to be that good at managing hormones (they just prescribed me Cialis)
Not a doctor but based on my personal experience it seems your prolactin levels are a bit high which can definitely affect libido and erections. I was taking some supplements that I found out were likely causing higher prolactin levels. Definitely review with a good hormone doc.
I've had both normal and slightly elevated levels before with not much noticeable difference but I will be getting updated blood work next week to see if it's still elevated and will discuss them with a TRT/hormone doc. Don't think I'm taking anything that should be elevating it.
If you choose to go on TRT, I would personally wait and see how you feel before introducing Fin. Yes, you are likely going to shed without being on Fin, but if you want to put your sexual health first, you need to see if TRT is actually helping. If you're sensitive to Fin, it may offset the TRT treatment. Once you know how you are responding to TRT, I would then add in Finasteride.
Yes if I go on TRT I will wait before trying any hair loss meds even though it may accelerate it, I was considering trying Fin or even Dut now to see how I respond since I already feel messed up hormonally but as you said my general/sexual health is more important and I need to see how well I respond to TRT so would do that first, trying a 5ari first probably wouldn't be the best idea even though I have seen some people say they've actually had an improved libido from taking 5ari specifically with Dut.
If you're not sensitive to Fin and can tolerate, make sure you stay on it as TRT can really accelerate your hair loss. The benefit for Fin while on TRT is that it will help mitigate not just hair loss, but some cystic acne that can occur.
This was one of the main reasons why I've delayed going on/trying TRT besides fertility (would freeze some sperm before also). If I go on TRT and see improvements I will be curious to see how adding fin/dut (oral or topical) effects my symptoms.
I saw someone comment this but not sure how much truth it has.
‘Side effects from fin come from low testosterone in the first place.... if your body relies heavily on DHT for androgen functioning because of low testosterone, then yeah, inhibiting DHT in that case will make you experience side effect from low androgen level as simple as that....therefore do a free testosterone analysis before taking fin’.