Testosterone Replacement Therapy

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RobertoKane

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I’ve had some symptoms of low testosterone and my labs came back confirming (350- and I’m 29). I’m fit, eat relatively ok and workout religiously. I’m a 121 airman and have an irregular schedule which I think hinders my testosterone levels. I’m thinking about getting on TRT and I’ve read it’s a fairly easy issuance with the FAA (1st class). I have no other medical problems. Blood work is perfect and I’m healthy.

Are there any gotchas with TRT and the FAA?
 
here you go.....
Thanks. Does the FAA have a defined value of low testosterone? Mine is around 350 which is technically still in range however, I do have symptoms such as low sex drive. See “
CACI qualified Hypogonadism”. I don’t want the FAA to think I’m blasting steroids (although I’d welcome the muscle mass)

Essentially if my Hematocrit is below 54% and not because I’m constantly donating blood and my condition is stable, my medical won’t get deferred?
 
Dude, once you start taking exogenous testosterone, forever will it dominate your destiny. Virtually every instance of "doc, I think I have low testosterone" that has walked into my clinic (especially low sex drive and erectile concerns) has almost always turned out to be life stressors, inadequate sleep, excessive alcohol, and often a crappy diet. Optimize that stuff, and maybe maybe maybe supplementation could be considered, and even then only with multiple, clearly low levels.

Trust me, back when we had a testosterone shortage a few years ago due to transgender transition demand, the testosterone supplement guys (usually put on by another clinician years ago, after a single "low" lab, with no follow-up) were showing up and blowing up my office phone looking for a supply like a heroin addict looking for a fix. You want to know what low testosterone really feels like? Supplement for a year or two, then go cold turkey.

My friend, unless you absolutely, positively NEED it, I really recommend you stay away.
 
Dude, once you start taking exogenous testosterone, forever will it dominate your destiny. Virtually every instance of "doc, I think I have low testosterone" that has walked into my clinic (especially low sex drive and erectile concerns) has almost always turned out to be life stressors, inadequate sleep, excessive alcohol, and often a crappy diet. Optimize that stuff, and maybe maybe maybe supplementation could be considered, and even then only with multiple, clearly low levels.

Trust me, back when we had a testosterone shortage a few years ago due to transgender transition demand, the testosterone supplement guys (usually put on by another clinician years ago, after a single "low" lab, with no follow-up) were showing up and blowing up my office phone looking for a supply like a heroin addict looking for a fix. You want to know what low testosterone really feels like? Supplement for a year or two, then go cold turkey.

My friend, unless you absolutely, positively NEED it, I really recommend you stay away.

I don’t drink, my diet is so-so (for being on the road constantly), I have normal life stressors and yeah my sleep sucks due to flying for a living. This is why I low key want to do it and avoid telling my AME/FAA.
 
I’ve had some symptoms of low testosterone and my labs came back confirming (350- and I’m 29). I’m fit, eat relatively ok and workout religiously. I’m a 121 airman and have an irregular schedule which I think hinders my testosterone levels. I’m thinking about getting on TRT and I’ve read it’s a fairly easy issuance with the FAA (1st class). I have no other medical problems. Blood work is perfect and I’m healthy.

Are there any gotchas with TRT and the FAA?
Mine was 730 at age 68, and I had a bit of fatigue and low libido!
Don't know if the high-grade PCa had anything to do with those things, but it's outta me now.
 
I don’t drink, my diet is so-so (for being on the road constantly), I have normal life stressors and yeah my sleep sucks due to flying for a living. This is why I low key want to do it and avoid telling my AME/FAA.
You don't have a legitimate medical indication and you're potentially putting yourself in a bad spot with the AME/FAA. This is not a magic elixir that's going to fix what ails you. Really consider walking away from this plan.
 
I can't tell you how many guys walk into my office with low normal levels thinking they should be high. Think very carefully before you go down this road. It's very difficult to stop once your natural testicular function is suppressed. You're looking at lifelong replacement for a low normal T. Future likely infertility and a whole host of other possible side effects. Yes, you'll statistically get some increase in your sex drive, but is it worth all the possible issues that go along with lifelong T...
 
You don't have a legitimate medical indication and you're potentially putting yourself in a bad spot with the AME/FAA. This is not a magic elixir that's going to fix what ails you. Really consider walking away from this plan.
How is it not legitimate? My libido is low, I lack energy after sleeping 7-9 hours, and my sex drive is non-existent. I went to a clinic and they tested my testosterone again, and it was around 330. I’m 29 years old and it’s ridiculous that I can’t take a supplement, while under medical supervision, to improve my quality of life. I have sex with my GF every 2-3 months due to my low libido. This is exactly why pilots do not want to report anything to the FAA or their AME. To say I do not have a legitimate medical condition without knowing my circumstances is laughable.

I’m not attempting to use these as PEDs.
 
Thanks. Does the FAA have a defined value of low testosterone? Mine is around 350 which is technically still in range however, I do have symptoms such as low sex drive. See “
CACI qualified Hypogonadism”. I don’t want the FAA to think I’m blasting steroids (although I’d welcome the muscle mass)

Essentially if my Hematocrit is below 54% and not because I’m constantly donating blood and my condition is stable, my medical won’t get deferred?

Doc posted the guidance above, but my AME had no issues with my packet. Was on a ADHD Fast Track from a “diagnosis” as a kid decades ago with meds continued within the year. FAA got the whole packet and background, TRT was never questioned. My paperwork was from a legit doc and monitored dutifully with labs every 6 months. A doc in the box giving it out like candy may not meet their bar for “legitimate”.

You will find that the reaction to TRT varies from end of the world to best thing ever. It’s been great for me, and I monitor it seriously. My doc isn’t a quack either.
 
Doc posted the guidance above, but my AME had no issues with my packet. Was on a ADHD Fast Track from a “diagnosis” as a kid decades ago with meds continued within the year. FAA got the whole packet and background, TRT was never questioned. My paperwork was from a legit doc and monitored dutifully with labs every 6 months. A doc in the box giving it out like candy may not meet their bar for “legitimate”.

You will find that the reaction to TRT varies from end of the world to best thing ever. It’s been great for me, and I monitor it seriously. My doc isn’t a quack either.
I went to a legitimate clinic that will require me to get labs every 3 months. What was your levels at when you started TRT?
 
How is it not legitimate? My libido is low, I lack energy after sleeping 7-9 hours, and my sex drive is non-existent. I went to a clinic and they tested my testosterone again, and it was around 330. I’m 29 years old and it’s ridiculous that I can’t take a supplement, while under medical supervision, to improve my quality of life. I have sex with my GF every 2-3 months due to my low libido. This is exactly why pilots do not want to report anything to the FAA or their AME. To say I do not have a legitimate medical condition without knowing my circumstances is laughable.

I’m not attempting to use these as PEDs.
Those symptoms aren't far off from clinical depression.
 
This is why I low key want to do it and avoid telling my AME/FAA.
Wait…you started off asking if there were any gotchas with the FAA and TRT as you considered getting an issuance and now you’re considering taking a med that will require a prescription and will need labs every three months and you wanna do what?!?

Think carefully…seems like there’s a falsification of your FAA medical down that pathway.
 
If you're going to try anything there are lots of supplements on the market to try to boost your natural production of testosterone. 330 is on the low side of normal, but not ridiculous.
Eat as clean as you can, and lift heavy **** when you workout. This advice is worth exactly what you paid for it.
 
If you're going to try anything there are lots of supplements on the market to try to boost your natural production of testosterone. 330 is on the low side of normal, but not ridiculous.
Eat as clean as you can, and lift heavy **** when you workout. This advice is worth exactly what you paid for it.
I do. I’m 5’11, 190 lbs and can bench 275 lbs. I squat 350 and deadlift 325. But hey, I’m depressed cause I can’t get an erection lmao!
 
I’m a 777 FO my circadian rhythm is always disrupted. I know most don’t really know about that here but it affects your hormones. I’m going to call ALPA/AMAS. I should’ve just done that from the start.

Thanks for the advice gents!
 
I’m 29 years old and it’s ridiculous that I can’t take a supplement, while under medical supervision, to improve my quality of life.
Get it through your head that despite a wildly profitable industry marketing "low T" to men, this isn't a "supplement" like you'd buy from GNC. This is exogenous replacement of something your body makes, that levels naturally varying significantly through the day, and that you have levels in the normal range. When you give your body testosterone, it stops making its own testosterone, which has its own health effects. You also don't get to just quit taking it when you feel better and return to your baseline right away. You can look forward to either a lifetime of supplementation, or about six months of feeling like absolute crap.

When you have multiple physicians in this thread cautioning you, maybe that should give you pause instead of throwing a tantrum.

Those symptoms aren't far off from clinical depression.
You are correct, and as usual in the men who have decided that testosterone will cure what ails them, the reaction to suggesting that (entirely reasonable) possibility is one of aggressive and angry denial. The reality is that the picture is rarely clear, and inadequate/disrupted sleep can cause a host of secondary symptoms (appetite, mood, libido, fatigue, concentration, etc.) which can often mimic depression-type symptoms. I wouldn't be inclined to diagnose OP with any sort of clinical depression given what he has otherwise reported, but at 29 years old and with a normal-range testosterone neither would I be willing to prescribe him exogenous testosterone supplementation. As I said above, if circadian disruption has been identified as a contributing factor, then fixing that is the first objective. Dosing yourself with a hormone to mitigate the effects of a bad work schedule is just nuts.
 
Get it through your head that despite a wildly profitable industry marketing "low T" to men, this isn't a "supplement" like you'd buy from GNC. This is exogenous replacement of something your body makes, that levels naturally varying significantly through the day, and that you have levels in the normal range. When you give your body testosterone, it stops making its own testosterone, which has its own health effects. You also don't get to just quit taking it when you feel better and return to your baseline right away. You can look forward to either a lifetime of supplementation, or about six months of feeling like absolute crap.

When you have multiple physicians in this thread cautioning you, maybe that should give you pause instead of throwing a tantrum.


You are correct, and as usual in the men who have decided that testosterone will cure what ails them, the reaction to suggesting that (entirely reasonable) possibility is one of aggressive and angry denial. The reality is that the picture is rarely clear, and inadequate/disrupted sleep can cause a host of secondary symptoms (appetite, mood, libido, fatigue, concentration, etc.) which can often mimic depression-type symptoms. I wouldn't be inclined to diagnose OP with any sort of clinical depression given what he has otherwise reported, but at 29 years old and with a normal-range testosterone neither would I be willing to prescribe him exogenous testosterone supplementation. As I said above, if circadian disruption has been identified as a contributing factor, then fixing that is the first objective. Dosing yourself with a hormone to mitigate the effects of a bad work schedule is just nuts.
He can’t fix the circadian issues. It’s how he gets paid.
 
He can’t fix the circadian issues. It’s how he gets paid.
Fix? No. Mitigate? Probably. He's far from the only guy flying with circadian issues and it's not a new issue. THAT is the conversation he should be having with his airline's medical staff and his personal physician.

Irrespective of all that, pumping yourself full of a hormone isn't the fix. Hell, sleep disruption is a side-effect of testosterone supplementation. If anything, he might get worse.
 
Get it through your head that despite a wildly profitable industry marketing "low T" to men, this isn't a "supplement" like you'd buy from GNC. This is exogenous replacement of something your body makes, that levels naturally varying significantly through the day, and that you have levels in the normal range. When you give your body testosterone, it stops making its own testosterone, which has its own health effects. You also don't get to just quit taking it when you feel better and return to your baseline right away. You can look forward to either a lifetime of supplementation, or about six months of feeling like absolute crap.

When you have multiple physicians in this thread cautioning you, maybe that should give you pause instead of throwing a tantrum.


You are correct, and as usual in the men who have decided that testosterone will cure what ails them, the reaction to suggesting that (entirely reasonable) possibility is one of aggressive and angry denial. The reality is that the picture is rarely clear, and inadequate/disrupted sleep can cause a host of secondary symptoms (appetite, mood, libido, fatigue, concentration, etc.) which can often mimic depression-type symptoms. I wouldn't be inclined to diagnose OP with any sort of clinical depression given what he has otherwise reported, but at 29 years old and with a normal-range testosterone neither would I be willing to prescribe him exogenous testosterone supplementation. As I said above, if circadian disruption has been identified as a contributing factor, then fixing that is the first objective. Dosing yourself with a hormone to mitigate the effects of a bad work schedule is just nuts.
And how exactly do I fix circadian rhythm problems when I’m a wide body pilot? I fly 12-17 hour flights, back of the clock across 8+ time zones. Domestic trips are trash too, 11-12 duty days with min rest per 117. I don’t expect GA pilots to understand or acknowledge how this affects the body over time, but it’s not good. Hence my low energy and decreased sexy drive.

This is my final reply. For those wondering, AMAS told me if it my health fits the within the CACI requirements, to go for it. And the only thing I’m “depressed” about is not being able to have intercourse with my girlfriend. I know, most are older and don’t get it but it’s important to me being 29. There’s also HGC that will ensure my body keeps making testosterone should I want to get off it eventually. My tantrum stems from docs like you who want to prescribe SSRIs, BP medication, and a whole host of other bs meds instead of taking a holistic approach.

Here is a google result.

“Yes, disrupted circadian rhythms, particularly from shift work or sleep disorders, can contribute to lower testosterone levels. The body's natural sleep-wake cycle (circadian rhythm) plays a crucial role in regulating testosterone production, and disturbances can lead to decreased testosterone production”.
 
I mean, if he's doing europe or asia he could bid the americas instead.
You’re still doing a double redeye and disrupting your sleep. And before someone tells me to bid domestic flying, it has a separate set of complications. Long duty days, delays, and minimum rest for 3-4 days straight is common. The airlines attempt to squeeze 117 as much as possible. Hotel conditions vary as well. AMAS told me TRT is fairly common and isn’t this voodoo thing some people on this sub are making it out to be.
 
More than 30 years ago, I took a 20% cut in gross pay to get better quality of home life. Neither I nor my wife regret that change. Money is not everything.

Bid better routes for your health.

I did the same after 10 years of my 25 year career (not in aviation). I made a change that brought less money but much greater quality of life, less travel, & nearly the same benefits package (if not slightly better). Sometimes folks get too focused on making money that quality of life suffers greatly.

It has been noted that when young we spend our health for wealth, and when old we spend our wealth to seek to regain the health we squandered away in our youth.
 
Different labs have different cutoffs for T. so 350 may be normal or it may be low. The national endocrine society recommends considering replacement in the case of repeatedly below normal (not low normal). From the single value of 350 you mentioned, not really enough information to make any diagnosis. You have to have multiple early morning, preferably fasting T levels, free T levels if you're overweight, to know if you really are subnormal. and you need to have consistently low normal levels to be considered.

Sigh you're 29. I don't know about your long term family plans, but exogenous testosterone suppresses your natural testosterone production. There is a good chance your testicles will shrink and you will become infertile with long term therapy. And getting off is challenging. And if you do, you may still have fertility issues. Besides the shrunken testicles, there are a host of other possible side effects...

If you really want to go down this road, get a few more appropriately done lab tests. Go to a few docs, get a second opinion, maybe see an endocrinologist and ask him or her for an honest opinion instead of shopping for Dr. Feelgood because you've done your research any you're sure T supplement will solve all your ills.

Look, I'm at the end of a long career in medicine. Early on, I fell for the marketing and nonsense, as did a lot of my colleagues, and wrote for a lot of T. In retrospect, most folks looking for the fountain of youth and vitality were disappointed.

It's the same thing as SSRI's. When Prozac and Zoloft were branded, the drug companies pushed and pushed, and all these patient would come in to my office with midlife malaise, and they'd done their research too, and they wanted Prozac, Zoloft, Abilify ("ask your doctor if it's right for you"), Adderall, etc.

Fast forward 20 years and now everyone's complaining we gave out too many SSRIs and ADHD meds.

I just don't want to hear it from you when you come on this board 10 years from now complaining that some "bad" doc convinced you to take T.
 
Here is a google result.

“Yes, disrupted circadian rhythms, particularly from shift work or sleep disorders, can contribute to lower testosterone levels
So… treating a low testosterone level that’s secondary to disturbed circadian rhythms is like flogging a fever due to pneumonia with Tylenol. All you’re doing is treating the symptom, not the cause, right?

Step back a bit and think about what’s really going on for you.
 
More than 30 years ago, I took a 20% cut in gross pay to get better quality of home life. Neither I nor my wife regret that change. Money is not everything.

Bid better routes for your health.
30 years ago there were fleets with "good routes" on domestic flying. Not so anymore. Saying "do this, it's what worked for me three decades ago" doesn't work with todays "optimized" schedules.
 
I’m a 777 FO my circadian rhythm is always disrupted. I know most don’t really know about that here but it affects your hormones. I’m going to call ALPA/AMAS. I should’ve just done that from the start.

Thanks for the advice gents!
I fly long haul too. Talk to folks that understand your situation, do a full work up on you and keep it all above board with the FAA/AME; that's the advice I would be looking for if I were in your shoes. Don't take it personally that the keyboard warriors are crashing your lifestyle without the first idea of what it's like. That's just the internet for ya. Hang in there, I hope you find something that works.
 
I fly long haul too. Talk to folks that understand your situation, do a full work up on you and keep it all above board with the FAA/AME; that's the advice I would be looking for if I were in your shoes. Don't take it personally that the keyboard warriors are crashing your lifestyle without the first idea of what it's like. That's just the internet for ya. Hang in there, I hope you find something that works.
Please, bouncing between continents in a self-flying pringles can hardly poses a problem set beyond the understanding of others. I've managed thousands of pilots on multiple continents, and somehow we've all made it through without pills or hormones. Similarly, many ATC personnel are constantly faced with a rotating schedule that is terrible for circadian rhythm. This isn't a new issue and it is well understood. Hell, I'm involved in some fatigue and performance management groups right now, looking at novel non-pharmacological interventions to help.

I'm fully aware and sympathetic to OP's situation, I'm just trying to caution him to not anchor onto testosterone replacement, since it has some hidden costs and may not help (or even worsen) his symptoms if the underlying problem isn't hormonal. To that extent, your advice to talk to others, complete a full workup(!), and keep it above board is excellent, and I fully endorse it. These situations are rarely due to a single factor, so a good work-up with appropriate non-pharmacological and pharmacological (if indicated) treatment sounds necessary.

The airline medical staff thing is weird though. I've been recruited a number of times for a position with the airlines as a physician. Evidently I misunderstood how you guys do business. I would have imagined that you would want a physician handy at major terminals to assist aircrew with illnesses and injuries.

Regardless, OP is going to do what he needs to do, and I wish him well.
 
Please, bouncing between continents in a self-flying pringles can hardly poses a problem set beyond the understanding of others. I've managed thousands of pilots on multiple continents, and somehow we've all made it through without pills or hormones. Similarly, many ATC personnel are constantly faced with a rotating schedule that is terrible for circadian rhythm. This isn't a new issue and it is well understood. Hell, I'm involved in some fatigue and performance management groups right now, looking at novel non-pharmacological interventions to help.

I'm fully aware and sympathetic to OP's situation, I'm just trying to caution him to not anchor onto testosterone replacement, since it has some hidden costs and may not help (or even worsen) his symptoms if the underlying problem isn't hormonal. To that extent, your advice to talk to others, complete a full workup(!), and keep it above board is excellent, and I fully endorse it. These situations are rarely due to a single factor, so a good work-up with appropriate non-pharmacological and pharmacological (if indicated) treatment sounds necessary.

The airline medical staff thing is weird though. I've been recruited a number of times for a position with the airlines as a physician. Evidently I misunderstood how you guys do business. I would have imagined that you would want a physician handy at major terminals to assist aircrew with illnesses and injuries.

Regardless, OP is going to do what he needs to do, and I wish him well.
Airlines haven’t employed physicians since the late 90s early 2000s due to lawsuits and liability, so I know that’s not true. Unions, sure. Airlines, no. They definitely wouldn’t recruit a former navy doctor who criticizes and gaslights as their goal is to keep airmen’s medicals.


There is no Physican standing around at airport terminals. Again, it’s not the Navy. You get sick, you call out sick, and a reserve pilot is called. There’s no mission.

I fly with many retired Naval/AF pilots who tell me they were drained while flying their 15 hour missions, but uppers and downers got them though.

I’ve been on TRT for years. Just keep your labs in range and it’s a nonissue.
 
More than 30 years ago, I took a 20% cut in gross pay to get better quality of home life. Neither I nor my wife regret that change. Money is not everything.

Bid better routes for your health.
I took a 60+% pay cut for QOL, and it wasn't even affecting my health yet. But it's amazing how much improving your situation can improve your health and happiness. And it's worth every dollar in trade IMO.

For the OP, ED is not the same as low libido, and what you don't seem to be hearing from the physicians responding here is that your symptoms are unlikely to be caused solely by a perhaps slightly lower than average T level, and thus unlikely to be addressed solely by supplementing it. Regardless, if that is your chief complaint, there are much less aggressive treatments that could be tried first.
 
AMAS told me TRT is fairly common and isn’t this voodoo thing some people on this sub are making it out to be.
Just want to point out that the "some people" cautioning you are doctors with experience with this. And no one said it was voodoo. Their concern seemed to be signing up for a lifetime of medication before considering approaches that might avoid that. But, yes, get a variety of input on this. AMAS seems like a valid source also.
 
My libido is low, I lack energy after sleeping 7-9 hours, and my sex drive is non-existent.
You mentioned disrupted circadian rhythms, but also getting 7 to 9 hours of sleep, which seems conflicting. If you're not getting 8 hours of sleep opportunity every night, you're killing yourself. Low libido, maybe the least of your problems, and neither testosterone nor anything else other than sleep will treat this issue. You should not expect to be able to "catch up" by occasionally getting 7-9 hours sleep.

 
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