Why Am I So Tired On TRT?

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Timeline

00:00

A 28-year-old man on TRT asks why he feels so tired while using testosterone, metformin, and telmisartan under a coach-directed regimen, prompting Dr. O’Connor to question whether each medication is actually necessary.

01:50

Dr. O’Connor raises the possibility that telmisartan could be lowering blood pressure too much and contributing to fatigue, then questions the long-term sustainability of escalating testosterone and adding Primobolan without physician oversight.

Video Summary

A 28-year-old man on TRT asks why he feels unusually tired while following a coach-directed medication regimen. Dr. O’Connor reviews his use of approximately 125 mg of testosterone enanthate weekly along with metformin and telmisartan and questions whether all of these medications are actually medically necessary for this young man.

The discussion focuses especially on telmisartan because Dr. O’Connor raises the possibility that excessive blood-pressure lowering could contribute to fatigue if the member is becoming hypotensive. He also explains that metformin can be valuable for selected patients with metabolic risk but should not simply be added to a regimen because another person uses it successfully.

The larger concern is the member’s plan to increase testosterone exposure and add Primobolan under the direction of a nonphysician coach. Dr. O’Connor emphasizes evaluating heart health, blood pressure, metabolic risk, long-term sustainability, and medication quality before escalating the regimen, particularly when underground products may not contain what the user expects.

Drug Callouts

Testosterone Enanthate

The member is using approximately 125 mg of testosterone enanthate per week and is considering increasing his androgen exposure. Dr. O’Connor questions escalating the regimen in a 28-year-old without first evaluating symptoms, blood pressure, cardiovascular health, and whether the current TRT dose is actually appropriate.

Metformin

The member is taking metformin despite the transcript not establishing that he has prediabetes or diabetes. Dr. O’Connor considers metformin useful for selected patients but questions automatically adding it to a young man’s TRT regimen without a clear medical indication.

Telmisartan

The member is taking telmisartan while complaining of significant fatigue. Dr. O’Connor raises the possibility that blood pressure may be falling too low and emphasizes that a medication he values for selected men on testosterone is not automatically appropriate for everyone.

Primobolan

The member’s coach reportedly plans to add Primobolan to the regimen the following month. Dr. O’Connor strongly questions escalating androgen exposure in this young man before understanding the cause of his fatigue and evaluating the long-term cardiovascular and metabolic consequences.

Condition Callouts

Fatigue

Persistent tiredness is the member’s main complaint while using testosterone, metformin, and telmisartan. Dr. O’Connor emphasizes investigating the complete regimen and broader health picture rather than assuming TRT itself is automatically responsible.

Hypotension

Dr. O’Connor raises low blood pressure as a possible explanation for the member’s fatigue because he is taking telmisartan without a clearly established need in the transcript. Men on testosterone using antihypertensive medication should have blood pressure checked rather than assuming the medication is harmless or necessary.

Key Takeaways

Fatigue on TRT should prompt review of the complete medication and androgen regimen rather than automatically blaming testosterone.
Telmisartan may contribute to fatigue if blood pressure is being lowered excessively in someone who does not need that degree of treatment.
Metformin can be useful for selected metabolic indications but should not automatically be added to every testosterone regimen.
Increasing testosterone and adding Primobolan before understanding the cause of fatigue may unnecessarily increase long-term androgen exposure.
Medication decisions should be based on the individual’s blood pressure, metabolic health, cardiovascular risk, symptoms, and medical history.
Underground testosterone or anabolic steroids introduce additional uncertainty because the actual contents, concentration, and quality may be unreliable.