New bloodwork

[frawnz]

Just got my new bloodwork results. I'm kind of annoyed that my Endo refuses to run Estriadol tests. I asked him why and he said there's no need because high levels of E would be very obvious through side effects such as breast growth and ankle swelling. He also didn't run as many thyroid tests on this last lab work.

T4:
Old: 6.1 New: N/A Ref Range: 4.5-12.5

T-Uptake:
Old: 33.3% New: N/A Ref Range: 22.5-37%

Free T:
Old: 2.0 New: N/A Ref Range: 1.4-3.9

TSH:
Old: 2.54 New: N/A Ref Range: 0.4-4.0

Total T:
Old: 265 New: 709 Ref Range: 270-1730

FSH:
Old: 6.0 New: 7.9 Ref Range: 0.7-11.1

LH:
Old: 9.4 (high) New: 4.8 Ref Range: 0.8-7.6

SHBG:
Old: 43 New: 20 Ref Range: 13-71



So the most notable differences are obviously my total T numbers, which is to be expected when going from no TRT to 150mg/week of Test C. Also, my LH went from 9.4 (above the ref range) to 4.8, my SHBG went from 43 to 20 and my FSH went up from 6 to 7.9

I wish he had run the full T panel for comparison, as well as Estriadol, but he doesn't seem to want to budge. I was running some questions by him on Estriadol, HCG, etc and was going to tell him that I was doing 150mg/week as opposed to his intended 100mg/week, but he records everything and was very defensive so I just left it alone. He's happy where I am and says to keep on keepin' on for another couple months and we will do some more blood work.

At this point, I am strongly considering an AA clinic nearbye that my friend uses. I contacted them and gave them my blood work copies and they want to start me at 250mg/week of test C, include 3xweek of HCG, and 3xweek of an anti-E med. It's a little more pricey due to them not taking insurance, but I also save on all the copays that I'm paying for regular visits to my Endo.

Thoughts?

[Vettester]

Based on your LH/FSH, I presume your condition is primary failure? HCG is a great product to run when there is no LH signal being sent from the pit gland, which isn't the case in your situation.

I agree with you about the whole doctor thing. He should give you a pregnancy test if you truly insist on it. That might be a bit exaggerated, but he should respect your wishes to run the labs you want to, and he should review the E2 thing a little closer to realize how significant it really is. There are plenty of articles about the need to check E2 levels in the Journals of Endocrinology, which are at his fingertips.

BTW, the lowered SHBG should help with freeing up some bio-available "T", which is usually a good thing. Does your endo believe in running labs for free "T"? I'm presuming the answer is "no" due to what you have told us already about him.

[frawnz]

It was definitely frustrating. On one hand, I respect his position as a specialized Dr., but on the other hand, it's quite obvious with the data/research out there that estrogen levels can be just as important as testosterone levels in men, and having too high/low of either can result in similar unwanted side effects. I don't know what his official diagnosis for me is. I know he mentioned hypogonadism one my first visit, based mostly on the size of my testicles. He hasn't mentioned it since though, although from my reading, a low total T level combined with a high LH level is indicative of primary failure, and that pretty much follows suit with my initial (pre-TRT) blood work of 251 total T and 9.4 LH.

Should I avoid the HCG then since it's not going to help much? I have also noticed a decline in the volume of my semen, although my arousal levels have definitely gone up significantly (not necessarily my desire to have sex, but random/morning erections and harder erections than usual).

[Vettester]

I'm obviously only seeing the few particulars posted on this thread, so there could be other variables involved. However, at a glance, no, I don't believe the HCG is going to be beneficial. The HCG will send a signal to the testicles, essentially a duplication of the hormone, LH. Your leydig cells are already receiving a signal with endogenous LH, but nothing is working to produce natural testosterone. IMO, HCG will only be redundant.

This is where hopefully the doctor/endo is looking further into the cause. I would want to know why my guys don't want to work as they should. I would want to also rule out any tumors/cysts and/or other complications. Your baseline labs definitely indicate a primary problem (IMO). The LH/FSH will rise when the body doesn't respond with producing testosterone. Your LH has dropped on your second set of labs, because it senses an increase of testosterone. The exogenous testosterone that is being implemented has basically fooled your pituitary, thus it begins to taper down on the production of LH.

[zaggahamma]

i couldnt see staying with a doctor LONG TERM that refuses to give me a pregnancy test i mean check estro....

numbers look good...other than a little increased arousal have u had any other gains since starting trt...since u started a brand new thread, i'm not sure what complaints were b4 or how long you've been on this 150mg ew...

in answer to your last question about hcg i'll leave it to vette to explain but from how he's explained it you are correct that since your lh numbers are where they are then the hcg wouldnt give u the same benefit as if u were secondary...

about going to a clinic...i would if i had the cash as it is so much less red tape...but just another option for u....u can go to a lab and run estradiol alone and have that for yourself...i believe u can have that lab run for well under a hundred

[frawnz]

It's hard to say. I started going back to the gym at around the same time I started TRT. Some days I feel like an endless energy fountain. Other days I feel almost instant fatigue. I would say that compared to olden days of going to the gym, my gains are coming a bit faster, especially in my legs. I still need to get my bodyfat down, because I'm sitting around 20% right now (down from 22.6% 45 days ago). It's been a real struggle dealing with pharmacies around here because almost no one has the 200mg/ml 10ml vials that my doctor prescribes me, and it's the same cost for the 100mg/ml 10 ml vials so I feel like I'm just wasting money.

Basically, the main reason I started going to the endo is because of the notable decrease in my sex drive. I went from wanting sex while in a relationship a few times a day to only wanting it once and having a hard time getting aroused again after the initial orgasm. I have a family history of testicular issues. I had a hernia operated on when I was like 3, and then the other side when I was in my mid 20s. My dad had similar, and actually had one testical removed and my brother had an operation when he was going through puberty.

I think I've decided to go with the AA clinic, just because getting my prescriptions is going to be practically hassle free, they know exactly what my needs are and are open to adjust my dosages, anti-E, add additional orals if needed, etc. The price isn't so much different that it's going to hurt my wallet, and peace of mind and comfort with my medication is worth the price difference to me.

[Vettester]

I don't blame you one bit for going that route, in fact I tip my hat to you (although I'm not wearing one). I did the same thing after being jerked around from the GP to the Endo. Like a lot of things in general, people are just tired of getting a poor product for the price you're paying. I'd rather pay a little more for a premium product, as opposed to getting a bargain for a crummy product.

[zaggahamma]

agree and think it will be close to 90% clinics for all trt...i think when people find out its helping people they'll have to stop that!

[forrest_and_trees]

If you end up at the AA clinic, I'm assuming you'll have another "complete" panel run? If not, jpkman is right, you can run an E2 on your own for about $50. Check any of the online testing sites. As far as your, "desire to have sex" [libido] did you happen to notice a short term spike early on your TRT followed by a drop again? While I can see what your Endo is referring to as far as puffy nipples and edema, [swelling of the ankles and hands] as they usually are the first "visible" signs of high E, loss of libido is too and can precede the visible signs which is why it's so important to know your numbers. [I know... preaching to the choir here.] FWIW, it wasn't until I got both my T up an my E down did my libido *really* return. Even now I'm playing the balancing act to find that "sweet spot" as Vette was say. As always, he's the man and speaks the truth and I fully agree with everything he's said. You can learn much from him; I know I have.

On a side note: Question for Vetteman- You mentioned that low LH numbers may indicate that HCG would not be necessary. If that's the case, would it be beneficial to run an LH/FSH test before choosing to add HCG to your program? In my case, I mention it yet again to my doc and he seems to be hesitant. He said he'd, "need to look in to it" which leads me to believe he's not too familiar with it's use as part of HRT. I'm just wondering if it would help me to make my case.
[Sorry for the thread jack, I now return you to your regular program.]

[Vettester]

Forrest, there might be some confusion. Low LH numbers would usually indicate the need for HCG. High LH levels would not require HCG, as for the testicles would respond to the LH if they were functioning properly. In the case of the OP, his baseline LH was high. It did come down, but that's probably associated with the exogenous testosterone that he is running. His condition appears to be primary related, which he confirmed is definitely a strong possibility.

YES, LH/FSH should be one of the first things a guy does before ever thinking TRT. If testosterone failure is occurring with a patient, shouldn't the doctor want to know why and where this is happening? If it's low LH/FSH, then a doctor would know it's more than likely secondary hypogonadism, thus they would derive the problem to be in the pituitary gland. A doctor could then take it a step further to rule out any tumors or other conditions that might be causing this problem.

Hope this helps. Frawnz, sorry for any hijack, but hopefully this information will also apply to what you're seeking.