New Guy. Low T. Doc/Endo recommendations in Houston, TX?

[Torqued]

Ok. Trying this again. Spam filter said there was a problem with my post but didn't tell me WHAT the problem was.

New guy here.

Have been feeling like cr*p for much of the past year. Have just about all of the typical low T symptoms. 42 yo, 6'3", 290 lbs. Not working out much due to lack of motivation and fatigue. Am going to Bikram Yoga 3 times a week and am having pretty significant exercise tolerance issues. Just can't seem to build any strength and/or add muscle mass. Had a 6mm kidney stone forcibly removed from my body this summer. During the follow up, I had my urologist check my T. Total T came back at 195. Looking back, I've probably been bouncing in and out of the low end of the range for several years. The urologist threw some Testim at me and said "Come back in 4 months." At this point, I started reading everything I could get my hands on re: low T. Got a copy of all of my labs from the urologist and discovered that he's a moron when it comes to low T. There were a LOT of labs that he didn't order - CBC, lipids, E2, etc. Was pretty obvious at that point that he wasn't interested in finding out why my T is low and I'm not confident in his ability to manage my low T issue since he didn't order baseline values for key labs that need monitoring.

I had been on Testim for about 6 weeks when I got an appointment with an endo. Was starting to feel a little better... not great, but had seen an improvement in my symptoms. The endo agreed that my urologist dropped the ball with the labs. Unfortunately, the endo wants me to stop the Testim and re-draw labs after 6 weeks (I have 5 more weeks to wait at this point... )

I'm not sure how this guy is going to approach treatment at this point. I figured if I can at least get the total workup completed by an endo, I may be able to approach my GP with something like Crisler's protocol and a bunch of medical journal articles I've saved if it looks like the endo isn't going to work with me. If anyone has any other TRT MD recommendations in the Houston, TX area (preferably near the Medical Center) I'd appreciate it. I'm not looking to cycle steroids, but would like to see how I feel near the upper quartile of the normal T range so long as the rest of my labs look ok.

Here are my labs pre-Testim:

FSH 5.0 [1.6-8.0]
LH 2.8 [1.5-9.3]
Prolactin 9.2 [2.0-18.0]
TSH 1.13 [0.40-4.50]
PTH 35 [10-65]
Test 195 [241-827]

[bass]

good for you for educating yourself, unfortunately a little too late. in my opinion both docs have no clue how to go about it, by now you are pretty much shutdown and within 5 weeks you will not return to your normal level naturally. you need to be restarted then wait few week and do BW to see what your body is doing by itself. 5 weeks from now all the new doc is going to see is a guy who's shutdown, and probably will put you on TRT and send you home.

at this point you need to post all your labs with ranges here in this thread, labs that you did prior to your TRT so we can better assist you. read Kelkel's thread regarding Finding a Physician for guidance of how to find a qualified Doc and what BW you need, its in the stickies. welcome, you are in good hands here.

[Torqued]

Thanks for the response.

Here are my labs pre-Testim:

FSH 5.0 [1.6-8.0]
LH 2.8 [1.5-9.3]
Prolactin 9.2 [2.0-18.0]
TSH 1.13 [0.40-4.50]
PTH 35 [10-65]
Test 195 [241-827]

Like I said. My urologist obviously dropped the ball on the labs.

Will check out the recommended info. Thanks!

[Torqued]

Here are the labs my endo has me scheduled for in 5 more weeks. Is there anything missing that you guys would recommend adding?

(#'s are Quest lab codes)

367 Cortisol, Total
211 ACTH, Plasma
11280 Cortisol, Free 24-hour urine LC/MS/MS
592 Creatine, 24 hour urine
16293 IGF I, LC/MS
16122 Prolactin, Total and Monomeric
36170 Testosterone, Free and Total, LC/MS/MS
4021 Estradiol
470 FSH
615 LH
510 Hemoglobin
10231 Comprehensive Metabolic Panel
6399 CBC (Quest Diff/Plt)

[bass]

well, your testosterone is definitely in the tank, and LH being very low which point to primary hypogonadism. your TSH looks good so looks like no issue in your thyroid. it seesm that you are a candidate for TRT, but TRT has to be done correctly, not just give you cream and send you home. proper TRT consists of teh following,

Testosterone injections or creams, injections preferred. starting dose should not exceed 100 mgs per week, and it has to be administered minimum once a week, or split twice a week is even better to avoid spikes/peaks and valley.

Aromatase inhibitor (AI) like Anastrozole as need it. BW will determine the dose and frequency.

hCG, to keep your testicles functioning properly and to prevent atrophy, this has to be tailored to the individual. some do 250 iu eod, 300 iu three times a week, 500 iu twice week, etc...

Donating blood as often as they allow to prevent thickening of the blood. CBC panel will show your RBC, Hemoglobin and Hemoticrit levels, make sure they are within range.

Vitamin D is essential for men with or without TRT

there are other supplements you can take but the above is the most important ones.

i think the next 5 weeks you're just going to feel miserable waiting to do BW then teh doc will say you need TRT, i'd suggest you find a TRT doc now and get started. its a lonmg process but once you're dialed in you'll be in great shape.

[bass]

BTW, your new doc seems to have ordered the right panels. its up to you to wait few more weeks and see what he says, but i guarantee you he'll put you on TRT.

[Jake14]

I can recommend a couple of doctors in Houston, in or not far from the Med Center. I tried to send an private message but either you are two new to receive messages or you need to change your set up to allow for them. I know you need 50 post to send, it may be the same to receive. Figure out if I can send you a private message or post a throw away email account. I will send you some recommendations.

[Torqued]

I can recommend a couple of doctors in Houston, in or not far from the Med Center. I tried to send an private message but either you are two new to receive messages or you need to change your set up to allow for them. I know you need 50 post to send, it may be the same to receive. Figure out if I can send you a private message or post a throw away email account. I will send you some recommendations.

Yeah. I don't have enough posts for PM's. You can shoot an email to ***** at ****. Thanks.

[Torqued]

i think the next 5 weeks you're just going to feel miserable waiting to do BW then teh doc will say you need TRT, i'd suggest you find a TRT doc now and get started. its a lonmg process but once you're dialed in you'll be in great shape.

BTW, your new doc seems to have ordered the right panels. its up to you to wait few more weeks and see what he says, but i guarantee you he'll put you on TRT.

Finding an endo that's interested in treating something other than thyroid and/or diabetes was a bit of a pain. This guy actually has a decent number of good reviews from patients but I'm not sure how many of them have low T. He's also younger (in his 40s), so hopefully he's not as set in his ways as some of the older endos. I'll suck it up for the next 5 weeks just to get through the labs/eval part so at least I'll have that data if I need to find a new doc. He did say that he wasn't a big fan of the gels on my first visit, so I believe he'll be up for injections... just have to see how he approaches the dose/frequency.

[Torqued]

good for you for educating yourself, unfortunately a little too late. in my opinion both docs have no clue how to go about it, by now you are pretty much shutdown and within 5 weeks you will not return to your normal level naturally. you need to be restarted then wait few week and do BW to see what your body is doing by itself. 5 weeks from now all the new doc is going to see is a guy who's shutdown, and probably will put you on TRT and send you home.

at this point you need to post all your labs with ranges here in this thread, labs that you did prior to your TRT so we can better assist you. read Kelkel's thread regarding Finding a Physician for guidance of how to find a qualified Doc and what BW you need, its in the stickies. welcome, you are in good hands here.

I don't really see the point of getting "restarted" when my T was 195 BEFORE I started Testim. I've felt like crap for a long time and getting started on TRT is exactly what I want.

[Jake14]

Yeah. I don't have enough posts for PM's. You can shoot an email to torqued713 at hotmail. Thanks.

Sent email. Let me know if you did not get it.

[Torqued]

Sent email. Let me know if you did not get it.

Got it. Replied. Thanks!

[HRTstudent]

Baylor is supposed to have some good docs in the TRT field I've heard.

[Torqued]

Baylor is supposed to have some good docs in the TRT field I've heard.

Thanks. I'll look into that. Trying to minimize wasting my time and copay $ playing doc roulette.

[Torqued]

Ugh. 3 more weeks before I get my blood redrawn before my next endo visit. I'll be interested to see what the results are this time. I definitely feel worse now than before I started on the Testim. Absolutely crushing fatigue... even if I get a full night's sleep, it's a struggle to stay focused and awake at work.

Are you guys using anything special to keep track of your lab results? Spreadsheet? Software? iPad/iPhone apps?

[Alpha-Male]

Pick up a copy of the Houston Press, there is a really good Men's Clinic that advertises in there...

[Torqued]

But do they take insurance and how far are they from my office? (I work in the medical center)

The endo I'm going to seemed to be reasonable on treatment at the first visit. I can also walk over to his office in about 10 minutes. He just wants to be sure of what my baseline levels for my labs before he starts treating. The urologist that started me on Testim didn't draw any of the important labs - no CBC, lipids, metabolic panel, etc. - that need to be monitored on TRT.

I'm just complaining because I feel like crap... but I need to suck it up these next few weeks and get through the "official" endo workup so if I need to shop for another doctor, I have all of the baseline info to start from.

[Torqued]

Had my follow up with my endo today. Most recent labs below. Low T but "normal" free T. He thinks my low T is because of my weight. (6'3", 287) - yeah, I need to lose some weight... but one of my biggest problems has been with motivation, fatigue, mental fog, low exercise tolerance, and just being unable to make any gains even if I force myself to exercise. Despite all of that, he had no problems with starting me off with 50mg Test-C twice a week. I thought it was strange that my estradiol was so low, especially with me being overweight and I've had some "nipple symptoms" (itching and sensitivity, but no gyno). Would appreciate any feedback on the results below. He didn't draw any cholesterol labs, so I made sure he added them to the next batch. He's not a fan of the gels and said that he has heard about subQ T injections at some of his meetings/conferences, but feels that we need better formulations of T for subQ.

So I'll run by the pharmacy this afternoon to get my supplies and plan on taking my first pin tonight. I still have to go by his office on Thursday and get my "official" training for injections, though. I'm not too worried about it. I was an RN in a previous career. I just need to check out the self-injection videos online and I should be good to go.

I know I have a kidney issue - working through that with my urologist. Have been battling kidney stones this year and have a follow up appointment with the dick doctor later this month.

I was also probably a little dehydrated when they drew those labs. Planning on getting started on the blood donations this week or next to be sure to keep RBC's in check.

edited to add:

He wasn't interested in an AI since my estradiol was so low. He wants to see how that is going to respond first. He also won't do HCG . Considering just running that myself.

Most Recent Labs (I'll come back later and fix the formatting):

TESTOSTERONE, TOTAL, LC/MS/MS	221			250-1100 ng/dL
FREE TESTOSTERONE	        48.8          		35.0-155.0 pg/mL
ESTRADIOL			<15			< OR = 39 pg/mL
WHITE BLOOD CELL COUNT	         6.2			3.8-10.8 Thousand/uL
RED BLOOD CELL COUNT		 5.52		4.20-5.80 Million/uL
HEMOGLOBIN			        15.6		13.2-17.1 g/dL
HEMATOCRIT				47.3		38.5-50.0 %
MCV						85.7		80.0-100.0 fL
MCH						28.3		27.0-33.0 pg
MCHC					        33.0		32.0-36.0 g/dL
RDW						13.8		11.0-15.0 %
PLATELET COUNT					212			140-400 Thousand/uL
ABSOLUTE NEUTROPHILS			3751		1500-***0 cells/uL
ABSOLUTE LYMPHOCYTES			1748		850-3900 cells/uL
ABSOLUTE MONOCYTES				353			200-950 cells/uL
ABSOLUTE EOSINOPHILS			316			15-500 cells/uL
ABSOLUTE BASOPHILS				31			0-200 cells/uL
NEUTROPHILS						60.5		%
LYMPHOCYTES						28.2		%
MONOCYTES						5.7			%
EOSINOPHILS						5.1			%
BASOPHILS						0.5			%
LH								4.1			1.5-9.3 mIU/mL
FSH								6.4			1.6-8.0 mIU/mL
CORTISOL, TOTAL					7.4	mcg/dL
CORTISOL, FREE, URINE			49.4		4.0-50.0 mcg/24 h
CREATININE, URINE				3.89		0.63-2.50 g/24 h
CREATINE, URINE					207			6-56 mg/24 h
CREATININE, URINE				3.17		0.63-2.50 g/24 h
GLUCOSE							86			65-99 mg/dL
UREA NITROGEN (BUN)				13			7-25 mg/dL
CREATININE						0.98		0.60-1.35 mg/dL
eGFR NON-AFR. AMERICAN			95			> OR = 60 mL/min/1.73m2
eGFR AFRICAN AMERICAN			110			> OR = 60 mL/min/1.73m2
SODIUM							138			135-146 mmol/L
POTASSIUM						3.9			3.5-5.3 mmol/L
CHLORIDE						104			98-110 mmol/L
CARBON DIOXIDE					26			21-33 mmol/L
CALCIUM							9.1			8.6-10.3 mg/dL
PROTEIN, TOTAL					7.2			6.2-8.3 g/dL
ALBUMIN							4.4			3.6-5.1 g/dL
GLOBULIN						2.8			2.1-3.7 g/dL (calc)
ALBUMIN/GLOBULIN RATIO			1.6			1.0-2.1 (calc)
BILIRUBIN, TOTAL				0.5			0.2-1.2 mg/dL
ALKALINE PHOSPHATASE			62			40-115 U/L
AST								17			10-40 U/L
ALT								18			9-60 U/L
ACTH, PLASMA					25			6-50 pg/mL
PROLACTIN, TOTAL				9.8			2.0-18.0 ng/mL
PROLACTIN, MONOMERIC			5.8			3.4-14.8 ng/mL
IGF I, LC/MS					134			52-328 ng/mL
Z SCORE (MALE)					-0.1		-2.0 - +2.0 SD

[bass]

no thyroid and PSA? your LH and FSH are okay, and yes your testosterone is in the tank! despite having kidney sotones your kidneys are in great shape. your hematocrit, hemoglobin and RBC are fine, so no need to donate blood for the purpose you've mentioned, however you can if you want to. what else did he prescribe, AI, hCG? SQ is a good way to administer especially at 287 lbs you will have no problem at all! it would have been nice to see what your cholesterol is, but we'll wait until next BW.

[Torqued]

He's using the original Thyroid labs from my other urologist. I'll get him to add a PSA. I'd like to go ahead and get on a donation schedule just to stay ahead of the game there - I don't want to have to stop treatment and/or screw around with trying to get a therapeutic draw. Plus, I work at a hospital and can just walk over to the blood bank during lunch. He wasn't interested in an AI since my estradiol was so low. He wants to see how that is going to respond first. He also won't do HCG. Considering just running that myself. I'm a little concerned about the creatine/creatinine highs on my 24hr urine, but have a follow-up visit later (and another 24 hour urine) for my urologist. Endo doesn't want a follow up until 3 months later. I'm thinking about just getting labs done via privatemdlabs @ 6 weeks and maybe push up the follow up based on those results.

While he comes up short on what most here would probably consider ideal, he seems to be better than some of the more frustrating/disappointing endo visits that I've heard of. He asked me if I wanted to try gels again or go to injections. Of course, I said injections. He initially recommended injections 100mg/wk or 200mg/2wks, but he had no problems with me asking if I could just do 50mg 2x/wk because of the half life, less aromatization, etc.. He seemed a little surprised and said that most patients don't like sticking themselves more frequently. At least I got my initial workup over with and am getting started. Now, if the guys here would just open up that clinic in Houston, I'd be set!

Anyone else have any thoughts on his comments of low total T vs the "normal" free T?

Thanks for taking the time to look at my labs, bass. I appreciate it.

I've seen a site recommended on this forum that was good for self-injection sites and techniques, but I can't find it now... if someone could point me in the right direction...? I thought I had subscribed to that thread, but apparently, I was mistaken..

[steroid.com 1]

TESTOSTERONE, TOTAL, LC/MS/MS 221 250-1100 ng/dL
FREE TESTOSTERONE 48.8 35.0-155.0 pg/mL
Both are low and points to hypogonadism...remember reference ranges are what they are...read the stickies on reference ranges.

ESTRADIOL <15 < OR = 39 pg/mL
Was this a "sensitive" assay? If not, it may very well not be accurate. With your low serum levels and the BF you are carrying I wouldn't be surprised at all if this came back completely different with a "sensitive" lab.

TSH 1.13 [0.40-4.50]
This from your last lab is useless. Using TSH as a lab to guage Thyroid function is like juding how fast you're driving your car by how far the accelerater is pushed to the floor. You need a complete thryoid workup inlcuding FT4, FT3, RT3 and Thyroid Antibodies...kid you not.

LH 4.1 1.5-9.3 mIU/mL
FSH 6.4 1.6-8.0 mIU/mL
These aren't bad for a guy your age to be honest.

CORTISOL, TOTAL 7.4 mcg/dL
CORTISOL, FREE, URINE 49.4 4.0-50.0 mcg/24 h
Cortisol Free is high but could because you're in the Doctor's office...this is one you need more of to get a accurate pattern...hell a sore muscle could cause it.


PROLACTIN, TOTAL 9.8 2.0-18.0 ng/mL
PROLACTIN, MONOMERIC 5.8 3.4-14.8 ng/mL
These are good for a guy your age and indicates it's probably not a Pituitary isssue.

You can self administer HCG there are a number of reliable RS for that like Peptide Man dot Com.

Consider my observation, and the others like bass; you appear to be age related androgen deficient and your start-up protocol seems good.

Add in the HCG right away, read the stick on HCG...it's a good one

[Torqued]

GD:

Thanks for the detailed feedback!

I did specifically ask him if it was the sensitive assay and he said it was. It was Quest Labs, Estradiol (4021). I've seen other references to that being the sensitive test.. I may get my GP to run the thyroid labs and PSA. I'm due for a physical, but he wanted me to finish my workup with the endo and urologist first.

I have read through all of the stickies more than once and have already visited Peptide Man.

[HRTstudent]

I use Quest. The quest lab for sensitive ranges at <=29. Furthermore, the sensitive test will give you an exact value, such as 4. It won't give you a range like you got ("<15"). Sorry but your doc gave you lip service and he may not even know what the sensitive test is. None of my docs knew either...

To be frank, it sounds like he is not a specialist in wellness. He's treating your low T which is probably a good thing. But he's not the creme of the crop by any means.

The quest sensitive test is called "estradiol ultrasensitive" for future reference.

[Torqued]

HRTs:

Yeah. I found the ultra sensitive one a little while ago after doing some searching. Thinking about getting it done vie privatemdlabs since it's not too expensive. I'm pretty sure his main gig is diabetes and thyroid issues (like most of them). But, at least I'm getting started. All of you guys have been a huge help. Thanks.

[kelkel]

Torqued, sorry I'm late, just got your PM. Great advice above and nothing that I can add. Be patient and in a little time you will feel like a new man! Get the sensitive assay as stated and begin keeping a file of all your BW. The site your looking for is spotinjections.com. Assuming your going SQ injections? If your getting more labs done remember dhea-s, pregnenolone and Vit D.

kel

[Torqued]

kel:

No problem. Thanks for chiming in. Yes! The spotinjections was the site I was trying to remember. Thanks!!

Already have a folder/binder for BW started. And a list of future labs I'm going to need. I'm going to start off with IM injections 2x/wk.

My wife is actually excited that things are getting going. She knows how bad I've been feeling for the past few years and wants me to feel better.

[steroid.com 1]

With your Testosterone protocol of 50 mg twice a week (Monday morning and Thursday night) you can do 250 IU of HCG on the mornings of Monday, Wednesday and Friday and you will do well.

Remember, the HCG is going to add some in natural production as well so you're going to get a really nice boost with this protocol...I think it's one of the best for IM.

The last thing is your E2 so get it checked now before you start so you have a baseline. If you're Doc doesn't order the "sensitive" lab next time (after you explain nicely how he needs to order it correctly and why - the sticky covers this) you will know how much AI to add in.

You're almost there my friend

[Torqued]

GD:

That's pretty much my plan. HCG will hopefully be here by the end of the week.

It looks like this panel from privatemdlabs will cover the bulk of stuff that was missed. It's redundant on a few things, but ends up being cheaper than picking up the E2, Thyroid, Lipids, and PSA individually. Plus, it's more data points.

Hormone Panel for Males

Description: The Hormone Panel for Males contains the following tests:
- Lipid Profile
-Complete Blood Count w/ Differential
-Estradiol, Sensitive
-Insulin Growth Factor (IGF-1)
-Comprehensive Metabolic Panel
-Testosterone (Free) , Serum (Equilibrium Ultrafiltration) With Total Testosterone
-Prostate-Specific Antigen (PSA)
-Thyroid Profile

Decided not to pin last night. Doc wrote the script for 2 1ml vials of Test C 200mg/ml. Pharmacy dispensed a 200mg/ml 10ml vial.

Going to get those labs drawn Thursday morning and have to report to the doc for my "official" injection training for 1st injection @ lunch time.

I also started Vit D 5000 twice a day. I get almost zero sun - have an office job with no window and get in early, leave late in the afternoon. Will add that to future labs.

With my T as low as it was, I'm really interested to see where this initial dose puts me.

My pharmacy sucks. They were arguing that I only needed 1 needle per syringe. Going to have to mail order some pins.

Thanks again for the feedback.

[steroid.com 1]

Great to see you taking control like this; you've educated yourself well and now know how to manage your blood work and TRT protocol...you now know more than your Doctor.

Get ready for the BIG change

BTW, good idea to pre-warn your wife, with both the HCG and increase in testosterone serum levels there will be a nice kick in Dopamine leves...meaning a screaming libido

[Torqued]

I'll tell my wife what you guys said.

I could really use some dopamine! And I'm interested in adding on some pregnenolone eventually. I've had some pretty crushing depression on and off these past few years. Mostly because I have felt like crap physically for so long. Complete lack of motivation and drive made it nearly impossible to try to "fix" issues like my diet and weight. I've had nearly all of the symptoms of low T.

I was discussing last night with my wife the feedback I got from you guys on the labs and stuff that the endo overlooked. She said that she was glad I found this forum and wondered what kind of half-assed and potentially harmful treatment I could have gotten if I hadn't stumbled across you guys. Scary stuff...

Thanks again!

[Torqued]

So I had my "official" self-injection training from my endo's nurse after I went and had the labs above drawn via privatemdlabs. What a colossal waste of time! First, he thought he was going to give me the shot. When I said "No. I'm here for self-injection training.", he sort of went and said "Oh.. ok.." and starts giving me instructions on how to stab myself in the ass. I ask him about rotating to other sites like the thigh and deltoid and he actually said "We don't recommend those. We only inject in the butt. You can alternate between the right and the left."



Regardless, I successfully stabbed myself in the ass with 50mg of Test C. Looks like I'll be checking out youtube and spotinjections for the rest of the info. Since the pharmacist gave me a hard time about the needles and syringes I wanted, I have on order inbound from ar-r. Hopefully my HCG from peptide man will be here in the next couple of days as well. Also have DHEA and pregnenolone inbound from lef.

If it hadn't been for you guys and this site, I would have been getting half-assed and potentially dangerous treatment for my low T. You guys f*cking rock. Thanks!