Surprising Results from Dr. Visit

[AngryElf]

Hey guys, new to the forum and learning a lot already. I wasn't looking for TRT... At my recent annual check-up I mentioned some general frustrations like not only an inability to lose weight but easily gaining, despite hitting the gym 4-5 times week and aggressive dieting. Long story short, she ran some BW and is telling me I could benefit from supplementation. This was a surprise as I wasn't even thinking about low T. I understand from the stickies that I need to do some due diligence in finding the best doctor. I am not ready to sign up for anything just yet. I would however, greatly appreciate any thoughts on my baseline results and if she is legit in her recommendation. From browsing the forums, I can see there is a lot of experience in this group. So your thoughts would be very helpful.

Test: Range : Result

Total T: 160-726 ng/dL : 234

Free T: 5.0-30.0 pg/mL : 2.8

SHBG: 10-57 nmol/L : 25

DHT: NA

Estradiol: 0-56 pg/mL : <20

LH: 0.8 -7.6 mIU/mL : 6.2

FSH: 0.7-11.1 mIU/Ml : 7.0

Prolactin: NA

Cortisol: NA

Thyroid Panel:
TSH 3rd Generation: .40-4.00 : 1.34
Free T3: 1.8-4.2 : 4.1
Free T4: .89-1.76 : 1.09

CBC:NA

PSA:NA

IGF-1: 109.0-284.0 ng.mL : 278.0

IGFBP-3: NA

Vitamin D: NA

Androstenedione: .330-1.340 : 0.553

PSA: <=4.0 : 0.8

Metabolic Panel
Male
Age: 37
Height: 67 in 170 cm
Weight: 204 lbs
BMI: 92.5
Resting Energy Expenditure: 1728 Cals

[jasondd1]

I'm not one of the experts on here but yea you look low. Actually you look really low. You might ask for more thorough thyroid panel though. The numbers seem off and could be the culprit, again I'm no expert. RT3 and thyroid antibodies would be a start.

[OingoBoingo]

Not an expert, but LH/FSH don't look too bad to me. Makes me think more Primary than Secondary. It might be a good idea to stop by a urologist's office, and get checked for a varicocele. A varicocele can cause low Testosterone and may be fixed. Worth a shot if that's the case.

If you don't know your Vitamin D level, get it checked.

Also good to know your baseline DHT.

[AngryElf]

Thanks guys, I appreciate the responses. I've been doing a ton of reading and I really want to dig more into this and figure out why the number is low. I don't want to just treat a symptom. Think I may head to an endocrinologist next and see what they think.

[ngtmarpete]

Endo would be a great state. He should run a through panel and go from there. Good luck. Your T levels made me cringe.

[kelkel]

Not an expert, but LH/FSH don't look too bad to me. Makes me think more Primary than Secondary. It might be a good idea to stop by a urologist's office, and get checked for a varicocele. A varicocele can cause low Testosterone and may be fixed. Worth a shot if that's the case.

If you don't know your Vitamin D level, get it checked.

Also good to know your baseline DHT.

Don't downplay your knowledge base OB. OP, Oingo is on point here. Your LH/FSH function is excellent for your age yet your test is low. This means the issue is primary like OB said. Your Hypothalymus / Pituitary are sending out great signals but your testicals are not responding in kind. Testing for a varicocele would be a great start. I'd opt for a Urologist in this matter, imho. When it comes to blood work I don't see the need for more at this time as prolactin, cortisol and thyroid could all be suppressive to your LH function but they definitely are not suppressed.

Let us know what you do please. Get an ultrasound on your boys asap.

[AngryElf]

Thanks guys. I made several calls today, asked some questions and now have an appointment next week with a local Urologist. Will keep you posted as I make progress down this path. Really appreciate the help.

[kelkel]

Update this thread after your appt please.

[AngryElf]

So I visited the Urologist today... He rubbed my balls and said no need for ultrasound. He did say that he didn't see any evidence of abnormalities. He ran his own blood work, but said that based on the previous test results, he didn't expect much difference. He offered to give me a shot before I left his office, but wants me back in every two weeks for ongoing injections.

The previous doctor wrote me an Rx for 100/wk cypionate, dhea 25 mg, and zinc 30mg. Last two are OTC. Self inject weekly. Think I'd rather go this route if I decide to move forward.

Nervous about starting this lifelong journey of manipulating my Hormone levels. I know there's a lot of guys on here with experience chuckling at my reservations, but I'm a bit nervous. Guess I will be starting tomorrow or Saturday with the shots. Unless I get some responses that recommend another option or questions that should be answered.

Again, thanks for the help.

[jasondd1]

I'm curious what the urologist thinks it could be. I mean he didn't see a need to ultrasound it so what does he attribute the primary hypogonadism to? I wouldn't go with his idea of every 2 weeks thats for sure

[Simon1972]

Inject weekly yourself. Twice a week if you can handle it. He may want you to visit his office for the first few pins, keeps his wallet full . insist on home pinning.

I'd be starting sub Q in the first instance. Maintain it, dial yourself in, its easier than IM and more manageable

But you do need to find out the cause first.

[DrApollo]

What is everyone's thoughts on getting cortisol levels checked? Are they worth measuring? Before discovering my low T I actually thought I had an issue with excess cortisol being produced. Is there any correlation between cortisol and testosterone levels? Not trying to hijack the thread, I'm just new to HRT like the OP and am trying to learn as well.

[AngryElf]

I asked about root cause and he just said that physically everything looked okay and that levels just decrease with some people. Now, this guy probably isn't that great or my balls were just that fetching. But he didn't see a reason to dig deeper into the why... So I could go to another doc or just move forward with treatment.

Wish there was a god way to report or rate doctors. It's a crapshoot most times.

[kelkel]

So I visited the Urologist today... He rubbed my balls and said no need for ultrasound. He did say that he didn't see any evidence of abnormalities. He ran his own blood work, but said that based on the previous test results, he didn't expect much difference. He offered to give me a shot before I left his office, but wants me back in every two weeks for ongoing injections.

The previous doctor wrote me an Rx for 100/wk cypionate, dhea 25 mg, and zinc 30mg. Last two are OTC. Self inject weekly. Think I'd rather go this route if I decide to move forward.

Nervous about starting this lifelong journey of manipulating my Hormone levels. I know there's a lot of guys on here with experience chuckling at my reservations, but I'm a bit nervous. Guess I will be starting tomorrow or Saturday with the shots. Unless I get some responses that recommend another option or questions that should be answered.

Again, thanks for the help.

I honestly don't think palpating your testicals is sufficient to make that determination. Your Uro's correct that some people's test just slows down quicker than others, that said, I'd still request the Ultrasound for peace of mind. Definitely disregard the Uro if he suggested every two week injections as it means he doesn't understand testosterone's half life and he'll probably faint at the request for HCG or an AI.

Your other doc's script is more on the money as he seems to have an understanding of how things work. Like Simon said, sub-q twice weekly injections (50mg each) would be a great way for you to start this journey as it's a tested methodology and as efficient as IM shots. Him suggesting dhea is also a clue that he's done some reading. Back-filling your cholesterol pathways is always a plus. I'd include pregnenolone along with the dhea at the same amount and take them in the morning. Both products need to be micronized to help survive the first pass through the liver and for best absorption / effectiveness. I referenced this in another thread earlier today that I recently switched to dhea.com which is Mcpherson Labs for both items. More expensive but the results I got (lab work) proved their worth.

Read this on SQ injections and then read the sticky at the top re dhea and preg.

Subcutaneous administration of testosterone. A pilot study report. - PubMed - NCBI

Remember to update this thread. We'll help keep you straight!

[AngryElf]

Started the IM injections on Saturday. Doc wants to start there since she is more comfortable with that process. Once she has me stable, she is open to my trying different options. HCG after my 30 day mark...

Curious, should my testicles be aching now? Never had pain issues until now. The discomfort started today and has me worried. Is this normal or am I having some other issues?

[hawk14dl]

Probably in your head. I don't believe one shot of testosterone would affect you so quickly (not at all actually)

[AngryElf]

Yeah, I figured I might be projecting. However, this sure feels real.

[hawk14dl]

I remember the first time I ran out of hcg, went like 2 weeks without. I thought my boys were going to fall off they were in so much pain.

I actually haven't used hcg in over a month. No ill effects (although I'll likely add it back in soon)

[AngryElf]

My first results are in and I would love some feedback before I go back for follow up in the morning. My free is low in range, but total is high? BW was done on week three, four days after IM injection.

What recommendations would you have if you were going in tomorrow? My Estradiol needs to go down. TT is high, but free is barely in range. Keep T higher to get Free number up more?

[AngryElf]

By the way, I'm on test cyp 200mg/wk. asking for HCG addition tomorrow...

[AngryElf]

Any thoughts from you guys would be appreciated. Thx!

[kelkel]

My first results are in and I would love some feedback before I go back for follow up in the morning. My free is low in range, but total is high? BW was done on week three, four days after IM injection.

What recommendations would you have if you were going in tomorrow? My Estradiol needs to go down. TT is high, but free is barely in range. Keep T higher to get Free number up more?

Nice total T number but your FT is quite low. This is possible indicative of a high SHBG level, which should have been tested. Remember, total T doesn't matter, it's FT that works for you.
Estradiol is the wrong test. It needs to be a sensitive estrogen assay. Standard estradiol is geared for women and reads higher in men. This can cause an over use of AI's. That said, you're three weeks in with a high starting dose (usually ends up too high) and I don't have any doubt you will need to use an AI as your E2 will surely continue to rise.

He tested FSH but not LH, WTF?

My recommendation is to print out the second set of BW in the Finding A Doc sticky and get that in about 3-4 more weeks. It will give you a much better picture of what's going on.

[AngryElf]

So after the visit today, the doc has me on this new plan... I've had some hot flashes lately. Doc says E is too high and anastrozole will help. Agreed to run the new BW as requested in 4 weeks for follow up. Should I go to a new doc or run this plan? This doc is easy to talk to and very open to options. Seems to educate and read up on topics I mention. I just feel like I may learning this process along with them. Hot flashes have me a little concerned. But, that being said, sexually I'm better than ever. So E shouldn't be too low causing the flashes right? From what I've read, 1mg of anastrozole is a lot... Is that a concern?

1. Continue testosterone cypionate at 200 mg/ml - 1 ml but switch to sq injection weekly

2. Add HCG on day 4 and 5 following injection at 250 IU sq

3. Add anastrozole 1 mg/week

4. Follow up in 1 month with hormone f/u labs and HCG level

[kelkel]

So after the visit today, the doc has me on this new plan... I've had some hot flashes lately. Doc says E is too high and anastrozole will help. Agreed to run the new BW as requested in 4 weeks for follow up. Should I go to a new doc or run this plan? This doc is easy to talk to and very open to options. Seems to educate and read up on topics I mention. I just feel like I may learning this process along with them. Hot flashes have me a little concerned. But, that being said, sexually I'm better than ever. So E shouldn't be too low causing the flashes right?

1. Continue testosterone cypionate at 200 mg/ml - 1 ml but switch to sq injection weeklly No, that's too much for SQ. Usual limit for sq is around 75mgs per pin. Much more can cause absorption issues, lumps, etc. I'd go with IM twice per week at 100mgs which will help with your E2 as well. Less injected = less spike in E2.

2. Add HCG on day 4 and 5 following injection at 250 IU sq
If you stick with once per week T then inject HCG both one and two days before your injection. If you go twice per week IM just put it in the same syringe. ***best option, imho***

3. Add anastrozole 1 mg/week Probably too much. I would not use more than .25 twice per week based on your situation. Consider guys on 500 mg cycle the avg dose is .25 eod. Do the math.


4. Follow up in 1 month with hormone f/u labs and HCG level

Be sure you get TT, FT, CBC and a sensitive E2 assay at a minimum. HCG level? Pull Vit D and SHBG if you can.

In bold above...

[AngryElf]

HCG is expensive! $300 month from local pharmacies...sticker shocked.

[dingobite]

At one point 6 months into my treatment i had to split the 100mg shot down to twice a week my heart rate was running so high off the one shot i couldnt get any sleep in during that time. So much as a 2.5mg over 50 would get me feeling giddy.

[AngryElf]

Hey guys, could use some feedback and help. I've started having ED issues since Tuesday. I can get it up, but can't keep it up. Night wood is still happening. Face and body acne has emerged.

I've got bloodworm from Tuesday's test attached. But I have to wait until next Friday for the sensitive E test result.

My routine right now:

TestCyp IM 100mg Tuesday and Friday
HCG 250 IU Tuesday and Friday
Arimidex .25 EOD

Started AI and HCG 3 weeks ago. Thinking I should stop the AI and HCG since things have been good until now? Surely I'm not too high on E2 on .25 EOD?

What do you guys think?

[AngryElf]

Would sensitive and standard estradiol test be that different?

[bigdil511]

Would sensitive and standard estradiol test be that different?

Yes they would, estradiol is a female test for estrogen. The sensitive essay would be accurate for a man.

[AngryElf]

If standard is out of range high, wouldn't you assume sensitive to be high? Have you guys seen different data that shows they can be at different ends of a statistical range?

[Baxter35]

Standard estrogen test does often read too high as compared to sensitive which can lead to over use of an AI when not needed. The sensitive really is what is needed for males. I noticed your free T is still pending. Update us when that comes in because I know it was low last time. It would be great if your free T started responding so you could maybe lower your dose a bit to get off the AI but you can't do that if the free T isn't coming in where you need it.

[AngryElf]

Will do, guess it's wait and see until next Friday. I'm going to take my injection today but stop the HCG and AI. Figure it will be easier to lower my E than raise it. I've read the longer you are lower, the longer it takes to recover. An AI can drop it fairly quick.

This is the first time I've ever had issues. Even with LowT, so it's got me worried.

[thisAngelBites]

HCG is expensive! $300 month from local pharmacies...sticker shocked.

Not to hijack this thread, but why is HCG so expensive in the US? I just looked at an online, proper chemist here in the UK (so a prescription is needed) and a 5000 iu vial is £3.94 (approx $6.12 at the midmarket rate).

[AngryElf]

Generally, anything you need here that isn't covered by insurance is ridiculously expensive. If I had insurance coverage for it, the cost would be under $25. I pay ~$15 for a months supply of testosterone that is covered by my insurance plan. Just how it works over here...

[AngryElf]

So between the two standard tests, I was under 20 now at 39. Considering my current problem, even though I am on an IU, I must assume I am too high. Very frustrating trying to figure this mess out...

Starting Lab: Estradiol: Range 0-56 pg/mL Result: <20
Current Lab: Estradiol: Range: <40 pg/mL Result : 39.1 H

[AngryElf]

So after my Friday injection and skipping the Arimidex. I am hot as hell today and my face feels sunburned... Have the AC as low as it will go. Wife is wearing long sleeves.

Will low E2 do that or is that only a high symptom? All other sides remain the same.

[jwh7699]

Hormones try to balance each other. As your Total Testosterone level went up your Estradiol Level goes up. Arimidex is ment to lower E2 so if you stopped it, then yes it will go up slightly.

You need to give your body time to adjust to starting on TRT.

I would recommend sticking with the same protocol:

TestCyp IM 100mg Tuesday and Friday
HCG 250 IU Tuesday and Friday
Arimidex .25 EOD

It's tough to have patience when you first start out, but dropping things here and there will cause fluctuations each time you change something.

I have had hot flashes in the evening before. They go away after a period of time. It's your body adjusting to the new hormone levels.

[Simon1972]

Tues morning and Friday night?

[AngryElf]

I inject Tuesday and Friday evening. No AI or HCG since Tuesday for me. Still taking my injections though.

[AngryElf]

Well it's been almost a week with no AI or HCG and I'm back in business for the wife. Guess my E2 is coming back up or some other miracle occurred... Had my MRI today for the high prolactin finally. Results should be in next week.