Info / Suggestions before starting TRT

[Chubbs1]

I am new here, 40 years old, and recently found out I have low testosterone.

A few months ago I was at the doctor (clinic) for a strep test and requested he do a lab for my test level, it came back at 206. To my disappointment they only tested total test.

A couple weeks ago I went to ago my PCP for a full physical and told him about my test result. He ordered a "full bloodwork" 3 tests came back out of range - 2 liver enzymes were slightly higher than normal (which I've found out can be normal if you work out strenuously) - I lift for about 2 hours a day 4 days a week, and do a little lifting and I run 4 miles the other 3 days of the week.

My test came back at 125 this time and "free test" came back at 26 with a reference range of 35-155 - I'm thinking this is bioavailable and not really free test. Anyway, apparently they did not test any other hormone levels.

A couple years ago I had fasting blood sugar levels a little out of range at 105 and 110 on 2 tests I had done. This time it was 86 which I think is due to losing significant fat (80 lbs?) and adding maybe 20 lbs of muscle over that time period.


Anyway my PCP's assistant called me with the results and told me to call my insurance company to find out if I am covered for Androgel. I am but it's $500 per month even with coverage and my deductible is 2500. The person in the pharmacy dept of my insurance co said I should look into injectible test which is $100 per 10 ML vial (200 mg per ML?).

I've read the stickies and some other posts here, and I'm fairly confident I will go on TRT, but it seems premature for my PCP to put me on it since he has not determined or at least informed me on his diagnosis for the cause. Or would the seriously low total and free reading be enough to diagnose hypogonadism?

I told my dad about this, he is a doctor, and he told me to go see his endo and was fairly adamant about it but didn't really say why - it was an akward discussion I didn't really want to have anyway...


So that's where I am.

It seems my concerns should be my desire to have kids in the future.

And the potential that raising my test could potentially impact prostate cancer? something like 5 out of 25 studies indicate there may be some causation there?



Anyway any advice, suggestions with next steps, or any thoughts on my lab results - I have the results, and there are 3 or 4 pages of blood level readings so if there is something else I should be looking at let me know.

Since last summer I have been taking the following suplements - the PCP said to stop taking all sups for a few weeks and to come back for more liver tests. My dad thinks the only sup that could really be causing the potential liver enzyme elevation is the vit A in my mens multi.

Protein powder
Mens multi
Fish oil
Vit D 4000 IU
Magnesium Citrate 300 mg
Zinc 25 mg (plus 15 mg in the multi)
Glocosamine

Thanks in advance for any advice

so I see average test is 668 with a standard deviation of 212 for a 35-44 year old man. So I'm well within the lowest 5% of test levels for a man my age.

The average is 386 with a standard deviation of 134 for an 85-100 year old man.

so I'm in the lowest 1/3 for someone who should be died already.

[ab037]

Welcome to the board. You're on the right track with wanting to find the root cause of the issue before beginning any type of treatment.
I believe there is a sticky with the appropriate labs to draw (on phone, so cant see em atm), but LH, FSH, Comp metabolic panel, full thyroid panel ( as hypothyroidism can cause hypogonadism) total T and free T which you have. SHBG, and albumin. Thats off top of head, im sure the vets will chime in and fill any I have missed.
Nothing wrong with getting another Dr's opinion (endo), hopefully he knows hormones. GL and im sure Kel will jump in and get you on the right track.

[Chubbs1]

I saw the Endo,

He said there appears to be nothing wrong with my testicles.
My initial bloodwork does not indicate any cause for the low test.
He ran more bloodwork.

I told him about my concerns about sperm production on test if I ever want to have kids again, and he said the effects of testosterone are completely reversible? If I ever decide to have kids, I can go off test and my sperm production wild return to normal?

I asked about hug and he said he was aware of it, but not comfortable prescribing it. I asked why not, and he said he could refer me to a reproductive urologist if that was something I was interested in.

He took more blood to check my pituitary gland and some other stuff.

Any thoughts anyone?

[Chubbs1]

I also asked about androgen vs injections.

He said injections are more like a rollercoaster with highs and lows after you get the injection is the high, the days leading up to your next injection are the lows.

But androgen is still like 5 or 10 times the cost depending on dosage.

He said a lot of people come in for their injections because it's difficult to inject deep into muscle - that would defeat the purpose of the shots (saving cash) if I have to pay for administration every 2 weeks.

[bigdil511]

Your endo isn't completely off but he's not totally correct. IM injections are easy there is no reason you shouldn't be able to do them on your own. A twice weekly protocol will keep your hormone levels much more balanced than once a week, but you should not do every two weeks as this will undoubtedly screw with your levels. Two times per week is the way to control levels and keep you from feeling the peaks and valleys, also will better control estrogen.

[Moonjumper]

Something else you might talk to him about is Clomid if you are concerned with fertility. It stimulates the pituitary and causes it to release LH and FSH. As I understand it, LH relates to natural testosterone production in the testicles (same hormone HCG mimics/replaces) and FSH encourages the testicles to continue to produce sperm. Some guys like it and some don't from the reading I've done.

And yes, any negatives in relation to natural suppression while on TRT can be reversed if you ever decide to stop but you will likely just go back to where you were prior to treatment.

[Moonjumper]

And hopefully someone else will answer the prostate question much better than I can. I've seen studies and articles that offer contradictory results. I think most that showed increases in size were in older men with other issues as well. However I have seen some that say a slight increase is normal and that it levels off in about a year with no further increases.