Few questions about TRT.

[juice2012]

Hello all,

I'm a 27 year old male, 5' 10", 165 lbs. I've been lifting on and off since I was 17, stopped lifting over the last 5 years due to injury and just started back up about 8 months ago. It was amazing how quickly I made gains (went from benching 185 to 225 1RM in about 6 weeks with only creatine). I've never done AAS but recently have been doing some research on it for the hell of it.

After reading "Testosterone for Life" by Abraham Morgentaler, I've been interested in what exactly my T level is at. The last few years I've experienced low energy levels and I always equated this to depression which I have dealt with in the past, but I haven't been on any depression medication for over 3 years. I also developed gyno during puberty.

3 weeks ago I was taking Beta-Alanine, taurine and whey protein shakes. I noticed my lifts in the gym weren't going so well so I stopped the beta-alanine and started taking creatine again. A few days later I was feeling pretty awful to the point where my coworkers were pointing out how terrible I looked. I went to a doctor and told him my symptoms (low energy, fatigue, etc) and he ordered some blood tests. I asked for Total T and Free T to be tested and he told me I too young for that to be an issue. So I told him about some libido issues I had with my girlfriend the previous month, which was true. After I hit my 1RM on bench while she was visiting, I felt like crap and lost all interest in having sex. I still *could* but I just didn't care either way and I've never felt like that before in my life.

So after the doctor heard my libido issues he added T and Free T to the list of tests. He did ask me if I was using AAS which I thought was funny considering how small I am lol.

Here are my test results:


Total Testosterone 276 250 - 1100
Free Testosterone 58.6 35.0 - 155.0

I also have a Vitamin D deficiency and this result also came back bad:

Alkaline Phosphatase 145 26 - 137


The doctor just mentioned the Vitamin D and the elevated Alkaline Phosphatase issues but made no mention of the T. Yesterday I was feeling so bad again at work that I left work early and went back to the doctor, I asked him about the T and he said it wasn't low because the Free T level was within range. From all my reading, I would say 276 Total T is really low for a 27 year old that lifts and eats fairly clean. But i'm not sure how to interpret the Free T result.

I don't know what is wrong with me right now, I doubt how I am feeling is strictly because of low T, but after I figure out what is wrong I want to get these T issue addressed.

I would love to hear everyone's thoughts on this.

[kelkel]

Welcome to the forum Juice. You really need to post up full BW with ranges for a proper evaluation. Be sure to include LS/FSH, Thryoid Panel, SHBG. Labcorp range for serum T is now 348 - 1197. You are clinically low and we need to find out the root cause. Proper BW is in the Finding a TRT Physician Sticky at the top of the forum, which you will probably need based on your current doc's evaluation of you so far. He obviously is not looking for the cause of this, as he should be. Take a big hint from that and move on IMO.

I'm interested in finding out if there are Pituitary issues (secondary hypogonadal) or testical issues (primary hypo) which your doc should have investigated (hint #2) or possibly hypothyroid issues. Anyway, get copies of the BW as they are yours and post up including ranges for us to see. Great members here with a diverse knowledge base all willing to help. We've been in your shoes. Best of luck! Others will surely chime in.

Start reading ALL the stickies btw. Know the answer to your questions before you even ask your doctor!

[juice2012]

Thank's for the help Kel! I'm going to post the rest of my bloodwork in this thread that I have now and post the rest as I do more bloodwork. Here is everything else I have so far:

CBC WITH AUTOMATED DIFFERENTIAL
White Blood Cell Count 7.8 4.0 - 11.0 K/uL
Red Blood Cell Count 5.25 4.40 - 6.00 M/uL
Hemoglobin 15.8 13.5 - 18.0 g/dL
Hematocrit 46.0 40.0 - 52.0 %
MCV 88 80 - 100 fL
MCH 30.1 27.0 - 33.0 pg
MCHC 34.3 31.0 - 36.0 g/dL
RDW 12.3 <16.4 %
Platelet Count 215 150 - 400 K/uL
Neutrophil 50 49 - 74 %
Lymphocyte 40 26 - 46 %
Monocyte 10 0 - 12 %
Differential Type Manual
White Blood Cell Morphology Normal
Red Blood Cell Morphology Normal
Platelet Morphology Normal



COMPREHENSIVE METABOLIC PANEL W GFR
Sodium 137 136 - 147 mmol/L
Potassium 4.1 3.5 - 5.1 mmol/L
Chloride 99 98 - 107 mmol/L
CO2 32 21 - 32 mmol/L
Glucose 87 70 - 100 mg/dL
BUN 10 6 - 25 mg/dL
CREATININE 1.0 0.6 - 1.3 mg/dL

GFR Est-Other >60 >60 See Cmnt
GFR Est-African American >60 >60 See Cmnt

Units: ml/min/1.73 m2. Estimated Glomerular Filtration Rate
values are calculated by MDRD equation and are valid only if
creatinine level is stable. GFRs are most accurate for results
60 ml/min/1.73 m2 or less.
Reference: www.nkdep.nih.gov/professionals/index.htm

Calcium 9.1 8.2 - 10.2 mg/dL
Total Protein 7.9 6.4 - 8.2 g/dL
Albumin 4.3 3.2 - 4.7 g/dL
Total Bilirubin 0.5 <1.1 mg/dL
Alkaline Phosphatase 145 26 - 137 U/L H
AST 20 0 - 37 U/L
ALT 41 15 - 65 U/L


THYROID STIMULATING HORMONE (TSH)
TSH 2.75 0.34 - 4.82 uIU/mL

VITAMIN D (25 HYDROXY)
VitD,25-Hydroxy Tot 20 30 - 100 ng/mL

[bass]

find a new doctor that knows TRT. thats exactly what my family doc said to me, my free T was just a point or 2 above the low range so was my total T and said i was fine.

[Brohim]

Find some vitamin D 5000iu and take 2 caps a day.

[kelkel]

More modern range for TSH is .3 - 3.0. Which can mean your leaning toward hypothyroidism as your pituitary is punting out extra TSH to stimulate your thyroid to speed up, so to speak. A full thyroid panel would be good at your next BW. Be good to see shbg also to see how much your binding. Selenium helps as does vit D. I believe Bass was successful in lowering his using a particular form of iodine. I'm sure he'll fill you in on that when he checks back in. Check this site out: http://www.stopthethyroidmadness.com/ Hypothyroidism can give the same symptoms as low T btw.

[juice2012]

I just got back from my regular doctor. He reviewed my test results and said my T level "jumped off the page". Which is good because the last doctor I saw didn't seem to think it was a big deal. Looks like the doctor I have now is a keeper. He immediately wanted to start treating the low T and prescribed me Clomid, which my insurance wouldn't pay for so I'm waiting for the pharmacy to try to get pre-authorization from my doctor. Any thoughts on this?

[kelkel]

Jumped off the page as in Low? Nothing wrong with clomid but what about your TSH and potential Hypothyroid? Google hypothyroid and low T.

[Vettester]

I just got back from my regular doctor. He reviewed my test results and said my T level "jumped off the page". Which is good because the last doctor I saw didn't seem to think it was a big deal. Looks like the doctor I have now is a keeper. He immediately wanted to start treating the low T and prescribed me Clomid, which my insurance wouldn't pay for so I'm waiting for the pharmacy to try to get pre-authorization from my doctor. Any thoughts on this?

So the million dollar question, respectfully, is: What's your LH & FSH score? I didn't see it on your posted labs. Presuming it must be low since the doctor is prescribing Clomid? I'm hoping this isn't a case where nobody knows!

[juice2012]

Oh this is definitely a case of no one knowing. My current doctor hasn't ordered any new bloodwork and LH + FSH was never ordered before. How should I go about asking my doctor for more bloodwork? Should I start taking the clomid even though I don't have these results yet?


kel - Yeah, by "jumped off the page" he meant it was so low that it really stood out.

[steroid.com 1]

At your age you need to know why you are hypogonadal, and kel is correct; your TSH by some would be called elevated and you need to know why.

LH/FSH will give us some indication if you are Primary or Secondary.

For a guy your age you should be peaking and you are not and there is a reason for that so you need to find out why!

Look at the sticky on the blood panels you really need and see your Doc.

Just being prescribed Testosterone is not a diagnosis...

[kelkel]

Like Vette, GD, Bass and I are saying. Get proper BW before you do anything. Find the problem before you attempt a solution. LH/FSH imperative!

[Vettester]

Juice, if you ask your doctor what exactly Clomid does, he should (permitting he knows) advise you that it stimulates production of GnRH -> to LH & FSH. It's a great compound to use if the HPTA has been suppressed, but healthy enough to restart. However, how can anyone prescribe something that for a condition that hasn't been properly diagnosed? For all we know, your pituitary is producing a sufficient amount of LH & FSH. He's presuming!!!

[juice2012]

So I should absolutely not take the clomid before getting bloodwork? I'm really impatient to try something right now because I've been missing work and feeling terrible and I just want to start something ASAP.

[Vettester]

I would not take anything of that nature until a full diagnosis is complete. You're dealing with the HPTA and your pituitary with this stuff. If your condition is primary, then it will have no effect. If your LH is low, then without doubt an MRI should be taking place. Just a bit too young for these issues. Do it right while you have the opportunity, and you will be miles ahead down the road. Just order a LH/FSH test online if needed and start from there. If it's completely normal and/or elevated, then obviously you don't want Clomid. Since you've never taken AAS (presuming that includes no PH's either?) then your doctor needs to rule a few things in/out and diagnose your condition correctly. No exceptions.

[juice2012]

That's correct, I've never taken any AAS or PH. I'm going to send my doctor a message through my medical facility's website requesting all this other bloodwork, stressing that I don't want to take the clomid before the extra BW. Thanks so much everyone for the advice, I seriously don't know what I'd do without it. It's been really stressful trying to go to work and deal with all this at the same time and it's really starting to get to me

[steroid.com 1]

I would not take anything of that nature until a full diagnosis is complete. You're dealing with the HPTA and your pituitary with this stuff. If your condition is primary, then it will have no effect. If your LH is low, then without doubt an MRI should be taking place. Just a bit too young for these issues. Do it right while you have the opportunity, and you will be miles ahead down the road. Just order a LH/FSH test online if needed and start from there. If it's completely normal and/or elevated, then obviously you don't want Clomid. Since you've never taken AAS (presuming that includes no PH's either?) then your doctor needs to rule a few things in/out and diagnose your condition correctly. No exceptions.

Bold.

Nuff said...

[ecdysone]

After reading "Testosterone for Life" by Abraham Morgentaler,

No offense, but you did you really read it??

Re-read Chapter 4 and you will know what you should be doing.

[juice2012]

No offense, but you did you really read it??

Re-read Chapter 4 and you will know what you should be doing.

Yes I did read it but to be honest chapter 4 was a long time ago and I'm having a really hard time remembering things right now on top of the fatigue. I just got up from being in bed for over 13 hours :\

I just emailed my doctor's team with the following:

Before I start the treatment with Clomiphene, can we determine if my Hypogonadism is Primary or Secondary?

Also, before I start any hormone therapy, I'd like to get the following bloodwork done so I have it on record:

• SHBG
• DHT
• Estradiol
• LH
• FSH
• Prolactin
• Thyroid Panel
• Lipid Profile

[juice2012]

The doctor quickly replied:

Sure thing, I went ahead and ordered the tests for you. You can come in to do the tests fasting at your convenience.

Does he mean I have to do the usual 12 hour fast? If so I should probably wait until morning.

[steroid.com 1]

Yes, wait till the am. In fact, try to get your pull as early in the morning as possible.

Read the stickies on what blood panels to order...you're missing a lot.

In short:

Primary: Testicles stopped functioning due to many reasons such as pathology or injury.
Secondary: HPTA performance has slowed significantly due to age or pathology.

[juice2012]

I did read the sticky on which blood tests to get, I just removed the ones I already have completed and the "optional" ones like HGH related. I should get the results back early next week. I still don't have the Clomid, thanks to the insurance company taking forever to handle the prior-authorization from my doctor. :\

[juice2012]

I just got the results back from the rest of my BW that was ordered last week:

Cortisol, AM Level 19.8 5.0 - 25.0
SexHormone Bind Glob 13.70 10 - 57
Prolactin 30.1 Male: 2.1-17.7
LH 4.6 20-70 Years 1.5-9.3
FSH 2.1 13-70 Years 1.4-18.1
Estradiol 25 Males,16 and over : 0-39.8pg/mL
Free T3 4.18 2.3 - 4.2
Free T4 1.02 0.59 - 1.61
Thyroglobulin AutoAb <20 <20
Thyroid Perox AutoAb 10 <35


The one that stands out to me the most is the Prolactin being high.

[Honkey_Kong]

If I were you, I ask that doctor to get an MRI done on my pituitary gland. You need to call him up first thing in the morning too.

[kelkel]

^^Concur fully with HK. Pituitary Adenoma's are more common than people think and are not the end of the world so don't stress out. I've got one myself actually. Read this on Prolactinomas from Wiki:

http://en.wikipedia.org/wiki/Hyperprolactinaemia

[juice2012]

OK, I've been doing a lot more reading on this. Kel, how did you get yours treated?

[HRTstudent]

I'd look at that prolactin number before taking the next step, clomid.

That number is out of range. Perhaps he will refer you to an endo, but maybe not. I'd try to rush it along if they do because if you play the medical game it could be another 2 months of waiting.

Also, clomid is a good option for many people and works well. There is a good thread going on about this right now. But I woud first figure out why that prolactin is above range. Nice to see your doctor is working with you thus far. You're doing damn good I would say!

[Honkey_Kong]

OK, I've been doing a lot more reading on this. Kel, how did you get yours treated?

Juice, how it's treated really depends on the severity of the problem. They treat it with either drugs, surgery or both. It's really dependent on a case specific thing. They do the surgery through your nose. so it doesn't leave a visible scar.

[kelkel]

^^Correct as expected. Treatment depends on the effect the tumor is presenting. My pituitary is 6mm in size and the microadenoma is 2mm. It shut down my T level to a 59 (and dropping fast) when discovered. The norm seems to be no surgery unless it's a macroadenoma but as stated above it is case/symptom specific. Plus I have a big nose so hopefully I'll get a discount if it ever gets to that point! My treatment was TRT which landed me on this forum, thank god. All is well and I'm sure will be for you too!

[steroid.com 1]

If I were you, I ask that doctor to get an MRI done on my pituitary gland. You need to call him up first thing in the morning too.

^^^^What he said.

Pathology seems to be the cause.

[juice2012]

Posting up some more bloodwork just for the record:

Testosterone 234 241 - 827

Total cholesterol 185 <200 mg/dL
Triglyceride 184 <150 mg/dL
HDL cholesterol 50 >40 mg/dL
LDL Calculated 98 0 - 160 mg/dL
Cholesterol to HDL Ratio 3.7 1.0 - 4.0
VLDL (Calculated) 37 5 - 40 mg/dL


Looks like testosterone has gone down even more in the 20 days since it was last checked. Now it's "officially" in the low range lol. I'm out of town until next week so I am going to try to email my doctor before get back to get that MRI scheduled.

[Honkey_Kong]

Posting up some more bloodwork just for the record:

Testosterone 234 241 - 827

Total cholesterol 185 <200 mg/dL
Triglyceride 184 <150 mg/dL
HDL cholesterol 50 >40 mg/dL
LDL Calculated 98 0 - 160 mg/dL
Cholesterol to HDL Ratio 3.7 1.0 - 4.0
VLDL (Calculated) 37 5 - 40 mg/dL


Looks like testosterone has gone down even more in the 20 days since it was last checked. Now it's "officially" in the low range lol. I'm out of town until next week so I am going to try to email my doctor before get back to get that MRI scheduled.

I seriously think you should consider finding another doctor. Just the fact he hasn't suggested this to you already tells me this isn't something he knows much about.

[juice2012]

Well I haven't talked to the doctor since I got that bloodwork taken and I'm away right now. You're probably right anyway on getting a new doctor but I have an HMO and have to stay within the same healthcare provider. So my doctor would have to refer me to a specialist within the same provider :\

[HRTstudent]

the biggest mistake I made in trt was sticking with a doctor who I thought was "okay" but knew was definitely not a specialist in male hrt. take that for what it's worth....

[juice2012]

I just got an update from my doctor before I had a chance to even email him:

I reviewed your most recent set of labs and it looks like the low testosterone is of secondary cause. Though the pituitary hormones are all in good standing, I'm going to be thorough and do a brain MRI to rule out any mass lesion that could cause this. I will submit the request and we will seek authorization through you insurance. You should hear back in about one week. If you don't please call the radiology department for an update. Please send me an e-mail if you have any questions.

[kelkel]

Wow. Nice. Get it done!

[juice2012]

I went and did my MRI this morning and got the results back online already:

Test: MRI Brain With and Without Contrast
Resulted Date: 6/7/2012 Status: Final Result
Addendum:Narrative:

History: Low testosterone . Rule out mass lesion.

Reference: None.

Procedure: Axial T2 and axial FLAIR weighted images of the brain obtained.
Additionally, thin section small field-of-view sagittal T1 pre-and post
administration of intravenous contrast and coronal T1 pre-and post
administration of intravenous contrast with dynamic coronal imaging performed
through the sella obtained. 16 cc of gadolinium utilized for this exam.

Findings: T2-weighted axial images reveal normal flow voids in the distal
vertebral arteries, in the basilar artery, and in the internal carotid
arteries. The ventricles are normal in size. There is no evidence of mass
effect or midline shift. The pituitary gland appears normal without evidence
of differential enhan***ent. The pituitary stalk is in the midline. The optic
chiasm appears normal.



Impression:

Impression:
1. Normal study.

I guess I should be happy, but now I'm left wondering why my T is so low with no clue about the cause

[kelkel]

Yes you should. One less thing to worry about. Now, how bout doing the bloodwork you spoke of in post 19 so you have a full picture to evaluate.

[juice2012]

Yeah, I posted the results in post 23 though. Is there anything I missed?

[juice2012]

So my doctor called me today to tell me I don't have a tumor and talked to my about my elevated prolactin level (which I brought up in person the day before). He said he talked to a colleague about it and prescribed me Cabergoline to lower the prolactin level (0.5mg 2x a week). He scheduled me to do a blood test for Testosterone and Prolactin in 30 days and then follow up with an appointment.

Any thoughts?