doc wants to start me on TRT, have a few Q's

**jacobk91** · 06-29-2012, 06:17 PM

here is my BW so far... (updated 7/9) with estradiol

TESTOSTERONE , FREE, BIO AND TOTAL

Testosterone, Total
Your Value: 361
standard range: 250 - 1100
Units: ng/dL

Testosterone, Free
Your Value: 34.7
standard range: 46.0 - 224.0
Units: pg/mL

Testosterone, Bioavailable
Your Value: 76.0
standard range: 110.0 - 575.0
Units: ng/dL

SHBG Your Value: 46 standard range: 10 - 50 Units: nmol/L

Albumin, Serum Your Value: 4.8 standard range: 3.6 - 5.1 Units: g/dL

LH

Your Value: 3.9
standard range: 0.8 - 7.6
Units: mIU/ml

FSH

Your Value: 6.1
standard range: 0.0 - 14.0
Units: mIU/mL

Prolactin

Your Value: 8.6
standard range: 4.4 - 16.4
Units: ng/mL

TSH

your value: 1.17

standard range: 0.40 - 4.00

units: uIU/mL

Estradiol, Sensitive:
Result: 5
Units: pg/ml
Reference interval: 3-70

My doc refuses to test for estriodol....says "its outside the scope of normal endocrinology".. he also says he doesnt prescribe AI's but that he would just lower the test dose if i was experiencing nipple issues. (i could always just use something from ar-r for that right?)

Hes also against hcg as he says "thats also outside the scope of normal practice". He said that testicle shrinkage would be minimal if the dose is right.

I realize this guy is not optimal, but its all i have. I can always get the hcg from another source that will just make things more difficult. What should i do? im thinking of just getting the prescription for Test from him and then finding a way to monitor the e2 myself and get HCG from somewhere once i get shut down. Thoughts?

Im gonna have to get e2 tested somewhere else, i know labcorp is good, but the nearest one is a ways away from me, are there other alternatives?

**Vettester** · 06-29-2012, 09:12 PM

Sounds like you're dealing with a real winner of a doctor there!! Maybe checkout the stickies and "Finding a TRT doctor" thread. If it's an absolute no option situation, then yes, go test your E2 sensitive through a place like privatemdlabs.com

Your SHBG is high, which in turn is keeping your free & bio test low. My suspicions are that your E2 is already elevated. Jumping on TRT will only make that situation worse if it is elevated. Your doctor is a fool, whether he will ever admit it or not. Tell him he's outside the scope of knowing what the hell he's talking about! If he would just read up on Dr. Crisler and/or other A4M certified physicians, he would see just how far out of touch he really is ...

You need to get this test done before you start. You get one chance to do it right when you start out. Please tell us more about yourself and what you have been going through with your struggles to this point. No one is here to judge you, only help ...

**jacobk91** · 06-29-2012, 09:58 PM

21 years old, perfect diet, never used any anabolic substances, zero sex drive, erectile disfunction, really hard to gain mass, fatigue. 165 at ten percent bf atm. Really frustrated with the way I feel riight now :/

I've also been on an ssri since a really young age

**auslifta** · 06-29-2012, 10:09 PM

Seems irresponsible to not check E2 levels, especially after seeing your blood results. An AI could be the only thing thats needed, but without knowing your E2 levels you'll never know.

**jacobk91** · 06-29-2012, 10:14 PM

I'm DEFINITELY going to get them checked before I start anything whether he orders it or not, hopefully this week, then get them posted here so someone can tell me what to do

**jdw999** · 06-30-2012, 08:58 AM

Jacob, You have come to the right place. Some of these guys here should have MD behind their names. There is a wealth of knowledge on this board and to tap into it all you have to do is ask. Like I have said before, I wish I would have found this place BEFORE I took my first injection.

Good Luck and Welcome,

JD

**jacobk91** · 06-30-2012, 10:07 AM

Thanks jd, I'm glad I'm here. On Monday I'm going to ask him to order me a sensitive estradiol assay, and if he won't, I will get it done through labcorp myself. Here is the message he sent me after I voiced my concerns over an email..

"Jacob,

For T replacement, in mainstream endocrinology, we usually do not check or follow estradiol levels. We also do not use aromatase inhibitors or hcg . These are things that are outside the scope of normal practice.

I do monitor T levels at regular intervals and adjust the medication accordingly. As long as you are not getting too much, then gynecomastia should not be an issue. If you develop gynecomastia, then the dose would be reduced, as opposed to adding an aromatase inhibitor.

With normal T replacement, there can be a shrinkage of the testicles, but in my experience, the shrinkage is minimal when the dose is appropriate. "

**kelkel** · 06-30-2012, 12:00 PM

Do what Vette suggested asap. Also start supplementing with Vit D immediately as it will help lower shbg and increase free T. I sound like a broken record preaching that but I guarantee you are low if not taking it already. Also stinging nettle root or avenacosides will also help to lower shbg.

Your doc's a retard but stay with him till you find better. Keep us posted please.

**jacobk91** · 07-02-2012, 12:01 PM

Originally Posted by kelkel

Do what Vette suggested asap. Also start supplementing with Vit D immediately as it will help lower shbg and increase free T. I sound like a broken record preaching that but I guarantee you are low if not taking it already. Also stinging nettle root or avenacosides will also help to lower shbg.

Your doc's a retard but stay with him till you find better. Keep us posted please.

i messaged him asking about whether he presribes Ai's Hcg or keeps track of estradiol levels, and this is what he said.

"Jacob, what you are reading is outside of mainstream practice. It is how things tend to be done in the bodybuilding world by normal men taking T in large doses. I want to answer all your questions, but it is more than I can handle in email or by phone. I recommend coming in to discuss."

Im going in to see him today. im going to demand that we check my estradiol levels. is he just an idiot? I dont want T in large doses...just normal levels for someone my age.

The good news is i found a TRT specialist about 45 minutes away who knows all about Dr Crisler's protocols. I have an appointment with him next week. The bad thing is that his nurse said he normally only treats men over 35, but that sometimes he makes exceptions. I hope he will make an exeception for me. Hes obviously my better choice so i will try to see him first and then if i cant, ill go to back to the doc i have now.

**bullshark99** · 07-02-2012, 12:57 PM

Plead with him if you have too and tell him you will continue with the idiot if he doesnt help you. Chances are if he takes his practice seriously he wont want to see you get hurt.

**jacobk91** · 07-09-2012, 11:36 AM

ok i got the results of my sensitive estradiol lab labcorp. here are the results:

Estradiol, Sensitive: Result: 5 Units: pg/ml Reference interval: 3-70

this seems low, is it?

**jacobk91** · 07-09-2012, 08:50 PM

Bump

**kelkel** · 07-09-2012, 09:16 PM

Your saying you were a 5 on the sensitive assay then you are very low. It is not healthy. Been there. LEF foundation suggest a range of 20 - 30 is best, but it really does depend on how you feel. Low E is just as bad as high E and gives basically the same sides. Exactly what is your current protocol jacob?

**jacobk91** · 07-09-2012, 09:33 PM

I'm currently not on a protocol. Never used any anabolics or hormones. Starting trt this week. Supplementing with test and hcg should raise my estrogen right?

On Friday I have an appointment to get my first shot of 100 mg test cyp a week with the shit docotor. If I end up having to use him I will have to get hcg somewhere else cuz he doesn't do that. However, I have an appointment with a doc on Wednesday who is familair with dr crislers protocols. If it goes well with him obviously I will use him instead. Only thing is his receptionist says he normally only treats men over 35, but that sometimes he makes exceptions. I'm hoping he will make one for me so I'm not stuck with the other guy. But if I have to I can get hcg online and an ai if needed, as well as all the bloodtests if I do get stuck with him.

**kelkel** · 07-10-2012, 08:37 AM

Yes, it will raise it. Question, why don't you wait and talk to this new doc first and maybe consider ancillary therapy with clomid or nolva-HCG in effort to raise your T level and jump start your own system before shutting it down with exogenous T? With your LH being on the lower end (for your age) did your doc ever speak to you about an MRI?

**jacobk91** · 07-10-2012, 08:39 AM

No he didn't. I'm going to to see the new doctor on Wednesday before I'm scheduled to get the first shot on Friday. I will ask him about that, and I could always cancel the Friday appointment if he agrees. What would we be looking for with an mri?

**kelkel** · 07-10-2012, 10:08 AM

Pituitary abnormalities can slow/shut down function. Good to rule in or out and find out why your low at your age. Relatively common, I have a microadenoma myself.

**GotNoBlueMilk** · 07-10-2012, 05:23 PM

My E2 was 4 before I started HRT. My Test was 440, which is on the lower side of things but not low enough for all my symptoms. My low E2 was causing me my biggest issues. Of course with men, you raise E2 by raising T.

**kelkel** · 07-10-2012, 08:35 PM

Even on my protocol of 60 x 2 per week plus HCG , my E runs relatively low at 15-16 steady, no AI.

**jacobk91** · 07-10-2012, 11:23 PM

Maybe that's the case with me as well. We shall see. I will ask about the mri

**jacobk91** · 07-11-2012, 05:21 PM

i have decided to go with the doctor i have been seeing instead of the new guy. Mainly this is because of the price. (really expensive and not covered by my insurance) Im getting my first shot of 100mg test this friday. I will have to get the HCG myself, but im not sure if i can get legit HCG online? is it possible? Is the hcg i see on all these peptide websites legit? i know i can get luquidex from Ar-r so im not worried about that.

also, i should get bloodwork done 6 weeks after my first injection of test right? should i just check estradiol and a test panel? what are other important things to check without breaking my wallet.

And about hcg, should i start right away or should I wait for the six week bloodwork and see where my lh is at? the only test my doc will order is the "testosterone bio free and total", i will have to pay for any other tests myself. thanks for any input.