Complete Blood Count - need advise

[pjbandit]

So before the first time I did TRT, this was my CBC:

Test Name 6/7 Result Reference Range
WBC Automated 5.5 3.7 - 10.5 x10^3/uL
RBC 5.43 4.6 - 6.2 x10^6/uL
HGB 16.3 14.0 - 18.0 g/dL
HCT 48.9 42.0 - 54.0 %
MCV 90 80 - 102 fL
MCH 30 26.0 - 32.0 pg
MCHC 33.3 30.0 - 36.0 g/dL
RDW 13.6 11.5 - 18.5 %
PLT, Automated 207 130 - 400 x10^3/uL
MPV 13 6.8 - 12.6 fL

I started on a shot every two weeks for 300mg, then 400, then 400 and prior to the 4th shot I had my blood tested again and the below was the updated CBC:

Test Name 7/19 Result Reference Range
WBC Automated 5.8 3.7 - 10.5 x10^3/uL
RBC 5.57 4.6 - 6.2 x10^6/uL
HGB 17.1 14.0 - 18.0 g/dL
HCT 53 42.0 - 54.0 %
MCV 95 80 - 102 fL
MCH 30.7 26.0 - 32.0 pg
MCHC 32.3 30.0 - 36.0 g/dL
RDW 13.7 11.5 - 18.5 %
PLT, Automated 196 130 - 400 x10^3/uL
MPV 12 6.8 - 12.6 fL


So after reading here and other forums, is there any cause for concern on my blood count. Is my HCT too high? What can I do to lower it?
MY first doctor (which I left bc of the bi-monthly injection) said he would monitor my blood bc it can get too thick on TRT. Should I donate blood, and if so, when during the week would be the best time to donate blood? After injection or right before? I have changed my injection amount (changed doctors) to go to a weekly protocol but have not been tested yet.

Thanks.

[kelkel]

From what I see all looks fine. Except for your TRT protocol. Exactly what is it? Are you still on an every two week protocol? If so, your doc does not understand the half life of Testosterone . Your injections should be weekly at a minimum. Some of us split our weekly dose in half and inject every 3.5 days for more stable levels. Just because more is injected it does not really alter half life. Some doc's seem to think it does. Keep in mind most docs don't really understand hormones.

Yes, donate blood. I do as often as possible. Good for you and good for society. It will dump a lot of iron out of your blood and keep your RBC, Hematocrit levels in line.

Welcome to the forum. Fill us in more on exactly what your doing protocol wise please?

[pjbandit]

From what I see all looks fine. Except for your TRT protocol. Exactly what is it? Are you still on an every two week protocol? If so, your doc does not understand the half life of Testosterone . Your injections should be weekly at a minimum. Some of us split our weekly dose in half and inject every 3.5 days for more stable levels. Just because more is injected it does not really alter half life. Some doc's seem to think it does. Keep in mind most docs don't really understand hormones.

Yes, donate blood. I do as often as possible. Good for you and good for society. It will dumpt a lot of iron out of your blood and keep your RBC, Hematocrit levels in line.

Welcome to the forum. Fill us in more on exactly what your doing protocol wise please?

Thank you kelkel. I am actually donating blood this Friday (double red donation)

I am now on my third doc and he will do weekly and let me self administer. But he is not the most up to date on trt protocol. I posted my story a week ago but may have slipped by you. Here is my story that I originally posted, its a little long..hope you can take some time and provide some advice?

Hello All,

Some great information on this site and I have learned so much over the last couple of months I feel like I know more than half the docs I spoke with about this. This is my (long) story and I would appreciate any input from the experts here:

First off, I am a 32 year old male

I was first recommended to a TRT doc back in June by a friend who used him and after asking him why he went, I told him I had pretty much the same exact symptons. Foggy thinking, depressed for no reason for days, moody, tired, irritable, cannot concentrate at work and ED problems (lack of wanting sex and physical problems during). These symptons have been going on for years but the last few years they have really gotten stronger and more noticeable.

So I went to see this doctor and his nurse practicioner heard my story and said I am a candidate and first took blood then gave me an injection of 300mg of test. He said the standard protocol was first shot would be 300mg, then in two weeks, 400mg and that will be it going further. So it was every two weeks of 400mg injection and if it was too much or too little, they would adjust until we got "dialed in". Mind you this doctor is a trt specialist and has written a book on test trt and has a website, etc...

This was on June 7th and these are my lab results prior to taking the first shot of Test(never did steroids previously either):

Glycohemoglobin 4.6 anything less than 5.7% is good acording to lab report
PSA 0.51 ng/ml lab range 0-4.00
Estradiol 21 pg/ml lab range 0-39.8 for male
TSH, 3rd generation 1.85 uIU/ml lab range 0.51 - 6.27
Total Testosterone 543 ng/dl lab range is 241-827
Free Testosterone 96 pg/ml lab range was 47-244 (HE CROSSED OUT 47 AND PUT MIN AS 94)
SHBG 44 nmol/L lab range was 13-71
Vitamin D 11 ng/mL lab range is 30-100
DHEA 193 ng/dL lab range is 31-701

He did a complete bloodwork up and said that was normal and a bunch of chemistry tests too and everything seemed to be ok besides my Vitamin D being very low which he said I could just take a supplement for. If there are other lab results you want to see let me know and I will put them on there from this report.
He said that his gut instinct was that I was a high test person when I was younger and my free was at the low end of normal and that is what is causing all my symptons so he recommended the trt. So I went back in two weeks and got the 400mg and then another two weeks another 400mg and after that third shot I really felt my emotions all over the place for the first few days. This is when I really started reading a lot about this and thought this was not the right way it was being done. When I went back for my 4th shot, I told them all this and they brought the dose down to 300 but I asked them to first take more blood and get some more results. They also gave me a B12 shot along with the Test saying that it would help smooth out the ride. They said they rarely give ant E and do not give HCG .

So the below is the results prior to my 4th shot (July 19th):

Total Testosterone 582ng/dL lab range is 241-827 (DOC CROSSED OUT 241 AND PUT 440 AS THE MINIMUM)
Free Testosterone 130pg/mL lab range is 47-244 (DOC CROSSED OUT 47 AND PUT 90 AS MINIMUM)
SHBG 31 NMOL/l lab range is 13-71
Estrogens, Total 79pg/mL lab range is 40-115

Even though the Estrogen lab is different, I believe this went up really high. Also not sure why the he decided to test for a different type of Estrogen. Maybe someone can help me understanding that?

So after the 4th shot, I was sick of doing the bi-monthly treatment and not getting Anti E or HCG liked I had been reading about ( I am also planning to have kids in the next few years) and decided to go to another doc. I found one that would administer the injections weekly and would provide hcg and anti e if necessary.

So on the day I was supposed to take my 5th bi-monthly shot last Thursday (August 2nd) I went to the other doc (who based on my original lab reports approved me) and got a 150mg shot of t-cyp along with a shot of 250iu of hcg as well as anastrazole (1mg pill spilt in half every 3 days take half). This new clinic said they would shoot to get my total test in the 800 range and really said they do not pay much attention to free testosterone but would run the results for me if I like. They said they would do 150mg weekly for 4 weeks then do labs and adjust accordingly.

I was pleading with them to give me self injections but they wont do that at least for 3 months and they would not let me self administer more than one week so I would have to come see them every other week.

Just to add, I work a high stress job and this lab is only open workdays and work hours, so this eventually will become an issue for me at work. IT might be hard for me to get there every week.

So this all leads me to today. I found a urologist literally around the block from my house who does give injections. I went to see him today and gave him my original lab and he told me my total testosterone was fine and I asked him about free Testosterone and he said he would never check that. He also said that he gives injections to people with total T in the 100-200 range. I told him that my free T was my concern and bringing down my estrogen. He didnt really seem that he knew much about this nor did he believe at my level was it an issue. He said that he would continue the trt for me though and he would have no problem letting me self inject! He said how annoying would it be to keep coming in every week. I couldnt believe what I was hearing! I then told him about hcg and I was not even sure he knew much about it but said to me he would have it next week for me or he would call a pharmacy for me and have it made and that I could also self administer if I like. I told him that was a SC shot and he said that should not be a problem. He asked me what dose and I told him 250iu same day as my weekly shot. He said ok he would have it for me next week. He then gave me a 100ml shot of T-cyp which I self injected into the arm muscle as he supervised. He said next time he can call the prescription in and you can then self administer. I was originally supposed to go the my other clinic this Thursday for a 150ml shot (which of course I will not be doing) so this was two days early and he said the lower dose would be better to do now.

There is pros and cons to this new urologist obviously. I do not believe he really knows much about this. I did give him Dr. John Crislers paper about how to administer TRT and he skimmed through it and was impressed with it and he promised me he would read through it all. I also pointed out to him if it would be ok to run all the tests that Dr. Crisler recommends and he said he could do that except a couple one of which was PSA which he said at my age was not neccessary and Test would not cause prostate cancer along with another test which I cant remember off the top of my head. Obvious pro is he is open to me self administering and is pretty much open to anything I say to him and will read literature I give him. But that is also my concern as safety is my number 1 priority and I want someone who will look over me and know when to test and what to look for. This guy is a successful urologist who is very well respected at this so I assume if he is looking at my results, he knows what he is looking at. In the end of the day, he believes that this trt will do nothing for me bc my levels are normal (but I dont feel like that!) according to him but even after this short amount of time I can see glimmers of myself feeling good again although I know I am definitely not fully there but I know something positive is happening from time to time.

I really want to keep going with the urologist for obvious reasons such as self administering and how close he is to my house (and he takes my insurance). But I also want to make sure that I have someone who knows what he is doing and although I have done research and know some things, I am not trying to tell my doctor how to do his job. I am also not sure if this doctor will know when I am "dialed in". I told him that I would like to get my free Test to the optimal level for a 20-29 year old male (which according to my lab range would be somewhere around 180-210).

I am really looking for some suggestions and help on what I should do here. Thank you for reading this all!!!

[kelkel]

Ok, you add exogenous T, your level of Total T is basically similar to your pre-TRT level. I'm hoping your BW was pulled the day before injection and that most of the week it was higher? Your free naturally goes up, your shbg gets pushed down. Extra T will do just this. Your E relative to the T goes up as expected, but you need a sensitive E2 assay for proper monitoring and then adjusting via an AI.

Looking at your pre-TRT levels I'm not sure I would have jumped into TRT. A thought would have been to work on lowering your shbg to allow more free T to be available, as well as examining your lifestyle (diet, exercise, etc) and making positive changes it needed. Only you really know what you need here and it has to be based on how you feel, not just numbers on BW.

And remember when dealing with your doctor you are in charge of your health. He is there to help you make an informed decision on your treatment. Know the answers to your questions before you even go into your doctors office. If you don't get the answer you expect be prepared to question as to why, in a diplomatic fashion of course.

[pjbandit]

Thank you for the reply.

Yes, someone else also told me that I should probably have not been on TRT to begin with. But the first doctor who is a TRT specialist told me that his gut feeling was that I was a high testosterone person when I was younger so I was a good candidate for TRT. He said my Free T was low normal and it could raise it. And then proceeded to do the two week protocol which I obviously know now is a mistake. I was referred to him and assumed he knew what he was doing.

I am not sure why they ran estradiol the first time, but the 2nd time I requested BW they ran estrogens. But this is now not a surprise to me considering this was the first doc who I now know is behind the times. My second BW was the day of my 4th bi-monthly injection (immediately prior to injection)

My issue is now what do I do. I have been on a weekly protocol now with my 3rd doc who is willing to let me self inject. He said he would also look into getting me HCG (I want to have kids in a few years should this be enough to keep production?)
So now that I am on a weekly protocol and tomorrow is supposed to be my injection day should I continue or stop TRT? If I stop, what should I do? I have been reading that you should be in optimal range, and in that case my free t should be around 180-210 to be in optimal range. Should I continue to get there or try something besides TRT? The frustrating thing is I have all the symptons (ED, cloudy/fuzzy thinking, very moody, depressed for no reason, etc...) and this has started to help, but has been uneven which I believe is because of my first doc.

I feel I am at a crossroads of sorts and not sure where I should go.

[kelkel]

I totally understand your frustration. I would do everything possible at your age to not be on TRT unless absolutely necessary. What area of the country do you live in as maybe your close to another members highly recommended doc who can lead you in the correct direction?

I would take tomorrows injection and then try to make your decision. You need to find a doc who is sharp with all this. Even if you have to travel a bit, it's worth it for the correct treatment. After an initial visit you usually don't have to see them face to face, circumstances permitting.

Google Dr. Michael Scallys Power PCT Program and do some reading. You will need some sort of PCT if you decide to come off and restart your own system. To me it would be worth a try and if you don't / can't get back to where you feel good then you can always return to TRT if you choose. This time with the right doctor.

Keep us posted on this thread please and good luck!

[pjbandit]

I totally understand your frustration. I would do everything possible at your age to not be on TRT unless absolutely necessary. What area of the country do you live in as maybe your close to another members highly recommended doc who can lead you in the correct direction?

I would take tomorrows injection and then try to make your decision. You need to find a doc who is sharp with all this. Even if you have to travel a bit, it's worth it for the correct treatment. After an initial visit you usually don't have to see them face to face, circumstances permitting.

Google Dr. Michael Scallys Power PCT Program and do some reading. You will need some sort of PCT if you decide to come off and restart your own system. To me it would be worth a try and if you don't / can't get back to where you feel good then you can always return to TRT if you choose. This time with the right doctor.

Keep us posted on this thread please and good luck!

I am in the NY, more specifically Connecticut area. But close to the NY area. Been trying to find a local doc, but it is tough. I am willing to pay a little to run all tests with someone if you think that is what it will take. But if TRT is not what I need, then I would really like to know what is causing all these symptoms.

You recommend any other ways to raise Free T? I am taking zinc, Vitamin D, Boron and was going to add DHEA and pregnolone to my supplement list.

I will google that PCT program, and I think I will inject today and try to get all BW done next week prior to 4th (original protocal was weekly shot for 4 weeks and then test, today is 3rd week).

Thanks and let me know if you can help with the doctor in the area.

[kelkel]

Google Dr. Eugene Shippen. He's in PA so it would not be a killer drive. Read about him. Very much one of the pioneers of TRT.