Bloodwork and Endocronologist - please comment

[MickeyKnox]

47 years old
6' tall
currently 190 lbs
bf% 16-17 maybe less


some background..

had bloods earlier this year (may/june). discovered low test on first testosterone assay 6.9nmol/l - canadian scale. (american scale would be 199ng/dl)

started trt protocol 100mg/once/wk for 4 wks. waited 4 wks for trough and results were 8.3nmol/l. my gp was unsure how to diagnose and suggested i see endo and said it would be months before i would be able to see someone.

in the meantime, july 1st i started 250mg 2/wk blast of test e. middle of july received notice of bloods were due on aug 9th. switched to prop 50mg eod up to aug 5th. no pct. gave blood three times - on the 9th (full blood assay), 12th, and 13th. blood was given morning, afternoon, and late afternoon respectively.

endo says im ok. doesn't support the idea of trt/hrt. he told me to leave my bloodwork (papers) at the front on my way out. i took my bloodwork (papers) with me.

these are my results.. (for reference NORMAL TOTAL TEST = 10 - 27 NMOL/L)



on fri aug 9th i gave a blood sample first thing in the morning. it came back at 17.6 nmol/l = (506 ng/dl)

on mon aug 12th i gave blood at noon. it came back at 8.1 nmol/l = (233ng/dl)

and on aug 13th i gave blood late afternoon 4pm it came back at 7.8 nmol/l = (224 ng/dl)


these are the remaining results from blood taken on Aug 9th.


TSH 250.....................(.46 - 4.68) mIU/L
FREE T4 14.6......................(8.3 - 23.1) PMOL/L
PSA 4.65..........<4.00 UG/L
FERRITIN 35.9.................(18 - 464) UG/L
LH <0.2................IU/L
FSH <0.7.............(1.6 - 9.7) IU/L
PROLACTIN 7.3........................(3.7 - 17.9) UG/L


Glucose - Random 4.8 <7.8 MMOL/L
Creatinine 84 (62 - 115) UMOL/L
Total Protein 81 (63 -82) G/L
Albumin 43 (35 - 50) G/L
Alk Phos 61 (38 - 126) U/L
AST/SGOT 43 (17 - 59) U/L
Sodium 141 (137 - 145) MMOL/L
Potassium 4.4 (3.5 - 5.1) MMOL/L
Chloride 105 (98 - 107) MMOL/L
Bicarbonate (co2) 23 (22 - 30) MMOL/L
Iron 10.5 (9 - 32) UMOL/L
Transferrin 31.8 (26 - 48) UMOL/L


Endocrinologist's comments: did not test for Estrogen because he said, "it isn't warranted". however upon my examination he checked me for gyno (squeezed my nipples) because, and i quote, "low test levels usually indicated a high e2 levels". what a fukin hypocrite.

also he said i was "i was a borderline candidate for hypogonadism" but told me i was normal. ??



anyway, what i can tell so far is that my test is low. and so is my lh and fsh.

looking for comments. if i am missing something or need to include more info let me know.

thanks.

[kelkel]

Hi Mickey.

I'm assuming your original protocol was probably cyp or enanthate ? Then you switched to the short ester (smart) after getting word on the BW and subsequently went cold turkey prior to your testing. It seems to me, unless I'm reading things wrong that these tests basically aren't valid when it comes to a trt protocol as there really hasn't been a consistent, stable pattern at this point.

Looking at the BW that PSA is up there. I know your up on things but do you run high normally? Have sex within a couple days? Even though I don't believe it would spike it that high. Consider low dose cialis for BPH. Low Ferritin levels can indicate an iron deficiency which coincides with your iron level. LH/FSH low as your shut down. More modern scale for TSH is .3 - 3.0.

What are your plans for continuing Mickey?

[MickeyKnox]

hey Kel,

your assumption is correct, and youre also correct in that i really haven't had a stable pattern. however i was hoping to learn about my current levels based on past history. this is an area that i am just starting to understand - the learning curve is quite large.

my plans are to remain constant without introducing any aas for awhile - at least enough time to restart and become basline. in the meantime ill continue to eat healthy and exercise and then get a full blood assay that will include cortisol, cholesterol, shbg, and e2 levels and then see if my fsh/lh have improved.

i noticed the psa as well Kel, however this was my first real assay so im not sure where i sit for my psa.

[kelkel]

Constant on a TRT protocol only or nothing at all? If nothing at all are you planning a pct?

That psa is high. Did the doc say anything to you? Recommend anything?

kel

[MickeyKnox]

no trt. i started pct using nolva only standard protocol (40/40/20/20) and 1000iu hcg /wk @ 500iu e3d immediately after last blood draw aug 12th.

will check bloods upon completion of pct.

doc never commented on psa (which concerned me) was only interested in ferritin (total iron) and test. not sure why?? he did not comment on low test values - said i was "normal". he did not test me for e2 levels?? and he was not on board at all for hrt/trt. all this added up to me to me taking my bloodwork and leaving quietly.

as for the psa, im not sure what to make of it. but if these values are still high when i re-due bloodwork after pct is complete, i will have prostate exam and go from there. perhaps 5mg/day of cialis as you suggested? i have no knowledge or experience in this area - im learning as i go.

[kelkel]

Good on the pct. It does sound like you need a new doc asap. Read the following on Cialis and BPH. Most insurances cover it, mine does for two a day:

http://www.fda.gov/NewsEvents/Newsro.../ucm274642.htm

And we will learn you up right quick over here!

[MickeyKnox]

ill take a peek. thanks for your help Kel.

ill post any updates/bloodwork in this thread later when i re-due them.

[MickeyKnox]

UPDATE:

seen my gp today to discuss bloods. he said im normal. yeah, apparently being under the commonly agreed Provincial values (10 - 34nmol/l) is normal. i truly feel sorry for all the Canadian men out there that are suffering from andropause because our physicians are too fvck'd up to realize the rest of the planet is leaps and bounds ahead in the medical field, particularly when discussing hrt.


here are some highlights for your entertainment:

doc, " youre normal. you're a bit low, but that's normal" (i suggested it wasn't normal and that it didn't even fall within Provincially accepted laboratory guidelines)

i asked him why he nor the endocrinologist tested me for E2 levels? his response, and i quote, "i have never tested a man for estrogen in my career, and im not about to, ever!" (hard to believe huh?)

doc, "i'm not giving you wkly trt injections. i don't need you in this office every week!" (apparently he's not interested in treating patients on a weekly basis)

doc, "Pfizer suggested protocol for trt is 200mg per month. that's what i'll give you!" (incorrect. Pfizer protocol as per website is 200mg bi-weekly. AND the show you that THEIR tests revealed baseline tests levels after only 14 days after a 200mg injection. i shared this with him. he got mad.

doc, "Depot testosterone cypionate is NOT the same as regular testosterone cypionate !" (i went on Pfizer's website and the structural formula is identical to Watson Cypionate. Depot is simply the brand name. Testosterone Cypionate is the generic name. there is NO difference whatsoever - Cyp is Cyp. i told him this and he got mad(er).

so, he got mad made a bunch of smart ass comments and made ANOTHER appt for me to get bloods. so i did earlier today. when the results come back low, like i know they will, i will simply let him know im seeking treatment elsewhere. oh and before i left i asked him one last question. i asked, 'if you had to choose which protocol would be more stable/balanced (bloods) which would it be? monthly, bi-weekly, or weekly? he said, "i'll call you when your blood work is in."

and there you have it. a day in the life with a Canadian medical professional.


BUT>>>>>>>>>>>not all is lost my fast feathered testosterone deficient friends!! when i arrived home i was relaying my story to a friend and i made an off the cuff remark that i would really like to be treated by an American doctor. he told me his doc is from the US and practiced anti aging down there!!! so i Googled him (with clean goggles) and low and behold his website clearly outlines testosterone replacement therapy!! i couldn't believe it! i was so happy!

so i called and left my info for a callback tomorrow and will be making an appt asap! looking forward to speaking WITH him and not having him speak down to me.

cheers.

[kelkel]

Stories like this never cease to amaze me. How a medical professional can even begin to "treat" someone for an issue they know nothing about is (to steal GD's terminology) borderline malpractice! It also seems all to common that when a doc does not know the answer to a TRT related question they either shut the patient down or become dismissive of it. I'll venture to say that most docs, unless trained in TRT, would not be able to keep up with us in anything close to an in-depth conversation on the matter.

Glad you have a light at the end of the tunnel and it's not a train! Would have loved it if you recorded that conversation!

[MickeyKnox]

unbelievable Kel. and i stayed calm and prefessinal. in fact the more sense i made, the angrier he got.

the problem here is that doctors don't like patients who are informed and capable of critical of thinking. they don't like patients who are interested in being pro-active in their healthcare. they want dumb down sheep to follow the line, do as they're told, not question anything, and say, baaaah.

cant wait to meet this American doc!

[kelkel]

Yes, an educated patient is an uninformed doctors worst nightmare. He now knows you know more than he does about the topic and he's uneasy with that. I landed a great one on my third doc. First GP (my family doc) was ok but referred me to an endo when he realized I was self-educating and asking him questions he was not sure of. Credit to him for his proper reaction. Endo was absolutely horrible and I easily knew more than he did. Eventually when he blatently would not answer legitimate questions or was just plain wrong, I told him he needed to stick to diabetes/metabolic diseases as he does not know TRT. Advised him I would not be returning and he was shocked.

Later than night my cell phone rings and it's the endo calling to try to build his case, or maybe satisfy his own ego, not sure. Tried to get me to come back. Said no. Think I hurt his feelings. Waaah.

After extensive searching and interviewing (hence the Finding a TRT Doc sticky was written with encouragement from GD/Bass) I landed a euro who is fantastic. At the first meeting I told him my expectations. Basically that I'm in charge and he's there to help. I'm an informed patient and will pretty much manage (micro-manage?) my own care with his guidance/consultation.

It's great. I go in with my BW in hand and he sits down and I go through everything and give my opinions and goals. We discuss any potential changes I want to make, etc. All the while he's writing out scripts as I bring a typed list of what I need. As long as it's logical, he will write it, no issues. He will also, at my request, write each one for a bit more than actually needed so as not to be micro-managed by any pharmacy. He even gave me his personal email for questions/issues. Fantastic doc and what has made it successful is the developement of trust between us. I hold nothing back from him whatsoever.

Long diatribe, sorry.

Sincerely hope it works out for you Mickey!

kel

[MickeyKnox]

ive always said, knowledge is power. and you my friend are powerful. i like that diabetes/metabolic diseases comment...priceless.

well, it turns out the American Dr that practices here is no longer taking on patients OR practicing trt treatments. why? because of the recent health cuts. the gov and healthcare proponents are at lager heads and there doesn't appear to be any light at the end of the tunnel for me here. however, down south in the Big Smoke (Toronto) there are several clinics i could try. but i have decided to attempt self admin trt.

basically, ill run it for 5wks starting today. then ill ask for blood work, and hopefully the results will demonstrate increased test levels, suitable hormone balance in other areas, an overall feeling of wellness, and eventually quality of life restored. i will decide whether to include an ai or hcg depending on my sides and feelings. i will monitor this closely.

thanks for your support Kel.

[kelkel]

You got it. Keep us in the loop. Like to know how you make out!