Any particular things I want to ask/tell doc besides what I want tested?

[rd27]

Hi All,

I have a GP appointment tomorrow to talk specifically about hormone levels and fatigue/libido/ED. I have realized my energy levels have been generally low for a while (though I get a good amount of exercise and feel fit). I also feel my excitement for life in general feels low (including libido). And I tested with low T levels in the past but didn't stick with fixing them (more below).

I'm wondering if folks have any suggestions for questions/topics I should bring up to my GP beyond what I want tested. I do plan to ask my GP for the Crisper-recommended labs listed in the Finding a TRT Physician sticky.

Also, in terms of the labs if there are particular ones I absolutely want and should "fight for" (in quotes because GP has worked with me in the past on other issues) please let me know. I'm assuming Total T, Free T, Estradiol Sensitive, and Vitamin D are the key ones. My physical is coming up, so I happily will be getting all the basics anyway (lipids, thyroid, PSA).


As background, tomorrow is technically a follow-up because I tried AndroGel for a few months in early 2009, but then dropped it without having a full discussion with my GP. I think I let it slip because my main concern at the time was ED aspects, and they were handled by Cialis (prescribed by same GP). My labs from then are below.

Since then I have researched hormones more thoroughly (including Nelson Vergel's book and all the forum stickies). That research has taught me the key difference between reference range and optimal range. With optimal in mind I am much more concerned about my levels in my old labs.

Here are the labs I have recorded. I started the AndroGel after the 10/15/09 lab and discontinued a while after the 12/20/09 lab, so I didn't give it much time.

Test Date T Free (Direct) T Serum       PSA Serum Vitamin D     Zinc Serum    Total Cholesterol
          6.8-21.5 pg/ml  249-836 ng/dl 0-4 ng/ml 32-100 mg/ml  70-150 ug/dL  100-199 mg/dl
10/15/09  9.4             388       
12/20/09  8.6             510           0.9                                   186
4/2/10    5.8             453       
8/5/11    7.8             541                     58.7          116           128

Thanks!
d

[SD421]

Make sure to ask about their experience with TRT and be prepared to request a referral to endo or urologist.

[steroid.com 1]

You didn't provide much info about yourself like age, weight, training, diet...this would help.

Get tested as early in the morning as possible...like no later than 9am.

Make sure for Thyroid to get TSH, T4, T3, FT4 and FT3.

The labs recommended in the sticky will do.

Post everything here complete with ranges and we'll jump in and provide input.

Good luck.

gd

[rd27]

Thanks, got pretty much the full workup at 10am after fasting. I will post when I get the results. My doctor is now using something called MyPreventiveCare so I will be able to get them online and a little quicker I hope. It also lets me see my results online for the last few years, which is pretty cool.

I actually came back to leave some more info on me, but couldn't because the post was in the moderator queue (because I am new poster). So while we wait for the labs, some more info me...

Age 43
Weight 166
Height 5'10"
BMI (from tanita scale) 16%

I do feel athletically I am ok, certainly when compared to the couch potato I was ten years go. I don't "train" or spend much gym time, but I do run, mountain bike, and occasional whitewater kayak 2-4 times a week. I do trail, mountain bike, and adventure races and actually podium fairly often in my age group on the trail runs (which still surprises me each time :).

My diet since early 2009 is mostly vegetarian and fish, with occasional meat when dining out. Note I went in for my first T test near the end of the same year I went most-vegetarian so I do wonder about my diet. If I need to add more meat for my health I am willing to do so.

The only medication I am currently taking is Concerta 18mg.

My current vitamin supplements are multi, fish oil, and some extras to end up with the following daily totals. Not including food and many others are not listed of course.

Vitamin C	3,392	mg
Manganese	8	mg
Glucosamine HCI	3,350	mg
Chondroitin	3,075	mg
MSM	300	mg
Vitamin D	2,800	IU
Vitamin K	75	mcg
Vitamin B6	50	mg
Folate (B9, Folic Acid)	600	mcg
Vitamin B12	1,100	mcg
Calcium	1,700	mg
Magneisum	100	mg
Fish Oil Concentrate	4,000	mg
Omega-3 (EPA, DHA, other)	2,300	mg
EPA	2,000	mg
DHA	300	mg
Zinc (as Zinc Oxide)	55	mg
Vitamin E	240	IU
Copper	2	mg

Thanks!
d

[HRTstudent]

So you got the blood labs then I take it?

Also, if I were pursuing treating the low T with the doc I would definitely be making sure the doctor is up to par. If they don't think checking estradiol is important then you know you can drop them. If they are WILLING to check it, however, it is worth keeping them around until you find the TRT expert.

Another easy question to ask is if they are ok with injections and what do they think about weekly injections. Any doctor who knows anything about Testosterone therapy knows that the old 2-3 week intervals for test cyp/enanthate is archaic and plain dumb.

Of course, if your T comes back mid-range I wouldn't even bother and I would probably look at optimizing T through more "natural" methods.

[SD421]

You may consider adding a D3 supplement to your multivitamin. I found one that is 5,000IU per capsule, and I have been taking 2/day for about 3 weeks now, and feel a lot better than I did, though still frustrated in my search for a doc to treat my low T.

[rd27]

Thanks. I do take a D3 supplement, 2 1000IUs - that is how I get to the 2800IU I show above. I actually take over a dozen pills each morning, what I listed above is the totals. 2800IU seemed to be the high end of what is recommended by most medical organizations and since my D tests didn't seem bad (58.7 range 32-100) I didn't see a reason to ho above. I also haven't found any toxicity information on D so I don't have a good feel for its "upper limits" in terms of supplements.

d

[SD421]

www. mayoclinic. com/health/vitamin-d-toxicity/AN02008

[SD421]

But you're probably right, your levels look good. I was at 20 on that range of 32-100.

[rd27]

deleted - moved to its own thread

[rd27]

Hi gdevine,

My tests came back with below range FSH and low LH. I noticed in the "hCG and Pregnenolone; What you should know" thread that you were diagnosed with secondary hypogonadism and I was wondering if you would have some thoughts.

I started a new thread with the results since my thread title was on something else (hopefully that isn't bad forum behavior). I can share the link unfortunately, but the thread title is " "HRT needed? Mid-low T, low Free T, bottom half Bioavailable T".

Thanks,
dave

[canesfan804]

Does it make that much difference in the time of day?