Hello Everyone..new to the forum...been using Fortesta for 6 wks..have some questions

[SF1098]

I have been using Fortesta for 6 weeks following my intial bloodwork and physcian consult.
Unfortunately, I can't locate my labs right now but I am sure of the following numbers:
Total Testosterone: 400ng/dl ref range: 250-1100ng/dl
Free Testosterone: 75ng/dl ref range: 35-155ng/dl

Symptoms:
1. Fatigue
2. Irritability (I can't remember when I wasn't) its been so long
3. Poor focus and memory
4. Excess body fat
5. Very little sex drive (I actually thought it was pretty good but my wife reminded me it's been nearly 6 months
6. Poor endurance (could also be attributed to 27% body fat)
7. Depression (I'm taking Zoloft)

Current State:
1. No change
2. I think I might be a little less irritable
3. No change
4. I was 240lbs and have lost 20lbs so I'm heading the right direction
5. No change
6. No change
7. Not sure as I am still taking Zoloft and need to talk to GP about tapering off it

So now for the questions:
1. I will be having my 6 week flowup with my HRT Physcian tomorrow, I believe he will repeat my bloodwork to see if the Fortesta has been effective. If the Fortesta hasn't worked he suggested implants. I'm not really excited about going that route.
Anyone had experience with implants?
It is my understanding that the implants can extrude and its difficult to get the dosage right since you have to wait so long between replacements. I would rather go with injections as it would be easier to more accurately "dial in" my dosage...Thoughts? I am just concerned that he may be apprehensive about prescribing injections.

2. With a Total T of 400ng/dl would I be a candidate for injections? The gel is kind of a pain. I have to apply it to my inner thigh and then wait to put slacks on for 30 min or so and when I do they stick to my legs. Additionaly, I have to really be careful around my two girls and it's expensive even with insurance.

3. I can't help but notice the add for LowTestosterone.com and I'm only around 275miles from their Houston office...Was curious if they tend to just go off the numbers of look at the entire picture when prescribing. Should I wait to have my bloodwork done for a few day after stopping the Fortesta before contacting LowTestosterone.com? I don't want my bloodwork to have overly inflated values when having bloodwork done for LT.com.

Any help would be greatly appreciated.

[EverettCD]

I've been on Fortesta (6 pumps & 200 iu HCG daily) for about 8-9 weeks myself. So far on not impressed with it, I'm waiting for my BW results from Monday. If my levels aren't up to par I'm going to request to go to injections.

Sent from my iPhone that was manufactured in a sweat shop in China

[LowT Mike]

I have been using Fortesta for 6 weeks following my intial bloodwork and physcian consult.
Unfortunately, I can't locate my labs right now but I am sure of the following numbers:
Total Testosterone: 400ng/dl ref range: 250-1100ng/dl
Free Testosterone: 75ng/dl ref range: 35-155ng/dl

Symptoms:







1. Fatigue
2. Irritability (I can't remember when I wasn't) its been so long
3. Poor focus and memory
4. Excess body fat
5. Very little sex drive (I actually thought it was pretty good but my wife reminded me it's been nearly 6 months
6. Poor endurance (could also be attributed to 27% body fat)
7. Depression (I'm taking Zoloft)

Current State:
1. No change
2. I think I might be a little less irritable
3. No change
4. I was 240lbs and have lost 20lbs so I'm heading the right direction
5. No change
6. No change
7. Not sure as I am still taking Zoloft and need to talk to GP about tapering off it

So now for the questions:
1. I will be having my 6 week flowup with my HRT Physcian tomorrow, I believe he will repeat my bloodwork to see if the Fortesta has been effective. If the Fortesta hasn't worked he suggested implants. I'm not really excited about going that route.
Anyone had experience with implants?
It is my understanding that the implants can extrude and its difficult to get the dosage right since you have to wait so long between replacements. I would rather go with injections as it would be easier to more accurately "dial in" my dosage...Thoughts? I am just concerned that he may be apprehensive about prescribing injections.

2. With a Total T of 400ng/dl would I be a candidate for injections? The gel is kind of a pain. I have to apply it to my inner thigh and then wait to put slacks on for 30 min or so and when I do they stick to my legs. Additionaly, I have to really be careful around my two girls and it's expensive even with insurance.

3. I can't help but notice the add for LowTestosterone.com and I'm only around 275miles from their Houston office...Was curious if they tend to just go off the numbers of look at the entire picture when prescribing. Should I wait to have my bloodwork done for a few day after stopping the Fortesta before contacting LowTestosterone.com? I don't want my bloodwork to have overly inflated values when having bloodwork done for LT.com.

Any help would be greatly appreciated.

We would love to help you. We make it very easy for the transferring TRT patient. We just verify your treatment and if you have labs that are less than 90 days old and have the panels we require then your good to go. Well make you an appointment to see the doc. As far as gels and creams go guys. Id say 20% of men can actually absorb and get levels up to where they need to be. Most guys only get a 100-200 point bump north. Most cant absorb at all. They also can will work for awhile then stop working. If thats not bad enough even with insurance I know andro-gel cost some 200-300 dollars a month. Big pharma at it again $$$.

Absorption rates vary usually only 15% gets absorbed and its different for everyone (See graph above). There also is more DHT release with creams and gels which is the culprit for the prostate. Also, if you forget for just 1day your levels are often back to baseline or lower. If you not squeamish about needles then injections is the way to go. Injections are 100% absorption for all men and are the gold standard.

To answer your questions about levels. I train all the LT docs and preach..."Dont treat the labs, treat the patient" WE do look at the big picture. symptoms, health history then labs. Labs are just a guideline. For example, This means if your total is 650ng/dl and you still feel symptoms of LT then our doctors will keep pushing you to the top of the "optimal" range well within safe ranges. Generally 1100-1300 if thats where you need to be to be symptom free. Men usually will start developing lipid issues, polycythemia, higher test conversion with levels that are superphysiological higher than that. We are here to help!

[SF1098]

Mike, I sincerley appreicate you reaching out. All of your comments certainly jive with all that I have been reading in Vergel's book. I'll keep my appointment at 4:00 today and then reach out to you guys. Thanks Again and I will be in touch. Bill

[LowT Mike]

Implants you mean pellets. Im not a fan. That means mildly invasive surgery every 3 months. Ive had patients complain they can feel them SubQ and its annoying. Not to mention once the pellets are in how are you going to titrate your dose up or down...back to the OR for mild invasive surgery thats how. Not a fan. Injections are the way to go. You can do SubQ T or IM. If your doctor says "well the pellets are the only bioidentical testosterone. He is wrong wrong wrong and needs to quit listening to a much less educated pellet pharm sales rep. ALL TESTOSTERONE IS BIOIDENTICAL. ALL OF IT.

[SF1098]

Hey Guys, I wanted to post my labs up for your input.

To save you from having to go back and look at my first (wordy post):

Towards the end of April to the begining of May prior to treatment with 6 weeks of Fortesta I was at 400 ng/dL and 75 ng/dL with the same reference scale listed below. My Total T and Free T dropped most likely because I ran out of gel 3 days before my blood test... The GP I found here that prescribed the Fortesta and ordered the labs below is very hard to work with... Its takes him 48 hours to respond and the response is always through an MA which then prompts me to ask more questions because she doesn't have a clue. I am hoping that he starts me on injectibles before the end of the week.

(Low T Mike) I would just transfer to you guys right now if I didn't feel like I was going to get a script this week.

So....my plan is to hopefully obtain a script from him then transfer to you guys. I just feel like I have waited to long and been through so much and I almost have this thing across the finish line to change now...as I would need to be seen in Houston prior to obtaining a script but I will say I understand that this is going to be a long process and I can't imagine having to continue working with my present physcian. (Please let me know if I am going about this the wrong way)...I have just got to do something...it's causing marital problems...I have grown increasingly more irritable and prone to flying off the handle...I got out of the car two weeks ago and got into a screaming match with a security guard in a parking lot in front of my 2 girls...they were crying... and scared...it wasn't good.

Comprehensive Metabolic Panel:
Glucose: 92 Ref Range: 65-99 mg/dl
Urea Nitrogen (BUN): 23 Ref Range: 0.60-1.35 mg/dl
eGFR non-Afr. American: 81 Ref Range: > or = 60mL/min/1.73m2
eGFR African American 93 Ref Range: > or = 60mL/min/1.73m2
BUN/Creatinine Ratio: Not Applicable
Sodium: 137 Ref Range: 135-146 mmol/L
Potassium: 4.8 Ref Range: 3.5-5.3 mmol/L
Chloride: 103 Ref Range: 98-110 mmol/L
Carbon Dioxide: 24 Ref Range: 19-30 mmol/L
Calcium: 9.9 Ref Range: 8.6-10.3 mg/dL
Protein, Total: 7.2 Ref Range: 6.1-8.1 g/dL
Albumin: 5.1 Ref Range: 3.6-5.1 g/dL
Globulin: 2.1 Ref Range: 1.9-3.7 g/dL (calc)
Albumin/Globulin Ratio: 2.4 Ref Range: 1.0-2.5 (calc)
Bilirubin, Total: .4 Ref Range: .2-1.2 mg/dL
Alkaline Phosphotase:70 Ref Range: 40-115 U/L
AST: 22 Ref Range: 10-40 U/L
ALT: 41 Ref Range: 9-60 U/L

Estradiol, Free, LC/MS/MS Estradiol, Free: .05 Ref Range: < or = .45 pg/mL
Estradiol: 2 Ref Range: < or = 29 pg/mL
Dihydrotestosterone, LC/MS/MS 18 Ref Range: 16-79 ng/dL

CBC (H/H, RBC, Indicies, WBC, PLT)
White Blood Cell Count: 5.1 Ref Range: 3.8-10.8 Thousand/uL
Red Blood Cell Count: 5.10 Ref Range: 4.20-5.80 Million/uL
Hemoglobin: 15.4 Ref Range: 13.2-17.1 g/dL
Hematocrit: 47.5 Ref Range: 38.5-50.0 %
MCV: 93.0 Ref Range: 80.0-100.0 fL
MCH: 30.2 Ref Range: 27.0-33.0 pg
MCHC: 32.5 Ref Range: 32.0-36.0 g/dL
RDW: 13.6 Ref Range: 11.0-15.0 %
Platelet Count: 228 Ref Range: 140-400 Thousand/uL

Testosterone, Free and Total, LC/MS/MS
Testosterone, Total, LC/MS/MS: 382 Ref Range: 250-1100 ng/dL
Free Testosterone: 70.9 Ref Range: 35.0-155.0 pg/mL

PSA (Free and Total)
Total PSA: 1.6 Ref Range: < or = 4.0 ng/mL
Free PSA: .3
% Free PSA: 19L Ref Range: >25%