New TRT Patient with side effects and in need of advice

[Newtampaman]

I will keep this post informative and to the point, but must warn it is long with all the labs attached.
I'm a 32-year-old white male, 5'8", 198 lbs. I began feeling very tired and lethargic in August of 2011. I also had been gaining weight around my mid-section rather quickly (+25lbs in 8 months) and I was too exhausted to even attempt working out to combat these changes. My libido was moderate however my erection frequency was diminished. I attributed these events to a stressful job and did not go see my primary doctor until January 2012.

Primary Care Office visit January 17, 2012 lab results (Quest Labs):

White Blood Cell Count (3.8-10.8 Thousand/u) 6.2
Red Blood Cell Count (4.2-5.8 Million/uL) 5.14
Hemoglobin (13.2-17.1 G/DL) 15.8
Hematocrit (38.5-50.0 %) 46.1
MCV (80.0-100.0 FL) 89.6
MCH (27.0-33.0 PG) 30.7
MCHC (32.0-36.0 G/DL) 34.2
Platelet Count (140-400 Thousand u) 211
RDW (11.0-15.0 %) 12.3
Absolute Neutrophils (1500-7800 cells/uL) 3026
Absolute Lymphocytes (850-3900 cells/uL) 2406
Absolute Monocytes (200-950 cells/uL) 496
Eosinophils (%) 3.8
Absolute Eosinophils (15-500 cells/uL) 236
Basophils (%) 0.6
Neutrophils (%) 48.8
Lymphocytes (%) 38.8
Monocytes (%) 8
Absolute Basophils (0-200 cells/uL) 37

T-3 Uptake (22-35 %) 36
T-4 (Throxine), Total (4.5-12.0 MCG/DL) 6.3
Free T4 Index (T7) (1.4-3.8) 2.3
Thyroid Stimulating Hormone 3rd Generation (0.40-4.50 MIU/L) 1.78

Fasting Glucose Serum (65-99 MG/DL) 97
Urea Nitrogen (BUN) (7-25 MG/DL) 11
Creatinine (0.60-1.35 MG/DL) 1.06
GFR Non-African American (> OR = 60 ML/MIN/1.7) 93
Sodium (135-146 mmol/L) 141
Potassium (3.5-5.3 mmol/L) 4.1
Chloride (98-110 mmol/L) 105
Carbon Dioxide (21-33 mmol/L) 27
Calcium (8.6-10.3 mg/DL) 9.9
Protein, Total (6.2-8.3 G/DL) 7.1
Albumin (3.6-5.1 G/DL) 4.4
Globulin (2.1-3.7 G/DL CALC) 2.7
Albumin/Globulin Ratio (1.2-2.1) 1.6
Bilirubin, Total (0.2-1.2 MD/DL) 0.9
Alkaline Phosphatase (40-115 u/L) 70
AST (10-40 u/L) 20
ALT (9-60 u/L) 24
Triglycerides (<150 MG?DL) 125
Cholesterol, Total (125-200 MG/DL) 184
HDL Cholesterol (> OR =40 MG/DL) 37

LDL Cholesterol (<130 MG/DL CALC) 122
Chol/HDLC Ratio (< OR =5.0 CALC) 5
"LDL/HDL Ratio (CALC)
Below Average Risk <2.28
Average Risk: 2.29-4.90
Moderate Risk: 4.91-7.12
High Risk: >7.13" 3.3
Non-HDL Cholesterol (MG/DL CALC)

Testosterone , Total (250-1100 NG/DL) 328
Free Testosterone (35.0-155.0 PG/ML) 83

Follicle Stimulating Hormone (1.6-8.0 MIU/ML) 4.2
Luteinizing Hormone (1.5-9.3 MIU/ML) 4.4

Prolactin (2.0-18.0 NG/ML) 11.2
Estradiol, Ultrasensitive, LC/MS/MS (< OR = 29 pg/mL)
Vitamin D, 25-OH, Total (30-100 NG/ML) 19
Vitamin D, 25-OH, D3 (NG/ML) 19
Vitamin D, 25-OH, D2 (NG/ML) <4

Advice from Primary: "Lose weight and get more active. Try to control your diet to lower your cholesterol" He also gave me a sample pack of V*****. I left and did my best to follow orders.
I was still experiencing increased weight gain (now up to 210 lbs) and fatigue. I was now also experiencing frequent interruptions in sleep, near zero erections, and could barely maintain erections for more than 30 seconds to a minute. I scheduled another office visit.

Office Visit April 6, 2013 lab results (Quest Labs):

White Blood Cell Count (3.8-10.8 Thousand/u) 6.1
Red Blood Cell Count (4.2-5.8 Million/uL) 5.16
Hemoglobin (13.2-17.1 G/DL) 15.5
Hematocrit (38.5-50.0 %) 46.6
MCV (80.0-100.0 FL) 90.3
MCH (27.0-33.0 PG) 30
MCHC (32.0-36.0 G/DL) 33.3
Platelet Count (140-400 Thousand u) 208
RDW (11.0-15.0 %) 12.1
Absolute Neutrophils (1500-7800 cells/uL) 3495
Absolute Lymphocytes (850-3900 cells/uL) 1879
Absolute Monocytes (200-950 cells/uL) 500
Eosinophils (%) 3.4
Absolute Eosinophils (15-500 cells/uL) 207
Basophils (%) 0.3
Neutrophils (%) 57.3
Lymphocytes (%) 30.8
Monocytes (%) 8.2
Absolute Basophils (0-200 cells/uL) 18

Thyroid Stimulating Hormone 3rd Generation (0.40-4.50 MIU/L) 1.5

Fasting Glucose Serum (65-99 MG/DL) 89
Urea Nitrogen (BUN) (7-25 MG/DL) 0
Creatinine (0.60-1.35 MG/DL) 1.06
GFR Non-African American (> OR = 60 ML/MIN/1.7) 107
Sodium (135-146 mmol/L) 142
Potassium (3.5-5.3 mmol/L) 4
Chloride (98-110 mmol/L) 104
Carbon Dioxide (21-33 mmol/L) 27
Calcium (8.6-10.3 mg/DL) 10.2
Protein, Total (6.2-8.3 G/DL) 7.2
Albumin (3.6-5.1 G/DL) 4.4
Globulin (2.1-3.7 G/DL CALC) 2.8
Albumin/Globulin Ratio (1.2-2.1) 1.6
Bilirubin, Total (0.2-1.2 MD/DL) 1
Alkaline Phosphatase (40-115 u/L) 73
AST (10-40 u/L) 24
ALT (9-60 u/L) 32

Triglycerides (<150 MG?DL) 205
Cholesterol, Total (125-200 MG/DL) 167
HDL Cholesterol (> OR =40 MG/DL) 35
LDL Cholesterol (<130 MG/DL CALC) 91
Chol/HDLC Ratio (< OR =5.0 CALC) 4.8
Non-HDL Cholesterol (MG/DL CALC) 132

Testosterone, Total (250-1100 NG/DL) 283
Free Testosterone (35.0-155.0 PG/ML) 82.6

Follicle Stimulating Hormone (1.6-8.0 MIU/ML) 4.5
Luteinizing Hormone (1.5-9.3 MIU/ML) 4.7

Prolactin (2.0-18.0 NG/ML) 9.6
Vitamin D, 25-OH, Total (30-100 NG/ML) 23
Vitamin D, 25-OH, D3 (NG/ML) 23
Vitamin D, 25-OH, D2 (NG/ML) <4
Vitamin D, 1,25 (OH)2, Total (18-72 PG/ML) 60
PSA (< OR = 4.0 NG/ML) 0.9
Vitamin B12 (200-100 PG/ML) 439
Folic Acid (NG/ML) 11.2 [Low: <3.4; Borderline: 3.4-5.4; Normal: >5.4]
Hemoglobin A1c (% of total) 5.3 [Decreased risk of diabetes: <5.7; Increased risk of diabetes: 5.7-6.0; Higher risk of diabetes: 6.1-6.4; Consistent with diabetes: > OR =6.5"]


My primary provided me a referral to see an endocrinologist and said that he had no idea what was happening.

I had unsuccessful visits with two different endocrinologists. One stating they don't treat low T and gave me a referral to a urologist and the other stated that I should see a sex therapist for my limited erections. and be prescribed anti-depressants. I wisely ignored their ridiculous advice.

I found a local "Men's Health Clinic" that advertised TRT so I scheduled an appointment on 6/26/2013 and no new labs were required as they just confirmed from the 4/17/13 recent visit. I was started on 300mg Cypionate that day along with B12 injection. The regimen prescribed was to return every 14 days for subsequent visits to receive injections in office. My visit schedule was as follows:

6/26/2013 - First injection

7/8/2013 - Second injection

7/19/2013 - Third injection. I informed the clinic nurse that I felt even more tired, had no erections, and was experiencing some leg cramping. She stated that she would have the Dr. call me (which he never did).

7/25/2013 - I stopped by office to speak with Dr. but he didn't come in that day so I asked for him to call me again.

7/27/2013 - I received a phone call from Dr. and he stated that I could come see him on 8/2/13 and there was nothing to worry about. He said my symptoms were unrelated to the TRT. This should have been my first clue that he might be clueless.

8/2/2013 - Fourth Injection. I met with Dr. and explained that I felt worse than ever. Explained my sleep hours are now exceeding 12 hours and I was still tired. I also stated that I had no more erections and inquired why this was happening. I also asked if I could be making more estrogen as my leg cramps had gotten so bad I was awakened at night and could not move my right leg as my calf and hamstring was literally stuck. His reply was, "I have over 1600 patients on TRT with the same dosing and regimen and you're the only one with this problem. There is no explanation why this is happening and estrogen has nothing to do with your low T." I then requested for a prescription for CBC, Calcium, E2, TT, FT, FSH, LH, PSA, Prolactin, and SBHG. He refused and only gave me the following (with results posted):

8/15/2013 - Fifth Injection
8/20/2013 - Lab results came back today, and the Dr. said that he cannot review them until Thursday which is when he wants me to return (duh to take more of my $ for an office visit).

Quest Lab Results: (NOTE: These labs were drawn on day 13 of my 14 day dosing schedule):
Hemoglobin (13.2-17.1 G/DL) 15.5
Hematocrit (38.5-50.0 %) 46.6
Testosterone, Total (250-1100 NG/DL) 448
Free Testosterone (35.0-155.0 PG/ML) 145.6
Luteinizing Hormone (1.5-9.3 MIU/ML) 0.2
Estradiol, Ultrasensitive, LC/MS/MS (< OR = 29 pg/mL) 47
PSA (< OR = 4.0 NG/ML) 1.2

Clearly my E2 is high and I have improved in FT and TT, but I'm concerned about my rising PSA in such a short time as well as my large decrease in LH being that I have only taken 5 injections. I'm stuck in a difficult situation and could seriously use some help and explanations if possible. My leg cramping is worsening, I have terrible back pains, and I've now developed burning and tingling in my arms and legs when I lay down.

Thank you in advance for everyone's help.

[PistolPete33]

That Protocol is TERRIBLE.... 14 days between injections is WAY TOO LONG. No wonder you feel like shit. Your hormones are on a rollercoster and you're along for the ride. I'm sure the more experienced will reply here and hopefully help you iron this all out. I hope you can get it fixed and start feeling human again.

[Newtampaman]

Thanks PistolPete.
That is my exact thought as well. However, my Dr. is less than willing to change any dosing and refuses to allow me to inject myself which makes it even more challenging. I would be more than willing to see another facility locally however, there are none that will work. I've found places that will not take people my age, places that will only do one dose and one frequency, another place who refuses to prescribe any sort of AI. In short, Florida is a difficult state to get the help you need that is reputable mainly due to a few bad apples who have ruined the system here.

[PistolPete33]

Have you contacted the lowT.com that is on this forum? I'm not sure if they do Florida or not but seems like they are putting together GREAT protocols for people and not a one size fits all approach. I would start there.

[PeteyP]

Hey OP where are you located in florida?

[Newtampaman]

Have you contacted the lowT.com that is on this forum? I'm not sure if they do Florida or not but seems like they are putting together GREAT protocols for people and not a one size fits all approach. I would start there.

I live in Tampa

[EverettCD]

If LowT.com isn't in your area check out American Academy of Anti-Aging Medicine - The World Leader in Anti-Aging, Regenerative, Metabolic and Functional Medicine Education, Conferences and Exhibitions. A good friend of mine found his Dr. this way & he seems to be squared away.

[rebelstate]

at first glance ur levels looked really good, ur test was in the low side.. then it caught my eye!.....ur Triglyceride is high!.... that means ur a heavy drinker!...are u an alcoholic?,,,,,,slow down ur drinking!...your doc knows what is causing it but he want come strait out and tell u....u drink way too much!...cut back on drinking and u might just save more than urself....good luck to u and wish u the best!

[rebelstate]

also alchol use will lower ur test levels...how do I know?....how do u think I got my levels low enough to get ins to pay for it......that's how I found out about high Triglyceride levels...been there, do that!

[bass]

yup find a new doc. 1600 patients with success at this protocol?! I don't think so! are you supplementing with vitamin D? if not get started while you're looking for a new doc, start with 20k ius ed then recheck in 4-6 weeks.

[Newtampaman]

also alchol use will lower ur test levels...how do I know?....how do u think I got my levels low enough to get ins to pay for it......that's how I found out about high Triglyceride levels...been there, do that!

Thanks for the advice, however, I've NEVER had a drink of alcohol in my life. So, I'm pretty sure this isn't my issue.

[Newtampaman]

yup find a new doc. 1600 patients with success at this protocol?! I don't think so! are you supplementing with vitamin D? if not get started while you're looking for a new doc, start with 20k ius ed then recheck in 4-6 weeks.

I've been on D3 4000IU daily for about 6 months now. I also went to see a new doctor today who is an a4m certified member. She is willing to make necessary adjustments, order smart blood panels (i.e. SHBG, DHEA, E2...) and also willing to prescribe AI or SERM if necessary. Sadly, the price is a bit high but at least I can get my levels in check and then make adjustments.

Thanks for confirming what I thought to do as well.