TRT candidate?

[The Noose]

Hello, everyone. I'm a newbie here and was hoping to get some advice. If I haven't been here long enough and am overstepping my bounds, please let me know.
BACKGROUND. I'm 44yo, 6'0", 248lbs. I don't know my body fat percentage, but would guess it to be around 30-35%. I was an athlete in high school - football, wrestling, track, baseball and played ball in college. I have always been fairly strong and in good shape. Married life, kids, a few injuries, and a super high stress job took me to 267lbs.
SYMPTOMS.
Irritable, way overweight esp belly, loosing muscle, no motivaton, no energy, grouchy - even dicky sometimes, no real interest in sex and trouble orgasming. I just can't close the deal. These things are all the exact opposite of my personality, sexuality, and physique.
LABS.
So I go to the Dr. and he says we should test my testosterone levels as he suspects low t. My first BW on 7/22 is as follows;
Creatinine, Serum .74 low (.76 - 1.27)
Triglycerides 341 high (0 - 149)
HDL 29 low (>39)
VLDL 68 high (5 - 40)
Testosterone , Serum 156 low (348 - 1197)
Free Testosterone (Direct) 4.3 low (6.8 - 21.5)
Everything else was in range. LH and SHBG were not tested. The sample was taken at a Labcorp in Orlando, Fl. The results of the second test should be available tomorrow or Monday and my Dr. appt is in 2 weeks. I cleaned up the diet, got back to exercising, and dumped the job. Any help, advice, observations would be greatly appreciated as this is all very new to me. Thanks in advance!

[Beethoven]

Looks like you are. Hopefully your Dr. Is knowledgeable in trt to get you on the right protocol. Do some reading in the stickies. Lots of valuable info there from Bloodwork to choosing the right Dr.

[Joco71]

Good luck and welcome!!

[jasondd1]

I'm sure others have posted lower numbers, just not sure Ive seen numbers lower than that. Yes you are a candidate.

[The Noose]

I was pretty sure, but I decided to come here and ask people who have walked the walk and what to expect. Additionally, I am hoping some of the super-gurus will take a look at these numbers and help me make sense of them. I feel my Dr. is willing to prescribe, but I wanted to help guide him via you guys guiding me - if that makes any sense. I'm not so much nervous as I am ignorant and unsure. I'm going through the forum now trying enlighten myself a bit.
Oh, yeah. I just found out the results of my second test will be available Wednesday.

[Chauffeur]

It looks like you might benefit from TRT, although some more detailed bloodwork before considering treatment would be a good thing. LH and FSH definitely need to be measured. There are some really helpful sticky's at the top of this forum to guide you with bloodwork.

My advice would be to study TRT before making any decisions. Many doctors are ill informed about it, and others don't explain the details to you. There is a lot to learn, and the sticky threads are a great place to start.

Finding a good doctor is also very important. They are not all created equal and the guys here will attest to that. Many are practicing terrible medicine when it comes to TRT.

[Low Testosterone]

Numbers look pretty low, no surprise you're experiencing the symptoms you mentioned. Could there be other factors at play? Possibly, but it's highly unlikely that you do not need testosterone .
It would be helpful to have an LH value.

As far as a prescription, the testosterone itself, how low your numbers are won't determine how much testosterone you need. Some automatically assume that because their numbers are at a certain level this means they need a specific amount of testosterone. But I've seen plenty of guys have their levels sky rocket on a mere 75mg/wk, while others need 200mg to reach the same level and the guy that needed less may have had lower starting levels. This actually happens quite frequently. In my opinion, 100-150mg/wk is often a good place to start along with a moderate dose of HCG . From there retest in 6-8wks and adjust as needed based on how you feel and how you're health is.

[The Noose]

Ok, guys BW just came back. Unfortunately, there is nothing new to report. Everything pretty much remained the same. He did not test for LH or FSH...again. Total test dropped to 140 and free test rose to 5.3 - both still low. I see my Dr. on the 25th when he is checking for prostrate and then, presumably, starting me on therapy. I'm not super confident in his experience with TRT since he didn't order the correct tests for my BW. I guess I'll print a few stickies, take them to him, and cross my fingers. Any ideas, thoughts, concerns, suggestions?

[Chauffeur]

Ok, guys BW just came back. Unfortunately, there is nothing new to report. Everything pretty much remained the same. He did not test for LH or FSH...again. Total test dropped to 140 and free test rose to 5.3 - both still low. I see my Dr. on the 25th when he is checking for prostrate and then, presumably, starting me on therapy. I'm not super confident in his experience with TRT since he didn't order the correct tests for my BW. I guess I'll print a few stickies, take them to him, and cross my fingers. Any ideas, thoughts, concerns, suggestions?

Odd that your doctor didn't feel that it was necessary to draw some more detailed labs. I'd ask him to test a few other things before getting started. There are certain labs that will be useless to test once you start TRT and your HPTA shuts down.

I'd also wager that if he didn't feel that more detailed bloodwork was necessary, his TRT protocols could be kinda scary.

[fastman9]

Although you are likely a candidate for TRT, I'd drop some serious weight first, like 50 pounds and start eating correctly. Let your body get used to the new you before you introduce extra androgen's. Your numbers will be all over the place just from the weight loss alone and will make it hard to get the right protocol for you. In the mean time educate yourself on TRT and approach it when healthy.

[bullshark99]

Some very good advice from chauffeur above, once started there are labs that will be useless because TRT and may be a good idea to have a baseline on prior to starting. Respectfully, not sure I agree with fast man regarding not starting until you lose weight. I see his point however, both mentally and physically you will accomplish your goals ( weight loss, mood improvement, libido and ECT) much quicker and easily if you are a canadate ( which it appears) for TRT.
Remember, TRT is a lifetime commitment, good luck!

[1979 Trans Am]

Hey The Noose,

Welcome to the club, Pal..!

I think your approach is the correct one in joining the forum and asking questions.

Based on the info you have shared, you will need SHBG levels and your PSA checked. It does make a difference in making sure you are indeed a good candidate. Your age alone is a good marker, but the details matter.

Also, fastman9 brings us a very important point - weight loss and how that alone will create additional positive outcomes for you. I would do some research on intermittent fasting to help you understand an effective approach to fat loss that is realistic. Again, this is an idea to consider and I have seen it work quite well for guys in our age bracket.

Regardless of my ideas, make sure you get all the lab details ironed out and well understood. Hope this post is helpful.

Best to you!

[Low Testosterone]

Although you are likely a candidate for TRT, I'd drop some serious weight first, like 50 pounds and start eating correctly. Let your body get used to the new you before you introduce extra androgen's. Your numbers will be all over the place just from the weight loss alone and will make it hard to get the right protocol for you. In the mean time educate yourself on TRT and approach it when healthy.

Respectfully disagree.
What bullshark99 said is correct. If test levels are low enough, fat loss becomes difficult to even impossible without seriously starving yourself and causing more problems for your body. And keep in mind, many men who have low testosterone have experienced larger increases in body fat because of the low testosterone - why punish yourself because of this? Attack the problem on all fronts.

[2Sox]

Respectfully disagree.
What bullshark99 said is correct. If test levels are low enough, fat loss becomes difficult to even impossible without seriously starving yourself and causing more problems for your body. And keep in mind, many men who have low testosterone have experienced larger increases in body fat because of the low testosterone - why punish yourself because of this? Attack the problem on all fronts.

Sensible and wise advice, IMO.

[The Noose]

Thanks for the input guys -all excellent points. As usual, Low Testosterone hit the nail on the head. I dumped the high stress job, really cleaned up my diet (a lot), and started exercising with a purpose and haven't dropped more than 3-4lbs in the last two months. My lifts haven't gone up, my mass is dropping if anything and I'm just as flabby as ever. I've been muscular and 10-15%BF my whole life. The next thing I know I'm a weak grouchy slob that could care less about sex and couldn't finish the deed even if I did. Trust me, I'm busting my ass to get back into shape, but my body just isn't responding.
I'm going to request one more blood test with shbg, lh, fsh, and psa numbers. Hopefully, my Dr. will be open to this. You guys do more for us newbies than you think - thank you!

[1979 Trans Am]

Hey The Noose,

I was reflecting on Bullshark99s and LowT's initial response - and thought I'd share some info that should encourage you.

Childhood friend of mine was in a similar position back in 2012. He had a very stressful job then and felt lousy. Basically, the stress and some issues with his wife got to him. He was 6'2, weighed 250 at the time and actually had fat tits along with the big belly to match it. This was not the guy I knew. Something wasn't right in his life. It seemed everything in his life was a soap opera.

I still remember the phone call. He vented on me for an hour. I told him he needs to get a grip on his health and go see his doctor. He hadn't been to a gym in over 5 years. He went to his PCP a week later and they referred him to another practice that put him on therapy, (Test). Around month 4 or 5, he said he felt so much better. The therapy helped him lose 30 pounds in 4-5 months (he did begin a program at his local gym as well) and he got his confidence back, sorted out the issues with his wife. Seriously, this is not made up. He's still on therapy and now weighs 195lbs, he looks great and is enjoying his life.

By all means, pursue this important matter with vigor, it will only get better! Keep us posted on your outcomes.

[bullshark99]

^^^^outstanding!

[2Sox]

Hey The Noose,

I was reflecting on Bullshark99s and LowT's initial response - and thought I'd share some info that should encourage you.

Childhood friend of mine was in a similar position back in 2012. He had a very stressful job then and felt lousy. Basically, the stress and some issues with his wife got to him. He was 6'2, weighed 250 at the time and actually had fat tits along with the big belly to match it. This was not the guy I knew. Something wasn't right in his life. It seemed everything in his life was a soap opera.

I still remember the phone call. He vented on me for an hour. I told him he needs to get a grip on his health and go see his doctor. He hadn't been to a gym in over 5 years. He went to his PCP a week later and they referred him to another practice that put him on therapy, (Test). Around month 4 or 5, he said he felt so much better. The therapy helped him lose 30 pounds in 4-5 months (he did begin a program at his local gym as well) and he got his confidence back, sorted out the issues with his wife. Seriously, this is not made up. He's still on therapy and now weighs 195lbs, he looks great and is enjoying his life.

By all means, pursue this important matter with vigor, it will only get better! Keep us posted on your outcomes.

Very encouraging post. It's good to read. I think it has many of us look back at our own journeys.

[The Noose]

Thank you, 1979 Trans Am. That story was inspiring. I appreciate that you took the time to post it. I'm very positive about the future and, like Low Testosterone said, I'm going to attack this on all fronts. I think my diet and exercise routine are good. The next piece of the puzzle is to get my sleep schedule under control. For example, it's 2a.m. and I'm up posting this because I can't go to sleep despite being tired and going to bed at 11:45. I very much appreciate the support.

[The Noose]

Hey guys. Apparently, I'm a dumb a$$. After reading every sticky, I went back and checked my labs. I did have my PSA checked on one of the labs.
Prostrate-Specific Ag, Serum .9 (0.0 - 4.0)
...which is good.
I'm still gonna talk to Dr. on Thursday about testing SHBG, LH, and FSH.

[1979 Trans Am]

Sounds good, bud. Glad you have your PSA value.

Let us know how it goes with your Doc!

[The Noose]

OK, guys. I'm officially a member of the club. I went to my GP today and was prescribed 100mg of test cyp every other week. They gave me the first shot IM in hip/glute area today and I am to repeat every other week on my own. He will titrate as needed based on labs. The entire process was covered by my insurance. 0$ copay for visits, $5 labs, and $5 for 10mL of 200mg/mL test cyp. I'm not sure where to get the needles and what size to get. If anyone here can help with that, I would be grateful. Anyway, this was the good news. The bad news is he will not prescribe HCG , period. It was a real dog fight to get the test cyp in the first place as he was only willing to prescribe Androderm. Eventually, I got him to write the test cyp, but he would only write it for 50mg EOW. Then the discussion began again and he wrote the 100mg EOW begrudgingly. He also said that he was uncomfortable with this protocol, as test cyp was old school and more likely to cause various cancers of the liver than a topical. He also said only the older Dr's still use it. Additionally, he mentioned lawyers twice. Indicting he did not want to be sued over using HCG in a way it was not meant to be used. He eventually bent to my will after I signed a statement that he advised me of the dangers of the test cyp and then stated that if I miss even one blood test he would not re-write as he wants to monitor closely. He scheduled my first BW for 2 weeks from today.?. Is this normal? I will only have todays injection to show on the BW. Anyway he wants BW in 2wks, 4wks, 8wks, and 12wks from todays date. I also asked for a referral to an Endo as he is obviously uncomfortable about delving into the black magic that is TRT and I would prefer to be in better hands for this. Thoughts?

[bullshark99]

Well my friend that protocol is not even close. Most people do 100-200 every week, some split it up to twice weekly shots cut in half of course.
No HcG ?? What about an A.I. If needed at some point, at his protocol if sure there is nothing to worry about.
Bottom line you need a new doc. Endo's typically not much better. You may really want to consider the sponser if you can afford it. Remember the purpose is for life, you really want to get this right.

[Beethoven]

^^^^^ Keep the test, dump the Dr. He is obviously in the dark ages, although not as dark as other stories we've heard. You're on the right course but you still need a good Dr. Two weeks on your protocol still is probably too early. Make sure when you do your next BW, be as close to the day you inject for your draw. Don't make the mistake of getting your shot say Wednesday and then BW on Saturday. That would not be a true indicator. Right now, I pin on Tuesday and Saturday. I schedule my BW on Saturday morning BEFORE my shot. Good luck.

[Chauffeur]

OK, guys. I'm officially a member of the club. I went to my GP today and was prescribed 100mg of test cyp every other week. They gave me the first shot IM in hip/glute area today and I am to repeat every other week on my own. He will titrate as needed based on labs. The entire process was covered by my insurance. 0$ copay for visits, $5 labs, and $5 for 10mL of 200mg/mL test cyp. I'm not sure where to get the needles and what size to get. If anyone here can help with that, I would be grateful. Anyway, this was the good news. The bad news is he will not prescribe HCG, period. It was a real dog fight to get the test cyp in the first place as he was only willing to prescribe Androderm. Eventually, I got him to write the test cyp, but he would only write it for 50mg EOW. Then the discussion began again and he wrote the 100mg EOW begrudgingly. He also said that he was uncomfortable with this protocol, as test cyp was old school and more likely to cause various cancers of the liver than a topical. He also said only the older Dr's still use it. Additionally, he mentioned lawyers twice. Indicting he did not want to be sued over using HCG in a way it was not meant to be used. He eventually bent to my will after I signed a statement that he advised me of the dangers of the test cyp and then stated that if I miss even one blood test he would not re-write as he wants to monitor closely. He scheduled my first BW for 2 weeks from today.?. Is this normal? I will only have todays injection to show on the BW. Anyway he wants BW in 2wks, 4wks, 8wks, and 12wks from todays date. I also asked for a referral to an Endo as he is obviously uncomfortable about delving into the black magic that is TRT and I would prefer to be in better hands for this. Thoughts?

Yikes, that is definitely not a good way to start TRT. To be honest, I'd probably hold off until you find a doctor who's willing to prescribe a more reasonable protocol. Youll probably end up feeling worse on than you did prior to TRT.

As for the supplies, you'll need some 1cc syringes, needles, and alcohol prep pads. For glute injections, it seems that most people use either 1" or 1.5" needles. You look like a bigger guy so you may want to opt for the 1.5". I use 25g needles to draw as well as to inject. It takes a bit longer to fill the syringe with such a small gauge needle but it's not a big deal. Many guys draw with a larger gauge needle and inject with a small one to cut down on time. Larger gauge needles may chew up the cap on the vial after multiple draws though.

Swab the top of the vial with an alcohol pad. Pull the same amount of air into the syringe as you'll be drawing out, inject the air into the vial. Draw with one needle, then cap and remove said needle, put a new needle on, clean the injection site, stick the needle in, aspirate to see if there is blood, if no blood, go ahead and inject. Swab the site with an alcohol pad and massage the site with your fingers for a few seconds.

Your pharmacy may carry everything that you need. If not, there are online vendors who sell them. Not sure which one is best since all of my supplies are sent to me by the site sponsor.

[bullshark99]

Listen to Bee above, wait until day 14 before you give blood. The last thing you want is to go in on day 3 or 4 and your T levels are 550 and this Doc says "see, we got you right where we want you". This Dr clearly does not understand what the half life of testosterone is. You may still be naturelly producing but after a few shots you will become shut down. you think you feel bad now, could only imagine what you will feel like toward the end of the 2 week period on this protocol.

[The Noose]

Thanks for the input gentlemen. I was pretty sure this dr. was not going to work out. Unfortunately, I can't afford anything not covered under my insurance. I find out Tuesday if he will write a refferal to an endo. If not, I guess I'll just start calling primary care physicians off my insurance company directory until I find one with some TRT experience. So should I not take any more, take the dose at 2 weeks like he suggested, or take it weekly and then tell him what i've been doing when i go see him for bw results? Damn, this is frustrating!

[The Noose]

Beethoven, I see your in S Florida. If you know of a dr. down there let me know and i'll see if he takes my ins. I don't mind the drive.

[Beethoven]

I have a decent one. What insurance do you have? Maybe it's worth a two and a half hour drive. If you can PM, shoot me one and I'll pass on the details.

[Chauffeur]

Thanks for the input gentlemen. I was pretty sure this dr. was not going to work out. Unfortunately, I can't afford anything not covered under my insurance. I find out Tuesday if he will write a refferal to an endo. If not, I guess I'll just start calling primary care physicians off my insurance company directory until I find one with some TRT experience. So should I not take any more, take the dose at 2 weeks like he suggested, or take it weekly and then tell him what i've been doing when i go see him for bw results? Damn, this is frustrating!

I can see why this is a tough decision for you. It would be hard to walk away from a doctor who's willing to treat you, no matter how crappy the treatment is. You just want to get better, I get that, and I was in your shoes not that long ago dealing with terrible doctors.

I re read your post and saw that your doctor is willing to titrate until you achieve the desired effect. That might not be a terrible thing if you can educate him on current TRT research and protocols by showing him some studies. I'd understand if he wanted to start on 50mg EW (still bad, but I can understand the desire to start low and titrate up) but 50mg E2W is completely insane.

[Beethoven]

I can see why this is a tough decision for you. It would be hard to walk away from a doctor who's willing to treat you, no matter how crappy the treatment is. You just want to get better, I get that, and I was in your shoes not that long ago dealing with terrible doctors.

I re read your post and saw that your doctor is willing to titrate until you achieve the desired effect. That might not be a terrible thing if you can educate him on current TRT research and protocols by showing him some studies. I'd understand if he wanted to start on 50mg EW (still bad, but I can understand the desire to start low and titrate up) but 50mg E2W is completely insane.

If he is willing to titrate you up then it will take a bit longer. Once he does BW at 50 mg EOW he will see you are in the tank. Stay with him until you find the other one. Patience, you'll get there.

[The Noose]

Thanks Beethoven - can't PM yet though. The insurance is Coventry. He has me on 100 eow so I guess I'm going to just do 50 ew, but I still have to find someone new as he will "never" prescribe hcg or adex. I guess worse case is go to one of the big anti-aging clinics here and pay for the visit out of pocket, but still use my insurance for labs and pharmacy. Not sure what that would cost or if they even work that way, but still on the table.

[bullshark99]

I use a clinic S Florida, you would have no issue whatsoever very reputable. They allow insurance use for all blood work but you do Ned to pay out of pocket for product from compounding pharmacy. I'll try to pm you, don't no if have enough posts?

[Beethoven]

I don't think he has enough yet. If you're going to pay out of pocket, I would go with low testosterone .com. $200 a month for everything isn't bad at all.

[1979 Trans Am]

Definitely listen to the advice from several people on this forum as they have been there done that.

I don't think your T dose is high enough either; and our doctor is fearful because he's probably not educated correctly on HRT's long term benefits.

That's what chaps me the most about physicians: they are willing to do things their way, even though deep down they know they are not now well versed in the practice, and create insufficient protocols while taking your money. You've gone this far - don't settle.

If you are not 100% confident in this provider, then find someone else ASAP.

I had a similar experience with my PA as he has no issue raising up my T levels, but made it clear he was not comfy with HCG . I told him to get educated about it or I will move forward with another provider (thanks Chauffeur!) and when I visited him this week, he said he talked it over with his colleagues and thinks HCG is a reasonable protocol based on my condition. They called it into the pharm and next week I will be using HCG in addition to my weekly Test Cyp 120mp IM.

[2Sox]

Thanks Beethoven - can't PM yet though. The insurance is Coventry. He has me on 100 eow so I guess I'm going to just do 50 ew, but I still have to find someone new as he will "never" prescribe hcg or adex. I guess worse case is go to one of the big anti-aging clinics here and pay for the visit out of pocket, but still use my insurance for labs and pharmacy. Not sure what that would cost or if they even work that way, but still on the table.

You may want to consider another alternative; ask this doctor to prescribe Androgel . I can't see how he could refuse since pharma and advertising are constantly bombarding all of us making it more acceptable. This will keep your numbers up and feeling good and give you time to find another doctor. And from my knowledge the monthly co-pay is bearable. And if you respond well to gel, it's really pretty good.

When you get enough posts here, we can give you the links to the places from which we get hCG and, if needed, Aromasin or Adex.

[The Noose]

Thanks for the input guys. Everytime I post something, I can't wait to get home and check out your responses. So much knowledge here. I'm going to venture out onto other forums on the site and bring my post count up - really interested in finding where to get HCG . I've decided to set an appointment with a new primary on Monday. He is very highly rated and works at a family and sports medicine center. If he pulls the same act, I'm going to call More T here in Orlando and see if they'll write the protocol and let me use my insurance for pharmacy and labs.

[1979 Trans Am]

Hey Noose,

Good stuff, isn't it? Lots of support and knowledgeable folks here.

Keep us posted!

[The Noose]

OK guys. I just went to Dr. today for BW results. They weren't good. My Test has dropped again from 158 in July to 140 in Sept to 94 in October. Why is it falling so fast in such a short period of time?
Here were the results from Labcorp:
Testosterone Serum 94 348-1197
Free Testosterone 3.1 6.8 - 21.5
Lh .3 1.7 - 8.6

Everything else was fine.
He said that since my test levels had actually decreased despite having injected 100mg of test cyp, coupled with the rate od decrease (158 to 94 in 2.5 months), along with my abnormally low Lh that I may have a tumor affecting my pituitary gland! Holy shi$! Is he kidding? I am supposed to go have a scan next week to verify this. I thought this was a stressful process before, but now I'm freaking out. Thoughts, theories, experiences? Anything for me to research or hold on to?

[The Noose]

Sorry, I forgot to mention that he doubled my dose from 100mg E2W to 200mg E2W, but still doesn't want me to split it in half and take weekly.