Normal to "test" level of response prior to TRT

[LikeAMachine]

Hey guys-

I was "profoundly low T" per my doctor, two years ago I tested at 247, this year I was in the hundreds. I'm only 33 so obviously this was a concern for me, my wife etc. My doc had me inject 300mg test-e this past Tuesday. I feel better after just the third day, not sure if placebo or not.

Anyway, my question is, is it normal to sort of test your response prior to starting a program? For example my doc had me inject this past Tuesday 6/23 and in two weeks wants blood tests done to test my response. Then re-inject at 3 weeks and go see him in 4 weeks. At that point we will determine what dose he wants me to start taking regularly. Is this normal?

[kelkel]

First, did you doc determine what is causing your test to be low? There's normally a causative factor and your doc's efforts should be to find it and correct it.
There's no need to "test your response" as if it may or may not work. It's testosterone and will raise your T levels effectively. Some docs will front load their first injection but we're talking 200 mgs. 300 is a bit much, imho.

It doesn't seem like your doc understands the half-life of testosterone, which is about 5-7 days metabolism dependent. Terminal life would be 14 to 18 days or so depending on the ester injected. Average starting dose would be about 100 mgs per week. You need consistency and time to properly determine a viable dosing protocol and blood work should be used to do this at about the 6 week mark.

Do you have BW you can post up? Love to see it and see what he may be missing. Did he even discuss what may be causing your low T? If not, you should have issues with that....

[bigdil511]

This whole plan is off. Your hormones are going to be completely out of whack on this protocol. Normal trt doses are 2x per week at the very least once a week due to the half life of the t you will have more balanced hormones splitting the dose twice a week. Usually you run 6 weeks on trt and than do blood work. A typical starting dose is 100 per week and than titrate up based on your blood work. I'm really not sure if your doc understands hormones that well.

[LikeAMachine]

Yeah, it seemed odd to me as well. I may have to find another doctor. What a pain in the ass, I finally got to the point where I could start the program I need and the guy doesn't know what he is doing. Starting over seems daunting.

[kelkel]

You don't necessarily "need" a program at all. You need to find the cause and fix it if possible. TRT is a great thing if and when it's needed, but no one wants to be on it a decade or so before it's necessary....

[APIs]

OP may not have to start over. If Doc is willing to listen, you can politely educate him on what he is missing. You should read-up on all the stickies on the first page and bring this info to him. He can always discuss it with one of his colleagues that may be more informed for verification. That would be the plan anyway...

[LikeAMachine]

First, did you doc determine what is causing your test to be low? There's normally a causative factor and your doc's efforts should be to find it and correct it.
There's no need to "test your response" as if it may or may not work. It's testosterone and will raise your T levels effectively. Some docs will front load their first injection but we're talking 200 mgs. 300 is a bit much, imho.

It doesn't seem like your doc understands the half-life of testosterone, which is about 5-7 days metabolism dependent. Terminal life would be 14 to 18 days or so depending on the ester injected. Average starting dose would be about 100 mgs per week. You need consistency and time to properly determine a viable dosing protocol and blood work should be used to do this at about the 6 week mark.

Do you have BW you can post up? Love to see it and see what he may be missing. Did he even discuss what may be causing your low T? If not, you should have issues with that....

I have my bloodwork from 2 years ago I can post however, I don't have the recent, it never posted to my online account, so yeah I think we have some issues with this doc. This is an Ohio State University Doctor, so I feel as if I am good hands, or felt. I just requested a copy of the bloodwork I had done a few weeks back, I'll come back and post that once I get it.

Here is from 2 years ago and in speaking with my doctor I am significantly lower than this now.
ESTRADIOL, ENHANCED 0.0 - 39.8 pg/mL 29.1
ALBUMIN 3.4 - 4.8 g/dL 4.6
SEX HORMONE BINDING GLOBULIN,SER 10 - 57 nmol/L 20
TESTOSTERONE 241 - 827 ng/dL 247
ESTRADIOL, SERUM 25
LH 8.5
FSH 3.1


We did have discussions about the causes or what the issue might be and he determined it to be hypogonadism.

[LikeAMachine]

OP may not have to start over. If Doc is willing to listen, you can politely educate him on what he is missing. You should read-up on all the stickies on the first page and bring this info to him. He can always discuss it with one of his colleagues that may be more informed for verification. That would be the plan anyway...

I definitely read all of the stickies before I went in to see my doctor, that's why I am questioning his method.

[kelkel]

I have my bloodwork from 2 years ago I can post however, I don't have the recent, it never posted to my online account, so yeah I think we have some issues with this doc. This is an Ohio State University Doctor, so I feel as if I am good hands, or felt. I just requested a copy of the bloodwork I had done a few weeks back, I'll come back and post that once I get it.

Here is from 2 years ago and in speaking with my doctor I am significantly lower than this now.
ESTRADIOL, ENHANCED 0.0 - 39.8 pg/mL 29.1
ALBUMIN 3.4 - 4.8 g/dL 4.6
SEX HORMONE BINDING GLOBULIN,SER 10 - 57 nmol/L 20
TESTOSTERONE 241 - 827 ng/dL 247
ESTRADIOL, SERUM 25
LH 8.5
FSH 3.1


We did have discussions about the causes or what the issue might be and he determined it to be hypogonadism.

Well, looking at your LH level here and assuming it's a normal Labcorp type range it's at the top of the scale. This would indicate the problem is primary in nature, meaning that your testicals are not responding to the ramped up stimuli (LH) from the pituitary gland.

Have you suffered any testicular trauma?
Have you been examined for varicoceles?

[LikeAMachine]

Well, looking at your LH level here and assuming it's a normal Labcorp type range it's at the top of the scale. This would indicate the problem is primary in nature, meaning that your testicals are not responding to the ramped up stimuli (LH) from the pituitary gland.

Have you suffered any testicular trauma?
Have you been examined for varicoceles?

No I have no suffered any trauma to my testes that I can remember. Yes, he did examine me for Varicoceles, he has felt up my balls more times than I would like to admit, ha.


I also had an MRI done, everything came back normal with my pituitary gland and brain stem.

[kelkel]

Well, I'm glad he did in fact examine you for it. Shows he's thinking! Good luck with your protocol and please update this thread with your progress. And welcome to the forum.

[LikeAMachine]

Thanks, I'm not sure his protocol is the right way to go, but I'll talk to him when I see him again. He was very reluctant to put me on TRT to begin with being that I am so young, so we tested for everything. I kept hearing it over and over again, too young, too young, too young. I feel like I've been dealing with this for a lot longer than just 2 years.

Thanks again, I'll update when I know more.

[kelkel]

Age is irrelevant if there's a legitimate issue that's not correctable. Ask him what he'd do it it were him? The testosterone you're injecting is the exact same thing as your body produces. No difference. Just make sure you monitor your BW properly. The second set of BW in the Finding A Doc sticky is good for your follow up.

Continue to educate yourself before your next appointment. Write down questions and take them with you so you don't forget anything. And make sure your protocol is at least weekly. Anything else is not acceptable. Do not assume that doctors automatically know hormones as they receive almost no training in them in med school. That said, do your homework!

[LikeAMachine]

I went back for bloodwork today. Next Tuesday I am supposed to "Re-inject". It's been two weeks (6/23/2015) since my last injection. I felt like a different person the first week, now I feel pretty much back to "normal". I am not sure how much was placebo and how much the Test-E actually affected me.

After doing more homework, this protocol is definitely not right. The problem is, do I deviate from what the Doc told me to do now, meaning start injecting weekly? Or do I stick to his plan, wait it out and have a more detailed conversation with him 7/21/2015?



Here are the questions I have for him, including the documentation of the study provided in the "things your doctor should know" sticky.


• Should I be taking HCG ?
o Human chorionic gonadotropin (HCG)- to increase sperm count lowered by TRT?


• Recent publications and Low T centers suggest dosing once a week
o 100-200mg depending on necessity. This is the protocol I want to be on.


Anything else?


Thoughts?

[LikeAMachine]

My test results from my bloodwork done about a month ago.


TESTOSTERONE

108 (L)

241 - 827 ng/dL

Final





TESTOSTERONE, FREE

3.12

3.00 - 29.00 ng/dL

Final





TESTOSTERONE, % FREE

2.89

1.3 - 3.5 %

Final





SEX HORMONE BINDING GLOBULIN

12.3

10 - 57 nmol/L

Final

[LikeAMachine]

I had a talk with a Low T clinic yesterday. I am just going to proceed with this doctors plan, for now. Next week I’ll inject and talk to him the following week. He is a urologist (originally I went for ED issues) so I think a low T clinic is going to be a better route for me long term.

[LikeAMachine]

I lied. Funk that, I went to the LowT clinic, had bloodwork done....I was even lower than before....97 ng/dl

Starting treatment, HCG being ordered.

LowT clinic started me at 140mg a week, bloods in 90 days.

[kelkel]

Sorry I missed your updates LAM! Be careful at 140 per week. May be a bit high to start. Keep an eye on your E2 and see if you can pull BW in 8 weeks, not 12.

[LikeAMachine]

Sorry I missed your updates LAM! Be careful at 140 per week. May be a bit high to start. Keep an eye on your E2 and see if you can pull BW in 8 weeks, not 12.

I took your advice and essentially ditched my Urologist. I went and saw a LowT clinic, they had such a better understanding and basically just shook their heads at 300mg every 3 weeks. They said it was pretty common to have GP or other doctors not really know or want to deal with LowT. Said a lot of guys end up there because they are getting shots but still feel like crap because it's not enough ot not frequent enough.


140 might be high, but I am as 97 ng/dl, I'll be reassessed soon.

Thanks for all of your help and your responses. I feel like I am finally on the right track.

[kelkel]

I totally understand. Just know that with TRT less is actually more. Meaning the less you can use and feel good (numbers aren't everything, just a guide) the better you will be long term. Less or hopefully no need for AI's, blood donations, etc. Always best to start low and ramp up based on future BW. And I know how you feel. I was down to a 59 T level.

Post up your first set of BW please on this thread.

[LikeAMachine]

I totally understand. Just know that with TRT less is actually more. Meaning the less you can use and feel good (numbers aren't everything, just a guide) the better you will be long term. Less or hopefully no need for AI's, blood donations, etc. Always best to start low and ramp up based on future BW. And I know how you feel. I was down to a 59 T level.

Post up your first set of BW please on this thread.

I need

[LikeAMachine]

I need

25 posts

[LikeAMachine]

25 posts

So that

[LikeAMachine]

So that

I can post

[LikeAMachine]

I can post

My lab results.

[LikeAMachine]

I totally understand. Just know that with TRT less is actually more. Meaning the less you can use and feel good (numbers aren't everything, just a guide) the better you will be long term. Less or hopefully no need for AI's, blood donations, etc. Always best to start low and ramp up based on future BW. And I know how you feel. I was down to a 59 T level.

Post up your first set of BW please on this thread.

Here are my lab results.

[kelkel]

Don't see TT or FT?
TSH is way high. You need further thyroid tests done. Modern range for TSH is .3 - 3.0
Add some NAC to your protocol to help with liver values.

[LikeAMachine]

Don't see TT or FT?
TSH is way high. You need further thyroid tests done. Modern range for TSH is .3 - 3.0
Add some NAC to your protocol to help with liver values.

Total T and Free T are left to right in the first image. Assuming that's TT and FT, TT= 94.7 and FT= .83

What is NAC? Oh the concentrated Veggies, yeah the center mentioned that.

I will be going back to review all these results next week.

[LikeAMachine]

I am taking notes to talk to the doctor. Thanks so much, I'll ask him about additional tests on my thyroid for my high TSH levels, and who I need to see. I will also ask about getting NAC.

Again, this has been very helpful, more helpful than any of the doctors I went to over the past 4 years.

[kelkel]

Still don't see them.
NAC is for liver support. Very healthy thing to take.
For thyroid you may want to look at TSH, FT3, FT4, RT3 and antibodies.
Take a look at Stop the Thyroid Madnessâ„¢ - Hypothyroidism and thyroid mistreatment
Don't settle for your TSH is "in range" bullshit. Read that link.

Glad to help.

[LikeAMachine]

Still don't see them.
NAC is for liver support. Very healthy thing to take.
For thyroid you may want to look at TSH, FT3, FT4, RT3 and antibodies.
Take a look at Stop the Thyroid Madnessâ„¢ - Hypothyroidism and thyroid mistreatment
Don't settle for your TSH is "in range" bullshit. Read that link.

Glad to help.

Total 94.7 ng/dl
Free 0.83 Mg/ml


Will definitely be asking about the thyroid stuff.

[mussina123]

Still don't see them.
NAC is for liver support. Very healthy thing to take.
For thyroid you may want to look at TSH, FT3, FT4, RT3 and antibodies.
Take a look at Stop the Thyroid Madnessâ„¢ - Hypothyroidism and thyroid mistreatment
Don't settle for your TSH is "in range" bullshit. Read that link.

Glad to help.

How much of NAC/daily do you recommend?

[kelkel]

600 daily is fine off cycle. Read this:

Essential Supplements, for those of you who don't like to supplement too much

On injectable only cycle I'd do about 1200. With orals added I'd double it.

[LikeAMachine]

600 daily is fine off cycle. Read this:

Essential Supplements, for those of you who don't like to supplement too much

On injectable only cycle I'd do about 1200. With orals added I'd double it.

Two questions Kel.

1. Who should I go to to test for Hypothyroidsim?

2. Can I just buy NAC liver support online, like at amazon or is that not legit? Script?

[kelkel]

1. Any doc who knows hormones. Title does not matter. Use the BW in the Finding A Doc Sticky at the top of this forum.
2. Yes. No script required. Amazon has it as does the site sponsor.

[LikeAMachine]

1. Any doc who knows hormones. Title does not matter. Use the BW in the Finding A Doc Sticky at the top of this forum.
2. Yes. No script required. Amazon has it as does the site sponsor.

Thanks again, your help has been invaluable. I'll report back when I speak to the doc about the TSH levels this week.

[LikeAMachine]

Discussed my TSH levels with my LowT center doc. I setup a time to get tested for Hypothyroidism with my normal doctor, does that sound right? I thought they would be able to do that at the LowT center?

[kelkel]

It's not their area of expertise so no, I would not expect them to dive into it.

[LikeAMachine]

It's not their area of expertise so no, I would not expect them to dive into it.

OK cool, thanks Kel. I'll go talk to my GP first and see if he wants to send me to a specialist.

[LikeAMachine]

Also-

Today was only my third dose. I know that you're not supposed to feel anything right away, but it's like fireworks going off in my body. The first time I thought it was likely placebo, the second time was 3 weeks removed from the first and I felt the same. I played softball on Tuesday and felt like I could go workout directly after, I haven't felt like this since at least my teenage years.

The only time I have been truly grouchy or irritable was that third week after my original shot when I decided to go see the LowT center at Kels advice, got tested and sure enough 94 ng/dl was why. My mood is night and day.

If this is a sign of where I was and where I am going, I have been walking around as a shell of myself for at minimum a decade. I lost 3 pounds last week and did nothing to earn that except play softball a couple of times. My focus is elevated, I used to drink 3 coffees a day and want to go to sleep when I got home. Now I drink 1 cup of coffee and I all but get the jitters from it. Sex drive hasn't come back fully yet though, which is why i started this to begin with but I know that takes time.


Again, I know I shouldn't and maybe I am in a very small percentage, but I feel fantastic.