Blood work help

[RedBeardedViking]

Hi all,

I am 35 years old, this is my first post, i have been lurking since getting involved and getting a referral to an Endocrinologist since my Test levels and sign are showing low results.

I am currently in the Military and don't have many options when being referred out to a doctor. It took me a year a new doctor and 3 different BW to get sent out.

it started when i was experiencing gyno in me right breast.

10 Mar 2014
Testosterone , Serum or Plasma Quantitative 315.70 ng/dL Reference Range 249-836
I was told all was great.


My new doctor sendt me for testing again this year.
27 May 2015
Testosterone, Serum or Plasma Quantitative 214.20 ng/dL Lower Than Normal Reference Range 249-836.
said i was low and wanted more testing done.

18 Jun 2015
Testosterone, Serum or Plasma Quantitative 280.9 ng/dL Lower Than Normal Reference Range 348.0-1197.0

Testosterone.Free, Serum or Plasma Quantitative 7.53 ng/dL Reference Range 5.00-21.00

Testosterone.Free/Testosterone.Total, Serum or Plasma Quantitative 2.68% eference Range 1.50-4.20.

I went to the doctor because my mood had plummeted, always tired ( falling asleep as soon as getting home from work), no sex drive, irritable, would not get fully erect or morning wood and no more ejaculation just more of a dribble. Wrists hurting and having trouble supporting my weight doing push-ups. I was referred to an Endocrinologist.

Endo took a quick look at my test BW and said nothing wrong with you, I got mad and said i wouldn't be here unless there was, and my life is draining me. He said to get more blood work after he checked my testicles and gyno.

23 Jul 2015
Testosterone, Serum or Plasma Quantitative 285.5 ng/dL Lower Than Normal Reference Range 348.0-1197.0

Testosterone.Free, Serum or Plasma Quantitative 6.25 ng/dL Reference Range 5.00-21.00

Testosterone.Free/Testosterone.Total, Serum or Plasma Quantitative 2.19% Reference Range 1.50-4.20.

Estradiol, Serum or Plasma Quantitative 5.6 pg/mL Lower Than Normal Reference Range 7.63-42.6

Lutropin, Serum or Plasma Quantitative 3.77 IU/mL Reference Range 1.7-8.6

Prolactin, Serum or Plasma Quantitative 12.3 ng/mL Reference Range 4.04-15.2

Dehydroepiandrosterone Sulfate, Serum or Plasma Quantitative 150.3 mcg/dL Lower Than Normal Reference Range 160.0-449.0

Follitropin, Serum or Plasma Quantitative 3.2 mIU/mL Reference Range 1.5-12.4

Choriogonadotropin, Serum/Plasma Quantitative <2.39 mIU/mL

Cortisol, Serum or Plasma Quantitative 13.1 mcg/dL

Sex Hormone Binding Globulin, Serum or Plasma Quantitative 25.3 nmol/L 16.5-55.9

I have another appointment with this doctor in 2 weeks, I am not really looking forward to see him after the last visit and how he represented himself, I called his office today and asked if there is anything that he is looking to treat me for or if i am going in for him to say that nothing is wrong with me again.

I am clue less here and would greatly appreciate some help from the TRT vets in here, maybe there isnt something wrong with me but my body is telling me different, maybe the doctor doesn't want to touch low test and giving me the run around. What are somethings I should go in armed with for my next appointment or should a run from this doctor?

[Juced_porkchop]

if you go in and he doesnt respect the fact you want to be on the upper end of the scale and not the bottom (being its your body) i would go see a new doc and bring the results you already have ( he will prob want do his own tests also, but still )

[Juced_porkchop]

ohh welcome to the forum! just noticed that was your first post!! : D

[PersuAsian]

I feel your pain brutha! I went through a couple of doctors to help with my issues as well. I ended up more frustrated with these docs as I continued to educate myself in this forum. An endo you would think has a better understanding of hormones, but that simply isn't always the case. My experience with an endo was the worst of all of the doctors. I fortunately am working with a new doctor that seems to be on top of everything. I took in the blood work that all of the rest of the doctors said was normal and recognized that for my age of 36 it was pretty low. I did some of my own self medicating before I saw him, and he actually wasn't too upset about it and even said he probably would have started me on a similar protocol if he had seen me with the numbers earlier. Now I am getting my blood pulled in a few weeks to see where I settled in.

I am sure that some of the vets will weigh in on your situation. Great first post though, you can tell you have been lurking. If you can find an A4M certified doctor you are bound to get some better answers. They are very well educated in this area. If there is a lowtestosterone.com center around you, you may want to think about that as well.

[RedBeardedViking]

I live in NY and there are no locations near me, I am covered throught the Military and I cannot self medicate or i would risk getting kicked out, I am to close to retirement for that. Thank you for your input, I am looking for feedback if i am a candidate for TRT and need to find a doctor that feels comfortable around TRT.

[RedBeardedViking]

Endo called yesterday and said all levels are normal. I have an internal Med doctor that wants to treat me for a month and see where that leads because she does not agree with my levels being normal.

[kelkel]

Endo called yesterday and said all levels are normal. I have an internal Med doctor that wants to treat me for a month and see where that leads because she does not agree with my levels being normal.

Normal? That's ridiculous and always amazes me.

Couple things:

They're using an older testosterone scale. More modern scale is 348 - 1197.
Make sure this new doc looks hard at your cortisol, prolactin and I'd get a full thyroid panel. Hypothyroid is a major cause of hypogonadism. All these things when elevated can suppress your LH levels, which are on the lower end, thus low testosterone .
Implore your new doc to find the cause of your Low T. Not just band aid it with TRT unless all potential causes are ruled out and it's determined to be idiopathic.
Many things can cause Low T such as the above mentioned items as well as pathologies, trauma (head - testicular) etc.

[RedBeardedViking]

Kelkel,

I was waiting for your input, thank you. There were more blood tests for thyroids as well as lymes, I will make sure to bring this to the new Doctor my wife is seeing for thyroid issues. I just want to get back to feeling normal and not feeling like crap anymore, the Army tends to just give you 800mg Ibuprofen and tells you to drink water.

[kelkel]

Update this thread with your progress please.

[RedBeardedViking]

sure will keep it updated. I appreciate your input Kelkel.

[RedBeardedViking]

Normal? That's ridiculous and always amazes me.

Couple things:

They're using an older testosterone scale. More modern scale is 348 - 1197.
Make sure this new doc looks hard at your cortisol, prolactin and I'd get a full thyroid panel. Hypothyroid is a major cause of hypogonadism. All these things when elevated can suppress your LH levels, which are on the lower end, thus low testosterone .
Implore your new doc to find the cause of your Low T. Not just band aid it with TRT unless all potential causes are ruled out and it's determined to be idiopathic.
Many things can cause Low T such as the above mentioned items as well as pathologies, trauma (head - testicular) etc.

I just remembered I had some trauma to my testicular 1 1/2 half ago and it was after the 1st BW, I wounder if it could be possible to drop that low just because of that. My good friend punched me damn good in the testicles on 4th of July, It was a good thing i had just got my wife pregnant with our last child.

[kelkel]

My good friend punched me damn good in the testicles on 4th of July,

Good friend? Think I'd have broken his nose as soon as my stomach ache was over.

[RedBeardedViking]

Finally had my first appointment with my new doc. I brought in all my blood work and she looked at it and asked me what my problems were, much better than the last doc i seen. She ended up putting me on a cream for 2 months and then get blood work to see where my levels are. I wasn't happy about getting on a cream due to that I am always around my young kids, she said that she isn't really allowed to prescribe the injections without the Endo giving the ok. For right now I am just happy and feel like I am heading in right direction.

[kelkel]

Couple things:

The doc had no interest in trying to find the cause?
Not allowed to prescribe injections? WTF. She's a doc isn't she?
I honestly do not think you're on the right track. The right track would have been finding the issue and resolving it. Maybe it is just "your time" for TRT and the cause is idiopathic. But what if it's not and you spend 10-15 years dealing with an issue (TRT) that you really didn't need to?

[RedBeardedViking]

Kel,

she is a Nurse practisioner but deals with TRT patients. She looked at all of my blood work i had drawn for Test and thyriod. she asked me of my symptoms. I think she just put me on the gel temp to see if i feel better in 2 months when i get back and see how my BW looks and then see the Endo to see if i should go on injections and to make sure its not something else. I wouldnt want to get on TRT and find out the issue was something else.

[kelkel]

I think she just put me on the gel temp to see if i feel better in 2 months when i get back and see how my BW looks and then see the Endo to see if i should go on injections and to make sure its not something else. I wouldnt want to get on TRT and find out the issue was something else.

Red you're not understanding me. You are now on TRT. The gel is a form of testosterone , no less, no more. Gel's, pellets, creams, injections it's all testosterone just different delivery systems. It's going to shut your natural production down.

[RedBeardedViking]

Kel, I understand what you are saying but what i meant was if this treatment doesnt get me back to feeling normal then I abviously need to look at other underlying issues, 8 weeks of TRT should not be enough to shut down my system from producing what little amounts of T it already is. The Endo found no issues with my thyroid from the tests he did and neither did the Nurse that deals with Thyroid and low test. I could post all my blood if you want to take a look at it, maybe you see something that needs to be addressed.

Right now I feel this is what is best for me, I am so tired of living in a cloud of smoke and have forgot what it is to feel normal and have energy to play with my kids again. My quality of life has been suffering for far to long.

[bigdil511]

Kel, I understand what you are saying but what i meant was if this treatment doesnt get me back to feeling normal then I abviously need to look at other underlying issues, 8 weeks of TRT should not be enough to shut down my system from producing what little amounts of T it already is. The Endo found no issues with my thyroid from the tests he did and neither did the Nurse that deals with Thyroid and low test. I could post all my blood if you want to take a look at it, maybe you see something that needs to be addressed. Right now I feel this is what is best for me, I am so tired of living in a cloud of smoke and have forgot what it is to feel normal and have energy to play with my kids again. My quality of life has been suffering for far to long.

8 weeks of trt will absolutely shut down your system.

[kelkel]

I absolutely understand how you must feel. Most of us have been there.
But yes, 8 weeks will shut you down and honestly it may take months to dial in your protocol to where you feel good and Test / estrogen are squared away.
Just be patient, you'll get there. Post up your first labs (on TRT) when you pull them which should be in about 6-8 weeks. Like to see how you make out.

[RedBeardedViking]

I will post up the follow up, Thanks for the advice and knowlege shared on this board.

[RedBeardedViking]

Update.

so after the first four days I started to feel great, I started to have energy to go workout everyday. All in all i am feeling much better, I did my 8 weeks BW wednessday last week and went in for a follow up today.

I wasnt sure if I was to apply the tropical cream before the BW so I didnt(still not sure on the process). Today i got my results and my total T was 52.9 estrogen was non existent, I am going to the Endo tomorrow and I will try to get on injections along with HCG .

[kelkel]

Get a copy of your BW and post it up please. Start maintaining your own file of BW as well.

[RedBeardedViking]

Kelkel,

attached is the BW i had done without applying any cream for that day. I have an appointment with the Endo tomorrow which I wanted anyway to see if I can get injections and start HCG .

[kelkel]

After 4 days your "feeling great" is just a placebo effect. Especially when you see your BW. The "cream" you are applying is not working for you. Some people simply don't absorb them well. And getting your BW without putting the cream on ahead of time is the appropriate way to do it. It gives you your trough level.

You need to change protocols immediately. I would not agree to simply adding more cream. Remember, if your in the states Aveed is now available. Do some research on it and be prepared to ask questions. Write them down!

Seriously, how do you feel?

[RedBeardedViking]

I was feeling ok on the cream or at least better than before. I went to the Endo today and she said we could try other creams until we found one that worked, I told her no and that I would prefer injections. She wrote me a Test C script for 100mg a week and said we will adjust it from there and also address the HCG if my insurance covers it. picked up the script and brought it to the other office for the RN to inject me, the pharmacy F#cked my script and put 50mg a week but gave me much more supply than a months worth. I told the RN what the Dr scripted me and she tried contacting her but could not be reached, she filled the syringe with .25ml and told me to pinch my thigh and stab the needle in there which i did. I am now waiting to hear back that the script got messed up and maybe ill just split the dose every 3.5 days at 50 mg.

[kelkel]

You will see a difference at 100 mgs per week. Obviously, splitting the dose is a great idea, imho. If possible pull some BW in about 6 weeks once on your full 100 mg dose.

[RedBeardedViking]

I got a call back and the pharmacy did mess up my script but on the plus side they gave me 2 months worth of test c 200mg per ml. I was told that I could just inject myself with the rest of the script tonight which I will just do in 3.5 days instead to get a more even distribution. I have another follow up with the endocrinologist in 3 months and in the mean time I will see the nurse practitioner who will fill my script monthly since I am in NY and I will ask her for BW after a month to see how it's working out.

[Juced_porkchop]

Kel, I understand what you are saying but what i meant was if this treatment doesnt get me back to feeling normal then I abviously need to look at other underlying issues, 8 weeks of TRT should not be enough to shut down my system from producing what little amounts of T it already is. The Endo found no issues with my thyroid from the tests he did and neither did the Nurse that deals with Thyroid and low test. I could post all my blood if you want to take a look at it, maybe you see something that needs to be addressed.

Right now I feel this is what is best for me, I am so tired of living in a cloud of smoke and have forgot what it is to feel normal and have energy to play with my kids again. My quality of life has been suffering for far to long.

I dont think you understand you wont KNOW or FEEL the underlaying issue if you are on cram or injections!
you need to stay at feeling a bit crappy for a little bit, trying other options before going on trt. ofcourse on TRT you will start to feel better, but thats ignoring other possible cause then it just being of age to start trt. the fact you mention the punch in the nuts tells me maybe you should go back to her and tell her before you start any creams or injections you wan to check a couple other avenues.

yes you will feel better on trt/hrt but that doesnt mean you actually found the cause. I think thats what kelkel was trying to stress.

if you are going to stay on hrt then hey... fuk it then i guess.. just know you could have potentially avoided having to deal with it for another 5-20 years is all...
i would even try clomid for a few months before jumping to hrt. although its not what i did in past...

[Juced_porkchop]

Kel, I understand what you are saying but what i meant was if this treatment doesnt get me back to feeling normal then I abviously need to look at other underlying issues, 8 weeks of TRT should not be enough to shut down my system from producing what little amounts of T it already is. The Endo found no issues with my thyroid from the tests he did and neither did the Nurse that deals with Thyroid and low test. I could post all my blood if you want to take a look at it, maybe you see something that needs to be addressed.

Right now I feel this is what is best for me, I am so tired of living in a cloud of smoke and have forgot what it is to feel normal and have energy to play with my kids again. My quality of life has been suffering for far to long.

8 weeks is... a few weeks is.. shut down will start as soon as you get elevated levels..

[RedBeardedViking]

I dont think you understand you wont KNOW or FEEL the underlaying issue if you are on cram or injections!
you need to stay at feeling a bit crappy for a little bit, trying other options before going on trt. ofcourse on TRT you will start to feel better, but thats ignoring other possible cause then it just being of age to start trt. the fact you mention the punch in the nuts tells me maybe you should go back to her and tell her before you start any creams or injections you wan to check a couple other avenues.

yes you will feel better on trt/hrt but that doesnt mean you actually found the cause. I think thats what kelkel was trying to stress.

if you are going to stay on hrt then hey... fuk it then i guess.. just know you could have potentially avoided having to deal with it for another 5-20 years is all...
i would even try clomid for a few months before jumping to hrt. although its not what i did in past...

I told her and the Endo about the hit in the balls, none of the blood tests shows a cause, I am also getting scanned for my pituritary. attached is my complete blood work requested by the first Endo that claimed nothing was wrong with me.

[RedBeardedViking]

when i go back for my BW again when would be the best time to pull them? should I go before on the day I am pinning? Also are there any reasons why the cream doesnt work for some people, could metabolism play a role? I was feeling ok on the cream but according to the BW I was crashing between applications.

[RedBeardedViking]

had an appointment with my GP so i asked him to pull BW for E2, T test and Free test after 7 days of my pin. I am still not feeling good but i think that is because my E2 is running on the higher side, I dont have the bloating symptoms but my nipples are sensitive. I am positive I am more prone to gyno since I got it during puberty.

I am currently pinning 100mg a week.
Estradial 46.5 (7.63-42.6)
Test 802.2 (348-1197)
Free test 28.48 (5-21)

I asked to have the sensitive estradiol test done but i am not familiar with the range and not sure if i was tested correctly. I am not scheduled to have full BW done with my Endo until end of Jan but i think i might have to go in earlier before my Gyno gets out of control, hopefully i will get some AI.

[RedBeardedViking]

Just got my blood test done last week a week after injection, not sure what is off but i am feeling as shitty as I did before TRT. I am real moody lately and not so nice to my wife, just feeling like crap in general.

doing weekly injection of Test E 100 mg no AI or anything else.

Kelkel any advice appreciated

[RedBeardedViking]

***** update*****

I have been on this forum from the day I registered trying to read up and educate myself as much as possible.


I have been on for 13 weeks now (Test C 100 mg/ week), still not feeling as good as I did when I first started the gel (energy/libido), I am thinking maybe my test levels are not high enough or my E2 is slightly elevated. I will go in for my follow up with the Endo on Friday, I will ask to get put on HCG as my sack has shrunken and my testicles are no hanging as they used too. I have also experienced some testicular pain that usually lasts for a few hours or longer, climax during sex isn't as good as I remember it used to be before my T level went low also I have no distance when ejaculating. I am hoping this can all be fixed with HCG.

I will also ask for an AI to be prescribed (Arimidex ) and take 0.25 after injections to see if i can lower my E2 down to 20 and see how i feel then, sex drive isn't as great as it was while on the gel but for some reason the gel didn't carry the test levels high enough until the next application so I asked for the Test C injections.

attached are the last 2 blood tests i have taken and they are somewhat similar except my SHBG is dropping.


any input would be greatly appreciated.

[kelkel]

Hi Red Beard.

First, 13 weeks isn't really that long. It can take up to a year to dial in for some people. Looking at your numbers, TT is low yet your FT is decent. This is due to your SHBG being on the lower end. SHBG rises with age yet testosterone will suppress it. Lower SHBG is fine as long as it's not in conjunction with other markers such as poor lipids, BP, insulin issues. Look up Metabolic Syndrome.

Your doc ran serum estradiol, not a sensitive assay. I would not add an AI with your current estradiol number as a sensitive assay will normally come in lower than standard estradiol. Often times much lower. Ask for a Sensitive Assay next time and stick with it on future tests. Feeling different when on the gel could simply be a more elevated DHT level. Gels are known to bump it up higher than injections. I liked the feeling I had on gels as well, I just could not maintain the T levels I liked plus I was up to 6 pumps per day of Agel. Like taking a bath in it!

Look up and print out Crisler's paper on HCG . Take it to your doctor. If he says it's not a proper usage of HCG advise him it's right on most package inserts for use in Hypogonadic Hypogonadism.

[RedBeardedViking]

Thank you for your input Kelkel it is much valued. I already brought up the fact about HCG and the doctor said she would look into it at this follow up, I didn't want to seem pushy and maybe lose her support as I have already had a tough time locating a doctor to start treatment. I am hoping she will up the dosage to maybe 150 mg/week to see where that puts me along with HCG. I will print Dr. Crisler's study and bring that a long, she didn't seem so familiar with the split dosage of 500 iu weekly. Thanks for being such a big help in the TRT section with you knowledge Kelkel.

[kelkel]

When was your last injection relative to getting the BW done? If it was a week prior it will explain your low (er) levels. You could easily be double that a day after your injection. Here's an example of what happens immediately after injection:




That said, you may consider splitting your dose and injecting it every 3.5 days. This way you'll maintain better serum levels with the added benefit of less conversion to estrogen.

[RedBeardedViking]

Correct Kelkel, both BW were pulled a week after pin. I looked up the metabolic syndrome and I do not have any of the triggers, I have always had an athletic build unless lifting heavy until a few years back when I suspects my test problems started however I have never been overweight although I started to see some increased fat in my midsection before getting treatment but that is being taken cared of. I am 5 10 175-180 20% or less be and that's being slightly high on my estimate.

[kelkel]

Switch up your pinning protocol to twice per week then. I'm betting you'll see a difference. Let us know please on this thread.

[RedBeardedViking]

I will keep updating this thread until I find a good plan that works for me and hopefully someone down the road can benefit from this.