TRT Consultation setup - Recovering from Bicep Distal Repair - Good idea?

[xLoganx]

Guys,

On 10/18/15 I suffered from a Bicep Distal Rupture, surgery was on 10/26/15 and I'm coming up on 4 weeks post op. Recovery is going well and I am in PT three times a week.

Ironically, my annual for blood work came up two weeks after surgery with my Family Doctor so I went and had it done, leading up to my injury I was feeling all the symptoms of Low T. Long story short is this.. last year my results were 478nl Test. The doctor then told me "normal levels for a guy your age is anywhere from 500-700nl.. you're just a hair below it. I don't think it warrants putting you on TRT right now, but let's check it again in a year".

Ok no problem.. still feeling the symptoms after that visit and being frustrated, I took it upon myself to do a cycle for the first time in my life and followed Austenite's thread to a 'T'. PCT was there and I ended the cycle back in May.

The nurse at the Family Doctors office calls me back yesterday and tells me all my levels look fine. I asked what my Test levels were at and she said 316nl, but "I'm in the range". Disgusted, I replied "Maybe for an 85 year old man with Type 2 diabetes!". I then told her I was coming there to pick up my lab results.

Sorry the long post.. but figured you guys would want some type of history up front. So my question regarding TRT is this:
Yesterday, after picking up my blood work from my Family Doctors office I consulted with a very well known establishment similar to LowT.com. Ironically, turns out they are in Tampa.. about an hour from my house. I am confident that they will want to start me on a TRT program.

I've been doing some reading on this forum and others about "cycling" with an injury being a bad idea, but quite the opposite with TRT. I just wanted to hear your guys opinion on starting TRT while recovering from an injury like mine. I'm still in the gym hitting legs like crazy and cardio until the arm heals up.

[bullshark99]

The purpose of TRT is not results in the gym, but rather to feel better. The gym is a benefit of being on TRT.
My advice f you need it, go on it. Don't push your injury to hard though...

[kelkel]

Why don't you post up your BW if you can. I'd be curious to see if there's anything else inhibiting your natural production. Also how old are you?
If your levels are that low and not fixable, it's TRT time.

[xLoganx]

Why don't you post up your BW if you can. I'd be curious to see if there's anything else inhibiting your natural production. Also how old are you? If your levels are that low and not fixable, it's TRT time.

Figures in my long boring post, I'd leave out my age. I'll be 41 in two months Kelkel. I am going for a few additional panels on Monday (DHEA, Luteinizing Hormone (LH), Estradiol and Free Test). Please see the attached blood work. let me know your thoughts....

[kelkel]

Unless I'm missing it the only thyroid test I saw was for TSH. It's an indicator of thyroid health but's it's a weak one. A full panel is more prudent. I do not see prolactin, cortisol or as you stated LH & FSH. Also Free Testosterone and SHBG. These are the ones that can impact testosterone levels and what you need to see. I'd probably take more or add to your D3 intake as well. Get yourself up to around 80 ish would be great. Remember it's fat soluble so take it with large meals and don't over-do it as to much for to long can be toxic.

Your MCV and MCH are borderline low as well. These can be indicators of anemia so keep on eye on them. Have you given blood lately?

[xLoganx]

Unless I'm missing it the only thyroid test I saw was for TSH. It's an indicator of thyroid health but's it's a weak one. A full panel is more prudent. I do not see prolactin, cortisol or as you stated LH & FSH. Also Free Testosterone and SHBG. These are the ones that can impact testosterone levels and what you need to see. I'd probably take more or add to your D3 intake as well. Get yourself up to around 80 ish would be great. Remember it's fat soluble so take it with large meals and don't over-do it as to much for to long can be toxic.

Your MCV and MCH are borderline low as well. These can be indicators of anemia so keep on eye on them. Have you given blood lately?

Kelkel.. thanks again. The TRT clinic is sending me for those additional panels that I mentioned on Monday. I haven't given blood lately at all and I can't imagine the surgery having anything to do with it... but it does seem like I am getting anemia like symptoms (fatigue, headaches, lightheadiness, etc.) right after the surgery but I was linking them to Low T. Another reason to be incredibly pissed off at my Family Doctor for not picking up on that like you did! What would you recommend.. adding some D3 and iron for a little while?

[kelkel]

Yes, they can be linked to Low T:

Testosterone deficiency is a cause of anaemia and reduced responsiveness to erythropoiesis-stimulating agents in men with chronic kidney disease. - PubMed - NCBI

D3 I'd add permanently. It's one of the healthiest things a man can take. It's a hormone, not a vitamin and in virtually every cell in your body. Most can easily handle 5K IU's per day. Just monitor your levels. Adding iron? Maybe, maybe not. As you stated it may correct itself when T levels are restored. If you do add some use elemental Iron at a low dose (like 65 mgs) and take it along with Vit C for better absorption. Again, not sure it's needed yet.

I also just saw that the clinic is testing estradiol. It's really the wrong test and should be a sensitive estrogen assay when testing men. Standard estradiol can read much higher and can be quite inaccurate causing the unnecessarily administration of aromatase inhibitors. No doubt clinics know this but estradiol is about ten times cheaper then E2 Sensitive at normal lab rates, which is why it's used.

Remember, a clinic is a business that doesn't make money when they turn you away. Make sure you get those other items tested which will allow you to fully assess your need for TRT. It may something that's correctable and I'd hate to initiate TRT if that's the case. Beyond that, it could simply be time for TRT. Either way, it's nice to have a clear conscience.

[xLoganx]

Kelkel.. Thanks for the link and info.

I'm gonna throw this out there, so forgive me up front if I sound like a complete moron. Before my injury I was taking in about 3000 calories with a 40/40/20 (Carb, Protein, Fat) macro split. Average of protein was about 250-325gr a day.. carb a little less. As well as taking Cissus XT, Omega 3-6-9, GNC Energy Multi-Vitamin, CLA and an extra 1000mg of Vitamin C each day. Right after the surgery, I hate to admit.. but my diet went to shit as I really down in the dumps about the injury for a solid two weeks before I got my head out of my arse and starting hitting legs. I was lucky if I was taking in over 1000 calories a day for about two weeks.

The timeframe when I went and had blood work done is when I just basically 'Cold Turkeyed' my healthy diet and exercise pretty much overnight due to the injury. It was about a week Post Op when I went and I was literally doing NOTHING but recovering.

Do you think this has any affect on the blood work, specifically the MCV, MCH, MCHC levels? Or possibly even the Test levels? Just wondering. I'll as the TRT doctor about D-3 injections when I go for the consultation.

[APIs]

Looks like you're covered on the TRT questions. I had a distal bicep tear & re-attachment done about 2 years before starting TRT. I'll just comment to take the PT seriously, as the exercises are meant to irritate the surgery site & to promote healing. Just do it, no matter how stupid the Physical Therapy seems. I also got right on the treadmill to get blood flowing thru the injury site. It took me a solid +year to get back to near normal again. Today it's 100%. Good luck...

[kelkel]

Do you think this has any affect on the blood work, specifically the MCV, MCH, MCHC levels? Or possibly even the Test levels? Just wondering. I'll as the TRT doctor about D-3 injections when I go for the consultation.

Lifestyle can have a lot to do with your BW.

[xLoganx]

Looks like you're covered on the TRT questions. I had a distal bicep tear & re-attachment done about 2 years before starting TRT. I'll just comment to take the PT seriously, as the exercises are meant to irritate the surgery site & to promote healing. Just do it, no matter how stupid the Physical Therapy seems. I also got right on the treadmill to get blood flowing thru the injury site. It took me a solid +year to get back to near normal again. Today it's 100%. Good luck...

APIs, glad you mentioned that about the PT. I was literally just having a conversation with my wife about this. It does appear the the PT is a waste..I'm going there to have my arm stretched out and iced. Next week I guess we start resistance bands. Doctor said it will be a solid 6 months before I am back to lifting light weight, a year 100%.

At this point, I have accepted the fact that 'body building' (for lack of a better term) is on hold for about a year. The interest in TRT is to address the other symptoms that I'm feeling that go hand in hand with Low T.

[APIs]

It does appear the the PT is a waste..I'm going there to have my arm stretched out and iced.

That's exactly where a lot of people go wrong. Just because we're gym goers we think we know everything. The PT is designed to irritate the injury site & promote healing. Nothing more. Believe it or not, you will not give it the needed attention yourself without the PT appointments. Please believe me on this one. Besides, you can substitute the PT appointments for every time you would have been at the gym.

If you're paying a co-pay for every visit and money is an issue, you can try and talk the facility down to say $10/visit. No one knows this, but co-pays are negotiable at PT facilities. If they say no, use a different one...

[xLoganx]

I hear ya bud. Today was actually the first day I felt there was some value out of it. She had me performing some different stretches that I could really feel working. I am (4) weeks Post Op today and already have full extension and can be out of the brace at home.. just can't lift anything yet. I'm definitely not going to be doing anything to risk re-injuring the arm. Supination and Pronation are at 100%, I can pick up slightly heavier things now than a coffee cup but I go real easy and ice the shit out of it.

My insurance is 80/20. So at the end of the day.. my responsibility is about $10/visit like you said. I agree with you though.. it seems like it's well worth it, that's why I asked for the script. Surgeon told me he was glad to see me going and that a lot of people don't even bother with PT.

[xLoganx]

Kelkel.. here is the remaining blood work panels. Thoughts?

[kelkel]

Well, your LH is low and thus your T is low. It follows suit. If your pituitary isn't sending enough signals downstream then your testicals will not produce enough testosterone . Remember, total T doesn't really matter. Free T does and yours is low. Free T is what works for us. You can have a 10K total t level but if free T is crap you'll still suffer the consequences of low t. Make sense?

The question still is, what's causing this? Is there something suppressing your LH like I mentioned earlier or is it simply age related and idiopathic? That's what you need to find out. If you can rule out thyroid, cortisol, prolactin then you may consider an MRI for pituitary issues if your doc feels it's warranted.

Just saw an older comment about D3 injections. No, just buy any D3 and take it with a large meal as it's fat soluble and absorbs best that way. Maybe 5K to start.

[xLoganx]

Got it, thanks. I realize the HCG is to keep the testes working while on cycle and helps promote a faster recovery while after cycling.. Should I inquire about HCG during TRT at my consultation? If so, why? (Not that I don't trust you, just so I'm educated about it before asking).

Any other topics I should discuss while there? I will ask about if the MRI is warranted.