Blood Work Results and Recommendations

[Justice4all]

I'm 45 6'2 225lbs with no history of injury that I know of and my thyroid has always tested out normal.

So I had my PCP test my levels over a month ago and my total t was at 221 ng/dL just below labs range of (225 - 635 ng/dL).
My doc orders more labs for 3 weeks later and they come back just above the bottom end for
Total Testosterone this time at 247 ng/dL (225 - 635 ng/dL), Testosterone Free 79.2 pg/mL (47 - 244 pg/mL), and Sex Hormone Binding Globulin 21 nmol/L (10 - 57 nmol/L).

Since Total T is above 225 this time he says I am fine even though I'm still lethargic, no libido, and really am only able to get things done by sheer will power but believe me I am burnt and have been for several years. So after reading the forums I check out a few clinics and the one that can treat me schedules some blood work this week and here are the results from my labs with their ranges
Testosterone Total 236 Low ng/dL (348 - 1197)
LH 5.0 mIU/mL (1.7 - 8.6)
Estradiol 19.2 pg/mL (7.6 - 42.6)standard assay
Prostate Specific Ag 0.8 ng/mL (0.0 - 4.0)
TSH 1.600 uIU/mL (0.450 - 4.500)
Cholesterol Total 210 High mg/dL (100 - 199)
Hematocrit 42.6 (37.5 - 51.0).

I have a consult next week to go over the labs and start TRT. From what I understand they will probably start me on
Test C 200mg a week
HCG 50 units x2 a week
Anastrozole twice a week anywhere from 2.0mg to 12mg

I know 200mg of test c is a lot to start with so I am planning on going 50mg x2 a week or maybe even 75mg x2 a week.

My question is since I have all the typical symptoms of low t as well as low estradiol, is my estradiol in fact nonexistent since it is the standard assay? If it is wouldn't it be good to hold off on the anastrozole to bring the estradiol up a bit? My goals are to feel normal again and then to start to push it back in the gym again!
Sorry for the long post, but please let me know if anything else stands out to you and your recommendations.

Thanks!

[dadroxx]

I know this isn't answering your question, but what type of Dr are you seeing? Endo, urologist, clinic...? Thanks

[Justice4all]

I know this isn't answering your question, but what type of Dr are you seeing? Endo, urologist, male aging...? Thanks

I started with my primary care physician without results and now i am going through a clinic so i guess it would be a male aging doc.

[kelkel]

Based on your LH value your pituitary function is fine, which indicates the issue is primary (testicular) in nature. Basically signals are being sent but testicularly you are not responding well, thus low T. Have you been examined for varicoceles or suffered any testicular trauma?

When it comes to clinics, most tend to want to start you higher. More test equals more ancillaries needed equals more money. It's a business. Rarely, imho, do clinics have your absolute best interest in mind.

Yes, it's a good idea to start with a lower dose of T.
Yes, the amount of adex is ridiculous (if you typed if correctly) as 12 mgs would treat someone the size of an elephant.
If you start at 200 mgs then you can guarantee the need for adex, just not as prescribed.
If you start at a reasonable dose then I would suggest not taking any until BW is pulled in about 6 weeks.

If at all possible I'd find another doctor. Your first one treats you like a number, which is pathetic. I've already talked about clinics above. I'd want to know the exact cause and if it's fixable. It could be simply age related but who knows without a proper medical evaluation.

[Justice4all]

I haven't been examined for varicoceles so that is a possibility. My doc could examine me but I don't think he would authorize surgery since he thinks my levels are fine. My problem with switching docs is the hmo i have will probably continue to give me docs that are limited by the hmo's protocols for labs and treatment values. Sadly it is the best coverage in my state so i think im going to have to go outside my coverage for now and look for a private physician in the meantime. Thanks kelkel!

[kelkel]

Well, do your best to find another doc and properly evaluated. It genuinely pisses me off when a doc doesn't listen to how a patient feels and treats them as a number. Plus you're not even close to being "in range." I'd be asking him if he'd accept that answer if he were the patient.

TRT can be a lifesaver when done properly, and it's not really that difficult. Do your best to find a better doc as treatment is not a one and done type thing. You need to develop a relationship with your doc that beneficial for you. Never accept that you are not in charge of your own health.

Post up how you make out please. Keep reading here and self-educate as it will make a big difference in how your treatment goes.