TRT test questions

I am now totally confused. Dr only checks total test. I have been consistently low. 169, a week later 172, off all suplementos for 6 weeks and same result 172.
I was then prescribed androgel and went back and requested other application. DR then sends me to an endocrinologist who now asks for test albumin, and shbg.
Test now tested 192.
Albumin. 4.5 g/dL. Range 3.3- 4.8
Shbg. 21 nmol/L. Range. 11-78
Why would my test increase so much?? Last cycle was completed in July.
I would have expected the albumin to be high with hypogonadism.
Does anyone have any insight on the results of these three items?

Low
Normal
Normal

You need to test LH/FSH, FT, TSH, FT3, FT4, Prolactin and Cortisol imho, if you have not already. Only thing you've determined is that your T is low. You need to find out why.

I had the additional testing when I was doing the tests myself outside of the country. I am now following Doc's requirements. He did do some of them but not all.
He is also only checking total test. Why would my testosterone levels increase so much? They appeared stable at 1.7.

What kel said^^^.

But why dont you ask the doctor? If I was paying for this bloodwork no way I would repeat bloodwork (with same tests) with only few weeks apart. I would just show him all the bloodworks and say I'm not paying for the same.

172 to 192 ng/dl is not a big testosterone increase.

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Originally Posted by Mr.BB

What kel said^^^. But why dont you ask the doctor? If I was paying for this bloodwork no way I would repeat bloodwork (with same tests) with only few weeks apart. I would just show him all the bloodworks and say I'm not paying for the same. 172 to 192 ng/dl is not a big testosterone increase.

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My opinion is that my Dr. Only feels comfortable with androgel after consulting with an endocrinologist. Once I stated that I did not feel comfortable with androgel, he sent me to endocrinology. The endrocrinologist wanted their own tests. I have a telephone conference tomorrow and I will ask the questions. I try to go into an appointment with knowledge for two reasons: I can ask the proper questions and i have an understanding and I can be cautious of what I say.
I feel that I am dealing with unknowledgeable individuals.. Another reason I ask the questions here first.

You experiencing what many here already have. The majority of doctors do not understand hormones. It's why so many push gels. They're simple and hard to screw up. Less work involved for the doctor.

Talked with endocrnologist. He says that I am fine. WTF?
He says that the shbg shows that I have enough free test so that is what counts. I do not want to go on TRT if I do not need to however 3 years ago they did actual free test bw and it was the free that was below the limit. Not sure how acurate the shbg test is. I know there is some sort of algorithm that calculates free test.
Missed out on time. Now its time to prepare for the 2017 competitions.

Well i know that my kidneys are functionng after all of the testing. ?

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Originally Posted by charger69

Talked with endocrnologist. He says that I am fine. WTF?
He says that the shbg shows that I have enough free test so that is what counts.

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Exactly how much FT did you have? I'd find it hard to believe that it's a substantial amount given your TT is so low.

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Originally Posted by kelkel

Exactly how much FT did you have? I'd find it hard to believe that it's a substantial amount given your TT is so low.

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Shbg is 21. Range is 11-78. That is what was used to determine free test. In the US. I asked the endocrinologist why they did not do an actual free test and he said that the medical group that I Am in does not do it... Maybe because of cost. They use the shbg method to determine free test.

Personally, I would not go to an Endo unless I had a reference from someone that they were "low test friendly." They aren't trained so much in treating low test in men and further they don't really care. I have a friend who is an Endo and she is adamantly opposed to pellets and does not think test should be prescribed if you fall anywhere in the normal range whatsoever. This is speaking to US, no idea the climate in other countries.

Most vets here are (kelkel for example) are WAY more knowledgeable than many docs. They teach an hour or two worth of lectures in med school on the whole HPTA axis and that's it.

There are good docs out there who do HRT for men who are not endo and who are good, just have to find them.

Keep telling you guys that endos are useless, you need an andrologist.

Pretty easy to search the internet for an andrologist in my small corner of the world, should be even easier in the US.

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Originally Posted by Mr.BB

Keep telling you guys that endos are useless, you need an andrologist.

Pretty easy to search the internet for an andrologist in my small corner of the world, should be even easier in the US.

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There are some that are considered as such, but it isn't even something I was familiar with (and I"m a doc here) until you mentioned it. The urologists make way bigger bank by operating and procedures than they do for TRT so a few will do it I am guessing by the profiles I found but it isn't as prevalent here.

There are some "anti-aging" or "age management" docs that are pretty okay and better than endocrine by leaps and bounds. See now, if you guys hadn't lost the revolutionary war we wouldn't be having this issue! :lol:

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Originally Posted by charger69

Shbg is 21. Range is 11-78. That is what was used to determine free test. In the US. I asked the endocrinologist why they did not do an actual free test and he said that the medical group that I Am in does not do it... Maybe because of cost. They use the shbg method to determine free test.

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Then working with those numbers puts you with a FT of 4.63 / 2.41% and Bio T at 109 which = 56.5%

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Originally Posted by kelkel

Then working with those numbers puts you with a FT of 4.63 / 2.41% and Bio T at 109 which = 56.5%

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Sorry kelkel.... Could you provide an interpretation.... You are talking above my intellectual level.

It's just calculating your FT from your TT, SHBG & Albumin. Bio T is just all the T that's free in your system, so it's a combination of your FT and whats loosly bound by albumin. Anything not bound by SHBG is bio-available.

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Originally Posted by kelkel

Then working with those numbers puts you with a FT of 4.63 / 2.41% and Bio T at 109 which = 56.5%

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With those results, would you say that they are within range? Would you pursue trying to get TRT with these numbers?
I was thinking on going and getting my free T testing accomplished. That is what started this whole thing years ago. My T was low but within range however my free T was way below.

Well, Labcorp's range for FT is around 7 - 24. That should answer your question. Caveat is that you should get more BW to see if you can find the root cause and correct it first instead of putting a band aid on it with TRT.

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Originally Posted by kelkel

Well, Labcorp's range for FT is around 7 - 24. That should answer your question. Caveat is that you should get more BW to see if you can find the root cause and correct it first instead of putting a band aid on it with TRT.

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Between you and Mr. BB, i will earn my degree as a Dr.! I think that i have found the magic search engine terminology that gives me what I am looking for .... And more.
Can you provide the website that you found this on? Most of them are 2%, which means my free test is ok..... I mean above the minimum.
I know that i am being a pest, but I need information when talking to the Dr. Because if I do not have the education I can only accept what they say.
I decided to have my test total and free accomplished in Mexico since I cannot in the US without a Dr. And the medical group that I am with does not do free test they use the albumin, shbg, and total test. My research shows that there are four major ways of calculating.
I am going to request an andrologist (-as requested by Mr. BB). Does anyone have input as to the argument to request an androgolist? My argument is that 2 Dr.'s have prescribed TRT and the endocrinologist has not. I want to further find out why my total test is low.

Thank you in advance for your advice. I want to know if I accept my condition or contimue to pursue answers.

Think you are confusing free testosterone and free testosterone %, its 2 different values.

Although in my book knowledge is always good, you dont really need it, you have your symptoms.

Would you accept going to a doctor with a broken hand and him saying you were fine, no treatment needed, while you were full of pain???

Why is it any different with hypogonadism? If you are not alright, and have symptoms you need to tell the doctor you need help. The doctor is not there to treat the bloodwork, he is there to treat the symptoms. Personally, if a doctor would tell me I was fine with less than 200ng/dL and that he wouldn't give me any treatment I would clearly say I would not pay for the consult. If it was a clinic/hospital would fill written complain referring doctor was denying me treatment.

Of course, that ultimately one should not need to go through such endeavours...

Edit: Argument->Doc, I feel like tired all the time, my libido is very low which is creating conflict with my wife and sometimes can't even get it up.

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Originally Posted by Mr.BB

The doctor is not there to treat the bloodwork, he is there to treat the symptoms.

Personally, if a doctor would tell me I was fine with less than 200ng/dL and that he wouldn't give me any treatment I would clearly say I would not pay for the consult. If it was a clinic/hospital would fill written complain referring doctor was denying me treatment.

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Perfectly said.

Kelkel- at mayomedicallaboratories.com the amount of free test for 50-55 years shows me 4.06. I am above that. Just want to have all my info in order.

I am now beginning to understand ( or at least think I am ). It seemed like Chinese at first but the research shows that it is not that complicated
I went to Mex. and am testing my free and my total test. The lab tech was not able to explain how the free test is determined. There is just one test purchased so I think it is direct however i did not find much info on the internet.

Under my insurance, i was not able to find an andrologist however there are urologists. Is a Urologist acceptable? I know that an andrologist is a Specialized Urologist. I will obviously ask for an Andrologist but expect to be recommended a Urologist.

You are not a number on scale developed using random people in an uncontrolled environment with god knows what issues. The number given may be the norm but honestly, who wants that? Only you know how you feel and like BB said, the doctor should treat the symptoms, not the bloodwork. One man may be perfect at that level, another may not.

Nothing wrong with Uro's at all. That's what mine is.

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Originally Posted by kelkel

You are not a number on scale developed using random people in an uncontrolled environment with god knows what issues. The number given may be the norm but honestly, who wants that? Only you know how you feel and like BB said, the doctor should treat the symptoms, not the bloodwork. One man may be perfect at that level, another may not. Nothing wrong with Uro's at all. That's what mine is.

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Thank you for your words of wisdom. I have a tendency to get caught up in the numbers from my education. You and Mr. BB have provided excellent guidance. This is exactly what the Dr. ordered...... No pun intended.