Had appt with VA Endo today

[dlhoulton]

Hello everyone,
As title states, had my VA Endo appt. today. I had previously posted a thread titled "VA doctors could care less". Well that was my local VA. I had to travel some hundred plus miles to a larger VA. There I was seen by a young resident who was somewhat up to date on things. Gave me a through exam and took a good history. All he had to go on LAB wise was what I had posted earler (basically just Free and Total Test, as well as LH, DHEA and a CBC with Lipids). As I had thought my PCP had gotten the wrong Estrogen. He then gave me some history on test (pros and cons/dangers). I then gave him my literature from the stickies and a print out from Dr. Crisler. He stated that he would like to get a more indepth workup and got everything that Dr. Crisler suggested and a little more. The test results will be available in a day or two at which time he well review them and contact me ( I also will go to my local VA and get copies). He stated with what he had to go on today (Free/Total Test and my physical sysptoms) that he would like to start me on TRT treatment today and that once lab reports came back we would eather adjust or maintain current dosage. He stated he would like to start out with 100mg EOW. Then we begain a descussion of half life and the roller coster effect of EOW treatment. So he stated he had no problem letting me self administer EW but only 50mg to start out with. Then we started talking about AI and he said we would wait for our 4 to 6 month followup and see (he had read the part where even Dr. Crisler did not initially start giving AI). He stated the VA did not carry AI's in there formulary and would have to be approved if needed. That AI's were only given to women who had brest cancer. As for HCG he stated lets wait on it. All this had to go through the Chief of Endo which came in and talked with me and agreed on the EW 50mg self administering as well as everything else.
As stated I will have a follow up in 4 to 6 months but he wants follow up labs in one month. Should I start treatment now or wait for the labs that were drawn today? I'm in no big hurry just courious. Also seems like the follow up labs are a bit soon???
Felt like everything went pretty good today and he was very open and excepting to suggestions and my conserns.
Any feed back here on any of this?? Would like to here some of your thoughts.

[bass]

its a good start, yes do your lab work in 4 weeks so he can see that 50mgs ew will do very little, it needs to be at a minimum 50mgs twice a week. make sure you give blood for lab work the day before you next injection. keep us posted.

[dlhoulton]

So bass, with just the little he had to go on should I go ahead and start? Also my Rx is a vial that is 200mg/ml and is of course only one ml. Very small vial and not much in it. I know big things can come in small packages!! Which means I will only be giving myself .25ml for each injection. The gear they gave me is monsterous so I will be going to my local VA in the AM to get smaller stuff. Just seems like such a small amount to inject weekly and each vial will yeld 4 doses!!!

[bass]

LOL, thats one dose for some of us! for that small of a dose i recommend you do SQ injections so you can draw more accurately with slin pin.

[APIs]

its a good start, yes do your lab work in 4 weeks so he can see that 50mgs ew will do very little, it needs to be at a minimum 50mgs twice a week. make sure you give blood for lab work the day before you next injection. keep us posted.

x2. Sounds like you hit a Home-Run with these guys, congrats. Especially their willingness to follow Dr. Crisler's protocal. I've seen a lot of people go through hell with the VA on this treatment. Def follow up on HCG & AI down the road. At only 50 mgs/week I wouldnt be too concerned with an AI until your next BW results come in. Long-term you will probably need HCG & Adex, especially if they up the dose. Good luck...

[kelkel]

^^^What the guys said. I'm happy you found a young doctor that is willing to work with you and did not arbitrarily dismiss the info you brought to the table, like so many seem to do. Keep educating yourself and keep bringing relevent info to the doc. When he sees you're serious about your health and gaining knowledge, he will himself better prepare for your appointments. Yes, 50mg will look really small in a syringe, so control yourself!

[HRTstudent]

50 mg per week MIGHT get you into normal, but it's a low starting dose. 75mg probably would have been more favorable, but obviously the doc wants to start slow. I would support their decision and absolutely follow through with their treatment.

See the study "Testosterone dose-response relationships in healthy young men" where they examined different doses and 50mg per week got the subjects into low-normal range. Most goals as far as I know for TRT aim for around 500-600 ng/dl.

[dlhoulton]

Just got my pre lab work back. Can't beleave how long the VA takes. Here are some of the results:
Total Test: 1.64 (2 - 7.5 ng/mL)
Free Test: 8.3 (7.2 - 24.0 pg/mL)
Estradiol: 44.0 (7.6 - 42.6 pg/mL)
LH (Lutropin): 3.8 (1 - 9 mIU/ml)
FSH (Follitropin): 3.6 (1 - 19 mIU/mL)
Prolactin: 3.8 (2.6 - 13 ng/mL)
T4 Free (Thyroxine): 0.80 (0.6 - 1.4 ng/dL)
IGF-1: 122 (87 - 238 ng/mL)

Everything else (CBC, Lipid Profile, PSA, etc. ) were all o.k.

Went today to get my three week post lab work done (Have had three weekly injectons of .25ml (50mg))
Find it kind of odd that the Endo just went ahead and started me out without even knowing these results. He did have my pre/pre Free and total test results from my PCP.
Now I just have to wait 7 to 10 days for these labs to come back. I made sure they drew for (Total, Free Test, Estradiol, LH, FSH, CBC, Comprehensive Metabolic Panel, Lipids, PSA, and IGF).
Not sure if the Endo will call me seeing the above results. Was kind of shocked with the Estradiol results!! Hate having such a long distance commute with him and almost being impossible to get in contact with him via phone!
Any thoughts or suggestions?

[bass]

wow your levels were in the tank, and e2 above normal! i suspect not much will change on that dose except maybe your e2 will be even higher. T4 is good, IGF-1 is low but with proper TRT that will go up a good amount. of course we are more interested in your recent blood work, so we'll see!

[steroid.com 1]

Total Test : 1.64 (2 - 7.5 ng/mL)
Clinically Low

Free Test : 8.3 (7.2 - 24.0 pg/mL)
Clinically Low

Estradiol: 44.0 (7.6 - 42.6 pg/mL)
This is a bit high and will most likley continue to increase with exogenous Testosterone. Have a serious discussion re an AI or most of what you inject will convert to E2 making you feel worse than when you started.

LH (Lutropin): 3.8 (1 - 9 mIU/ml)
Low but not that bad...you testicles are most likely not producing like they should.

FSH (Follitropin): 3.6 (1 - 19 mIU/mL)
ok

Prolactin: 3.8 (2.6 - 13 ng/mL)
Low. How is you libido?

T4 Free (Thyroxine): 0.80 (0.6 - 1.4 ng/dL)
Why would they test this and not TSH and FT3? Silly I say! Your FT4 is low and it should be on the high end. This could suggest Hypothyroidism so discuss with your Endo. You want to rule out Hypothyroidism as it has many of the same symptoms as Low T. Also, Low T can and will cause Hypothyroidism.

IGF -1: 122 (87 - 238 ng/mL)
Not to shabby, better on the high end but you are not a candidate for GH.

[dlhoulton]

Thanks for the replies and advice. Gdevine, to answer your question about libido, that was one of my pre symptom complaints. Now it seems worse as well as nipple soreness and even less energy and motivation. I've also noticed in the last few years more hart palpatations. Currently seeing doc for this!!, as well as for mild hypertension.

[ecdysone]

Also seems like the follow up labs are a bit soon???

I think you're lucky to be able get anything back so soon, because at 50 mg it's a given you will need to up your dosage.

I'm not sure how tied you are with the VA system, but off-hand it doesn't sound like your endo is very knowledgeable about TRT with that dosage recommendation. There are clinics available online that won't charge you all that much for proper TRT if these guys don't dose you into the proper range.

I would also recommend you prepare a presentation that shows an acceptable total test level is well above their 200 ng/dL lower range for normal.

[steroid.com 1]

Thanks for the replies and advice. Gdevine, to answer your question about libido, that was one of my pre symptom complaints. Now it seems worse as well as nipple soreness and even less energy and motivation. I've also noticed in the last few years more hart palpatations. Currently seeing doc for this!!, as well as for mild hypertension.

Points to elevated E2 levels.

As noted, E2 must be managed or you won't get the benefits of your Testosterone.

Learn about aromatization and what it does and how it can be managed.

Read the stickies and Google is your friend.

ecd is also correct; 50 mg per week is very small dose...figure maybe 75% of that will make it into your bloodstream where it can do its magic.

[dlhoulton]

Got some labs back today. Doc (Endo) wanted me to get labs at 2 weeks, I thought that was a bit early so I stretched it out to 3 weeks. Didn't want him calling and complaining!! I'm only getting 50mg (.25ml) per week and nothing else. The pre labs were posted above so here are the 3 week post. They were taken six days after my thrid dose.

Free Test: 14.1 pg/mL (7.2-24.0)
Total Test: 4.02 ng/mL (1.68-7.81)
Bioavailable had three results: All had the same ranges (Adult male >18 yr: 348-1197 ng/dL, Males (50-69yr: 95-285))
Test: 527 ng/dL
Test Bioavailable: 277 ng/dL
Test Bioavailable/Total: 52.6 %
Estradiol: 26 pg/mL (3-70)
Estradiol: 29 pg/mL (3-70) some reason they did two!!
Bioavailable #2 (They did two for some reason) the ranges were the same as the above))
Test: 543 ng/dL
Test Bioavailable: 274 ng/dL
Test Bioavailable/Total: 50.6 %
PSA: 0.68 ng/mL (0-4)
IGF-1: 153 ng/mL (87-238)

CBC, Lipid Profile were all good. I asked for LH and FSH but not sure if they did them or the test results are not back??
Looks like my E2 went down from Pre lab work results. Would like to here any thoughts or suggestions.

[kelkel]

I think you've made great progress in a short period of time. Noted a different range on the current E2 test which is more in line with the sensitive assay. Do you know exactly what test was performed on your first test?

[dlhoulton]

kelkel, Not sure. I get my labs directly online from the VA. It's a program that allows me to log into and view lab results. I can get "details" but not very informative.
The first Estradiol test that was high (pre TRT) stated:
Performing Location: LabCorp of America (then address), then had Comments: Roche ECLIA methodology, Test performed by LabCorp of America (then address).

The two other Estradiol test (3 week Post TRT) stated:
Performing Location: LABCORP OF AMERICA 358 South Main Street , Burlington, NC 27215
Status: Final
Interpretation:
Comments:
Male Female
0- 6 yrs. 0 - 15 0 - 15
7-10 yrs. 0 - 15 0 - 70
11-12 yrs. 0 - 40 10 - 300
13-15 yrs. 0 - 45 10 - 300
>15 yrs. 3 - 70 See Below
Ovulating Female
Follicular Phase 9 - 175
Luteal Phase 44 - 196
Periovulatory 107 - 281
Oral Contraceptives 0 - 91
Postmenopausal
Treated 42 - 289
Untreated 0 - 19
.
Estradiol results obtained with different
assay methods cannot be used interchangeably.
It is recommended that only one assay method
be used consistently to monitor serial
patient results.

Thats's about all the information that I could find. Hope that made any since!

[kelkel]

I'm not very familiar with the Roche method other than it's a Electrochemiluminescent Immunoassay (ECLIA.) Go ahead, try and say it fast. The norm here is the Sensitive Assay which appears to be your last test when looking at the verbiage. Be consistent with your test method so you can follow progress. Happy for you! Progress!