Its official......I have low testosterone levels...What now?

[Motobro]

I am 46 years old and have been lifting steady for about 10 years.
6' 250lbs, decent build for my weight.
Still one of the biggest guys at the gym. LOL!
I have done 4-5 cycles that involved testosterone cypionate and have used the PCT recommended by this forum.
For about the past 10 months, I have had very low libido. Its still works effectively, but not hitting it 3 times a week like I used to.
The girlfriend began to question my devotion to the relationship.
So off to the doc i went.
In a recent blood test, my test was 290, the test level of a 60 year old as my doc put it.
So he prescribes some gel, which I still have to pick up at the pharmacy.
He wants to test again in 2 months.
He is just a general practioner so this is not his specialty.
So.....why is this happening
Is it a result of my steroid use ??????
Is my estrogen level too high ?? doc didn't test that.
Did I f up my system using steroids ???
Or is it just natural aging ??
Looking forward to getting my levels back up ........when I was on a cycle of test , I was INVINCEABLE and felt like I was 21 !
Input anyone ????
Thanks
Motobro

[bass]

it could be any of the conditions you've listed. at this point and based on your history i don't think you can get your natural production back. a complete hormone blood work needs to be done before making any decisions regarding TRT, need to find out if you're primary or secondary. find a good doctor and don't waste time, especially if you're in good shape you don't want to stay at this level for too long. for a good start check out KelKel's thread regarding Finding a Physicians.

[HRTstudent]

Sounds like the standard protocol you would get from an uninformed general practitioner. They get most of their information from the drug reps (testim and androgel) so....

typically they will not look at other hormones (estrogens, LH, FSH, prolactin, etc etc)
typically they will base a decision on a first time test of low total testosterone
typically they will dose you too low
and typically they will refer you to an endo if anything unusual happens.

My advice... before you start then see a doctor who specializes in male TRT. This is probably not an endo, but rather someone who deals especially with males on hrt.

The worst thing I see here is that the doc won't even do a follow up test for 2 months. What happens if on that 1 dose a day you simply shut your own T down? Well, I will tell you you will feel worse than you do now, and you'll be out of 2 months time and some more co-pays. With gels, you get a stable level within days and you should follow up blood test in 2 weeks. For injects you typically follow up in 4 weeks. 2 months... well that's too long. You have a doctor who knows very little about male TRT.

[steroid.com 1]

In complete agreement with bass. At 290 you are clinically low and you need to know why.

From your email I can surmise that this was more a sudden onset rather then one that is more age related with very slow declines over many years.

Just so you know, the use of gels/creams are hit and miss and more the later so don't expect a lot. You also don't have to wait 2 months to re-test on a gel either; in fact you can get tested in one to two weeks to see if the gel is working or not.

Nevertheless, you need a complete male hormone panel conducted. Read the sticky on finding a TRT Doc and what bloods you need.

You need the correct care Motobro and while your PCP may be a nice guy he's not going to meet your needs any time soon.

[HRTstudent]

Go to allthingsmale web site and read Dr Crislers document about starting on TRT. It is a good primer and should get you thinking about a lot.

[kelkel]

^^^Agree. You must start with full BW to make an informed decision. Get a copy from your doc and post up here with ranges. LH/FSH important as it will help us determine if your primary or secondary and why it's happening.
How long ago was your last cycle and what was it?
What type of gel? Androgel 1.62?
If so, and with most gels you don't need to wait that long. I'd re-test at 4 weeks, maybe less.

Welcome to our world!

[HRTstudent]

Read everything you can from Dr John Crisler DO and Dr Romeo Mariano MD. These are 2 medical doctors who know a lot about male HRT.

You "may" not have to go on TRT because there are things you can do to try to improve that number without it. However... you're at about that age where it is expected to drop and probably? past worrying at all about fertility.

Here's a good read on other elements at play...

Hormones and Lab Pointers

by Romeo Mariano, MD on June 20, 2009
1196812_94704783.jpg

Some pointers from answering a recent post.

DHEA:

DHEA is important – but in the hierarchy of signals in the body, there are more important signals to consider improving first since otherwise DHEA is a minor player in a person’s overall health. For example, in men, the following hormones are more important to address: thyroid, cortisol. If DHEA is greater than 200, I would address the other issues first.

DHEA can go to estrone rather than testosterone or estradiol. Thus if DHEA levels are difficult to increase, then aside from elimination issues and absorption issues as previously discussed, the metabolism of DHEA is important to consider. If one has an overly active enzyme pathway that leads to DHEA being converted to Estrone, then one has a significant problem. Estrone is a pro-carcinogenic / pro-cancer estrogen. Taking DIM or iodine may help convert this to less carcinogenic estrogens, but then one will have to closely monitor this over time, reducing DHEA supplementation if necessary to avoid the conversion to estrone. Addressing the overall impairment in adrenal function to help improve natural production of DHEA may be a better idea than adding more exogenous DHEA. In an older man, where the DHEA producing layer of the adrenal gland has thinned out due to aging, some DHEA supplementation may be necessary – so long as estrone production is minimized. This is why I may settle for a lower level of DHEA – not severely low, but a “good enough” level – rather than risk excessive estrone.

ESTRADIOL:

Different tests for estrogen will give you different levels of estradiol. The different protocols involved simply give different numbers. If a person is obsessive-compulsive or rule-bound, all of the different results would drive that person nuts. Given this scenario, one has to CHOOSE ONE of the tests and base their clinical decisions on the observations and experience with that one test. It is one’s experience and observations, then, that would help determine the interpretation.

For myself, I have found that the ultrasensitive estradiol is the most clinically useful test for estrogen signaling activity. This means whether or not estrogen is too high or too low in relationship to the other hormones, neurotransmitters, and other signals. This is particularly important for signals which are directly affected by estrogen: testosterone, thyroid hormone, serotonin, dopamine, norepinephrine.

The fractionated estrogens test is useful for determining possibly what is happening to estrogens or in the case of DHEA, where it is going. But a 24-hour urine hormone test – where many hormones and their metabolites are measured (such as done by Meridian Labs or Rhein labs) would tell you more about the pathways involved.

GROWTH HORMONE:

Growth hormone is generally the last hormone to optimize. This is because it potentially affects many of the other hormones negatively (such as thyroid and the adrenal hormones), causing more problems and complicating the clinical picture if it is added first. Additionally, and possibly more importantly, if one addresses the other hormones and neurotransmitters first, then the dose of growth hormone needed to improve function is LOWER. This can then save a person a lot of money in the treatment.

IGF-1 is one indirect way of measuring growth hormone. A 24-hour urine growth hormone can also be done but IGF-1 is the most frequently used test. IGF-1 is increased by growth hormone, testosterone, DHEA, dopamine, thyroid hormone, among other signals. It is multiply-determined and is thus not purely determined by growth hormone. However, IGF-1 does the bulk of the work for growth hormone and is thus a valid measure of its activity.

At what level of IGF-1 indicates growth hormone deficiency (the only legal indication for growth hormone treatment) is actually subjective. Anti-aging doctors, who want to optimize growth hormone levels, tend to use 250 as the lower end of the reference range for IGF-1. Some doctors use a lower level. Many won’t treat unless it is definitely below the lower reference range. For myself, 250 is a bit on the high end for a lower reference range. If it is closer to 150, I would consider growth hormone treatment.

Growth hormone can improve a person’s sense of well-being when used well. Improved mood, libido, energy can occur – once the other hormone and neurotransmitters are optimized. However, it may not prolong life. It may actually limit one’s lifespan to about the 90s rather than letting one live past 100. Thus one has to assess whether one chooses to live well or live longer.

THYROID HORMONE:

A useful target if considering primarily lab tests for optimizing thyroid hormone is the following:

TSH <= 1.0 Free T3 between 3.3 to 3.9 Total T4 between 8-12

If at least one lab test is below these ranges, then a person may exhibit signs of hypothyroidism.

T4 levels are important since the brain does its own conversion of T4 to T3. The brain compartment can have different T4 and T3 levels than the rest of the body. The brain and body are in two different compartments, separated by the blood brain barrier. In Alzheimer's disease, brain thyroid levels are lower than the rest of the body.

TSH is not as important a measurement compared to measuring Free T3 and Total T4. If a person has some metabolic problem - including having heart disease, diabetes, low iron, etc. then the nervous system cannot function well and TSH will be abnormally low since the brain will have difficulty monitoring thyroid hormone and making TSH.

FERRITIN:

Ferritin is the most important measure of iron. Iron in the body is mostly in hemoglobin and myoglobin. However, iron is also used by every single cell in the body as part of many enzymes. Many of the enzymes which participate in the citric acid cycle to generate ATP - the basic energy storage unit in the body - in mitochondria have iron in their structure. Ferritin gives one an idea of how much iron is available to the rest of the body's cells for metabolic purposes.

Without iron, cells are significantly impaired in metabolic activity. They can't make enough ATP to do their activities. Thus, optimizing hormone, neurotransmitters and other signals doesn't work very well since they are only signals. They are signals to trigger cellular activities. But these activities cannot be done without ATP.

An optimum iron level as measured by Ferritin in men is about 150. In women, it is about 100-120. These are mid-range values. A ferritin of 75, in one study, was found to be the lower end of normal for senior citizens. They can be even develop iron-deficiency anemia at that level of iron.

Excessive iron is dangerous. It is highly oxidizing. It will also trap nitric oxide - used among other things to reduce blood pressure and improve blood flow. It is destructive to tissues - causing cell death in the testes, ovaries, thyroid gland, liver, brain, etc. In testing Ferritin, I have surprisingly found a large number of patients, who have been treatment resistant, to have hemochromocytosis - a disease of excessive iron storage. It usually occurs in about 1 in 200-400 Caucasian men.

CORTISOL:

Outside of Addison's disease, where there is actual destruction of the adrenal glands, low cortisol and adrenal cortex output may occur from stress-related conditions. This has been called "Adrenal Fatigue". However, in retrospect, I don't think this is a good term in that it implies something is wrong structurally with the adrenals - a bone of contention and misunderstanding. A better term is hypothalamic-pituitary-adrenal axis dysregulation (HPA dysregulation, for short). Then the problem may lie anywhere from the nervous system, endocrine system, immune system, metabolism and nutrition, etc. Posttraumatic stress disorder is an example where there is hypothalamic-pituitary-adrenal axis dysregulation, resulting in low cortisol. Frequently, in PTSD, I find cortisol levels around 6 and below. When I see such levels, I would inquire about a person's traumatic experiences.

Cortisol treatment may help. The problem is that Cortisol treatment also slows down the output of the adrenal cortex - including DHEA, Pregnenolone, Progesterone, Testosterone, Estradiol, etc. These other signals also are important. They also can regulate mood. Thus in some people, it is not enough to add cortisol. It is also important to optimize the other adrenal hormones/signals to avoid causing mood dysregulation and other problems with a cortisol-alone treatment.

Improving sleep is a huge help in improving adrenal cortex function.

PREGNENOLONE:

Pregnenolone is the most produced neurotransmitter in the brain. It is important for memory and attention. DHEA is the second most produced neurotransmitter in the brain. Pregnenolone is also produced by the adrenal glands. Pregnenolone treatment is a drop in the ocean when addressing low pregnenolone levels. Thus I don't expect levels to improve. But enough exogenous pregnenolone can improve memory and mood when at least some gets into the brain. It can also be metabolized to the other steroid hormones. Thus these may have to be monitored. In the experience of Thierry Hertoghe, MD, a colleague, and considered Europe's best anti-aging doctor (though I told him he should have stayed a psychiatrist), Pregnenolone is safe to use up to a dose of around 200 mg a day. But in a few people, its metabolites will need to examine. Jonathan Wright, MD, for example, told me of a couple of men who had problems gaining muscle mass when exercising, who he found to have increased estrogens from pregnenolone, as a problem.

GLUCOSE:

From a behavioral point of view, the optimal range for Glucose is between 93-100. Thus a person with a glucose below 93 I would consider hypogly***ic from a behavioral/brain function point of view. They would have problems with gluconeogenesis or glycogenolysis usually secondary to impaired cortisol or thyroid hormone production, though metabolic issues such as low iron problems may cause this as well.

CHOLESTEROL:

The liver is the major signal ender for the long-distance fluid-transmitted signals in the body - e.g. the hormones. A signal needs to be ended as well as transmitted. The liver's enzymes degrade hormonal signals.

The liver also does signal processing.

The liver produces the major hormone binding proteins (e.g. thyroid binding globulin, etc.) which then influence hormone signaling. These binding proteins also prolong the signals - causing them to be slow-release signals. For example, without sex hormone binding globulin, testosterone's half-life will be reduced to 10-100 minutes.

The liver also monitors hormone status. It monitors steroid hormone levels, for example. When steroid hormone levels are low, the liver produces cholesterol from glucose. Cholesterol is the building block for the steroid hormones. Thus, outside of a genetic disease which causes excessive cholesterol production, a high cholesterol level indicates one has a hormone deficiency.

VITAMIN D:

Vitamin D is a steroid hormone.
DHEA:

DHEA is important – but in the hierarchy of signals in the body, there are more important signals to consider improving first since otherwise DHEA is a minor player in a person’s overall health. For example, in men, the following hormones are more important to address: thyroid, cortisol. If DHEA is greater than 200, I would address the other issues first.

DHEA can go to estrone rather than testosterone or estradiol. Thus if DHEA levels are difficult to increase, then aside from elimination issues and absorption issues as previously discussed, the metabolism of DHEA is important to consider. If one has an overly active enzyme pathway that leads to DHEA being converted to Estrone, then one has a significant problem. Estrone is a pro-carcinogenic / pro-cancer estrogen. Taking DIM or iodine may help convert this to less carcinogenic estrogens, but then one will have to closely monitor this over time, reducing DHEA supplementation if necessary to avoid the conversion to estrone. Addressing the overall impairment in adrenal function to help improve natural production of DHEA may be a better idea than adding more exogenous DHEA. In an older man, where the DHEA producing layer of the adrenal gland has thinned out due to aging, some DHEA supplementation may be necessary – so long as estrone production is minimized. This is why I may settle for a lower level of DHEA – not severely low, but a “good enough” level – rather than risk excessive estrone.

ESTRADIOL:

Different tests for estrogen will give you different levels of estradiol. The different protocols involved simply give different numbers. If a person is obsessive-compulsive or rule-bound, all of the different results would drive that person nuts. Given this scenario, one has to CHOOSE ONE of the tests and base their clinical decisions on the observations and experience with that one test. It is one’s experience and observations, then, that would help determine the interpretation.

For myself, I have found that the ultrasensitive estradiol is the most clinically useful test for estrogen signaling activity. This means whether or not estrogen is too high or too low in relationship to the other hormones, neurotransmitters, and other signals. This is particularly important for signals which are directly affected by estrogen: testosterone, thyroid hormone, serotonin, dopamine, norepinephrine.

The fractionated estrogens test is useful for determining possibly what is happening to estrogens or in the case of DHEA, where it is going. But a 24-hour urine hormone test – where many hormones and their metabolites are measured (such as done by Meridian Labs or Rhein labs) would tell you more about the pathways involved.

GROWTH HORMONE:

Growth hormone is generally the last hormone to optimize. This is because it potentially affects many of the other hormones negatively (such as thyroid and the adrenal hormones), causing more problems and complicating the clinical picture if it is added first. Additionally, and possibly more importantly, if one addresses the other hormones and neurotransmitters first, then the dose of growth hormone needed to improve function is LOWER. This can then save a person a lot of money in the treatment.

IGF-1 is one indirect way of measuring growth hormone. A 24-hour urine growth hormone can also be done but IGF-1 is the most frequently used test. IGF-1 is increased by growth hormone, testosterone, DHEA, dopamine, thyroid hormone, among other signals. It is multiply-determined and is thus not purely determined by growth hormone. However, IGF-1 does the bulk of the work for growth hormone and is thus a valid measure of its activity.

At what level of IGF-1 indicates growth hormone deficiency (the only legal indication for growth hormone treatment) is actually subjective. Anti-aging doctors, who want to optimize growth hormone levels, tend to use 250 as the lower end of the reference range for IGF-1. Some doctors use a lower level. Many won’t treat unless it is definitely below the lower reference range. For myself, 250 is a bit on the high end for a lower reference range. If it is closer to 150, I would consider growth hormone treatment.

Growth hormone can improve a person’s sense of well-being when used well. Improved mood, libido, energy can occur – once the other hormone and neurotransmitters are optimized. However, it may not prolong life. It may actually limit one’s lifespan to about the 90s rather than letting one live past 100. Thus one has to assess whether one chooses to live well or live longer.

THYROID HORMONE:

A useful target if considering primarily lab tests for optimizing thyroid hormone is the following:

TSH <= 1.0
Free T3 between 3.3 to 3.9
Total T4 between 8-12

If at least one lab test is below these ranges, then a person may exhibit signs of hypothyroidism.

T4 levels are important since the brain does its own conversion of T4 to T3. The brain compartment can have different T4 and T3 levels than the rest of the body. The brain and body are in two different compartments, separated by the blood brain barrier. In Alzheimer's disease, brain thyroid levels are lower than the rest of the body.

TSH is not as important a measurement compared to measuring Free T3 and Total T4. If a person has some metabolic problem - including having heart disease, diabetes, low iron, etc. then the nervous system cannot function well and TSH will be abnormally low since the brain will have difficulty monitoring thyroid hormone and making TSH.

FERRITIN:

Ferritin is the most important measure of iron. Iron in the body is mostly in hemoglobin and myoglobin. However, iron is also used by every single cell in the body as part of many enzymes. Many of the enzymes which participate in the citric acid cycle to generate ATP - the basic energy storage unit in the body - in mitochondria have iron in their structure. Ferritin gives one an idea of how much iron is available to the rest of the body's cells for metabolic purposes.

Without iron, cells are significantly impaired in metabolic activity. They can't make enough ATP to do their activities. Thus, optimizing hormone, neurotransmitters and other signals doesn't work very well since they are only signals. They are signals to trigger cellular activities. But these activities cannot be done without ATP.

An optimum iron level as measured by Ferritin in men is about 150. In women, it is about 100-120. These are mid-range values. A ferritin of 75, in one study, was found to be the lower end of normal for senior citizens. They can be even develop iron-deficiency anemia at that level of iron.

Excessive iron is dangerous. It is highly oxidizing. It will also trap nitric oxide - used among other things to reduce blood pressure and improve blood flow. It is destructive to tissues - causing cell death in the testes, ovaries, thyroid gland, liver, brain, etc. In testing Ferritin, I have surprisingly found a large number of patients, who have been treatment resistant, to have hemochromocytosis - a disease of excessive iron storage. It usually occurs in about 1 in 200-400 Caucasian men.

CORTISOL:

Outside of Addison's disease, where there is actual destruction of the adrenal glands, low cortisol and adrenal cortex output may occur from stress-related conditions. This has been called "Adrenal Fatigue". However, in retrospect, I don't think this is a good term in that it implies something is wrong structurally with the adrenals - a bone of contention and misunderstanding. A better term is hypothalamic-pituitary-adrenal axis dysregulation (HPA dysregulation, for short). Then the problem may lie anywhere from the nervous system, endocrine system, immune system, metabolism and nutrition, etc. Posttraumatic stress disorder is an example where there is hypothalamic-pituitary-adrenal axis dysregulation, resulting in low cortisol. Frequently, in PTSD, I find cortisol levels around 6 and below. When I see such levels, I would inquire about a person's traumatic experiences.

Cortisol treatment may help. The problem is that Cortisol treatment also slows down the output of the adrenal cortex - including DHEA, Pregnenolone, Progesterone, Testosterone, Estradiol, etc. These other signals also are important. They also can regulate mood. Thus in some people, it is not enough to add cortisol. It is also important to optimize the other adrenal hormones/signals to avoid causing mood dysregulation and other problems with a cortisol-alone treatment.

Improving sleep is a huge help in improving adrenal cortex function.

PREGNENOLONE:

Pregnenolone is the most produced neurotransmitter in the brain. It is important for memory and attention. DHEA is the second most produced neurotransmitter in the brain. Pregnenolone is also produced by the adrenal glands. Pregnenolone treatment is a drop in the ocean when addressing low pregnenolone levels. Thus I don't expect levels to improve. But enough exogenous pregnenolone can improve memory and mood when at least some gets into the brain. It can also be metabolized to the other steroid hormones. Thus these may have to be monitored. In the experience of Thierry Hertoghe, MD, a colleague, and considered Europe's best anti-aging doctor (though I told him he should have stayed a psychiatrist), Pregnenolone is safe to use up to a dose of around 200 mg a day. But in a few people, its metabolites will need to examine. Jonathan Wright, MD, for example, told me of a couple of men who had problems gaining muscle mass when exercising, who he found to have increased estrogens from pregnenolone, as a problem.

GLUCOSE:

From a behavioral point of view, the optimal range for Glucose is between 93-100. Thus a person with a glucose below 93 I would consider hypogly***ic from a behavioral/brain function point of view. They would have problems with gluconeogenesis or glycogenolysis usually secondary to impaired cortisol or thyroid hormone production, though metabolic issues such as low iron problems may cause this as well.

CHOLESTEROL:

The liver is the major signal ender for the long-distance fluid-transmitted signals in the body - e.g. the hormones. A signal needs to be ended as well as transmitted. The liver's enzymes degrade hormonal signals.

The liver also does signal processing.

The liver produces the major hormone binding proteins (e.g. thyroid binding globulin, etc.) which then influence hormone signaling. These binding proteins also prolong the signals - causing them to be slow-release signals. For example, without sex hormone binding globulin, testosterone's half-life will be reduced to 10-100 minutes.

The liver also monitors hormone status. It monitors steroid hormone levels, for example. When steroid hormone levels are low, the liver produces cholesterol from glucose. Cholesterol is the building block for the steroid hormones. Thus, outside of a genetic disease which causes excessive cholesterol production, a high cholesterol level indicates one has a hormone deficiency.

[Vettester]

^^ Good information ... Glad that the doctor noted the importance of checking ferritin. It seems to be widely overlooked when discussing lab work. My ferritin used to be up in the 1500 range, as I have the gene for hemochromatosis. Donating blood will keep it in check, but if you have elevated levels and don't deal with it, make no mistake, it will mess you up!

[ecdysone]

^^^ Nothing wrong with measuring ferritin except it can be difficult to interpret (and therefore less useful diagnostically).

But you're so right that hemochromatosis is such a tragic disease in that it can easily be detected (by my preferred serum iron +TIBC tests) and if not treated is usually fatal.

But to the OP: please read and respond to kel's #6 post as it encompasses (imo) everything else we need to know about you to offer much in the way of suggestions.

[zaggahamma]

good luck bro

welcome to the board

youre in good hands

[Motobro]

Yeah my doc just sticks to the basics as he is a general practioner.
Just checkin the boxes.
Anyway , my last cycle was about 2years ago maybe 3.
I got a little to big for my own good and decided no more juice.
I am aware or the trt docs or centers, but would like to make my own doc do as much as possible as thats where my insurance is good.
I called my health insurance plan and they are not sure if injctable steroids are covered.
I can see where this is going, its probable cheaper for me to by test cyp, pregnyl, anostrozole on line and get occasional blood tests.
You guys mentioned PRIMARY and Secondary, what does that mean. ???
I also ordered the book 'Testosterone Syndrome' to educate myself more on the subject.
Thanks for all your input.

[HRTstudent]

I really liked the book Testosterone for Life it was by a Harvard MD too. After reading that and reading Dr Crislers TRT primer I got a really good baseline.

Also, depending on your insurance it is definitely good to use that because it should be cheaper than ordering online. That's why you pay such high premiums in the first place right!?

Primary and secondary relates to why, at the end, you have low T. Probably a good wiki on it.

I would avoid a TRT "clinic" because they will probably want you to use their pharmacy and you will pay a LOT more out of pocket.

I understand that you want to stick to your GP, but I am telling you he simply does not know much about male hormones. You are not in very qualified hands. I'm not saying he's a bad guy or a terrible doctor, but he's not trained in this area. I started off just like you. I liked my doc and thought it was good, but what happens when things get more complicated? Don't you think you owe it to yourself to put your health in the hands of a professional trained in the drugs you are taking? That's just my take on it. After all some people are okay injecting test cyp once every 3 weeks!