Back on TRT after having MRI. Need help with bloodwork results.

[Rock Chalk]

I'll try to keep it short to bring you up to speed. I have previous posts from a few years ago explaining all of this. About 2 years ago I started TRT. Previously my wife had an ectopic pregnancy. After about 3-4 months of TRT my wife decided she wanted us to go to a fertility clinic and see if there was anything causing her to not be able to get pregnant. I did a semen analysis and it came back extremely low. I was told by the fertility doctor that I needed to come off TRT if I wanted to get my wife pregnant. They wanted off TRT for 2 months and then come back to retest semen. Regardless of whether the doctor was wrong or right, I made a commitment to my wife that I would get off TRT if she thought it would help. After that we never really tried to get pregnant again because both of us are very busy in our professional lives.

Skipping ahead to last month, I had my physical completed by my regular doctor, not the doctor that put me on TRT. I am 42 years old. During my physical I started talking to my doctor about all of the symptoms I was having and the fact that I haven't been to the gym in a year. Lost all of my motivation to even go...and I used to live to go every day. He knows I was previously seeing another doctor for TRT but that I had stopped a few years ago. He agreed to do a complete blood panel and pretty much do every test he could do to see what was going on. Blood work came back (results below) and he had some concerns. Low Vitamin D, which I was treated for before. Test levels extremely low, cholesterol levels really high. HDL was low, Triglycerides through the roof and LDL could not be tested due to the triglyceride levels. Blood pressure was also really high. Turns out my Prolactin levels were also pretty high and so he scheduled and MRI of my brain to see if there was anything going on with my pituitary. He told me that, after he got the results, then we could talk about possibly going back on TRT, depending on the results of the MRI. He wanted to rule out Prolactinoma or any other pituitary issues that could be causing my symptoms. The MRI results came back normal so he agreed to put me on TRT, knowing that I was on it before under another doctor.

His TRT dosage for me is 200mg of Test Cyp per week for the first 3 weeks, and then 200mg once per month for maintenance. I know that even if I split it up into 50mg each week, it isn't going to do shit. Last doctor had me on 150mg per week and I was feeling really good with test levels around 1100. Anyway, I called today and told him that I had concerns about the low level he prescribed but they told me that every doctor starts out at different levels, and that this is where he starts everyone at. They want me to stick with it and come back in 3 months to get T levels checked. I'm not looking for 300mg per week, but I'd like to at least be at 100mg.

Here are my blood results:

Testosterone Total: 187 ng/dL
Free Testosterone: 6.6 pg/mL
Vitamin D: 20.6 ng/mL
Hematocrit: 45.6
Cholesterol Total: 248 mg/dL
Triglycerides: 574 mg/dL
HDL Cholesterol: 36 mg/dL
VLDL Cholesterol: Not valid when triglycerides >400 mg/dL
TSH: 4.260 uIU/mL
LH: 2.9 mIU/mL
FSH: 10.1 mIU/ml
Prolactin: 16.0 ng/mL

[Mr.BB]

Im with you on the TRT, many doctors have this dosing schedule, probably outdated protocol from the 70's, would like to see his face when you ask for HCG lol

Now, TRT will not fix your bloodwork, it might even put added stress. You might be looking at metabolic disease, and you are only 42, start exercising, begin eating healthier, set some boundaries for your professional live, and catch some sun enjoying the outdoors. People get obsessed with busy life, and dont enjoy life while have health and are young enough. No one at your professional life will care for you once you retire, and you cant take any money to the grave

[kelkel]

Good stuff ^^^^.

Has any doctor looked into your thyroid? That's a wicked high TSH level which requires more in depth testing. Hypothyroidism causes hypogonadism.

[Rock Chalk]

Both great responses guys. Yes, I am aware that the test will not fix blood issues. When I was working out 5 days a week and doing cardio, the levels were much more in line with where they should be. The doctor wasn't too surprised to see the numbers where they were considering I went from working out 5 days a week and doing cardio, to do absolutely nothing. I actually do eat pretty healthy; I don't eat fast food, candy, chips, or anything like that. Watch my carb intake and eat fish, chicken, red meat, eggs and vegetables. Not all the time, but often enough. Getting back to the gym should really help improve my numbers.

On another note. I went back to my original doctor today who had prescribed the TRT for me before. He looked over all of my blood work and we have plan in place to get things back in check. Going to continue to monitor the triglycerides and cholesterol, as well as TSH levels. He also gave me a script for 150mg of Test Cyp per week; as that is what he had me on before and it was working nicely. Also supplementing with 5000 IU per day of Vitamin D3. We will re-check everything in a few months and make adjustments as needed. He definitely thought that the other doctor's method of dosing was outdated. I'm glad he at least listened to me and took the time to understand the concerns I had.

Kelkel, interesting on the TSH level. Every other time I have had it tested, the doctors said there was nothing to be worried about. They didn't see any cause for concern of hypothyroid. Last time I had blood work done 2 years ago, TSH was 3.77 uIU/mL. I have more labs from back then but can't find them right now. Definitely something to keep an eye on.

[kelkel]

Definitely get to work on your cholesterol. You may consider digging deeper into your thyroid. TSH is a weak indicator of thyroid health but those are very high numbers which require further testing. It could easily be the root of your problems. Your doc's are looking at a lab report that is probably still using an old range of .5 - 5.0 or so. A more modern, accepted range is .3 - 3.0 and anything over 2 should be looked at.

You need to pull a full thyroid panel. Consider (at a minimum) TSH again, FT3, FT4, RT3 and Antibodies. Also, take some time and read up at Stop the Thyroid Madnessâ„¢ - Hypothyroidism and thyroid mistreatment as there's great info there which will help you. Just as most doc's don't know hormones, thyroid is a close second when it comes to lack on knowledge.

I'd strongly suggest looking into this first, before you initiate TRT. Be nice to get back to a normal, healthy T level and not have to worry about TRT for some years to come.

[Rock Chalk]

Definitely get to work on your cholesterol. You may consider digging deeper into your thyroid. TSH is a weak indicator of thyroid health but those are very high numbers which require further testing. It could easily be the root of your problems. Your doc's are looking at a lab report that is probably still using an old range of .5 - 5.0 or so. A more modern, accepted range is .3 - 3.0 and anything over 2 should be looked at.

You need to pull a full thyroid panel. Consider (at a minimum) TSH again, FT3, FT4, RT3 and Antibodies. Also, take some time and read up at Stop the Thyroid Madnessâ„¢ - Hypothyroidism and thyroid mistreatment as there's great info there which will help you. Just as most doc's don't know hormones, thyroid is a close second when it comes to lack on knowledge.

I'd strongly suggest looking into this first, before you initiate TRT. Be nice to get back to a normal, healthy T level and not have to worry about TRT for some years to come.

KelKel,

I already started the TRT because based on FSH levels, I am primary hypogonadal. I don't think the Thyroid issue is related to that, so probably going to need TRT no matter what. Currently taking 150mg of Cypionate per week. No AI until after I pull E2 labs to see where Estradiol is at...which I'm guessing it is high.

Also, I have more labs scheduled for tomorrow morning. Doing a full thyroid panel wit fT3 and fT4 included. Hopefully that will tell me more. The effects of the TRT were great the first 2-3 weeks but have since started to weaken. I had more energy, looked forward to lifting, got NRB's (No Reason Boners) during the day and morning wood like a mofo. Hypothyroid would make sense that these initial results would only last a few weeks. In addition to that, I'm cold a lot, my temps are in the low 97's in the morning and rarely hit 98.4 in the afternoon. I have dry skin, brittle nails, and I'm still tired all the time....although not as bad as before I started back on TRT. However, I think all that could also be E2 related as well. 150mg of Cypionate a week is a lot for TRT, especially with no AI.

One of the questions i can't figure out is, what is causing my Prolactin levels to be so high. MRI has ruled out pituitary tumor. Doctor has referred me to an Endo to look a little deeper into that.

I have been in the gym hitting it hard 4 days a week for the last 2 months. Hoping that helped lower my cholesterol and triglycerides. Diet is pretty good. Rarely eat fast food or junk food so not sure why the levels are so high.

[IncreaseMyT]

Many of our clients get pregnant while on TRT, usually a decent dosing schedule of HCG will do the trick. If not discontinuing exogenous testosterone and sticking with HCG mono therapy almost always does the trick. If not a bout of Clomid will almost definitely do it.

Those are the progressions our doctors use.

I would guess 90% of our guys never make it to stage two.

Hope this helps.

[hammerheart]

KelKel,

I already started the TRT because based on FSH levels, I am primary hypogonadal. I don't think the Thyroid issue is related to that, so probably going to need TRT no matter what. Currently taking 150mg of Cypionate per week. No AI until after I pull E2 labs to see where Estradiol is at...which I'm guessing it is high.

Also, I have more labs scheduled for tomorrow morning. Doing a full thyroid panel wit fT3 and fT4 included. Hopefully that will tell me more. The effects of the TRT were great the first 2-3 weeks but have since started to weaken. I had more energy, looked forward to lifting, got NRB's (No Reason Boners) during the day and morning wood like a mofo. Hypothyroid would make sense that these initial results would only last a few weeks. In addition to that, I'm cold a lot, my temps are in the low 97's in the morning and rarely hit 98.4 in the afternoon. I have dry skin, brittle nails, and I'm still tired all the time....although not as bad as before I started back on TRT. However, I think all that could also be E2 related as well. 150mg of Cypionate a week is a lot for TRT, especially with no AI.

One of the questions i can't figure out is, what is causing my Prolactin levels to be so high. MRI has ruled out pituitary tumor. Doctor has referred me to an Endo to look a little deeper into that.

I have been in the gym hitting it hard 4 days a week for the last 2 months. Hoping that helped lower my cholesterol and triglycerides. Diet is pretty good. Rarely eat fast food or junk food so not sure why the levels are so high.

For the phrase in bold - absolutely true! Hypothyroidism will deny any benefits from TRT, I can tell from personal experience. I can also say it will increase sensitivity to high E2. PRL too is due to raised TRH, an hypothalamic hormone that triggers pituitary TSH release but stimulates PRL as well.

Do you think 97 is bad? I had temp readings as low as 95 before LT4 treatment.

[hammerheart]

KelKel,

I already started the TRT because based on FSH levels, I am primary hypogonadal.

Isolated LH deficiency is rare, but possible. Elevated FSH might be compensative.