Newly on TRT Concerns

[Bill_boy2005]

After reading through the forums for a couple days I have some concerns over the treatment that my dr has me set up on. Background- The past couple years my t levels have been low, last year and the year before around 237-250. This years pysical my results came back very low in the 30's (full results below for all blood work). After last years ;ab test I asked my family physician if I should be on some sort of treatment, he is very old school and told me that low normal was normal and that the risks with treatment did not justify it. So I continued to deal with the fatigue, depression, etc. Finally after this years labs he suggested I go to a urologist to get myself checked out. Due to pain in one of my testicles that comes and goes my urologist had a ultrasound completed, which came back clean. We have another round of blood work scheduled for next week to test my prolactin levels, if they are high I guess I will be getting an MRI to check the pituitary gland. In the meantime she has started me on test-c at 200mg/bi-weekly (which I am going to move to 100mg/weekly per recommendations on here).

Anyhow, after reading through the forums here it seems like TRT may not be the best first step, especially when used alone. It would seem that treatment should likely include other drugs instead of taking trt which will likely worsen my hypogonadism.

It seems that I may be better off to move my treatment away from my urologist once all of my testing is complete and take it to a hormone repla***ent clinic, as from what I can gather from my reading, they tend to be more educated on the proper treatment protocols for this.

What are the groups thoughts on this? Am I just being paranoid?



Component
Your Value
Standard Range
Units

Sax Hormone Binding Globulin
8
11 - 80
nmol

T, Adult Male
37
300 - 1080
ng/dL

Test Information: T, Adult Male
To convert to nmol/L, multiply ng/dL by 0.0347.

T, Free Calculation
10
47 - 244
pg/mL

REFERENCE INTERVAL: T, Free
Tanner Stage IV 35 - 169 pg/mL
Tanner Stage V 41 - 239 pg/mL
To convert to pmol/L, multiply pg/mL by 3.47.
The concentration of Free T is derived from a
mathematical expression based on the constant for the
binding of testosterone to sex hormone binding globulin.

T, Percentage Free
2.8
1.6 - 2.9
%



Component
Your Value
Standard Range
Units

WBC
8.4
3.9 - 11.6
x10^3/uL

RBC
4.75
4.4 - 6.18
x10^6/uL

HGB
15.3
13.3 - 16.8
g/dL

HCT
44
39 - 53
%

MCV
93.3
80 - 100
um^3

MCH
32.2
26 - 35
pg

MCHC
34.5
31 - 36
%

RDW
12.9
11.5 - 14.8
%

PLTS
313
140 - 440
x10^3/uL

MPV
7.1
6.9 - 12.2
um^3

LYMPH %
25.1
10 - 50
%

MONO %
7.3
4 - 12.8
%

SEG %
63.0
42 - 72
%

ABS LYMPH
2.1
1.1 - 4.3
x10^3/uL

ABS MONO
0.6
0 - 0.8
x10^3/uL

ABS SEGS
5.3
1.5 - 7.5
x10^3/uL

ABS BASO
0.1
0 - 0.2
x10^3/uL

ABS EOS
0.3
0 - 0.3
x10^3/uL

EOS %
3.9
0.5 - 11.0
%

BASO %
0.7
0 - 3.4
%

[zaggahamma]

bump

[FONZY007]

I used AS at a young age 20-21 years old after a few cycle and being inexperience an no real knowledge I ended up having low test levels 140ng/ml in currently 30 years old. I have had an MRI on my pituitary gland and ultra sounds also.. Take a half a mg a week to keep somewhat level test levels!!

Questions; have you ever used AS? If so when?

Also I felt very tired and was losing a lot of hair until I jumped on trt which took me a year and a half to get the doctor to prescribe!!

P.s. go see an endo doctor!! That's what I have !

[flatscat]

I say get your MRI and see what the uro has to say - then make a decision.

[Bill_boy2005]

I used AS at a young age 20-21 years old after a few cycle and being inexperience an no real knowledge I ended up having low test levels 140ng/ml in currently 30 years old. I have had an MRI on my pituitary gland and ultra sounds also.. Take a half a mg a week to keep somewhat level test levels!!

Questions; have you ever used AS? If so when?

Also I felt very tired and was losing a lot of hair until I jumped on trt which took me a year and a half to get the doctor to prescribe!!

P.s. go see an endo doctor!! That's what I have !

I have not used AAS in the past, but had been planning to do so after I had lost some of the fat I am carrying and had gotten closer to my natural capacity. That plan is on hold while I figure out what's going on currently.

Thanks for the advice. Once the urologist section of treatment is done I will fund an endocrinologist.

Thanks.

[bass]

i never seen test levels that low! good job on reading and educating yourself, thats a good first step! like the guys said, get all your testing done then make a decision! not sure if you mentioned it, how old are you?

[Bill_boy2005]

36 going on 37.

[fit2bOld]

Damn that's really low test, and your right most the guys are on a combinations of Test, HCG and a AI.it took over a year to find my sweet spot and switching from a clinic to a PA thats done all the research. Definitely do the testing to rule out other causes. I keep a book of all my blood work,etc so you have reference if you move to a new Dr. and work to dial it in on HRT.

[steroid.com 1]

I say get your MRI and see what the uro has to say - then make a decision.

Exactly what Flats stated.

[FONZY007]

i never seen test levels that low! good job on reading and educating yourself, thats a good first step! like the guys said, get all your testing done then make a decision! not sure if you mentioned it, how old are you?

Mine where down to 47 ng/ml before. Only For a short period

[bass]

yea at 220 i felt like a 70 year old man! i just can't imagine what would have been like if my levels were at 37!

[Bill_boy2005]

yea at 220 i felt like a 70 year old man! i just can't imagine what would have been like if my levels were at 37!

Not sure if I just got used to the low levels. Ill be doing my fourth marathon in two years in January. I work out several days a week. I am a part time student. And I work 60-70 hrs a week. I assume you adjust to what you have. The thing that suffered/suffers most is libido and general wellness. I will say since mu first shot I Jane felt steadily better starting a few days in. Not great yet, but headed in a better direction.

[bass]

well that goes to show you that some of us reacts differently to low test!

[Bill_boy2005]

Not sure I react differently, or if I am just hard headed and do things whether I feel good or not. Knowing myself, I would say the latter.

[Vettester]

Definitely agree with the MRI.

Also, maybe I overlooked it, but did they run a lab for LH/FSH? Permitting there are no issues with the MRI, this lab really needs to be checked to determine a primary or secondary diagnosis.

Not always, BUT in a lot of cases where I have seen guys with really, really low test scores, like yours, the problem seems to be related to testicular issues, not as much related to pituitary issues. This is strictly observational on my part from reviewing members stories for many years. The MRI is a must, but regardless, an LH/FSH lab could also tell us if the testicles are responding and possibly capable of producing endogenous testosterone. If your LH is elevated, then that pain you were feeling in the testes may need to be looked at a little closer.

One thing for sure ... I would wager that your LH is 1) Really High, or 2) Really, really low (in the tank). Wish you the best and let us know your results.

Best,
VM

[Bill_boy2005]

Definitely agree with the MRI.

Also, maybe I overlooked it, but did they run a lab for LH/FSH? Permitting there are no issues with the MRI, this lab really needs to be checked to determine a primary or secondary diagnosis.

Not always, BUT in a lot of cases where I have seen guys with really, really low test scores, like yours, the problem seems to be related to testicular issues, not as much related to pituitary issues. This is strictly observational on my part from reviewing members stories for many years. The MRI is a must, but regardless, an LH/FSH lab could also tell us if the testicles are responding and possibly capable of producing endogenous testosterone. If your LH is elevated, then that pain you were feeling in the testes may need to be looked at a little closer.

One thing for sure ... I would wager that your LH is 1) Really High, or 2) Really, really low (in the tank). Wish you the best and let us know your results.

Best,
VM

They've not ran the lab for it yet. My yearly physical is where we found the low T. Those will be in my next labs.

Thanks for the insight. Very much appreciated.

[Bill_boy2005]

Got the prolactin test back today, it came back at 4.0, so that was good. PSA was .40. Test was at 459 and free test was 142. Not really happy with the testosterone levels, but she stated she will not medicate to a high normal level, especially since my free test level was above mid point.

She also stated that I have primary hypogonadism, so that is a relief, in a sense. So now its time to find someone who will medicate to high normal. I am scheduled at Crisler next month, but am also considering Maximus HRT. Does anyone on this site go to them?

[steroid.com 1]

Thanks for keeping this thread updated Bill.

Free is more important than total at this point so mid point for that is not too bad (you didn't post ranges).

But it's more than this; what did your E2 panel say?

How dose she know your Primary? What were you LH/FSH ranges?

Crisler is one of the leading (there are others) TRT specialists and you'd be in great care under this mans guidance.

[Bill_boy2005]

GD, she will not test for the other items, E2, LH/FSH. Pretty solid in it being for "body builders" only. I think the lack of testicles on her part makes it hard to convince her of the necessity.

I know that I have to move my treatment, just want to make sure that I am going with someone progressive that knows their stuff. I will stick with Crisler. The scary part for me is the cost for the other Dr's. Right now this is all covered by my insurance. Looking at Crisler's and Maximus's prices spooks me.

[moparmuscle]

Use labcorp though privet md labs online and test for the missing stuFf yourself.

[steroid.com 1]

GD, she will not test for the other items, E2, LH/FSH. Pretty solid in it being for "body builders" only. I think the lack of testicles on her part makes it hard to convince her of the necessity.

I know that I have to move my treatment, just want to make sure that I am going with someone progressive that knows their stuff. I will stick with Crisler. The scary part for me is the cost for the other Dr's. Right now this is all covered by my insurance. Looking at Crisler's and Maximus's prices spooks me.

John's office will provide all the insurance codes you need to submit claims to your insuracne company so you should still be covered.

What type of health insurace coverage do you have? If not an HMO/PPO you should be fine.

[moparmuscle]

John's office will provide all the insurance codes you need to submit claims to your insuracne company so you should still be covered.

What type of health insurace coverage do you have? If not an HMO/PPO you should be fine.

About John do you have to visit in person or is it all tela (phone/email/fax), I would love to use insurance (I have great insurance but current clinic doesnt take/won't work).

[Bill_boy2005]

John's office will provide all the insurance codes you need to submit claims to your insuracne company so you should still be covered.

What type of health insurace coverage do you have? If not an HMO/PPO you should be fine.

I go to Lansing next Wednesday for a Thursday appt. The $500 upfront is no big deal, its the running cost that scared me. Talking to my insurance company they assured me that it would be covered.

We have Blue Cross/Blue Shield. He's out if network, but should cover 80% of the visit and then I will have my copays on the pills and injectables, which is very little.

[Bill_boy2005]

About John do you have to visit in person or is it all tela (phone/email/fax), I would love to use insurance (I have great insurance but current clinic doesnt take/won't work).

Unless he consults with your doctor, I believe you hae to make at least one visit with him. From there your office visits can be virtual visits.

[Bill_boy2005]

Last Lab Results
Here is the rest of what was ran on Dec 20. I should get a much more complete view as I am heading to Michigan tomorrow to see Dr. Crisler on Thursday.

PSA .4 (0-4)
Prolactin 4 (2.1-17.7)
Testosterone 459 (300-1080)
SHBG 9 (11-80)
Testosterone, Free 135 (47-244)

[zaggahamma]

Last Lab Results
Here is the rest of what was ran on Dec 20. I should get a much more complete view as I am heading to Michigan tomorrow to see Dr. Crisler on Thursday.

PSA .4 (0-4)
Prolactin 4 (2.1-17.7)
Testosterone 459 (300-1080)
SHBG 9 (11-80)
Testosterone, Free 135 (47-244)

must feel like a kid going to disney world

[Bill_boy2005]

must feel like a kid going to disney world

Just a little maybe

[ecsaaron]

With levels that low I bet he will be at 200-300 mg wk when he gets dialed in. Mine was 30s to 57 was the high and most know what im on..

[ecsaaron]

jpkman is that a cardigan sweater you got on for the winter in that avy?

[Bill_boy2005]

Any thoughts on what I need to discuss with Crisler while I am there Thursday aside from the basic question on the planned protocol? I am taking the last couple years of blood work, my last physical, and other recent medical data. Any other thoughts?

[Vettester]

Any thoughts on what I need to discuss with Crisler while I am there Thursday aside from the basic question on the planned protocol? I am taking the last couple years of blood work, my last physical, and other recent medical data. Any other thoughts?

Just relax, he's used to this routine, he will get you on the right track.

I'm still really puzzled how your previous doctor could assess that your condition is primary, but there's no LH or FSH labs to support this, or nothing mentioned where she ran specific tests in your testicular region. Definitely mention that to Dr. Crisler so that he can review it, and so that he can accurately diagnose you..

Good luck!!

[JD250]

I'm VERY interested on how BC/BS covers Crislers protocol....PLEASE update on your experience with insurance. I've got BC/BS too and if they cover Crislers care and protocol.....hell man, I'm gettin on the bus as soon as I can, I've had about enough of clinic prices and buying AIs and HCG from pharmacies in India.

[zaggahamma]

jpkman is that a cardigan sweater you got on for the winter in that avy?

yes..yes it is..twas a Christmas gift a long long time ago...they wouldnt exchange it

[Bill_boy2005]

Well im off to see the Dr. Should be interesting compared to the last few Dr's I have seen.

[zaggahamma]

Well im off to see the Dr. Should be interesting compared to the last few Dr's I have seen.

i'd be expecting a eintstein/lincoln but in arnolds body experience from what i hear

good luck bro

[Bill_boy2005]

First off genuinely a good guy. Spent an hour going through my medical history and asking questions. We reviewed my fitness and nutrition, he made some recommendations for changes in several areas, and ordered my labwork. We will follow up after that. He also started me on hcg as well. Due to sides that are likely low E2 related I will be stopping the AI as well till a level of requirement is established after my bloodwork.

Feel like I am in very good hands now. Definitely a good use of time and effort to travel to his practice.

[HRTstudent]

Just curious what were the changes in several areas he talked to you about?

[Bill_boy2005]

Just curious what were the changes in several areas he talked to you about?

Primarily tweaks to my diet. Addressing my intake of tuna, too much bottled water due to the contaminants, other diet mistakes I am making, possibly excessive running, and a few others. I will detail more when i am on my laptop.

[HRTstudent]

Primarily tweaks to my diet. Addressing my intake of tuna, too much bottled water due to the contaminants, other diet mistakes I am making, possibly excessive running, and a few others. I will detail more when i am on my laptop.

Great, thanks.

[zaggahamma]

wow didnt know he gave nutrition orders/advice as well...first i've heard..

bottled water, bad?