I will keep this post informative and to the point, but must warn it is long with all the labs attached.
I'm a 32-year-old white male, 5'8", 198 lbs. I began feeling very tired and lethargic in August of 2011. I also had been gaining weight around my mid-section rather quickly (+25lbs in 8 months) and I was too exhausted to even attempt working out to combat these changes. My libido was moderate however my erection frequency was diminished. I attributed these events to a stressful job and did not go see my primary doctor until January 2012.
Primary Care Office visit January 17, 2012 lab results (Quest Labs):
White Blood Cell Count (3.8-10.8 Thousand/u) 6.2
Red Blood Cell Count (4.2-5.8 Million/uL) 5.14
Hemoglobin (13.2-17.1 G/DL) 15.8
Hematocrit (38.5-50.0 %) 46.1
MCV (80.0-100.0 FL) 89.6
MCH (27.0-33.0 PG) 30.7
MCHC (32.0-36.0 G/DL) 34.2
Platelet Count (140-400 Thousand u) 211
RDW (11.0-15.0 %) 12.3
Absolute Neutrophils (1500-7800 cells/uL) 3026
Absolute Lymphocytes (850-3900 cells/uL) 2406
Absolute Monocytes (200-950 cells/uL) 496
Eosinophils (%) 3.8
Absolute Eosinophils (15-500 cells/uL) 236
Basophils (%) 0.6
Neutrophils (%) 48.8
Lymphocytes (%) 38.8
Monocytes (%) 8
Absolute Basophils (0-200 cells/uL) 37
T-3 Uptake (22-35 %) 36
T-4 (Throxine), Total (4.5-12.0 MCG/DL) 6.3
Free T4 Index (T7) (1.4-3.8) 2.3
Thyroid Stimulating Hormone 3rd Generation (0.40-4.50 MIU/L) 1.78
Fasting Glucose Serum (65-99 MG/DL) 97
Urea Nitrogen (BUN) (7-25 MG/DL) 11
Creatinine (0.60-1.35 MG/DL) 1.06
GFR Non-African American (> OR = 60 ML/MIN/1.7) 93
Sodium (135-146 mmol/L) 141
Potassium (3.5-5.3 mmol/L) 4.1
Chloride (98-110 mmol/L) 105
Carbon Dioxide (21-33 mmol/L) 27
Calcium (8.6-10.3 mg/DL) 9.9
Protein, Total (6.2-8.3 G/DL) 7.1
Albumin (3.6-5.1 G/DL) 4.4
Globulin (2.1-3.7 G/DL CALC) 2.7
Albumin/Globulin Ratio (1.2-2.1) 1.6
Bilirubin, Total (0.2-1.2 MD/DL) 0.9
Alkaline Phosphatase (40-115 u/L) 70
AST (10-40 u/L) 20
ALT (9-60 u/L) 24
Triglycerides (<150 MG?DL) 125
Cholesterol, Total (125-200 MG/DL) 184
HDL Cholesterol (> OR =40 MG/DL) 37
LDL Cholesterol (<130 MG/DL CALC) 122
Chol/HDLC Ratio (< OR =5.0 CALC) 5
"LDL/HDL Ratio (CALC)
Below Average Risk <2.28
Average Risk: 2.29-4.90
Moderate Risk: 4.91-7.12
High Risk: >7.13" 3.3
Non-HDL Cholesterol (MG/DL CALC)
Testosterone, Total (250-1100 NG/DL) 328
Free Testosterone (35.0-155.0 PG/ML) 83
Follicle Stimulating Hormone (1.6-8.0 MIU/ML) 4.2
Luteinizing Hormone (1.5-9.3 MIU/ML) 4.4
Prolactin (2.0-18.0 NG/ML) 11.2
Estradiol, Ultrasensitive, LC/MS/MS (< OR = 29 pg/mL)
Vitamin D, 25-OH, Total (30-100 NG/ML) 19
Vitamin D, 25-OH, D3 (NG/ML) 19
Vitamin D, 25-OH, D2 (NG/ML) <4
Advice from Primary: "Lose weight and get more active. Try to control your diet to lower your cholesterol" He also gave me a sample pack of V*****. I left and did my best to follow orders.
I was still experiencing increased weight gain (now up to 210 lbs) and fatigue. I was now also experiencing frequent interruptions in sleep, near zero erections, and could barely maintain erections for more than 30 seconds to a minute. I scheduled another office visit.
Office Visit April 6, 2013 lab results (Quest Labs):
White Blood Cell Count (3.8-10.8 Thousand/u) 6.1
Red Blood Cell Count (4.2-5.8 Million/uL) 5.16
Hemoglobin (13.2-17.1 G/DL) 15.5
Hematocrit (38.5-50.0 %) 46.6
MCV (80.0-100.0 FL) 90.3
MCH (27.0-33.0 PG) 30
MCHC (32.0-36.0 G/DL) 33.3
Platelet Count (140-400 Thousand u) 208
RDW (11.0-15.0 %) 12.1
Absolute Neutrophils (1500-7800 cells/uL) 3495
Absolute Lymphocytes (850-3900 cells/uL) 1879
Absolute Monocytes (200-950 cells/uL) 500
Eosinophils (%) 3.4
Absolute Eosinophils (15-500 cells/uL) 207
Basophils (%) 0.3
Neutrophils (%) 57.3
Lymphocytes (%) 30.8
Monocytes (%) 8.2
Absolute Basophils (0-200 cells/uL) 18
Thyroid Stimulating Hormone 3rd Generation (0.40-4.50 MIU/L) 1.5
Fasting Glucose Serum (65-99 MG/DL) 89
Urea Nitrogen (BUN) (7-25 MG/DL) 0
Creatinine (0.60-1.35 MG/DL) 1.06
GFR Non-African American (> OR = 60 ML/MIN/1.7) 107
Sodium (135-146 mmol/L) 142
Potassium (3.5-5.3 mmol/L) 4
Chloride (98-110 mmol/L) 104
Carbon Dioxide (21-33 mmol/L) 27
Calcium (8.6-10.3 mg/DL) 10.2
Protein, Total (6.2-8.3 G/DL) 7.2
Albumin (3.6-5.1 G/DL) 4.4
Globulin (2.1-3.7 G/DL CALC) 2.8
Albumin/Globulin Ratio (1.2-2.1) 1.6
Bilirubin, Total (0.2-1.2 MD/DL) 1
Alkaline Phosphatase (40-115 u/L) 73
AST (10-40 u/L) 24
ALT (9-60 u/L) 32
Triglycerides (<150 MG?DL) 205
Cholesterol, Total (125-200 MG/DL) 167
HDL Cholesterol (> OR =40 MG/DL) 35
LDL Cholesterol (<130 MG/DL CALC) 91
Chol/HDLC Ratio (< OR =5.0 CALC) 4.8
Non-HDL Cholesterol (MG/DL CALC) 132
Testosterone, Total (250-1100 NG/DL) 283
Free Testosterone (35.0-155.0 PG/ML) 82.6
Follicle Stimulating Hormone (1.6-8.0 MIU/ML) 4.5
Luteinizing Hormone (1.5-9.3 MIU/ML) 4.7
Prolactin (2.0-18.0 NG/ML) 9.6
Vitamin D, 25-OH, Total (30-100 NG/ML) 23
Vitamin D, 25-OH, D3 (NG/ML) 23
Vitamin D, 25-OH, D2 (NG/ML) <4
Vitamin D, 1,25 (OH)2, Total (18-72 PG/ML) 60
PSA (< OR = 4.0 NG/ML) 0.9
Vitamin B12 (200-100 PG/ML) 439
Folic Acid (NG/ML) 11.2 [Low: <3.4; Borderline: 3.4-5.4; Normal: >5.4]
Hemoglobin A1c (% of total) 5.3 [Decreased risk of diabetes: <5.7; Increased risk of diabetes: 5.7-6.0; Higher risk of diabetes: 6.1-6.4; Consistent with diabetes: > OR =6.5"]
My primary provided me a referral to see an endocrinologist and said that he had no idea what was happening.
I had unsuccessful visits with two different endocrinologists. One stating they don't treat low T and gave me a referral to a urologist and the other stated that I should see a sex therapist for my limited erections. and be prescribed anti-depressants. I wisely ignored their ridiculous advice.
I found a local "Men's Health Clinic" that advertised TRT so I scheduled an appointment on 6/26/2013 and no new labs were required as they just confirmed from the 4/17/13 recent visit. I was started on 300mg Cypionate that day along with B12 injection. The regimen prescribed was to return every 14 days for subsequent visits to receive injections in office. My visit schedule was as follows:
6/26/2013 - First injection
7/8/2013 - Second injection
7/19/2013 - Third injection. I informed the clinic nurse that I felt even more tired, had no erections, and was experiencing some leg cramping. She stated that she would have the Dr. call me (which he never did).
7/25/2013 - I stopped by office to speak with Dr. but he didn't come in that day so I asked for him to call me again.
7/27/2013 - I received a phone call from Dr. and he stated that I could come see him on 8/2/13 and there was nothing to worry about. He said my symptoms were unrelated to the TRT. This should have been my first clue that he might be clueless.
8/2/2013 - Fourth Injection. I met with Dr. and explained that I felt worse than ever. Explained my sleep hours are now exceeding 12 hours and I was still tired. I also stated that I had no more erections and inquired why this was happening. I also asked if I could be making more estrogen as my leg cramps had gotten so bad I was awakened at night and could not move my right leg as my calf and hamstring was literally stuck. His reply was, "I have over 1600 patients on TRT with the same dosing and regimen and you're the only one with this problem. There is no explanation why this is happening and estrogen has nothing to do with your low T." I then requested for a prescription for CBC, Calcium, E2, TT, FT, FSH, LH, PSA, Prolactin, and SBHG. He refused and only gave me the following (with results posted):
8/15/2013 - Fifth Injection
8/20/2013 - Lab results came back today, and the Dr. said that he cannot review them until Thursday which is when he wants me to return (duh to take more of my $ for an office visit).
Quest Lab Results: (NOTE: These labs were drawn on day 13 of my 14 day dosing schedule):
Hemoglobin (13.2-17.1 G/DL) 15.5
Hematocrit (38.5-50.0 %) 46.6
Testosterone, Total (250-1100 NG/DL) 448
Free Testosterone (35.0-155.0 PG/ML) 145.6
Luteinizing Hormone (1.5-9.3 MIU/ML) 0.2
Estradiol, Ultrasensitive, LC/MS/MS (< OR = 29 pg/mL) 47
PSA (< OR = 4.0 NG/ML) 1.2
Clearly my E2 is high and I have improved in FT and TT, but I'm concerned about my rising PSA in such a short time as well as my large decrease in LH being that I have only taken 5 injections. I'm stuck in a difficult situation and could seriously use some help and explanations if possible. My leg cramping is worsening, I have terrible back pains, and I've now developed burning and tingling in my arms and legs when I lay down.
Thank you in advance for everyone's help.
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Originally Posted by rebelstate
