Please help! Trt not working!

[akhman]

it is about time I brought my problems to the experts . I've been struggling with a lot of low testosterone symptoms I've been losing muscle mass even though my diet and workout program are better than ever . I first started getting TRT 11 months ago when it was discovered that my total testosterone levels were at 380 . My side effects have been depression anxiety low energy and loss of muscle mass and decreased sex drive.I am 37yrs old I started taking andro-gel and after 2 months my levels had gone up a little bit to the middle four hundreds however my levels of free testosterone plummeted at the same time from just inside they consider the normal range to well below . My total testosterone continued to go up a little bit over the next few months but my free testosterone levels continued to be well below even what they consider the normal range. My symptoms haven't gotten any better as a matter of fact are worse now than when I first started on TRT. Most recently my endocrinologist had me do an MRI and says that my pituitary gland is shrunken. I recently went to naturopath and she switched me to bio identical testosterone cream and she is treating me for adrenal fatigue. but after 6 weeks I continue to lose muscle mass as well as all the other symptoms. I have lost a total of about 10 pounds of muscle since starting TRT. The last time I got my testosterone levels checked they were at 420 which was down from the previous high of 500 and the free testosterone levels remained very low and my SHBG levels remain high. I have done 3 cycles of steroids the last 1 being about 4 years ago. The first 2 I did just boldenone by itself and the last cycle I did testosterone and boldenone and a small amount of Dianabol. I did appropriate PCT after the last cycle only. My endocrinologist thinks that this steroid use along with a history of opiate dependence is the cause of my problems. I have been off opiates now for 3 years. The rather low amount of steroid use doesn't make sense to me either from my research. I'm worried that even if I'm able to get my total testosterone levels up which I haven't been able to do this point that my free testosterone levels will remain awful. Please help I will post my labs

[Anabolic4Health]

Sorry to hear this. I don't have any answers but just wanted to wish u well. Good luck bro. Hopefully the knowledgable guys will have some good advice

[JD250]

Complete blood work and some stats would be very helpful...... any advice based on the minimal amount of information you've given us would be a wild guess at best, which is what your doc is doing if he has been treating you based on total T alone.

[steroid.com 1]

What JD said; we need to see complete blood work as your symptoms could be caused by any number of things.

[akhman]

ok i was only able to locate the first two labs but i remember the latter ones pretty well and so i will be doing some estimating on the last two. My TRT started about a week after the first lab results so the second lab results were after about 7 weeks of using androgel. ive had a total of 4 labs done. As you will see my free test dropped significantly between my first and second lab and after that they remained about the same. The same with SHBG. It rose significantly between the 1st and 2nd lab and remained about the same on the next two. The fact that SHBG goes up and free t goes down obviously fits as my test is being binded but why i don't know. One of the free testosterone levels was just outside and one just within the "normal range" when the problem was diagnosed but both fell well outside of that range only 7 weeks after TRT began and never recovered. This is the most confusing and frustrating part to me. As we all know even their "normal range" is'nt really normal. I'm a health conscious, active, and fit person and should be in the upper end of their ranges. Basically after 10 months of taking adrogel my total t was slightly higher but free t and SHBG were worse. Also the edocrinologist says that she bases her decisions on total testosterone only, because the free test labs are inaccurate(???) Then why do them? Does'nt make sense. I know that the free t level is the most important!!! I will be going back to the endocrinologist in January for more tests. Wanted to know what to ask for. I had been offered injections by my regular doctor and that's when i asked for a referral to an endocrinologist for another opinion. The endocrinologist agreed to trying the bio-identical testosterone suggested by my naturopathic doctor (who has really helped with other issues in the past), but really wanted me to take clomid instead and that is her next step if my levels arent better in January. Is that a viable option? Or should i just do weekly injectables? If so will that fix the free test problems? Hate the idea of having to pin for the rest of my life but if that is what it takes to feel right again i'll do it. Here are my labs...thanks guys for taking the time to read all this i really appreciate it. I know there are a lot of different blood work tests, but here are the ones the endocrinologist took. hopefully they are helpful.

37yrs old, 6'0, now only 170lbs, healthy, active, very little body fat maybe 5%?


Date:1/23/12 (reference ranges)<units>
SHBG 42 f (20-60)<nmol/L>
%free testosterone 1.4 f (1.5-3.2)<%>
testosterone, free 54.0 f (52-280) <pg/mL>
testosterone, total 387 f (348-1197)<ng/dL>

3/19/12
SHBG 55 f
%free test 0.8 f
testosterone, free 37.0 Lf (don't know why this has Lf and the last test just had f but thats how it was printed)
testosterone, total 466.0 f

The next 2 labs were basically the same as this last one in march except the total t went up to app. 510 in July and then down to app. 420 in September.

Wtf? sorry guys i've got this chart separated out when i'm typing it, but when i post it it all crams together can't edit it cuz it looks right on my screen when i try. when i post it it removes all the spacing. don't know what else to do i know it makes it hard to figure out. lemme know if its just unreadable or if you know what i need to do to fix it....ok i'll put the reference range in parentheses maybe that will help and i'll put the units in< >...the first numbers are my actual levels

[JD250]

I guess what I meant to say is that even though this is all the blood work your doc ordered it is in no way helpful to us or a doctor without it being complete..... to help you understand what a complete work up would look like.....check this example..... it's only an example that I copied from a labwork website but as you can see there is more than just Test levels. I would imagine that a few people here could add several other tests that would be helpful in addition to those listed.



Description: The Male Ultimate Anti-Aging Panel is our Ultimate Anti-Aging Panel, with the addition of Ferritin, Prostate-Specific Antigen (PSA) test and includes Estradiol, Sensitive and Free (Direct) Testosterone. The Male Ultimate Anti-Aging Panel contains the following tests:

-Lipid Cholesterol Profile
-Complete Blood Count w/ Differential
-Estradiol, Sensitive
-Hemoglobin A1c
-Cardiac C-Reactive Protein Test, High Sensitivity
-Insulin Growth Factor (IGF-1)
-Thyroxine-Stimulating Hormone (TSH)
-Gamma Glutamyl Transpeptidase (GGT)
-Insulin, Fasting
-Comprehensive Metabolic Panel
-Luteinizing Hormone(LH)
-Testosterone, Free (Direct), Serum With Total Testosterone
-Sex Hormone binding Globulin, Serum
-Urinalysis, Routine
-Follicle-Stimulating Hormone (FSH)
-Magnesium, Serum
-Thyroxine (T4) Free, Direct
-Ferritin, Serum
-Prostate-Specific Antigen (PSA)
-Iron Serum w/TIBC
-Dehydroepiandrosterone Sulfate (DHEA)

Significant deviations from the normal range may require further evaluation by your physician.



Includes: Percent of saturation; serum iron; total iron binding capacity; unsaturated iron binding capacity; Ferritin, serum; Prostate-Specific Antigen (PSA), Serum; Cholesterol, total; high-density lipoprotein (HDL) cholesterol; low-density lipoprotein (LDL) cholesterol (calculation); triglycerides; very low-density lipoprotein (VLDL) cholesterol (calculation); Hematocrit; hemoglobin; mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); mean corpuscular hemoglobin concentration (MCHC); red cell distribution width (RDW); percentage and absolute differential counts; platelet count; red cell count; white blood cell count; Estradiol, Sensitive; Hemoglobin (Hgb) A1c; Cardiac C-Reactive Protein, High Sensitivity; IGF-1; Thyroxine-Stimulating Hormone (TSH);Gamma Glutamyl Transpeptidase (GGT); Insulin; A:G ratio; albumin, serum; alkaline phosphatase, serum; ALT (SGPT); AST (SGOT); bilirubin, total; BUN; BUN:creatinine ratio; calcium, serum; carbon dioxide, total; chloride, serum; creatinine, serum; globulin, total; glucose, serum; potassium, serum; protein, total, serum; sodium, serum; Luteinizing Hormone(LH); Testosterone, Free (Direct), Serum With Total Testosterone ; Sex Hormone binding Globulin, serum; Color, appearance, specific gravity, pH, protein, glucose, ketones, occult blood, leukocyte esterase, nitrite, bilirubin, and urobilinogen. These tests are done on all routine urinalysis ordered and if protein, leukocyte, occult blood, nitrite, and turbidity are all negative, microscopic examination is not performed; just the above parameters are reported; Follicle-Stimulating Hormone (FSH), serum; Magnesium, serum; Thyroxine (T4) Free, Direct; Dehydroepiandrosterone Sulfate (DHEA).

[JD250]

Common results with androgel, it does work well for a few but many have the same results as you. In the stickies at the top of this forum you will find several articles of interest.... 1st is the write up by Marcus concerning lab work 2nd is one by GD about estradiol (e2)

The blood work that you posted is extremely basic and doesn't tell much of a story. I know its frustrating and expensive but keep educating yourself here and you WILL start to understand all this a little better. For right now learn about the proper labs required to make an educated diagnosis and find a doctor who is willing to do the same, don't be a guinea pig for a doctor who only tests for free T before writing a script, a buddy at the gym could make a wild guess like that, it's your health so dont be afraid to question your Doc.

[JD250]

How could I forget..... a must read sticky.... "Finding a TRT physician" by Kelkel..... good stuff about labwork in that one also.