Low T, What Would You Do?

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Serif12

New Member
In October I decided to see my doctor due to fatigue and concentration issues. Thinking my cause was shiftwork and sleep disorder.


After initial blood work, it was apparent I had low Test. I had my blood checked at in the am, to see if there was an increase. Meantime I was prescribed Androgel 1.62%. 2 pumps for 1 month, did not help. 6 weeks at 3 pumps and nothing.

Updated...

Went to a Urologist and got more blood done. Im waiting on that now. Though the doc wants me to get 14 testopel's in my ass. I am not sold on that idea so far. I have 3 weeks before that can happen anyways.

I am more for personal injections. Not sure how to arrange it, and have the doc on board.



Male
34
5-11
215
Body Fat 26%
BMI 29.98




Here are my results so far...

10/01/14 3:11pm
TEST 229


10/03/14 7:50am
Test 303
Test Free 7.54
%Free Test 2.49
HGB 42.9
HCT 15.2


11/10/14 7:50am
Test 281
Test Free 7.11
%Free Test 2.53
HGB 15.2
HCT 44.4






What would you do?


Is there anything I should ask my doctor?


What are my options?


What other prescriptions should I be open to for T Replacement/Supplementation?


Is an E blocker needed?


I read about Testicle shrinkage, what should I be taking if this occurs?


Is there any other blood work that I may be missing, or need to follow?


At what point should I seek help elsewhere?








From my research and understanding... I would like to think 700-900 on the T levels would ideal. I am open to all responses and treatments. Supplements, vitamins, herbal and mineral included. Even though I work out 3-4 times a week and eat a healthy diet, I feel like I am fighting a losing battle.


I know this may be a loaded Post, I feel that I can only get the best answers from the men and women that have tackled Test, Energy, Libido and Growth issues that we live with today.








-Sex- Male
-Age- 34
-Height- 5'-11
-Waist- 38
-Weight- 215-220
-Body Type- Endomorph
-Body and Facial hair - Forearms, thy and legs, average.
-Fat placement, and changes- Blessed with equal fat distribution. Gut and love handles increased in last 24 months.
-Health conditions, Symptoms [history]- Low Testosterone. Fatigue, Decreased libido, Concentration and Sleeplessness. Feel powerless, drained and hollow at gym, compared to what I know I can , should and have done. No depression initially, though I do feel a bit low or moody at times due to my inability to perform at the level I should be able to.
-Rx and OTC drugs, Other - Multivitamin, Vit D w/minerals, Glucosamine and Chondroitin and Provigil -Modafinal-
Prescribed Provigil to help Shift Work Disorder and Fatigue during long days and long drives.


Stopped all Protein, Creatine and Pre-Workout Supps to give tests a solid baseline. Reduced alcohol to 3 beers/week tops.




-Lab Results with ranges
Labs being updated

10/01/14 3:11pm
Testosterone
TESTOSTERONE 348-1197 ng/dL 229


Thyroid Cascade
TSH 0.27-4.20 mcU/mL 1.28


Comprehensive Metabolic Panel
POTASSIUM 3.5-5.5 mmol/L 4.0
SODIUM 133-145 mmol/L 140
CHLORIDE 98-110 mmol/L 103
Glucose 65-99 mg/dL 100
CALCIUM 8.4-10.4 mg/dL 9.4
ALBUMIN 3.5-5.0 g/dL 4.8
SGPT (ALT) 5-40 U/L 51
SGOT (AST) 10-37 U/L 30
BILIRUBIN TOTAL 0.2-1.2 mg/dL 0.3
Alkaline Phosphatase 25-115 U/L 105
BUN 6-22 mg/dL 19
CO2 20-32 mmol/L 22
CREATININE 0.5-1.2 mg/dL 1.1
eGFR African American >60.0 >60.0
GLOBULIN SERUM 2.0-4.0 g/dL 2.3
A/G RATIO 1.1-2.6 ratio 2.1
TOTAL PROTEIN 6.4-8.3 g/dL 7.1
ANION GAP 15.4


CBC W/Differential
WBC x 10*3 4.0-11.0 K/uL 6.2
RBC x 10*6 3.80-5.80 M/uL 5.35
HGB 13.2-17.3 g/dL 15.2
HCT 36.6-51.9 % 42.9
MCV 80-95 fL 80
MCH 26-34 pg 28
MCHC 32-36 g/dL 35
RDW 10.0-16.0 % 13.4
PLATELET 140-440 K/uL 220
MPV 6.0-10.8 fL 10.9
SEGMENTED NEUTROPHILS 40-75 % 60
LYMPHOCYTES 27-45 % 29
MONOCYTES 3-9 % 11
EOSINOPHIL 0-6 % 1
BASOPHILS 0-2 % 1
ABSOLUTE NEUTROPHILS 1.8-7.7 K/uL 3.7
ABSOLUTE LYMPHOCYTES 1.0-4.8 K/uL 1.8
ABSOLUTE MONOCYTE COUNT 0.1-0.9 K/uL 0.7
ABSOLUTE EOSINOPHIL 0.0-0.5 K/uL 0.0
ABSOLUTE BASOPHIL COUNT 0.0-0.2 K/uL 0.0






10/03/14 7:50am
TESTOSTERONE,FREE AND TOTAL
Testosterone 348 - 1197 ng/dL 303
Testosterone Free 5.00 - 21.00 ng/dL 7.54
%Free Testosterone 1.50 - 4.20 % 2.49






11/10/14 7:50am
TESTOSTERONE,FREE AND TOTAL
Testosterone 348 - 1197 ng/dL 281
Testosterone Free 5.00 - 21.00 ng/dL 7.11
%Free Testosterone 1.50 - 4.20 % 2.53


H&H
HGB 13.2-17.3 g/dL 15.2
HCT 36.6-51.9 % 44.4


PSA SCREEN
PSA SCREEN <=1.400 ng/mL 0.866


1/12/15 8:45am
TESTOSTERONE,FREE AND TOTAL


Testosterone 348 - 1197 ng/dL 277
Testosterone Free 5.00 - 21.00 ng/dL 4.68
%Free Testosterone 1.50 - 4.20 % 1.69


H&H
HGB 13.2-17.3 g/dL 14.8
HCT 36.6-51.9 % 43.4


Hepatic Function Panel
ALBUMIN 3.5-5.0 g/dL 4.1
TOTAL PROTEIN 6.4-8.3 g/dL 6.7
GLOBULIN SERUM 2.0-4.0 g/dL 2.6
A/G RATIO 1.1-2.6 ratio 1.6
BILIRUBIN TOTAL 0.2-1.2 mg/dL <0.1
BILIRUBIN DIRECT 0.0-0.3 mg/dL <0.2
SGOT (AST) 10-37 U/L 28
Alkaline Phosphatase 25-115 U/L 118
SGPT (ALT) 5-40 U/L 36


1/16/2015


ESTRADIOL 8-43 ng/L 15
CORTISOL 6.49
DHEA Sulfate 138.5 - 475.2 ug/dL 152.5




-Diet-
4-5 days a week.
Meal 1 - 4:30-5:30am
2-3 Eggs with Plain oats, Cream of Wheat or Grits.
1 pint of 2% Milk


Snack 1 - 10:00am While Working
Apple or Orange


Meal 3 - Noon Lunch Break
1 Bag of BBQ Baked Chips <-guilty
2-3 Hard boiled eggs


Snack 2 - 4:00pm In Car
Apple or Orange


Snack 3 - 5:00pm
1 can of Tuna fish or Fruit Smoothy -Frozen berrys and water-
or
1-2 Hard boiled eggs


Meal 3 - 7:00-8:00pm 50%


Home cooked meal, boneless meat and veggies
or
Mom and Pop Diner, Chain Restaurant, Take out Chinese or Pizza. <- Guilty




-Current Training- Gym 3-4 days/week. Med weight/Med Reps.
-Testes ache, ever, with a fever? - Only once have I had a noticeable pain in the left testicle. Recently.
-Morning/Night wood - Yes. Fully operational. No changes that I am aware of.
 
Defy Medical TRT clinic doctor

Serif12

New Member
I have one more doc I would like to see in my area. She is a Endocrinologist. I would like her to help me diagnose my root cause. Once I have more info on that, I would like to me forward with treatment.

If all fails here, I will take you up on Trombley. I drive 2-4 hours a day, on top of 8 hour work shift as a steelworker. Distance is not an issue. I am not far from 64 and 95 either.

It seemed to me that this Urologist I visited, was interested in treatments, but not the cause. I have a few people following this exact information on another forum, and they suggest looking deeper into possible thyroid issues.

Main reason I asked for more detailed blood work before I commit to any new treatment.

I accepted the Androgel naively. My primary doc, did not suggest or aknowledge other prescriptions to counter act outside Test. Or to Boost natural with HCG.

Does he allow self administered injections? I am starting to lean more to this to keep my levels in check through labs until I can get checked 2 times a year.
 

CoastWatcher

Moderator
Many, perhaps most of us, on the forum have had to search carefully for a doctor we can trust and work with. Don't be surprised - or discouraged - if it takes time to find a doctor who understands male hormone replacement therapy.
 

Nelson Vergel

Founder, ExcelMale.com
Serif12

I am disturbed by the amount of blood testing your doc has performed without improving your numbers.

You do not have to agree to Testopel. But keep in mind that doctors make more money prescribing Testopel, so you are probably be pressured to choose that option.

The folks from Defy Medical or lowtestosterone.com can also help.
 

Serif12

New Member
New Labs are in.


LH 2.9


Testosterone, Total , LC/MS 317.8 "hishest its been in 6 months"
Free Test 7.0


HGB 15.2


TSH 0.84


FSH 2.11


Prolactin 4.02




Odd how my T is higher when I am off Androgel. Either way I came to a fast conclusion on Testopel.




I am open about my issue to those that are truly concerned with health and fitness. That being said, I discuss my current issue with you here, and 2 other forums along with members of my gym.


Being open about my concerns with Testopel, a gym member I only speak to in passing, came forward and told me he has been on Testopel for over a year. I had no idea he was on TRT. He explained that he works in an office, sitting 5-6 hours day, so its not that bad on him. That bruise was 3 days old. Today was his first day back in the gym. He showed what Testopel's can do to one's ass cheek. I am not having that done. I am a steel worker. I work in confined spaces. There is no way that procedure will work for me. Even though he was happy with it, I was turned off. Large bruising and looked red around the edges.






After seeing that, I had to call my Urologists office. I just left a message with my doc's secretary, and will discuss other treatments.
 

Nelson Vergel

Founder, ExcelMale.com
I think Testopel is only justified for men who really do not remember to apply daily gel or inject weekly. It has no other benefit and potential for scaring, infections and extrusion is too high. Most men are also provided too few pellets and their docs wait too long to insert new ones.
 

Nelson Vergel

Founder, ExcelMale.com
Your TSH seems fine but as you well know TSH does not provide a full picture of thyroid function. At a minimum, free T3 and free T4 should accompany TSH.
 

Serif12

New Member
Due to my low body temps, and near shutdown for some unknown reason, it seems I have a few symptoms of hypothyroidism.

I had just found out that my father was diagnosed with hypothyroidism. He is on Synthroid, if I recall correctly.

Covering all bases before starting a new treatment plan.
 

Serif12

New Member
Update


Good News


New Prescription
2x Test Cyp 200 /month Or 100/Week
Started 3/20/2015




I asked for 2 per week, and he just suggested me to do that my self since he didn't want to write that as a prescription.
Came with a ton of over sized syringes. I did not feel a pinch or anything.
Today I feel a bit more pep in my step. More than I have in a while. I had very little caffeine through the day, and a small coffee at 3pm.


I ordered smaller gauge and CC in bulk, with wipes.




Bad News


Doc would not prescribe anything for E blocking, or HCG at all.
I tried to talk to him about looking into it. He shrugged off the information.


When I asked about followup blood work, he said that he would like to check my blood for allergic reaction. Hemoglobins I suspect.
I asked about T, LH, FSH, Prolactin, and E, he just looked about me funny and said.. "Ok we can check those also"
Scheduled a appoinment with his nurses to show me how to inject... 4 weeks out....and a Lab Appointment 6 days after that.




So currently I am looking for another Urologist.


Other than calling pharmacies and asking who prescribes HCG and Anastrozole with Test...
I would like to see someone that my insurance will not have troubles with as they are very picky.


What would you suggest?

I have contacted the references, and I will follow up with them if I cannot find means on my own locally.


On another note, I have an appointment on a Endocrinologist April 2. I would like to see their opinion on my thyroid, and levels. I would like to know why my levels are low. And if I can just start my own T levels with HCG or other means.
 

Serif12

New Member
3/19/15

I was prescribed 100mg Test Cyp/Week. Being week 3, I do feel better .Though I have not had any labs yet.

I am was not thrilled with this Uro. His concerns were not my concerns at all. He was not goign to do labs on my lT or levels at all. He just wanted to see if I had an Allergy to Test Injections.

I talked him in to checking my T's and E for a minimum. That lab is scheduled on the 4/22/15. This is going to be moved up to 4/10/15 if I can.

I was not satisfied with his response to my concerns... I sought another doctor's opinion. I found a well respected Endo in my area....

Just got back from my first visit with the Endocrinologist.


The doctor felt that I was not tested correctly, not diagnosed correctly and not prescribed correctly. The Doc is calling for all medication/treatments to stop in order to provide clean labs.


I have a couple months to clear my system of Test Cyp and Provigil. And 1 month to let my body return to its normal state untreated.


1 multi vitamin a day is all I should be taking.


Ugghh... I should have started here!


It does suck that I have to start over to began right, but I do feel this is the best road. Only this way will I know what truly is the cause of my low T.


On a good note, this doctor was very informative and thorough. For the first time in a long time I felt I was at the right doctor.


Lab Orders Entail


ACTH Assay
Follicle Stimulating Hormone (FSH)
Free Thyroxine
Free Triiodothyronine
Luteinizing Hormone (LH)
Prolactin
Quantitative Immunoassay, - Alpha Pituitary Sub-Unit
Sex Hormone Binding Globulin
Somatomedin
Testosterone, Free
Testosterone, Total
Thyroid Stimulating Hormone (TSH)
Total Cortisol




Well, here goes 2-3 month of feeling crappy to get to the bottom of this.


Nelson, thanks for the support and info. I will update as needed. I will be around.

Meanwhile I will continue to eat right, workout and get 8-9 hours of sleep.
 

Serif12

New Member
I have finished up with the Endo. My Thyroid and Pituitary is fine, from what the doc says.

Though she says I should not be on TRT. That my T levels are fine. I disagree and will follow up with my Uro.

(07/10/2015 7:45 AM EDT)

ACTH
15.8

7.2-63.3 pg/mL

FSH
2.5

1.5-12.4 mIU/mL

T4 FREE
1.0

0.9-1.8 ng/dL

T3 FREE
3.6

2.3-4.2 pg/mL

LH
4.0

1.7-8.6 mIU/mL

Alpha Subunit (Free)
0.16
ng/mL

Sex Hormone Binding Globulin
31.9

16.5-55.9 nmol/L

SOMATOMEDIN C INSULIN-LIKE GROWTH FACTOR I
144

88-246 ng/mL

%Free Testosterone
2.63

1.50-4.20 %

Testosterone Free
8.47

5.00-21.00 ng/dL

Testosterone
322

348-1197 ng/dL

TSH
1.12

0.27-4.20 mcU/mL

CORTISOL
17.1 mcg/dL


PROLACTIN
12.5

4.0-15.2 ng/mL

DHEA Sulfate
141.3

138.5-475.2 ug/dL

I am going to start TRT today.

100ml Test C
500ui HCG
1mg Anastrozole

Per Week and have my T and E checked again. Goal is 750+ on T and 15-20 on E.
 

Nelson Vergel

Founder, ExcelMale.com
Why are you going to get on anastrozole? You may not need it and you can always bring it in later if your E2 is found to be high at week 6 or 8.

You may want to supplement DHEA at 50 mg/day
 

CoastWatcher

Moderator
You are measuring your estradiol on the sensitive test? Otherwise, the resukts you get will be of no value. As to control of estradiol - Nelson is right. I would be very hesitant to use an AI until I was certain I needed one. Further to that point, if E2 does climb too high, it can frequently be managed with subtle changes in your protocol (dose and frequency). But if you and your doctor insist on Anastrozole, the dose you indicated, 1mg, is an awfully large amount. Easy to send your levels into the gutter.
 
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