What should I do?

Wrecks24 · May 5, 2016

So, I know this question gets asked a lot around here, but I have had symptoms of low testosterone for quite some time now. No Libido, just feel down all of the time. I have had blood work done multiple times and seem to be all over the chart. I see a Urologist tomorrow.

I am 39 years old.
My Height and weight is 5'10/175lbs
Non Smoker

My latest lab results are as follows:

///////////////////////////////////
Testosterone, Serum or Plasma Quantitative - 447ng/dl____Reference Range: 348-1197

Testosterone Free, Serum or Plasma Quantitative Direct - 7.0pg/mL ____Reference Range: 8.7-25.1

How do these results look to you guys? My Free testosterone is obviously low (even stated on paperwork as "Below Normal"). What should I expect? Should they prescribe anything?

I would just like to know what I should be looking for while talking with the Doc.

Thanks for your input.

ERO · May 5, 2016

Best advice - skip the Urologist and seek out a TRT specialist. The worst protocols (decades out of date) seen on this forum come from the everyday Urologist or Endo. Many of use use and highly recommend Defy Medical.

Wrecks24 · May 5, 2016

Thanks for the quick reply, but unfortunately I am at the hands of the military when it comes down to it. If this apt goes south, I may ask my Primary care manager to give me a referral to a TRT specialist.

Vince · May 5, 2016

As usual, I agree with ERO. At least call Defy Medical to see if they are affordable for you. http://www.defymedical.com/

CoastWatcher · May 5, 2016

Wrecks24 said:
So, I know this question gets asked a lot around here, but I have had symptoms of low testosterone for quite some time now. No Libido, just feel down all of the time. I have had blood work done multiple times and seem to be all over the chart. I see a Urologist tomorrow.

I am 39 years old.
My Height and weight is 5'10/175lbs
Non Smoker

My latest lab results are as follows:

///////////////////////////////////
Testosterone, Serum or Plasma Quantitative - 447ng/dl____Reference Range: 348-1197

Testosterone Free, Serum or Plasma Quantitative Direct - 7.0pg/mL ____Reference Range: 8.7-25.1

How do these results look to you guys? My Free testosterone is obviously low (even stated on paperwork as "Below Normal"). What should I expect? Should they prescribe anything?

I would just like to know what I should be looking for while talking with the Doc.

Thanks for your input.

Whether you look for medical care elsewhere is something you can decide down the road. You have an appointment tomorrow, so, here are some thoughts.

Your total testosterone is certainly lower than it ought to be. Keep that in mind - you are, technically, "in range", and some doctors will simply glance at your labs and dismiss you. It shouldn't work like that. Simply put, most of us don't feel the positive effects of TRT if total testosterone is below 700. You certainly have low testosterone. But...why?

What other lab results do you have? I hope a more thorough workup was undertaken. LH, FSH? Very important tests as they will help determine if you have primary or secondary hypogonadism. A full thyroid panel? That includes TSH, FT3, FT4, RT3, and thyroid antibodies. Thyroid irregularities can - and do - play havoc with health. Cortisol? Not serum cortisol (a test of limited value), but the 4-point saliva test. SHBG? Should you initiate TRT, your SHBG level will help determine protocol and dosing. PSA? A baseline prostate lab ought to be taken before TRT and repeated regularly.

What other medications and supplements are you taking? History of opiate use? Anabolic steroids? Head or testicle injury? Is fertility an issue? TRT will suppress your fertility unless steps are taken to counter that potential problem.

Post up what you can and you will be surprised at the response. All the best...and welcome to Excelmale!

ERO · May 5, 2016

In that case, be wary of the 'one shot every 2 weeks' or 'one shot every 4 weeks' protocols and ask if you can do your own injections. They may say 'no' but its worth asking - if you can do your own shots then you can inject every 3.5 days instead.

Wrecks24 · May 5, 2016

CoastWatcher said:
Whether you look for medical care elsewhere is something you can decide down the road. You have an appointment tomorrow, so, here are some thoughts.

Your total testosterone is certainly lower than it ought to be. Keep that in mind - you are, technically, "in range", and some doctors will simply glance at your labs and dismiss you. It shouldn't work like that. Simply put, most of us don't feel the positive effects of TRT if total testosterone is below 700. You certainly have low testosterone. But...why?

What other lab results do you have? I hope a more thorough workup was undertaken. LH, FSH? Very important tests as they will help determine if you have primary or secondary hypogonadism. A full thyroid panel? That includes TSH, FT3, FT4, RT3, and thyroid antibodies. Thyroid irregularities can - and do - play havoc with health. Cortisol? Not serum cortisol (a test of limited value), but the 4-point saliva test. SHBG? Should you initiate TRT, your SHBG level will help determine protocol and dosing. PSA? A baseline prostate lab ought to be taken before TRT and repeated regularly.

What other medications and supplements are you taking? History of opiate use? Anabolic steroids? Head or testicle injury? Is fertility an issue? TRT will suppress your fertility unless steps are taken to counter that potential problem.

Post up what you can and you will be surprised at the response. All the best...and welcome to Excelmale!

Wow! that's a lot, I don't believe I have had most of those, Although I did have the Estradiol lab work done.

Estradiol, Serum or Plasma Quantitative - 29pg/mL____Reference Range: (6.5-61.1)
Prolactin, Serum or Plasma Quantitative - 4.82ng/mL____Reference Range: (2.12-14.90)
Thyrotropin, Serum or Plasma Quantitative - 1.624_____Reference Range: (0.35-3.74)
Follitropin, Serum or Plasma Quantitative - 1.25mIU/mL
Lutropin, Serum or Plasma Quantitative - 2.24mIU/mL

CoastWatcher · May 5, 2016

Wrecks24 said:
Wow! that's a lot, I don't believe I have had most of those, Although I did have the Estradiol lab work done.

Estradiol, Serum or Plasma Quantitative - 29pg/mL____Reference Range: (6.5-61.1)
Prolactin, Serum or Plasma Quantitative - 4.82ng/mL____Reference Range: (2.12-14.90)
Thyrotropin, Serum or Plasma Quantitative - 1.624_____Reference Range: (0.35-3.74)
Follitropin, Serum or Plasma Quantitative - 1.25mIU/mL
Lutropin, Serum or Plasma Quantitative - 2.24mIU/mL

Your doctor ordered the wrong estradiol test. That is the "standard" assay - of almost no value with men. Ask for the sensitive, Liquid Chrom, dual mass spec (LC, MS/MS) which is appropriate for men. Don't be surprised if your doctor looks at you with a baffled squint - many will have no idea what you are talking about. A rough guess would indicate your levels *may* be ok - the test you had tends to overestimate estradiol in men.

You did have the lutropin and follitropin tests - do you have ranges?

No PSA?

An inadequate thyroid evaluation.

What about other drugs and supplements? Head or testicle injuries?

CoastWatcher · May 5, 2016

Should you be offered testosterone replacement, and if you are seeing a military doctor that is by no means certain, don't be surprised if the initial mode of treatment prescribed is a topical (a gel or cream). That isn't unreasonable, on the face of things, but don't be surprised if it fails to impact you at all. Topicals don't work for a large number of men, I was one of them, and they either move to injections or grow frustrated and walk away from the process. Should a topical be I. Your future, give it a good-faith effort and evaluate it with appropriate bloodwork.

kspat · May 7, 2016

what do you mean by "Simply put, most of us don't feel the positive effects of TRT if total testosterone is below 700"?

CoastWatcher · May 7, 2016

Ss

kspat said:
what do you mean by "Simply put, most of us don't feel the positive effects of TRT if total testosterone is below 700"?

It was a comment made in regard to reference ranges. To be told one has "normal" testosterone levels, while in the lower quintile of the reference scale, is misleading. Men who have been hypogonadal for some time tend to begin "responding" to TRT when levels cross the 700 mark. Optimal response is usual higher.

kspat · May 7, 2016

oh I see what yer saying..wasnt quite awake earlier

thanks

AKFlyer · May 7, 2016

Your free T is below range. I have low total T but normal free T and feel fine. I would get more work ups by an Endo to try and figure out why your free T is low.

ERO · May 8, 2016

Better idea - skip the Endo and seek out a TRT specialist. We see decades-out-of-date TRT protocols here all the time from your average Endo, and - surprise - since they are decades out of date, guys on them typically feel awful. Give Defy Medical a call.

Mr_F1tness · May 9, 2016

Just briefly read your post. I just wanted to chime in, as I just left the military, and suffered from low T just before I enlisted. I can't speak for all Branches, but I can tell you that Navy Docs are all terrible for the most part, as they just kept sending me to endocrinologists who did very little to help me. I ended up seeing a local TRT doc out of my own pocket without them knowing about it. My advice to you would be to do the same, and I highly recommend DEFY Medical.

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