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Testosterone Replacement, Low T, HCG, & Beyond
Blood Test Discussion
New Guy Here. TRT has been prescribed--but does my bloodwork warrant it?
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<blockquote data-quote="Vettester Chris" data-source="post: 11040" data-attributes="member: 696"><p>OK, thanks for clarifying the AAS subject. It's just the pattern with the cortisol rhythm and LH/FSH values had presented that as a possibility. I don't fully agree with the way your endo is looking at this. I know several HRT physicians that would want to run an MRI based on your current labs, and would not make the prolactin lab contingent with further exams. His doubts are speculation and he could rule it out real quick. Good chance the HPTA is experiencing suppression due to other factors, possibly previous and current medications, but I'd want to know with an MRI just to be safe (just my .02).</p><p></p><p>I agree that if you can correct the issue so that your HPTA produces more LH & FSH, then that's the route to go. However, depending on the length of time that your axis has been suppressed, it might be difficult to sustain a level of secretion that will provide optimal production of endogenous testosterone. Possibly running a proper PCT or HPTA restart with clomid & HCG would more than likely increase your values. Again, the million dollar question is would it hold?</p><p></p><p>Like Gene mentioned, there's no E2 sensitive assay mentioned. That would be good to know at this point, and will definitely need to be reviewed regularly "if" you elect to go on some form of HRT.</p><p></p><p>OK, on the thyroid ... Again, not to break skulls with your doctor, but I just don't agree with his assessment. Actually, it's not as much me as it is some of the trained specialists that are at the top of their field like Dr. Bruce Rind, Dr. Jeffrey Dach, Dr. James Yang ... The list goes on ... </p><p></p><p>I had an endo once tell me that only guys like Manny Ramirez take HCG, and there's "no place for it" in HRT and hypogonadal males. I sent that doctor a paper from the Journal of Endo Society, and a paper from Dr. Crisler, which disputed his claims. Well, the long and short of that was that endo fired me as a patient. It was indeed the best thing that ever happened to me!!</p><p></p><p>Anyways, back on topic ... I would gather to say that your pituitary function is suppressed and not responding to any feedback from your T4 and T3 levels, thus your TSH is tanked and probably does not deviate much, otherwise it would be elevated somewhat in relation to the current T4 and T3 readings. FT4 is at 20% of range, FT3 is at 47%. Ideally, if everything is working correctly and T3 is adequately getting to the cells, one would probably like to see both FT3 and FT4 in the 50% to 80% area of the reference range (aiming to keep both relatively close together), along with a FT3/Reverse T3 ratio that is > 20 (25 would be even better). </p><p></p><p>Your FT3/RT3 rato is at 16. Your FT3 is sitting to the right of FT4 (47% compared to 20%). Considering your cortisol situation, I suspect your T3 is pooling, which in turn in turn could create excess conversion of RT3, causing a down-regulation effect of ATP. I would be curious to know your body temperature throughout different times of the day if you are checking it? </p><p></p><p>In addition to the E2 sensitive lab that was mentioned, it would also be good to see iron serum, TIBC, ferritin, B12, and thyroid antibodies TPO & TgAb, and an ACTH in relation to your cortisol. I highly encourage you to consider getting a few more opinions from some other qualified physicians. There are several good doctors and clinics that post on this forum .. Just let us know if you are looking for a referral. Regardless, I think you have a situation that needs addressed and not "shrugged off". </p><p></p><p>None of this is going to just auto-correct itself. IMO, I'm not convinced that jumping on TRT is the best thing at the moment without addressing some of the other talking points. TRT isn't going to correct the cortisol or thyroid situation, and the last thing you need is more stress and demand being put on the body when it can't properly react to it.</p></blockquote><p></p>
[QUOTE="Vettester Chris, post: 11040, member: 696"] OK, thanks for clarifying the AAS subject. It's just the pattern with the cortisol rhythm and LH/FSH values had presented that as a possibility. I don't fully agree with the way your endo is looking at this. I know several HRT physicians that would want to run an MRI based on your current labs, and would not make the prolactin lab contingent with further exams. His doubts are speculation and he could rule it out real quick. Good chance the HPTA is experiencing suppression due to other factors, possibly previous and current medications, but I'd want to know with an MRI just to be safe (just my .02). I agree that if you can correct the issue so that your HPTA produces more LH & FSH, then that's the route to go. However, depending on the length of time that your axis has been suppressed, it might be difficult to sustain a level of secretion that will provide optimal production of endogenous testosterone. Possibly running a proper PCT or HPTA restart with clomid & HCG would more than likely increase your values. Again, the million dollar question is would it hold? Like Gene mentioned, there's no E2 sensitive assay mentioned. That would be good to know at this point, and will definitely need to be reviewed regularly "if" you elect to go on some form of HRT. OK, on the thyroid ... Again, not to break skulls with your doctor, but I just don't agree with his assessment. Actually, it's not as much me as it is some of the trained specialists that are at the top of their field like Dr. Bruce Rind, Dr. Jeffrey Dach, Dr. James Yang ... The list goes on ... I had an endo once tell me that only guys like Manny Ramirez take HCG, and there's "no place for it" in HRT and hypogonadal males. I sent that doctor a paper from the Journal of Endo Society, and a paper from Dr. Crisler, which disputed his claims. Well, the long and short of that was that endo fired me as a patient. It was indeed the best thing that ever happened to me!! Anyways, back on topic ... I would gather to say that your pituitary function is suppressed and not responding to any feedback from your T4 and T3 levels, thus your TSH is tanked and probably does not deviate much, otherwise it would be elevated somewhat in relation to the current T4 and T3 readings. FT4 is at 20% of range, FT3 is at 47%. Ideally, if everything is working correctly and T3 is adequately getting to the cells, one would probably like to see both FT3 and FT4 in the 50% to 80% area of the reference range (aiming to keep both relatively close together), along with a FT3/Reverse T3 ratio that is > 20 (25 would be even better). Your FT3/RT3 rato is at 16. Your FT3 is sitting to the right of FT4 (47% compared to 20%). Considering your cortisol situation, I suspect your T3 is pooling, which in turn in turn could create excess conversion of RT3, causing a down-regulation effect of ATP. I would be curious to know your body temperature throughout different times of the day if you are checking it? In addition to the E2 sensitive lab that was mentioned, it would also be good to see iron serum, TIBC, ferritin, B12, and thyroid antibodies TPO & TgAb, and an ACTH in relation to your cortisol. I highly encourage you to consider getting a few more opinions from some other qualified physicians. There are several good doctors and clinics that post on this forum .. Just let us know if you are looking for a referral. Regardless, I think you have a situation that needs addressed and not "shrugged off". None of this is going to just auto-correct itself. IMO, I'm not convinced that jumping on TRT is the best thing at the moment without addressing some of the other talking points. TRT isn't going to correct the cortisol or thyroid situation, and the last thing you need is more stress and demand being put on the body when it can't properly react to it. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Blood Test Discussion
New Guy Here. TRT has been prescribed--but does my bloodwork warrant it?
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