Jk78 case - from before the starting line

I am at the very beginning of this process. I know I have some work to do, but would like to know if I'm heading down the right path. I have felt a steady decline lately, and I would like to stop it. I'm still fairly young and active, have a great wife and family, and would like to improve somethings and stay ahead of the curve. I feel like the wheels are starting to spin though. Thanks for reading. Heres my snapshot:

age -37
-height -6'3"
-waist -35"
-weight -200lbs
-married
-no childrenof my own. One step-son. We are a complete family. I had a vasectomy in Feb 2015.
-have not done TRT or any cycles
-urination seems fine. Some nights I get up once to go, most I don't.
-facial hair fairly thick,small amount of chest hair, lower arms have hair, legs normal to light hair, no hair on upper arms or back,
-Have ALWAYS had a ring of fat around my belly button area, sides, and lower back. ALWAYS! I cannot shake this, no matter how lean the rest of me gets.
-no regular medication except Advile once or twice a month. No prescriptions
-I take creatine mono 5g and beta-alinine 4g, chianti seeds, multivitamin and fish oil daily.
-diet is fairly dialed in. Past 3 years I have tried to add muscle starting in fall, about 300cals over maintenance (2,400cals), gain 10-15lbs, shed it starting late winter 300-400 call under maintenance. Roughly 150g protein daily.
-started lifting 3 years ago. 4 days of resistance training /wk now, 2 upper & 2 lower body including compound lifts. 15-30 minutes of cardio 1-3 days a week usually not on lifting days.
-morning erections maybe once a week now, maybe. Used to be more frequently. They have steadily dwindled last three years.
-I had blood work done in Aug 2013 and Feb 2015 for my general doctor. I requested total and free test. I know there are other things I need lab work for, but again, I know I'm not even at the starting block yet.

AUGUST 2013 BLOOD WORK RESULTS. BLOOD DRAWN AT 10:05AM AND FASTED
-Total test
355ng/dl range 250-1100
-Free test
49.5pg/ml. range 35.0-155
-White blood count
5.9 range 3.8-10.8
-Red blood count
5.17 range 4.2-5.8
-Hemoglobin
16.0 range 13.2-17.1
-Hematocrit
46.6% range 38.5-50
-MCV
90.1 FL range 80.0-100
-MCH
30.9 pg range 27.0-33
-MCHC
34.3 g/dL range 32.0-36
-RDW
13.6% range 11.0-15
Platelet count
209 range 140-400
Absolute neutrophils
3440 range 1500-7800
-Absolute lymphocytes
1906 range 850-3900
-Absolute monocytes
472 range 200-950
-Absolute eosinophils
59 range 15-500
-Absolute basophils
24 range 0-200
-Neutrophils
58.3% range na
-Lymphocytes
32.3% range na
-Monocytes
8.0% range na
-Eosinophils
1.0% range na
-Basophils
0.4% range na
-Albumin
4.6 g/dl range 3.6-5.1
Albumin/Globulin ratio
2.3 (calc) range 1.0-2.5
-Alkaline phosphatase
53 u/l range 40-115
-ALT
26 u/l range 9-46
-AST
26 u/l range 10-40
-Bilirubin, total
1.0 mg/dl range 0.2-1.2
-Calcium
9.6 mg/dl range 8.6-10.3
-Carbon dioxide
25 mmol/L range 19-30
-Chloride
107 mmol/L range 98-110
-Creatinine
1.02 mg/dl range 0.6-1.35
-eGFR (non-African American)
95 range > or =60
-Globulin
2.0g/dl(calc) range 1.9-3.7
-Glucose
87 mg/dl range 65-99
-Potassium
4.1 mmol/L range 3.5-5.3
-Protein, total
6.6 g/dl range 6.1-8.1
-Sodium
-141 mmol/L range 135-146
-UREA Nitrogen (BUN)
24 mg/dl range 7-25
-Triglycerides
�¢?�ª39 mg/dl range�£??<150
-Cholesterol total
148 mg/dl range 125-200
-HDL Cholesterol
57 mg/dl range > or =40
-LDL
range < 130
-CHOL/HDLC ratio
2.6 (calc) range < or =5.0
-NON HDL cholesterol
91 (calc) range LDL range+30


FEBRUARY 2015 BLOOD TEST RESULTS. BLOOD DRAWN AT 8:48AM FASTED
-Total test
339ng/dl range 250-1100
-Free test
48.4pg/ml. range 35.0-155
-White blood count
4.6 range 3.8-10.8
-Red blood count
5.25 range 4.2-5.8
-Hemoglobin
16.0 range 13.2-17.1
-Hematocrit
47.5% range 38.5-50
-MCV
90.4 fL range 80.0-100
-MCH
30.4 pg range 27.0-33
-MCHC
33.6 g/dL range 32.0-36
-RDW
14.1% range 11.0-15
-Platelet count
236 range 140-400
-Absolute neutrophils
2245 range 1500-7800
Absolute lymphocytes
1932 range 850-3900
-Absolute monocytes
345 range 200-950
Absolute eosinophils
55 range 15-500
Absolute basophils
23 range 0-200
Neutrophils
48.8% range na
Lymphocytes
42.0% range na
-Monocytes
7.5% range na
-Eosinophils
1.2% range na
-Basophils
0.5% range na
Albumin
4.5 g/dl range 3.6-5.1
-Albumin/Globulin ratio
2.1 (calc) range 1.0-2.5
-Alkaline phosphatase
59 u/l range 40-115
-ALT
29 u/l range 9-46
-AST
26 u/l range 10-40
-Bilirubin, total
1.0 mg/dl range 0.2-1.2
-Calcium
9.5 mg/dl range 8.6-10.3
-Carbon dioxide
25 mmol/L range 19-30
-Chloride
104 mmol/L range 98-110
-Creatinine
1.01 mg/dl range 0.6-1.35
-eGFR (non-African American)
95 range > or =60
-Globulin
2.1g/dl(calc) range 1.9-3.7
-Glucose
94 mg/dl range 65-99
-Potassium
4.5 mmol/L range 3.5-5.3
-Protein, total
6.6 g/dl range 6.1-8.1
-Sodium
139 mmol/L range 135-146
-UREA Nitrogen (BUN)
19 mg/dl range 7-25
-Triglycerides
51 mg/dl range <150
-Cholesterol total
158 mg/dl range 125-200
-HDL Cholesterol
60 mg/dl range > or =40
-LDL Cholesterol
88 mg/dl(calc) range <130
-CHOL/HDLC ratio
2.6 (calc) range < or =5.0
NON HDL cholesterol
98 (calc) range LDL range+30


I brought up the low T levels in 2013. Of course doc said "You're in range,nothing to worry about."
The last year I have noticed a substantial loss of libido and energy. Very little muscle and strength gain, and all I do is gain and lose the same 15lbs of fat every year. I find myself short with my family, crabby for no reason and I avoid yard work like the plague which I used to enjoy. By 2pm, I'm exhausted. This year I again brought up the low T, and doc said I'm in range, but recommended a urologist. I am going to a wellness doctor for a free consultation first just for more info. I have also started to record body temps beginning yesterday (97.7 upon waking up, 98.6 in evening). In the multivitamins I take I get a total of 200mg Selenium per day, split morning and evening.

I would like to find a doctor to work with, get more blood work done, and start TRT this fall. In my research and daily life, I feel I am a candidate. Do you agree?

Is there anything glaring in my past two blood test (again, I know things are missing and I am very eager to find out my E2 levels) that would throw a red flag? When I do find a doc to work with, I want to be as armed as possible!

Thanks again for all input!

With the two blood tests both showing your total T in the 339 - 350 range, it is likely that you could benefit from TRT. Nelson has a link here that shows what blood work one should get before and during TRT.

A lot of us here use and recommend Defy Medical. Starting TRT with the wrong doctor is worse than not starting and staying with low T.

Welcome to Excelmale! ERO is on the money in sending you the link to lab tests. There's a lot you don't yet know, thyroid, SHBG, prolactin, a number of things. I am not a Defy Medical patient, but know many members of Excelmale are and are very positive about their treatment.

I would also read this first https://www.excelmale.com/forum/showthread.php?501-How-to-Increase-Testosterone-Naturally
It's also been posted that Cialis raises testosterone https://www.excelmale.com/forum/showthread.php?1884-Where-to-Buy-Cheaper-Generic-Cialis

Thank you guys. I have read all of those links, as well as looked up Defy Medical in the recent past. I have also looked at the post with the guide to finding a doctor on this site and looked up docs on the a4m website as well. I'm taking a bit of time to educate myself as much as possible. I would prefer to work with a local doctor, and i am fortunate to live just outside a major city. I want to take corrective measures, but don't want to jump head first in a 3' pool and drown from stupidity.

JK78

Where do you live?

Nelson Vergel said:

JK78

Where do you live?

Click to expand...

In the Chicagoland area.

Dr Daniel Berger. He is a nice guy and very educated on hormones. Say hi to him for me if you see him.

[h=3]Phone: 773.296.2400[/b]

Nelson Vergel said:

Dr Daniel Berger. He is a nice guy and very educated on hormones. Say hi to him for me if you see him.

[h=3]Phone: 773.296.2400[/b]

Click to expand...

Thank you. I will keep him on my short list.

So I went to a local medical spa clinic yesterday. I brought the two sets of labs with that I posted above. The doctor agreed that I should start treatment. He would not start until further blood tests where taken (good for him) and we went over the costs I could expect. I'd like to get your opinions on these costs. I do have insurance, but it comes with a $2,500.00 deductible (which I've used none of this year), $250.00 consultation (not yesterday, but after blood work), initial blood work about $650.00, follow up blood work about $450.00 (1st year every 3 months), and he said about $100 per month for meds & supplies. So probably over $1,000.00 to start. Do these numbers sound apropiate?

He said a lot of the right things, but that seems like a big nut up front. Also, geographically speaking, it's not the most convenient.

I have 2 more docs I want to go see, but lowtestosterone.com is actually tempting as I can up my health savings account contributions slightly, and it will only "feel" like $150/month due to pre-tax dollars being used. At least to get going, know I can get the labs I need to get dialed in, then re-eveluate.

Thoughts?

Ask the doctor you just saw if you can use an outside source for labs like discountedlabs.com

He will probably say no since he has to make money off lab margins, but it is good to ask.

Why have you not considered Dr Berger and stop guessing? He takes insurance.

Agree with Nelson 100%. Starting TRT with the wrong doctor (or just a doc that is not a TRT expert) is WORSE than remaining un-treated for your low T.

Nelson Vergel said:

Ask the doctor you just saw if you can use an outside source for labs like discountedlabs.com

He will probably say no since he has to make money off lab margins, but it is good to ask.

Why have you not considered Dr Berger and stop guessing? He takes insurance.

Click to expand...

Nelson, he is one of the two doctors I want to see. With my current insurance though, the first $2,500.00 is going to come out of pocket, so I was wondering if these prices seemed high or in line with the industry, including blood work and meds/supplies.

Again, I'm just trying to educate myself and figure out the best path BEFORE I begin. I wondered if anyone here had first hand experience with lowtestosterone.com. I've read the interview with them and looked at other posts, but have not seen any actual feedback.

Thanks a lot guys. I really appreciate it, and do actually listen.

Yes talk to more than one doctor. Before I started TRT, I saw three local endorcrinologist and talk to a number of clinics I also read 5 books on low testosterone, it can really be a pain. If I were you I would definitely consider Dr Berger just on Nelson's reommendation.

Jk78 said:

Nelson, he is one of the two doctors I want to see. With my current insurance though, the first $2,500.00 is going to come out of pocket, so I was wondering if these prices seemed high or in line with the industry, including blood work and meds/supplies.

Again, I'm just trying to educate myself and figure out the best path BEFORE I begin. I wondered if anyone here had first hand experience with lowtestosterone.com. I've read the interview with them and looked at other posts, but have not seen any actual feedback.

Thanks a lot guys. I really appreciate it, and do actually listen.

Click to expand...

Since you are researching, why not reach out to Defy Medical as well, I use them and many others here do as well. (I have no affiliation with them) They know what they are doing and have great pricing as well.

I'll chime in on Defy also my labs were way cheaper and using Discounted labs you could do even better. Contact Jason directly and have Hume give you the complete rundown he will get right back to you.

I have been on Defy's and discounted labs website quite a few times. I would really like to work with a local doctor if at all possible. Call me old fashioned. I'm sure I will utilize discount labs at some point, either for all my blood work or for some follow ups along the way. I called and spoke to Dr. Berger's office, but need to call back on Monday make an appointment. The office was very helpful in answering some questions.

I have a question though. I know E2 numbers and how your feeling will show whether an AI is needed, but I see posts of some people doing anything NOT to take it. I've looked for side effects and didn't see anything that made me say "F that!". I've read that smaller more frequent test injections (at least twice a week) can help control it. But my question is what's the fear of it if it does become a necessity?

One more thought and this does not get promoted enough you can schedule a one on one phone review of all of your labs with Nelson for a very reasonable cost.
As you are just getting started getting base line blood work is a great opportunity with no other variables to really get started on the right foot.
Like you I was getting all tangled up in what my insurance would or would not cover then finally said to myself within reason I was going to go out of pocket since I have to to get this treatment right.
When I considered the time and effort of trying to have certain tests and prescriptions like HCG within my current health plan going a few hundred bucks out of pocket was the best money I have spent. My program is on track and I have never felt better.

Jk78 said:

I have been on Defy's and discounted labs website quite a few times. I would really like to work with a local doctor if at all possible. Call me old fashioned. I'm sure I will utilize discount labs at some point, either for all my blood work or for some follow ups along the way. I called and spoke to Dr. Berger's office, but need to call back on Monday make an appointment. The office was very helpful in answering some questions.

I have a question though. I know E2 numbers and how your feeling will show whether an AI is needed, but I see posts of some people doing anything NOT to take it. I've looked for side effects and didn't see anything that made me say "F that!". I've read that smaller more frequent test injections (at least twice a week) can help control it. But my question is what's the fear of it if it does become a necessity?

Click to expand...

Ther is nothing to fear if the use of an AI is a necessity. The problem arises when a doctor routinely prescribes it without considering alternative methods of managing elevated estradiol. In the first place, E2 is not a pointless by-product in the male bloodstream; too little of it can lead to serious health issues for men. Suppressing it, as a matter of routine, is a tendency many doctors engage in. So, one needs a healthy level of estradiol to feel and function well. If those levels can be achieved without the use of a drug, and Anastrozole is a notoriously difficult drug to dose properly, so much the better. TRT is a complex practice, the more variables that can be eliminated, the better. If needed, it should be prescribed. But only when needed, and then with care.

Nelson Vergel said:

Dr Daniel Berger. He is a nice guy and very educated on hormones. Say hi to him for me if you see him.

[h=3]Phone: 773.296.2400[/b]

Click to expand...

I have an appointment here a week from today. Thanks again.