Blood Work, New Doc, Concerns

[ef88]

So my pcp retired, I now have a new pcp who says he cannot prescribe TRT. I was referred to Endo and it's a 6-8 month wait. I'm on my last 1ml vial. I injected .15ml on Monday vs the usual .25 . I've also been out of HCG for 3 weeks...and strangely I can feel the difference.

Furthermore I just got bloodwork done and some numbers are higher than I'd like.

RBC was 5.59 , now 5.9
HCT was 50 , now 54
Hemoglobin was 17.4 , now 18.1
AST was 27 , now 35
ALT was 49 , now 75
Total T was 1,049 , now 859
HDL was 51 , now 43
SHBG only 20?
Albumin 4

Changes I've made in the last year:

Added: Maca, DHEA, Ashwagandha, Fadogia agrestis, Tongkat Ali, high strength diuretic (2x a day), zinc, Beast SuperTest, 6g l-citrulline/day, d aspartic acid, calcium beta hydroxy methylbuterate, yohimbine...and more. edit; also been on a colon cleanse for 2 weeks. It sucks. I'm sure it's adding to the dehydration along with the diuretics.

I imagine my liver and body are tired. I've been taking 400-800mg ibuprofen for allergy headaches and back pain at least 2-3 times a week for months now. I think the addition of the *dry xt, diuretic twice a day doesn't help either. I also started doing low intensity steady state cardio vs my usual high intensity cardio which could explain the HDL? Unsure why total T went down about 200 points. My blood pressure is fine. HR is fine. I sleep well.

I just ordered some NAC. I am going to discontinue the diuretic and other pills for now. I am going to start high intensity cardio again. I will cut out all alcohol. Increase water intake to 1+ gallon again as I started drinking less water.

Now what to do about the prescription not being renewed....do I reach out to a TRT clinic until I can see the endo? I used to go with TRT Nation and they were pretty relaxed. Are my numbers above going to be of concern in your opinion?

Tips?

 

[Systemlord]

RBC was 5.59 , now 5.9
HCT was 50 , now 54
Hemoglobin was 17.4 , now 18.1

These levels are fine if there are no symptoms. I wouldn’t expect there to be if you can tolerate high altitude.

 

[ef88]

I personally have no symptoms and imagine I can solve some of those numbers with easy lifestyle changes. I did forget to include I'm a mile above sea level so it's expected that I have higher RBC and HCT.

My doctor has read my last two messages and left me on read. Insane. I simply cannot accept an abrupt cutoff to my medications.

 

[Systemlord]

I did forget to include I'm a mile above sea level so it's expected that I have higher RBC and HCT.

The direct mechanism for elevated HCT at high altitude is a natural man not on TRT is a spiking of testosterone -> HCT goes up. Men on TRT are treated differently for some strange reason even though the condition is the same.

A guy at sea level on TRT is no different than a natural guy living at high altitude as far as the elevated HCT.

 

[ef88]

talked to my new PCP. He is doing a short term TRT prescription so I don't crash in hopes that an endo opens up soon. This is all very annoying, no wonder people bypass their doctor and go to TRT mills. I'm almost more knowledgeable than my PCP.

He didn't know what HCG was and was scared it could hurt me so he decided not to renew that. I want HCG for testicular atrophy prevention, heightened libido, and some semblance of fertility. I explained to him, the mechanism of action and possible side effects and he said he could lose his medical license if anything happened to me while on it...what.

Anyone know ways to source HCG? I am retaking my blood test as well since I don't believe the HCT scores were accurate.

 

[ef88]

Does reliable pharmacy still not require a script for HCG?

 

[Guided_by_Voices]

An observation... when dealing with anything that requires specialization, go to a specialist. I would not refer to the clinics such as those that advertise here as "TRT mills" as the term is disrespectful and plays into the hands of people who want to restrict access to critical medications. The specialized doctors/nurses/assistants do nothing but focus on hormone issues and hence know far more about every aspect than general doctors. As a doctor friend of mine says, it's less than 1% of doctors who are any good at non-obvious issues.

 

[ef88]

Luckily, my prior PCP was able to monitor and prescribe hormones. He had been in practice for a long time and always made sure to message me and set up labs all the time. I liked it. I've been on TRT/HCG for about 2 years now and it's been great. Being off HCG, my testicles are getting achy as they start shutting down fully again. I hate this feeling. I meant no disrespect by 'mills', just hear the term a lot. And I know, it seems most general doctors know nothing about hormone therapy.

I need to find a work around for HCG. I'm sure it exists. I'll continue my usual dose and continue to monitor my labs. My new pcp sounded almost SCARED of HCG.

 

[Guided_by_Voices]

There was a lot of discussion about HCG substitutes when the compounded version went away some time ago and I have not heard of a satisfactory substitute. In fact, I am one of the few who (used to) come off of TRT for a period of time and based on that experience, I would (hypothetically) stop T and use HCG only, instead of coming off of HCG if I had to since a lot of the benefits seemed to be cooing from HCG. There was some discussion of using clomid as a substitute but it seems to create issues for many people. Unofficial sources likely have HCG as well, but I would find a clinic since there are other things you may eventually need and having a good relationship with a clinic in advance will put you in a better position for the long run.

 

[ef88]

Makes total sense. And I too am thinking that many of my benefits are from HCG, secondary hypogonadism would indicate that LH and FSH imitation would have this make sense. I've noticed lowered libido, weaker erections, smaller semen volume, aching testicles, etc. And getting a little tired again like pre-trt, although nowhere near how bad it was. I never imagined I'd be 'cut off' like this as it's a prescribed medication and I'm not using over the top amounts, and my blood work has been historically great. It seems all specialists are booked out forever and I somehow need prior authorization again with my insurance for the Test Cyp. Hoping that comes in soon. i'm dosing at .15ml out of my last 1ml vial and I don't like it.

 

[andrewBwinter]

The direct mechanism for elevated HCT at high altitude is a natural man not on TRT is a spiking of testosterone -> HCT goes up. Men on TRT are treated differently for some strange reason even though the condition is the same.

A guy at sea level on TRT is no different than a natural guy living at high altitude as far as the elevated HCT.

Like Bolivia at 4000m ASL:

"Defining the range of normal hematocrit and hemoglobin levels in residents of high altitude is required to diagnose chronic mountain sickness (CMS) and other conditions defined, in part, by hematocrit or hemoglobin values. We studied 1,934 healthy, young (aged 15 to 29 yr) male and female residents of Potosí, Bolivia (4000 m), to determine the average and normal range of hemoglobin and hematocrit values, defining normal as within 2 standard deviations of the mean or encompassing 95% of the observed variation. Male hematocrit averaged 52.7% and hemoglobin averaged 17.3 m/dL whole blood. The corresponding female values were 48.3% and 15.8 g/dL whole blood, respectively. The range of normal values was 45% to 61% for hematocrit and 13 to 21 g/dL for hemoglobin in the men and 41% to 56% for hematocrit and 12 to 19 g/dL for hemoglobin in the women. These data indicate that hematocrit values above 61% in men or 56% in women and hemoglobin values above 21 g/dL whole blood in men or 19 g/dL whole blood in women are outside the normal range."