Hi!

Hello, 36 year old man currently on TRT for the past month. Before, I had several complaints of items such as fatigue, no libido (both items that I just thought were normal for being a father/husband with very little kids). I would be moody and not comfortable with that. Always tired,never slept well. Suffered from random muscle pains in my body out of no where, like my muscle were breaking down.... always sore. I also had chief complaints of dry mouth and dry eyes (which stick shut every night in the late hours). SO my dr set up labs for Rheumatoid factors that came back negative, thyroid which came back high end of normal, and testosterone of 259. SO we talked about TRT and I went on 200mg Cyp IM q 10 days. I would notice elevated mood, and increased libido, and I slept better, but that would fall off halfway through the 10 days, but seems to be getting short and shorter with each does.I don't do blood work for another 2 months so I'm looking forward to learning about the things that can happen, and how i should be tested. I have gained over 10lbs since starting, which i'm hoping most is water weight, but I would love to shift the back into losing weight since i'm hitting the gym again.

Welcome to ExcelMale. You are very young for TRT, proper labs are important. Nelson has a nice thread on them.

Suggested Lab Tests and Questions Before and After Initiation of Testosterone Replacement

https://www.excelmale.com/forum/sho...-After-Initiation-of-Testosterone-Replacement

Your protocol doesn't sound very good, most inject T every 3 1/2 days to keep their levels nice and to avoid spikes. Have your doctor talked about adding HCG to your protocol.

Welcome to Excelmale. As Vince noted, your TRT protocol is far from ideal. If you post your pre-treatment lab results a thorough discussion will unfold.

Vince said:

Your protocol doesn't sound very good, most inject T every 3 1/2 days to keep their levels nice and to avoid spikes. Have your doctor talked about adding HCG to your protocol.

Click to expand...

I have not spoken to my pcp since the day she prescribed the testosterone cyp. I was instructed to do lab work in 3 months and we'll go from there.

CoastWatcher said:

Welcome to Excelmale. As Vince noted, your TRT protocol is far from ideal. If you post your pre-treatment lab results a thorough discussion will unfold.

Click to expand...

Hi, thank you. I don't really have much to offer as far as pre-treatment labs.
2016 Total T was 389,
2017 Total T was 259; TSH 3.69

I'm new here so I'm not sure how much extra information you want from labs. I don't think anything like estrogen, etc. I have standard cbc stuff.

modawg2k said:

Hi, thank you. I don't really have much to offer as far as pre-treatment labs.
2016 Total T was 389,
2017 Total T was 259; TSH 3.69

I'm new here so I'm not sure how much extra information you want from labs. I don't think anything like estrogen, etc. I have standard cbc stuff.

Click to expand...

You received an inadequate workup. You are on a TRT protocol with questions unanswered. You're unlikely to achieve success with your protocol and your underlying health problems, actual and/or potential, have not been addressed.

At at a minimum you need to run the following labs prior to the start of TRT.

Total and free testosterone, LH and FSH (to determine if you are a patient with primary or secondary hypogonadism - is the problem in your testicles or your pituitary?), SHBG (an essential test to help set up your protocol - how much and how often you inject is determined by your SHBG value, it's a must-have), PSA (a baseline is mandatory as prostate issues have to be carefully monitored, both the discreet score and the rate of rise, and without a baseline you don't know where you started), DHT, and DHEA, CBC, CMP, estradiol/sensitive assay, and a full thyroid panel.

In respect to thyroid, your TSH is in range but hardly normal. Anything above 2.5 requires further investigation. You should have ft3, ft4, rt3, and thyroid antibodies checked. Failure to correct thyroid problems undermines TRT efforts time after time.

You need better care than you have received so far. You deserve it.

Well I haven't been happy with this PCP from day 1 of the 2 years that I've started seeing him, so I don't mind looking elsewhere. Who is the practitioner of choice for managing a correct TRT protocol. An endo?

Just following up on my question.... should I be looking to follow up with an Endo to properly oversee my TRT?

It is very difficult to find a doctor who really knows how to manage men on hormone replace,met therapy. One can't rely on designation, endocrinologist, urologist...it doesn't matter. It becomes a bigger challenge if you require an in-network doctor. Simply put, very little time in medical school or residency is devoted to androgen replacement. We can offer a referral to one of the national practices, Defy Medical or Prime Body, leading practitioners in this field who treat many of our members at a price that is likely to be far lower than you might expect. But if you tell us where you live it may be possible to generate a local name.

CoastWatcher said:

It is very difficult to find a doctor who really knows how to manage men on hormone replace,met therapy. One can't rely on designation, endocrinologist, urologist...it doesn't matter. It becomes a bigger challenge if you require an in-network doctor. Simply put, very little time in medical school or residency is devoted to androgen replacement. We can offer a referral to one of the national practices, Defy Medical or Prime Body, leading practitioners in this field who treat many of our members at a price that is likely to be far lower than you might expect. But if you tell us where you live it may be possible to generate a local name.

Click to expand...

I live in Phoenix. I have a PPO that allows me to see any doctor in or out of network, and I can see specialists without referrals. If no recommendations, I may try to continue with my current PCP who started me on the therapy, but perhaps I will tell them things I want done (i.e. labs, dosing adjustments, etc.) based off what I learn on my own. I'm a healthcare professional so I think they are more open to hearing my ideas on my therapy.

Endos tend to be worse than GPs. I'd look into a specialists like Defy or Prime Body at the top/right of the page.

modawg2k said:

Hello, 36 year old man currently on TRT for the past month. Before, I had several complaints of items such as fatigue, no libido (both items that I just thought were normal for being a father/husband with very little kids). I would be moody and not comfortable with that. Always tired,never slept well. Suffered from random muscle pains in my body out of no where, like my muscle were breaking down.... always sore. I also had chief complaints of dry mouth and dry eyes (which stick shut every night in the late hours). SO my dr set up labs for Rheumatoid factors that came back negative, thyroid which came back high end of normal, and testosterone of 259. SO we talked about TRT and I went on 200mg Cyp IM q 10 days. I would notice elevated mood, and increased libido, and I slept better, but that would fall off halfway through the 10 days, but seems to be getting short and shorter with each does.I don't do blood work for another 2 months so I'm looking forward to learning about the things that can happen, and how i should be tested. I have gained over 10lbs since starting, which i'm hoping most is water weight, but I would love to shift the back into losing weight since i'm hitting the gym again.

Click to expand...

Welcome to our community.

Can you post your most recent blood tests including:

Total and Free Testosterone
TSH
Free T3 (not total T3)
Free T4 (not total T3)
CBC and CMP panel ?

The link Vince shared has a questionnaire some docs use to do a baseline assessment. Answers to those questions also can clarify your situation.

Nelson Vergel said:

Welcome to our community.

Can you post your most recent blood tests including:

Total and Free Testosterone
TSH
Free T3 (not total T3)
Free T4 (not total T3)
CBC and CMP panel ?

The link Vince shared has a questionnaire some docs use to do a baseline assessment. Answers to those questions also can clarify your situation.

Click to expand...

And there is the problem, Nelson - his workup was deficient...as so many find out after acting in good faith.

CoastWatcher said:

And there is the problem, Nelson - his workup was deficient...as so many find out after acting in good faith.

Click to expand...

I second this and can confirm from personal experience that it is far less costly in the long run to have proper labs done up front and get treated by a competent practitioner. Without both of those things you could spin your wheels for a long time and still not get the benefits you seek. We don't often measure the cost of substandard care but when you feel crappy you are clearly paying a cost every day - even if it isn't a financial one.

Nelson Vergel said:

Welcome to our community.

Can you post your most recent blood tests including:

Total and Free Testosterone
TSH
Free T3 (not total T3)
Free T4 (not total T3)
CBC and CMP panel ?

The link Vince shared has a questionnaire some docs use to do a baseline assessment. Answers to those questions also can clarify your situation.

Click to expand...

Hi, as others stated, I did not received what those on here would deem proper initial lab workout. Below is what I have from a month ago. I am missing Free T, Free T3 & Free T4.

- I left off with the doctor from the initial visit that I would follow up with her after the 3 month marker after being on testosterone cyp 200mg q 10-14 days. I've been doing the every 10 days (because sure why not). From what I'm seeing here, I really should have them order up a proper set of labs now.

- Until I can have my T levels properly evaluated, I'm considering halving my dose and doing it every 5 days since it seems that most on here have better results from more frequent injections.

- Had biometric screen for work today and my HDL dropped in 2 months from 44 to 34 (a number I've never seen so low)

Blood work:
TSH, High Sensitivity 3.69 0.45 4.50 mU/L
Testosterone, Total 259 250 840 ng/dL

CBC w/ Differential, w/ Platelet
WBC 9.4 4.0 11.0 k/mm3
RBC 5.41 4.30 6.00 m/mm3
Hemoglobin 14.7 13.0 18.0 g/dL
Hematocrit 44.3 40.0 53.0%
MCV 81.9 78.0 100.0 fL
MCH 27.2 27.0 34.0 pg
MCHC 33.2 31.0 37.0 g/dL
Platelet Count 323 130 450 k/mm3
RDW(sd) 36.5 L 38.0 49.0 fL
RDW(cv) 12.4 11.0 15.0 %
MPV 10.0 7.5 14.0 fL
Segmented Neutrophils 53.7* %
Lymphocytes 30.5 %
Monocytes 10.7 %
Eosinophils 3.8 %
Basophils 1.0 %
Absolute Neutrophil 5.05 1.60 9.30 k/uL
Absolute Lymphocyte 2.87 0.60 5.50 k/uL
Absolute Monocyte 1.01 0.10 1.60 k/uL
Absolute Eosinophil 0.36 0.00 0.70 k/uL
Absolute Basophil 0.09 0.00 0.20 k/uL
Immature Granulocytes 0.3 0.0 1.0 %
Absolute Immature Granulocytes 0.03 0.00 0.10 k/uL
NRBC RE, Nucleated Red Blood Cell Percent 0.0 0.0 1.0 %


Comprehensive Metabolic Panel
Glucose 88* 65 99 mg/dL
Urea Nitrogen (BUN) 13 8 25 mg/dL
Creatinine 0.94 0.60 1.50 mg/dL
GFR Estimated (NonAfrican
American) 103 ≥61 mL/min/1.73m2
GFR Estimated (African American) 120 ≥61 mL/min/1.73m2
BUN/Creatinine Ratio 13.8 10.0 28.0
Sodium 142 135 145 mmol/L
Potassium 4.1 3.5 5.2 mmol/L
Chloride 103 96 110 mmol/L
Carbon Dioxide (CO2) 23 19 31 mmol/L
Anion Gap 16 4 18
Protein, Total 6.9 6.0 8.0 g/dL
Albumin 4.8 3.3 4.9 g/dL
Globulin 2.1 2.0 3.7 g/dL
Albumin/Globulin Ratio 2.3 1.0 2.4
Calcium 9.8 8.7 10.5 mg/dL
Alkaline Phosphatase 45 40 129 IU/L
Alanine Aminotransferase 30 5 60 IU/L
Aspartate Aminotransferase 25 10 50 IU/L
Bilirubin, Total 0.3 0.2 1.3 mg/dL

modawg2k said:

Hi, as others stated, I did not received what those on here would deem proper initial lab workout. Below is what I have from a month ago. I am missing Free T, Free T3 & Free T4.

- I left off with the doctor from the initial visit that I would follow up with her after the 3 month marker after being on testosterone cyp 200mg q 10-14 days. I've been doing the every 10 days (because sure why not). From what I'm seeing here, I really should have them order up a proper set of labs now.

- Until I can have my T levels properly evaluated, I'm considering halving my dose and doing it every 5 days since it seems that most on here have better results from more frequent injections.

- Had biometric screen for work today and my HDL dropped in 2 months from 44 to 34 (a number I've never seen so low)

Blood work:
TSH, High Sensitivity 3.69 0.45 4.50 mU/L
Testosterone, Total 259 250 840 ng/dL

CBC w/ Differential, w/ Platelet
WBC 9.4 4.0 11.0 k/mm3
RBC 5.41 4.30 6.00 m/mm3
Hemoglobin 14.7 13.0 18.0 g/dL
Hematocrit 44.3 40.0 53.0%
MCV 81.9 78.0 100.0 fL
MCH 27.2 27.0 34.0 pg
MCHC 33.2 31.0 37.0 g/dL
Platelet Count 323 130 450 k/mm3
RDW(sd) 36.5 L 38.0 49.0 fL
RDW(cv) 12.4 11.0 15.0 %
MPV 10.0 7.5 14.0 fL
Segmented Neutrophils 53.7* %
Lymphocytes 30.5 %
Monocytes 10.7 %
Eosinophils 3.8 %
Basophils 1.0 %
Absolute Neutrophil 5.05 1.60 9.30 k/uL
Absolute Lymphocyte 2.87 0.60 5.50 k/uL
Absolute Monocyte 1.01 0.10 1.60 k/uL
Absolute Eosinophil 0.36 0.00 0.70 k/uL
Absolute Basophil 0.09 0.00 0.20 k/uL
Immature Granulocytes 0.3 0.0 1.0 %
Absolute Immature Granulocytes 0.03 0.00 0.10 k/uL
NRBC RE, Nucleated Red Blood Cell Percent 0.0 0.0 1.0 %


Comprehensive Metabolic Panel
Glucose 88* 65 99 mg/dL
Urea Nitrogen (BUN) 13 8 25 mg/dL
Creatinine 0.94 0.60 1.50 mg/dL
GFR Estimated (NonAfrican
American) 103 ≥61 mL/min/1.73m2
GFR Estimated (African American) 120 ≥61 mL/min/1.73m2
BUN/Creatinine Ratio 13.8 10.0 28.0
Sodium 142 135 145 mmol/L
Potassium 4.1 3.5 5.2 mmol/L
Chloride 103 96 110 mmol/L
Carbon Dioxide (CO2) 23 19 31 mmol/L
Anion Gap 16 4 18
Protein, Total 6.9 6.0 8.0 g/dL
Albumin 4.8 3.3 4.9 g/dL
Globulin 2.1 2.0 3.7 g/dL
Albumin/Globulin Ratio 2.3 1.0 2.4
Calcium 9.8 8.7 10.5 mg/dL
Alkaline Phosphatase 45 40 129 IU/L
Alanine Aminotransferase 30 5 60 IU/L
Aspartate Aminotransferase 25 10 50 IU/L
Bilirubin, Total 0.3 0.2 1.3 mg/dL

Click to expand...

If you are going to make an injection adjustment, I suggest 50-60mg every 3.5 days (essentially twice a week, an example would be a shot on Monday morning/Thursday night). That's a reasonable starting dose that many find success with.

Having not obtained a PSA, it should be added to your list of necessary labs. Prostate specific antigen levels must be monitored during TRT. A baseline should have been obtained before treatment began since the rate of rise, in addition to the discreet score, are both necessary elements. It should be repeated annually.

You also want estradiol. However, be sure the right test is ordered - the sensitive, also known as ultra sensitive, test employing the LC, MS/MS assay. The standard test (ECLIA) is unreliable when used to test estradiol levels in men.

CoastWatcher said:

If you are going to make an injection adjustment, I suggest 50-60mg every 3.5 days (essentially twice a week, an example would be a shot on Monday morning/Thursday night). That's a reasonable starting dose that many find success with.

Having not obtained a PSA, it should be added to your list of necessary labs. Prostate specific antigen levels must be monitored during TRT. A baseline should have been obtained before treatment began since the rate of rise, in addition to the discreet score, are both necessary elements. It should be repeated annually.

You also want estradiol. However, be sure the right test is ordered - the sensitive, also known as ultra sensitive, test employing the LC, MS/MS assay. The standard test (ECLIA) is unreliable when used to test estradiol levels in men.

Click to expand...

1. Why the day and night doses... just because it makes that it much more closer to breaking the week in half?
2. PSA: I had a PSA a year ago at 1, but will for sure order that in my next round of labs here.

thanks for the information

Hey, im Jari and new here, Nice to meet you

Hi I'm Joey , I'm looking for help with
Trimix