First Blood Work after 6 weeks of Injections-Canadian Numbers

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AR

New Member
So had my first follow up blood work done after 6 weeks of 100mg a week via SubQ injection. I am Canadian and with Dr. Greenspan in Ontario, Canada. He did not measure my SHBG levels for some reason or estradiol. I know that estradiol tests in Canada can measure high anyway so I guess not a big deal there. Prior to my first injection here is my blood work:

Hematology
WBC
5.6 4.0 - 11.0 x E9/L
RBC
4.81 4.50 - 6.00 x E12/L
Hemoglobin
141 135 - 175 g/L
Hematocrit
0.42 0.400 - 0.500L/L

MCV
86 80 - 100 fL
MCH
29.3 27.5 - 33.0pg
MCHC
340 305 - 360g/L

Platelets
203 150 - 400x E9/L
RDW
13.3 11.5 - 14.5%Differential
Neutrophils
3.1 2.0 - 7.5x E9/L
Lymphocytes
2.0 1.0 - 3.5x E9/L
Monocytes
0.4 0.2 - 1.0x E9/L
Eosinophils
0.1 0.0 - 0.5x E9/L
Basophils
0.0 0.0 - 0.2x E9/L

Pituitary Function
Follicle Stimulating Hormone [FSH]
2.3 1.0-8.0IU/L
Luteinizing Hormone [LH]
2.4 1.0-7.0IU/L

Reproductive and Gonadal
Testosterone
11.1 8.4 - 28.8nmol/L
Total Testosterone levels may not reflect the
biologically-active testosterone when SHBG levels
are abnormal.

Testosterone Free
283 196-636pmol/L


Just got my results yesterday. Here they are:


Hematology
WBC
5.1 4.0 - 11.0x E9/L
RBC
4.94 4.50 - 6.00x E12/L
Hemoglobin
144 135 - 175g/L
Hematocrit
0.43 0.400 - 0.500L/L
MCV
87 80 - 100fL
MCH
29.1 27.5 - 33.0pg
MCHC
336 305 - 360g/L
Platelets
213 150 - 400x E9/L
RDW
13.8 11.5 - 14.5%Differential
Neutrophils
3.0 2.0 - 7.5x E9/L
Lymphocytes
1.7 1.0 - 3.5x E9/L
Monocytes
0.4 0.2 - 1.0x E9/L
Eosinophils
0.1 0.0 - 0.5x E9/L
Basophils
0.0 0.0 - 0.2x E9/L


Reproductive and Gonadal
Testosterone
18.1 8.4 - 28.8nmol/L

A nice jump in T level. I know Dr. Greenspan like to see his patients in the 20's so excpect an increase in dosage next week. Overall feeling a bit better. Energy and workouts a bit better and libido has slightly improved. Mind is a bit clearer as don't feel like I have that constant fog. A bit moody and find my appetite has increased but that could be due to workouts being better too.


Not sure why he didn't request free testosterone or FSH levels again to see if there was a change. Here in Canada hard to get any decent doctor to take you on so I was just happy he was willing to treat me and really didn't look at the lab req until got home from a 4 hr round trip. I will ask next week at my follow appointment for these. Is there anything else I should be asking for in terms of dosage increase and blood work?

Thanks for all you help.
AR
 
Defy Medical TRT clinic doctor

CoastWatcher

Moderator
Glad to hear from you again, and pleased you're in treatment. As a fellow Canadian, though not a patient of Dr. Greenspan, I understand your frustrations. Some observations. You don't need to test FSH after starting TRT, it's going to be undetectable; exogenous testosterone shuts it down within a very short time. It's simply the way the game is played. You didn't miss anything by not repeating that test. It is odd that SHBG and estradiol (even though it's the standard e2 test) should have been run. SHBG is a critical test that helps map a protocol. If high, more testosterone injected less frequently is called for. If low, just the opposite - less testosterone injected more often. It's as important as measuring total and free testosterone because it helps explain why the total and free testosterone levels sit where they do. Estradiol/standard (the Canadian option) is not an ideal test by any means, but a good doctor and a careful patient can learn to associate the (probably) elevated e2 results with symptoms in an effort to manage the possibility of elevated estrogen levels.

Push him for SHBG, along with DHT, PSA, and DHEA. My own Toronto doctor, who is on top of things, is happy I test in the US for e2, via Discounted Labs. If that's an option for you, it's worth considering. I believe Madman is a patient of Dr Greenspan, so he may have some ideas on how to convince him to test you properly.
 
Last edited:

AR

New Member
Thanks CoastWatcher! I will push for those tests you recommend. Hopefully he is open to it.
Why test DHT and DHEA? I will do a search for those here but curious on your take on the importance of them.

Appreciate the help!
Thanks,
AR
 

CoastWatcher

Moderator
Thanks CoastWatcher! I will push for those tests you recommend. Hopefully he is open to it.
Why test DHT and DHEA? I will do a search for those here but curious on your take on the importance of them.

Appreciate the help!
Thanks,
AR
DHT and DHEA are certainly in the "nice-to-have" category if you're going to be mounting a campaign to institute testing he's resistant to. You can decide if you want to push or not based on the reaction you get to the SHBG, e2 request. You did have a baseline PSA?
 

AR

New Member
Yes I have PSA from June which was .70. I will ask for the most important ones and then see how he reacts to that and bring up DHT and DHEA. How often should I get PSA done once on TRT?
 

AR

New Member
So went and saw Dr. Greenspan approx. two weeks ago. Protocol is to stay the same of 100mg a week and then redo blood work in 3 months to see if test has gone up more. I have gone ahead and decided to split the dose this time around and do 50mg every 3.5 days. Asked him to test for SHBG and his reply is that it is taken into account when free testosterone was tested and that I am in range so no need to do. Since I got a quick , no on that one didn't bring up e2 test or any of the other.

I feel that unless I am willing to go down the US and pay for my own tests I am at the mercy of my doctor. Since it is hard to get any doctor in Ontario to treat low T when not below the range then not sure I have any other recourse except to go to the US. Even if I do get the needed tests in the US, not sure how I would bring those up with the doctor if he already thought it was a waste of time to test for SHBG and then I would be on my own to deal with the test results.
 

CoastWatcher

Moderator
So went and saw Dr. Greenspan approx. two weeks ago. Protocol is to stay the same of 100mg a week and then redo blood work in 3 months to see if test has gone up more. I have gone ahead and decided to split the dose this time around and do 50mg every 3.5 days. Asked him to test for SHBG and his reply is that it is taken into account when free testosterone was tested and that I am in range so no need to do. Since I got a quick , no on that one didn't bring up e2 test or any of the other.

I feel that unless I am willing to go down the US and pay for my own tests I am at the mercy of my doctor. Since it is hard to get any doctor in Ontario to treat low T when not below the range then not sure I have any other recourse except to go to the US. Even if I do get the needed tests in the US, not sure how I would bring those up with the doctor if he already thought it was a waste of time to test for SHBG and then I would be on my own to deal with the test results.

As fellow Canadian, I have great sympathy for the situation that you find yourself in. I'm fortunate to have a doctor who's understands TRT, is open to ideas, and is an enthusiastic supporter of US testing as she is aware that (in regard to the estradiol test) some things just aren't available here. But...what should you do? He wasn't open to the SHBG even though the peer-reviewed article I sent, the link above, calls for it? Did you sense he was annoyed with you for being your own advocate?
 

AR

New Member
Maybe it seemed he was a bit annoyed but just overall get a sense that he has his way of doing things and keep things short and to the point.

I am leaning towards heading to the US and just paying for it myself but again not sure exactly what I would do with the results as it seems the doctor may not be open to me presenting those results. It would be about 6hrs of driving and cost of the tests. Hardest part is getting away with two kids and two jobs and of course the cost.

Much to think about.

Thanks for you help CoastWatcher.

As fellow Canadian, I have great sympathy for the situation that you find yourself in. I'm fortunate to have a doctor who's understands TRT, is open to ideas, and is an enthusiastic supporter of US testing as she is aware that (in regard to the estradiol test) some things just aren't available here. But...what should you do? He wasn't open to the SHBG even though the peer-reviewed article I sent, the link above, calls for it? Did you sense he was annoyed with you for being your own advocate?
 

CoastWatcher

Moderator
Maybe it seemed he was a bit annoyed but just overall get a sense that he has his way of doing things and keep things short and to the point.

I am leaning towards heading to the US and just paying for it myself but again not sure exactly what I would do with the results as it seems the doctor may not be open to me presenting those results. It would be about 6hrs of driving and cost of the tests. Hardest part is getting away with two kids and two jobs and of course the cost.

Much to think about.

Thanks for you help CoastWatcher.

I hear you. You could walk into his office with lab results showing an SHBG level that is out of whack, or a sensitive estradiol result that demands attention and he wouldn't even hear you out. Time and money wasted. However, there's great debate in the medical community on the reliability of the free testosterone assay. Queen's University (Kingston) questioned the value of the measurement given the inconsistency in testing methodologies. I will raise this with my own doctor (who, sadly, isn't taking patients at this point) and see if she has any ideas. It's frustrating to be held in this patronizing grip...
 
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