23 year old, 1 month TRT... WHAT THE?!?! You gotta see this...

[MunchEase]

Hey guys,

Once again thank you to this awesome community. Holy hell you guys... I just don't know what to do anymore. My bloodwork is ridiculous... May 3/2015 - pre TRT here is what I rang in at.

Testosterone: 10.1 nmol/L OR 291 ng/dl ———> (reference 8.0-29.0)
SBGH: 34 nmol/L ———> (reference 10-55)
Free Testosterone: 201 pmol/L OR 15.62 ng/dl ———> (reference 175-700)
DHEA: 12.3 umol/L ———> (reference 2.2-13.0)
TSH: 2.29 mIU/L ———> (reference 0.20-4.00)
Prolactin: 12 ug/L (reference 0-15)
Free T3: 5.9 pmol/L (reference 3.5-6.5)
Free T4: 18.9 pmol/L (reference 10.0-25.0)
Estradiol: 45 pmol/L (reference 0-160)
Cortisol AM: 500 nmol/L (reference 200-690)
Progesterone: 3.3 nmol/L (reference 0.0-3.0)
FSH: 15 IU/L (reference 1-18)
LH: 5 IU/L (reference 1-9)
Iron: 13 umol/L (reference 12-31)
Ferritin: 41 ug/L (reference 30-400)

The doctor started me on 4 pumps/day Androgel. I had the test done 3 hours after applying Androgel. I was also exhausted after 20 hours of airport travel, traveling for 14 days, so it probably would've been better to wait a few days before doing bloodwork, but I was anxious to see where I was at. I was a month into Androgel, still had horrible libido, erection quality, depression, etc. Was arguably worse off than I was before. Here is my bloodwork now.

Testosterone: 52 nmol/L (reference 8.0-29.0) <--- ARE YOU KIDDING ME?!
Estradiol: 96 pmol/L (reference 0-160)
FSH: 3 IU/L (reference 1-18)
LH: >1 IU/L (less than 1) (reference 1-9)
Progesterone: 4.0 nmol/L (reference 0.0-3.0)
Prolactin: 8 ug/L (reference 0-15)
DHEA: 12.3 umol/L (reference 2.2-13.0)
.
Can anyone make anything of this/give me any advice? Looking for any guidance here! I am worried my testosterone is so jacked I am doing real serious/irreversible damage to my testicles.

I have an endo appointment in 3 weeks (they take forever to get in Canada). This is because they're thinking I might have a pituitary adenoma. I kinda thought I would get my external health issues sorted out, then come off TRT with the use of HCG. Now I'm not so sure. Please help and I thank you x1000 for your time!

 

[CoastWatcher]

Here in Canada, you will have no luck getting the sensitive estradiol test. I self-test, through Discountedlabs.com in the States. The sensitive E2 test, here in Ontraio, at least, is limited to inpatients (go figure). The standard test you are using is of no real value. If you can get to the States, and self-test, it is worth it.

Why did you start TRT before sorting out the underlying issues that might be causing your problems?

 

[MunchEase]

Here in Canada, you will have no luck getting the sensitive estradiol test. I self-test, through Discountedlabs.com in the States. The sensitive E2 test, here in Ontraio, at least, is limited to inpatients (go figure). The standard test you are using is of no real value. If you can get to the States, and self-test, it is worth it.

Why did you start TRT before sorting out the underlying issues that might be causing your problems?

Is the sensitive E2 test a huge factor in this equation?
I thought there were mathematical equations you could do to calculate sensitive off of the standard (multiply by 0.2724), you arrive at 23 pg/ml.

I was more alarmed by my testosterone being at 52 nmol/L, and my LH/FSH being virtually 0 after only a month. I don't know what is normal, I am only self-taught on the internet!

I was experiencing severe E.D., low libido, and severe depression/anxiety. I was struggling! I had exhausted every option/supplement on GNC's table, was already in peak shape, ice showers, clean diet, etc, and zero improvement. I had finally had it! Wouldn't have been as big of deal if I was single (could've just road it out), but I had recently started dating a new girl who was a keeper and couldn't bear to "wait 3 months for the endocrinologist", then potentially another year for surgery (if it is a pituitary adenoma), etc.

I also discovered I carry an MTFHR mutation, something I'll be posting info on for everyone else later! Real break through stuff (some 40% of people have it, and it can cause all sorts of issues!). Essentially (through your genes), your body is unable to break down folic acid, causing your system to have big issues detoxifying, and therefore, affecting every aspect of your mental/physical health. You fix it by supplementing methylfolate and methylated vitamin B-12. I will be doing a big post on all this later. Another factor to take into account when dealing with hormones/physical health.

 

[Vince Carter]

You should never apply the gel and get tested three hours later. Of course it's astronomical, your Dr was all wrong. First thing in the morning, blood draw, THEN, gel. For the same reason your Estradiol skyrocketed. You're really not receiving competent care. You're using T, your LH/FSH are going to be statistically zero as the introduction of the T Gel stops your body's production.

I would stop with the Pituitary Edonoma(?) and get on a properly administered regiment and reevaluate later. Lastly, four weeks is no point to make judgements on treatment working or not.

 

[MunchEase]

You should never apply the gel and get tested three hours later. Of course it's astronomical, your Dr was all wrong. First thing in the morning, blood draw, THEN, gel. For the same reason your Estradiol skyrocketed. You're really not receiving competent care. You're using T, your LH/FSH are going to be statistically zero as the introduction of the T Gel stops your body's production.

I would stop with the Pituitary Edonoma(?) and get on a properly administered regiment and reevaluate later. Lastly, four weeks is no point to make judgements on treatment working or not.

I thought the advice of getting tested immediately after application might be weird.

I thought (based on these ridiculous results), I might taper down from 4 pumps to 3 until I see the endocrinologist in 3 weeks, and work on getting HCG in the mean time to keep everything up and running. What do you guys think about this? Anyone have any general advice?

I know medical advice isn't allowed, but would seriously appreciate any suggestions.

Thanks again for your time!

 

[Vince Carter]

One critical key to TRT is steady no-change treatment, I mean, some changes are inevitable but you really can't as you say I'm gonna change from 4 to 3 and see in three weeks...it doesn't work that way. You have to stay steady for 4-6 weeks, test, and make small changes...go steady 4-6 weeks, test, small changes.

You're nuts are not going to be impacted by TRT this early in the game without HCG.

 

[Pacman]

Your testosterone levels were pretty high and out of range based off your blood work, and yes, you probably should have had the blood drawn before you applied the gel, but I highly doubt that there would be that huge of a difference anyways, as Androgel is known to keep T levels in the blood more or less stable. This means that the result from the blood work had you not applied the gel first would be lower, but not that much lower. Chances are you would still have very high T. Why didn't you add in the free T and the DHT? Did they not test those in your second blood test? Those are just as important to know as the total T itself....

I wouldn't be worried about irreversible damage from TRT to your testicles, definitely not from one month in any case. Testicular atrophy generally takes longer than one month to start occurring, and the majority of the time, it's temporary.

Another important thing to keep in mind is to not automatically assume that you must have pituitary adenoma, just because the doctor "suspects" you might have it. There's a reason he's calling you in to his office, which is for further testing. In other words, he sees a symptom that is consistent with a symptom of pituitary adenoma, and he wants to rule that out. Let's see what the test results provide.

By the way, on your pre-TRT blood work results, none of the results seemed to be out of range. Your T was definitely low though...

 

[CoastWatcher]

With all the respect in the world, you're driving fast with no headlights. The standard estradiol test, which you presented differs from the sensitive test in methodology - you can't simply "convert" your standard results to sensitive ones via a calculation any more than you can turn an orange into a tangerine. Two different tests. As Vince points out, you are going to wind up suppressing your LH/FSH before you have an endocrine consultation.

You are talking about changes at 4 weeks when you have no reliable data to base those changes on. Your total test is high, but quite possibly pulled at the wrong time; your estradiol is high, but is being measured on the wrong scale. Step back and consult a qualified doctor who knows this area of medicine. Even in Canada, they can be found (as I learned).

TRT is a marathon, it's no sprint. It takes some time for things to balance and get dialed-in. Gene Devine, one of the moderators, always urges men to "start low and go slow." That is good advice.

 

[MunchEase]

With all the respect in the world, you're driving fast with no headlights. The standard estradiol test, which you presented differs from the sensitive test in methodology - you can't simply "convert" your standard results to sensitive ones via a calculation any more than you can turn an orange into a tangerine. Two different tests. As Vince points out, you are going to wind up suppressing your LH/FSH before you have an endocrine consultation.

You are talking about changes at 4 weeks when you have no reliable data to base those changes on. Your total test is high, but quite possibly pulled at the wrong time; your estradiol is high, but is being measured on the wrong scale. Step back and consult a qualified doctor who knows this area of medicine. Even in Canada, they can be found (as I learned).

TRT is a marathon, it's no sprint. It takes some time for things to balance and get dialed-in. Gene Devine, one of the moderators, always urges men to "start low and go slow." That is good advice.

Zero offense taken! Thank you for all your input boys! I'd buy ya a beer if this were real life

The free testosterone has to be done in the morning, I am going to go back and do that on a day I don't work. DHT I have never seen on any of my bloodwork, in Canada, it might be different, I'm not sure. I asked for the E2 sensitive when I was getting my requisition done, and the guy said it was unnecessary. I don't even know if it's available in Canada.

I am completely baffled that my results were that high - I only started with 4 pumps of the 1%, which is the standard starting dose, and my T was very low to begin with. But to go from 10.1 ---> 52 in a month using 4 pumps... something seems off!

So I know no medical advice is allowed, but at this point in the game, does anyone have any general suggestions? Don't worry, I know to consult my doctor and form my own opinions, but I'm curious what the veterans would have to say if they were in my shoes. I don't know whether to lower my dose, keep it steady until the endocrinologist, if having levels that high are dangerous for now, if I should be looking into getting HCG, etc.

 

[MunchEase]

As for the pituitary, that's based off two 24 hour urine cortisol tests, 2 blood tests, and a 24 hour saliva test, all which pointed in that direction, blurred vision, etc, but I'm not too worried either way!

 

[HarryCat]

Both Dr's Shippen and Crisler recommended getting blood drawn 2-3 hours after applying a topical, looking for the peak, in order to know how well you are absorbing it.

Where are you applying the gel? Any chance you contaminated the blood draw site? It is really important that no gel be applied anywhere near the blood draw site on you arm. This will cause false high readings.

 

[MunchEase]

Both Dr's Shippen and Crisler recommended getting blood drawn 2-3 hours after applying a topical, looking for the peak, in order to know how well you are absorbing it.

Where are you applying the gel? Any chance you contaminated the blood draw site? It is really important that no gel be applied anywhere near the blood draw site on you arm. This will cause false high readings.

Very likely site was contaminated, I apply to both shoulders as well as abdomen. Blood was drawn from upper forearm but easily could've had excess Androgel from 3 hours previous on it.

Just going to run my tests over again.