26 Year Old With Extremely Low Testosterone Levels - Need Guidance

[Avaleria]

Hello ExcelMale forums,

Since being diagnosed with Hypogonadism, I have been a regular lurker, on this forum and many others trying to better educate myself on my condition. Though at this point, I require the advice from those that have dealt with this struggle themselves.

My struggle started in late 3rd qtr. 2015, I began showing all the hallmark symptoms of Low Testosterone, and I originally chalked this up to just not being as young as I used to be. I continued to deal with these issues until in August 2016, when my wife got tired of the lack of intimate time, and sent me to my GP. In August 2016, they did a whole litany of blood work and urine analysis to attempt to diagnose my problem.

The results of importance are as follows: Note: all labs were taken @ ~7:30AM.

LH – 3.0 Acceptable Range 1.7-8.6(mIU/mL)
FSH – 0.6 Acceptable Range 1.5-12.4(mIU/mL)
Prolactin – 22.6 Acceptable Range 4.0-15.2(ng/mL)
TSH – 2.480 Acceptable Range 0.450-4.500(uIU/mL)
T4, Free – 1.04 Acceptable Range 0.82-1.77(ng/dL)
Testosterone, Serum – 169 Acceptable Range 348-1197(ng/dL)

After getting these results back, my GP prescribed me Androgel 1.62 @ 2 pumps a day; I took this dosage from September – December 2016. For about the first week after starting the Androgel, I felt better than I ever had. Though after the first week, I went back to feeling the same way I had previously. I continued this regimen, and in Late December, my GP took another blood sample to check my levels.

My testosterone came back as follows:
Testosterone, Serum – 209 Acceptable Range 348-1197(ng/dL)

At this point my GP upped my dose to 3 pumps a day of Androgel 1.62, and I at this point realized that I should probably see a specialist. Made an appointment with an urologist, due to my elevated Prolactin levels, he scheduled me to get a CT scan to eliminate a possible pituitary growth. The CT scan came back normal, and the urologist prescribed me 1cc of 200mg Testosterone Cypoinate every two weeks (Doctor did not want to do weekly injections, and said they do not generally prescribe an AI) My wife and I went to the office to get my first injection, and allow her to watch so that she could do all future injections. This was on a Wednesday, and from Thursday to Sunday night, I felt noticeably better in the sex drive area, and felt noticeably better mood wise as well(though this could be a placebo effect). Come Sunday night/Monday morning, things changed, I went from feeling a lot better to back to where I felt before I began taking testosterone. I suspect that my body is aromatising a large portion of my testosterone, but without an Estrogen test, i can not be sure.

I give you all this background, so that possibly someone with more knowledgeable experience, can guide me on if I should be doing things differently. Should I press my doctor to check my Estrogen levels, and insist on an AI, and weekly injections, or should I stick with what I’m doing?

I appreciate any help that this community can give, and I apologize for the length of this post.

 

[Sean Mosher]

Absolutely at the minimum you need weekly injections.
Every 2 weeks is unacceptable (that's what I'd tell him; he works for you, not vice versa).
Consider hCG as well.
And absolutely your estrogen levels need to be monitored along with a variety of other things (use sensitive estradiol test).

 

[CoastWatcher]

Welcome to Excelmale. You are on a protocol that will not lead you to success, I can guarantee it will result in failure. The half-life of testosterone is such that it simply doesn't lend itself to injections on an every two week schedule. It doesn't matter how much you inject every two weeks, your body will eliminate it well before your next injection and you will feel miserable. That's the first signal that your doctor is, at best, uninformed. The second? His failure to monitor estradiol. Estradiol needs to be followed by every TRT patient - it's simply part of a protocol. Guess what? On 200mg of testosterone every two weeks you are far more likely to spike your e2 than on a sane protocol involving more frequent, smaller injections.

There is, however, a third signal that ought to concern you. What was said about your elevated prolactin and what is your SHBG value? If the answer to the prolactin question is, "nothing," and your SHBGG wasn't measured then you hit the trifecta of physician incompetence. Prolactin, if elevated can hammer libido. SHBG is an essential test to help tailor a protocol. As a bonus. - given you age was anything said about a restart protocol?

You aren't the first fellow who fell into the care of a doctor who didn't know how to manage a TRT patient. You need better care, you deserve better care. It can be found. Please consider these points as you're not heading in the right direction.

 

[CSI007]

Listen to everyone here. The protocol you are on is destine for failure. Best approach is to start with a lower dose twice per week (I started with and am still on 50mg twice per week every 3.5 days). Don't do an AI unless you start showing sign of high E2 symptoms and confirm it with blood work.

You can do the shots yourself too. A lot of us use a small insulin needle 28 to 30 gauge subcutaneously. I am willing to bet they injected you intramuscular and with a small harpoon sized needle.

 

[Avaleria]

CoastWatcher,

I appreciate your honest feedback regarding my question. To answer your questions:
1. After my CT scan came back as all clear, nothing was mentioned again about my Prolactin levels.
2. As far as i know my SHBG was not measured, i believe only my total testosterone was measured.
3. This is the first i have heard about a restart protocol, so i have not done any research on this topic.

I did mention to my doctor that i was concerned about the 'Roller Coaster" effects of EOW injections, but was assured that the effects are not really that bad, that it will level out, and that none of their other patients have had any complaints. I have been trying to do as much research as i can about low testosterone, to the point that my wife says that i am researching to much, and should let the doctor do what is best.

I have always heard about drug addicts going from doctor to doctor looking for another prescription, and i do not want to be seen as that type of person. I really don't want to be seen as a doctor hopper, but knowing that this is more than likely a condition that i will deal with forever, i want to get on a proper protocol sooner rather than later. From what my doctor told me, they will recheck my levels after 6 weeks, once before my shot, and then 48 hours after. I do not think that i can continue to feel decent for 4-5 days, and then feel terrible until my next shot. Is there a possibly that things will get better if i continue this treatment plan, or as your said is it truly going to result in failure?

My doctor prescribed my a month supply of testosterone(two 1 cc vials), from what i have read on other places of knowledge, people will advise to split that dose up, and instead of 1 cc EOW, take 0.50 cc Every week. Off label dosing is something that is frowned upon, but is that something i should consider if my doctor is unwilling to prescribe me every week injections? What i really am asking, is that should i give my doctor the benefit of the doubt and hope i can convince him, or should i look for a new specialist. And if so, what type of specialist should i see?

 

[CSI007]

Getting such a large dose of testosterone all at once will do a couple of possible things:

1) If you amortase the T into E2 at a high rate you will probably have issues with E2 that you will have to deal with later. Lower doses reduce the chance of this happening.
2) Higher likelihood of elevated hematacrit levels and then you will be dealing with giving blood on a regular basis to control it.
3) If your body uses up the T at a fast rate by the end of week 2 you will be dealing with all kinds of side effects. Low E2, Low T. LowE2 it is terrible.

 

[Vettester Chris]

I did mention to my doctor that i was concerned about the 'Roller Coaster" effects of EOW injections, but was assured that the effects are not really that bad, that it will level out ... How can it level out when the medication/serum level is completely regulated by Half Life?? It's not like taking an iron supplement, and eventually the serum results level out!! It will NEVER level out!, and that none of their other patients have had any complaints. I have been trying to do as much research as i can about low testosterone, to the point that my wife says that i am researching to much, and should let the doctor do what is best.

Here's the thing, your serum levels will peak in approx. 3 days after injection. Half life is about 7 days; meaning the injection will have run it's entire course in 14 days. You don't have to take my word, anyone's word, or your doctor's word, just pony up and run serum labs at Day 3, Day 7 and 14 days before your next injection. You won't be at baseline, but you will be dropping fast, and the comparison between Day 3 and Day 14 will be Substantial!

The name of the game is balance! The guy who is taking .25cc twice a week will have very consistent, stable serum levels, with the most minimal variance with peaks and troughs. This will also carry over in other areas, like with E2, where excessive conversion is regulated with smaller, more frequent dosages, with an emphasis to mimic the body's natural rhythmic order.

 

[CoastWatcher]

CoastWatcher,

I appreciate your honest feedback regarding my question. To answer your questions:
1. After my CT scan came back as all clear, nothing was mentioned again about my Prolactin levels.
2. As far as i know my SHBG was not measured, i believe only my total testosterone was measured.
3. This is the first i have heard about a restart protocol, so i have not done any research on this topic.

I did mention to my doctor that i was concerned about the 'Roller Coaster" effects of EOW injections, but was assured that the effects are not really that bad, that it will level out, and that none of their other patients have had any complaints. I have been trying to do as much research as i can about low testosterone, to the point that my wife says that i am researching to much, and should let the doctor do what is best.

I have always heard about drug addicts going from doctor to doctor looking for another prescription, and i do not want to be seen as that type of person. I really don't want to be seen as a doctor hopper, but knowing that this is more than likely a condition that i will deal with forever, i want to get on a proper protocol sooner rather than later. From what my doctor told me, they will recheck my levels after 6 weeks, once before my shot, and then 48 hours after. I do not think that i can continue to feel decent for 4-5 days, and then feel terrible until my next shot. Is there a possibly that things will get better if i continue this treatment plan, or as your said is it truly going to result in failure?

My doctor prescribed my a month supply of testosterone(two 1 cc vials), from what i have read on other places of knowledge, people will advise to split that dose up, and instead of 1 cc EOW, take 0.50 cc Every week. Off label dosing is something that is frowned upon, but is that something i should consider if my doctor is unwilling to prescribe me every week injections? What i really am asking, is that should i give my doctor the benefit of the doubt and hope i can convince him, or should i look for a new specialist. And if so, what type of specialist should i see?

You are being treated by a doctor who failed to properly conduct the appropriate testing when you came to him after Androgel failed (as it does for so many men). This same doctor prescribed a protocol that, no matter how long you wait, will NEVER, EVER level out. Every two weeks you will inject, your testosterone will shoot up, then your estradiol will shoot up, and you will feel miserable. Repeat this cycle every two weeks. Misery upon misery. But, since your doctor never tested your e2, or your SHBG, he will attribute failure to respond to his scheme as...well, I don't know what he'll attribute it to. All I know is he will have compounded his prescription of a flawed protocol with his failure to conduct the proper diagnostic testing to correct and compensate as time unfolds. Honestly? You have been victimized by one of the worst protocols presented here at Excelmale in the past six months.

It it is your body, health, and money. I wouldn't stay another minute with this doctor. The selection of a physician to help manage a protocol is the single most important decision a man will make when he commits to TRT. It is that important. We can offer you the names of qualified physicians - you shouldn't have to put up with this.

 

[Avaleria]

I would sincerely appreciate the names of any qualified professionals that are near me, and that accept insurance.

I was so excited to think that i was finally going to be on the right track, but it seemed like the more and more research i did, the more questions i had.

I do appreciate the guidance all those above have cast in. I do hope to find a doctor that is more keen to what are correct ways to administer and monitor low testosterone.

 

[CoastWatcher]

I would sincerely appreciate the names of any qualified professionals that are near me, and that accept insurance.

I was so excited to think that i was finally going to be on the right track, but it seemed like the more and more research i did, the more questions i had.

I do appreciate the guidance all those above have cast in. I do hope to find a doctor that is more keen to what are correct ways to administer and monitor low testosterone.

And now we come to your next surprise - finding a capable doctor in the area of androgen replacement who is local and accepts insurance is likely to be very difficult. Here's the thing: for reasons that frustrate all of us, most doctors, including those who should know this field (endocrinologists and urologists) have little training when it comes to male hormones. Your doctor is almost certainly not a bad guy, just ill-trained and, therefore, a menace to guys like you who consulted him in good faith. This is the case all over the United States and Canada (I live in Toronto); it's worse in Europe and Asia. You live in northern Alabama? Near Birmingham? I will contact a friend in Atlanta who practices endocrinology, and is one of the "good guys," to see if he knows of anyone in your area. Otherwise, we'd urge you to consult Defy Medical or Prime Body, the two leading national practices - they treat a lot of Excelmale members...successfully.

Don't freak out; it's not as expensive as you fear it may be. Consider it an investment in your future. One step at a time. There is a way to move out of the bind you're in.

 

[CoastWatcher]

Was I correct in assuming Birmingham was a convenient major metropolitan area for you to access?

 

[Avaleria]

Yes, you were correct. Huntsville is closer, but Birmingham is not all that far.