38yr old newly on T-Gel and not happy.

[silentj47]

Sorry in advance for the long story.


I’m 38 years old and currently on a TRT gel prescribed by my primary doc- here’s my story. 4 years ago I made a dr appointment to discuss the embarrassing ED issues I was having, the Doc ordered blood work and I came back in for a followup. She said my T levels were normal (did not share the numbers, and I didn’t ask) and she recommended ed meds. I started using those and it helped for sure but did not address the other issues, mood, energy level, libido, focus etc.


Fast forward 4 years and I’m still having similar issues. My dr. office sends me an email inviting me to a “patent portal” that I logon to and find a wealth of information- all of my past lab results etc. I noticed my T levels from back in 2013 and see that it’s clearly in the low range:


2013 numbers:
Testosterone Total 276 ng/dl
Testosterone Free 6.5 pg/ml


I got online and started reading everything I could about testosterone and quickly learned that my numbers were not good and this could be the cause of my ongoing issues. I asked the doc to order updated blood work and the results were even worse.


Feb 2017 numbers:
Testosterone Total 84 ng/dl
Testosterone Free 2.6 pg/ml
TSH 1.58 uiu/ml
FSH .9 mIU/ml
Prolactin 7.3 ng/ml


Doc puts me on T-Gel 25mg/2.5gm 1% once daly. Which I find out later is a very low dose. After nearly 3 months on that protocol I don’t FEEL any different so I get blood work again and the Doc calls and says my levels are back to the “low end of normal”. When my results post to the portal I was shocked to see what she called “normal”.


April 2017 numbers:
Testosterone Total 189 ng/dl
Calc Testosterone Free 4.6 ng/dl
Calc Bioav. Testo 107. ng/dl
Free Androgen Index 31.8%
SHBG 20.6 nmol/L


More about me:
I’m 6’4” 207 lbs, I work out 5x/week (weight training) and have not had much success in muscular gains. I have a very healthy diet and lifestyle, I track all of my calories but still have excessive abdominal fat. I also get 7-8hrs of sleep every night. I have fathered 2 children and wish to maintain fertility.


Any constructive advice would be much appreciated!

 

[Vince Carter]

Many men do not do well enbough on topicals, they encounter absorption problems, too, I can't say if 25mg/2.5g is a low dose but sure looks that way with your follow up labs. Had you applied that cream the day you had the latest test?

 

[silentj47]

Good question. I apply the gel every morning after my shower, the morning of my blood work I went in early prior to application.

 

[CoastWatcher]

Sorry in advance for the long story.


I'm 38 years old and currently on a TRT gel prescribed by my primary doc- here's my story. 4 years ago I made a dr appointment to discuss the embarrassing ED issues I was having, the Doc ordered blood work and I came back in for a followup. She said my T levels were normal (did not share the numbers, and I didn't ask) and she recommended ed meds. I started using those and it helped for sure but did not address the other issues, mood, energy level, libido, focus etc.


Fast forward 4 years and I'm still having similar issues. My dr. office sends me an email inviting me to a “patent portal” that I logon to and find a wealth of information- all of my past lab results etc. I noticed my T levels from back in 2013 and see that it's clearly in the low range:


2013 numbers:
Testosterone Total 276 ng/dl
Testosterone Free 6.5 pg/ml


I got online and started reading everything I could about testosterone and quickly learned that my numbers were not good and this could be the cause of my ongoing issues. I asked the doc to order updated blood work and the results were even worse.


Feb 2017 numbers:
Testosterone Total 84 ng/dl
Testosterone Free 2.6 pg/ml
TSH 1.58 uiu/ml
FSH .9 mIU/ml
Prolactin 7.3 ng/ml


Doc puts me on T-Gel 25mg/2.5gm 1% once daly. Which I find out later is a very low dose. After nearly 3 months on that protocol I don't FEEL any different so I get blood work again and the Doc calls and says my levels are back to the “low end of normal”. When my results post to the portal I was shocked to see what she called “normal”.


April 2017 numbers:
Testosterone Total 189 ng/dl
Calc Testosterone Free 4.6 ng/dl
Calc Bioav. Testo 107. ng/dl
Free Androgen Index 31.8%
SHBG 20.6 nmol/L


More about me:
I'm 6'4” 207 lbs, I work out 5x/week (weight training) and have not had much success in muscular gains. I have a very healthy diet and lifestyle, I track all of my calories but still have excessive abdominal fat. I also get 7-8hrs of sleep every night. I have fathered 2 children and wish to maintain fertility.


Any constructive advice would be much appreciated!

Welcome to Excelmale. You are another in a long line of men who failed to respond to topical testosterone delivery. It's a perfectly rational first step in treating hypogonadism, and you are certainly hypogonadal, but in a solid minority of men it simply fails to achieve the desired blood levels. Your dose could be higher, it might be worth trying an increased dose, but I'd urge you to consider shifting to injections.

As for your blood work, this is all that was run? You are missing some key values. PSA, estradiol/sensitive (LC, MS/MS), CBC, CMP, LH (which will now be inaccurate due to suppression of your natural axis), t3, t4, rt3, thyroid antibodies, DHT, DHEA. An effort was made to test appropriately, but with so many missing labs it would seem your doctor is relatively inexperienced in regard to male androgen therapy.

What what was said about fertility? Was there any discussion of HCG, to preserve your testicular vitality? It's a basic element of a good protocol.

I fear that you're unlikely to achieve your goals working with your current physician. She ordered an incomplete workup, she is satisfied that you're "in range," and confuses that with "normal," and has managed to further suppress your endogenous production of testosterone on a protocol that leaves you feeling flat.

You need a new doctor. If local, quality care can't be found we can offer you referrals to nationally regarded physicians. You deserve better care than you're receiving.

One last note, when posting lab values down the road, please include reference ranges.

 

[Vince Carter]

Good question. I apply the gel every morning after my shower, the morning of my blood work I went in early prior to application.

ya mistake was made, you should be applying the gel as normal prior to your blood draw about an hour or two.

 

[CoastWatcher]

Good question. I apply the gel every morning after my shower, the morning of my blood work I went in early prior to application.

With topicals, unlike injections, many doctors ask you to apply and test an hour or two later.

 

[Vince]

I wonder why do you have low testosterone, your too young to be on trt. I would concentrate on finding out the reason why and then do the things you need to do, to improve your testosterone.

 

[silentj47]

I may be "too young" for this, but do you have any constructive suggestions? I eat right, I sleep right, I exercise 5 days per week. I go to my Dr. for an annual physical, and yet I'm still symptomatic.

I wonder why do you have low testosterone, your too young to be on trt. I would concentrate on finding out the reason why and then do the things you need to do, to improve your testosterone.

 

[silentj47]

Thanks for the reply! I'm thinking that I agree and need to look for a new Dr.

I asked my Doc about HCG and she said that it wouldn't work for me that its part of a "fad diet". From what I'm reading many people here are using it regularly to maintain testicular function. She also said she would not prescribe injectable testosterone because it's a controlled substance, that I would have to see an endocrinologist. I'm also seeing that the labs she requested were not thorough enough.

Welcome to Excelmale. You are another in a long line of men who failed to respond to topical testosterone delivery. It's a perfectly rational first step in treating hypogonadism, and you are certainly hypogonadal, but in a solid minority of men it simply fails to achieve the desired blood levels. Your dose could be higher, it might be worth trying an increased dose, but I'd urge you to consider shifting to injections.

As for your blood work, this is all that was run? You are missing some key values. PSA, estradiol/sensitive (LC, MS/MS), CBC, CMP, LH (which will now be inaccurate due to suppression of your natural axis), t3, t4, rt3, thyroid antibodies, DHT, DHEA. An effort was made to test appropriately, but with so many missing labs it would seem your doctor is relatively inexperienced in regard to male androgen therapy.

What what was said about fertility? Was there any discussion of HCG, to preserve your testicular vitality? It's a basic element of a good protocol.

I fear that you're unlikely to achieve your goals working with your current physician. She ordered an incomplete workup, she is satisfied that you're "in range," and confuses that with "normal," and has managed to further suppress your endogenous production of testosterone on a protocol that leaves you feeling flat.

You need a new doctor. If local, quality care can't be found we can offer you referrals to nationally regarded physicians. You deserve better care than you're receiving.

One last note, when posting lab values down the road, please include reference ranges.

 

[madman]

Sorry in advance for the long story.


I’m 38 years old and currently on a TRT gel prescribed by my primary doc- here’s my story. 4 years ago I made a dr appointment to discuss the embarrassing ED issues I was having, the Doc ordered blood work and I came back in for a followup. She said my T levels were normal (did not share the numbers, and I didn’t ask) and she recommended ed meds. I started using those and it helped for sure but did not address the other issues, mood, energy level, libido, focus etc.


Fast forward 4 years and I’m still having similar issues. My dr. office sends me an email inviting me to a “patent portal” that I logon to and find a wealth of information- all of my past lab results etc. I noticed my T levels from back in 2013 and see that it’s clearly in the low range:


2013 numbers:
Testosterone Total 276 ng/dl
Testosterone Free 6.5 pg/ml


I got online and started reading everything I could about testosterone and quickly learned that my numbers were not good and this could be the cause of my ongoing issues. I asked the doc to order updated blood work and the results were even worse.


Feb 2017 numbers:
Testosterone Total 84 ng/dl
Testosterone Free 2.6 pg/ml
TSH 1.58 uiu/ml
FSH .9 mIU/ml
Prolactin 7.3 ng/ml


Doc puts me on T-Gel 25mg/2.5gm 1% once daly. Which I find out later is a very low dose. After nearly 3 months on that protocol I don’t FEEL any different so I get blood work again and the Doc calls and says my levels are back to the “low end of normal”. When my results post to the portal I was shocked to see what she called “normal”.


April 2017 numbers:
Testosterone Total 189 ng/dl
Calc Testosterone Free 4.6 ng/dl
Calc Bioav. Testo 107. ng/dl
Free Androgen Index 31.8%
SHBG 20.6 nmol/L


More about me:
I’m 6’4” 207 lbs, I work out 5x/week (weight training) and have not had much success in muscular gains. I have a very healthy diet and lifestyle, I track all of my calories but still have excessive abdominal fat. I also get 7-8hrs of sleep every night. I have fathered 2 children and wish to maintain fertility.


Any constructive advice would be much appreciated!

You never had a chance to even see if you would respond to the topical t as 25mg is too low dosage let alone testing before you applied it, most start on 50mg/daily and many have to have dosage increased to 100mg eventually to achieve good levels, barring you are a responder.

 

[CSI007]

Thanks for the reply! I'm thinking that I agree and need to look for a new Dr.

I asked my Doc about HCG and she said that it wouldn't work for me that its part of a "fad diet". From what I'm reading many people here are using it regularly to maintain testicular function. She also said she would not prescribe injectable testosterone because it's a controlled substance, that I would have to see an endocrinologist. I'm also seeing that the labs she requested were not thorough enough.

Time for you to get a new Doctor. Poor starting dosage of topical T, has no understanding of HCG and what it does for the androgen pathways and won't prescribe an injectable if the topical won't work? She's a Doctor, they prescribe controlled substances all the time.

Since you got some increase in levels with the topical, at least give it a chance with a proper dosage and the right testing after you apply....If it's a no go then move forward with other plans.

 

[Vince]

I may be "too young" for this, but do you have any constructive suggestions? I eat right, I sleep right, I exercise 5 days per week. I go to my Dr. for an annual physical, and yet I'm still symptomatic.

I would consider having a consultation with a good TRT doctor, check out all your options. At your age you may also be able to do a restart. Especially if you would like to remain fertile.
This Thread may help. https://www.excelmale.com/forum/showthread.php?501-How-to-Increase-Testosterone-Naturally

 

[CoastWatcher]

Thanks for the reply! I'm thinking that I agree and need to look for a new Dr.

I asked my Doc about HCG and she said that it wouldn't work for me that its part of a "fad diet". From what I'm reading many people here are using it regularly to maintain testicular function. She also said she would not prescribe injectable testosterone because it's a controlled substance, that I would have to see an endocrinologist. I'm also seeing that the labs she requested were not thorough enough.

She's out of her depth. First of all, topical testosterone applications are controlled substances. Any pharmaceutical product containing testosterone and dispensed in the US or Canada is a controlled substance. It's painfully embarrassing to read that she doesn't seem to realize that. Doctors regularly prescribe controlled substances on a regular basis. Secondly, HCG use in dieting is controversial - and has nothing at all to do with maintaining fertility when being treated for hypogonadism. Head for another physician's office.