41 year old with questions

[Neckbeard]

Hello All,

As stated, I'm 41 years old and have been reading though the forums for a couple weeks or so. I stopped into a trt clinic yesterday to get a free tt screening. They called back and told me today that my tt was 340. We set consultation appointment for next week.

Reason for considering trt:

Anxiety (I've had it for most of my life)
Low energy
Obese (most of my life)
Depression
Concentration
Focus
High blood pressure
Low motivation
Constant worrying
A.d.d
Binge drinking and eating

Most of these symptoms I've had as far back as I can remember. In my late 20s I finally saw a Dr about my anxiety/worrying (which they said was depression, but I never really thought I was depressed. I would have really bad irratability.) Anyway, they prescribed me an ssri and I've been riding the wave ever since. Over the years I've probably been on 5 or 6 different anxiety/depression meds. Around 2009 I found a website called marks daily apple and over the years I have yo yod probably 200lbs on a primal/keto diet. I'm currently 6' 285lbs. I hadnt been to a gym since I was 23 until about 2 years ago i started lifting again. I currently havnt been lifting since June or eating right for that matter. It seems like I can go good for about 3 to 4 months and then I fall off the wagon. A year ago I was @240lbs as a reference.

My questions:

What could I expect from trt?
How to tell if the trt clinic is a good one?
Should I tell my general practioner?
Has anyone had help from trt with my symptoms?

Obviously, with the anxiety and worrying issues I'm a little concerned about taking 2-3 shots per week forever.

I'll quit rambling, any thoughts are welcome

Thanks

 

[Vince]

Yep first you need to find a good Clinic. You can start a thread and post your area maybe someone will know a good doctor in that area. Also we have two Clinics that advertise on this site.
If you can post all of your labs you can get a good discussion.

Doctor and Clinic Reviews

https://www.excelmale.com/community/forums/doctor-and-clinic-reviews.38/

 

[Systemlord]

Typically these TRT clinics (T-mills) are bad news, they don't usually have knowledgeable doctors and don't run enough tests to determine a proper TRT protocol. It's shown depression and anxiety the majority of the time is hormones related that doctors throw drugs at which only makes things worse down the road.

It may dull the anxiety and depression but you will always feel something isn't right. That's usually when the cause in hormonal and other drugs were just a bandaid that never really address the core problem.

I've seen guys who are grumpy old men before TRT, much like that of men in retirement communities, yet after going on TRT they are a completely different person. If this clinic didn't run SHBG, run from this clinic!

You have the hormone levels of an 80 year old so it's no surprise you feel the way you do.

Do you have the lab results?

 

[Neckbeard]

Thanks for the replies.

They just did a total testosterone screening.

I go next Thursday to have a consultation to talk about protocol and price. I'm assuming at that time they will order a complete lab workup.

 

[Systemlord]

Thanks for the replies.

They just did a total testosterone screening.

I go next Thursday to have a consultation to talk about protocol and price. I'm assuming at that time they will order a complete lab workup.

Oh I figured as much, these clinic only want to do enough testing to be able to legally prescribe you testosterone, balancing all your other hormones didn't even enter their into their plan. I expect a TRT protocol to look like 200-300mg weekly, 1mg estrogen blocker EOD and HCG without regard for SHBG or estrogen.

Their goal is to sell as much product as they can for the sake of profit without any regard for your health.

Cancer that consultation!

I'm assuming at that time they will order a complete lab workup.

It's a mistake to think that, they had their chance and didn't do it because they never intended to do it.

 

[Neckbeard]

I stopped in for a free tt that they offered on their website. I have a buddy who was a patient of theirs for 3 years and I know they tested all of those markers. I'll find out and if they don't do complete blood panels then I won't do it. I looked at the list of Drs. In the sticky and o found nobody in indiana, which is where I am.

 

[Neckbeard]

What is the minimum required labs that the trt clinic should have me do?

 

[Vince]

1------ Estradiol- ultrasensitive via LC/MS test (not EIA!) [Quest Labs code 30289]
(Labcorp code: 140244) (baseline, week 6 or 8, month 6)

GOAL: 20-50 pg/mL

2 ------- Testosterone, Free, Bio/Total (LC/MS/MS) (baseline, week 6-8, month 6, then yearly)

GOAL: Total testosterone oer 500 ng/mL and free T 2 percent or more of total T.

3 ------- DHEAs (baseline, month 6, month 12 (if supplementing))

4 ------- Comprehensive Metabolic Panel w/EGFR (baseline, week 6-8, month 6 and then once a year)

GOAL: Normal CBC including liver enzyme elevations under 20 percent and eGFR over 60

5 ------- CBC w/ diff/PLT (baselines, week 6-8, month 6 and then once or twice per year)

GOAL: Normal CBC

6 ------- Lipid profile (fasting sample) (baselines, month 6, then once per year unless high)

GOAL: Normal lipids

7 ------- T3, free (for those with low thyroid symptoms)

GOAL: Upper quartile free T3

8 ------- T4, free (for those with low thyroid symptoms)

Goal: Normal free T4

9 ------- Ultrasensitive TSH (baseline, month 6, yearly after that depending on value and treatment)

GOAL: TSH under 2.5

10 -------- Prostatic Specific Antigen (PSA) (Baseline before testosterone treatment, 6-8 weeks after and then yearly)

GOAL: PSA under 3

11-------- LH and FSH (for men not on testosterone yet)- Used to diagnosed primary or secondary hypogonadism. Do not waste money testing your LH and FSH if you are on testosterone since they will be undetectable.

https://www.excelmale.com/forum/thr...-initiation-of-testosterone-replacement.1956/

 

[Vince]

Here's my last panel that I posted.

My protocol is 16 mg of testosterone cypionate daily, 500 iu of HCG twice a week, 25 mg of DHEA and no AI.

testosterone serum 1117 ng/dL range 264 - 916
Free T 30.3 pg/mL range 6.6 - 18.1
DHEA - Sulfate 347.3 range 48.9 - 344.2
Estradiol, Sensitive 29.5 range 8.0 - 35.0
SHBG 48.8 range 19.3 - 76.4
HCT 47.9 range 37.5 - 51.0

 

[Neckbeard]

Wow, thank you. I'll see what they say.

 

[mooseman109]

To add to Vince’s list SHBG as well

 

[Neckbeard]

I was listening to a t.o.t podcast and he said the obese people (which I am) shouldn't start trt until they lose the weight. Is there any truth to this? Among all of my other symptoms, weight loss is one I was hoping trt would help.

 

[Sean Mosher]

Neckbeard, I would start/continue to eat right and train while you are pursuing getting the proper set of labs run.
We need to see the full picture, but by all means, yes, please continue with the healthy lifestyle promoted on the TOT podcast.
His book is a great read too for all things testosterone and will help you along in your journey.
Nelson has an excellent book and this site has endless amounts of information for you at your fingertips.

 

[Systemlord]

I was listening to a t.o.t podcast and he said the obese people (which I am) shouldn't start trt until they lose the weight. Is there any truth to this? Among all of my other symptoms, weight loss is one I was hoping trt would help.

If you can't gain muscle do to low T then you can't lose weight, it's a double edge sword my friend. The more muscle you have the more calories you burn. I'm 50 pounds overweight and losing weight with a total T of 120 isn't going to happen.

 

[Neckbeard]

Have you had any negative side effects on try? Do you notice a difference?

 

[Systemlord]

Have you had any negative side effects on try? Do you notice a difference?

I had severe anemia and doing simple things like climbing a single flight of stairs was like attempting Mount Everest. Studies showed two groups of men with low testosterone, some where given TRT and told not to exercise, men with low testosterone were told to exercise, the men on TRT who hadn't exercised lost weight and build muscle and the men with low testosterone who were exercising lost no weight and gained no muscle.

When a man goes on TRT his muscles start growing without any exercise, more muscle, the more calories you burn.

 

[Neckbeard]

Ok, this is a list of panels on the initial blood work done at the clinic. Estradiol, FSH, LH, PSA, TSH, CMP, CBC, Lipid Panel, and a Vit D 25 Hydroxy. She didn't say anything about shbg. Is this going to give them enough info to give the correct dosage. She said my insurance will likely cover some of the charges and that they start out on a low dose and work up gradually. Obviously after they read my blood work.

 

[MarkM]

The Estradiol test must be the Estradiol Sensitive LC/MS/MS assay. Make sure that is the one they are using for estradiol. If they are using the Roche ECLIA methodology to test estradiol that is not correct. The Roche test id for women and the Sensitive test is for men.

You must have Total and Free Testosterone tested and it is critical that SHBG be tested. You can not develop a proper protocol for TRT without testing for SHBG.

 

[Systemlord]

Starting TRT without SHBG is going forward without a plan and is a bad sign your doctor isn't up to speed on TRT. It will prolong the time it takes for you to start feeling normal again, I waste more than a year on doctors who randomly suggest we try this or try that without ever knowing what they were doing.

There are very few doctors who know how to do TRT well, most of those aces aren't inside any insurance network.

 

[Neckbeard]

I put in another email asking about free t and shbg. We'll see what they say.