47 years old looking for advise. NEWBIE

[timzjp]

Here is my long story short version.
For the last 5 years I complained to my primary doctor about lack of drive and being beat ass tired. Blood work came back as slight type 2 diabetic and test levels mid 300.
He said he can't do anything until numbers fall below 300! TREAT THE NUMBER NOT THE SYMPTOMS ???
Now current times.... new endo doc, was on androgel 2 pumps levels went from 228 to 189. 4 pumps put me exactly back to pre treatment 228. For the last month I have been doing cypionate (sp?). 200 MG per ml. Vial at .5 ml injection per week. Feeling Absolutely no difference in the way I feel.
He wants to retest in 8 weeks. I'm not sure what to do.
47 years old.
5ft9
250 lbs lots of belly fat.
Thanks for any advise

 

[CoastWatcher]

Welcome to Excelmale; we're glad you joined us. You're absolutely right - the important thing is to treat the patient and his symptoms not the numbers. That said, we need some more information from you, including a few numbers. Other than total testosterone, can you post the rest of your lab work, with ranges? Free testosterone, LH, FSH, estradiol (via sensitive testing), SHBG, DHT, prolactin, your thyroid function panel?

Typically, better results are achieved if testosterone injections are smaller in dose and more frequently administered. A good starting point would be to split your dose into 50mg every 3.5 days. That also helps manage estradiol peaks (a potential problem particularly given your weight). Once we know a bit more a solid discussion will unfold.

 

[timzjp]

Thanks for the reply.
These are the only test that he requested.
1st test,Total test serum 228

2nd test after 2 pumps androgel
Total test serum 189
hematocrit 46.2
Estradiol 8.7

3rd test
Total test serum back to 228.

NO OTHER TEST THAT YOU LISTED.
Thanks

 

[CoastWatcher]

Thanks for the reply.
These are the only test that he requested.
1st test,Total test serum 228

2nd test after 2 pumps androgel
Total test serum 189
hematocrit 46.2
Estradiol 8.7

3rd test
Total test serum back to 228.

NO OTHER TEST THAT YOU LISTED.
Thanks

Please don't take this personally, but your doctor is a menace to your health. He failed to do an adequate pre-TRT workup. You don't know if you are dealing with primary or secondary hypogonadism. You aren't sure what your SHBG is, your protocol isn't tailored to your body's metabolism of testosterone and may be working against you. He didn't get a psa - how can he monitor your prostate's response to exogenous testosterone and determine if an elevated number can be set aside or is an indication of cancer? Did he tell you your testicles are likely to shrink unless you add HCG to your protocol because what little natural production you were able to crank out is now shut down? Thyroid issues impact the success of TRT; you should have had a full workup. I could go on, but you get the picture.

These aren't "nice to have" tests, they are essential aspects of managing your health while on TRT. Where do you live? Would you consider changing physicians? You deserve better.

 

[Gene Devine]

What CoastWatecher said times 10!

Your "new" physician is not trained properly in how to evaluate the hypogonadal male and put together the proper protocol based on results.

The labs he ran would not even get close to doing an proper evaluation so how can you put together a therapeutic protocol.

Go to the forums and learn what labs you need to do the proper evaluation so you can learn:

https://www.excelmale.com/forum/showthread.php?6751-Blood-Tests-Pre-and-On-Testosterone-Replacement

You're not going to better without the proper medical evaluation and correct medical treatment...start looking for a well trained TRT Physician and get better.

 

[timzjp]

I live in the St Louis Missouri area.

 

[timzjp]

Please don't take this personally, but your doctor is a menace to your health. He failed to do an adequate pre-TRT workup. You don't know if you are dealing with primary or secondary hypogonadism. You aren't sure what your SHBG is, your protocol isn't tailored to your body's metabolism of testosterone and may be working against you. He didn't get a psa - how can he monitor your prostate's response to exogenous testosterone and determine if an elevated number can be set aside or is an indication of cancer? Did he tell you your testicles are likely to shrink unless you add HCG to your protocol because what little natural production you were able to crank out is now shut down? Thyroid issues impact the success of TRT; you should have had a full workup. I could go on, but you get the picture.

These aren't "nice to have" tests, they are essential aspects of managing your health while on TRT. Where do you live? Would you consider changing physicians? You deserve better.

I do apologize....
My Primary that put me on the Androgel did in fact do a PSA and thyroid test but NOT the SHBG, free testosterone, FSH etc. The thyroid and PSA were normal. However the NEW ENDO doctor only ran the Total testosterone, hema, estradiol. He suggested not using HCG as I asked why I shouldn't his reply was that your are done having kids.

Sorry for the lack of info on previous test

 

[Jackie Treehorn]

I do apologize....
My Primary that put me on the Androgel did in fact do a PSA and thyroid test but NOT the SHBG, free testosterone, FSH etc. The thyroid and PSA were normal. However the NEW ENDO doctor only ran the Total testosterone, hema, estradiol. He suggested not using HCG as I asked why I shouldn't his reply was that your are done having kids.

Sorry for the lack of info on previous test

You said that your thyroid and PSA were normal. Define normal. Post up what limited labs that you have so we can have a look. I'll bet your thyroid panel consisted of a TSH test, and that's it, right?

All kinds of red flags from your primary care physician, and your Endo as well. Totally inadequate bloodwork for a pre TRT analysis, and your Endo didn't do much better either. Neither of these medical professionals bothered to look at your LH, FSH, SHBG, and do you even know which estradiol test was drawn? Was it the regular test (meant for women only) or the sensitive estradiol test (meant for men)?

The comment by your Endo explaining why you shouldn't use HCG would be laughable, if it weren't so sad. His lack of TRT knowledge is frightening, and I would be running from his office.

Do yourself a huge favor, and call Defy Medical. They are professionals that know what the hell they are doing. You don't have to see them in person, but Dr. Saya and his crew will take good care of you. You'll learn more from one of his phone consultations than you can imagine.

You need help, and you aren't getting any from your current medical team. In fact, I would say they're hurting you. Do the smart thing, and call Defy. You won't regret it.

 

[timzjp]

I was able to log in to get results.
These are from the primary when he first put me on Androgel
All it says is TSH 1.5 uiu/ml
Range. .27-4.2

Psa .6 ng/ml
Range <4.0

Wow, I had no idea all of the testing needed. And to think going to an Endo for a better outcome is leading me down this path.
Thanks for all of the help!
Do you know if Defy accepts insurance?

 

[Gene Devine]

PCP's and most Endo's are not trained in hormone therapy in men...I've seen this for many years moderating these forums.

You need to do your work and find a physician who is either trained in TRT for men (and if you have done your due diligence you know what to ask) or most anti aging physician's are well trained in TRT as well.

You need to learn, there are a few books on the site you can download very inexpensively. Also the forums are loaded with everything you need to learn.

If you had some knowledge you would have known from the outset that neither of these physician's were going to be of much help...but in fact may even hurt you.

Learn!!!

 

[timzjp]

Thank you for the advise. I will look thru forum for lititure tonight.

 

[CoastWatcher]

I was able to log in to get results.
These are from the primary when he first put me on Androgel
All it says is TSH 1.5 uiu/ml
Range. .27-4.2

Psa .6 ng/ml
Range <4.0

Wow, I had no idea all of the testing needed. And to think going to an Endo for a better outcome is leading me down this path.
Thanks for all of the help!
Do you know if Defy accepts insurance?

You aren't the first, and sadly, won't be the last man to learn the hard way that most doctors simply don't have sufficient training in managing androgen issues in men. You must become your own advocate, not just in regard to your hormonal issues, but in all matters related to health. This forum can put a world of information in your hands. As Gene said, read and consider. You will be glad you invested the time.