7 weeks in, minimal improvement in total T, high estradiol

[Amaes]

I was diagnosed with low T at the end of August, after specifically asking for a testosterone test due to decreasing libido over the past few years and stubborn weight gain. I have a family history of type 2 diabetes and hypothyroidism. Results as of August 31 were:

Weight: 202
TSH: 3.17
eGFR: 76
HBa1c: 5.6
Total test: 246ng/dL

Doc started me on 100mg testosterone cyprionate intramuscular 1x per week for 4 weeks, then 100mg every 2 weeks. For the first couple weeks I had significant increases in hunger, and gained about 10 pounds in the first 4 weeks. My workouts improved somewhat, my mood improved somewhat, and I was sleeping less without significant fatigue.

After the 4th injection, I waited 2 weeks, and went back in for more bloodwork - my weight gain was significant and not dropping off even though I was watching what I ate, my libido hadn't improved, focus and mood were slipping again. After some Google work and finding this site, I asked for sensitive Estradiol as well as free/total T and T3, given my elevated TSH over 3.0. Results from 19 October:

Weight: 209
Total Test: 282ng/dL
Free Test: 72.2pg/mL
Estradiol: 63
T3, total: 81ng/dL

My total T3 looks awfully low, and my E2 very high given that it had been 15 days since my last injection of 100mg. My doc isn't particularly aggressive with treatments, didn't consider my TSH high, and hadn't even considered testing for E2. I'm thinking about looking for another doc to handle my metabolic / hormonal problems and get more thorough testing done.

Where should I go from here?

 

[johndoesmith]

I honestly don't know where to even begin here. I will try. I am making a list of thoughts and questions. Please answer them, it will help not only me but the rest of the site to help you.

Questions:
1. Reference ranges are STRONGLY needed. Please post them.
2. Are those all the tests your doctor ordered? eGFR without a CMP is really really strange. Post all the labs you have, with reference ranges.
3. You listed weight, but no height, post your height and age.
4. Why did you wait 2 weeks after E7D injections to get tested?
5. What were your symptoms before TRT?

Your doctor is treating you poorly, almost to the point of harm. 100mg E14D is absolutely ridiculous, even E14D protocols alone are ridiculous, but this is an insane variation of E14D protocols. I'd highly highly recommend you get another doctor who is experienced with TRT. There also is not sufficient testing to start TRT, determine diagnosis, or establish a baseline of labs pre TRT. You should have way more than what he ordered.

You also have some questionable lab values, borderline high A1C, high TSH, and low eGFR. Reference ranges would help figure out exactly how bad these are.

If that is a sensitive E2, then that is absolutely sky high, especially relative to where total test is.

 

[Vince Carter]

I honestly don't know where to even begin here. I will try. I am making a list of thoughts and questions. Please answer them, it will help not only me but the rest of the site to help you.

Questions:
1. Reference ranges are STRONGLY needed. Please post them.
2. Are those all the tests your doctor ordered? eGFR without a CMP is really really strange. Post all the labs you have, with reference ranges.
3. You listed weight, but no height, post your height and age.
4. Why did you wait 2 weeks after E7D injections to get tested?
5. What were your symptoms before TRT?

Your doctor is treating you poorly, almost to the point of harm. 100mg E14D is absolutely ridiculous, even E14D protocols alone are ridiculous, but this is an insane variation of E14D protocols. I'd highly highly recommend you get another doctor who is experienced with TRT. There also is not sufficient testing to start TRT, determine diagnosis, or establish a baseline of labs pre TRT. You should have way more than what he ordered.

You also have some questionable lab values, borderline high A1C, high TSH, and low eGFR. Reference ranges would help figure out exactly how bad these are.

If that is a sensitive E2, then that is absolutely sky high, especially relative to where total test is.

There may not be much to go on with this Dr though he may be willing to learn it's just wrong, all wrong.

 

[Amaes]

Apologies, posted the basic test results and didn't think to include all of the usual tests mentioned here on ExcelMale. I asked for T to be tested as part of my normal annual checkup due to difficulty losing weight, being hella out of shape, and significant decline in libido over the past year or so. Height is 5'8". Initial protocol was 100mg E7D for four weeks, followed by 100mg E14D - so I completed the initial 4 week cycle then went in to update my test results before starting E14D to see where I was at in the trough.

Edit: 41 years old, no prior fertility issues (3 sons plus a couple other failed pregnancies in the past; vasectomy 7 years ago). Initial test results from 31 August (CBC, HLVC, CS, UA, TSH, Total Testosterone):

Testosterone,Total,Male,Adult,IA (ng/dL) 246 250-827
WHITE BLOOD CELL COUNT (Thousand/uL) 8.9 3.8-10.8
RED BLOOD CELL COUNT (Million/uL) 4.68 4.20-5.80
HEMOGLOBIN (g/dL) 14.9 13.2-17.1
HEMATOCRIT (%) 45.1 38.5-50.0
MCV (fL) 96 80-100
MCH (pg) 31.9 27-33
MCHC (g/dL) 33.1 32-36
PLATELET COUNT (Thousand/uL) 230 140-400
RDW (%) 13.6 11.0-15.0
MPV (fL) 8.6 7.5-11.5
ABSOLUTE NEUTROPHILS (cells/uL) 5767 1500-7800
ABSOLUTE LYMPHOCYTES (cells/uL) 2367 850-3900
ABSOLUTE MONOCYTES (cells/uL) 641 200-950
ABSOLUTE EOSINOPHILS (cells/uL) 98 15-500
ABSOLUTE BASOPHILS (cells/uL) 27 0-200
NEUTROPHILS (%) 64.8
LYMPHOCYTES (%) 26.6
REACTIVE LYMPHOCYTES (%) 0.0
MONOCYTES (%) 7.2
EOSINOPHILS (%) 1.1
BASOPHILS (%) 0.3
SPECIFIC GRAVITY 1.029 1.001-1.035
PH 5.5 5.0-8.0
PROTEIN NEG. NEG.
GLUCOSE NEG. NEG.
KETONES NEG. NEG.
BILIRUBIN NEG. NEG.
OCCULT BLOOD NEG. NEG.
LEUKOCYTE ESTERASE TRACE NEG.
NITRITE NEG. NEG.
WBC (/HPF) 0-5 0-5
RBC NONE SEEN 0-2
SQUAMOUS EPITHELIAL CELLS NONE SEEN 0-5
HYALINE CASTS NONE SEEN NONE SEEN
BACTERIA NONE SEEN NONE SEEN
SODIUM (mmol/L) 140 135-146
POTASSIUM (mmol/L) 4.3 3.5-5.3
CHLORIDE (mmol/L) 104 98-110
CARBON DIOXIDE (mmol/L) 26 20-31
GLUCOSE (MG/DL) 92 65-99
UREA NITROGEN (MG/DL) 13 7-25
CREATININE (mg/dL) 1.19 0.60-1.35
BUN/CREATININE RATIO N/A 6-22
CALCIUM (MG/DL) 9.1 8.6-10.3
PHOSPHATE (MG/DL) 3.7 2.5-4.5
URIC ACID (MG/DL) 6.5 4.0-8.0
PROTEIN, TOTAL (G/DL) 6.9 6.1-8.1
ALBUMIN (G/DL) 4.2 3.6-5.1
GLOBULIN, CALCULATED (G/DL) 2.7 1.9-3.7
A/G RATIO 1.6 1.0-2.5
BILIRUBIN, TOTAL (MG/DL) 0.6 0.2-1.2
BILIRUBIN, DIRECT (MG/DL) 0.1 0.0-0.2
AST (U/L) 15 10-40
ALT (U/L) 24 9-46
LDH (U/L) 157 100-220
ALKALINE PHOSPHATASE (U/L) 60 40-115
GGT (U/L) 25 3-95
IRON (mcg/dL) 91 50-180
CHOLESTEROL (mg/dL) 185 125-200
TRIGLYCERIDES (mg/dL) 123 <150
HDL CHOLESTEROL (mg/dL) 47 > or = 40
LDL CHOLESTEROL, CALCULATED (mg/dL) 113 <130
VLDL CHOLESTEROL,CALCULATED (MG/DL) 25 <30
TSH (mIU/L) 3.17 0.40-4.50
NON-AFRICAN AMERICAN eGFR (mL/min/1.73m2) 76 > OR = 60
AFRICAN AMERICAN eGFR (mL/min/1.73m2) 88 > OR = 60

Tests on 19 October (specifically asked for total/free test, T3, and sensitive estradiol):

Testosterone,Total,LCMSMS (ng/dL) 282 250-1100
Testosterone, Free (pg/mL) 72.2 35.0-155.0
T3, TOTAL (ng/dL) 81 76-181
ESTRADIOL (pg/mL) 63 < or = 39

Based on what you said (and my results to date), I'm pretty sure you're right about needing a new doctor. I'll probably look into getting the Defy Medical recommended initial panels done this week, and see what those look like.

 

[johndoesmith]

There may not be much to go on with this Dr though he may be willing to learn it's just wrong, all wrong.

Do you mean the doctor, or what I said? Maybe I am being dense, but I find your sentence a bit vague lol.

 

[Re-Ride]

...
After the 4th injection, I waited 2 weeks, and went back in for more bloodwork .... focus and mood were slipping again...

Was it the physicians idea to wait an extra week beyond what should have been the low trough on this inadequate protocol?
You do understand, that in the future, you will test just before your next shot is due?

 

[Amaes]

Was it the physicians idea to wait an extra week beyond what should have been the low trough on this inadequate protocol?
You do understand, that in the future, you will test just before your next shot is due?

Correct - the doc's instructions were to take 100mg/week for four weeks, then wait 2 weeks before the next dose of 100mg. I went in for bloodwork in the morning on the start of week 6, took 100mg dose #5 that evening.

I'm assuming she was wanting to build a base of testosterone and then level it off, but she's a GP rather than an endocrine specialist, so I'm not at all certain that she's aware of proper TRT protocols.

 

[CoastWatcher]

Correct - the doc's instructions were to take 100mg/week for four weeks, then wait 2 weeks before the next dose of 100mg. I went in for bloodwork in the morning on the start of week 6, took 100mg dose #5 that evening.

I'm assuming she was wanting to build a base of testosterone and then level it off, but she's a GP rather than an endocrine specialist, so I'm not at all certain that she's aware of proper TRT protocols.

She has a medical license, but when it comes to andrology she's an idiot. Exogenous testosterone doesn't level off following an injection. It peaks and is eliminated. Simple as that. It is for that reason that most men find success on smaller, frequent injections (every 3.5 days, every other day, or - in the case of a few of us - every day). Putting yourself under her care for this issue will not lead to improved health. And no, despite what some believe, it isn't a case of gender bias. My own TRT provider is a woman and I couldn't be happier.

Take some time and invest it in finding a capable practitioner. This site is sponsored by Defy Medical and Prime Body, both national practices (with different models). Take some more time and read the material here on the Forum - you have to be your own advocate...as we've all learned.

 

[Jackie Treehorn]

I'm assuming she was wanting to build a base of testosterone and then level it off, but she's a GP rather than an endocrine specialist, so I'm not at all certain that she's aware of proper TRT protocols.

Build a base of Testosterone? Good God, you need to get educated on TRT, and you need to fire your doctor. She's clueless, and is doing you more harm than good. You're never going to feel good on that ridiculous protocol she has you on now. Do something smart now, and call Defy.