Blood tests after 6 weeks of TRT.

[jjno]

This is gonna be a long post so please bear with me guys. This is my 4th round of TRT but this time I'm going through my physician. Due to insurance changes and deductibles I decided to go to my regular physician instead of a clinic. Anyway, prior to seeing my physician I had to take a break from TRT as the previous clinic had not been tracking my hematocrit levels and they got high enough that I was the one who noticed something was really off when I started getting winded with minimal exertion. When I brought it to their attention they checked my hematocrit levels and they were extremely high to the point that I had to donate blood three times within a two week period to bring them back down. It was this carelessness on their part that forced me to re-think going back to the clinic as well. When I approached my doctor about testosterone he was opened to the idea and he put me on a regimen of 200mg/wk of testosterone plus 500units(.5ml) of Pregnyl. He also prescribed Anastrazole every other day at 1mg dosage. Anyway, before I filled the prescription I wanted to make sure my heart was ok not knowing whether it was a temporary condition created by my elevated hematocrit levels or some other underlying issue. Needless to say everything checked out so I'm chalking it up to the hematocrit. Fast forward to this past July when I decided to get back on the TRT prescribed by my doctor back in January. The first couple of weeks I did the full 200mg injection as well as the Pregnyl injection on the same day. After reading some of the comments I've been doing twice weekly test injections at .5ml on Mondays and Thursday with the full Pregnyl injection on Monday. As far as the Anastrazole is concerned I haven't been as diligent with that dosage as the previous clinic did not have me on it. I'm going in for bloodwork this coming Thursday and I'm interested in what tests I should ask the doctor to perform besides the standard SHBG, etc. I've read some of the posts here concerning "morning wood" and sexual desire but those concerns really don't register with me. My reasons for taking testosterone are strictly for personal well being and having the energy to work out. I figure if I look good then I feel good and that's all that matters. So far I feel good and my workouts have been pretty good so I've got no complaints. As far as feeling like Superman I wouldn't even know how that might feel as I am the type of guy that downplays my own feelings. I guess you could say that I'm borderline pessimistic but truth be told I have been treated for depression and anxiety in the past. BTW I am 51 yo. Again, I apologize for the long post but I figure if I'm gonna be on testosterone it's probably gonna be up to me to manage my levels and dosage. As a reference my testosterone levels usually run high 100's to low 200's when off the therapy. Thanks!

 

[Systemlord]

You shouldn't be trying to teach doctors how to treat you, why don't you seek someone who knows what their doing? We can provide references to doctors who do TRT daily and are good at it. I wouldn't start the horrendous protocol, it will end in you quitting again! Another thing, 1mg anastrozole EOD, that's insane and you will just crash your estrogen!

What good are these tests if your doctor doesn't know how to interpret them?

Total T
Free T
SHBG
Estradiol Sensitive (E2)
LH-Luteneizing Hormone
FSH-Folicle stimulating hormone
Prolactin
Cortisol
Ferritin
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel

 

[jjno]

That's why I figured I'd post here first. There's a fine line between wanting/needing to go to my physician knowing that he doesn't have the knowledge nor the time necessary to deal with "mundane" issues such as lack of energy when he's having to deal with patients with diabetes, alzheimers, etc. Also, I went from a $35 co-pay every 10 days when I was still going to the testosterone clinic to $211 my first visit on my new insurance plan.

 

[jjno]

I actually felt lucky my doctor is young enough that he didn't quickly dismiss the idea of testosterone therapy as it's been my experience so far that most regular physicians don't want to even consider it.

 

[Systemlord]

I actually felt lucky my doctor is young enough that he didn't quickly dismiss the idea of testosterone therapy as it's been my experience so far that most regular physicians don't want to even consider it.

That's a rare find if he is willing to learn, the majority of the time doctors are guided by fear and are quick to dismiss concerns because they want nothing to do with TRT. SHBG needs to be run before you attempt another protocol, it just might save you from misery.

 

[Vince Carter]

Concur with everything from my friend SystemLord

 

[jjno]

Here are the latest results from my recent bloodwork. My doctor called and told me to get back on the Anastrazole and take it every other day. Any suggestions will help. Just a refresher: I am taking testosterone injections twice a week Mondays and Thursdays (200mg/week). I am also taking .5ml of Pregnyl on Monday as well. I was not taking the Anastrazole as prescribed (maybe followed the every other day regimen the first week and then maybe once or twice a week after that) as the previous clinic did not have me on it. I'm actually very surprised at how high my Total T is as I never got higher than 900 when visiting the T clinic. I feel ok and my workouts have been decent. The biggest change I've noticed has been weight gain but I don't believe it's all muscle. I attribute it more to eating and drinking but most of the weight is in my gut area.

 

[MarkM]

Well, you surely have supra-physiological testosterone levels for sure. Total T almost 1,800 , almost twice the upper limit of the range and the Free T is about 2 1/2 times the upper limit. Your Estradiol test was the wrong one. You were tested using the Roche ECLIA methodology which is the test for women. You should have the Estradiol Sensitive LC/MS/MS assay instead which is more accurate for men because it is more "sensitive". So your 64.9 non-sensitive estradiol is likely a lot lower on the sensitive test.

Your SHBG of 23.2 is low for the range, 19.3 - 76.4. You would probably be better served injecting EOD with an SHBG that low, maybe every day. You probably have very high Free Estradiol as well.

How do you feel with testosterone levels that high?

 

[jjno]

I feel alright but i can’t say I feel leaps and bounds differently then before I started the injections. Libido has changed some towards the positive side but like I stated before that wasn’t a concern of mine to begin with. No morning “wood” or anything of that sort. I’m actually apprehensive about my total T being that high.

 

[MarkM]

I am surprised your hemoglobin and hematocrit are as low as they are with such a large dose of testosterone. Watch that diet, your Glucose was a little high.

 

[jjno]

Sorry for the stupid question but which tests reflect the hemoglobin and hematocrit levels? I’m used to seeing “hematocrit”.

 

[MarkM]

It is on your labs you posted. It is part of the CBC portion of your lab work. It will say "Hemoglobin" and "Hematocrit". Double check, it's there.

 

[jjno]

Should I be concerned about my test being that high. Should I cut back to only one .5ml injection per week?

 

[MarkM]

I think you should cut you dose back quite a bit. You could probably cut it back to 100 mg per week and have great testosterone levels. With a low SHBG more frequent injections, multiple injections per week would help you. That would help bring down your Estradiol too but you still need to get the right estradiol test, Estradiol Sensitive, LC/MS/MS assay.

You should consider 30 mg EOD.

 

[jjno]

Thanks.