Blood work on Tcyp 80mg every 5 days sq no ai no hcg after six pins in one months time

[T4 Life]

TT 685 250-1100 ng/dL
FT 126.0 35-155.0 pg/mL
SHBG 28 10-50 nmol/L
E2 Ultra sensitive 50 <29 pg/mL
Hematocrit 51.0 38.5-50%
Hemoglobin 16.7 13.2-17.1
TSH 4.86
T4 Free 0.9 0.8-1.8 ng/dL

I thought I had either low or high shbg because I'm having issues, low libido, loss of sensitivity, weak erections no spontaneous erections morning or night and it takes forever to ejaculate. I can't seem to figure out what is causing this maybe someone can identify something I can't in these test results and point me in the right direction, Thanks to you all.

 

[Vince Carter]

My suggestion is to try 85 or 90mg E3.5D. Your TT is nothing to write home about and 5 days is just a touch too far apart. That's the only thing I would do at this point, get your total and Free T out to the upper ranges. You didn't mention any high E2 symptoms like nipple or breast issues so I'll take that as a No. I have the same symptoms you mention, sexually.

You'r Thyroid though...your Dr talking to you about that? your TSH is pretty darn high and T4 very low. SHould have had a Free T3 in there as well. Others here are much better with thyroid issues than I am.

 

[ERO]

Having poor libido on TRT seems almost the norm rather than the exception. I have been on TRT for over 4 years and my libido was better when I had low T.

I agree that you should go to E3.5D and see how you feel.

 

[Vettester Chris]

A good portion of your issues are probably E2 related. You're 21 points over the max on the "US" reference range. Talk to your doctor about the steps needed to manage this. A little Arimidex could get this resolved ... And little meaning .25mg a couple times per week, maybe 3x, then run follow up E2 labs in 3 to 4 weeks.

Yeah, the thyroid needs further investigation. With what you've provided, we also need to see Free T3, Reverse T3, and antibodies (TgAb & TPO). Depending on what those labs say, additional labs might be warranted for cortisol, iron, ferritin, D3, mag, electrolytes, etc... I would take care of the additional thyroid labs sooner than later if it were me ...

 

[CoastWatcher]

My SHBG values are similar to yours. When I switched from weekly to every 3.5 days as my injection schedule I noticed significant improvement. All the best.

 

[T4 Life]

My endo does not allow for higher T levels he reduced my dose as soon as my total T got to 723 (250-827) the last time even though my free T was only 85.5 (46.0-224.0) he claims that he did it because my hematocrit came back at 52.1 (38.5-50.0).

As for thyroid he only checks TSH and Free T4 he insist I take synthriod I refuse because I want to try Armour or other NDT but he said he will not prescribe those or give me a reason why, so I'm stuck with him for now until I can find better. I will ask for the Free T3 and reverse T3 at my next appt. Have you guys had success relieving your symptoms on the 85 to 95 mg E3.5 days?

I'm going to keep trying the ai even though I wanted not to stay on this route but it seems like without it my E2 is always at 50 on the ultra sensitive.

 

[CoastWatcher]

My endo does not allow for higher T levels he reduced my dose as soon as my total T got to 723 (250-827) the last time even though my free T was only 85.5 (46.0-224.0) he claims that he did it because my hematocrit came back at 52.1 (38.5-50.0).

As for thyroid he only checks TSH and Free T4 he insist I take synthriod I refuse because I want to try Armour or other NDT but he said he will not prescribe those or give me a reason why, so I'm stuck with him for now until I can find better. I will ask for the Free T3 and reverse T3 at my next appt. Have you had success relieving your symptoms on the 85 to 95 mg E3.5 days?

You can draw your own blood tests, without a doctor's order. Consider having that done in regard to the thyroid tests referenced above, get some feedback from the Forum, and go to your next appointment with some sound discussion points. Many of us use Discountedlabs.com for this.

it was pointed out that your estradiol is high, on the sensitive test. Perhaps I missed it, but did your doctor comment on that?

 

[T4 Life]

You can draw your own blood tests, without a doctor's order. Consider having that done in regard to the thyroid tests referenced above, get some feedback from the Forum, and go to your next appointment with some sound discussion points. Many of us use Discountedlabs.com for this.

it was pointed out that your estradiol is high, on the sensitive test. Perhaps I missed it, but did your doctor comment on that?

I had to practically beg him for a script for ai he said he has 200 hundred patients on trt and none use it. I asked about HCG it was denied. Just as others I have difficulty in dosing the ai but I will keep at it to see if I can get better results.

My insurance covers my blood work quite well as I was surprised to find out all I need is a Dr.'s cooperation (I need one with gonads) but even that seems difficult and I can understand to a point because the insurance coverage varies so much from one to the other.

I'm going to ask for NDT again at my next appt. and see what happens. I can't however understand the link between ED and thyroid?

 

[CoastWatcher]

I can't however understand the link between ED and thyroid?

It's real. I can't possibly speak to it as Chris does, he's the moderator who really grasps the thyroid's role and how it can go off the rails.

http://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-1-issue-1/vol-1-issue-1-p-22/

Here's one link, however, that does address the issue. You can also check the sticky posts on the Forum - they have a wealth of information.

 

[vincentv]

Did you fix this? Thanks

 

[T4 Life]

Did you fix this? Thanks

No I have not.

 

[John O'Connor]

I'm new to forum, but seem to be seeing common mistakes. Patients/Doctors are treating symptom (low T) without first diagnosing the cause. You need to go off T completely and have all baselines tested to know if you are Primary or Secondary/Tertiary hypogonadal. Your LH & FSH will artificially be low while taking T, so going completely off T is necessary to diagnose correctly. And yes - you do have a thyroid issue, which should be treated first. Good news is you are catching the thyroid issue relatively early - many people don't realize thyroid is problematic until its much higher than 5.0 Also I would bet $100 that you have low vitamin D, which very recently has been linked to thyroid and other auto-immune diseases. Note - I know most of this because I also have Hashimoto's Thyroiditis - diagnosed in 2006 w/ TSH at 3.8. I was diagnosed w/ primary hypogonadism November, 2015 due to left testicular vericocele since age 18. Note left testicular vericocele is very common cause of primary hypogonadism. I take 50mcg levothyroxine which brings my TSH to 1.0 where it should be. Low T was undiagnosed until this past year. TT level was 204 in afternoon & 340 in morning, Free T was 48 (low). LH = 8.2 (1.7 - 8.6) & FSH 16.8 (1.5 - 12.4) both very high = primary hypogonadism. Just had vitamin D checked = 19 (range 30-100). Now doctor is prescribing high dose D3 and will recheck in 6 weeks. Goal should be to get vitamin D over 50 and above 65 would be even better. Let's get your issue fixed. Get Vitamin D checked, get treated for thyroid, go off T to get baseline numbers of FSH & LH. And when you go back on T - use lower dose. Right now you have gas pedal to the floor, but the parking break is on.

 

[T4 Life]

I'm new to forum, but seem to be seeing common mistakes. Patients/Doctors are treating symptom (low T) without first diagnosing the cause. You need to go off T completely and have all baselines tested to know if you are Primary or Secondary/Tertiary hypogonadal. Your LH & FSH will artificially be low while taking T, so going completely off T is necessary to diagnose correctly. And yes - you do have a thyroid issue, which should be treated first. Good news is you are catching the thyroid issue relatively early - many people don't realize thyroid is problematic until its much higher than 5.0 Also I would bet $100 that you have low vitamin D, which very recently has been linked to thyroid and other auto-immune diseases. Note - I know most of this because I also have Hashimoto's Thyroiditis - diagnosed in 2006 w/ TSH at 3.8. I was diagnosed w/ primary hypogonadism November, 2015 due to left testicular vericocele since age 18. Note left testicular vericocele is very common cause of primary hypogonadism. I take 50mcg levothyroxine which brings my TSH to 1.0 where it should be. Low T was undiagnosed until this past year. TT level was 204 in afternoon & 340 in morning, Free T was 48 (low). LH = 8.2 (1.7 - 8.6) & FSH 16.8 (1.5 - 12.4) both very high = primary hypogonadism. Just had vitamin D checked = 19 (range 30-100). Now doctor is prescribing high dose D3 and will recheck in 6 weeks. Goal should be to get vitamin D over 50 and above 65 would be even better. Let's get your issue fixed. Get Vitamin D checked, get treated for thyroid, go off T to get baseline numbers of FSH & LH. And when you go back on T - use lower dose. Right now you have gas pedal to the floor, but the parking break is on.

Thank you for your input you seem to know more about my condition than my endocrinologist and I very much like your suggestions It's been 29 days since my last T shot and have been on hcg only for the past 24 days which has been sustaining me to some extent because as soon as I stop taking it a few days later I feel awful and go right back on again I just got blood drawn For TT and FT on my own this past thursday and I'm waiting on the results. I do take Vit D daily 5000iu which when last tested put me at 48 maybe I should increase to 10,000iu daily and retest. I just need to find out how long do I have to go cold turkey in order to get a good baseline and like you said start treating the thyroid first which is what my doctor should have done before putting me on T.

 

[John O'Connor]

It's good to hear you are taking Vitamin D & have your levels up to 48, but yes try to get those levels to 65 or higher if possible. I missed the fact that your doctor wanted to put you on Synthroid. That is standard protocol and should work. I'm guessing he will either start you on 25mcg or 50mcg. The TSH goal should be 1.0. Also once on synthroid/levothyroxine take each morning on empty stomach & don't eat for 1 hour to maximize absorption. Don't take multivitamin, orange juice or milk with it as the calcium can block absorption. Also - once on synthroid/levothyroxine - do not take it the morning you get TSH rechecked, as that can cause an artificially low TSH reading. It has a 6-7 day half life, so missing a day occasionally will not be an issue. As for how long you need to get off T & hcg to get your natural LH & FSH levels checked. I'm guessing 3-4 weeks will be enough, especially since you have not taken T in the last 29 days. So start taking synthroid (or levothyroxine). Get off hcg and then have LH & FSH checked. I'm assuming when you were originally diagnosed - these were not checked. Correct?

 

[T4 Life]

It's good to hear you are taking Vitamin D & have your levels up to 48, but yes try to get those levels to 65 or higher if possible. I missed the fact that your doctor wanted to put you on Synthroid. That is standard protocol and should work. I'm guessing he will either start you on 25mcg or 50mcg. The TSH goal should be 1.0. Also once on synthroid/levothyroxine take each morning on empty stomach & don't eat for 1 hour to maximize absorption. Don't take multivitamin, orange juice or milk with it as the calcium can block absorption. Also - once on synthroid/levothyroxine - do not take it the morning you get TSH rechecked, as that can cause an artificially low TSH reading. It has a 6-7 day half life, so missing a day occasionally will not be an issue. As for how long you need to get off T & hcg to get your natural LH & FSH levels checked. I'm guessing 3-4 weeks will be enough, especially since you have not taken T in the last 29 days. So start taking synthroid (or levothyroxine). Get off hcg and then have LH & FSH checked. I'm assuming when you were originally diagnosed - these were not checked. Correct?

My Endo checked my LH & FSH once in two years and they came back at FSH <0.7 and LH at <0.2 and was unnecessary I was already suppressed because he knew I had been prescribed T by my GP (which he never checked my FSH & LH) before putting me on T. He then discharged me as a patient after I pleaded for some arimidex to bring down my E2 which was at 54 the first time I asked him to checked it.

 

[ERO]

Getting a consult with Defy Medical would be a good idea even if you stay with your current provider.

 

[John O'Connor]

I'd like to say that is medical malpractice - but unfortunately the TRT clinical guidelines give these doctors no clue of how to treat hypogonadism. My doctor is a Family Medicine - 2nd year resident. I'm his 1st ever TRT patient. He and I are learning together (mostly me teaching him), but at least he is trying. I will give him huge credit for testing my LH & FSH along with my TT and therefore accurately diagnosing me with primary hypogonadism. He has also been good about checking PSA, Liver panel, CBC w/Hemoglobin & Hematocrit. But he missed some key tests too (free T, SHBG, DHEA-S, & Vitamin D). Luckily he is now open to checking these. We already ran the Vit D and I'm now taking D3 50k IU per week. As I've become more educated and explained the importance to him - he is cooperating with me. I'm only now in my 4th month on TRT and its nice to be getting necessary questions answered. I'm sure many guys go years on TRT without proper management.

 

[John O'Connor]

Check out this YouTube video on differentiating primary/secondary/tertiary hypogonadism. This guy "BigNoKnow" is basically documenting his last 4 years on TRT. Unfortunately when he was originally diagnosed they did not figure out if he was primary or secondary. His new doctor, Erica Zelfand, is now helping him figure that out.

 

[John O'Connor]

Sorry here is the link: https://www.youtube.com/watch?v=fUitMlwMlkw 3 Types of HYPOGONADISM (Low Testosterone) TRT | feat. Dr. Erica Zelfand

 

[T4 Life]

Sorry here is the link: https://www.youtube.com/watch?v=fUitMlwMlkw 3 Types of HYPOGONADISM (Low Testosterone) TRT | feat. Dr. Erica Zelfand

Thanks for the link I found the information helpful as I had never heard of tertiary hypogonadism only primary and secondary. You have a progressive doctor that's very important in fact I believe that is the most important link to good health and successful medical treatment.