Concerned - DHT Spikes

[Dinosan]

Hello fellas,
My Doctor just put me in a TRT protocol consisting of Testosterone cream (applied to the scrotum), vitamin D, Melatonin and DHEA. The compounded pharm is MedQuest. I should receive the medications sometime next week and will be able to post the exact doses and concentrations then. I am concern in regards to DHT spikes or over conversion of T to DHT while applying the cream to the scrotum. No blood work has been done to determine the levels of total and free test (although a year ago total-T was tested at 567 nq/dl), and the Doctor has indicate will start TRT based on empirical data and symptoms. After 30 days I will then get blood work done which will test for; T-total, T-free, DHEA/s, IGFI, T3, estradiol, insulin, LH, cortisol, SHBG, prolactin and HGH.
Should I ask the Doc to include DHT levels with this blood work or should I let him do it's job. He seems to be covering all the Bases, and then, I am a novice.

 

[CoastWatcher]

You may consider yourself to be a novice, but you are right to be concerned about your health. One thing that all of us need to realize is that we must be our own advocates. A good doctor, who understands current TRT protocols, is essential, but we all need to be in charge of our health care.

To start a new protocol, or make a change in an existing one, in the absence of blood work is foolish. That seems to be what your doctor is doing. I don't understand how the two of you will monitor progress in the absence of objective values. DHT and a PSA level should be captured at this point. If he won't measure them turn to www.discountedlabs.com and pull them yourself.

The same applies to the absence of total and free testosterone numbers...you are starting a protocol without knowledge of where you currently stand??? What in the world does he mean by "empirical data" in the absence of lab tests?

Your raising questions is on point. A question you didn't raise, but I will, is whether this doctor is really on top of things.

 

[Vince Carter]

Using a cream on the nuts is a little unorthodox as the primary delivery route for T and I would absolute go for DHT and PSA.

 

[Dinosan]

My PSA level was captured along with a battery of blood tests and other cardiovascular tests since I am open heart patient. I have asked the doctor for a DHT test. I am waiting for the medication to arrive sometime this week. I will then sit with the doctor to make sure I the procedures clear. In the meantime I will continue to read and learn as much as I can about TRT.
BTW, all the tests, including the cardio screenings results were normal.

 

[CoastWatcher]

I'm glad to know your cardiovascular test results were solid. But your post about initiating TRT in the absence of total and free testosterone levels is puzzling. What "empirical data" is he using to design and track your protocol?

 

[Dinosan]

Quite frankly I am inclining to guess he is working by experience and my symptoms as a starting point. I have been dealing with low test symptoms for approximately two years. Even though the total T test I mentioned before seemed to be all right for my age according to my previous doctor, the symptoms and signs were also quite notable. When I change doctors I had been dealing with low hemoglobin and hematocrit for almost two years. I am not in the business of criticizing a professional but the truth is blood works indicating problems with anemia were just been piling up in my medical record, no cause or treatment provided. Thus the reason I change doctors. This doctor took care of my problem right away, send me for a load of diagnostics tests and started treating my anemia which, as of today has been cleared. I tend to trust his judgement for now. I am guessing he will start me on a low dose and adjust after the first blood work (the goal is for 1100 ng/dl Tot-T or close to that mark). Again, I have to read the med label first and sit with him if the initial dosage makes me uncomfortable.

 

[CoastWatcher]

I certainly wish you the best as you work to treat the hypogonadism you're dealing with. I will only add this - don't hesitate to second-guess a professional. Learn as much as you can about the diagnosis and treatment of the issues you're dealing with, and insist that your questions and concerns be answered to your satisfaction. Managing an androgen deficiency is a lab and symptom-based process - far too many of us spent far too much time working with doctors who were out of their depth. Good luck.

 

[Vince]

If your serious about starting TRT, you need to learn all you can about it, so you can be a well-informed patient and take an active role in your care.

 

[Weasel]

No way I would start TRT without knowing actual FreeT and TT numbers. Get those tested as well, if nothing else, for a good baseline.

 

[davidrn]

If your serious about starting TRT, you need to learn all you can about it, so you can be a well-informed patient and take an active role in your care.

Last year my Urologist (Dr Alexander Berry, Massachusetts) said to me that he believed medicine wasn't being controlled any longer by drug companies/reps and MD inservices, but by patients knowing answers to questions,that they ask the MD. Basically he said, the internet is what is driving the future of medicine.

 

[Vince]

Last year my Urologist (Dr Alexander Berry, Massachusetts) said to me that he believed medicine wasn't being controlled any longer by drug companies/reps and MD inservices, but by patients knowing answers to questions,that they ask the MD. Basically he said, the internet is what is driving the future of medicine.

Like Doctors, patients can also be wrong. You must weigh all your options, someone like Nelson, who's been on trt for many years. Had many struggling and definitely can help. It's easy for a for a doctor if you say "you're the doctor I'll trust you" but a well informed patient will make him earn his paycheck.

 

[Dinosan]

Yes, thanks a lot for all your suggestions. My intention is to learn as much as I can and become an active participant in regards to my therapy. As soon as I get my next lab results I will start a thread and post them and will also start some type of log where I'll post all I can in reference to my experience, hoping to receive as much input from you all. I think is a good way to increase knowledge. I will also start to review studies related to TRT starting with the many suggested in this forum. Appreciate very much all your views and counsel. Will also appreciate any ideas or direction in terms of posting lab reports. Again as soon as I get my Rxs I will list medication Id and dosages.