DAY ONE - The Start - What Initial Tests To Get Done?

[jacb]

I have read with interest the recommended Blood Tests prior to starting TRT; "Discounted labs Pre-TRT Male Hormone Wellness Panel" .... but am I not correct in saying that the panel was designed for a Dr so that he/she could identify the best/safest TRT treatment plan?
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At the moment I haven't proved that I have hypogonadism (even if I think I know the answer in my mind) .... I would have thought that just "Total and Free Testosterone (LC/MS assay)" would be all that is currently required to prove my current status?
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The reason that this makes such a difference to me, is because the full set of tests is so expensive where I live, that it would make more sense to fly to the USA and have the tests done there prior to starting any TRT.
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Thoughts please.

 

[Vince]

We have a member form New Zealand that may be able to help you, I would PM him.

https://www.excelmale.com/member.php?17757-glenn

 

[jacb]

We have a member form New Zealand that may be able to help you, I would PM him. Member: glenn

Thanks Vince .... Good plan once I have 15 points and the system lets me PM. "Note: Until your post count is 15 you will be able to send PMs to Staff only".
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Glenn if you happen to see this perhaps you would care to make contact. I would like to ask you about your TRT Experience in NZ etc.

 

[Vince]

Thanks Vince .... Good plan once I have 15 points and the system lets me PM. "Note: Until your post count is 15 you will be able to send PMs to Staff only".
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Glenn if you happen to see this perhaps you would care to make contact. I would like to ask you about your TRT Experience in NZ etc.

I've should have known that, thanks for letting me know. Hopefully you'll get your 15-point soon.

 

[jacb]

I note that "www defylowt" has a "Get Tested" Page that seems to imply that their first blood test will measure your total and free Testosterone level. If ones levels are indeed low further testing is required .... but this would seem to confirm that this is all that is needed as the first step.

 

[jacb]

I've should have known that, thanks for letting me know. Hopefully you'll get your 15-point soon.

Thanks again Vince
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Made a few posts and got past the 15 point issue only to find "glenn has chosen not to receive private messages or may not be allowed to receive private messages. Therefore you may not send your message to him/her".
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I found that by default the PM option is turned off in the account settings and I dare say that glenn hasn't even seen it. Hopefully he will see my message above reply and/or change the PM setting.

 

[Vettester Chris]

jacb, thanks for joining, welcome to EM!

If you were to get a GREEN light on all the labs, below is IMO most of what you need. There could be a few others, but this would cover most of it. The only one I didn't run at the get go was the 4x Saliva Cortisol kit, but I did run it a few years thereafter (and glad I did, AM deficiency and suboptimal DHEA correlation was a factor)

Going into it, you definitely want to know how your LH/FSH looks compared to total test serum, along with PSA, SHBG and/or free/bio test, plus all the thyroid. If an area like your thyroid is lagging, then seeing optimal results with TRT is going to be somewhat problematic. And since hypothyroidism and hypogonadism can be correlated, it's essential to see the complete picture.

Total Testosterone Serum
Free & Bio Testosterone
LH
FSH
SHBG
Estradiol (E2) Sensitive
Prolactin
DHT
Cortisol (4x Saliva Panel) ...
... ACTH (not always needed, but it will portrait the feedback loop productivity with the adrenals, and help if certain diseases are in question i.e., Addison's, Cushing's,)
DHEA
Thyroid Panel ...
... -TSH, Free T4, Free T3, Reverse T3, Thyroid Antibodies (TPO and TgAb)
Iron & TIBC (or UIBC can be calculated for total)
Ferritin
CBC w/Diff
Comprehensive Metabolic Panel
Lipid Panel
PSA
IGF-1
Vitamin D3 (essential hormone that so many are deficient with)
Vitamin B12

 

[OMI100]

Chris knows what he is talking about.
Here is my Mantra....
A LOT of info to digest...
I would recommend getting the books and do some reading on the subject....
I would also download DR. John's paper and powerpoint presentation.
Other link cover a LOT of ground to include thyroid.
Remember... Education is your friend...
********************************
First step is education....
********************************
Cannot tell how much research you have done on TRT.
If not a lot, I recommend you get a few books.
Get a few good books and educate yourself now:
1. Get Nelsons book "Testosterone: A Man's Guide".
2. Get Lee Myer's book "Natural Versus Testosterone Therapy".
3. Get “Testosterone for life - Dr. Abraham Morgentaller “.
4. Get “The Definitive Testosterone Replacement Therapy MANual: How to OptimizeYour Testosterone For Lifelong Health And Happiness” by Jay Campbell.
These books will give you a much better understanding of TRT....
********************************
ExcelMale.comGuide to Testosterone Replacement
https://www.excelmale.com/forum/showthread.php?5823-ExcelMale-com-Guide-to-Testosterone-Replacement
**********************************
One other forumthat has great info that might be useful to you is:
http://www.peaktestosterone.com/
GREAT article onE2 – A MUST READ
http://www.peaktestosterone.com/Hdr_Estrogen.aspx
********************************
Dr Saya's Videos on Testosterone Therapy and Side Effect Management
https://www.excelmale.com/forum/showthread.php?15207-Dr-Saya-s-Videos-on-Testosterone-Therapy-and-Side-Effect-Management
*********************************
DR.Saya's HCG Study
https://www.excelmale.com/forum/showthread.php?6133&p=32234#post32234
**********************************
Second step might be to have a look at your thyroid and see if any issues there.
********************************
Do some research.
I do like Tiredthyroid as a starting point.
Easy to read sections.
References at the bottom of each section (and NOT from people wearing "tinfoil" hats)
See below:
Basic sources to research Thyroid issues and testing:
******************************************
https://stopthethyroidmadness.com/
Spend time here and get the 2 books, “STTM: The Revised Book” and “STTMII:Authored by Doctors”.
*******************************************
http://www.tiredthyroid.com/
Great simple to understand articles.
Get her book.... “Tired Thyroid: From Hyper to Hypo to Healing—Breaking the TSHRule”, https://read.amazon.com/kp/embed?asi...Channel=system
A lot of clear researched information that is easy toread and understand.
***************************
https://hypothyroidmom.com/
Good info here. Look around.
*************************
https://www.restartmed.com/?s=thyroid
A LOT of good articles and a youtube page.
Spend time here looking around and reading after getting labs back.
************************************
Do you have Hypothyroidism?
The CompleteHypothyroidism User Guide for Patients (2018 Edition)
https://www.restartmed.com/hypothyroidism/
*********************************
Need information on thyroid testing....
Read here:
http://www.tiredthyroid.com/what-labs.html
And here:
http://www.tiredthyroid.com/optimal-labs.html
and here:
https://stopthethyroidmadness.com/recommended-labwork/
and here:
https://www.restartmed.com/thyroid-tests/
and here:
https://www.restartmed.com/hormone-testing/
And here:
https://www.restartmed.com/normal-thyroid-levels/
**************************************
Some additional links to read before you receive the books you have already ordered
Go here:
http://www.allthingsmale.com/publications.html
and download:
TRT: Recipe For Success
Print out.
and
HCG Update.
and the TRT Power Point presentation.

Dr. Crisler is one of the "TRT Cutting Edge DR's" here in the states....
Also go here:
http://www.drjohncrisler.com/the-cri...part-deux.html
and also print out the article.
***************************
ALSO look at the videos that are posted on this site. A LOT of great info to take in....
******************************
Now you will have a great reference library and knowledge base to go forward on!

 

[jacb]

Thank you all for your very informative reply's. I have read them with great interest - However we may in danger of putting the "Cart before the Horse". As I stated at the outset:

At the moment I haven't proved that I have hypogonadism (even if I think I know the answer in my mind's eye) .... I would have thought that just "Total and Free Testosterone would be all that is currently required to prove my current status?
.
Thoughts please

Because of the difficulty of obtaining access to the full blood test panel (required prior to starting TRT) here in New Zealand. I have today had blood drawn for the following INITIAL tests purely to provide hard evidence for the forthcoming discussion with my Dr. Hopefully the test results coupled with the symptoms I have been experiencing will allow my Dr to make available the other tests, if required for TRT.
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Todays requested tests are:
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Total Testosterone
Free Testosterone
FSH
LH
PSA
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I used www Northland Pathology for the tests.

 

[jacb]

Well I got the starting point results and they both confuse and concern me somewhat.
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The concern: PSA (Roche) 4.2 ug/L (Range < 3.50) ...... I better go and see my GP. Any advice?
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The confusion: I thought that I needed to take two separate blood tests in order to establish my Free & Total testosterone. The blood for both tests was drawn at the same time. Now the results have come through I see that the samples were analysed by different labs within the same group. The results are.
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Free Testosterone Test:
Testosterone 12.3 nmol/L (Range 6.7 - 26.0)
SHBG 33 nmol/L (Range 13 - 71)
Free Testosterone 248 pmol/L (Range 163 - 473)
.
Serum Testosterone Test:
Testosterone 15.1 nmol/L (Range 8 - 29)
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My confusion is how can the Testosterone Levels (Not Free Testosterone) be different when taken from the same sample? Am I missing something?
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FSH 7.8 IU/L (Range 2 - 12)
LH 7.0 IU/L (Range 2 - 9)
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I don't know if the ranges have been adjusted for my age: 58
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Can anyone explain to me why the Testosterone Levels are different?
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From what I have read the testosterone range that would make a good working target for me is 17.3 - 20.8 nmol/L .... so one of the above test results would be good whilst the other would not - Confused?

 

[jacb]

Help?

Can this be correct?
I signed up for two tests: Free Testosterone & Total Testosterone.
The blood was drawn at the same time and sent to two labs within the same Path Lab Group. (The closest Lab doesn't offer Free T).
Here are the results .... Surely it must be a mistake that the basic T levels are not the same or am I missing something?
Can anyone explain these results to me?

 

[Vettester Chris]

Not completely sure, but they have two (2) different reference ranges, maybe indicating 2 different facilities & standards for measurement (?), don't know for sure. If you compare the two labs, your first result is at approx 29% of reference range, and the 2nd is at approx 33% of reference range ... There's some variance, but it's not extreme.

 

[Systemlord]

Labs aren't an exact science, labs are determined by lab technician skill. Labs can on average be off by as much as 100-200 points on the same blood sample.

 

[jacb]

Thank you both for your input.
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Whilst I am new here I have done some reading and it seems to me that it is best to treat the symptoms and not aim for a number .... BUT you have to start somewhere and that needs a numeric target at the outset. Eg how do you feel at ......?
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I wanted to find out what my numbers were to prove or disprove what my symptoms are telling me and as an aid to helping me get my Dr "On Team" .... but with such a large acceptable test error range (200ng/dL or 6.9 nmol/L if you are correct Systemlord) I don't see how the numbers will really help with that conversation!
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I had thought that a suitable "Starting" target range for my age (58) would be 500-600ng/dL or 17.3-20.8 nmol/L.
.
My lowest result was 12.3 nmol/L or 354ng/dL = LOW
The highest test was 15.1 mnol/L or 435.5ng/dL = Also Low
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But this may be academic until I find out what is happening to my PSA @ 4.2 ug/L .... What is the "acceptable" test range error range for the PSA test?
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I understand that my PSA needs to be below 3 ug/L before I should even consider taking TRT.

 

[Systemlord]

Here's some studies on testosterone and prostate cancer, it seems the thinking about men being on testosterone with prostate cancer is starting to shift.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5000551/

https://www.youtube.com/watch?time_continue=306&v=6a0vvEh_GtE

The use of testosterone therapy in men with prostate cancer was previously contraindicated, although recent data challenge this axiom. Over the past 2 decades, there has been a dramatic paradigm shift in beliefs, attitude, and treatment of testosterone deficiency in men with prostate cancer.

 

[jacb]

WOW .... Now that is News - GOOD NEWS!
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In the article it actually said "Normalizing testosterone levels may be important in prostate cancer control".
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However according to https://www.discountedlabs.com/blog...ment-blood-test-targets-and-their-management/ Nelson Says: PSA &#8804; 4 ng/mL. If high, talk to your doctor about potential prostatic infection or a referral to an urologist. TRT is contraindicated if PSA is 4 ng/mL or greater.
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Nelson if you are reading this, could we ask for your thoughts on the subject?
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For me I guess DRE is the next step - Joy! (Not)

 

[CoastWatcher]

WOW .... Now that is News - GOOD NEWS!
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In the article it actually said "Normalizing testosterone levels may be important in prostate cancer control".
.
However according to https://www.discountedlabs.com/blog...ment-blood-test-targets-and-their-management/ Nelson Says: PSA &#8804; 4 ng/mL. If high, talk to your doctor about potential prostatic infection or a referral to an urologist. TRT is contraindicated if PSA is 4 ng/mL or greater.
.
Nelson if you are reading this, could we ask for your thoughts on the subject?
.
For me I guess DRE is the next step - Joy! (Not)

A PSA in excess of 4ng/ml is a contraindication for TRT pending doctor's clearance. You'll be through the DRE in a few moments...wish you the best!

 

[jacb]

A PSA in excess of 4ng/ml is a contraindication for TRT pending doctor's clearance. You'll be through the DRE in a few moments...wish you the best!

Thanks CoastWatcher .... As you said the DRE was no big deal.
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I am pleased to say that my GP said that all was normal with DRE and suggested that I take another PSA test in three weeks and then assuming that there is no negative change (increased PSA) I monitor the PSA level every six months. He did not suggest I do anything else .. nothing was prescribed.
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So on the basis of the information (video & report) above, do I once again consider TRT or shelve the idea? Personally I feel it's time to get the full Pre TRT, Baseline tests completed for a fuller picture of my hormone health before deciding.
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I am still having trouble finding where to get the tests carried out in New Zealand, especially the Estrdiol (sensitive male LC/MS assay) so if any readers know where to get that test in NZ, please PM me.

 

[jacb]

I have been thinking about what to do about my elevated PSA test results of 4.2 ug/L.

My Doctor wants to do nothing and do a PSA retest in 12 Weeks! I don't think that this issue will just go away by itself .... It may stay the same or develop into full blown cancer in the fullness of time. If it stays the same I would have thought a course of Antibiotics would be the best way forward, but these antibiotics have their own risks and very real side effects.

I have read with interest about a study by Ilias Karaiskos, MD, of Hygeia General Hospital in Athens, Greece, and colleagues included 20 patients with a mean age of 53.6 years. Oral fosfomycin was taken once daily at a dosage of 3 grams for the first week, followed by 3 grams every 48 hours for a total of 6 weeks. Of the 20 patients, 17 (85%) experienced clinical cure, meaning all signs of infection (clinical and imaging) had resolved or improved during therapy.

Has anyone here had any experience of Fosfomycin Antibiotic (Monurol) in connection with prostatitis?

I hope if the time comes for Antibiotics, that my Dr/Urologist gives me the chance to try what I believe to be a "kinder/gentler" med. I really don't like the sound of the big-guns sulfa or quinolones.

 

[jacb]

Anyone have any good recommendations about where to purchase Fosfomycin (Monuril/Monurol) .... the prices I am being quoted are crazy for the amount needed above.