Endocrinologist has me terrified of my blood work

[rdas82]

I've been dealing with low T issues since 2014. My PCP drew a testosterone test and discovered that I had low total t levels.
He sent me to an endocrinologist who has been testing me since 2016.
She said that while my total levels were low my free t levels were normal. I have low SHBG and slighting elevated prolactin.
She did an MRI and ruled out a tumor. Not sure what the low SHBG could be from, she said all my other lipids looked good.
In 2019 she tested me again and me total t was 205 ng/dl. Since my erectile issues and moods were really starting to hurt my marriage I got a second opinion from a urologist. He put me on 100 mg test cyp per week.
He tests my total t every 6 months, but that is all he tests next to H&H. He tests me the day before my injections and I'm always around a 600 total.
With all that being said my endocrinologist called me in to test my prolactin levels again. In the process she pulled my total t, free t, SHBG, prolactin, etc. again.
They drew blood the day after my injection. My total testosterone was 1,281, my free was 60.72!! and my SHBG was 9.1. My prolactin was 24.
She proceded to tell me that this level of testosterone was going to kill me. I'm very worried about why my SHBG would be so low, and why my free would be so high.
I really don't want to stop TRT, I feel great, my wife and I are happy.

What do you all think, is this an unsafe level?
Should I quit TRT and let me urologist know why I'm quiting?

I've attached a lot of my blood work in case anyone wants to review it. It's past data and recent.
Thanks in advance for any input that any of you might have.

 

[Deleted member 16042]

Your two stated labs are comparing peak and trough levels. It sounds like you are taking one 100mg dose per week?

Because your SHBG is low, you are a rapid excreter. You peak high, then the T does not stay in your system very long, hence the seemingly wild swings in level.

Typically Low SHBG guys even this out by doing small doses daily. That way you'd not be getting a large dose with such peaks and troughs.

 

[rdas82]

Your two stated labs are comparing peak and trough levels. It sounds like you are taking one 100mg dose per week?

Because your SHBG is low, you are a rapid excreter. You peak high, then the T does not stay in your system very long, hence the seemingly wild swings in level.

Typically Low SHBG guys even this out by doing small doses daily. That way you'd not be getting a large dose with such peaks and troughs.

I just started splitting the dose into two injections.
I'm hoping that helps, I don't want to pin every day, I'm not particularly fond of it, lol.
I thought about asking him to prescribe the scrotal cream instead.

Do you think that those levels are dangerous?

 

[bochinit]

I just started splitting the dose into two injections.
I'm hoping that helps, I don't want to pin every day, I'm not particularly fond of it, lol.
I thought about asking him to prescribe the scrotal cream instead.

Do you think that those levels are dangerous?

No, it's not.

 

[swoops36]

I just started splitting the dose into two injections.
I'm hoping that helps, I don't want to pin every day, I'm not particularly fond of it, lol.
I thought about asking him to prescribe the scrotal cream instead.

Do you think that those levels are dangerous?

There’s nothing dangerous about it as long as your other health markers look good.

I know you said you don’t want to inject everyday, but with that low SHBG, you really should be. Try EOD at least, for 6-8 weeks, and I’ll bet you’ll feel better.

you can also look into why your SHBG is so low. Insulin resistance? Diet?

 

[Systemlord]

She proceded to tell me that this level of testosterone was going to kill me.

This is a ridiculous uneducated statement. I get the impression none of your docs are well versed in TRT and don't come across as very knowledgeable in sex hormones which is commonplace in western medicine.

The low SHBG could be genetic, but TRT is expected to lower it in most cases.

 

[Deleted member 16042]

I just started splitting the dose into two injections.
I'm hoping that helps, I don't want to pin every day, I'm not particularly fond of it, lol.
I thought about asking him to prescribe the scrotal cream instead.

Do you think that those levels are dangerous?

If you have aversion to injections, may i ask what size/gauge needle you are using?

 

[SSHSSA74]

I just started splitting the dose into two injections.
I'm hoping that helps, I don't want to pin every day, I'm not particularly fond of it, lol.
I thought about asking him to prescribe the scrotal cream instead.

Do you think that those levels are dangerous?

Nope. Don’t seem dangerous at all

 

[madman]

I've been dealing with low T issues since 2014. My PCP drew a testosterone test and discovered that I had low total t levels.
He sent me to an endocrinologist who has been testing me since 2016.
She said that while my total levels were low my free t levels were normal. I have low SHBG and slighting elevated prolactin.
She did an MRI and ruled out a tumor. Not sure what the low SHBG could be from, she said all my other lipids looked good.
In 2019 she tested me again and me total t was 205 ng/dl. Since my erectile issues and moods were really starting to hurt my marriage I got a second opinion from a urologist. He put me on 100 mg test cyp per week.
He tests my total t every 6 months, but that is all he tests next to H&H. He tests me the day before my injections and I'm always around a 600 total.
With all that being said my endocrinologist called me in to test my prolactin levels again. In the process she pulled my total t, free t, SHBG, prolactin, etc. again.
They drew blood the day after my injection. My total testosterone was 1,281, my free was 60.72!! and my SHBG was 9.1. My prolactin was 24.
She proceded to tell me that this level of testosterone was going to kill me. I'm very worried about why my SHBG would be so low, and why my free would be so high.
I really don't want to stop TRT, I feel great, my wife and I are happy.

What do you all think, is this an unsafe level?
Should I quit TRT and let me urologist know why I'm quiting?

I've attached a lot of my blood work in case anyone wants to review it. It's past data and recent.
Thanks in advance for any input that any of you might have.

Absolutely not as these are your TT/FT levels at peak and they will be much lower towards the end of the week.

Just keep in mind that because your SHBG is so low that having a higher-end TT 1281 ng/dL has your FT levels through the roof as 60 ng/dl is 3x the top end of the reference range 5.0-21.0 ng/dL and that is using the most accurate testing method for FT the gold standard Equilibrium Dialysis.

Your FT pre-trt was roughly 10 ng/dL and as you can see injecting a larger dose of T (100mg) once weekly drove it up to a whopping 60 ng/dL at peak.

Definitely not an optimal injection protocol.

As you can see your TT trough level by the end of the week is in the 600s on average as you stated so your FT will also be much lower.

Most men do well having FT in the 20-30 ng/dL range.

You would definitely do much better injecting more frequently as not only will you minimize the peak--->trough but your blood levels will be more stable throughout the week.

Many would tell you that with such a low SHBG injecting daily or EOD would be much better.

Much respect to you for testing your FT using an accurate method.

Where does your RBCs/hemoglobin/hematocrit sit on such protocol (100mg/week)?

 

[broker]

Seriously, your endo should not be saying that.
i had the exact same T levels as you while on 100 mgs per week.
knock it down to 2x per week. Try 40 mgs every monday and thursday.
as long as your BP and hematocrit is ok, you are good.

 

[UCFguy01]

Nothing looks bad that I've seen on your blood work. It looks really good actually. I'd take the advice of others about daily injections with an insulin syringe. I use 29 gauge and preload 10 of them at a time. It takes me 15 minutes to fill them every 10 days and about a minute each morning to inject. Super simple. I have low SHBG as well. I inject 25mg a day and keep my levels around 1,200 - 1,400 total T.

 

[tareload]

Nothing looks bad that I've seen on your blood work. It looks really good actually. I'd take the advice of others about daily injections with an insulin syringe. I use 29 gauge and preload 10 of them at a time. It takes me 15 minutes to fill them every 10 days and about a minute each morning to inject. Super simple. I have low SHBG as well. I inject 25mg a day and keep my levels around 1,200 - 1,400 total T.

What's your Hct look like on this protocol and what if anything do you do to control it if above range?

Thanks in advance.

 

[UCFguy01]

My Hct was 45-46 the last few times I had it tested. When I first started injections my Hct would get up to 51-52 and I would give blood every 4-5 months. I bought a Hct and Hemoglobin tester for home use so I'd monitor it every few months. After a year or so on injections, the Hct leveled out and it doesn't get high any more. Not sure why.

 

[tareload]

Wow, that's impressive. Congratulations and good work being so diligent. I never got that response after 2 years so I am down to 50 mg/week TC. Very nonlinear dose response even without JAK2 mutation. Thanks for your time.

 

[TucsonJJ]

If you REALLY dislike pinning IM... a lot of guys here advocate Sub-Q... and with 27g or 28g 1cc insulin syringes, it really is almost painless.
I pin MWF 100mg/wk, IM in delts... no problems. But I did Sub-Q for awhile and it was easy.

 

[buckeye22]

I've been dealing with low T issues since 2014. My PCP drew a testosterone test and discovered that I had low total t levels.
He sent me to an endocrinologist who has been testing me since 2016.
She said that while my total levels were low my free t levels were normal. I have low SHBG and slighting elevated prolactin.
She did an MRI and ruled out a tumor. Not sure what the low SHBG could be from, she said all my other lipids looked good.
In 2019 she tested me again and me total t was 205 ng/dl. Since my erectile issues and moods were really starting to hurt my marriage I got a second opinion from a urologist. He put me on 100 mg test cyp per week.
He tests my total t every 6 months, but that is all he tests next to H&H. He tests me the day before my injections and I'm always around a 600 total.
With all that being said my endocrinologist called me in to test my prolactin levels again. In the process she pulled my total t, free t, SHBG, prolactin, etc. again.
They drew blood the day after my injection. My total testosterone was 1,281, my free was 60.72!! and my SHBG was 9.1. My prolactin was 24.
She proceded to tell me that this level of testosterone was going to kill me. I'm very worried about why my SHBG would be so low, and why my free would be so high.
I really don't want to stop TRT, I feel great, my wife and I are happy.

What do you all think, is this an unsafe level?
Should I quit TRT and let me urologist know why I'm quiting?

I've attached a lot of my blood work in case anyone wants to review it. It's past data and recent.
Thanks in advance for any input that any of you might have.

Hi. Here’s a simplified answer. FIRE YOUR FEMALE ENDOCRINOLOGIST AND STAY WITH YOUR MALE UROLOGIST!!!

 

[JanSz]

Your Total cholesterol is on the low side.
Hormones are made from cholesterol.
You may be a missing building material.

Consider getting complete DUTCHtest.com
and
Spectracell.com Micronutrient analysis and cholesterol (lipid) analysis.
You will get an excellent view of your body.
You can order those tests yourself by internet.
Look up their sample reports and numerous educational videos so you will learn what makes them tick.

SHGB---->excessive testosterone lovers it.
SHGB---->too low estrogens lovers it. (You may have low estrogens (there is many estrogens, not only E2)

High prolactin may get down when using (slow-acting) cabergoline.
Cabergoline is a long-acting dopamine receptor agonist.
Dostinex
Stay away from (fast-acting) Cycloset.

OR try

MUCUMA Pruriens

Amazon.com : mucuna pruriens bulk supplements

Functional Medicine, Abdominal Pain, SIBO, H pylori, Orange, CA 92866
DrEttinger

 

[JanSz]

Men's Health and the DUTCH Test® - DUTCH Test

The DUTCH Test® provides excellent information for men looking to optimize their health and wellbeing. While it is common to focus only on increasing testosterone,…

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[JanSz]

....

Adrenaline is a killer of erections.