Finally joined after lurking driving myself crazy researching

[modlinb]

Hi, Guys, I'm 45 6'3 240 18% BF and have really run out of gas. After a lot of research, I told my doc I wanted to be tested for low T and it came back at 154. He only put me on 100mg a week of cyp and after 3 weeks went to TT 384 ng/dl and FT 107 pg/ml. Don't feel any different yet. I don't understand at that low number why he wanted me to stay on the same protocol for another 4 weeks then do a full blood panel. I really like my doc but I sure as hell hope he don't try and keep me around 400

 

[Systemlord]

It doesn't sound like your doctor even knows how the TRT game is played and seems anxious about increasing the dosage to youthful levels, it's because he has no idea what he's doing. You require a lot more labs to determine a dosage and injection frequency based off your blood biomarkers. One injection per week isn't good enough, your levels peak within 24-48 hours and begin to drop and by the end of the week you are low again, this is why you feel no different.

Most of us pay out of pocket because we also find it difficult to find a doctor that knows how to do TRT well, most insurance doctors will be no different than the one you already have, androgen replacement has been ignored by the medical community for decades and is why few doctors know how to do it. Your SHBG will largely determine dosing and injection frequency. Your doctor is also drawing labs too soon as it take 4-6 weeks for the injections of test to build up in your system. This must be a garden variety GP prescribing TRT, a ticket to failure.

When are you drawing labs in relation to your injection?

 

[modlinb]

I researched the crap out of it first and saw it was best to take atleast every week. He wanted me to sart on 200mg every 2 weeks. I planned on testing early morning before my next injection but had to get a job done first so it was about noon and then i took the next shot. He took it really well when i told him i wanted it every week instead and said he would work with me after i told him about all the research ive been doing but it shouldnt take 7 weeks for all my numbers to level out to do the blood work should it? I have no problem with injecting more often and in a couple weeks when i get the blood work and he needs to up the dose i will split it at that time. I'm just not sure why he's waiting so long. ready to feel better i guess

 

[Deleted member 16042]

Your levels do seem low for the dose. 100mg/week is a very reasonable starting dose. However there may be problems related to your SHBG and injection frequency, or you may just need to take more to get levels up.

Did your doc measure sex hormone binding globulin (SHBG) before putting you on T cyp? And what is your injection frequency? (Edit: OK you say once a week)

If you have low SHBG you will use up what you can fast and excrete the rest rapidly, so if your dose is say once a week, if you get a lab test at trough right before your next dose, your results can indeed be very low.

200mg every two weeks is a horrible thing to do to anyone. This is a big red flag that your doc doesn't have aclue how to manage your TRT.

And yes, steatdy state with T cyp takes 6 weeks, but you should be feeling it after several weeks, in fact most guys are in the "honeymood period" around then.

 

[modlinb]

I went back and looked at labs and he did not check SHBG. I'm guessing that will be on the next in 3weeks.

 

[Systemlord]

I originally started out TRT injecting once weekly, as time went on I began to feel really bad after 3-4 days. My SHBG is fluctuates between 16-18 and unless I'm injecting 16-20mg EOD I feel mediocre. I respond poorly to TRT injecting twice weekly even with good numbers. You need to test SHBG and monitor your estrogen level using the E2 sensitive LC/MS/MS labs.

I suspect your SHBG is lower, 75mg once weekly got me to 440 on trough day (right before injection). You have a higher dosage and are scoring lower, if low SHBG is confirmed you just may need to inject everyday or EOD. You can inject using Easy Tough 27-29 gauge insulin syringes in shoulder or outer quads SQ or IM, SQ is great for lower SHBG guys.

I would also like to see thyroid labs, and not just TSH, but Free T3, Free T4, Reverse T3 and antibodies. Low testosterone and low thyroid share common symptoms.

 

[Deleted member 16042]

he did not check SHBG. I'm guessing that will be on the next in 3weeks.

If he didn't check to begin with he has no idea of its importance. I would not expect he has a clue to look at it in the future. Your dosing frequency depends entirely on this. It can make or break your treatment.

 

[modlinb]

I will message my doc and make sure this next blood work has everything you mentioned. If you can think of anything else that needs tested let me know

 

[Deleted member 16042]

You really need to educate yourself. please refer to Orrin's list here: https://www.excelmale.com/forum/showthread.php?15083-New-to-The-forum&p=111250#post111250

And refer to Nelson's discounted labs list of tests: My post here: https://www.excelmale.com/forum/sho...d-trying-to-adjust-dosage&p=110911#post110911

 

[CoastWatcher]

You are hardly the first member of Excelmale to find out that their doctor is inept. It's the single most common problem men encounter when seeking treatment for hypogonadism. Simply put, we shouldn't have to explain to our physicians how to test and diagnose these issues.

I write this to suggest you consider finding better, more comprehensive care. We can offer referrals. You deserve better.

 

[OMI100]

You really need to educate yourself. please refer to Orrin's list here: https://www.excelmale.com/forum/showthread.php?15083-New-to-The-forum&p=111250#post111250

And refer to Nelson's discounted labs list of tests: My post here: https://www.excelmale.com/forum/sho...d-trying-to-adjust-dosage&p=110911#post110911

TY Blackhawk..
I would recommend printing out Dr. Johns "TRT: Recipe For Success" and give to your DR. if he/she is open minded.
That paper was written by a DR. FOR DR's......
BTW IF your DR. IS open minded you might also print out the Power Point presentation and provide.
Again, developed by a DR. FOR DRs.

 

[Vettester Chris]

Welcome to the EM community! Glad you joined!

 

[MathewsON]

Hi and welcome, aboard!

 

[modlinb]

OK Ive finally got my results after 6 weeks.
my TT was at 579ng/dl
my FT was at 131pg/ml
SHBG 22nmol/l
Estrogen 40 He didnt know anything about the sensitive test until i told him so that will be on the next labs.

I had him check the t3 t4 and others recomended and they all came back fine. He is lost about why im not feeling better yet and i told him i wanted to up my dose and inject tIwice a week but he wanted me to speak to an endo first. Its been a week and i havent heard anything from the endo so the first of next week i'm just going to tell him i need to up it. I am injecting 100mg per week and that got me up about 300 points so i was thinking to take it up to 200 per week 100 per injection to keep E2 down and to keep it more stable. do you think this would be the right choice or would it be to much?

Thanks

 

[Nelson Vergel]

Hi Guys I'm 45 6'3 240 18% BF and have really run out of gas. After alot of research i told my doc i wanted tested for low T and it came back at 154. He only put me on 100mg a week of cyp and after 3 weeks went to TT 384 ng/dl and FT 107 pg/ml. Dont feel any different yet. I dont understand at that low number why he wanted me to stay on the same protocall for another 4 weeks then do a full blood panel. I really like my doc but I sure as hell hope he dont try and keep me around 400

Welcome to ExcelMale. I am glad you are not lurking anymore. We are friendly guys and have great moderators that keep harmony among 19,000 members.

Do you have any idea why your T was so low at baseline? Most patients that have no reason to have T that low have their prolactin checked to make sure that they do not have a prolactin-secreting tumor (benign) in their pituitary.

Were you exposed to anabolic steroids, have a head injury, have taken corticoid steroids, opiates or other meds that could lower your T? What are your height and weight? Do you sleep well? Do you have your LH and FSH at baseline?


Your dose should probably be 200 mg per week. But digging into the cause of your low T is important.

 

[madman]

OK Ive finally got my results after 6 weeks.
my TT was at 579ng/dl
my FT was at 131pg/ml
SHBG 22nmol/l
Estrogen 40 He didnt know anything about the sensitive test until i told him so that will be on the next labs.

I had him check the t3 t4 and others recomended and they all came back fine. He is lost about why im not feeling better yet and i told him i wanted to up my dose and inject tIwice a week but he wanted me to speak to an endo first. Its been a week and i havent heard anything from the endo so the first of next week i'm just going to tell him i need to up it. I am injecting 100mg per week and that got me up about 300 points so i was thinking to take it up to 200 per week 100 per injection to keep E2 down and to keep it more stable. do you think this would be the right choice or would it be to much?

Thanks

As others have stated your SHBG should have been tested pre-trt as ones SHBG will dictate dose/injection frequency and is critical to the effectiveness of trt.

Knowing SHBG before starting trt can save many grief as it takes 6 weeks for testosterone levels to stabilize. Now you found out 6 weeks after starting your protocol that your SHBG is low hence why your protocol is not optimal.

Do understand that just because 100mg/week of testosterone bumped your TT level up 300 ng/dL in no way does it mean that adding another 100mg/week is going to cause the same increase.....200mg/week is a rather large dose of testosterone for trt and that is a significant increase from injecting 100mg/week.

Ones SHBG, sensitivity of the AR (androgen receptor) play a big role in what dose of testosterone is needed and how one responds.

Seeing as your SHBG looks to be low 22 nmol/L (you did not provide range) you would do better injecting lower doses of testosterone daily or EOD and if anything even though TT is good to know and your numbers may not seem impressive on paper FT is what really matters as it is the unbound active fraction of testosterone.

Men with low/lowish SHBG can usually obtain higher FT using lower doses of testosterone injected more frequently.

As you know your e2 test was done using the wrong method and the sensitive assay (LC/MS-MS) is needed to truly know where your e2 sits.

You state " I am injecting 100mg per week and that got me up about 300 points so i was thinking to take it up to 200 per week 100 per injection to keep E2 down and to keep it more stable. do you think this would be the right choice or would it be to much?

.....so you have no idea where your e2 sits as it was not tested with the sensitive estradiol assay and now you want to double your dose from 100mg/week--->200mg/week (100mg every 3.5 days), thinking it will keep e2 down and more stable when in fact it will skyrocket especially seeing as you have low SHBG.

I would definitely look into injecting EOD or daily using lower doses of testosterone and definitely not 200mg/week.

You need to provide ranges for TT, FT, SHBG, E2?

 

[modlinb]

Never taken steroids or opiates. Always bumping my head but not trama. I do not sleep very well i own a buisness and always under stress from that and in the oilfields 40 hours straight at times so i do not eat properly either.

I'm 6'3 240 my doc didnt check LH and FSH until after i was on HRT so nothing before.

 

[modlinb]

TT ranges 300-890
FT ranges 47-244
SHBG 11-80

I wasnt talking about keeping the E2 more stable i was refering to the TT i dont want to be swinging. I pretty much have to force myself to go to the gym and getting out of bed in the mornings is not fun. I'd like to get my numbers 900 to 1000 to see if the higher end will give me the energy i used to have and just plain feel better.

 

[Deleted member 16042]

With your SHBG at 22, you need more frequent injections. Depending on when you had your blood drawn, this aspect may have affected your levels. With SHBG at 22, you will have less bound to SHBG and after a week, if you are tested when you should be, right before your next injection, those levels are not surprising at all.

The problem is with lower SHBG you will access a lot of the injected T as free testosterone, metobolise and excrete it rapidly so that by your next shot you will be low again.

At 22, i would want injections every other day (EOD)or possibly even daily.

The 100mg/week amount may be just fine if it is divided up into more frequent doses

 

[madman]

TT ranges 300-890
FT ranges 47-244
SHBG 11-80

I wasnt talking about keeping the E2 more stable i was refering to the TT i dont want to be swinging. I pretty much have to force myself to go to the gym and getting out of bed in the mornings is not fun. I'd like to get my numbers 900 to 1000 to see if the higher end will give me the energy i used to have and just plain feel better.

Forget worrying about TT being in the higher end of the physiological range and concentrate on FT and seeing as your FT is 131 pg/ml just under mid-normal range as the range is 47-244 so the mean (mid range) would be 145.5 pg/ml which means you may need to get your FT up a little more near the top end of the physiological range and seeing as your SHBG is lowish you will not need to increase your TT a lot in order to bump up your FT and even than you need to look into injecting daily or EOD using lower doses of T.

Also once you have the e2 sensitive assay it may very well be high and as we know too high e2 can have negative effects on ones mood/libido/erectile function among other things!