First blood test... at three months!

[Chris72]

Hey guys, 45 yrs old, 6'1, 170(20-25%BF),weights 3-4 x's wk, cardio 5-6 x,s wk. 10 years low T symptoms. Test cypionate 100mg/ml IM once a week for first 8 weeks. Bad chest and nipple tenderness/sensitivity, clear discharge from nipples, Oily then dry skin. Split dose to 50mg E3.5D reduced nipple problems about 90%, no discharge. At 3 months, barley any increase in test levels(test 336ng/dl, free 81ng/dl, up from 256,49).Doc sent message saying she was fine with new level's! I replied saying I strongly disagree. She said she has no idea what my goals are, but willing to increase to 120mg wk, 60mg E3.5D. Yesterday was third injection at new dose. Increased nipple/chest puffiness/sensitivity, puffy or pointy nipples, no discharge. increase in already high anxiety(upper back, neck and especially jaw)back and chest acne.
WBC 4.25K/uL(4.0-10.4)Hgb 15.1g/dl(13.0-17.0)Hct 46.7%(39-48)RBC 5.33M/ul(4.40-5.60)Vit D54ng/mL(30-100)Cortisol 9.3ug/dL(2.3-19.4)SHBG 45(10-50)TSH 1.42ulU/ml(.030-4.20)Estradiol 37pg/ml(26-61 lab never heard of sensitive)Prolactin 15.2ng/ml(4.0-15.2,down from 27.1)FSH 0.10miU/ml(1.5-12.4)Test 336ng/dl(250-900)Test free 81ng/dl(50-585)PSA 0.58ng/ml(>3.90)
Labs 42 hrs (fasting)after Sunday evening injection. Doctor wont prescribe AI. Dosage and or injection frequency recommendations? Can post previous labs and supplemets if helpful. Thanks,Chris

 

[Systemlord]

The problem you're dealing with is insurance based doctors cannot prescribe AI's under any circumstances, it's not standard of care so they won't do it. Insurance doctors/endo's are the worst choice for male hormones as they receive no training for it which is why she's happy with a 336 ng/dl which is ridiculous since you were probably scoring these numbers before seeking TRT. Studies show a threshold of 440 ng/dL for CVD, I think it's time you select a doctor who knows that stuff.

Unfortunately that isn't with insurance based doctors, the only ones who know what their doing are private practice. I've been through 3 endo's and I'm done, I need an AI is TRT is going to be successful. It sounds like you convert a lot of your testosterone into estrogen, you will require an AI for TRT to be successful, or you risk manboobs or gyno.

As clueless as this doctor is I'll guess that isn't even the proper E2 labs, you need the LS/MS/MS method for men.


https://www.ncbi.nlm.nih.gov/pubmed/27843074

CONCLUSION:

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction. Further study is required to evaluate the validity of these testosterone thresholds for CVD risk.

 

[Chris72]

My main goal once my finances are straight is to go with Defy medical. But right now I'm basically on my own and she wont do labs again for another 6-12 months, even with changing the dose. Right now I'll wait for possible dosing recommendations before deciding if I'm going to stay at 120mg a wk or increase. Because of lab costs It will definitely be cost effective to jump up to 130mg or 140mg a wk right now, but is it the safest option? Might be able to get estrogen under control by upping some of my supplements and or adding DIM. I definitely think my OCD is getting the better of me, because I'm spending way to much time looking at my chest in the mirror! Thanks for the quick reply

 

[Systemlord]

When gyno happens know it's without warning, by the time gyno rears its ugly head it's already too late. DIM will effect free E2, but not the bound E2 so your levels will remain unchanged. When I have issues with estrogen I use DIM and Calcium D glucarate, one suppresses and the other rids excess estrogen.

 

[Chris72]

I actually just added calcium d glucarate about a week ago. I started with 250mg twice daily then increased last night to 500mg twice daily.

 

[Systemlord]

I actually just added calcium d glucarate about a week ago. I started with 250mg twice daily then increased last night to 500mg twice daily.

Definitely, 250 is a maintenance dose, I tend to need double when having problems.

 

[FeelingLost]

My main goal once my finances are straight is to go with Defy medical. But right now I'm basically on my own and she wont do labs again for another 6-12 months, even with changing the dose. Right now I'll wait for possible dosing recommendations before deciding if I'm going to stay at 120mg a wk or increase. Because of lab costs It will definitely be cost effective to jump up to 130mg or 140mg a wk right now, but is it the safest option? Might be able to get estrogen under control by upping some of my supplements and or adding DIM. I definitely think my OCD is getting the better of me, because I'm spending way to much time looking at my chest in the mirror! Thanks for the quick reply

Hi Chris welcome to the forum,
No cash for proper blood tests or and AI. You are on the fast track to man boobs and feeling like shit from high E2 and prolactin.
I'd stick with 100/wk until you can afford proper care. That OTC stuff to reduce E2 and prolactin doesn't work.

 

[Chris72]

Hey feeling lost, thanks. It sucks having insurance and a prescription drug plan and not being able to use them because the doctor doesn’t understand proper protocol. I’m going to stay with this dose a few more days to see if I adjust. Other than the sore nipples I feel pretty good. If not I’ll drop back down and talk to defy, maybe they could prescribe just the AI. Definitely don’t want to take chances with the man boobs. In the meantime I’ll get with discount labs and get some proper labs done and go from there.