latest labs T even lower?

[slp053]

I've been on Androgel 1.62% 2 pumps/day since Feb. 2013. My latest labs show a sharp drop in T to 108ng/dL. I requested to switch to injectable and my Dr. prescribed 200mg to be injected every two weeks. I discussed the half life with him and requested a Monday morning/Thursday evening schedule with a lower dose but he said this was protocol. I just picked up my T-cyponate and syringes (23G) and will do my first injection soon. Here is my labs:

Here is a lab comparison chart with my lab results over the past year and a half:

Lab	10/24/2012	12/13/2012	12/21/2012	4/30/2013	7/15/2013	12/2/2013	3/19/2014
Cholesterol, Total	212 mg/dL					196 mg/dL	198 mg/dL
HDL Cholesterol	75 mg/dL					64 mg/dL	71 mg/dL
Triglycerides	58 mg/dL					65 mg/dL	52 mg/dL
LDL Cholesterol	124 mg/dL(calc)					119 mg/dL(calc)	117 mg/dL(calc)
CHOL/HDLC Ratio	2.8 (cal)					1.9 (cal)	2.8 (cal)
Non-HDL Cholesterol	137 mg/dL						127 mg/dL
Glucose	90 mg/dL			97 mg/dL		88 mg/dL	95 mg/dL
Urea Nitrogen (BUN)	14 mg/dL			13 mg/dL		14 mg/dL	21 mg/dL
Creatinine	0.89 mg/dL			0.86 mg/dL		0.92 mg/dL	0.93 mg/dL
eGFR Non-Afr.Amer	94 mL/min/1.73m2			95 mL/min/1.73m2		90 mL/min/1.73m2	89 mL/min/1.73m2
BUN/Creatinine Ratio	N/A (calc)			15 (calc)		15 (calc)	N/A
Sodium	142 mmol/L			142 mmol/L		139 mmol/L	141 mmol/L
Potassium	4.3 mmol/L			4.6 mmol/L		4.0 mmol/L	4.4 mmol/L
Chloride	102 mmol/L			104 mmol/L		100 mmol/L	104 mmol/L
CO2	26 mmol/L			26 mmol/L		25 mmol/L	25 mmol/L
Calcium	9.0 mg/dL			9.2 mg/dL		9.2 mg/dL	9.2 mg/dL
Protine, Total	6.9 g/dL			6.9 g/dL		6.6 mg/dL	6.9 mg/dL
Albumin	4.2 g/dL			4.3 g/dL		4.1 g/dL	4.2 g/dL
Globulin	2.7 g/dL (calc)			2.6 g/dL (calc)		2.5 g/dL (calc)	2.7g/dL (calc)
Albumin/Gobulin Ratio	1.6 (calc)			1.7 (calc)		1.6 (calc)	1.6 (calc)
Bilirubin, Total	1.4 mg/dL			0.8 mg/dL		1.5 mg/dL	1.4 mg/dL
Alkaline Phosphatase	76 U/L			78 U/L		80 U/L	79 U/L
AST	17 U/L			16 U/L		21 U/L	20 U/L
ALT	11 U/L			13 U/L		14 U/L	18 U/L
WBC	5.1 Thousand/uL			4.5 Thousand/uL		6.8 Thousand/uL	4.6 Thousand/uL
RBC	4.93 Million/uL			5.17 Million/uL		4.98 Million/uL	5.06 Million/uL
Hemoglobin	15.6 g/dL			16.0 g/dL		15.2 g/dL	15.8g/dL
Hematocrit	45.90%			47.00%		44.90%	48.00%
MCV	93.2 fL			91 fL		90 fL	94.9 fL
MCH	31.6 pg			30.9 pg		30.5 pg	31.2 pg
MCHC	33.9 g/dL			34.0 g/dL		33.9 g/dL	32.8 g/dL
RDW	13.70%			13.10%		13.40%	14.00%
Platelet Count	244 Thousand/uL			344 Thousand/uL		261 Thousand/uL	256 Thousand/uL
Absolute Neutrophils	3040 cells/uL			2.9 x 10E3/uL		4.8 x10E3s/uL	3022 cells/uL
Absolute Lymphocytes	1642 cells/uL			1.1 x 10E3/uL		1.6 x10E3/uL	1274 cells/uL
Absolute Monocytes				0.4 x10E3/UL		0.4 x10E3/uL	290 cells/uL
Absolute Eosinophils	41 cells/uL			0.0 x10E3/uL		0.0 x10E3/uL	9 cells/uL
Absolute Basophils	20 cells/uL			0.0 x10E3/uL		0.0 x10E3/uL	5%
Neutrophils	59.60%			65%		70%	65.7%
Lymphocytes	32.20%			26%		24%	27.7%
Monocytes	6.90%			8%		6%	6.3%
Eosinophils	0.80%			1%		0%	0.2%
Basophils	0.40%			0%		0%	0.1%
Immature Granulocytes				0%
Immature Grans(Abs)				0.0 x10E3/ul
PSA, Total	1.5 ng/mL			2.2 ng/mL	2.8 ng/mL	1.8 ng/mL
Testosterone, Total		451 ng/dL	229.1 ng/dL	405 ng/dL		399 ng/dL	108 ng/dL
Testosterone, Free		76.9 pg/mL				7.1 pg/mL	16.6 pg/mL
DHEA, LC/MS/MS							111 NG/Dl
FSH		12.2 mIU/mL					0.7 mIU/mL
LH		2.5 mIU/mL					0.2 mIU/mL
Prolactin		5.1 ng/mL
Estradiol		29 pg/mL					20 pg/mL
Alpha-fetoprotine, serum			6.1 ng/mL
Assay of Thyriod(T3 or T4)(T3 update			41.00%
Assay of Total Thyroxine (T4, Total)			12.0 MCG/DL
Assay of TSH			4.9 Index
TSH							0.86 mIU/L
T4, FREE							1.0 ng/dL
T3, Total							92 ng/dL
Cortisol
hCG			<5.0 mIU/mL
SHBG			37.1 nmol/L

10-24-12 labs routine physical, 12-2-13 labs by Lab Corp 03-19-14 labs by Quest Diag.

 

[Gene Devine]

So hard to make sense of labs without reference ranges.

Clearly, you are not absorbing well and not an uncommon event...happens to many men.

Injections will do you well but not at 200 mg every two weeks...and it is NOT protocol.

Your Doctor doesn't understand the half life of the drug.

Here from our good friend Dr. John Crisler:

"The IM test cyp must be administered in weekly injections, as opposed to taking twice the dosage every other week. Some physicians even dose every third or fourth week, producing wide swings in serum androgen levels. Where else in medicine do physicians dose medications completely void of consideration for the pharmacokinetics of same? This puts the patient on an emotional roller coaster, increases the risk of developing polycythemia, greatly accentuates aromatase activity (and therefore unnecessarily elevated E production requiring expensive aromatase inhibition), and actually leaves them lower than they were when they started for the last half of the injection cycle”.

 

[slp053]

Last two labs with ref range: Lab	12/2/2013	ref range	3/19/2014	ref range
Cholesterol, Total	196 mg/dL	100-199 mg/dL	198 mg/dL	125-200 mg/dL
HDL Cholesterol	64 mg/dL	> 39 mg/dL	71 mg/dL	> or = 40 mg/dL
Triglycerides	65 mg/dL	0-149 mg/dL	52 mg/dL	< 150 mg/dL
LDL Cholesterol	119 mg/dL(calc)	0-99 mg/dL	117 mg/dL(calc)	< 130 mg/dL (calc)
CHOL/HDLC Ratio	1.9	0.0-3.6 ratio units	2.8 (cal)	< or = 5.0 (calc)
Non-HDL Cholesterol			127 mg/dL	mg/dL (calc)
Glucose	88 mg/dL	65-99 mg/dL	95 mg/dL	65-99 mg/dL
Urea Nitrogen (BUN)	14 mg/dL	8-27 mg/dL	21 mg/dL	7-25 mg/dL
Creatinine	0.92 mg/dL	0.76-1.27 mg/dL	0.93 mg/dL	0.70-1.12 mg/dL
eGFR Non-Afr.Amer	90 mL/min/1.73m2	> 59 mL/min/1.73	89 mL/min/1.73m2	> or = 60 mL/min/1.73m2
BUN/Creatinine Ratio	15	10-22	N/A
Sodium	139 mmol/L	134-144 mmol/L	141 mmol/L	135-146 mmol/L
Potassium	4.0 mmol/L	3.5-5.2 mmol/L	4.4 mmol/L	3.5-5.3 mmol/L
Chloride	100 mmol/L	97-108 mmol/L	104 mmol/L	98-110 mmol/L
CO2	25 mmol/L	19-28 mmol/L	25 mmol/L	19-30 mmol/L
Calcium	9.2 mg/dL	8.6-10.2 mg/dL	9.2 mg/dL	8.6-10.3 mg/dL
Protine, Total	6.6 mg/dL	6.0-8.5 g/dL	6.9 mg/dL	6.1-8.1 g/dL
Albumin	4.1 g/dL	3.6-4.8 g/dL	4.2 g/dL	3.6-5.1 g/dL
Globulin	2.5 g/dL (calc)	1.5-4.5 g/dL	2.7g/dL (calc)	1.9-3.7 g/dL (calc)
Albumin/Gobulin Ratio	1.6 (calc)	1.1-2.5	1.6 (calc)	1.0-2.5 (calc)
Bilirubin, Total	1.5 mg/dL	0.0-1.2 mg/dL	1.4 mg/dL	0.2-1.2 mg/dL
Alkaline Phosphatase	80 U/L	39-117 IU/L	79 U/L	40-115 U/L
AST	21 U/L	0-40 IU/L	20 U/L	10-35 U/L
ALT	14 U/L	0-44 IU/L	18 U/L	9-46 U/L
WBC	6.8 Thousand/uL	3.4-10.8 x10E3/uL	4.6 Thousand/uL	3.8-10.8 Thousand/uL
RBC	4.98 Million/uL	4.14-5.80 x10E6/uL	5.06 Million/uL	4.2-5.8 Million/uL
Hemoglobin	15.2 g/dL	12.6-17.7 g/dL	15.8g/dL	13.2-17.1 g/dL
Hematocrit	44.90%	37.5-51.0 %	48.00%	38.5-50.0 %
MCV	90 fL	79-97 fL	94.9 fL	80.0-100.0 fL
MCH	30.5 pg	26.6-33.0 pg	31.2 pg	27.0-33.0 pg
MCHC	33.9 g/dL	31.5-35.7 g/dL	32.8 g/dL	32.0-36.0 g/dL
RDW	13.40%	12.3-15.4 %	14.00%	11.0-15.0 %
Platelet Count	261 Thousand/uL	155-379 x10E3/uL	256 Thousand/uL	140-400 Thousand/uL
Absolute Neutrophils	4.8 x10E3s/uL	1.4-7.0 x10E3/uL	3022 cells/uL	1500-7800 cells/uL
Absolute Lymphocytes	1.6 x10E3/uL	0.7-3.1 x10E3/uL	1274 cells/uL	850-3900 cells/uL
Absolute Monocytes	0.4 x10E3/uL	0.1-0.9 x10E3/uL	290 cells/uL	200-950 cells/uL
Absolute Eosinophils	0.0 x10E3/uL	0.0-0.4 x10E3uL	9 cells/uL	15-500 cells/uL
Absolute Basophils	0.0 x10E3/uL	0.0-0.2 x10E3uL	5%	0-200 cells/ul%
Neutrophils	70%	40-74 %	65.7%	%
Lymphocytes	24%	14-46%	27.7%	%
Monocytes	6%	4-12 %	6.3%	%
Eosinophils	0%	0-5 %	0.2%	%
Basophils	0%	0-3 %	0.1%	%
Immature Granulocytes
Immature Grans(Abs)
PSA, Total	1.8 ng/mL	0.0-4.0 ng/mL
Testosterone, Total	399 ng/dL	348-1197 ng/dL	108 ng/dL	250-1100 ng/dL
Testosterone, Free	7.1 pg/mL	6.6-18.1 pg/mL	16.6 pg/mL	35.0-155.0 pg/mL
DHEA, LC/MS/MS			111 NG/Dl	61-1636 ng/dL
FSH			0.7 mIU/mL	1.6-8.0 mIU/mL
LH			0.2 mIU/mL	1.6-15.2mIU/mL
Prolactin
Estradol			20 pg/mL	< or = 39 pg/mL
Alpha-fetoprotine, serum
Assay of Thyriod(T3 or T4)(T3 update
Assay of Total Thyroxine (T4, Total)
Assay of TSH
TSH			0.86 mIU/L	0.40-4.50 mIU/L
T4, FREE			1.0 ng/dL	0.8-1.8 ng/dL
T3, Total			92 ng/dL	76-181 ng/dL

 

[slp053]

Sorry I didn't include the ref. ranges but I didn't have them included in my lab comparison chart.
THANKS for the quick reply.
I agree that the 2 week injection is not best and purchased enough supplies to do an injection at least weekly. I plan to inject 100mg/week. I question why my T level dropped from 399 to 108 in such a short time as I never missed applying the 2 pumps/day of Androgel.

I am scheduled for my next appointment in 6 weeks and will be either getting a better plan from my Dr. or hunting for a different Dr.

 

[slp053]

Added reference ranges. Any comments on labs?

 

[Gene Devine]

Were you still on the transdermal when you had the second blood pull?

Either way, you just don't absorb well because your first pull still had Testosterone serum levels in the bottom 20% of the reference range which is not good.

If you switched to twice weekly injections you can get blood tested 6 weeks after starting to see where your serum levels are at; but I will tell you they will be much better than the transdermals.

Make sure to get Estrogen tested and make sure it's the "Sensitive" lab...this is very important.

I hope you are using HCG as well.

 

[slp053]

Thanks for your advise. Had I not found your site, I wouldn't have known to question my current Dr.'s advise.

Yes, I was still on 2 pumps/day when my latest labs were drawn. My journey began with painful nipples in Oct. 2012 that initiated my first Dr. Visit. After an exam, more blood work and a Mammogram (which ruled out cancer and confirmed Gyno), I was diagnosed with Gynecomastia and Hypogonatropic Hypogonadism. I was at 229 ng/dL when I began TRT/androgel in Feb.2013. My Gyno has resolved but I am still dealing with ED. I had to initiate my latest labs and will add the "sensitive" estrogen when we do the next draw in early June. No, I am not taking HCG. I plan to discuss that as well during my next visit. I have checked and HCG is not covered by my insurance. I knew nothing about HCG until I found your site.

I am already trying to locate a knowledgeable Dr. in my area and hope I have located one. I plan to get by her office and ask some questions before I cancel my appointment with my current Dr.

 

[Gene Devine]

I think your last sentence sums up perfectly what you need to do; find a properly trained Physician in hormone replacement for men and get the right care.

 

[Nelson Vergel]

As Gene suggested...

[h=2]How to Find a Good Doctor that Prescribes Testosterone[/b]

 

[slp053]

Again, thanks for your advise. I have viewed all your threads and videos and will have a list of questions for the prospective Dr. Found her info through one of your links.

 

[Gene Devine]

Again, thanks for your advise. I have viewed all your threads and videos and will have a list of questions for the prospective Dr. Found her info through one of your links.

Keep us updated on your appointment and progress here in this thread.

 

[slp053]

I had my first appointment with the new Dr. Monday and am scheduled for new labs Tuesday the 27th. She ordered a complete lab work-up including some vitamin levels. I am to see her again on June 9th for results.
I was not impressed as she advised she would refer me to a Urologist for titration of T-cyp.......and her practice does not do pre-auth with insurance. Looks like I will again be on the search for a competent Dr.
I am injecting 50mg on a Monday morning, Thursday evening schedule.
I will post my new labs when they come in. THANKS

 

[Nelson Vergel]

I had my first appointment with the new Dr. Monday and am scheduled for new labs Tuesday the 27th. She ordered a complete lab work-up including some vitamin levels. I am to see her again on June 9th for results.
I was not impressed as she advised she would refer me to a Urologist for titration of T-cyp.......and her practice does not do pre-auth with insurance. Looks like I will again be on the search for a competent Dr.
I am injecting 50mg on a Monday morning, Thursday evening schedule.
I will post my new labs when they come in. THANKS

Where do you live?

 

[slp053]

FL panhandle.

 

[Gene Devine]

Drive to Tampa and see our friends at Defy.

 

[slp053]

Thanks, I will definitely keep Tampa in mind. I go for my latest lab results with the new Dr. Monday and will decide then if my assessment of our first meeting was accurate or if I need to give her another chance.

I have noticed that after completing my injection that there is about 10mg of T-cyp still in the syringe no matter how hard I press the plunger. This would amount to between 80-90mg loss over a month of shots. Is this typical? Are the dosage marks on the syringe calibrated for the residue remaining? Do l overdraw that amount each shot or is there something I may be doing wrong? I am using a 1 m syringe and swapping the 1/2" needle to a 1" 25g.

Thanks for your information and support! Especially providing this site...

 

[Nelson Vergel]

Yes, there is some waste of T due to this issue. Some men run out of T before a refill is due. When using two needles (loading and injection ones), the waste is double.

 

[slp053]

I was able to obtain my latest labs online and they are much improved.
Do you see areas of discussion for my upcoming (Monday) Doctor appointment?

Lab	5/27/2014	ref range
Cholesterol, Total	169	125-200 mg/dL
HDL Cholesterol	58	> or = 40 mg/dL
Triglycerides	47	< 150 mg/dL
LDL Cholesterol	102	< 130 mg/dL (calc)
CHOL/HDLC Ratio	2.9	< or = 5.0 (calc)
Non-HDL Cholesterol	111	159 mg/dL (calc)
Glucose	97	65-99 mg/dL
Urea Nitrogen (BUN)	19	7-25 mg/dL
Creatinine	0.9	0.70-1.12 mg/dL
eGFR Non-Afr.Amer	93	> or = 60 mL/min/1.73m2
BUN/Creatinine Ratio	N/A
Sodium	142	135-146 mmol/L
Potassium	4.5	3.5-5.3 mmol/L
Chloride	106	98-110 mmol/L
CO2	28	19-30 mmol/L
Calcium	9.1	8.6-10.3 mg/dL
Protine, Total	6.8	6.1-8.1 g/dL
Albumin	3.8	3.6-5.1 g/dL
Globulin	3	1.9-3.7 g/dL (calc)
Albumin/Gobulin Ratio	1.3	1.0-2.5 (calc)
Bilirubin, Total	1.0	0.2-1.2 mg/dL
Alkaline Phosphatase	89	40-115 U/L
AST	16	10-35 U/L
ALT	13	9-46 U/L
WBC	6.5	3.8-10.8 Thousand/uL
RBC	5.01	4.2-5.8 Million/uL
Hemoglobin	15.6	13.2-17.1 g/dL
Hematocrit	48.10%	38.5-50.0 %
MCV	95.9	80.0-100.0 fL
MCH	31.1	27.0-33.0 pg
MCHC	32.4	32.0-36.0 g/dL
RDW	15.0	11.0-15.0 %
Platelet Count	291	140-400 Thousand/uL
Absolute Neutrophils	4498	1500-7800 cells/uL
Absolute Lymphocytes	1430	850-3900 cells/uL
Absolute Monocytes	488	200-950 cells/uL
Absolute Eosinophils	65	15-500 cells/uL
Absolute Basophils	20	0-200 cells/ul
Neutrophils	69.2	%
Lymphocytes	22.0	%
Monocytes	7.5	%
Eosinophils	1.0	%
Basophils	0.3	%
PSA, Total	2	< or = 4.0 ng/mL
Testosterone, Total	602	ng/dL
Testosterone, Free	119.2	pg/dL
Testosterone, Bioavailable	214	ng/dL
Prolactin	9.3	2.0-18.0 ng/mL
Thyroglobulin Antibodies	<20	<20 IU/mL
Thyroid Peroxidase Antibodies	13	<35 IU/mL
TSH	1.7	0.40-4.50 mIU/L
T4, FREE	1.1	0.8-1.8 ng/dL
SHBG	23	22-77nmol/L
Albumin, Serum	3.9	g/dL
Vitamine B12	394	200-1100 pg/mL
Folate, Serum	23.4	5.5 ng/mL
		Low: <3.4
		Borderline: 3.4-5.4
		Nornal >5.4
T3, Free	3.4	2.3-4.2 pg/mL
Vitamin D, 25-OH, Total	58	30-100 ng/mL
Vitamin D, 25-OH, D3	58	ng/mL
Vitamin D, 25-OH, D2	<4	ng/mL

 

[Gene Devine]

I don't see lab reference ranges for the Testosterone assays???

Assuming the ranges for these are what Lab Corp uses you look decent.

When did you have your blood pulled in reference to your last injection?

I don't see Estrogen as well???

 

[slp053]

The last 2 labs were done by Quest and I listed all the ranges they gave on the report. Hopefully the Doctor will have the rest when I go Monday. My blood was pulled Tuesday morning. I did an injection the previous Thursday night and held off on the Monday morning shot and injected it after the labs were drawn Tuesday. The Doctor did not order E2. The ref ranges on the last Quest lab report were :

T- total 250-1100 ng/dL
T- free 35.0-155.0 pg/mL

THANKS!