Low Testosterone Discussion

[Hoss91]

Good evening,

First post here! Mods, please move to the appropriate section, but I figured this is a good place to post this thread. I will try to be brief (post edit: I lied apparently, sorry for the lengthy rant).

Backstory
- Cannot gain muscle or strength despite being on proper programming, consuming gram of protein/lb of body-weight, religiously tracking calories and very clean eating (and weighing food), trained by friends who were bodybuilders and/or powerlifters, also by trainers not my friends who were powerlifters. I got enough calories, sleep (moderately good, always had sleep issues despite controlling for all factors), stress was minimal. My max weight I capped out at 178lbs, eating 3800 calories and still not gaining weight (or strength). Been at this for six years. Strength always capped out at very pitiful numbers on squat, bench, deadlifts, press.

- Cognition - Lack of focus, clarity, memory problems, sleep issues, always tired, always irritable. A lot of the other symptoms of low testosterone. Got my levels checked in May 2015 when I was at my heaviest (178lbs) results:
Free Testosterone: 349 (Lab range 196 - 636). Note: Free testosterone is estimated from
measured total testosterone and sex hormone-binding globulin using Vermeulen's algorithm.

I was told I was normal. Well, I did research a couple of months ago, and nope, not normal. According Vermeulen's research, which while dated, it is still cited everywhere today, I should be at 617ng/dl. So I got my levels tested again. See word doc attached for recent bloodwork. I don't have the older bloodwork in electronic form.

According to online converters, I am at 225ng/dl. Kind of funny, right? Three times less than where I should be. My GP agrees with me about where I should be (I printed off the actual paper, and showed her, and explained this). I have been referred to an endocrinologist for the 28th of January, and suggested I get on testosterone shots.

I am so frustrated (that is an understatement), yet relieved in that I have an answer why I cannot get stronger (or bigger) (along with the cognitive side effects). The endocrinologist will do other bloodwork to determine any compounding factors such as thyroid. I want to know what people here have to say about my recent bloodwork.

Current stats:

Height: 6'0, weight: 160lbs, age: 25, location: Canada eh? body type: small frame and joints, tall and very lanky. Do not have recent bodyfat measurements. When I was 164lbs two months ago, I was according to calipers 11% BF, with 145.757 LBM.

Questions:

- I am a bit scared that these shots will mess up my fertility and have many adverse side effects such as increased risk for liver damage, testicle shrinkage, and prostate cancer.... I do realize that once you go off testosterone, chances of fertility not returning to normal is very low, but it's the other side effects I am worried about. I honestly hope it's a thyroid issue, and I just have to take an oral pill instead of testosterone shots every 10 days). What has been your experiences of side effects?

- Do I have a reasonable case to get my testosterone to 617ng/dl?


Edit: I can't post links or images due to low post count. Any preliminary thoughts are welcome.

 

[ERO]

Age 25 is very young to start TRT. It may be worth trying to boost your natural T production with Clomid - much like a re-start protocol. That usually only works well with a good Doc, though.

 

[Vince]

Welcome to ExcelMale. At age 25, you're too young to start TRT. I would have thorough testing done. You say you live in Canada, I bet Coastwatcher can help you find a good doctor.

 

[Hoss91]

I am told this endocrinologist is well renowned. Clomid is a fertility treatment, no?

I will exhaust all other avenues (i.e., other confounding factors in the ensuing blood tests). But if it's necessary, I don't see the problem. Sure, it's a hassle (every 10 days), but if it improves my quality of life that is worth it in itself.

Edit: What would be my levels of treatment?

Level 1: Addressing any other variable found in blood work. What should I get tested in this blood-work? Thyroid, T3, T4, reverse T3, what else?
Level 2: If it's truly low testosterone, then Clomid
Level 3: If that fails, then TRT?

 

[CoastWatcher]

Welcome to Exclemale. Like you, I'm a Canadian and it can be a challenge to obtain proper treatment, though it can be done. Message me if you'd like, and we can discuss some ways you may be able to achieve what you are looking for.

The ideal list of blood tests - total and free testosterone, SHBG, estradiol (you will NOT be able to obtain the appropriate, sensitive estradiol test in Canada - I travel to the States to access it - but the standard test should be run anyway), prolactin, LH, FSH, DHT, PSA, TSH, t3, t4, rt3, and thyroid antibodies.

If if it's truly low testosterone, and you are dealing with secondary hypogonadiam, then Clomid should be considered. That's where the challenges of living in Canada will come into play - few doctors are familiar with a Clomid restart. But, one step at a time...

 

[johndoesmith]

Welcome to ExcelMale. At age 25, you're too young to start TRT. I would have thorough testing done. You say you live in Canada, I bet Coastwatcher can help you find a good doctor.

Vince, I don't think that you can make a statement that 25 is too young for TRT, in all cases. That is simply not true. I have primary hypogonadism so what is it you recommend I do since I'm under 25?

 

[Hoss91]

Welcome to Exclemale. Like you, I'm a Canadian and it can be a challenge to obtain proper treatment, though it can be done. Message me if you'd like, and we can discuss some ways you may be able to achieve what you are looking for.

The ideal list of blood tests - total and free testosterone, SHBG, estradiol (you will NOT be able to obtain the appropriate, sensitive estradiol test in Canada - I travel to the States to access it - but the standard test should be run anyway), prolactin, LH, FSH, DHT, PSA, TSH, t3, t4, rt3, and thyroid antibodies.

If if it's truly low testosterone, and you are dealing with secondary hypogonadiam, then Clomid should be considered. That's where the challenges of living in Canada will come into play - few doctors are familiar with a Clomid restart. But, one step at a time...

Thank you very much for your insight and offer for further conversation. Is the list that you posted exhaustive? Is there anything else that I should push to get tested in addition to what you outlined?

In Canada, what sort of TRT drugs will I be given? Are there any secondary drugs administered to counter the side effects? Is the treatment for low testosterone a leveled approach (see my above post for an example)?

 

[CoastWatcher]

Thank you very much for your insight and offer for further conversation. Is the list that you posted exhaustive? Is there anything else that I should push to get tested in addition to what you outlined?

In Canada, what sort of TRT drugs will I be given? Are there any secondary drugs administered to counter the side effects? Is the treatment for low testosterone a leveled approach (see my above post for an example)?

To discuss TRT treatment in "Canada" (as we are both doing) is misleading. Your treatment will depend on your doctor, of course, and where you live. Treatment in the Atlantic provinces is a significant challenge, while greater options exist in Toronto, Hamilton, Montreal, Ottawa, Calgary and Vancouver. Even in those cities, however, it can be difficult to find a doctor who understands androgen replacement.Where do you live? I can be a bit more focused in my discussion if I know that.

As an aside, you noted that you hoped you wouldn't take a shot every ten days. I hope you don't either - if that is what a doctor prescribes you will know with certainty they don't know what they are doing. Injections are, at a minimum, weekly, typically more frequently. I raise this to show you how we have to be our own advocates.

 

[Hoss91]

To discuss TRT treatment in "Canada" (as we are both doing) is misleading. Your treatment will depend on your doctor, of course, and where you live. Treatment in the Atlantic provinces is a significant challenge, while greater options exist in Toronto, Hamilton, Montreal, Ottawa, Calgary and Vancouver. Even in those cities, however, it can be difficult to find a doctor who understands androgen replacement.Where do you live? I can be a bit more focused in my discussion if I know that?

As an aside, you noted that you hoped you wouldn't take a shot every ten days. I hope you don't either - if that is what a doctor prescribes you will know with certainty they don't know what they are doing. Injections are, at a minimum, weekly, typically more frequently. I raise this to show you how we have to be our own advocates.

Oh I agree. My personal philosophy is that everyone should be proactive in their health. This includes preventative measures (healthy eating, exercise), and when problems go wrong, ascertain what the problem is, and eliminate any confounding variables that could impact that conclusion.

I live in Ottawa. See attached for my recent bloodwork.

 

[CoastWatcher]

Oh I agree. My personal philosophy is that everyone should be proactive in their health. This includes preventative measures (healthy eating, exercise), and when problems go wrong, ascertain what the problem is, and eliminate any confounding variables that could impact that conclusion.

I live in Ottawa. See attached for my recent bloodwork.

Living in Ottawa, you should consider consulting this doctor http://www.peakmenshealth.com/home.

Imdo not know him, but have heard of him (favourably). He practices privately, outside of OHIP. Did I miss it, or was FSH not run?

 

[Hoss91]

Thanks for the referral. I do have insurance (government), but I am not sure if the insurance would cover TRT. I am not even sure if OHIP covers TRT due to the motif "not medically necessary".

Edit: Sorry, I just saw your question. FSH was not tested.

 

[CoastWatcher]

Thanks for the referral. I do have insurance (government), but I am not sure if the insurance would cover TRT. I am not even sure if OHIP covers TRT due to the motif "not medically necessary".

Care is covered by OHIP because hypogonadism is most certainly "medically necessary." The problem is most doctors are ignorant of proper protocols and won't treat or mistreat. I was fortunate to find a doctor who, practicing within OHIP, knew her way around the field of male androgen replacement. I am in the States regularly and consulted a doctor there who confirmed my doctor's knowledge and treatment plans. I would have been more than happy to pay for private care outside of OHIP had that been necessary - and it typically is. I pay for private lab work, Discountedlabs.com, when I visit the US as the sensitive estradiol test isn't available here.

Please consider it as an investment in regaining your health. As I wrote, this clinic has a good reputation. Arm yourself with knowledge and questions.

And, again - was FSH run?

 

[Hoss91]

Of course. I paid for the bioavailable testosterone test because it was not covered by OHIP. It's more that I am currently in a financial limiting situation right now, which may cause difficulties if I have to pay for the treatment. I will cross that bridge if and when I get to it.

I edited my previous post to answer your question, but I guess I edited the post too late - FSH was not tested. Is there anything else in my blood-work that is worrisome?

Lastly, is my idea of 617ng/dl reasonable? I see people on this forum shoot for 450ng/dl, but based on the information I have come across (link to excerpt below) suggests 617ng/dl. While dated, this researcher is seemingly well respected, and his research is cited very often.

Research reference: Vermeulen, A

 

[CoastWatcher]

Of course. I paid for the bioavailable testosterone test because it was not covered by OHIP. It's more that I am currently in a financial limiting situation right now, which may cause difficulties if I have to pay for the treatment. I will cross that bridge if and when I get to it.

I edited my previous post to answer your question, but I guess I edited the post too late - FSH was not tested. Is there anything else in the blood-work that is worrisome?

Lastly, Is my idea of 617ng/dl reasonable? I see people on this forum shoot for 450ng/dl, but based on the information I have come across (Link to excerpt below) says 617ng/dl. While dated, this researcher is seemingly well respected, and his research is cited very often.

Research reference: Vermeulen, A

Don't chase numbers. Really, how do you know what your optimal testosterone level will be? Some guys do very well with a trough reading below what many others find acceptable. You start with a reasonable protocol, a good starting point is 50mg every 3.5 days, support it with HCG, attend to how you feel, and test in six weeks.

The question of topical testosterone replacement should be addressed, too. It's a rational approach to therapy. There is a significant problem, however, and that is the fact that topicals aren't well absorbed by a lot of men. Androgel,was a total bust in my own case. Excelmale is an injection-oriented forum, for just that reason. However, it is a delivery system you may wish to consider. Just be aware that you may be frustrated.

Your labs present as hypogonadal, but you are missing a lot. FSH, PSA, thyroid panel. Your LH is slightly above the midpoint of the range. Not diagnostic, but raising the possibility of your being a patient with primary hypogonadism. All the more reason to dig deeper with more labs.

 

[Hoss91]

Thanks for the insight. That's very true to go by how you feel, instead of chasing numbers. I was told by my GP that the topical gels are usually less effective as you outlined. It is something to consider.

Is it possible to receive these injections as self-administered? For example, people with blood clots receive Innohep as a pre-filled, self injection. I suspect not due to the potential abuse and sale to athletes or bodybuilders.

I am also hesitate to go by lab ranges. Labs receive obese patients, anorexic patients, young patients, obese patients, fit patients, not fit patients. As I said above, when I got my testosterone levels tested in May 2015, I was just inside the "normal" range, yet I currently present the same symptomatology.

 

[CoastWatcher]

Thanks for the insight. That's very true to go by how you feel, instead of chasing numbers. I was told by my GP that the topical gels are usually less effective as you outlined. It is something to consider.

Is it possible to receive these injections as self-administered? For example, people with blood clots receive Innohep as a pre-filled, self injection. I suspect not due to the potential abuse and sale to athletes or bodybuilders.

I am also hesitate to go by lab ranges. Labs receive obese patients, anorexic patients, young patients, obese patients, fit patients, not fit patients. As I said above, when I got my testosterone levels tested in May 2015, I was just inside the "normal" range, yet I currently present the same symptomatology.

Don't accept any protocol that doesn't let you self-inject. It's the standard way to proceed. Typically, men inject at least twice a week, many inject every other day, and a few, I am one of them, inject every morning (in my case, 16mg on a daily basis). It's an easy procedure to learn.

 

[Hoss91]

Don't accept any protocol that doesn't let you self-inject. It's the standard way to proceed. Typically, men inject at least twice a week, many inject every other day, and a few, I am one of them, inject every morning (in my case, 16mg on a daily basis). It's an easy procedure to learn.

If that's all it is, than in my opinion, it is not a big deal.

I will report back once I have my appointment with the endocrinologist on the 26th. In the meantime, I will read. Thank you for your help.

 

[CoastWatcher]

If that's all it is, than in my opinion, it is not a big deal.

I will report back once I have my appointment with the endocrinologist on the 26th. In the meantime, I will read. Thank you for your help.

Spend time here on the Forum reading posts, particularly then"sticky" posts. You need to be able to talk the talk with your doctor.

 

[CoastWatcher]

Finally,months be surprised if you come away frustrated. I hope that doesn't happen, but it is an all too common result. The first doctor I consulted holds an endowed chair in endocrinology at the U of T. He was out of his comfort zone.

Keep us posted.

 

[Hoss91]

Finally,months be surprised if you come away frustrated. I hope that doesn't happen, but it is an all too common result. The first doctor I consulted holds an endowed chair in endocrinology at the U of T. He was out of his comfort zone.

Keep us posted.

I do have another question. I understand that libido, morning wood, and erectile dysfunction are the "big three" indicators of low testosterone. I cannot remember the last time I have had morning wood to be honest. Despite the last couple of months, I would say that my libido was normal. I was horny very often, and never had erectile dysfunction. This was the same when I got my levels checked in 2015 when I lifted more often, and was heavier.