My Dr. is an idiot I think. Can you guys give me a lil help here please?

[kidcharlemagne]

Hey all,

My urologist seems to be a bit of an idiot where TRT is concerned and thought I’d ask you guys if you think my bloodwork needs more management. I’d really appreciate you taking a look. I should also say that I had a serum blood test a year earlier and had a serum test of 517. I’m 49 years old and suffered from low libido (even with over 500 tests). I took this guys first test unfasted and past noon and here were results:

T3(thyroid) :60 (which is low)
Free test: 1.89
Test serum: 196

First off, should I have even trusted this test given that it was unfasted and past morning? Especially since my test registered over 500 a year ago? Ok so here were my results after trt (.6mg 2xweek). In this case, he took my blood test the morning after I had an injection and I understand that’s not the way to do it. Anyway here’s the data:

Estradiol: 77
LH: 0.18
FSH: 0.26
Prolactin: 15.51
Free Test: 30.28
Serum Test: 839
My Libido is back.

Virtually all those besides the test are out of range, but are they out of range such that they require additional meds do you think? Thanks in advance!

 

[Vince]

It would have been interesting to see a complete thyroid panel with reverse T3. Yes testosterone panels should be done early in the morning on a fasting State especially if you're not on trt. Any chance you can find a new trt Dr.

 

[kidcharlemagne]

Hey all,

My urologist seems to be a bit of an idiot where TRT is concerned and thought I’d ask you guys if you think my bloodwork needs more management. I’d really appreciate you taking a look. I should also say that I had a serum blood test a year earlier and had a serum test of 517. I’m 49 years old and suffered from low libido (even with over 500 tests). I took this guys first test unfasted and past noon and here were results:

T3(thyroid) :60 (which is low)
Free test: 1.89
Test serum: 196

First off, should I have even trusted this test given that it was unfasted and past morning? Especially since my test registered over 500 a year ago? Ok so here were my results after trt (.6mg 2xweek). In this case, he took my blood test the morning after I had an injection and I understand that’s not the way to do it. Anyway here’s the data:

Estradiol: 77
LH: 0.18
FSH: 0.26
Prolactin: 15.51
Free Test: 30.28
Serum Test: 839
My Libido is back.

Virtually all those besides the test are out of range, but are they out of range such that they require additional meds do you think? Thanks in advance!

I realize I should have posted ranges:

Estradiol: 77 (0-47)
LH: 0.18 (1.24-8.62)
FSH: 0.26 (1.27-19.26)
Prolactin: 15.51 (2.64-13.13)
Free Test: 30.28
Serum Test: 839 (185-781)

 

[FeelingLost]

Your numbers are typical for a T mono protocol. Here is my first bloods when my PCP attempted TRT.
You are going to need an AI. If your doc is not willing to give you one you are going to need a new doc.

 

[Sean Mosher]

Before thinking about an AI, are you sure that's the right estrogen test?
Doesn't look like it to be honest...........

 

[madman]

Hey all,

My urologist seems to be a bit of an idiot where TRT is concerned and thought I'd ask you guys if you think my bloodwork needs more management. I'd really appreciate you taking a look. I should also say that I had a serum blood test a year earlier and had a serum test of 517. I'm 49 years old and suffered from low libido (even with over 500 tests). I took this guys first test unfasted and past noon and here were results:

T3(thyroid) :60 (which is low)
Free test: 1.89
Test serum: 196

First off, should I have even trusted this test given that it was unfasted and past morning? Especially since my test registered over 500 a year ago? Ok so here were my results after trt (.6mg 2xweek). In this case, he took my blood test the morning after I had an injection and I understand that's not the way to do it. Anyway here's the data:

Estradiol: 77
LH: 0.18
FSH: 0.26
Prolactin: 15.51
Free Test: 30.28
Serum Test: 839
My Libido is back.

Virtually all those besides the test are out of range, but are they out of range such that they require additional meds do you think? Thanks in advance!

Testing for total t needs to be done fasted and the best time to be tested is between 8-10 am and one should be tested at least twice on different days as endogenous (natural) testosterone levels of a healthy young male rise (peak) in the early morning and are elevated throughout the day and than slowly lower (trough) in the late afternoon/early evening due to the natural (24 hr) circadian rhythm.

You stated your total t 1 year earlier was in the low 500s and it was having labs done past noon. Not sure if you had it tested more than once.

The only symptom you mentioned was suffering low libido. How did you feel overall aside from having a low sex drive regarding energy/mood/erectile function/body composition changes?

You stated that your thyroid test came back low? A dysfunctional thyroid gland can effect libido negatively among many other things and mimic the symptoms of low t.

I think you should have looked into things deeper before jumping on trt, but you are already on now.

Do you have more complete lab work pre-trt/post trt?

Overall one would want to look total t, free t, estradiol (sensitive assay), shbg, dht, prolactin, dhea, LH/FSH, vitamin D, full thyroid panel, cbc (complete blood count) which would include hemoglobin/hematocrit (critical markers) and other health markers to get an overall look at many factors which can effect ones hormonal and body chemistry.

Post trt labs as FeelingLost stated your e2 is high (but looks to be the wrong e2 test?) and your prolactin is high which can lower ones libido among causing other negative issues.

 

[kidcharlemagne]

Before thinking about an AI, are you sure that's the right estrogen test?
Doesn't look like it to be honest...........

It was referred to as estradiol, non-preg, serum. I'm beside myself at this point after seeing what an idiot my doc is. He started me on 240 mg test cyp a week and never even mentioned fertility issues.

 

[CoastWatcher]

It was referred to as estradiol, non-preg, serum. I'm beside myself at this point after seeing what an idiot my doc is. He started me on 240 mg test cyp a week and never even mentioned fertility issues.

He tested you with the estradiol study used for women. It's of no value in men. An AI based on this lab value is senseless.

 

[Systemlord]

You might want to inform your doctor that there's no reason in testing LH and FSH while on TRT, unless there's fertility issues in regards to FSH.

 

[kidcharlemagne]

So if the Doc gave me 240mg a week (120x2) which I've heard is too high a starting dose and I came out with an 839 Test and a 77 E2 (albeit wrong test). Do you think a good doc would try lowering the T dose before adding an AI (after taking the right tEst), or keep the test at 839 and add an AI?

 

[Systemlord]

It's difficult to say if that dosage is too high without having SHBG tested, that would be how we would be able to tell if test levels are too high. I'm also assuming you don't have access to the proper E2 labs, men really require the LC/MS/MS method since the other tests overstate a man's estrogen level.

It sounds like your current doctor is just unskilled and probably won't be able to do much for you. It's not like doctors learn anything about TRT in medical school.

 

[kidcharlemagne]

It's difficult to say if that dosage is too high without having SHBG tested, that would be how we would be able to tell if test levels are too high. I'm also assuming you don't have access to the proper E2 labs, men really require the LC/MS/MS method since the other tests overstate a man's estrogen level.

It sounds like your current doctor is just unskilled and probably won't be able to do much for you. It's not like doctors learn anything about TRT in medical school.

Thanks for consistently responding to my posts. You've been super helpful. Don't DR's typically shoot for an 800-1000ish range regardless of what their shbg level is(which you're right he didn't take)? Plus he took the blood test close to my peak- about a day after injection. I'm trying to stick with this dr since he takes Medicare and I'm on disability so I'm hoping to guide him with expertise from here. I'll have him take the right e2 test and shbg when I see him but I'm trying to figure out if I should lower my dose to something normal , like 150 or 200, so I can see what labs look like under a usual dose in the mean time. I'm not asking you what I should do but what a well informed self-experimenter might try. Thanks

 

[Systemlord]

Thanks for consistently responding to my posts. You've been super helpful. Don't DR's typically shoot for an 800-1000ish range regardless of what their shbg level is(which you're right he didn't take)? I'm trying to stick with this dr since he takes Medicare and I'm on disability so I'm hoping to guide him with expertise from here. I'll have him take the right e2 test and shbg when I see him but I'm trying to figure out if I should lower my dose to something normal , like 150 or 200, so I can see what labs look like under a usual dose in the mean time. I'm not asking you what I should do but what a well informed self-experimenter might try. Thanks

Your welcome, glad I could help.

If this doctor is willing to listen and learn stick with him because it could be next to impossible to find a knowledgeable doctor on Medicare, insurance in general is useless for TRT do to doctors not knowing very much about male hormones. An open minded doctor is usually a good thing, it means he's willing to learn. Try bringing a few studies for your doctor to see, then he might be more willing to listen.

Here --> https://www.excelmale.com/forum/sho...rum-Levels-and-Urges-Testing-for-TRT-Patients

 

[madman]

Thanks for consistently responding to my posts. You've been super helpful. Don't DR's typically shoot for an 800-1000ish range regardless of what their shbg level is(which you're right he didn't take)? Plus he took the blood test close to my peak- about a day after injection. I'm trying to stick with this dr since he takes Medicare and I'm on disability so I'm hoping to guide him with expertise from here. I'll have him take the right e2 test and shbg when I see him but I'm trying to figure out if I should lower my dose to something normal , like 150 or 200, so I can see what labs look like under a usual dose in the mean time. I'm not asking you what I should do but what a well informed self-experimenter might try. Thanks

Truthfully what matters is your relief/improvements in your low t symptoms whether that requires men to have testosterone levels (trough) in the mid-normal or high-normal physiological range.

Many men do well with testosterone levels in the mid- normal range where as others need to have levels in the high-normal range.

Some doctors do aim to have their patients levels closer to the higher end but it does not mean that is what is always needed!

If your total t was 839 ng/dl the day after your injection than it would be when your levels are increasing as peak is usually (24-48 hrs) post injection and 839 is by no means high for a peak.

 

[nagami]

Loving this thread!