My initial bloodwork

[MikeK]

After reading Nelson's book I decided to talk to my doctor about my symptoms.

I have had a lot of problems with being able to focus in the past, and all i was prescribed was brain stimulants that did more harm than good.

After i passed 29 years of age i became obese and working out seemed worthless. The more i work out all i seemed to gain was fat in my belly.

I got depressed and was diagnosed with OCD and put on antidepressants.

I am now 31 and my doctor ran an initial blood work, my total t levels came back at 210ng/dl

He then waited a month and ordered another test (Attached). It is more detailed

He diagnosed me with low t and referred me to a urologist to start treatment.

I hope i can finally start living again.

 

[CoastWatcher]

You have every reason for being hopeful. Most of us, those like myself who are new to TRT and still adjusting our protocols, and those, such as the moderators, who are experienced in the intricacies of the entire process, can relate to the emotional and physical challenges you have been through.

You our will find a supportive community here!

 

[Vince]

Hi Mike, your testosterone definitely does look low, I use defy medical for my TRT http://www.defymedical.com/ but there are many good clincs and doctors out there, also a lot of bad ones.

 

[MikeK]

Thank you CoastWatcher! Excited to be part of the community

 

[MikeK]

I use defy medical for my TRT http://www.defymedical.com/ but there are many good clincs and doctors out there, also a lot of bad ones.

Thank you Vince.

I wish defy medical has a location close to me. I live in a small town in SC.

My PCP recommended a urologist with a great reputation in male hormone replacement therapy.

Ill see him in a couple of days.

 

[Tom Larabee]

Mike - Defy is national and you don't need to go to an office to use them.

 

[MikeK]

Mike - Defy is national and you don't need to go to an office to use them.

Tom,

I went over their website last week but would rather have a local doctor I can visit every couple of months.

I would like to learn more about the cause of my low t.

My insurance should also cover the cost of office visits and treatment.

If my appointment tomorrow doesn't go as i expect, i will definitely call them up.

 

[Vince]

Mike, let us know how it goes with the urologist, I saw three endocrinolgist in Wisconsin and was disappointed. That's why I decided to go with defy.

 

[MikeK]

Mike, let us know how it goes with the urologist, I saw three endocrinolgist in Wisconsin and was disappointed. That's why I decided to go with defy.

Vince,

I visited my new urologist today and took a copy of my bloodwork. He discussed my options on TRT but recommended i start treatment with injections. He prescribed 2 small 1/ml vials of testosterone cypionate (200mg/ml) and said to inject 1 vial today and the other in 14 days. I go back and see him in a month for new blood work. He also gave me 5 refills to cover me thru September.

I watched a video on youtube and learned how to inject myself. I did my first injection in my thigh muscle.

Best of all, my insurance is paying for it. My copayment for 2 vials was $8.

I told him about HCG he said he will start me on that after 30 days.

I will give it a couple months, hopefully i can feel a difference.

 

[Vettester Chris]

Mike, as noted, we are glad you joined, welcome to the community.

I don't want to come off harsh, abrasive, or negative in anyway, I promise this isn't my intention, BUT (there's always a but) ... There are all sorts of things WRONG with how your program is starting out ...

Starters ... 200mg of C or E injected every two weeks is no good!! Here's what happens, serum levels will peak at/around Day 2 to 3, half life is at around Day 7, by Day 14 you probably won't be baseline, but you're heading that direction real fast. Your serum levels between day 3 to day 14 will probably fluctuate 700ng/dl points (give or take). The best option if you have 200mg to work with, please do 50mg every 3.5 days, or worse case 100mg one time per week.

Additionally, nothing appears to be addressed on E2. Quite possibly yours could be currently above a desired level. A 200mg injection is going to convert at a higher rate downstream to estrogen. This needs to be managed, there's no way around it. The more frequent injection protocols will be less problematic, as conversion becomes less of an issue. Estradiol sensitive labs need to taken baseline, and at your six week checkup. Also, you can inject SubQ with smaller syringes if that works easier for you.

They ran a FSH lab, but they also needed a LH lab to accompany it. LH is the key hormone that is triggered by endogenous testosterone, or should I say it's demand is increased when testosterone serum levels decline. Your FSH is pretty low, so I would suspect your LH will follow suit (?). If so, that would make your diagnosis "Secondary". HCG could be administered immediately, but the adjustments to your current exogenous test protocol will have to be considered, as HCG "should" provide an increase in endogenous test, permitting the leydig cells are healthy.

Lastly, there's an entire litany of other labs that need addressed .. Thyroid, adrenals (cort/DHEA), Vitamin D, iron, ferritin, metabolic, lipids, etc. Maybe some of these labs are present, just not posted? By what you've described, I wouldn't be surprised if there are also thyroid issues. If they're just looking at TSH, and or any of that T3 Index bologna, then it's not being addressed correctly. This is why clinics like Defy are getting attention, plus others and the A4M physicians community.

We're here to help, but again, I'm not going to sugarcoat something when it's not all that sweet. If it's not a good deal, and I already know you're not going to be feeling all that great in a few months, then what's the point? Now, with that said, I'd suggest you really do some heavy research and see what you think. Check out other boards if needed, heck, talk to Jasen at Defy, or contact some of the other reputable clinics, or physicians like Dr. Crisler, Dr. Gaines, etc., I could go through a big list on this.

 

[CoastWatcher]

Vince,

I visited my new urologist today and took a copy of my bloodwork. He discussed my options on TRT but recommended i start treatment with injections. He prescribed 2 small 1/ml vials of testosterone cypionate (200mg/ml) and said to inject 1 vial today and the other in 14 days. I go back and see him in a month for new blood work. He also gave me 5 refills to cover me thru September.

I watched a video on youtube and learned how to inject myself. I did my first injection in my thigh muscle.

Best of all, my insurance is paying for it. My copayment for 2 vials was $8.

I told him about HCG he said he will start me on that after 30 days.

I will give it a couple months, hopefully i can feel a difference.

The straight talk from Chris is right on the money. The initial doctor I consulted prescribed a protocol very similar to the one you were given. I had to find a more informed physician, and was fortunate that I was able to. You should consider seeking medical guideance from another source.

You are hardly the first member of the forum to be told this. Many have struggled to find a doctor who is in top of things. All the best.

 

[MikeK]

Mike, as noted, we are glad you joined, welcome to the community.

I don't want to come off harsh, abrasive, or negative in anyway, I promise this isn't my intention, BUT (there's always a but) ... There are all sorts of things WRONG with how your program is starting out ...

Starters ... 200mg of C or E injected every two weeks is no good!! Here's what happens, serum levels will peak at/around Day 2 to 3, half life is at around Day 7, by Day 14 you probably won't be baseline, but you're heading that direction real fast. Your serum levels between day 3 to day 14 will probably fluctuate 700ng/dl points (give or take). The best option if you have 200mg to work with, please do 50mg every 3.5 days, or worse case 100mg one time per week.

Additionally, nothing appears to be addressed on E2. Quite possibly yours could be currently above a desired level. A 200mg injection is going to convert at a higher rate downstream to estrogen. This needs to be managed, there's no way around it. The more frequent injection protocols will be less problematic, as conversion becomes less of an issue. Estradiol sensitive labs need to taken baseline, and at your six week checkup. Also, you can inject SubQ with smaller syringes if that works easier for you.

They ran a FSH lab, but they also needed a LH lab to accompany it. LH is the key hormone that is triggered by endogenous testosterone, or should I say it's demand is increased when testosterone serum levels decline. Your FSH is pretty low, so I would suspect your LH will follow suit (?). If so, that would make your diagnosis "Secondary". HCG could be administered immediately, but the adjustments to your current exogenous test protocol will have to be considered, as HCG "should" provide an increase in endogenous test, permitting the leydig cells are healthy.

Lastly, there's an entire litany of other labs that need addressed .. Thyroid, adrenals (cort/DHEA), Vitamin D, iron, ferritin, metabolic, lipids, etc. Maybe some of these labs are present, just not posted? By what you've described, I wouldn't be surprised if there are also thyroid issues. If they're just looking at TSH, and or any of that T3 Index bologna, then it's not being addressed correctly. This is why clinics like Defy are getting attention, plus others and the A4M physicians community.

We're here to help, but again, I'm not going to sugarcoat something when it's not all that sweet. If it's not a good deal, and I already know you're not going to be feeling all that great in a few months, then what's the point? Now, with that said, I'd suggest you really do some heavy research and see what you think. Check out other boards if needed, heck, talk to Jasen at Defy, or contact some of the other reputable clinics, or physicians like Dr. Crisler, Dr. Gaines, etc., I could go through a big list on this.

Chris,

Thank you for the detailed post. Maybe i didn't give much details about the visit.

First i told him i prefer injecting weekly instead of bi-weekly. He was open to it but insisted my first month i inject twice. In 1 month, after my first visit and blood work he will prescribe a 10ml vial (100mg/ml) or tell me to split current refills i have into 2 weekly shots.

Second he ordered new blood work with LH and estrogen levels included and insisted i draw blood prior to my first injection. Got my results in today (attached). Not sure how my levels compare.

Thank you for the pointers. I will discuss a lot of the other issues with him during my next visit.

 

[CoastWatcher]

Did your doctor explain why he "insisted my first month i inject twice?"

 

[MikeK]

Did your doctor explain why he "insisted my first month i inject twice?"

I believe he was worried about me injecting at home. I told him i never did it before but i learned how on youtube. He was kinda surprised and resisted at first. Until i told him my sister is a nurse and she will teach me (total b/s). I guess he didnt want me shooting myself twice a week myself until he made sure im doin ok in 30 days.

It was simple thanks to youtube and nelsons videos.

 

[Gene Devine]

I can't add on to anymore than what Chris did or I'd have an identical post.

Your Urologist is not trained properly in TRT for men.

For starters, as Chris noted, they should have ran significantly more labs to determine what might be causing your Hypogonadism at such a young age. I highly doubt this is age related androgen decline so something else may be wrong with you. All pathologies must be weeded out first BEFORE starting TRT.

I didn't see anything about the use of HCG in your protocol nor any estrogen eval to determine if increased E2 may be an issue on your protocol.

I didn't see hematocrit nor PSA which are must labs before starting TRT.

If we've seen it once here we've seen it a thousand times; your Doctor isn't trained in TRT for men and he is probably going to really screw you up even more here shortly.

I would have an open and frank discussion with him about his indepth knowledge of hormone replacement protocols with men and does he feel he's at the top of the TRT game when it comes to caring of men?

This is VERY IMPORTANT for your health.

Read in here in all the forums and stickies and once you start to learn and see what he's not doing you will understand.

 

[ERO]

100% agree with Vettsester Chris!

200 mg every 2 weeks is far more likely to make you feel worse instead of make you feel better for all of the reasons he already outlined. If you have to stick with this Dr, at least ask him if you can self-inject and then pin 50 mg twice a week instead of 200 mg every 2 weeks. He might say "no" but its worth asking.

A better option is a different clinic. I am in the midst of switching to Defy Medical right now and I like what I see so far.

 

[Vettester Chris]

As suspected, the LH followed suit with FSH, appears to be secondary; meaning the pituitary isn't producing a sufficient amount of GnRH to LH or FSH. It's usually common in younger patients to run an MRI when gonadotropin levels are suppressed, or other issues like hyperprolactinaemia are present. Again, just something to research. An MRI was probably the first event that took place on my end at age 41, just to cover the bases.

Your E2 lab is a standard assay used for females. The measurement accuracy and value range is vastly different with the "sensitive" platform. Again, not to sound like the dark cloud of the place, but IMO it's virtually impossible to "effectively" manage the E2 portion of your program with that standard lab. You could be 5, 10, even 15 points out of the desired range area with the sensitive assay, but that other lab might only deviate a few points either way, plus it just shows anything < 57pg/ml is good.

What I'm trying to say is if your labs are 22pg/ml, 42pg/ml or 2pg/ml on that platform, what does that mean to you and your physician? If it is those values on a sensitive assay, every properly trained HRT physician in the country will know exactly what that means, and they will have a good idea what steps are or are not needed to effectively manage your protocol.

Yeah, that Vitamin D3 lab needs addressed. My suggestion, look into some therapeutic levels of D3, or even talk with your doctor about a script of Drisdol, which is 50,000iu, 1x per week. You can do Drisdol for a month or two, then just move over to D3 oral, or I've actually preferred D3 injections, which can be stacked easily with a testosterone shot. The D3 result also just emphasizes that you need to really take a close look at the thyroid. Low test, low D3, in many cases go hand-n-hand with some sort of thyroid issue.

Keep us posted ... Thanks