New Here, TRT Not Going Well for Me

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T-dog

Member
I’m glad to find a forum with some really knowledgeable people, and I have a couple questions, but let me give you my scenario and introduction first.

I’m an otherwise healthy male, 39-years-old, who discovered this year I have low testosterone. I discovered this when I had to change health plans and went in for a physical. They ran a blood test and I noticed my T levels were sitting at 405 ng/dL (lab paper said reference levels were 348-1197).

The physician’s assistant who saw me said they were in the “normal” range, so I shouldn’t be worried. In fact, he didn’t even point it out…I had to bring it to his attention.

I had mentioned things I was worried about in general, and didn’t even know these were symptoms of Low T when I was telling him this (before the blood tests came back):

- My testes had shrunk…they had been pretty large before so unfortunately I know it would be hard for a third party to believe they were smaller

- I usually would have sex 3 times a night with a partner to ejaculation (bedtime, waking up in middle of the night, morning) but after a period of over a year without meeting a woman I finally started going out again and found I wasn’t even able to ejaculate approximately 70%-80% of the time. The sensation of being touched went away as well. I thought this was a huge drop-off since I literally had sex 5 times one night a year-and-a-half before the point I couldn’t even get it up with my current girlfriend (during our first time) and from what I read the drop-off in sexual performance shouldn’t be so sudden in a normal person

- I wasn’t able to sleep throughout the night. I would wake up a couple hours into sleeping and just lie there for hours on end

- I had little to no energy during the day and would constantly be in a state of drifting off to sleep. For the first time in my life I needed coffee a couple times a day in order to stay awake at work.

- I would get occasional night sweats, but not all the time

- I really had no desire to have sex. I may even go over a month without masturbating, and actually had trouble masturbating to completion.

- I had already finished 3 rounds of P90X, and 2 rounds of a pretty intense weight lifting routine…with my diet dialed in…(I’m now in the middle of round 5 of the 12-week weight lifting cycle) and I was barely seeing any results in putting on muscle mass during weight lifting, or fat loss was extremely lower than what it should have been when I was being strict in diet combined with the amount of calories burned

- I no longer had morning erections (or many erections much at all…sorry to be so sex-heavy about all this)

Anyway, I don’t want to go on and on, but these were the symptoms I told him about before the test, and after contacting him, he wrote back: “Thanks for reaching out. The testosterone is on the lower end of normal and may contribute to your symptoms. However there can be many other factors that can cause you symptoms. I do think it is reasonable to have you see an endocrinologist…”.

So luckily I headed over to see her (the Endocronologist).

She took a blood test (she wants to be conservative in treatment since she told me TRT is usually for life) and found my level was no longer 405 ng/dL, it was 285. So she did a third test at a different time of day to make sure I needed TRT, and it came back 319 ng/dL, with 5.7 pg/mL Free Testosterone.

She prescribed me Androgel 1.62% with two pumps. I had high expectations after reading all the reviews online, and was even nervous that might be too much for me…would I start having Roid Rage?...but I felt no difference. No positive benefits, no negative side effects. (actually, let me edit this, I did start to be able to sleep throughout the night. That is one huge positive benefit of being on T)

Three months afterwards was my follow-up, and I told her I felt no different (other than being able to sleep through the night...still low energy and sleepy during the day). She said something to the effect of, “If we raised your levels and you’re still experiencing symptoms, we may have to send you to someone else to figure out what’s wrong.” This had me worried, but sure enough I was in touch with my body enough and I was right…my levels had barely risen. The results came back with 7.2 pg/mL Free Testosterone. She said she didn’t order the total T levels because Free T is more accurate.

Anyway, she upped me to 3 pumps instead of two…and I’m honestly still not noticing anything. This was 9/23 of this year…today is 12/4 (I put the gel on everyday in the morning, right after the shower on my shoulder and upper arm, just like the directions say). I don’t have an appointment to see her for another month.

She also recommended me to a urologist, who said he would see me again after we saw how this round of 3 pumps a day went, but prescribed me Cialis in the meantime. I took it once and my back was sore for half a week. I thought it may have been due to a heavy back workout, so I tried it again and got one of the worst headaches I’ve had in years (don’t normally get headaches) and was sore as well. So I haven’t tried it again. Also, it seemed like it only had minimal help…still had trouble ejaculating if at all.

Anyway, I’m sooooo sorry for the long post. Even if no one responds, it’s helped me organize my thoughts here. Here are the questions:

- What levels should I have as a target for my Free T or Total T? I feel like she wants me to barely hit “normal” for my levels, when I would rather be in the mid to upper range of what a person has. If I’m at 7.3 pg/mL…is she going to cut me off when I get up to 8.7, or should I be aiming higher since the range is 8.7-25.1?

- Do you think she should continue to barely increase my dosage of Androgel until I start to feel something (in which case, I might not know that even more could help me revert to the old me)…or lean more towards gambling to give me enough I might feel negative side effects and then pull back (which she’s probably adverse to, and could cause other problems)?

- Should I see if there is something else I can use besides Androgel? Either another topical, or switch to injectable…or spend another 3-months trying to tweak levels of something that hasn’t had any benefit to me so far? She seemed to be pro-topical because shots will taper T off near the end of the week…but since I’m not feeling any benefit, I’d rather get at least some feeling for some part of the week.

- Since my T levels were low, is it possible that has that kept me from achieving results when working out? I feel like I’m putting in 80% more effort than a normal person to achieve average results.

- Is there any course of action you would recommend next time I see my doctor? (topics I should bring up, way of handling it I haven’t done so far, etc.) I’m worried she is going to think I’m some hypochondriac testosterone-addict (do those even exist) that just wants more and more, thinking it will be a miracle cure.

Thanks for taking the time to read this, for any advice you could give me, and for having a forum for people to get information about this.
 
Defy Medical TRT clinic doctor
Hi T-Dog, and welcome to the forum...you came to the right place!

Nice post and very well stated but so sorry for your condition.

You are without a doubt hypogonadal as your Testosterone serum levels indicate and supported by your symptoms.

Clearly, you are not absorbing the transdermals well as your serum levels did not elevate accordingly...this is not uncommon with transdermals.

You would do much much better with weekly injections as this will guarantee that you will get the testosterone into your bloodstream.

Please know, most Endos and Uros are not trained well in TRT in men unfortunately. You really need to find a TRT Specialist who knows and understands hypogonadism in men.

There are many reasons why your serum levels dropped so quickly; anything from a Pituitary Tumor to Thyroid conditions to simply age-related decline.

For us to really help you we need to see your bloodwork before you started your transdermal.

If you can get those and post them here in this thread complete with ranges that would be great.

Also, I think you may be better cared for with a Physician who only practices hormone replacement in men.

There are a number of clinics here on the site you can call and discuss your options for a better medical evaluation.

Your situation can be fixed but you need to be in the right care for that to happen.

Post your blood work if you can.
 
For us to really help you we need to see your bloodwork before you started your transdermal.

Thanks Gene. It's good to hear there is still hope. It sounds like a daunting process and a lot to go through, but I don't want to spend the rest of my life in this condition when I know there is a better state of being. So I imagine I will do what I have to do.

I will attach the complete pre-transdermal bloodwork results I received, although I don't know if it will have the tests you are looking for since it was a general test. And I attached the bloodwork after three months of treatment in which the doctor says my overall health and thyroid seem to be in good shape.

Do these help at all? And I'm still curious what level I should be aiming for with my Free Testosterone? (I know I asked a lot of questions, and I have more based on your response...but that may be of the most curious to me right now since I know people don't have time to answer everything)
 

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T-Dog, you are missing just about every necessary hormonal lab to make any type of assessment as to why your serum levels are low. Given that your Physician didn't order these leads me to believe that the he/she is not trained in Testosterone Replacement Therapies in men.

This is what you should have had tested:

Testosterone Total
Testosterone Bioavailable
Testosterone Free
DHEA-S
Estradiol (“sensitive” assay only)
Chemistries
CBC
SHBG
LH/FSH
PSA
Prolactin (if T <150, or if sexual dysfunction exists)
DHT
Full Thyroid Panel (not just TSH)

There is no way in the world to know how your Androgen pathway or HPTA is performing without these labs.

Have a frank conversation with your Doctor and ask directly if he/she is fully trained in Testosterone Replacement Therapies in men and have the latest training in this field...I think you may be surprised by the answer.

You need the right care to get better.
 
I'm not surprised all that wasn't ordered from the first place, because they were doing a general blood test to check a bunch of things in general. But yeah, if all that stuff is important, I have no idea what it is from the doctor I'm seeing...or if those were tests she ordered to be done. I believe only have the information she released to me, not the entire test results.

I am going to research and discuss the things you've brought up and talk about injections with my doctor when I see her next month. Then I can take it from there. I see the lowtestosterone.com banner on your site, and upon visiting them on the web see they could be an alternative if I need it.
 
I'm not surprised all that wasn't ordered from the first place, because they were doing a general blood test to check a bunch of things in general. But yeah, if all that stuff is important, I have no idea what it is from the doctor I'm seeing...or if those were tests she ordered to be done. I believe only have the information she released to me, not the entire test results.

I am going to research and discuss the things you've brought up and talk about injections with my doctor when I see her next month. Then I can take it from there. I see the lowtestosterone.com banner on your site, and upon visiting them on the web see they could be an alternative if I need it.


I think Defy Medical would be a much better choice.

www.defymedical.com

Call and ask for Jasen and tell him I told you to call him...you will be in excellent hands.
 
T-Dog, welcome to EM! Fully agree with Gene, you need additional labs, and you should probably look at the advantages and benefits of a clinic like Defy. They have a great staff that can address your needs thoroughly!!

Glad you joined, we're here to help!
 
T-Dog, welcome to EM! Fully agree with Gene, you need additional labs, and you should probably look at the advantages and benefits of a clinic like Defy. They have a great staff that can address your needs thoroughly!!

Glad you joined, we're here to help!

Thank you Chris. I need to educate myself a little more on what all this stuff is so I can be better informed. I kind of just took it for granted I was getting more T so that would fix things.

My plan of action is read more here, contact my doctor to see what she suggests if my levels still aren't good (which i can't imagine they are) and find out how high she'd like me to have them, look at Defy and figure out if they take insurance or if I can afford them, and then do what's best for my health.

I'm pretty healthy and don't hardly ever go to doctors, so I'm not even sure how to stop seeing the one I'm going to if I'm able to do Defy. Something I'll have to figure out, but I imagine its like a painful breakup.
 
Beyond Testosterone Book by Nelson Vergel
T-Dog, your approach and mindset is spot-on! Education will only lead to knowledge. You will gain a wealth of knowledge at this place, that I promise you!

My journey with this also started with my GP, which by coincidence is a female M.D. She didn't have any problem admitting that BHRT and anti-aging therapies was not her strong point. When I went to a specialized HRT clinic, they did not take over as my PCP, they just handle the hormonal part of my health care. My GP still does my health exams and everything else, and she is very supportive with my HRT endeavors. I provide her with detail facts about my protocol, and administration thereof.

Through the years she has gained a better insight to how this all works, and she has seen the results first hand! Heck, the thyroid discussion I had with her one day was worth the copay itself! If anything, it got her thinking a little more about how it all comes together.

Keep an open mind, and you don't have to look at it as a one or the other situation. A specialized clinic like Defy would just be a collaboration to your current health program.
 
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