** New Labs/Thyroid Panel ** New TRT -- Initial Consult with "Doctor" SMH!!!

[NoHablo]

Team EM,

First, I'd like to say, "thank you!!" This forum is an invaluable resource to those considering TRT -- a very serious decision (obviously)!! I am very impressed with the members of this site (community), respect their commitment and involvement, and appreciate the high-quality information shared here.

Second, I am a 51 years old, 250 pounds (17% body fat), retired GI, who exercises regularly (weights and cardio 4-6 days a week), eats clean, and doesn't smoke or drink. I have experience all of the classic low T symptoms for several years. It's difficult to say when this began as they slowly increased over time. I simply tried to live with them as best I could. Embarrassment and pride kept me from addressing these issues sooner.

Honestly, I can't live like this anymore. It seems like I am fighting myself -- I cannot fight an enemy that I cannot see!

So, finally, after careful consideration, I have decided to pursue a potential TRT solution. Attached are my labs. Please take a look and let me know if there is anything that you think might be helpful to me as I continue my journey to optimal health.

Thanks in advance! Salute!!

 

[Systemlord]

Hello and welcome,

Studies are associating testosterone below 440 with cardiovascular disease, men with high normal testosterone have the least cardiovascular risk and lowest incidence of stroke of those in the middle ranges and lower. Cardiovascular risk only increases as you go lower in testosterone.

If you are considering TRT you might want to consider more testing as you are missing some important tests. It's always a good idea to get a baseline sensitive estradiol (LC/MS/MS method) test as this value will guide your TRT protocol in one direct or the another.

If estrogen is already in a good range (20-35) while testosterone is well below midrange, I wouldn't recommend a protocol that focuses on one large weekly injection, otherwise it will make you estrogen dominant and you won't feel well.

Another important biomarker is SHBG which binds sex hormones testosterone and estrogen, the latter is more weakly bound. SHBG also will guide your TRT protocol, lower SHBG and you may want to focus on frequent injections two or more per week.

TSH looks good, T4 is best midrange, fT3 is missing and the most important. fT3 increases body temperatures and increases metabolism. T4 is converted to fT4 and fT3 is the end result is unknown, fT3 is the most potent thyroid hormone and we don't know where it sits.

Men can lose glucose control when testosterone is low, especially men approaching middle age. TRT can improve morning insulin levels within days, but effects on glycemic control become evident only after 3–12 months.

Red blood cells carries oxygen throughout the body, RBC and hematocrit are all on the lower end, TRT will increase both. Platelet counts is very high, I'll let someone more experienced comment on high platelet and RDW counts. You may need to donate platelets while on TRT from time to time.

If you've had blows to the head, PTSD and or traumatic brain injury as a result of your service, any one of these can affect hormone production.

The hard part will be finding a knowledgeable doctor skilled at TRT under insurance and more so if under the care of the VA, if you are with the VA and considering to have your TRT managed there, please look elsewhere!

I thank you for your service!

 

[Gman86]

Clearly you are in need of TRT. So getting on TRT is a no brainer. Like systemlord said, really wish you had free T3 drawn. Without that, it’s hard to know whether you have thyroid issues or not. And thyroid can make or break how you feel on TRT, so it’s extremely important. I would just start checking your oral temperature every morning immediately upon waking. If it’s not in the high 97’s, or 98’s, there’s a high chance you could have an underfunctioning thyroid. SHBG is absolutely necessary as well. And like he said, knowing where your sensitive estradiol sits would be very beneficial as well.

 

[NoHablo]

SystemLord/Gman86,

Riddle me this; how does doctor establish baseline protocol if no sensitive estradiol, free T3, and more importantly, no SHBG?? Please don't tell me it's a SWAG !!??

 

[Systemlord]

SystemLord/Gman86,

Riddle me this; how does doctor establish baseline protocol if no sensitive estradiol, free T3, and more importantly, no SHBG ?? Please don't tell me it's a SWAG !!

Body fat percentage a good predictor if you will have estrogen sides, as for those others doctors can only guess. It doesn't really matter where SHBG was because TRT is for life and you must play your cards where they fall.

I never had SHBG and estrogen baseline testing done, endo was a dingleberry.

 

[NoHablo]

Systemlord,

Gotcha and understand. Appointment with Doc next week to discuss labs and initial protocol. If all goes well, my journey will begin in short order. Anything you can think of (lessons learned) that I should keep in mind for this discussion ??.....

 

[Systemlord]

Systemlord,

Gotcha and understand. Appointment with Doc next week to discuss labs and initial protocol. If all goes well, my journey will begin in short order. Anything you can think of (lessons learned) that I should keep in mind for this discussion ??.....

If you doctor offers 200mg every 2 weeks, just get up and walk out of the office and don't look back, this would indicate your doctor is inept to manage your TRT protocol.

 

[Gman86]

SystemLord/Gman86,

Riddle me this; how does doctor establish baseline protocol if no sensitive estradiol, free T3, and more importantly, no SHBG?? Please don't tell me it's a SWAG !!??

Pretty easily. For thyroid, just test your oral temperature upon waking, if you have a temp of 98.0-98.9, or even high 97’s, most likely your thyroid isn’t in bad shape. If your temp is low, I would just talk to him about getting the proper thyroid tests done asap, to rule it out. But even if labs look good, but temp is low, it might be worth asking him to trial some thyroid medication. There’s no harm in trying it.

As far as E2, your starting protocol should be fine without that info. Most guys won’t need an ai, and do well just letting E2 end up where it ends up. Just get it on your next bloodwork and you’ll be fine.

I would guess that your SHBG is about mid range. Maybe 20-35. Mine was 50 before I started, and I had literally the exact same free T as you, but my total was close to 700. So with you having the same free T as me, with a much lower total T, I would say your SHBG is about mid range. So I would try to get him to put you on EOD injections, or E3.5D injections.

And for your starting protocol, it’s easy. ALWAYS just start low and go slow. So have him start you on a low dose, like 100mg/week. Do testosterone only at the beginning. If you do test and HCG from the beginning, and don’t feel good, you won’t know if it’s the HCG, or the dosages. You can always add HCG later if you want. But keep it simple at the beginning.

 

[CoastWatcher]

Perhaps I missed it, but did you include a baseline PSA in your testing? It's an essential value to include prior to the start of TRT.

May I ask where you live and what experience your doctor has in androgen management?

 

[NoHablo]

CoastWatcher,

I did baseline PSA. It is 2.0. I am in Northern Va., just outside of Washington, D.C., however, I will be taking a Skype consult, based on a recommendation from a friend. I now know that many of the guys here are with Defy, so if I don't like what I hear, Defy will be my next move.

 

[NoHablo]

Gman86,

Thanks for sharing your experience ... It helps me to contextualize my situation. You have captured my way ahead perfectly ... go low and slow (T-only), while managing/mitigating symptoms/sides along the way !!

 

[Gman86]

Gman86,

Thanks for sharing your experience ... It helps me to contextualize my situation. You have captured my way ahead perfectly ... go low and slow (T-only), while managing/mitigating symptoms/sides along the way !!

Can’t go wrong there. Glad I could help. And Defy is AMAZING, couldn’t be happier with them. So if you end up not being happy with Titan, hit up Defy and they’ll take care of ya. Good luck!

 

[NoHablo]

Systemlord, Gman86,

Thanks for taking time out of your schedules to provide me valuable feedback !! I am deeply appreciative!

Please, don't take lightly the good you (and other EM brothers) do for those who are trying to get their arms wrapped around their health.

My hat goes of to you both -- salute my friends !!

 

[Systemlord]

You're welcome.

Defy Medical is a no brainer, all other places charge a lot more and the doctors at Defy are amazing. I never heard of Titan Medical.

 

[tmaxey1]

I'm a new guy also but I would recommend having your reverse T3 checked. This puts the brakes on your T3 to block the receptors the regular T3. My thyroid function would look acceptable if I didnt pay the extra money to test this also. I found out my T4 is converting in high percentages to reverse T3. This also helped the doctor to give me T3 instead of T4 like they generally start people on.

I was on the fence about having the thyroid test done in the beginning. I finally said to heck with the money. I haven't seen a doctor or had blood work done in 20 years. I may as well run as many test as possible to find out why I was feeling like I had the flu for the last 3 or more months.

Found out at 43 my test was only 177 and my E2 was only 7.
I wish I would have started this sooner.

Good luck to the OP. Its worth it.

 

[Airborne Warrior]

The hard part will be finding a knowledgeable doctor skilled at TRT under insurance and more so if under the care of the VA, if you are with the VA and considering to have your TRT managed there, please look elsewhere!

I thank you for your service!

I applaud the US in the way they look after their veterans. I work alongside many ex-US Special Forces and am amazed and also saddened in the variances between the US and UK aftercare for veterans.

 

[NoHablo]

Had initial consult with "Doctor!" today ... SMH !!!

"... just get up and walk out of the office and don't look back, this would indicate your doctor is inept to manage your TRT protocol (Systemlord)."

Well, let's just say that I followed Systemlord's advice ... I got up, walked out, and didn't look back!!!

Then, I immediately called Defy, scheduled more labs (thanks tmaxey1 and others), and will be working with them "yesterday!!"

UNBELIEVABLE !!! Please tell my I was dreaming ..... Frightening!!

 

[CoastWatcher]

Had initial consult with "Doctor!" today ... SMH !!!

"... just get up and walk out of the office and don't look back, this would indicate your doctor is inept to manage your TRT protocol (Systemlord)."

Well, let's just say that I followed Systemlord's advice ... I got up, walked out, and didn't look back!!!

Then, I immediately called Defy, scheduled more labs (thanks tmaxey1 and others), and will be working with them "yesterday!!"

UNBELIEVABLE !!! Please tell my I was dreaming ..... Frightening!!

Please let us know how this plays out.

 

[NoHablo]

CoastWatcher,

You, Systemlord, and others called it !! This forum prevented me from being "quaked!" Thanks!!

I'll withhold political commentary, but I must say, our system (not just hormone replacement) is broke. How did we get here ?? Anyway...

Will provide updates over time....

Godspeed!!

 

[NoHablo]

You guys were right!! My current labs below, including the recommended missing variables and thyroid panel, proves this point. Please take a look and let me know what you think !!

Total testosterone: 307 (294-916)
Free Testosterone: 7.0 (7.2 - 24.0)
DHT: 22 (30 - 85)
LH: 9.0 (1.7 - 8.6)
Estradiol (LC/MS/MS): 17.6 (8.0 - 35.0)
SHBG: 36.4 (19.3 - 76.4)
T4 Free (Direct): 1.12 (.82 - 1.77)
Free T3: 2.8 (2.0 - 4.4)
Reverse T3: 20.3 (9.2 - 24.1)
TSH: 1.540 (.450 - 4.500)
Prolactin: 10.2 (4.0 - 15.2)

Thanks again, for saving me from a sh*t load of *ss pain !!!

Respectfully,