New Member & Newly Diagnosed

[Dukedvl]

First off, thank you for everyone who posts on these forums. I have learned a lot of valuable information from going through theses posts as well as the books I am in the process of reading.

I'm 42 years, 5’9”, 175lb, exercise some but could be more

Like many of you, I was having low energy/brain fog/loss of libido among other symptoms. It started so long ago that I don’t remember when it started. I had gone to doctor three times over the past 3 years complaining of these symptoms. Each time they tested to see if I was anemic and then said I was probably just stress, anxiety, and depression. They wanted to put me on a SSRI to help. Since I didn’t think that was the issue I never went on them.

Fast forward to four weeks ago. I went in with the same symptoms and just told the new doctor that something isn’t right. No matter how much I sleep, I am always rundown. She again tested to see if I was anemic which came back negative but she also ordered other tests including testosterone. I went back two days later to find out I had low levels of vitamin D (8.9 ng/mL), B12 (172 pg/mL) and testosterone (168 ng/dL). She said all three of those could have me feeling rundown and didn’t know how I was functioning. I already knew I had low vitamin D as I was diagnosed with osteoporosis about 10 years ago. I could not tolerate any of the osteoporosis drugs so I have pretty much just been on calcium and vitamin D but I guess it wasn’t enough. I wish the doctor 10 years ago would have thought to check my testosterone levels at that time as I wonder how it could be related.

I also found out I had high cholesterol/triglycerides and my liver enzymes were high. She put me on a 50,000 IU of vitamin D weekly, monthly B-12 injections, and fenofibrate for the cholesterol/triglycerides. She said she was not knowledgeable enough to treat me for the testosterone and referred me to a urologist.

I met with the urologist last week. He went through the standard questions and an overview the different treatment options. He said some work better than others depending on your body chemistry, said I should do some research to see which method I am most comfortable with and we could discuss them in more detail when I came back for my follow up. He ordered blood work and said the insurance company usually requires two low samples taken around the same time before they would approve anything.

The first test from a week ago (8:50am) came back at 178 ng/dL. He also tested for other things and everything came back within the acceptable range except for ALT was still high. There were some at the high and low end of the ranges though (Estradiol, Prolactin, AST)

I just had the second testosterone test a week later at 9am and it came back at 334 ng/DL. I was not expecting to see it almost double. Keep in mind I have not had my follow up visit to discuss any of the test results and what they mean. That is in another 2 weeks.


Questions I have:

1. Is it normal to see such a large fluctuation in testosterone from one week to the next and what could have caused the jump (1st-168, 2nd-178, 3rd-334)?
2. Will this latest testosterone result that now is in the “acceptable range” cause insurance not to approve treatment?
3. The doctor did not test for free testosterone or SHBG which I think I am going to ask so that I have a baseline. Any others I should have tested?
4. Should I wait for the vitamin D, B-12, cholesterol, and liver enzymes to get into the normal range before starting TRT?
5. I’m considering seeing an endocrinologist to do more thorough testing for thyroid/pituitary. Do you think this would be beneficial?

Any other advice you have would be greatly appreciated. I have been reading so much over the past three weeks as I want to make an informed decision. I'll include the blood results I have below in case it will help.




8/13/18 (GP):




8/30/18(Urologist):


9/6/18 (Urologist):

 

[Systemlord]

One who is low testosterone long enough and accompanied by low estrogen would expect to be diagnosed with osteoporosis, estrogen is required for bone mineral density. My sister got osteoporosis 20 years after menopause do to low estrogen, she fell on her back and found out the hard way. Restoring testosterone will increase estrogen may help you with your osteoporosis, but it will take time to put bone back in bone.

I will however give your doctor credit for ordering the correct estrogen test, we rarely see it

I'm concerned about any doctor failing to run SHBG and free testosterone though, this is where I usually tell the member to start looking for an new doctor. SHBG guides injection frequency, I'm a low SHBG guy and require frequent injections EOD or everyday, otherwise it's like injecting water.

You're labs are indicating primary failure, testicles are damaged. LH is midrange and total testosterone should be as well. Probably a mixture of both primary and secondary.

The low Vit D in my case was caused by low testosterone, went on TRT and Vit D magically went back up on it's own. When one or more hormones are out of balance, it can disrupt so may others including Vit D.

I must warn you the majority of endocrinologists have no clue how to do TRT, endocrinologists usually do thyroid and diabetes and not TRT, finding a knowledgeable one will be your biggest challenge. In my case I went private, all my endo's randomly changed my TRT protocol when they had no clue what they were doing.

You spend a couple hours reading on Excelmale and take these concerns to your endo and get used to the deer in headlights look on their faces. Almost no time is devoted to male/female hormones in medical school, however anti-aging and sports medicine has been doing TRT for 40+ years.

 

[Dukedvl]

Thanks for the feedback! I had similar concerns as you about the tests not being ordered. They did change me over to a nurse practitioner on my first visit as the doctor/urologist was double booked. I wonder if the tests ordered would have been different if I had seen the doctor. My follow up to review results and treatment options is scheduled with one of the doctors. Hopefully they are ready for my concerns and questions.

 

[MarkM]

Your hemoglobin and hematocrit, while within range, are on the higher end of the range. When and if you start TRT these levels will typically rise so you will have to monitor those levels (as we all do).

Prolactin, while within range, is definitely on the high side.

Curious, are you a smoker?

 

[Dukedvl]

Your hemoglobin and hematocrit, while within range, are on the higher end of the range. When and if you start TRT these levels will typically rise so you will have to monitor those levels (as we all do).

Prolactin, while within range, is definitely on the high side.

Curious, are you a smoker?

Thanks for the reply. I have never smoked. When I was younger, I did have lung issues that required surgeries. Since that time my oxygen saturation usually stays around 95% which is at the low end of the normal range. Not sure if that would contribute to the hemoglobin and hematocrit being near the high range.

To help with the triglycerides, I have stopped drinking sodas and pretty much only drink water as well as many other dietary changes. I have also increased my exercise activity. From what I have been reading, those should also help the hemoglobin and hematocrit but I'm not sure how much or how quickly.

I will make sure to bring that up during my follow up visit with the doctor.

 

[MarkM]

Thanks for the reply. I have never smoked. When I was younger, I did have lung issues that required surgeries. Since that time my oxygen saturation usually stays around 95% which is at the low end of the normal range. Not sure if that would contribute to the hemoglobin and hematocrit being near the high range.

To help with the triglycerides, I have stopped drinking sodas and pretty much only drink water as well as many other dietary changes. I have also increased my exercise activity. From what I have been reading, those should also help the hemoglobin and hematocrit but I'm not sure how much or how quickly.

I will make sure to bring that up during my follow up visit with the doctor.

Since your oxygen saturation is around 95% it is possible that you are making more red blood cells to help carry oxygen which would increase your hemoglobin and hematocrit but your RBC count is not high. So, yes, just follow up with your doctor on that.

 

[Systemlord]

Sleep apnea sufferers also see hemoglobin and hematocrit increase do to the lack of proper breathing and oxygen deprivation.

 

[LTChris]

I would definitely get a more comprehensive thyroid panel done. Thyroid therapy can be a game changer when needed. optimal thyroid is necessary to get the most out of trt as many here will attest.