New to Site - First TRT Appointment Soon

[cfarone]

I am a 47 year old male who has been dealing with very low energy and brain fog for the last 13 months. My primary care physician sent me to a Neurologist who conducted an MRI which came back normal. Referred me to a audiologist and test came back fine. I asked about low testosterone and the doctor said that was not the issue without testing. Now 13 months later my neurologist tested my testosterone at my request and it came in at 228 with the low being 241 high 827 on the specific lab report. Also, my pm cortisol tests was 1.7 with a range of 3.1 to 16.7. Could the results of these test be the cause of my lack of energy.

I am going to see a Urologist on Thursday who has experience in TRT. My question is this; should I see an endocrinologist as well. My Primary Care Physician referred me to an endocrinologist and said that the endocrinologist would likely be better as they specialize in hormones.

Any advice would be appreciated.

 

[CoastWatcher]

I am a 47 year old male who has been dealing with very low energy and brain fog for the last 13 months. My primary care physician sent me to a Neurologist who conducted an MRI which came back normal. Referred me to a audiologist and test came back fine. I asked about low testosterone and the doctor said that was not the issue without testing. Now 13 months later my neurologist tested my testosterone at my request and it came in at 228 with the low being 241 high 827 on the specific lab report. Also, my pm cortisol tests was 1.7 with a range of 3.1 to 16.7. Could the results of these test be the cause of my lack of energy.

I am going to see a Urologist on Thursday who has experience in TRT. My question is this; should I see an endocrinologist as well. My Primary Care Physician referred me to an endocrinologist and said that the endocrinologist would likely be better as they specialize in hormones.

Any advice would be appreciated.

You have been wandering in the valley of medical ignorance for 13 months - you've deserved far better care than you have received. In answer to your first question, your hypogonadism that was revealed in the initial lab work could certainly account for the symptoms you described. Far more testing is necessary, as I'm sure you know, but TRT may well be a course of action for you.

As for who you should turn to for treatment, urologist or endocrinologist, it really doesn't matter the specialty designation if the doctor knows how to manage men on androgen replacement. That said, most doctors - regardless of specialty - have no idea how to play this game. The vast majority of us experienced this first hand; we were maltreated by endocrinologists, urologists, internists...you name it.

So, what to do? Keep the appointment you have with the urologist. Read all you can here on the Forum about hypogonadism and treatment protocols. We have to become our own advocates. Ask questions here, and if what a doctor tells you seems wrong, don't hesitate to seek better care.

First of all, you need to demand proper testing: a repeat of what you've run along with CBC, CMP, SHBG, prolactin, estradiol/sensitive (LC, MS/MS), PSA, DHT, DHEA, thyroid (TSH, ft3, ft4, rt3, both antibody panels).

Let us know how it all unfolds.

 

[cfarone]

Thank you so much for the advice, it is greatly appreciated. I am doing as much research as I can prior to the appointment so I can ask well educated questions. I am hoping that I am finaly on the right track to feel normal again. You certainly do not appreciate good health until its gone.

 

[CoastWatcher]

Thank you so much for the advice, it is greatly appreciated. I am doing as much research as I can prior to the appointment so I can ask well educated questions. I am hoping that I am finaly on the right track to feel normal again. You certainly do not appreciate good health until its gone.

For many of us, TRT was a life-changing therapy. I wish you well - you certainly have the right attitude.

 

[Nashtide]

I am a 47 year old male who has been dealing with very low energy and brain fog for the last 13 months. My primary care physician sent me to a Neurologist who conducted an MRI which came back normal. Referred me to a audiologist and test came back fine. I asked about low testosterone and the doctor said that was not the issue without testing. Now 13 months later my neurologist tested my testosterone at my request and it came in at 228 with the low being 241 high 827 on the specific lab report. Also, my pm cortisol tests was 1.7 with a range of 3.1 to 16.7. Could the results of these test be the cause of my lack of energy.

I am going to see a Urologist on Thursday who has experience in TRT. My question is this; should I see an endocrinologist as well. My Primary Care Physician referred me to an endocrinologist and said that the endocrinologist would likely be better as they specialize in hormones.

Any advice would be appreciated.

Welcome aboard. The single biggest mistake newbies make is disregarding the advice of experienced TRT users. They get started on totally ridiculous protocols then change those dumb protocols for other dumb protocols and complain that TRT isn't helping. Happens every week. If you don't want to waste months trying to get this right, then read everything on this site and listen to the folks that are dialed in and loving life. It's a decent chance the urologist will be clueless. You need to be your own advocate. Please come back with all your labs with ranges and the protocol this new doc comes up with. Best of luck.

 

[cfarone]

Thank you for the advice. I will post lab results and prescribed protacal once I have a plan.

 

[cfarone]

Update: I saw a Urologist today and he reviewed all of my previous medical history to include my testosterone of 228. He noted that I had low T (hypogonadism) and that with my symptoms should begin Testosterone Therapy. He ordered additional tests prior to starting 200 MG of Testosterone Cypionate with an injection every 14 days. The additional tests are Hematocrit, PSA Diagnostic, Prolactin, Total Testosterone and Free T.

I noted that more frequent injections might provide better results by decreasing the fluctuations in my Testosterone Levels. He stated that we could start and 200 MG every 14 days and make adjustments as required. He has also ordered a Testosterone Blood test for 2 days after my 1st injection to record my high T reading.

The journey begins.

 

[Nashtide]

Update: I saw a Urologist today and he reviewed all of my previous medical history to include my testosterone of 228. He noted that I had low T (hypogonadism) and that with my symptoms should begin Testosterone Therapy. He ordered additional tests prior to starting 200 MG of Testosterone Cypionate with an injection every 14 days. The additional tests are Hematocrit, PSA Diagnostic, Prolactin, Total Testosterone and Free T.

I noted that more frequent injections might provide better results by decreasing the fluctuations in my Testosterone Levels. He stated that we could start and 200 MG every 14 days and make adjustments as required. He has also ordered a Testosterone Blood test for 2 days after my 1st injection to record my high T reading.

The journey begins.

Remember I mentioned stupid protocols? Here's exhibit 1. This protocol sucks. No other way to say it. Here's my prediction for the future. You will come back here a few days after the first shot talking about how amazing you feel. Libido, morning wood, mood etc. Then... you will come back and ask what happened? I feel like shit. Libido is gone. Acne on my back. Emotional instability etc. I know this sounds harsh, but your doc doesn't have a clue.

 

[Saul]

Everyday there are these posts detailing terrible doctor care. Makes me appreciate my Dr. I complained of the same thing and after one blood draw and tests he identified everything - and my T was higher than yours. Cfarone - Dr are put on a pedestal and really looked up to by society. There are many good ones, but you need to question their advice and know they often give bad advice and treatment. Nashtide gives good advice - listen to the advice from this forum. My opinion is that 200 mg of T cyp is too high to start and every 14 days it too long between injections.

 

[CoastWatcher]

He's incompetent. From the protocol he prescribed to the day he wants to draw blood...I would call it unbelievable if we didn't see it here day after day.

https://www.excelmale.com/forum/sho...-Testosterone-Injections-Every-Two-Weeks-Fail

Here is the 11 year old study that shows, without doubt, that injecting every two weeks will lead to failure. You deserve better care.

 

[Saul]

I was not very constructive. Since your Dr said he was willing to adjust, another option is to ask him if you can start slow. Most Dr are ok with starting with less. Maybe he/you would go with 50 mg per week, with weekly shots as a starting point. Not perfect but a compromise starting point to see how it works for you. As a reference point, I inject every 3 days, weekly total is about 93 mg. 28 gauge needle. Total T stable at ~650 tested right before injection. Different things work for different people, but like Coastwatcher said, it is very unlikely you will be happy long term at 200 mg every 2 weeks.

 

[cfarone]

Thank you for the advice and I agree that it makes more sense to inject weekly instead or every 14 days. I made that recommendation to the Doc and he said that 200 mg every 14 days was the standard measure of care. To be perfectly honest, I was simply happy he was prescribing Testosterone!!! I am going to try what the doctor recommended and adjust as required. I would prefer 100 mg 1 time per week and will adjust in 14 days. Again, I appreciate your input.

 

[cfarone]

As instructed by my doctor, I had blood draw prior to taking my first ever Testosterone injection. Received the results today and my Testosterone was 400. How can this be, it was 228 just over a month ago?

 

[CoastWatcher]

As instructed by my doctor, I had blood draw prior to taking my first ever Testosterone injection. Received the results today and my Testosterone was 400. How can this be, it was 228 just over a month ago?

Depends on the timing of the blood draw, for one thing. Endogenous testosterone is at its highest in the morning. There is also normal serum variation between draws.

 

[cfarone]

The reading of 228 was at around 3 and the reading of 400 was at 10:30 am.

 

[CoastWatcher]

The reading of 228 was at around 3 and the reading of 400 was at 10:30 am.

So, as is typical, your morning level was higher than one drawn later in the day. Diagnostic blood-draws should always be done in the morning. That said, your morning value is not impressive.

 

[cfarone]

Ok, I was getting concerned that I started testosterone injections right after I had my blood drawn. My doctor made the diagnosis of hypogonadism based off the 228 reading.