New to the Forum...started TRT 2 months ago

[jasinc81]

Hello everyone..I've been casually reading through these forums the past few days and thought I would register and tell my "story". I'm 36 years old, and started TRT about 2 months ago after a year and a half of dieting and possibly "over-training". After finally convincing my doctor to have some tests, it was pretty clear my Low T was an issue. My symptoms were major fatigue, lack of stamina, ZERO libido, and inability to lose fat or gain muscle. Here are my initial test results (just total tests were done initially, but in June a test, free test was done):

11/16: 161.4 ng/dL
12/16: 280.3 ng/dL
1/17: 173.9 ng/dL (SHBG: 36 nmol/L | FSH: 4.4 | LH: 1.0)
3/17: 243.7 ng/dL
5/17: 294.9 ng/dL (FSH: 5.7 | LH: 1.4 )
6/5: Test Free: 51.7 pg/mL

In Feb 2017 I was able to finally get in and see an endo and he initially started me on a month of clomid to see if that would kick things back up. That didn't quite help as my test was only raised a bit but the symptoms continued to worsen. The doctor finally agreed to start me on a TRT protocol and I started the first week in July. He prescribed my fortesta gel 40MG (4 pumps, 2 on each thigh everyday). Since starting this, I have noticed my mood and focus has gotten a little better, but I still have ZERO libido. Also, I have gained a significant amount of weight (~15lbs), mostly around my waist. My diet is very strict (~2000-2400 calories a day), and I workout 6 days a week for 45min-1hr. Just wondering if this is normal or whether there might be some other underlying issue. Also, does the libido come back slowly? Or should I experience something by now. I just did some bloodwork the other day and I'm waiting for the results as I have a follow-up appointment next week. I appreciate any insights as I hope to get on the right path towards recovery.

 

[CoastWatcher]

Absent labs, we're only guessing as to what might be going on. With that in mind, be aware that a high percentage of men fail to respond to gels and creams (I was one of them). You mentioned that you had a poor workup from your primary care provider, did the endocrinologist do a full-scale appropriate battery of labs?

 

[jasinc81]

Absent labs, we're only guessing as to what might be going on. With that in mind, be aware that a high percentage of men fail to respond to gels and creams (I was one of them). You mentioned that you had a poor workup from your primary care provider, did the endocrinologist do a full-scale appropriate battery of labs?

Yes, sorry. There are other tests done but I just focused on the main ones to prevent the initial post from being long-winded. Here's all the blood tests that were done in January when I initially saw the Endo, the first follow-up in March after Clomid, and then a couple months later (to see if I would rebound before starting TRT):

January 16, 2017:
PROLACTIN 6.1 ng/mL 2.1 - 17.7 ng/mL
FSH 4.4 mUnits/mL 1.4 - 18.1 mUnits/mL
LH 1.0 mUnits/mL mUnits/mL
TSH 1.822 mcUnits/mL 0.350 - 5.000 mcUnits/mL
T4, FREE 0.9 ng/dL 0.8 - 1.5 ng/dL
SHBG 36 nmol/L 11 - 80 nmol/L
Testosterone Male 173.9 ng/dL 280.0 - 1,100.0 ng/dL

March 27, 2017: (After Clomid treatment)
Testosterone Male 243.7 ng/dL 280.0 - 1,100.0 ng/dL


June 5, 2017:
Testosterone Male 294.9 ng/dL 280.0 - 1,100.0 ng/dL
Testosterone Free Males ED 51.7
FSH 5.7 mUnits/mL 1.4 - 18.1 mUnits/mL
LH 1.4 mUnits/mL mUnits/mL
PHOSPHORUS 3.7 mg/dL 2.4 - 4.7 mg/dL
Comprehensive Metabolic Panel:
Fasting Status 13.0 hrs
Sodium 144 mmol/L 135 - 145 mmol/L
Potassium 4.9 mmol/L 3.4 - 5.1 mmol/L
Chloride 109 mmol/L 98 - 107 mmol/L
Carbon Dioxide 25 mmol/L 21 - 32 mmol/L
Anion Gap 15 mmol/L 10 - 20 mmol/L
Glucose 76 mg/dL 65 - 99 mg/dL
BUN 52 mg/dL 6 - 20 mg/dL
Creatinine 1.17 mg/dL 0.67 - 1.17 mg/dL
GFR Estimate, African American >90
eGFR results = or >90 mL/min/1.73m2 = Normal kidney function.
GFR Estimate, Non African American 80
eGFR 60 - 89 mL/min/1.73m2 = Mild decrease in kidney function.
BUN/Creatinine Ratio 44 7 - 25
CALCIUM 9.5 mg/dL 8.4 - 10.2 mg/dL
TOTAL BILIRUBIN 0.4 mg/dL 0.2 - 1.0 mg/dL
AST/SGOT 35 Units/L <38 Units/L
ALT/SGPT 45 Units/L <79 Units/L
ALK PHOSPHATASE 61 Units/L 45 - 117 Units/L
TOTAL PROTEIN 6.8 g/dL 6.4 - 8.2 g/dL
Albumin 4.3 g/dL 3.6 - 5.1 g/dL
GLOBULIN 2.5 g/dL 2.0 - 4.0 g/dL
A/G Ratio, Serum 1.7 1.0 - 2.4

 

[CoastWatcher]

No estradiol was captured, no PSA was run, and where is the CBC? Were any comments made about your thyroid? Sure, your TSH looks good, but that's not enough, particularly when your t4 was so low. No t3 and no thyroid antibodies? A lot of unanswered questions, questions that ought to be answered to sort out what is, and what is not, going on here.

 

[jasinc81]

No estradiol was captured, no PSA was run, and where is the CBC? Were any comments made about your thyroid? Sure, your TSH looks good, but that's not enough, particularly when your t4 was so low. No t3 and no thyroid antibodies? A lot of unanswered questions, questions that ought to be answered to sort out what is, and what is not, going on here.

That's what I was concerned with...I feel like there's something else going on that TRT alone isn't going to solve. I did a saliva test on my own in May, which had some interesting results (high cortisol, low DHEAS). I plan on talking with my endo next week about them, but I'm concerned they will dismiss them. This is my first face-to-face appointment since January so I will ask about additional testing as well.

Salivary Steroids: 5/25/17
Estradiol 0.6 (0.5-2.2 pg/mL)
Progesterone 40 (12-100 pg/mL)
Testosterone 125 (44-148 pg/mL )
DHEAS 7.6 (2-23 ng/mL)
Cortisol 11.0 (3.7-9.5 ng/mL) (morning)
Cortisol 2.6 (1.2-3.0 ng/mL) (noon)
Cortisol 1.8 (0.6-1.9 ng/mL) (evening)
Cortisol 1.4 (0.4-1.0 ng/mL) (night)

 

[CoastWatcher]

That's what I was concerned with...I feel like there's something else going on that TRT alone isn't going to solve. I did a saliva test on my own in May, which had some interesting results (high cortisol, low DHEAS). I plan on talking with my endo next week about them, but I'm concerned they will dismiss them. This is my first face-to-face appointment since January so I will ask about additional testing as well.

Salivary Steroids: 5/25/17
Estradiol 0.6 (0.5-2.2 pg/mL)
Progesterone 40 (12-100 pg/mL)
Testosterone 125 (44-148 pg/mL )
DHEAS 7.6 (2-23 ng/mL)
Cortisol 11.0 (3.7-9.5 ng/mL) (morning)
Cortisol 2.6 (1.2-3.0 ng/mL) (noon)
Cortisol 1.8 (0.6-1.9 ng/mL) (evening)
Cortisol 1.4 (0.4-1.0 ng/mL) (night)

Salviary steroid testing for anything other than cortisol are an utter waste of money. Self-testing of serum levels can be obtained through www.discountedlabs.com. Many of us use them to track our own progress.

A PSA when androgen replacement therapy is initiated is a required test. A baseline must be obtained as a PSA score can, and does, rise during treatment. The discreet score is important, as is the rate of rise. You have no baseline to know where you stood when TRT began. Get one as soon as you can. Repeat that test annually.

No CBC was captured. Hematocrit and hemoglobin are critical values to follow as a great number of men see those numbers rise. Should they reach a certain level, blood must be given. Get one as soon as you can.

You need far more thyroid evaluation. Don't let them brush you off with the comment that your TSH is "normal."

Estradiol, measured with the LC, MS/MS test, is an essential hormone to evaluate while on TRT. It's a necessary hormone, and it can be a tricky one to balance against your total testosterone.

While you're at it, get a new doctor. You deserve far better treatment than has been provided...and that you paid for. It's a sad story, one we see here all the time - doctors who don't understand androgen replacement. I initially consulted an endocrinologist who holds an endowed chair at a local medical school in the city in which I live. I didn't get a protocol that helped until I left his practice. Your care is mismanaged and that is simply wrong.

 

[jasinc81]

A PSA when androgen replacement therapy is initiated is a required test. A baseline must be obtained as a PSA score can, and does, rise during treatment. The discreet score is important, as is the rate of rise. You have no baseline to know where you stood when TRT began. Get one as soon as you can. Repeat that test annually.

No CBC was captured. Hematocrit and hemoglobin are critical values to follow as a great number of men see those numbers rise. Should they reach a certain level, blood must be given. Get one as soon as you can.

You need far more thyroid evaluation. Don't let them brush you off with the comment that your TSH is "normal."

Estradiol, measured with the LC, MS/MS test, is an essential hormone to evaluate while on TRT. It's a necessary hormone, and it can be a tricky one to balance against your total testosterone.

While you're at it, get a new doctor. You deserve far better treatment than has been provided...and that you paid for. It's a sad story, one we see here all the time - doctors who don't understand androgen replacement. I initially consulted an endocrinologist who holds an endowed chair at a local medical school in the city in which I live. I didn't get a protocol that helped until I left his practice. Your care is mismanaged and that is simply wrong.

Thanks for being up-front with me...I had a feeling I wasn't getting the right answers. I will get a PSA and CBC blood test from discountedlabs immediately. Luckily, they have a facility where I live. I will also look at getting a new doctor...which may be tricky because of insurance and the back log of all the endo's in my area. I appreciate the advice.

 

[jasinc81]

** Update **

So, I got my latest blood test back that my Doctor ordered (just Total, SHBG, Free, % Free) and the results are a little confusing. I'm in the process of looking for a new doctor to get some additional blood tests, but I thought I'd share them with everyone.

TOTAL TESTOSTERONE >1500 ng/dL (300 - 1080 ng/dL)

SEX HORMONE BINDING GLOBULIN 32 nmol/L (11 - 80 nmol/L)

TESTOSTERONE, FREE >355 pg/mL (47 - 244 pg/mL)

% FREE TESTOSTERONE >2.4% (1.6 - 2.9 %)

Luckily I have my first follow-up tomorrow morning, but aren't these numbers extremely high? I still have NO sex drive/libido, and continue to put on fat (+2lbs since last week) around my waist. Could the high test be contributing to my weight gain? My strength/lifts aren't that great over the past couple months, so I'm a little confused.

 

[CoastWatcher]

** Update **

So, I got my latest blood test back that my Doctor ordered (just Total, SHBG, Free, % Free) and the results are a little confusing. I'm in the process of looking for a new doctor to get some additional blood tests, but I thought I'd share them with everyone.

TOTAL TESTOSTERONE >1500 ng/dL (300 - 1080 ng/dL)

SEX HORMONE BINDING GLOBULIN 32 nmol/L (11 - 80 nmol/L)

TESTOSTERONE, FREE >355 pg/mL (47 - 244 pg/mL)

% FREE TESTOSTERONE >2.4% (1.6 - 2.9 %)

Luckily I have my first follow-up tomorrow morning, but aren't these numbers extremely high? I still have NO sex drive/libido, and continue to put on fat (+2lbs since last week) around my waist. Could the high test be contributing to my weight gain? My strength/lifts aren't that great over the past couple months, so I'm a little confused.

When was the blood drawn? The appropriate time to test a protocol is immediately PRIOR to an injection, when your levels are at trough.

 

[jasinc81]

When was the blood drawn? The appropriate time to test a protocol is immediately PRIOR to an injection, when your levels are at trough.

The doctor instructed me to have blood drawn 2 hours after applying 40mg of fortesta. I applied my test gel at 6am and had blood drawn at 8:30am

 

[CoastWatcher]

The doctor instructed me to have blood drawn 2 hours after applying 40mg of fortesta. I applied my test gel at 6am and had blood drawn at 8:30am

You're on a topical, so, yes, you tested at the appropriate time...it's a different game for topicals. Where do you apply the Fortesta? Is there a chance the blood draw was exposed to residual gel on the skin?

 

[jasinc81]

You're on a topical, so, yes, you tested at the appropriate time...it's a different game for topicals. Where do you apply the Fortesta? Is there a chance the blood draw was exposed to residual gel on the skin?

I apply it on my inner thighs, no chance of contamination as I wash my hands immediately because of my wife and 2 young boys. This was actually the 2nd test, to verify the high numbers. The first one was 5 days earlier and came back very similar, around 1400.

 

[CoastWatcher]

I can only imagine what your estradiol MIGHT be if you have been spiking your estradiol like that. If elevated, and that wouldn't be at all surprising, it could explain how you feel. You have no baseline, be sure you ask your doctor to order the appropriate estradiol test - sensitive (or ultra sensitive), LC, MS/MS assay. Any other is unreliable for men.

 

[jasinc81]

I can only imagine what your estradiol MIGHT be if you have been spiking your estradiol like that. If elevated, and that wouldn't be at all surprising, it could explain how you feel. You have no baseline, be sure you ask your doctor to order the appropriate estradiol test - sensitive (or ultra sensitive), LC, MS/MS assay. Any other is unreliable for men.

I ordered the estradiol sensitive test along with CBC and PSA through discounted labs. Just waiting for the order from them so I can get the test. I'll ask the doctor for one as well. Thanks again for the help!

 

[CoastWatcher]

I ordered the estradiol sensitive test along with CBC and PSA through discounted labs. Just waiting for the order from them so I can get the test. I'll ask the doctor for one as well. Thanks again for the help!

Discountedlabs.com is based in Tampa. They are on a hurricane alert at the moment; it will take a bit longer to hear from them than is typical.

 

[jasinc81]

Discountedlabs.com is based in Tampa. They are on a hurricane alert at the moment; it will take a bit longer to hear from them than is typical.

Just received my order from them today. Should I do the labs in the morning 2 hours after applying the fortesta gel, as I did with my other tests? I ordered these tests:

Estradiol, Sensitive
CBC With Differential/Platelet
Prostate-Specific Ag, Serum

 

[CoastWatcher]

Just received my order from them today. Should I do the labs in the morning 2 hours after applying the fortesta gel, as I did with my other tests? I ordered these tests:

Estradiol, Sensitive
CBC With Differential/Platelet
Prostate-Specific Ag, Serum

That should be fine.

 

[jasinc81]

Got my tests done this morning, so I will post the results when I get them. As for my Doctor visit, it was very basic. He was concerned about the high level of test, so he asked me to go down to 1 pump on each leg (instead of 2) and retest in early November. Hopefully that will stabilize by then. I did ask about PSA, and he said my numbers were fine, but I don't remember getting a test done on that. Either way, I still had one completed through discountlabs. I was also concerned about Estradiol levels and he said I am not experiencing any symptoms of high levels. He did offer a morning and evening cortisol test to see if something is going on there. Either way, once I get my results back I will make a decision to change doctors and get another opinion. I have already started calling around to providers that take my insurance, so we will see who has availability. I still don't feel the greatest and my libido is non-existent, so I hope to get more clarity soon. More to follow..

 

[Systemlord]

You know even after you get your protocol all dialed in it could take months to start noticing changes, too many guys expect immediate results and that's not how TRT works. The extra weight you describe is normal in the first coulpe months, some guys that have low T also have low estrogen and when you begin TRT your testosterone increases and so to does estrogen causing some to gain weight or feel bloated. It tapers off after awhile when your body reaches a new balance. If you ever get tired of lousy endos you can always give Defy Medical a try, you don't even need to go in for an appointment. It's a service that contacts you by phone or via video conferencing on your computer, it averages out to $100-$150 a month and some insurances will cover labs decreasing the cost some.

 

[jasinc81]

Received my blood tests back. The results were interesting...it appears my Estradiol is low. Any intrepritations or advice on these blood tests are greatly appreciated.

Thanks!
CBC:

PSA:

Estradiol: