Strum: what I find in my medical practice involving men that are either getting ADT (androgen deprivation therapy) or TRT (testosterone replacement therapy) is that most physicians do not obtain baseline lab results, do not monitor changes over time, often forget a major dictum (Above all do no harm), and rarely keep records where they can observe trends. The functional part of testosterone is the free testosterone. And all lab measurements are subject to being affected by the nature of the methodology used in the lab. LC/MS/MS is one of the most accurate methods used so make sure your test report indicates the nature of the assay as well as the range of normals.
Also, realize the major potholes involved in any therapy. For TRT, measure free testosterone but also keep an eye on estradiol (E2) and if high normal or elevated that use an aromatase inhibitor (AI). Often it only takes a 1/2 tab of anastrozole (Arimidex) 2 or 3 times a week to be effective. So titrate the dose of meds and "helper" meds.
Note that TRT will send a negative feedback message to the hypothalamic-pituitary tract to shut down LH. This often causes testicular shrinkage and I would be also concerned re penile shrinkage. This brings into play other drugs to stimulate "end-organs or tissues" like HCG.
Many men harbor occult prostate cancer (PC) so monitor the PSA over time and look for a serial increase that should alert you to a probably occult prostate cancer situation. The TRT does not cause PC but it will stimulate already present PC to grow and to start synthesizing PSA. If this occurs it is a red light to stop TRT and of course alert your MD.
There are many people on this forum that have a wealth of knowledge that should be shared. I am sure I can learn a lot from periodically looking at posts.
