New TRT @ 55 yrs

[Formula364]

55 years old, lift 4x week (45-60 min), eat fairly clean, no other health concerns, no OTC meds or meds of any kind. 6'4", 235 lbs. Never used steroids. Supplement with protein, multi vit/min, creatine, beta-alanine, and aminos.

I've been feeling like somebody dropped the boat anchor (just didn't dawn on me), ED, fat accumulation on abdomen, etc.. Then, trouble sleeping prompted me to try a sleep apnea test. No apnea, but doc ordered VitD, A1C, and TT and FT (I asked for this).
TT - 230 ng/dL (240-950)
FT - 5.98 ng/dL (3.87 to 14.7)
Done by Equilibrium Dialysis
VitD - 27.6 ng/mL (30.0 - 100.0 ), taking 2k IU's now.
A1C - 5.3 % (4.5 - 5.6 %)

Doc said I did not need TRT. Best I could get was a referral to an Endo with a late Nov. date. So much for the PPO.

I tried the IR protocal - morning temps rose by .4. Then, I contacted Defy. Following blood test shows the elevated TSH as I was still taking 50 mg/day at time of test.
Previous in April was:

TSH

0.559 mcUnits/mL

(0.350 - 5.000)

CBC With Differential/Platelet
WBC 7.7 x10E3/uL (3.4 - 10.8)
RBC 4.98 x10E6/uL (4.14 - 5.80)
Hemoglobin 16.1 g/dL (12.6 - 17.7)
Hematocrit 46.2 % (37.5 - 51.0)
MCV 93 fL (79 - 97)
MCH 32.3 pg (26.6 - 33.0)
MCHC 34.8 g/dL (31.5 - 35.7)
RDW 12.6 % (12.3 - 15.4)
Platelets 208 x10E3/uL (150 - 379)
Neutrophils 72 %
Lymphs 15 %
Monocytes 10 %
Eos 3 %
Basos 0 %
Neutrophils (Absolute) 5.5 x10E3/uL (1.4 - 7.0)
Lymphs (Absolute) 1.2 x10E3/uL (0.7 - 3.1)
Monocytes(Absolute) 0.8 x10E3/uL (0.1 - 0.9)
Eos (Absolute) 0.3 x10E3/uL (0.0 - 0.4)
Baso (Absolute) 0.0 x10E3/uL (0.0 - 0.2)
Immature Granulocytes 0 %
Immature Grans (Abs) 0.0 x10E3/uL (0.0 - 0.1)

Comp. Metabolic Panel
Glucose, Serum 96 mg/dL (65 - 99)
Specimen received in contact with cells. No visible hemolysis
present. However GLUC may be decreased and K increased. Clinical
correlation indicated.
BUN 9 mg/dL (6 - 24)1
Creatinine, Serum 0.87 mg/dL (0.76 - 1.27)
eGFR If NonAfricn Am 97 mL/min/ 1.73 >59
BUN/Creatinine Ratio 10 (9 - 20)
Sodium, Serum 143 mmol/L (134 - 144)
Potassium, Serum 3.9 mmol/L (3.5 - 5.2)
Chloride, Serum 102 mmol/L (97 - 108)
Carbon Dioxide, Total 23 mmol/L (18 - 29)
Calcium, Serum 8.7 mg/dL (8.7 - 10.2)
Protein, Total, Serum 6.9 g/dL (6.0 - 8.5)
Albumin, Serum 4.4 g/dL (3.5 - 5.5)
Globulin, Total 2.5 g/dL (1.5 - 4.5)
A/G Ratio 1.8 (1.1 - 2.5)
Bilirubin, Total 0.7 mg/dL (0.0 - 1.2)
Alkaline Phosphatase, S 128 IU/L (39 - 117)
AST (SGOT) 21 IU/L (0 - 40)
ALT (SGPT) 20 IU/L (0 - 44)

Lipid Panel w/ Chol/HDL Ratio
Cholesterol, Total 179 mg/dL (100 - 199)
Triglycerides 63 mg/dL (0 - 149)
HDL Cholesterol 58 mg/dL (>39)
Comment 01
According to ATP-III Guidelines, HDL-C >59 mg/dL is considered a
negative risk factor for CHD.
VLDL Cholesterol Cal 13 mg/dL (5 - 40)
LDL Cholesterol Calc 108 mg/dL (0 - 99)
T. Chol/HDL Ratio 3.1 ratio units (0.0 - 5.0)

Estradiol, Sensitive 11.8 pg/mL (8.0 - 35.0)
LH 7.3 mIU/mL (1.7 - 8.6)
TSH 2.750 uIU/mL (0.450 - 4.500)
DHEA-Sulfate 154.5 ug/dL (48.9 - 344.2)
Progesterone 0.4 ng/mL (0.2 - 1.4)
Prostate Specific Ag, Serum 0.4 ng/mL (0.0 - 4.0)


I do not have SBHG or FSH numbers, but based upon my reading, this is secondary hypogonadism - correct?
Will cholesterol levels come down with TRT?

I have a consult scheduled with Dr. Crisler on 9/6. I would appreciate any observations, questions to ask, anything that would help me get the most out of the consult.
Thanks,

 

[Dr Justin Saya MD]

With LH level of 7.3, you are more PRIMARY hypogonadal (in which case TRT is the solution).

Your cholesterol numbers actually look pretty darn good. Particularly your HDL of 58 ("good cholesterol") and your HDL:LDL ratio of about 1:2.

 

[johndoesmith]

To add onto what Dr. saya said, you look to be more primary. FSH would help, and SHBG as well, it's possible they're still processing. I remember once it took a few days for certain lab results to come back, after I'd received most of my labs.

I'd highly recommend you get a new primary if he saw the results you posted here, and said TRT isn't needed. That is a doctor who will most likely be hostile towards you starting TRT, and probably has an attitude. I've noticed a trend, the more they're against TRT, the more rude and hostile they are as doctors.

 

[Gene Devine]

Your Primary Care Physician has no clue re your hypogonadism. As noted, probably a combination of Primary and Secondary...welcome to getting old.

You are clearly a candidate for TRT and you need to be cared for by someone who is well trained in testosterone therapy in men...and you probably won't find that within you PPO unfortunately.

The good news is that if you have to pay for it it's not that expensive if you keep it to just a testosterone and HCG protocol.

You need this to feel not only better but for all the long term health reasons as well.

Keep us posted in this thread how things work out for you.

 

[Formula364]

Thanks for your replies,
That was the sleep Dr., not my PCP. He should know better, though. I went there thinking bad REM sleep would cause Low T (now I know it is the reverse). I don't have much hope with the Endo. I don't know if I'll keep the appointment or not.
Yeah, it doesn't matter at my age and my numbers - TRT it is. The actual cause doesn't seem to be of too much concern. It's a bummer that I worked out, ate clean, and stayed away from PED, yet still ended up here.
I would like to know SBHG, so I know what to expect when I start. With such low TT and E2, it is probably fairly low as well. I've been reading here that guys with low SBHG can be the difficult responders, or I could rebound quickly - something to watch for.

 

[johndoesmith]

Thanks for your replies,
That was the sleep Dr., not my PCP. He should know better, though. I went there thinking bad REM sleep would cause Low T (now I know it is the reverse). I don't have much hope with the Endo. I don't know if I'll keep the appointment or not.
Yeah, it doesn't matter at my age and my numbers - TRT it is. The actual cause doesn't seem to be of too much concern. It's a bummer that I worked out, ate clean, and stayed away from PED, yet still ended up here.
I would like to know SBHG, so I know what to expect when I start. With such low TT and E2, it is probably fairly low as well. I've been reading here that guys with low SBHG can be the difficult responders, or I could rebound quickly - something to watch for.

There really isn't much rhyme or reason to SHBG levels from what I understand. Yes E2 raises it, and test lowers it, but it only changes it if that makes sense.

Also a very important level to know before TRT. I'd highly recommend getting it checked before.

 

[warrior1]

good advise here, once you get squared away all the hard work you do (gym, diet, supps) will be all worth while.

 

[Formula364]

I guess SBHG and FSH were never part of the panel - OK. Maybe not worth the cost.
With TT, FT, and E2 so low, it' obvious what the plan is. SBHG is probably low as well. The starting point is probably not all that significant in the overall picture, and reducing the upfront cost is always appreciated.

I am thinking about E3D - both T and hCG, KISS principle. E3.5D seems too long for the hCG and easy to forget the half day swing, plus I don't like the idea of a morning and afternoon rundown on a 4th day (sleeping through the other one is ok). I see many EOD and E3.5D, but have not seen many E3D protocols mentioned. Any reasons why? Syringe measurement difficulty?
EOD seems a bit much for a newbie, and I'll need to get used to needles.

 

[johndoesmith]

I guess SBHG and FSH were never part of the panel - OK. Maybe not worth the cost.
With TT, FT, and E2 so low, it' obvious what the plan is. SBHG is probably low as well. The starting point is probably not all that significant in the overall picture, and reducing the upfront cost is always appreciated.

I am thinking about E3D - both T and hCG, KISS principle. E3.5D seems too long for the hCG and easy to forget the half day swing, plus I don't like the idea of a morning and afternoon rundown on a 4th day (sleeping through the other one is ok). I see many EOD and E3.5D, but have not seen many E3D protocols mentioned. Any reasons why? Syringe measurement difficulty?
EOD seems a bit much for a newbie, and I'll need to get used to needles.

FSH isn't really THAT necessary, SHBG is really important. It is not a waste of money. Are you paying for labs?

SHBG will dictate what kind of protocol you are on, and what would be best for you. It's also good to have as much of a baseline as possible before starting TRT.

I can make an approximation that you're probably low range, maybe slightly mid based on your total and free testosterone. I'd say 15-25 SHBG.

I do E3D myself, and the reason it's not as common is for simplicity. With E3.5D, you can do monday and thursday every week. With E3D, it changes days so you have to write it down, or have a perfect memory. It can be annoying to keep track of.

Syringe measurements have nothing to do with it, you can always buy syringes with different markings on them.

Again, you're getting ahead of yourself. Let Dr. Crisler take into consideration your preferences and he will give you a protocol I'm pretty sure you will like. He's not as popular on this forum, but he's very popular on others, and plus he works for Defy so they've approved of his knowledge and experience with TRT.

I agree with you on the E3.5D morning and night issue. I am not useful in the morning, and I can't imagine putting a needle anywhere near my body on a morning. E3D is an alternative as long as you can be organized.

 

[Formula364]

Had my consult today:
80 mg T 2x/week (ex. T & Fr)
500 IU hCG 2x/week (ex. M & Th)
25 mg DHEA 2x/day

Blood re-test at 8 weeks.