Obtaining TRT in Canada - Blood Work Posted

[Backpulse]

Hi Everyone,

I have been lurking this forum for about a month trying to digest everything I can before posting. Excel Male is one of the best resources I have found on the internet to self educate on the topic of TRT and I want to begin to contribute my experiences.

I am in the early stages of trying to obtain doctor prescribed TRT in Ontario, Canada and below is a an introduction and a summary of my journey to date.

Bio/Current Stats:

- Canadian Male - Caucasian
- 41 years old - Born in 1975
- Married with 3 kids ages 6, 9 and 10.
- College diploma in civil engineering
- 5' 8 3/4" GP doctor measured in Dec 216 - was always slightly above 5' 9" but seem to have lost some height in the past few years
- 180 lbs body weight - athletic build with small bone structure and increasing abdominal fat
- No history of prescription drugs except for antibiotics the odd time
- No recreational drugs
- Only surgery I have ever undergone is a vasectomy in 2013
- No traumatic injuries
- No past testosterone or steroid use
- Regular exercise averaging 3 times a week. I have high relative strength and have completed in amateur powerlifting.
- Moderate alcohol consumption - a few beer on weekends
- Non-smoker
- Great childhood and awesome parents
- I hardly ever get sick. I have not vomited or had a fever in over a decade.
- Due to family history I had a colonoscopy and rectal/prostate exam in December 2016 - all clear
- My wife is a Phlebotomist
- I have tested my BP once a week recently at the drug store and it has averaged 123/88 and 69 BPM

Symptoms:

Over the past couple of years I have felt many of what seem to be symptoms of testosterone deficiency.
- Lack of energy and motivation to do pretty much anything.
- I have a very hard time with concentrating/focusing at work and in 2016 for the every first time ever I received some negative feedback on my yearly performance review. Brain fog is the prefect description.
- My mood and personality has taken a drastic turn and I tend to reach my boiling point much easier especially with my wife and kids.
- I feel gloomy a lot and may have moderate depression but not sure. I've never felt this way before and have no reason to.
- My libido and erection strength has decreased. I do not have ED as I can perform but the occasion is rare. I just feels like it is beginning to go downhill.
- I find it hard to get motivated to go the gym anymore and when I do the intensity is very poor and when I do I take forever to recover.
- Previously when in good shape, my heavyweight hovered around 170 so I'm up about 10 lbs
- My sleep is crappy and it is very hard to get out of bed every morning. I consume a lot of caffeine during the day. Avg 300 mg per day.

Doctor Visits and Labs:

As of this post I have had 3 separate blood draws:In November 2016 I decided it was time for me to go to the GP for a checkup, blood work and request colonoscopy/prostate exam. I informed him of all my symptoms as described above and he was wiling to test only for TSH and total testosterone which came back at 8.7 nmol/L.

I went back to see him again to discuss the results and he said I was within range. I asked him to do further testing and he only agreed to check my free test which came back at 206 pmol/l.

The next visit he again said I was within rage on both tests and did not see the need for treatment. I asked for a second opinion and he said he would set up a consult with an Endocrinologist. I have not yet been contacted for an appointment.

I have now taken the initiative and contacted PEAK in Ottawa for help. I have an appointment in late March and I have completed the first round of blood work. As you can see it is much more thorough. My testosterone results have come back higher but still not near optimal.

My GP is a good guy and he takes care of my family and I very well. I just don't thing this is something he is comfortable with. I also don't want to wait for months to see and Endo and possibly be told the same thing so I have taken matters into my own hands with PEAK.

I feel I'm in very good relative health with the exception of sub optimal test levels for which I'm currently really suffering from.

Please let me know your thoughts if yo think I'm a good candidate for TRT and offer any advice you can for me moving forward.

I have already started Vit D with with 2000 UI/day

Thanks in advance!!

 

[Vince]

Welcome to ExcelMale. One of our Moderators, Coastwatcher is also from Canada. It would be nice if you started TRT with a good TRT doctor. You will have a lot less problems if you do.

 

[CoastWatcher]

We're glad you joined us here at EM. I, too, am in Canada, Toronto, and understand the frustrations of obtaining quality advice regarding TRT. It can be done, I have managed it, and I have heard positive things about Peak, the practice in Ottawa you'll be consulting.

You are certainly a candidate for TRT and there is every reason for you to be positive. I'll message you some details on how I've navigated the system here. Perhaps some of those tricks may help you.

We hope you'll be an active member!

 

[Backpulse]

Thanks!! I will update when I reach the next step.

 

[Backpulse]

Just an update that due to a cancellation my appointment was moved from late March to today.

I have been prescribed a starting dosage of 140 mg of test cyp per week. I asked if I could split that in half and go with 70 mg every 3.5 days. He said I could do whatever frequency I wanted as long as I hold to the 140 per week total dose. He said to let him know if I feel any sides that could indicate he needs to control estrogen.

I just injected 70mg of Pfizer in the right quad tonight. Used 18g to draw and 23g to inject. The cost was only 6 bucks for the 10ml vial with my work benefits.

I will have bloodwork done in 4 weeks to check levels and the doc will adjust dose if required. He wants to focus on my free test getting to upper range of normal - about 600 pmol/L - but will back off if sides appear.


Unfortunately, as noted on their website PEAK is no longer accepting new clients.

 

[CoastWatcher]

Just an update that due to a cancellation my appointment was moved from late March to today.

I have been prescribed a starting dosage of 140 mg of test cyp per week. I asked if I could split that in half and go with 70 mg every 3.5 days. He said I could do whatever frequency I wanted as long as I hold to the 140 per week total dose. He said to let him know if I feel any sides that could indicate he needs to control estrogen.

I just injected 70mg of Pfizer in the right quad tonight. Used 18g to draw and 23g to inject. The cost was only 6 bucks for the 10ml vial with my work benefits.

I will have bloodwork done in 4 weeks to check levels and the doc will adjust dose if required. He wants to focus on my free test getting to upper range of normal - about 600 pmol/L - but will back off if sides appear.


Unfortunately, as noted on their website PEAK is no longer accepting new clients.

I hope more is being done in regard to potential side effects than simply asking you to monitor how you feel. When are your first follow-up labs? As for injecting, you can use much finer needles. (including an insulin syringe).

We here in Canada are so limited in obtaining quality TRT care..I regret they have a full practice and hope things work out for you.

 

[Vince]

I draw and inject with the same syringe, Easy Touch 27g 1/2". I inject in my shoulders, like Nelson's video but I use two syringes. https://www.youtube.com/watch?v=0uXoBb6mkys

 

[Backpulse]

I will have my first follow up labs done in 4 weeks from starting. He said if I notice anything negative before that to let him know and we can figure out whats going on.

If everything looks ok after the first month he will then have my labs done every 3 months.

Where do you obtain you needled/syringes in Canada. The doc gave me a months supply but just wondering if I can walk into Shoppers Drugmart and pick some more up.

 

[CoastWatcher]

I will have my first follow up labs done in 4 weeks from starting. He said if I notice anything negative before that to let him know and we can figure out whats going on.

If everything looks ok after the first month he will then have my labs done every 3 months.

Where do you obtain you needled/syringes in Canada. The doc gave me a months supply but just wondering if I can walk into Shoppers Drugmart and pick some more up.

Shopper's, Rexal, an independent (my independent store matches any online price).

 

[madman]

Just an update that due to a cancellation my appointment was moved from late March to today.

I have been prescribed a starting dosage of 140 mg of test cyp per week. I asked if I could split that in half and go with 70 mg every 3.5 days. He said I could do whatever frequency I wanted as long as I hold to the 140 per week total dose. He said to let him know if I feel any sides that could indicate he needs to control estrogen.

I just injected 70mg of Pfizer in the right quad tonight. Used 18g to draw and 23g to inject. The cost was only 6 bucks for the 10ml vial with my work benefits.

I will have bloodwork done in 4 weeks to check levels and the doc will adjust dose if required. He wants to focus on my free test getting to upper range of normal - about 600 pmol/L - but will back off if sides appear.


Unfortunately, as noted on their website PEAK is no longer accepting new clients.

Welcome backpulse....................my tt/free t numbers are similar to yours pre trt. I have just finished my sixth week at 50mg every 3.5 days sub-q. Surprised they would start you at 140mg/week off the hop as on average especially in Canada most are usually started at 100mg/week. I think it is better to start low get labs 6 weeks in to see how your blood work looks at that dosage than if need be you can go up from there. You may feel good at first on 140mg/week but after some time may not will have to go by your labs and overall well being. I am from Hamilton, Ontario glad you joined hope things work out for you..........keep every one up to date on how your protocol unravels.

 

[Backpulse]

Thanks for the support Madman. I have been following your thread as well and hopefully you can have your protocol adjusted to suit your needs.

Seems like your issue with Test Enanthate being on back order is a common one. My doc said he will only prescribe test cyp for this very reason and that Valeant is a sketchy company.

Based on what I have read on this forum, I asked my doc if I could inject 2x per week. I started with 70 mg every 3.5 days on Thursday Feb 2nd and had my second shot this Monday am. My injection pattern will be Monday mornings and Thursday evenings until I have my first bloodwork done in early March.

 

[Backpulse]

1 Month on TRT - Updated Blood Work - 6 March 2017

Hi Everyone,

I just had my first blood draw on Monday since starting TRT about 4.5 weeks ago on Feb 2nd.

Results are below. Pre TRT labs are in Post #1 of this thread.

My starting protocol has been 140 mg of Pfizer Test Cypionate per week split into 70 mg every 3.5 days Monday am and Thursday pm. My compliance has been perfect. This blood draw was done before my Monday injection so it should be a true trough reading.

After reviewing these results my doctor has lowered my dose from 140 mg per week to 120 mg per week to get my test levels into range.

The only negative side affect I have is overly sensitive nipples and minor swelling with a tiny pea sized lump on the right side. I think I am predisposed to gyno as I recall having very sore-hard nipples in early puberty.

Because of this he has given me a prescription for Arimedex for 0.5 mg twice per week on injection days. Non-sensitive test result is now up to 139 pmol L from 48 pmol L

Hct is basically the same as pre-TRT. Down to 0.45 from 0.46.

Next labs will be done again in 8 weeks which is 3 month mark.

Overall I feel much better than pre TRT and it has been a positive experience so far.

I will be in the USA on vacation this month and I am planing on having the sensitive estrogen test done along with Free and Total Test.

 

[CoastWatcher]

Things look good. I have all my blood work done in the States via discountedlabs.com - I'm glad to hear you'll monitor your estradiol with them. The free testosterone value you posted suggests a low SHBG, do you have that value?

 

[Backpulse]

The only SHBG value I have is pre TRT which was 34.9 nmol L with a free test of 230 pmol L and tot test of 11.9 nmol L.

 

[CoastWatcher]

The only SHBG value I have is pre TRT which was 34.9 nmol L with a free test of 230 pmol L and tot test of 11.9 nmol L.

I would have expected a lower SHBG. I hope the concerns regarding the small lump that was noticed in your nipple area resolves. The fact that a lump, and not just sensitive tissue, presented merits attention.

 

[madman]

The only SHBG value I have is pre TRT which was 34.9 nmol L with a free test of 230 pmol L and tot test of 11.9 nmol L.

Your shbg,total t ,free t is very similar to mine pre trt. My shbg was 34.7,total 11.3-11.7 and free 225. Your latest labs overall look good. Too bad you may have issues with your estradiol at 140mg/week. You should have went to Dynacare for your follow up bloods as the total t top range is 31.1 so you would have still been in range mind you your free t may have still been high as I am not sure if Dynacares range for free t is higher than Lifelabs range.

I mentioned to you before that I started my trt at 100mg once weekly and had labs after 6 weeks and my total came back at a dismal 16.7 nmol/L roughly 480 ng/dL. I should have started at 50mg every 3.5 days maybe I would have had better numbers but wanted to see how my body reacted to once weekly. As stated before my dose was increased to 150 mg/week so I have been injecting 75mg every 3.5 days for just over 2 weeks and I already notice a big difference so far. Hoping when I have my blood work done at the 6 week mark my numbers come back good. My libido is kicking in a lot more, more frequent morning/daytime erections, mood/energy is great and I have added 20lbs to my squat/bench and increasing weight on all my other exercises in 8 weeks..............unreal how much stronger I feel. Was always strong for my size but hard to believe I have been lifting all these years and had low t for who knows how long. When you are used to having low t for so long it is hard to believe how good it feels when your levels improve. To actually feel/experience it is amazing to say the least. Glad to hear you are doing well!

 

[Backpulse]

My doctor said from the beginning that he wants to target the Free test in the upper normal range (about 600) while maintaining healthy levels of everything else and making sure I feel good as well. Disappointed that I have to drop my dose as I was feeling really good on it especially in weeks 4 and 5. Basically I had triple the levels I had pre TRT but getting the E2 and side affects with my nipples under control takes current priority. I took my first dose of Arimidex last night.

I hope 150 a week works out for you if you feel that good and your blood work comes back OK. Make sure you update us with results.

Agree with you how amazing it feels in the gym recently. I feel like I was cheated out of some good years of my life by having low test. I have really noticed in the last week I have recovered much quicker after heavy training. A few days ago I pulled a 5 x 5 @ 80% and I am hardly sore!! Before TRT, a deadlift session like that would lay me up for a week.

 

[Backpulse]

Updated labs after protocol change with Sensitive Estradiol - Discounted Labs - 20 March 2017

Hi Everyone,

While on vacation in Florida I took the opportunity to have extra blood work done approximately 2 weeks after a protocol change to include the Sensitive Estradiol test not available in Canada.

This is a trough blood draw after 2 weeks of reducing dose from 70mg to 60mg every 3.5 days and adding .5 mg of Arimidex on injection days to help reduce sides with my nipples.

Previous labs are in Posts #1 and #12 in this thread.

Arimedex has definitely helped with my nipples. Sensitivity has been greatly reduced and swelling has gone down as well.

Seems like these results on paper are ok only 2 weeks after protocol change and I am feeling pretty good on the current protocol.

Might consider tweaking AI dose to smaller and more frequent. Maybe .25 EOD so that I dont suppress E2 too far.

Next blood work is scheduled for early May at the 3 month mark of starting therapy.

 

[CoastWatcher]

Hi Everyone,

While on vacation in Florida I took the opportunity to have extra blood work done approximately 2 weeks after a protocol change to include the Sensitive Estradiol test not available in Canada.

This is a trough blood draw after 2 weeks of reducing dose from 70mg to 60mg every 3.5 days and adding .5 mg of Arimidex on injection days to help reduce sides with my nipples.

Previous labs are in Posts #1 and #12 in this thread.

Arimedex has definitely helped with my nipples. Sensitivity has been greatly reduced and swelling has gone down as well.

Seems like these results on paper are ok only 2 weeks after protocol change and I am feeling pretty good on the current protocol.

Might consider tweaking AI dose to smaller and more frequent. Maybe .25 EOD so that I dont suppress E2 too far.

Next blood work is scheduled for early May at the 3 month mark of starting therapy.


View attachment 3399

I'm glad you had the opportunity to get an accurate read on your e2. I would urge you to seriously consider a discussion with your doctor about cutting back on your AI. While in-range, that's a significantly low estradiol value, given that your trough testosterone posted at a somewhat lower than expected level.

 

[Backpulse]

Thanks CW. It was mainly your posts about the sensitive E2 test that drove me to have it done.

Do you think the reduced dose I mentioned below of .25 EOD would be a logical next step to try.