Please Review Blood Tests

[Jason1234]

Background:36 years old male... For the past 3 years I have felt run down, poor concentration, no sex drive, anxious....pretty much have felt like crap. I have been tested for everything.... finally found out my testosterone is low and could be the reason I feel like I do. Doctor has prescribed me Cypionate testosterone injections every 2 weeks at 200 mg/ML per injection. I was injected for the first time yesterday and notice minor improvement.

My question is, from my blood results, do you think the above treatment is the best program for me? Is there any addition medication I should look into? Any additional tests that should be performed?

Thanks for looking at my blood tests and look forward to your thoughts.

Endocrine Results:
Testosterone, Total: 193.2 ng/dL (180-780 ng/dL)
Testosterone, Free -LOW-: 8.06 pg/ML (8.69-54.69 pg/mL)
Cortisol, am: 12.5 ug/dL (6.2-19.4 ug/dL)
Estradiol Assay (not sensitive): 30 pg/mL (<48 pg/mL)
PSA, Total: 0.4 ng/mL (0-2.7 ng/mL)
Prolactin: 8.9 ng/mL
TSH Sensitive: 1.07 uIU.mL (0.34-5.60 uIU/mL)
Thyroperox. Abs: <5IU/mL (<9 IU/mL)
Follicle - Stimulating Hormone: 4.3 IU/L
Luteinizing Hormone: 2.8 IU/L


Hematology
WBC: 7.3 K/uL (3.6-10.0 K/Ul)
RBC: 5.20 M/uL (3.96-5.5 M/uL)
HGB: 15.2 g/dL (14.0-16.4 g/dL)
HTC: 45.4% (42.0-47.2%)
MCV: 87 fL (80-100fL)
MCHC: 33.5% (32.0-36.0%)
RDW: 13.4% (11.9-15.2%)
Platelet Count: 158 K/uL (150-400 K/uL)
Neutrophil: 3.8 K/uL (1.8-6.0 K/uL)
Neutrophil %: 58.0%
Lymphocytes: 2.2 K/uL (1.0-3.2 K/uL)
Lymphocytes %: 34%
Monocytes: 0.4 K/uL (0.2-0.9 K/uL)
Eosinophils: 0.1 K/uL (0.0-0.5 K/uL)
Eosinophils %: 1.8%
Basophils: 0.0 K/uL (0.0-0.2 K/uL)
Basophils %: 0.2%
Sed Rate: 4 mm/hr (0-20 mm/hr)


Electrolytes
Sodium: 141 mmil/L (136-144 mmil/L)
Potassium: 3.9 mmil/L (3.4-5.0 mmil/L)
Chloride: 103 mmil/L (96-110 mmil/L)
Bicarbonate Level: 29 mmil/L (22-32 mmil/L)


General Chemistry
BUN: 12 mg/dL (10-23 mg/dL)
Creatinine, Serum: 1.2 mg/dL (0.7-1.3 mg/dL)
GFR non African American, Calc: 69 mL/min/1.73m2 (>60 mL/min/1.73m2)
GFR African American: 83 mL/min/1.73m2 (>60 mL/min/1.73m2)
Calcium: 9.6 mg/dL (8.5-10.1 mg.dL)
Magnesium 1.8 mEq/L (1.5-2.1 mEq/L)
Alkaline Phos: 65 U/L (38-126 U/L)
Bilirubin Total -HIGH-: 1.5 mg/dL (0.2-1.1 mg/dL)
Bilirubin Direct: 0.2 mg/dL (0.0-0.5 mg/dL)
AST/SGOT: 20 U/L (8-36 U/L)
ALT/SGPT: 18 U/L (7-55 U/L)
Total Protein: 7.5 g/dL (6.4-8.3 g/dL)
Albumin Assay: 4.5 g/dL (3.5-5.0 g/dL)
Cholesterol: 180 mg/dL
Triglyceride -HIGH-: 157 mg/dL (10-150 mg/dL)
HDL Cholesterol: 41 mg/dL
LDL Cholesterol: 108 mg/dL
25(OH) Vitamin D Deficiency Assessment: 41 ng/mL
HbA1C: 5.1% (4.2-5.8%)
Estimated Ave Glucose: 100 mg/dL


Glucose
Glucose Fasting: 92 mg/dL (70-99 mg/dL)
Glucose Assay: 90 mg/dL (70-99 mg/dL)


Immunology Results
Anti Nuclear Antibody - Negative
Rheumatoid Factor Screen - Negative
IGG: 1090 mg/dL (670-1450 mg/dL)
IGA: 184 mg/dL (66-436 mg/dL)
IGM: 104 mg/dL (57-285 mg/dL)
Inf. Mono Screen - Negative

 

[CoastWatcher]

Welcome to Excelmale. You are on a highway to almost certain failure. Your protocol, 200mg every two weeks is an old, outdated approach to TRT. Your testosterone will jump, then your estradiol will soar, and then - before your next injection - you will have metabolized your first shot - and you will feel terrible. Then you will start the process all over again.

Current, cutting-edge practitioners have patients self-inject (no reason at all for your doctor to require you to visit his office for your injection), and they inject smaller, more frequent amounts of testosterone. Fifty milligrams every 3.5 days is an excellent starting point. That most likely would work. What you are doing is not going to.

You were tested, as you realize, with the wrong estradiol test and I don't see SHBG results - a very important test. Was HCG discussed?

So, while TRT looks appropriate, you are not likely to benefit from it as it has been presented to you. This isn't your fault, it happens all too often.

 

[Jason1234]

Thank you for your reply. I am in the process of getting to do my own injections. The next appointment the nurse will show me how to self-inject the testosterone and get me some syringes to self administer.

No SHBG test was done. Can this test be done after testosterone injections have begun?

I did ask for the sensitive estradiol test, but looking at the test results, this was not done. According to the lab where I got the test done, there was not a sensitive test available.

HCG has not been discussed, but I plan on asking at my next appointment.

I have seen multiple doctors, an endocrinologist, and a urologist. Just seems like none of the doctors I've seen really know what they are doing. I'm just tired of feeling like absolute garbage. I'm lucky to have a loving supporting wife who has been very understanding the past 3 years.

Thanks again for your reply. I look forward to further insight on my road to feeling well again.

 

[johndoesmith]

Thank you for your reply. I am in the process of getting to do my own injections. The next appointment the nurse will show me how to self-inject the testosterone and get me some syringes to self administer.

No SHBG test was done. Can this test be done after testosterone injections have begun?

I did ask for the sensitive estradiol test, but looking at the test results, this was not done. According to the lab where I got the test done, there was not a sensitive test available.

HCG has not been discussed, but I plan on asking at my next appointment.

I have seen multiple doctors, an endocrinologist, and a urologist. Just seems like none of the doctors I've seen really know what they are doing. I'm just tired of feeling like absolute garbage. I'm lucky to have a loving supporting wife who has been very understanding the past 3 years.

Thanks again for your reply. I look forward to further insight on my road to feeling well again.

You are almost lucky in a sense, your testosterone is low enough that even regular doctors will treat. Plus you can be pretty sure most of your symptoms are from low testosterone.

I am confused why you couldn't get the sensitive test, you're in the united states. Did you use labcorp or quest? It's possible the staff at the doctor's office simply didn't know it existed. You can look on their websites and find the test code. If the doctor requests it by code, it makes it so there's no confusion. Hell when I get scripts with lab names(cbc, vitamin d or something) I write up a list using the labs specific codes for the exact test. I don't want to have any mistakes where they run the wrong test because the lab tech isn't educated on this.

As the previous poster said, 200mg every two weeks is a terrible protocol, and will possibly make you think TRT feels bad.

I have no idea if I'm off base, but judging from your total and free testosterone, I'd guess you're on the lower end of SHBG range. I'd say under 30 definitely. This is just a slightly mildly educated guess. If I'm right, you'll have a really bad time with 200mg every two weeks.

 

[CoastWatcher]

Thank you for your reply. I am in the process of getting to do my own injections. The next appointment the nurse will show me how to self-inject the testosterone and get me some syringes to self administer.

No SHBG test was done. Can this test be done after testosterone injections have begun?

I did ask for the sensitive estradiol test, but looking at the test results, this was not done. According to the lab where I got the test done, there was not a sensitive test available.

HCG has not been discussed, but I plan on asking at my next appointment.

I have seen multiple doctors, an endocrinologist, and a urologist. Just seems like none of the doctors I've seen really know what they are doing. I'm just tired of feeling like absolute garbage. I'm lucky to have a loving supporting wife who has been very understanding the past 3 years.

Thanks again for your reply. I look forward to further insight on my road to feeling well again.

SHBG is tested routinely as part of your ongoing monitoring protocol. By all means add it to your lab list. I mistyped in my initial response - a typical protocol would have you injecting 50mg every 3.5 days, not the five days I incorrectly stated. You are fortunate to have support such as you described, and yes, I know how it feels to travel from doctor to doctor, getting nowhere, feeling miserable. We can offer suggestions, provide contact data for proven, capable physicians.

 

[Sean Mosher]

Agree with the sentiments above.
If you are unable to get your doctor on board with a modern protocol that will actually help you, then its
time probably to find a new doctor and get the care you deserve.
There are 2 TRT specialists endorsed by this site.
I personally go through PrimeBody and have had great success.
Please keep us posted on your journey!