Post Weight Loss Surgery and Not Feeling Great

[kenb]

Hello all, My name is Ken from Washington and I was diagnosed with Low-T May 2014. I've been having troubles as of late and retested and sure enough I was low again. I scheduled a appt with a urologist as I don't think my GP is up to speed on it all. Below are my stats;

Date Tested	Total T. (2-7.3 ng/mL)	Free T. (30-140 pg/mL) Calculated.	SHBG (13 - 90 nmol/L)	RX at time of test
5/1/2014	1.8	48	21	Initial Test
5/30/2014	2.1	60	18	50mg inj. wkly
7/20/2014	5.9	179	18	100mg inj. wkly
12/2/2014	1.2	28	24	75mg inj. wkly

Today my GP increased my dosage back to 100mg injection weekly. I haven't taken any other tests for estrogen or HCG. My GP felt there was nothing that could be done for Atrophy. I had weight loss surgery in October and had to stop taking my injection for a couple weeks. I'm just not sure why my most recent test is so off two months after my surgery. having said that, I have lost 50lbs in those two months. I feel horrible, have no sex drive, problems with staying "excited" and its a total 180 from how I felt in July when my numbers were higher. My GP decreased my dosage because he said the 179 pg/mL Free-T was too high. I tried to convince him that I didn't want to change as I was feeling great, strong erections, high libido, but he insisted and said there were side effects to worry about with a 179 pg/mL Free-T level.

Thanks for reading my ramble but I thought I would introduce myself and kinda share what I'm experiencing. I should also mention my wife is REALLY unhappy about having a husband who lays around all the time tired, isn't interested in sex, and when we do can't keep it up. YA! good times at home!

Thanks,
Ken

 

[Gene Devine]

Clearly your Doctor is not trained in TRT in men or he would know that HCG is commonly used as an LH analog replacement therapy to keep the testes alive when a man is on TRT plus a bunch of other health benefits of HCG use when on TRT...you can learn all of this here on the site.

What was the time period from when you stopped TRT after surgery to when you started and when you got your blood work done?

 

[kenb]

Surgery was middle of October. Resumed first of November. Been back on it a month when I retested. I did switch from weekly to biweekly for two shots and tested in the trough like usual. I'm back to weekly now. Seeing the urologist on Monday. Trying to be educated enough to ask the right questions or call bullshit if needed.

 

[Gene Devine]

Surgery was middle of October. Resumed first of November. Been back on it a month when I retested. I did switch from weekly to biweekly for two shots and tested in the trough like usual. I'm back to weekly now. Seeing the urologist on Monday. Trying to be educated enough to ask the right questions or call bullshit if needed.

If you switched to one injection every two weeks and tested in the trough that would explain your low serum levels.

You would do much better injecting twice a week to get nice stable and smooth serum levels and lower the risk of increase estrogen levels.

 

[kenb]

If you switched to one injection every two weeks and tested in the trough that would explain your low serum levels.

You would do much better injecting twice a week to get nice stable and smooth serum levels and lower the risk of increase estrogen levels.

Thank you Gene for taking the time to respond to my post. Currently I'm injecting using a 21g 1-1/2" needle. Do you recommend this for the 2X a week routine? I've seen some buzz around using insulin type needles? Do you know if there is an post or article regarding the advantages/disadvantages of subcutaneous vs intramuscular testosterone injections?

 

[Gene Devine]

Go to the video section of the site and look for the video by Dr. John Crisler on why SQ injections are better and how do to them as it will explain everything.

 

[kenb]

Went to a urologist today. He referred me to an endocrinologist saying that my case is more complex then what they deal with (older guys with low T due to advanced age.) He didn't leave me without a parting gift. A crotch and prostate exam. Thanks! I have an endo appt end of January.

Also recommended a couple labs but suggested I go off TRT for a few months before taking the labs to get a baseline. Pretty sure I would be divorced by that time.

 

[Gene Devine]

Went to a urologist today. He referred me to an endocrinologist saying that my case is more complex then what they deal with (older guys with low T due to advanced age.) He didn't leave me without a parting gift. A crotch and prostate exam. Thanks! I have an endo appt end of January.

Also recommended a couple labs but suggested I go off TRT for a few months before taking the labs to get a baseline. Pretty sure I would be divorced by that time.

You can't come off TRT...Jesus when will some of these Docs learn.

You will crash and will not go back to baseline.

Just wait till you see the Endo and make sure that the new Endo is trained in TRT for men...most Endo's are not.

 

[kenb]

You can't come off TRT...Jesus when will some of these Docs learn.

You will crash and will not go back to baseline.

Just wait till you see the Endo and make sure that the new Endo is trained in TRT for men...most Endo's are not.

I posted a note on my medical record asking if the Endo has been trained specifically for TRT. My guess is I will have to go to Seattle (4 hour drive) to see a TRT trained specialist.

 

[Gene Devine]

I posted a note on my medical record asking if the Endo has been trained specifically for TRT. My guess is I will have to go to Seattle (4 hour drive) to see a TRT trained specialist.

It's worth the drive if you have too; trust me.

 

[Nelson Vergel]

kenb

What kind of weight loss surgery? Lap band? If so, a lot of vitamins and minerals do not get absorbed properly due to a smaller stomach surface area. Are you taking vitamins?
Weight Loss Surgery

 

[fireplug]

Ken, Hello...I also had weight loss surgery ...an Endo should do the correct tests and take the time to fine tune you. At least mine did and continues to guide me...Now all my meds are prescribed and monitored by my Endo Dr. It took about 6 months after the initial weight loss surge (75 lbs) for me to get the energy levels, not just back, but for me, at age 35 levels. Once the body adjusts to the new you, Good things begin to happen! Next it will be your wife who wont be able to keep up with you!

 

[kenb]

kenb

What kind of weight loss surgery? Lap band? If so, a lot of vitamins and minerals do not get absorbed properly due to a smaller stomach surface area. Are you taking vitamins?
Weight Loss Surgery

I got a vertical sleeve. I am taking a bariatric vitamin, but not as much as they recommend. I take 1 a day and they recommend 2 in the morning and 1 at night.

I'm still waiting to hear whether the Endo I have an appt with next month has any specialized training in TRT. I have looked through your list of recommended Dr's and the closest one is 4 hours away. I will make the drive if I have to.

 

[kenb]

I heard back that the Endo does treat and diagnose Hypogonadism but she is not a specialized andrologist with specialized training in testosterone.

 

[kenb]

Ken, Hello...I also had weight loss surgery ...an Endo should do the correct tests and take the time to fine tune you. At least mine did and continues to guide me...Now all my meds are prescribed and monitored by my Endo Dr. It took about 6 months after the initial weight loss surge (75 lbs) for me to get the energy levels, not just back, but for me, at age 35 levels. Once the body adjusts to the new you, Good things begin to happen! Next it will be your wife who wont be able to keep up with you!

Awesome news! I'm at 100 lbs lost exactly. I will go to my Endo appt with an open mind and take it from there.

thanks everyone!

-Ken

 

[kenb]

Update after visit with Endo

I thought I would give everyone an update and ask for thoughts. I apologize in advance for the ramble. I went to the Endo and having read my chart dialog with my GP, she knew what I was looking for and flat out told me that when it comes to TRT she plays it pretty much by the book. We talked for more then an hour and got her to acknowledge 2X a week subq injections were probably better although she was concerned about skin abscesses. She was aggravated as am I that my GP didn't diagnose primary or secondary hypogonadism before starting me on TRT. I told her I wasn't interested in going off TRT for a few months to get the diagnosis. She wants to taper my dosage down and said my body would wake up and compensate so I could slowly get back to that pre-TRT baseline so they could determine primary or secondary. The notion of playing with my levels like that scares the crap out of me. As I mentioned before that November 2014 when my levels were really low, was very difficult on my marriage. She is opposed to HCG even those I have what I feel is pretty severe atrophy. She feels that if the atrophy is significant, its because your testosterone dosage is too high.

She ordered a bunch of tests which the results are below. As I inject .25ml every Monday morning and Thursday evening, she had me take these tests Wednesday morning. I hope to hear from my Endo on Monday regarding these results. Thank you for your time in reading my post.

Test	Result	Range
Total T:	4.9 ng/ml	2.0 - 7.3 ng/mL
SHBG:	22 nmol/L	13 - 90 nmol/L
Free T:	135 pg/mL	30 - 140 pg/mL
Thyroxine Free:	0.82 ng/dL	0.61 - 1.12 ng/dL
Free T3:	2.62 pg/mL	2.50 - 3.90 pg/mL
TSH	2.00 u[iU]/mL	0.34 - 5.60 u[iU]/mL
Prostate Specific Ag	0.45 ng/mL	0.00 - 4.00 ng/mL
Estradiol	53.8 pg/mL	<20-47 pg/mL
LH	<0.20 mIU/mL	1.24-8.62 mIU/mL
FSH	0.21 mIU/mL	1.27-19.26 mIU/mL
Cortisol	12.2 ug/dL	6.7 - 22.6 ug/dL
Prolactin	19.63 ng/mL	2.64 - 13.13 ng/mL
Vitamin D 25-Hydroxy	18.4 ng/mL	30.0 - 100.0 ng/mL
Magnesium	2.0 mg/dL	1.8 - 2.5 mg/dL
GLUCOSE	110 mg/dL	70 - 99 mg/dL
BUN	13 mg/dL	8 - 20 mg/dL
Creatinine, Ser	1.00 mg/dL	0.90 - 1.30 mg/dL
Calcium	9.4 mg/dL	8.6 - 10.2 mg/dL
Sodium	136 mmol/L	136 - 144 mmol/L
Potassium	3.9 mmol/L	3.6 - 5.1 mmol/L
Chloride	104 mmol/L	101 - 111 mmol/L
CO2	28 mmol/L	22 - 32 mmol/L
Albumin	3.9 g/dL	3.5 - 5.0 g/dL
Bilirubin	0.9 mg/dL	0.3 - 1.2 mg/dL
Alkaline Phosphatase	73 IU/L	32 - 91 IU/L
Total Protein	6.9 g/dL	6.5 - 8.1 g/dL
ALT	28 U/L	17 - 63 U/L
AST	16 U/L	15 - 41 U/L
WBC	7.2 10*3/uL	4.5 - 11.0 10*3/uL
RBC	5.44 M/uL	4.50 - 5.90 M/uL
HGB	15.6 g/dL	13.5 - 17.5 g/dL
HCT	46.3 %	41.0 - 53.0 %
MCV	85.2 fL	80.0 - 94.0 fL
MCH	28.6 pg	26.0 - 34.0 pg
MCHC	33.6 g/dL	31.0 - 37.0 g/dL
RDW	13.5 %	11.5 - 14.5 %
Platelet Count	170 10*3/uL	150 - 400 10*3/uL
Neutrophils	58	-
Lymphocytes	31	-
Monocytes	9	-
Eosinophils	1	-
Basophils	1	-
Absolute Neutrophils	4.2 10*3/uL	1.8 - 7.8 10*3/uL
Absolute Lymphocytes	2.2 10*3/uL	1.0 - 4.8 10*3/uL
Absolute Monocytes	0.6 10*3/uL	0.0 - 0.8 10*3/uL
Absolute Eosinophils	0.1 10*3/uL	0.0 - 0.5 10*3/uL
Absolute Basophils	0.10 10*3/uL	0.00 - 0.20 10*3/uL

Thanks again,
Ken

 

[CoastWatcher]

It may take your body a fair bit of time to "wake up" (as she put it) and restore your test levels to pre-treatment baseline. I will let those with more experience offer thoughts on your lab work, but I know that recovering baseline readings can be slow and uncomfortable.

 

[Tom Larabee]

Need the ranges for each of those tests since each lab has a different set of ranges they work off of.

 

[kenb]

Thanks Tom. I added those ranges. I was unsure on Estradiol, LH, and FSH. The values seem out of the standard range but it wasn't marked as low on my providers website like the Vitamin D, Prolactin, and FSH is.

 

[kenb]

Bump. Perhaps this should be moved into the blood test forum instead of introduction.