Results and questions (including one for the Doc)

[crazycanuck]

Did my first set of blood work with the CBC portion coming in damn near perfect on all markers. The Dr was also only wanting to run TT and FT this first round, just to make sure that I was responding to the therapy and that a full panel will be drawn at the 3 month mark. Well, I am responding but not as I had hoped. My results are after 6 weeks are (bloods taken before Hcg and Test shots and same time as last blood draw):

TESTOSTERONE - 13.9 (6.0-27.0) nmol/l up from 5.7
FREE TEST - 367 (196-636) pmol/l up from 161.

Now the Total number looks okay until you convert it. Turns out I went from 164 ng/dl to 401 ng/dl which still has me in the LOW normal range.

I am taking 100 mg of Test -c (divided into 50mg twice a week) and played with the Hcg and found a happy number of 400iu twice a week, the day before the test. So I realize that the TEST at 400 is not an optimal number, especially considering that I still have symptoms of fatigue, energy crash and brain fog at times. Heck, I managed to get my Test up to 375 by using natural boosters, weight loss and exercise previously.

I was actually prescribed 2000iu twice a week but started out at 200 for the the first few shots. Spoke with a pharmacist who said that 2000iu is a high dose for TRT but suggested a try and see if I notice side effects. I did 2000 iu then stepped down to 1000 iu and then down to below 500 iu again due to a raging headache about 1-1.5 hours after a high dose shot. So, it appears that under 500 iu and my body tolerates it nicely and I get very positive results from it

So, here are my questions:

1) Considering I went from patch to gel (18 days prior) to injecting over the course of 6 weeks, would that have an impact on my numbers i.e. is it too early to determine if the dosage is too low?

2) Should I ry once a week T injections vs twice a week subq?

3) Is the headache common at higher dosages of Hcg? (My pharmacist says it is a side effect)

4) with the Test and Hcg, should my numbers not be higher?

and

5) For the Doc. - As I am a Hereditary Hemochromatosis (controlled with no secondary complications) suffer, would it interfere with the uptake of the Testosterone injection?
and is Hcg beneficial for me with that as an underlying issue?

I have a follow up next week with the Urologist so I want to go in prepared for a chat about what to do.

 

[CoastWatcher]

Correct me if I misunderstood, but in the six weeks prior to these blood tests you were on three different testosterone delivery methods, patch/gel/injections? And you changed your HCG dose? If that's the case, I don't know how anyone can draw any conclusions from these results. I know that my doctor is strict - no change, not a single change, in the window period leading up to a blood draw. That is even more important when initiating TRT. There is no way serum levels will have reached stability.

 

[crazycanuck]

Thanks for the reply. Yes that's correct that there have been the three changes but the test injections have been for close to a month but that as on of the questions as to whether that would I,pact the numbers or not. I just thought that the numbers would be higher considering the delivery method.

 

[Vince Carter]

Piggy backing with Coastwatcher, you should also be testing your SHBG.

 

[crazycanuck]

Just want to give an update as I went to the doctor's yesterday and this is what he told me.

The Doc looked at my number and said "your numbers are normal, how do you feel?" I advised that I am still having some issues with fatigue / energy, fog but I'm slowly seeing improvements in other areas. He quickly replied that "its not your testosterone then".

I asked if it was too soon to have stable serum testosterone level and he said that I have been on replacement therapy for over one month and regardless of the delivery methods, my serum level would be affected and therefore accurate. He added that as I am getting some positives from therapy, he won't stop the treatment. What the??? First strike. he did say that he is willing to see what the next labs show as "there could be some adjustments in my serum levels.

I asked if we should be aiming for a higher number to which he replied that my number is normal and where he would like to see it. He advised that if it went too much higher, we would have to adjust the dose down because it would become "supra therapy" and get into performance enhancing / bodybuilding levels. Strike two....

He set me up for blood work in a months time to ensure my levels are still good and despite his claims that any issues I still have are not due to the testosterone, he noted that all my current blood work results are excellent. I asked about E2, DHT, SHBG testing to which he replied "those aren't important as you're testosterone level is normal". This was also his comment when I questioned why we are only testing my Total numbers and not Free. Strike three????

We chatted about my protocol and he was a bit taken aback that the specialist had me on subq shots and not IM and when he read that Hcg was included in the protocol, he said "thats the next level TRT stuff and beyond what I usually do". (his words exactly). Strike four??????? I will give him some points for understanding that the 2000iu x 2 per week I was prescribed was high and he was happy to hear that I have cut back to a 500iu X 2 per week max.

He left the door open for me to return to the subq specialist to consult about blood testing for the "extras" if I become symptomatic but that might be 3-4 months down the road.

So, after having a great start to my TRT journey, I've hit a major speed bump. The way I see it right now, I have three options:

1) continue with this urologist and educate him that <500 is not optimal and usually will still result symptoms remaining. This will probably take him out of his comfort zone and result in a battle about how much test-c I should be dosing as he does not want to to raise levels too high.

2) go through the next month and continue with the status quo to achieve a stable serum level, get the basic blood work done and at eh follow up appointment, if he refuses to discuss options, request I be transferred back to the care of the specialist / other urologist. I could also simply skip this next blood work / appointment and go directly back to the specialist, bot this could cause more problems with potential care.

3) say screw it, and go through a private clinic that specializes in TRT and will do the necessary work ups.

I know it is a long post but had to vent a bit too. I'm still in shock from the appointment.

 

[crazycanuck]

I should add that if I went with the third option, my PCP would not have issue with assisting with the therapy as she was open to learning and seeking info.

 

[Vince Carter]

I should add that if I went with the third option, my PCP would not have issue with assisting with the therapy as she was open to learning and seeking info.

That might be your next best option, if they're local and you like her and she's willing to learn.

 

[ERO]

Any doc that thinks that a Total T any higher than "low normal" is too high is a huge red flag that he doesn't understand TRT. I'd give your PCP a try ASAP.

 

[johndoesmith]

I should add that if I went with the third option, my PCP would not have issue with assisting with the therapy as she was open to learning and seeking info.

Any doctor would be better than the doctor you just posted about. Infact, can I have a referral to your PCP? I think I just had an aneurysm reading about your TRT doctor.

He is just so off base it's not even funny.