Would love some input on lab results

[mdm14]

I am 29 years old 6'3 200lbs with the following symptoms. Low libido, brain fog in afternoons, low motivation/drive, competitiveness gone, social anxiety, fatigue.


After some googling (as my GP was no help), I decided to get my levels checked. This was harder than I thought living in Canada. I ended up ordering on discounted labs and getting checked when on a shopping trip down to the US with my wife. This actually worked great and I wish we had something like this in Canada.


Any insight on the labs would be very helpful. Also, if anyone has experience with TRT in Canada (Vancouver area) and finding a physician experienced in TRT in the Vancouver area?

Thanks!

 

[CoastWatcher]

I live in Toronto. These two clinics are known to prescribe TRT. I can not speak to any other aspect of their practice.

http://www.polohealth.com/treatments...erone-therapy/
https://www.antiagingvancouver.com/m...-consultation/

 

[CoastWatcher]

Sky-high SHBG...your free testosterone is handcuffed...

 

[mdm14]

Thanks for the responses Coast. I will give those clinics a try.

 

[mdm14]

Also, I have had my levels checked in the a month or so ago in Canada at LifeLabs. When I convert the results to US units, the results are quite similar. However, the ranges at LifeLabs seem to be much larger and my results fall within this range.

I have a feeling this may be a sticking point here.

 

[CoastWatcher]

It's going to take a good doctor, one who understands the nuances of treating male hormonal issues to help you sort this out. Many will look at your total testosterone and tell you things are fine; they won't look long and hard at the free testosterone value you've posted and dig deeper. Do you have any additional thyroid results?

 

[mdm14]

Unfortunately no. I simply ran the male wellness panel on discounted labs and added SHBG.

 

[madman]

Also, I have had my levels checked in the a month or so ago in Canada at LifeLabs. When I convert the results to US units, the results are quite similar. However, the ranges at LifeLabs seem to be much larger and my results fall within this range.

I have a feeling this may be a sticking point here.

Any doctor that is well versed in trt would see your high shbg as a red flag and understand that your free t fraction is absurdly low.

As far as a doctor treating a patient with trt again if he/she is well versed in the area.

Under the Canadian Testosterone Deficiency Guidelines if a patient is experiencing low t symptoms along with blood work (usually 2 seperate tests) done on different days in a fasted state in the morning between 8-10am and the patients total t levels came back lower than the bottom end of the lab range or 8-12 nmol/L (considered the GREY ZONE) than the patient would meet the requirements for a 6 month trial of trt!

So do not be discouraged, hopefully you find a knowledgeable doctor to treat you.

 

[madman]

According to the British Columbia College of Physicians and Surgeons he is currently suspended from the practice of medicine for the sixth time. He has been suspended in the past for fondling a patient (female) and had conditions attached to his license.

Yes I did mention in the post to mdm14 he had a lot of issues regarding his medical practice license "so not sure if he would be worth looking into" and it upsets me what he has been accused of.

 

[mdm14]

Thanks guys. Have an appointment with my GP on Thursday and hopefully he will refer me to an endo. I will start there and if that doesn’t work, I will check out the clinics noted.

 

[mdm14]

Well had my appointment with my GP today and he prescribed me Andriol capsules at 40mg twice daily. Anyone have experience with this?

 

[madman]

Well had my appointment with my GP today and he prescribed me Andriol capsules at 40mg twice daily. Anyone have experience with this?

Absorption is very poor and it needs to be taken with a meal containing some fat to allow for optimal absorption and your dose needs to be spread out and taken 2 times/day in the morning/evening and 80mg (40mg twice daily) is usually a common starting dose for men and some times increased to 160mg (80mg twice daily) depending on testosterone levels and effectiveness of the therapy.

You would be far better off with injections (testosterone enanthate or testosterone cypionate) as there are no issues with absorption/effectiveness and one can easily attain mid-normal or high-normal physiological levels of testosterone as oppose to using oral capsules -Andriol (tesosterone decanoate) which if one does have effective absorption men are usually only able to attain mid-normal testosterone levels.

Not saying achieving mid normal total t/free t levels is bad as many men do well in those ranges but there are others who need to have levels in the high-normal physiological range to experience relief/improvement of low t symptoms.

If anything I am shocked that he would not put you on transdermal testosterone-Androgel or Testim as it is common for men to start trt using transdermal testosterone gels/creams if they are uncomfortable using injections.

Transdermals can be effective and there are men who do very well on them and attain good testosterone levels and results but at the same time there are many who react poorly due to absorption issues and they end up switching to injections.

If anything get off the oral and at least convince him you want to try transdermal or even injection.

He should have given you the option of transdermal or injections instead of pushing the oral Andriol as not many doctors would prescribe it for trt simply knowing that absorption/effectiveness is poor!

Even though women were used in this study it will give you some insight on the pharmacokinetics of Andriol and the and the effect of food composition on serum testosterone levels after administration. [url]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1859980/


[/URL]

 

[madman]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4269219/#R22

 

[madman]

Read this when you have time.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4168025/

 

[mdm14]

Thanks man. Will read on my lunch break today.

 

[mdm14]

I was chuckling a bit while reading this. Seems that 200mg twice a day can get men to average levels and 300mg twice a day for upper range. My current prescription of 40mg twice a day doesn’t look like it will do much at all.

I think there are 60 capsules in each bottle so 300 mg twice a day would last 4 days taking 15 capsules a day to get to upper normal

 

[madman]

I was chuckling a bit while reading this. Seems that 200mg twice a day can get men to average levels and 300mg twice a day for upper range. My current prescription of 40mg twice a day doesn't look like it will do much at all.

I think there are 60 capsules in each bottle so 300 mg twice a day would last 4 days taking 15 capsules a day to get to upper normal

Do not get to caught up on the doses used in that study.

I had thought that the starting dose was 80 mg/day (40mg morning/40mg evening).

It is actually 120-160mg (60-80mg morning/60-80 mg evening) for the first 2-3 weeks to get blood levels elevated and than a maintenance dose of 40-120mg/day split in 2 doses based on ones following testosterone levels and whether the patient is benefiting from therapy.

So you should be using double the dose you are on.....hard to believe he is starting you on such a low dose as most doctors know of the poor absorption of Andriol hence why it is rarely prescribed for trt.

You can give it a go but honestly transdermal or injections (most effective) would serve you much better!

Here is the pdf for Andriol (manufactured by Merck) in Quebec.

On page 11 of the pdf you will see Recommended Dose and Dosage Adjustment look over when you have time and explain this to your doctor.https://www.merck.ca/static/pdf/ANDRIOL-PM_E.pdf

 

[madman]

If he does not want to give you the option of using a transdermal or injections than I would look into finding another doctor.

The simple fact that he put you on Andriol right away knowing or at the very least should be aware that absorption is poor let alone it is very hard to achieve high-normal physiological testosterone levels (not that is is always needed in every patient) and stable levels if that.

He started you on a very low dose half of what is recommended.

You deserve much better care!

 

[mdm14]

Thanks again for your help!

When I mentioned injections to my doctor he said I would have to come in once a month for an injection. Unless this is test-u, it seems like a very old protocol and a recipe for disaster but regardless, he wanted me to try the Andriol first.

I haven't gotten my prescription for the Andriol filled yet as the pharmacy had to track some down as it isn't prescribed very often. When I get it, I will give it a go for 3 weeks and go back and see him as he requested. Ill be sure to take it with a scoop of coconut oil or something for absorption. At that time I will try and talk him into self administered injections at one or twice per week. My hesitation is that he might not be the most knowledgeable on dosing and side effect management given his current suggestions.

Another thought would be to see if he will refer me to an endo or urologist to manage the therapy. I know on the UBC website it shows endos with a clinical interest in Hypogonadism. Ideally I could get a referral to one of them.

 

[Systemlord]

My hesitation is that he might not be the most knowledgeable on dosing and side effect management given his current suggestions.

That's an understatement! I'm dying to know where they get these ideas about injections once a month or once every two weeks on medicine with a 5-8 day half life.