T Nation

2 Months on Androgel - Total T Decreased?


#1

As the subject states, I started TRT a little more than 2 months ago (androgel 5mg daily). I am 39 yrs old.

Since then, my total testosterone has decreased.

Here are my results

Total T
Before TRT (4/16/2010) - 382 (Range 280-800 ng/dL)
After TRT (6/26/2010) - 286 (Range 280-800 ng/dL)

I asked for Free T or Bioavailable T tests, but they are not available according to doctor.

Other tests:

ESTRADIOL - <12 (no reference range)

LH - 1.4 (no reference range)

The fact that my Total T has dropped almost 100pts has me concerned. I dont know if the estradiol and LH test results are helpful.

Just in case it's relevent, I have been on a VLCD (ketogenic diet) for the last 6 weeks and I train 4 times a week (for the past 9 months) with rarely a missed workout.

Some of my symptoms have improved (I felt great for the first 2-3 weeks) , but not all. I am at a loss at this point. My doc (Primary Care Physician - Internal Medicine) doesnt seem to be up on TRT and I would like to have some idea of what is going on (or what needs to be done to pinpoint what is going on) so I can discuss it with him.

I appreciate some thoughts.

Thanks


#2

Get a new doc–your current one doesn’t know shit


#3

Ghost rider where are you located?


#4

@VT - Yep. I know. Looking at my options
@hardasnails - I’m in So. Calfornia.

Any ideas on why my TT decreased? Nuts shutdown?

Thanks


#5

a lot of people have problems absorbing transdermal T. When I was on transdermal, I absorbed just barely enough to shut down what was left of my own T production and jack up my Estradiol levels. I had a few months of feeling good before everything fell apart, and my T levels dropped. A number of people have experienced the same thing - that is why you see most people here recommending T-Cyp shots at the longest interval of twice weekly.

Have you read through all of the stickies? If so, print out the parts you like and take them to you doctor - treatment ideas, blood test requirements, more specific complaints regarding your symptoms, etc. if your doctor won’t listen (which is actually expected) then try and find one that will. The best ones I have found are the ones that normally don’t take insurance, but it is definitely worth the money when you find a good one.


#6

You need the original lab reports. Always get those and retain.

5mg a-gel is basically too little. However, those with thyroid problems are often?always non-absorbers. So you should test thyroid levels too. + If not using iodized salt, get it. You can find iodized sea salt if you look for it.

Over training can trash hormone levels and may be causing adrenal problems too.

Get a proper male panel done, find at lef.org and pay out-of-pocket.


#7

I had my Thyroid levels checked before starting A-gel. They came back normal. Doc didnt order thyroid this round.

I’m taking 10 days or so off training. I originally decided to do this to allow a few injuries heal, but it seems there is another incentive to rest a little.

Apparently, I was a little naive to think 5g TD daily would cause any real issues.

T-cyp is usually dosed in 100mg of which 75mg is T. So, it is accurate to say [to my doc] we are only doubling the T and changing the delivery method. Am I correct?

When should I be concerned about using an AI? I imagine it would be if my estradiol rise significantly. Also, I have read Crissler recommends HCG. Does anyone have any experiences with HCG they can share?

Obviously, the biggest hurdle is finding a doctor who is either knowledgable enough about HRT or open to learning more about it.

Thanks for all the valuable advice.


#8

Here are the results of my Thyroid panel - lab standard ranges in parenthesis:

T3 93 (58-159 ng/dL)

T4 FREE 1.19 (0.81-1.48 ng/dL)

TSH 0.62 (0.35-4.00 uIU/mL)


#9

Hard to ever know what to say to docs. I would not argue the doubling T thing, really, you are wanting to triple your serum levels. You are really only asking for a delivery system that works and injections never fail to deliver. Read the stickies for more.

Please post the lab and the labs ID for the E2 test.


#10

Thanks KSman,

Unfortunately, I dont have E2 labs. I only have the estradiol results posted above with no reference range. Getting these labs has been much more difficult than I expected. Under my old plan, I would simply ask for lab work (although, I did not ask for hormones panels) and they would pretty much order them for me.

Under this new plan, I am also told that some labs are not available and I am not sure what that means (is it that the labs do not exist under Kaiser which is hard to believe, or have I not met some clinical prerequisites for the labs, or are there certain labs that only a specialist can order?).

I have also noticed some testicular atrophy which is troubling.


#11

Perhaps a silly question, but should I continue on A-gel 5mg or stop and wait to see what doc says?


#12

[quote]Ghosttrider wrote:
As the subject states, I started TRT a little more than 2 months ago (androgel 5mg daily). I am 39 yrs old.

Since then, my total testosterone has decreased.

Here are my results

Total T
Before TRT (4/16/2010) - 382 (Range 280-800 ng/dL)
After TRT (6/26/2010) - 286 (Range 280-800 ng/dL)

I asked for Free T or Bioavailable T tests, but they are not available according to doctor.

Other tests:

ESTRADIOL - <12 (no reference range)

LH - 1.4 (no reference range)

The fact that my Total T has dropped almost 100pts has me concerned. I dont know if the estradiol and LH test results are helpful.

Just in case it’s relevent, I have been on a VLCD (ketogenic diet) for the last 6 weeks and I train 4 times a week (for the past 9 months) with rarely a missed workout.

Some of my symptoms have improved (I felt great for the first 2-3 weeks) , but not all. I am at a loss at this point. My doc (Primary Care Physician - Internal Medicine) doesnt seem to be up on TRT and I would like to have some idea of what is going on (or what needs to be done to pinpoint what is going on) so I can discuss it with him.

I appreciate some thoughts.

Thanks

[/quote]
It all depends on the patients age if you are under 30 then I would discontinue for 10 days then I would do a clomid challenge to see if you are primary or secondary. 2 months ios way too long to have people single dosage. We have people retested in just 10 days then adjust up wards, add in HCG, or if e2 is out of balance then add adex.


#13

Thanks…I’m 39…thoughts?


#14

You are in between. Certainly not a young guy will no age related components. Clomid will verify the hypothalamus-pituitary and LH-testes responses. hCG would focus on the LH-testes response. But in any case, after you get the data, you have to fix the root cause or do TRT. In most cases it will have to be TRT.

With clomid you can look for LH/FSH response and T response. With hCG you look only for T response. If the testes are exposed to increased LH or hCG and T response is poor the testes are not going to support any kind of restart in any case. The exception is when there are blood circulation problems to the testes that can be successfully repaired when the testes are otherwise in good order.

If the top end is good and the testes are not, then one would have higher levels of LH and low T from the start. Great theory, but I have not seen a clear cut case of that yet in my exposure to these problems.


#15

[quote]VTBalla34 wrote:
Get a new doc–your current one doesn’t know shit[/quote]

100 points is not a significant difference considering the spread for total T ranges from 300 to 1200 ng/dl.

I’ve been taking 7.5 or 10 grams of Androgel for almost nine years. I don’t test the same all the time. I usually test every six months somewhere between 700 to 1000. On a few occasions I’ve tested in the 600s and on one occasion, tested at 1500 with 10 grams of gel.

Five grams may simply not be enough for you.

But I’m not a doctor. Get to a competent doctor. As I’ve written before, I recommend seeing a urologist with a fellowship in andrology if you can find one.


#16

Brick,

I think VTBalla was referring to the blood tests the doctor was running (wrong estrogen test + failing to run free T, etc.), the general treatment plan (slap on 5mg androgel and you’re good to go), and the lack of estrogen control - the 100 point drop was just extra icing on the top.


#17

Pure: I see.

5 grams of Androgel MIGHT be all that’s needed. I use 10 grams with no other drugs and NEVER had a problem with estradiol and my LH and FSH levels are normal, albeit LOW normal.


#18

[quote]PureChance wrote:
Brick,

I think VTBalla was referring to the blood tests the doctor was running (wrong estrogen test + failing to run free T, etc.), the general treatment plan (slap on 5mg androgel and you’re good to go), and the lack of estrogen control - the 100 point drop was just extra icing on the top.[/quote]

^^^ This

Plus this:

[quote]
I asked for Free T or Bioavailable T tests, but they are not available according to doctor. [/quote]

“Not available” or “doc doesn’t know enough about them to interpret so he won’t prescribe them”?

Don’t worry Brick, I’m not hating on your Androgel.


#19

[quote]KSman wrote:

With clomid you can look for LH/FSH response and T response. With hCG you look only for T response. If the testes are exposed to increased LH or hCG and T response is poor the testes are not going to support any kind of restart in any case. The exception is when there are blood circulation problems to the testes that can be successfully repaired when the testes are otherwise in good order.

If the top end is good and the testes are not, then one would have higher levels of LH and low T from the start. Great theory, but I have not seen a clear cut case of that yet in my exposure to these problems.[/quote]

Looks like I may have made a convert…


#20

That is all good challenge-response trouble shooting. In most cases TRT is the only recourse. For older guys, such trouble shooting seems pointless and borders on unnecessary.