-Describe body and facial hair
Normal levels of body and facial hair / no change.
-Describe where you carry fat and how changed
Carry fat in stomach, lovehandles, rear.
-Health conditions, symptoms [history]
Early onset of male pattern baldness, TRT related issues described at the end.
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever
On Doxycycline, Rogaine, Propecia 1MG (Was on propecia for 4 months before TRT without issue)
-Lab results with ranges
Will attach lab history at the end.
-Describe diet [some create substantial damage with starvation diets]
Few processed foods, mostly protien (steak / chicken) and vegtables with rice etc. Think Chipotle Steak bowls, Homemade tacos etc.
-Describe training [some ruin there hormones by over training]
Moderate weight training 3x week
-Testes ache, ever, with a fever?
Have noticed small amount of testicle ache, accompanied by VERY noticeable shrinkage after two months of TRT.
-How have morning wood and nocturnal erections changed
Morning wood and nocturnal erections were rare before starting TRT, have improved on TRT however in the last few weeks not as much as they had been.
2/14/2013 -INITIAL TEST RESULTS FROM COMPLETE PHYSICAL BEFORE TRT (Not on Propecia here)
WBC 7.8 4.0 - 10.0 th/mm3
RBC 5.32 4.40 - 5.70 mil/mm3
HGB 15.5 13.0 - 17.0 g/dL
HCT 46.2 39.0 - 51.0 %
MCV 86.8 81 - 100 fL
MCH 29.2 27.0 - 35.0 pg
MCHC 33.7 32.0 - 37.0 g/dl
RDW 12.5 0 - 15.1 %
PLATELET CT 219 150 - 400 bil/L
COMPREHENSIVE METABOLIC PANEL (CMP)
SODIUM 138 136 - 144 mEq/L
POTASSIUM 4.1 3.6 - 5.2 mEq/L
CHLORIDE 101 101 - 111 mEq/L
TOTAL CO2 29 22 - 32 mEq/L
ANION GAP 8 5 - 15
GLUCOSE 88 60 - 99 mg/dL
Normals printed are for fasting.
No normals for random.
UREA NITROGEN 16 8 - 20 mg/dL
CREATININE 0.9 0.5 - 1.5 mg/dL
CALCIUM 9.7 8.9 - 10.3 mg/dL
PROTEIN, TOTAL 7.5 6.1 - 7.9 g/dL
ALBUMIN, S 4.7 3.5 - 4.8 g/dL
GLOBULIN 2.8 2.3 - 3.8 g/dL
A/G RATIO 1.7 1.0 - 2.0
BILIRUBIN,TOTAL 0.9 0.3 - 1.2 mg/dL
AST(GOT) 20 15 - 41 U/L
ALT (GPT) 22 17 - 63 U/L
ALK PTASE 43 38 - 126 U/L
CHOLESTEROL 207 100 - 200 mg/dL
200-239 Borderline-High (Adult)
TRIGLYCERIDE 78 0 - 150 mg/dL
<150 Normal (Adult)
HDL CHOLESTEROL 49 40 - 59 mg/dL
LDL CHOLESTEROL 142 0 - 129 mg/dL
100-129 Near or above optimal
130-159 Borderline high
189 Very high
CHOL/HDL RATIO 4.2 0 - 6.7
4.0-6.7 Avg risk (Male)
TRIG/HDL (CALC) 1.6
NON-HDL (CALC) 158
THYROXINE,FREE 1.11 0.57 - 1.25 ng/dL
TSH 1.41 0.34 - 5.60 uIU/mL
VIT D (25 OH) 27.6 32 - 100 ng/mL
Values vary with exposure to sunlight.
VITAMIN B12 / FOLATE
VITAMIN B12,SRM 618 pg/mL
Deficient (Low) <145
FOLATE,SERUM >20 ng/mL
TESTOSTERONE, TOTAL 374.63 241 - 827 ng/dL
SEX HORM BND GLB 35.1 nmol/L
20-50 years 13.3-89.5
FREE ANDROGEN IND 37.0
20-50 years 24.3 - 110.2
(range updated 9/13/2012, previously 13.3-89.5)
TESTOSTERONE,FREE 9.2 8.7 - 25.1 pg/mL
ESTIMATED GLOMERULAR FILTRATION RATE (EGFR)
EGFR (NON-BLACK) 99 >60 mL/min
EGFR (BLACK) 120 >60 mL/min
eGFR imprecision is increased for values greater than or equal to 60.
3/12/2013 --BEFORE STARTING TRT BASELINE TESTS from Urologist
(Different lab so different test methodologies possibly)
Testosterone Total 414 ng/dL 241-827
Testosterone Free 72.2 pg/mL Range: 46.0 - 224.0
Dihydrotestosterone DHT 28 ng/DL Range: 16-79
Estradiol 26.2 pg/mL Range: 11.6 - 41.2
LH 4.3 mIU/mL Range: 2.00-12.00
Prolactin 12.0 ng/mL Range: 1.6 - 18.7
SEX HORMONE BINDING GLOBULIN (SHBG)
SHBG 33.2 nmol/L Range: 11.0 - 80.0
4/16/2013 SECOND BASELINE TESTS (He wanted two before starting TRT) I had been on Propecia for a month or more for these without noticing any difference in mood / sexual performance etc.
Testosterone Total 386 ng/dL 348-1197
Testosterone Free 7.5 pg/mL Range: 8.7 - 25.1
6/12/2013 After 6 Weeks TRT on 200mg (1mL). Test is 1 week after injection.
Testosterone Total 838 ng/dL 300-1200
I went to my Primary Care doctor complaining of classic low Testosterone symptoms. Low energy, low sex drive, brain fog, etc. He ran the first battery of tests and said I was fine. I looked closer at the Testosterone numbers and saw that I clearly wasn't fine especially the free test. I went back and forth with him to try to get him to test E2 and DHT and everything else for a complete picture of what was going and to consider TRT, he refused. I began looking for a doctor who would work with me and consider TRT.
I found the Urologist and showed him the tests the Primary Care doctor had done, he said I was fine. Low end but fine. I pressed and explained symptoms and he agreed to retest. He did two blood tests spaced apart and finally agreed to trial TRT. I was given a 200mg injection every two weeks. After 6 weeks he ran total testosterone and it came back 830. He said everything is great and at this point allowed home injections. I came in and was trained on home injections and received one more 200mg injection at the 8 week mark. The doctor wanted me to do a sperm analysis after the 6 week mark which I did.
So far I have had four total injections of 200mg each over 8 weeks. This is without an AI or HCG as he made no mention of them and I forgot to persist. A few days after the last injection I finally noticed how much my testicles had shrunk. I would estimate probably 50% shrinkage, and most of the time the scrotum is pulled up against my body. I called and made an appointment to see the doctor to talk about the shrunken testicles and the results of the sperm analysis.
I need some advice as to what the best course of treatment would be at this point to restore my testicles and get into a TRT regimen that keeps everything working properly. I will probably need documentation to show the doctor to convince him of whichever is the best course of action.
I was planning on splitting the doses as is recommended in the sticky and then pressing for the Urologist to prescribe hCG and Arimidex. Will adding them to the continuing TRT be sufficient to reverse the testicular shrinkage?
Is Clomid the correct route? What would the Clomid dosage optimally be? Is Clomid by itself while stopping the TRT the best option for returning testicles to size?
Alternatively, is it possible to continue the 100mg/wk Testosterone while adding Clomid and Arimidex? With possibly switching from Clomid over to hCG after the testicles have returned to size.
I would like to continue the TRT as I am enjoying the benefits, but shrinky balls are a serious downer on the whole process.
I have a sinking feeling that I am going to walk in knowing more about all of this than him, so I would like to be equipped! Thanks very much guys.
EDIT: I just saw the Urologist who had no idea about HCG or an AI and said go see an Endocrinologist.