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31, Thinking of TRT, Opinions Before Bringing Up with Doctor

Test labs came back in today and they’re pretty bad:

Total: 242.1 ng/dL
Free: 12.7 pg/mL

This has spooked the office and they’re now sending me out to an endocrinologist before they’re willing to treat me; specifically mentioned that they believe I may have issues with my pituitary gland.

This is basically becoming my journal.

Doctor wants me to see an endocrinologist to evaluate secondary hypogonadism.

The patient has secondary hypogonadism if his serum testosterone concentration and/or the sperm count are low and/or his serum LH and FSH concentrations are inappropriately normal or low, which would be inappropriate if gonadotroph cell function were normal.

So to qualify for secondary hypogonadism, you need to:

  1. Have low testosterone levels
  2. Have low or normal LH and FSH levels

In my case, I match that criteria as my:

  1. Free (12.7 pg/mL) and total (242.1 ng/dL) testosterone levels are very low
  2. LH (6 mIU/mL) is normal
  3. FSH (2.4 mIU/mL) is at the very low end of normal

Secondary hypogonadism is caused by issues with the pituitary or hypothalamus… And that is terrifying. What started as low energy is turning in to issues with my brain. Fuck.

Hormonal, not mental.


Your brain issues. Its just your hormones. You aren’t crazy!

Trying to be optimistic.

Had an appointment with an Endo on Wednesday.

  1. She thinks I am fine. All normal. LH, FSH, Testosterone - everyone. No need for therapy at all. Pretty normal response, and what I’ve come to expect, I’d say.
  2. She has no immediate concern about hypogonadism.
  3. As my last labs were drawn around 11AM, she doesn’t consider them valid.
  4. She ordered new labs and then wants a 3-month follow up, where she’ll order a pituitary MRI if there are signs of secondary hypogonadism (which she doesn’t think there currently are).
  5. She cautioned against TRT as it has the potential for long-term damage, as well as infertility.
  6. When I asked about hCG to help with infertility, she said that she never prescribes it because it is “nasty” stuff that is “bad” for your health.
  7. Recommended that I go with clomid if my labs come back and show low T (which she doesn’t believe I currently have).

If we remember this definition:

Then by her, I do not have hypogonadism. My concern is regarding her definition of the word “low”.

I went for labs yesterday morning at 8AM and they’ll be in next week.

Currently I have an appointment Monday morning at the original center for TRT pending the Endo convincing them that I don’t belong there.

Reminder to self to do a post on what “low” means, in the context of reference ranges and LH, FSH and Testosterone levels regarding different types of hypogonadism.

Let us look at just my most recent labs:

  • LH 6.0 (1.7-8.6 mIU/mL) normal-to-high
  • FSH: 2.4 (1.5-12.4 mIU/mL) normal-to-low
  • Total T: 242.1 (264-916 ng/dL) low
  • Free T: 12.7 (8.7-25.1 pg/mL) normal-to-low

Based on those labs, I’d say I certainly do not have secondary hypogonadism.
While the total T is indeed very low, the free T is spot on.

Do I even have low T?

That’s crazy, time for a new doctor! What’s even more nuts is you are below the ranges and still says you are not low, it sounds like her knowledge of TRT is leaning towards that it’s potential for long-term damage. Everything she knows is wrong so it seems this doctor won’t be able to help you. It really sounds like since your LH, FSH and FT and just within range she declaring you normal even though your T is below range. Stupid doctors!

Your T levels should be just north of 500 ng/dL for your age. Your low SHBG is another reason why you are feeling the typical symptoms of low-T, even if your TT was in range your low SHBG is likely the reason you feel the way you do.

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I think bouranch has asked a very good question here. Does he really have low T? His FREE T is perfectly mid range. His Estrogen is perfect as well. Total T doesn’t really matter right as most of it is not bio available any ways right?

You also need to consider his symptoms which some doctors ignore and only look at blood work, symptoms and blood work tell a bigger story than either one by itself. Let’s say he has good erections and his sex drive is good, but suffer the symptoms of mood swings, loss of interest in life which could be the beginning early symptoms of low-T if one looks at his TT. I’m no doctor but I’d say he’s not to far away from full blown symptoms in the years to come. His TT should be greater than 500 ng/dL at his age. Not all suffer full blown symptoms in the 300’s, but they do suffer minor symptoms at the least.

Amen about the symptoms. Regardless of what the numbers say, I have the symptoms.

One more important measurement is SHBG. Lets look at my Jan 2016 labs (at 29 years old), as my latest labs did not include SHBG, and extrapolate from there.

Total: 282 (290 - 1300) low
Free: 73 (46 - 224) low
SHBG: 13 (10 - 51) low

I’d say that’s a pretty obvious case of low testosterone.

I need to schedule another set of labs so that I can get total, free and SHBG all in the same test.

“Between my lab results, weight gain, trouble sleeping, general “meh” attitude about life, gynecomastia and hair loss at young age - among other things - I want to talk to my doctor about TRT and want to be as prepared as can be.”

Are these the symptoms your referring to? I wemt through all your comments and thats all I see…

I was looking at those ranges incorrectly.

Total T is definitely low, however so is Free T.
With a range of 8.7-25.1, the midline is 16.9.

So, my total T is low, and my free T is below normal by a good amount.

I don’t know how to interpret the LH and FSH numbers, or their relevance. I understand that they are chemicals released by the pituitary (?) that tell the gonads to produce testosterone and sperm, respectively (?).

So, my LH is above average, which signals the gonads to produce testosterone, yet my testosterone is low.

So, it looks more like I have primary hypogonadism - AKA low testosterone.

Please note that I am half talking to myself, and half looking for feedback to correct me if I am wrong.

Latest labs came in.
These damn non-absolute values are outrageous.

From the last test to this one - a few weeks apart - LH went from high to low, and free T went from low to normal.

What the fuck? It is almost like these labs are not accurate to begin with and each lab is just a shot in the dark.

  • total test 251 249-800
  • free test 17 4-30
  • lh 2.5 1.2-10
  • fsh 1.7 .7-10
  • prolactin 7.1 2.5-17
  • ferritin 61 26-380

Essentially these labs show that I have secondary hypogonadism - a problem with my pituitary - where-as the last labs indicate primary hypogonadism - a problem with my testes.

Or they show that everything is completely normal, as total T doesn’t matter, and free T is smack in the middle.

I’d say that I need a SHBG lab to see the whole picture.
I’d also say that the inconsistencies in these results is making me damn frustrated.

Doctor’s office called and said that they need explicit approval from the Endo before they’ll start treating me, for liability reasons.

I appreciate that they’re covering their ass, and that they want to be through, but: damn it.

Left a VM with the Endo’s office about this, waiting to hear back.

Essentially, my script is this:

Well, I gave up on the original office, and on the Endo, and went to a local ‘Numale’ clinic.
I walked in, and 40 minutes later had 100mg of T Cyp running through my ass.

I’ll quickly document my experience at the Numale clinic.

  • Very ‘sales’ oriented. Be prepared to spend a lot of money.
  • Cost me $2400 for the year ($800 down, then $160 a month for 10 months).
  • The ‘membership’, or whatever it is, includes everything you need (testosterone, HCG, needles, syringes, labs at 3 weeks until dosage is figured out, then every 3 months).
  • You don’t get a prescription for T or HCG, as they give you all of your supplies.
  • They ship you your T and HCG - you can’t shop around for better prices.
  • Covered labs are total T (not even sure if they test free), E2, psa, and hematocrit. I’ll need to get my own labs for anything else worth testing.
  • Anastrozole was called in to a local pharmacy where I picked up and payed out of pocket ($6 for a month supply)
  • They also offer pellets, but don’t push one over the other.
  • No HCG shot yet, as they don’t store it on-prem. One it ships to me I’ll be self injecting. Starting me at 30iu 3x per week (which I know is well below the recommended dose in the protocol for injection sticky). I’ll get it moved up as my wife monitors the size of my balls.
  • They give you 23g 1.5" needles for IM injection. I asked for something smaller, and got 27g 1.25" needles that they want me to stick in to my ass muscle.

Starting me at 100mg per week of T Cyp self injection (minus first injection in office). Told the doctor that I’m going to do 2x per week, which he is fine with, except he wants me to do 1 shot per week for 3 weeks, and then a follow up visit, to test my levels.

I’d like to move to 2x per week right away, but that’ll throw off my labs (they’ll be expecting more T in my system as I’ll have injected 100mg 2 days before the followup, as opposed to 50mg 2 days before the followup).

As I had already exhausted 3 doctors and a lot of time, I went ahead and just signed up, knowing full well that their prices are high - but I’m tired of the game.

Since taking 100mg T Cyp and a dose of anastrozole yesterday afternoon, I do not feel any different today. Sleep may have been slightly better, though I also started taking ZMA two nights ago. I have a hellish training session today (squat 330lb 5x5, press 150 5x5, deadlift 310 1x5), so I’ll see if I notice anything.

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That place is expensive

30iu of HCG is a drop. It is probably 300 iu which usually equals 300mg. That ipretty standard about 50mg over the standard protocol here. Up to 500mg is normal. 1000iu is one ml and typicaly HCG is mixed at 1000mg per ml.

Your clinic is expensive but they do test enough to get you set up well

That place is definitely expensive, but I was at the end of my options. My (two) GP wouldn’t treat me, my Endo wouldn’t treat me, and the damn center that I went to that specifically deals in HRT / TRT wouldn’t treat me. I wasn’t walking out of there without getting started.

I can’t remember if he said 30iu or 30mg - probably 30mg now that you mention it. I’ll have to verify.