T Nation

38 Y/O, Newly on T-Gel and Not Happy


#1

Sorry in advance for the long story.

I’m 38 years old and currently on a TRT gel prescribed by my primary doc- here’s my story. 4 years ago I made a dr appointment to discuss the embarrassing ED issues I was having, the Doc ordered blood work and I came back in for a follow up. She said my T levels were normal (did not share the numbers, and I didn’t ask) and she recommended ed meds. I started using those and it helped for sure but did not address the other issues, mood, lack of morning erections, energy level, libido, focus etc.

Fast forward 4 years and I’m still having similar issues. My dr. office sends me an email inviting me to a “patent portal” that I logon to and find a wealth of information- all of my past lab results etc. I noticed my T levels from back in 2013 and see that it’s clearly in the low range:

2013 numbers:
Testosterone Total 276 ng/dl
Testosterone Free 6.5 pg/ml

I got online and started reading everything I could about testosterone and quickly learned that my numbers were not good and this could be the cause of my ongoing issues. I asked the doc to order updated blood work and the results were even worse.

Feb 2017 numbers:
Testosterone Total 84 ng/dl
Testosterone Free 2.6 pg/ml
TSH 1.58 uiu/ml
FSH .9 mIU/ml
Prolactin 7.3 ng/ml

Doc puts me on T-Gel 25mg/2.5gm 1% once daly. Which I find out later is a very low dose. After nearly 3 months on that protocol I don’t FEEL any different so I get blood work again and the Doc calls and says my levels are back to the “low end of normal”. When my results post to the portal I was shocked to see what she called “normal”.

April 2017 numbers:
Testosterone Total 189 ng/dl
Calc Testosterone Free 4.6 ng/dl
Calc Bioav. Testo 107. ng/dl
Free Androgen Index 31.8%
SHBG 20.6 nmol/L

More about me:
I’m 6’4” 207 lbs, I workout 5x/week (weight training) and have not had much success in muscular gains. I have a very healthy diet and lifestyle, I track all of my calories but still have excessive abdominal fat. I also get 7-8hrs of sleep every night. I have fathered 2 children and wish to maintain fertility.

Any constructive advice would be much appreciated!


#2

Change doc or ask him tonput you on Test C injections. Gel is not worth more costly and can cause e2 issues if not monitored properly. Moreover there is always risk for members of family.
Your TRT is not going properly since your levels are not good.
Androgel absorbtion will be low if you have thyroid issues.
Switch to injections with 150mg in 1 week. The dose can be divided in 2 each of 80 mg for 1 week.
Get your levels tested and see where you stand and adjust doae accordingly. If e2 is high you have to take anastrozole. This is my theoritical knowledge but there are more practicle and experienced guys here who can help you more.
One thing is sure yout doc is not treating you properly so change her or convinve her to keep ypur Total T in 800 ng/dl or above and free T in upper normal range.


#3

You need to find a doctor that cares about you. From what you said, she’s trying to get you to the low range of “normal”, instead of trying to alleviate your symptoms.


#4

yes, doctors are the biggest problem with male hormone care, the often to not care and typically seem to be clueless

Inability to absorb transdermal T is a symptom of low thyroid function. Please see the last paragraph to self-eval this.

Training with low-T and/or low thyroid function can be stressful for the adrenals.

You have secondary hypogonadism and your low prolactin indicates that this is not caused by a prolactin secreting pituitary adinoma.

T-gels are 10% absorbed at best, often much less. Youthful levels would be 10mg/day, or 10% absorbed of 100mg applied T, 4 times your dose. So we do not know with this low dose what exactly is going on.

Self-injected T is 100% absorbed, least cost and least E2 potential. Transdermals have highest E2 potential. You can inject with #29 1/2" 0.5ml insulin syringes. Inject SC/SQ, not IM. That avoids muscle damage and provides more even T levels.

  • self-inject 50mg T cyp/eth twice a week
  • 0.5mg anastrozole at time of injections, adjusted to get near E2=22pg/ml
  • 250iu hCG SC/SQ EOD to preserver testes and fertility, often improves mood

Labs with ranges if you have these? list format please
TT
FT
E2
LH/FSH
prolactin
CBC
hematocrit
fasting cholesterol
DHEA-S
AST/ALT
Cortisol [time of day needed]

The stickies are required for knowledge gain. You cannot be passive with your hormone care.

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.


#5

Thanks for the detailed reply- I really appreciate the advice. I’m working on finding a new Dr. to take over my TRT care, I’m considering seeing Dr. John Crisler since he’s only about a 2.5hr drive from me. The only issue is he’s cash only.

I’ll read through the stickys as you suggested.