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42, Test Results. 3 Months TRT, Endo Suggestions?

So I’ve been using TRT for 3 months now, through my family Dr. My Dr consulted with an endocrinologist who’s suggesting I don’t need TRT, despite my low levels, which is frustrating. Endo said that my Pre-diabetes and being overweight is why my T is low.
So I’m 42 5’10" 220 lbs. here’s my test results before and after. No FT were done as I think those have to be ordered by an endocrinologist here in my province (Alberta Canada)
My Dr wasn’t allowed to test DHT either.

2 Testosterone levels tested a week apart
6.2 nmol/L = 178 ng/dl
7.2 nmol/L 207 ng/dl
2 IU/L reference Range 1-9
16 nmol/L. Reference Range 10-55
7 ug/L. Reference Range 0-15

Total Testosterone
8 nmol/L 231 ng/dl
Estridol 95 pmol/L 25.87 pg/ml
Free Androgen Index
61.5. Reference Range >=30
13 nmol/L. Reference Range 10-15
375 ng/dl
0.6 ug/L. Reference Range 0-2.5
<1 IU/L. Reference Range 1-18
Cortisol AM
392 nmol/L. Reference Range 170-500
15 ug/L. Reference Range 0-15

Now I’ve been ‘Pre-Diabetic’ for a decade or more, and my mothers been told that forever also. I guess even my grandfather, yet there’s no history of actual Diabetes in my family.
I really don’t understand how my Low T is no concern to this Endocrinologist and he even suggested my MRI next month be canceled (pituitary). My Dr wasn’t impressed that he didn’t even suggest seeing me, and said if I want to continue TRT I could, but said Endocrinologist recommended I quit and get a FT test.
I’ve learned enough to know that a lot of Endocrinologist are clueless about TRT, so I’m very skeptical. I have major fatigue, recent ED issues, irritable, can’t lose weight at all and I wonder if my prediabetes could be because of low T.

Any help is greatly appreciated.

Apparently my thyroid results are good, and I use lots of table salt (iodized).
I don’t snore, and doubt I have sleep apnea but it’s possible I guess. I’ve video recorded myself sleeping a couple times recently, and nothing seems abnormal.
I’m on disability and don’t have much to spend, yet if I had to spend $50 on a lab test or something I could.
I was very hopeful trt would’ve given me some energy by now, yet I feel like I could fall asleep at any moment.
I finally asked about getting my T levels checked after a couple months of losing erections during sex, which never happened before. Once I seen all the symptoms I was certain my levels were low.
I was getting 200 (mg?) every 2 weeks, but the past month I’ve been doing 100 every week now. I was getting very depressed before my next shot.
At about 5 weeks of trt my ED issues got bad but seem to be better with shots every week now.

Your low SHBG can also be a symptom of diabetes.

Low SHBG means more of your T is free T, but that will still be low in absolute terms. In that context, free androgen index is rather meaningless.

Your E2 [estradiol] = 95 is not great. We target E2=80 when TRT guys have high T levels. If you increase T levels, E2 can only go up. This means that E2 can be too high for your when on TRT. With low TT, FT we expect E2 to be low as there is little FT for FT–>E2. Liver clearance of E2 might be impaired. Do you have AST/ALT labs? Some drugs, Rx and OTC can interfere with E2 clearance.

Prolactin was low, now high. Keep tracking this. Concern is prolactin secreting pituitary adinoma and they cancelled the MRI to check for that. If serious, prolactin can get very high. Prolactin can be elevated and affecting lab results from recent orgasm, cuddling babies, puppies or kittens. So abstain for next labs.

Your T is very low. If self-injecting, inject 50mg SC/SQ, not IM, twice a week. Use #29 1/2" 0.5ml insulin syringes. Or inject EOD - see below

Do labs always halfway between injections.

You may be a testosterone hypermetabolizer. Such guys typically need 300mg T per week to get where others are in 100mg per week. And effective half-life is shortened and injections should be EOD [every other day]. Doctors do not know this and it is not in the literature.

Low thyroid function can affect glucose levels and insulin sensitivity.
Do you use iodized salt and/or vitamins that list iodine+selenium? [YES}
See last paragraph in this post!

Low T also affects insulin sensitivity.

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.

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Thank you very much for the reply Ksman.
My Dr didn’t cancel the MRI, but the Endocrinologist suggested to.
I do take a 1 a day vitamin with selenium, yet no iodine. If table salt use is sufficient, I’m golden cause I use probably too much.
I’ve made sure not to have an orgasm for 2-3 days before labs. My libido is almost too healthy, and I can’t keep my hands off the wife. Combined with failing erections and numbness, it’s a cruel combo.

I wouldn’t be surprised at all if I was a hypermetabolizer since after my first 2 shots I don’t feel much if any effects. And I was amazed my T levels were so low after 3 months. I did the labs on injection day, 7 days after last shot of 100.

My liver tests were ok, yet I’ve had a ‘fatty liver’ for 5 years or more. I take 225 mg of Effexor antidepressant and have for around 10 years. All of my body fat is on my waist / gut.

I’ll ask for all my thyroid, liver, blood test results for the past few years next appt. I’ve mentioned SQ injections to my Dr but despite agreeing in principle doesn’t tell me anything.

I’m a little worried about going on my own with things like SQ shots, and was planning on giving her protocol a good go before making changes. It could make things awkward if I tell her I’m doing this and that without her on board. I’d guess she’d be ok with almost anything I’m seriously convinced is best.

Ugh, I always seem to have the complicated health issues where I have to be my own Dr, and my Dr ends up as my consultant. My government is cutting health care costs wherever they can recently, and restricting a lot of blood work.

I’ll begin my Oral temperature monitoring now. I just did one now at noon and it was 96.9 - 97.1. That seems pretty low. The room I’m in is kinda cool, yet for the past week or so I seem to remember having cold hands and feet. Also had a few mild headaches the past couple weeks. My wife is Hypothyroid so I’m somewhat familiar with the symptoms. She noticed her hair falling out more then normal, which is when she got tested. I’d probably loose half my scalp before noticing that, lol.

Low body temps and no thyroid labs. Labs will probably be “normal” so labs would not cause doc to do anything. Ball is in your court. Please confirm “iodized” on salt label.

Check wife’s temps too. If low, she is under medicated.

In Alberta, you can get insulin syringes without a Rx?

Salt is iodized, yet I just read your sticky regarding info on thyroid and iodine and I’ll get some IR soon.
I can get any syringe, and my mother in law is diabetic so I can just get some from her.
My wife just did a blood test again for thyroid but I’ll start taking hers also. She should find out test results soon also.
I’m willing to do almost anything to feel better, I just have some caution. I actually trust your opinion on Endocrinology then my Dr or any Endocrinologist I’ll meet unless they gained my trust by demonstrating their knowledge.
I can’t even express how grateful I am for your replies and your generosity towards strangers here. Not trying to blow sunshine up your arse, but I hope you understand how helpful you are and the impact you have on many people’s lives.

So I will dose as you advised 50 twice a week SQ. my MRI is in 3 weeks, so maybe I’ll stick to that alone till I see my Dr regarding MRI?
If E2 is still high, use an inhibitor? I forget the ‘A’ word / name.
If TT is still low I’ll increase?
Dr said after MRI I’ll see an Endo, but I’m feeling very pessimistic about that now, even more then I was before hearing his opinion. Yet I won’t pretend to know more then he does, and will have an open mind.

Do you need a prescription to get armidex? I’m in Canada and there’s some steroid sites that it looks like I can just order it, but one online pharmacy said a prescription is needed.
I’m not sure I could afford it without a prescription anyways.
After my last Drs visit I think I got the impression I’m on my own for the most part. She did all my injections till I did my own 2 weeks ago. I was telling her I was comfortable doing them myself.
Yet we talked that I would do one, then see her for another a week later, which was last week. I noticed after she didn’t make me an appointment and asked if I was just going to inject myself.
I normally stay fairly involved with my Heath and treatments, but I feel like I need some serious direction here. I think I’m having some brain fog issues, or getting older and less able to wrap my head around everything lately.

It looks like ‘metabolic syndrome’ might be at least part of my issue. Yet when I got my lab print outs the dr wrote “diabetes? Weight?” For reference as things to ask my online experts ‘Ksman’ 8-).

Yet why she didn’t order glucose tests seems odd. I haven’t had a fasting glucose test for 4 years or more. I’ve been drinking Coke Zero and using sweeteners with coffee for a year and a half now. I’ve recently read some studies that suggest sweeteners may actually increase insulin and cause diabetes more than sugar. So I’m going to cut those out and commit more effort to better diet and exercise.

From what I’ve gathered one shouldn’t just take Testosterone alone, but Armidex to be dose adjusted with tests, and HCG. I haven’t read all the details on HCG but it seems mainly for testicle concerns. In all honesty I don’t care much about my testies, I’m fixed anyways.

Anyone know of a list of good TRT Drs for a list of cities? I’m planning on seeing an Endocrinologist after my MRI in 2 weeks, but I have little hope they’ll be much help.

The Endo who said I should be off Test cause my levels are likely from prediabetes (Metabolic syndrome), sounds like one to avoid. I read studies that show TRT reduce sudden death rates in test participants with Low T and prediabetes or diabetes, compared to low t and non-diabetic and a control.

Plus what does it matter why I’m low? I mean it matters but why would I want to be low, simply because it’s caused by something other then hypogonadism?

Does my recent T results of 8 on day of weekly shots seem odd? I would think after 13-14 weeks I should be way above that. I should be at a peek level after 7 days if I’m not mistaken.

And does that mainly imply I’m a hypermetabolizer of T?

So many questions, and sad I have to be the one figuring this all out.

I’ve also been on TRT for three months and am also borderline diabetic type 2 and last week my new doctor lowered my dosage from 200mg every three weeks to 75mg weekly. Five days after my shot I started feeling the best since starting TRT, my E2 was through the roof on the 200mg for the first week and a half! Lots of guys that have low T at around age 40 and overweight also have type 2 diabetes, sometimes they go hand and hand. My doctor wanted to see is lowering the dose would lower my E2 to where I wouldn’t need Armidex. I would stick with the weekly injections before throwing in the towel.

I’m not throwing in the towel anytime soon, just feeling a bit overwhelmed trying to find the best path.
It’s nice to hear I have some company in this. I’ve only done 2 shots at once a week so it might still have some benefits to come.
I’ve already noticed the absence of the ‘swing’ in ups and downs. I was getting serious depression, and my erections were good or 25%, with lots of 25% days. Since weekly shots it’s been better.
I guess I’ll just dose at EOD at 50, and wait till after my MRI to do tests and see if I should make changes like Armidex.
Thanks for the replies.

So MRI is clear, and I’ve been injecting 50mg twice a week SC/SQ. it’s been just over 4 months and still no major effects like much needed energy.
I did a sleep study and have a follow up in 2 days, and not sure if they always follow up, or only if there’s concern.
Now my Dr said she wants me to stop taking Test and then check my levels after a bit. I think her logic is im prediabetic and overweight and my low T is likely Andropause related.
Yet I don’t see the sense in that. I’d like to keep taking T for a year and see if I can loose weight and give it a full go. I also want to test mid cycle as suggested, and see if my dose is too low as I suspect. I’ve been a hypermetabolizer for other / most drugs, and the effects of meds wear off on me much quicker and stronger then the average bear.
I started taking Wellbutrin and I’ve lowered my Effexor dose from 225mg to 37.5 with drastic results regarding my elusive orgasm and fading erection. I’ve been on it around 10 years so it’s odd that after that long my side effects would change. Yet it seems it has.
I feel better mood wise and my wife says I look thinner all the time. I might have lost 10 pounds yet I go up and down from 220-230 all the time. Regardless of diet I never get under 220, which might be low t or Effexor or both related.
I don’t think I’ll get any help with aromatase inhibitors or HCG from my current Dr, but I’ve been seeing a male Dr who might be more understanding.
I’m actually hopeful I have sleep apnea even though I don’t snore unless I’m on my back, and never sleep on my back. But if I was it could be the culprit for my constant fatigue.
One week, the last IM shot I did I tried 150mg, then 50 a week later, followed by the 50mg twice a week. I felt a bit better that week, but not much.
I wish I could just kidnap Ksman and have someone who knows what is really going on with me. It seems like Endocrinology is black magic and almost nobody seems to know all they should.
It’s like one of those issues where there’s 2 sets of opinions and everyone in the medical field has their own take on why it should be A vs B. Ugh

Do you know what your blood pressure is like? Do you dream much? You say you fatigued but do you feel like you could take a nap every day or sleep in much later?

If the answer to most these is yes you probably have apnea.

Also, you said you do snore when laying on your back, you are 42 and carrying extra weight.

Getting a CPAP machine, if you need one, and if you can get used to it, can be a life changing event and improve your quality of life quite a bit (personal experience).

But you have some hormonal things I don’t think will change with it.

I have 40 or more pounds of extra weight, all around my mid section. And I mean all.
I could and often do fall asleep at anytime. Especially after dinner, and I can sleep till 2 in the afternoon. It’s not hard for me to wake up, in fact it seems odd how I can get up with 3 hours sleep, get kids ready for school no problem.
My mother in law found out she had apnea and started using a machine. She said it was amazing how much more energy she had. She convinced me to get tested.
I’m not sure about dreams, yet I do have some. Since starting Wellbutrin their a little more vivid.
I think my blood pressure is good but can be on the high end of good at times.
I know I’ll be able to use a cpap machine for awhile, especially if I get results. I hope I can keep using it if I need it, as I’ve heard from a few who said it gets hard to stay with it long term.

I’ve got a new Dr who seems to be more motivated in finding my problem.
We did an A1C test and I was 6.5, 6.4 is prediabetic and 6.5 is type 2. At first he said it’s not a concern but I followed up on it and he decided to put me on 1500 mg of metformin. Just started 3 days ago, but hoping I’ll lose some weight. I’m also going to seriously work on diet and exercise.
Sleep study said I was just barely in the apnea range. Apnea Hypopnea Index (AHI) was 5.2 or 5.4 when below 5 is the benchmark. She didn’t think a cpap would do me much good, and it’s $2700.
I’ll be doing another Testosterone blood test in a few days, and he said I might need to up my dose, considering I was 8 nmol/L 231 ng/dl after around 3 months at 100 mg / week. That was taken day of injection of 200 mg / 14 days. Going to draw next test as ksman suggested between injection of 50 mg twice a week.
I’ll do another A1C test in mid August (6 weeks from now). Still no energy, ED and orgasm difficulty. Also random depression and worsening irritability. Hoping keeping blood sugar down will help, and if not getting T in Range will.

Do you have some thyroid bloodwork?

Yes and recent TSH, but apparently normal. I just asked if further testing would help as I’ve read that TSH isn’t the be all end all tool.
I got a patronizing explaination that it’s not. Despite what the Mayo clinic says. Pretty sure it was Mayo, maybe endocrine something.
I suspected Hyperthyroid and read that fatigue and the absence of weight loss are possible with it. I asked about a ‘T7’ test which is apparently what’s it’s refered to, yet didn’t seem to know what that was.