T Nation

5 Weeks of TRT

Just go my bloodwork back from “Life Exetension”.

History (diagnosed with primary hypogonadism about two months ago)
I have been on on tube of Testim a day for 5 weeks.

Current bloodowork:
Testosterone, Serum 257 ng/dL (241-827)
Free Testosterone(Direct) 8.9 pg/mL (8.7-25.1)
Estradiol 19 pg/mL (0-53)

Previous bloodwork (different lab, different tests and ranges):
Total Testosterone: 181 (250-1100 ng/dL)
Free Testosterone: 47.8 (35.0-155.00 pg/mL)

The good news is my Estradiol is 19.
The bad news is free T is down and total T has barely gone up after being on TRT for 5 weeks.
Originally went to a Uro who prescribed the testim and doesn’t want to see me for 3 months.

I have an appt with an Endo this Friday for a second opinion.

Scenarios as I see it. Testim is not absorbing or the dose needs to be upped to two tubes a day. Uro said next action was to up the dose to two tubes if I didn’t respond to one tube.

Ejaculatory volume and power is down. Sensation is down. Sex drive is down.

Mood seems a little better, but have more mood swings.

Energy seems a little better, but not great.

I wouldn’t consider midrange estradiol good news, especially since it is pared with low range testosterone. Pretty much explains all your symptoms as far as I can see.

Your goal should be high range testosterone and low range estradiol.

That being said, you (and your doctor) should never forget that you’re not on TRT so you can produce numbers on a blood test. How you feel is the only thing that matters.

A couple of things I believe. In spite of all the posts regarding “E2 should be in the low 20’s”, the low 20’s may not be the magic number for you personally. You’re at 19, and it sounds like you may be too low on Estrogen; mood swings, power is down, etc…
You don’t mention if either doctor ran a thyroid test or not. Hypothyroidism is know to cause ineffective absorption of the T gels/creams in many men. It certainly seems on a tube a day for that much time your T numbers should look better than they do.
Any plans to ask the new doc about shots instead of the gel?
I personally didn’t respond to Gels, or Striant tabs, and got my doc to give me shots so I could “get my life back”.
I’ve been on shots for two plus years now, and life is predictable at the gym and in the bedroom too. Just my $0.02

Yes, I am going to try and get on the shots. It’s hard to get the recommended frequency prescribed so you are stable and I have a thing about needles, so self administer will be tough. However, I will work hard to overcome my phobia.

Thanks for the correction about the E2. I was expecting it to be high and the cause of my problems. After posting I realized 19 was on the low side.

I think my primary doc did check thyroid. Is the the test TSH?

TSH, 3rd geneartion 1.29 (0.40 - 4.5 mIU/L)

I am sure the endo I am seeing on Friday will probably check thyroid again. I will mention it.

Also interesting to note, WBC was little elevated in the last blood test.

BTW- Thanks for all of the helpful replies. I really appreciate the info and support :slight_smile:

I know the shots are better. However, if two tubes of testim would get me where I need to be, I would prefer that.

What a pain in the ass it is to find a doctor to work with you on this.

I mean my endo doesn’t wasn’t to see me for 3 months. Seems like you could find out sooner if something is working or not right?

i did absorb the gels either and went to injections. It is a pian to find a good doctor and I have been luck so far. But did go through several doctors all good but the first 2 did not know about HRT. It takes a while to get dialed in so be patient.

TSH test only means one one thing: your particular doctor still lives in the stone age.
Granted, TSH is the measure of of what the pituitary is telling the thyroid to do, and should be the “easy answer” to knowing but it isn’t.
My TSH was not indicative of what was really going on in my body, but my doctor ran all the thyroid related tests and found out I needed to be on meds. I’m still on Armour Thyroid, and after another year of HRT/TRT, I need my dosage upped again. (Classic side effect of HRT)
Anyway, if you want to know what your body is really doing, (ammunition to take to the doctor is why) Every morning for as many days as you can, take your armpit temperature. This must be done while you are still in bed, and not moving about and you should keep the thermometer in place for 5 minutes.
Keep a written record of every day and if your waking temperature is consistently less than 98.0, your thyroid may need a little help from medication.
I appreciate your “two tube” theory, and you may be one of the lucky ones that gels don’t cause excessive E2 or DHT issues, but odds are not you’re likely to be that guy. There are some, and I may be wrong. Again.

Thanks KNB. You guys have done way more research and have more experience than me. I sincerely appreciate you taking the time to reply.

Just so I can understand more on where your advice is coming from. When you say “odds are I am not the guy who will respond to two tubes”, what data are you basing this on. Personal experience? What you have read on forums from other’s experiene? Reliable medical studies? All of the above? I would like to learn more and get to the primary sources of this data. If you could point me to this data, I would greatly appreciate it. I am not challenging you or disagreeing om anyway.

Thanks in advance :slight_smile:

[quote]KNB wrote:
TSH test only means one one thing: your particular doctor still lives in the stone age.
Granted, TSH is the measure of of what the pituitary is telling the thyroid to do, and should be the “easy answer” to knowing but it isn’t.
My TSH was not indicative of what was really going on in my body, but my doctor ran all the thyroid related tests and found out I needed to be on meds. I’m still on Armour Thyroid, and after another year of HRT/TRT, I need my dosage upped again. (Classic side effect of HRT)
Anyway, if you want to know what your body is really doing, (ammunition to take to the doctor is why) Every morning for as many days as you can, take your armpit temperature. This must be done while you are still in bed, and not moving about and you should keep the thermometer in place for 5 minutes.
Keep a written record of every day and if your waking temperature is consistently less than 98.0, your thyroid may need a little help from medication.
I appreciate your “two tube” theory, and you may be one of the lucky ones that gels don’t cause excessive E2 or DHT issues, but odds are not you’re likely to be that guy. There are some, and I may be wrong. Again.
[/quote]

I would also add that I think the gel is absorbing, because clearly my HPTA has shut down or at least backed off. I say this because testicles have shrunk a little and I have notice some other differences down there.

How you feel is what is important. also look into HCG. It has helped me a great deal. Most of my data comes from her on the forums and researching on the net or books. I have also gotten alot of great advice from friends I lift with. Just a few urls that might help. Read Dr. Crisler’s articles.

http://musclechatroom.com/forum/forumdisplay.php?f=2