T Nation

Am I On The Right Track?

After a long time,how long I can’t really remember,I went and had my blood work done. A long time of being tired,only making it through the day on tons of caffeine,belly fat that I couldn’t get rid of no matter what I figured I might as well. My blood was taken at 9 am as I have seen you’re highest in the morning. My family practitioner only provided a total serum count, it came back at 256. I’m 38 years old, 178lbs. She saw no problem with this number as the lab used a spread of 135-850 as a “normal” range. For the past 10 months I have quit smoking,cut way back on alcohol, 5 day split in the gym,pretty clean diet, 8 hours of sleep a night. To me from the research I’ve read, that is an extremely low number and general rule is anything under 300 is cause for treatment. I have made an appointment with an endo doc for next month, just wanted to get an opinion on my thoughts on this?

At the very minimum you need to get the following tested:

Free T
Total T

Bonus if you can get:

(You’ll want to get those anyway before starting a protocol).

If the endo follows the ranges, which is likely, you’ll have the same result as you did with your GP. You’re operating with about one third of the testosterone you should.

Ask the doctor to add DHEA-S and VitD to the tests above, assuming your GP obtained lipids, CMP and PSA. You could check IGF-1 as well.

The following were done as well
Metabolic panel
I came up slightly anemic

Interesting that she checked hCG, given what she didn’t check.

Can you elaborate on this

This is not the normal range accepted by medical institutions, even elderly men score higher than 135 ng/dL, your doctor has become complacent. The normal range is 264-916 and even and some men start to experience low testosterone symptoms when dipping below 500.

Managed health care is kind of a debacle, a lot of doctors are just not that knowledgeable and can be prescribe TRT to men scoring <300 ng/dL and even up to 345 ng/dL using clinical judgement.

You actually qualify for TRT and it doesn’t seem your doctor even bothered checking the free portion of testosterone or SHBG for that matter which deactivates testosterone when bound to this protein. Only the Total T, the inactive portion of testosterone was tested.

Evolution of Guidelines for Testosterone Replacement Therapy

Besides the variation in T assays, the cutoff value for low testosterone is different between studies. The Endocrine Society and the AUA recommend using a TT level below 300 ng/dL with repeated measurements of morning TT as a reasonable cutoff in support of the diagnosis of low testosterone, preferably using the same laboratory with the same method/instrumentation for measurements. The ISSAM and the ISSM use the cutoff value of TT <12 nmol/L or 350 ng/dL; they widened the indication of TRT to TT <350 ng/dL or 12 nmol in 2008 however in 2015 they suggested that TRT may be reasonably offered to symptomatic patients with TT concentration higher that 12 nmol/L (345 ng/dL) based on clinical judgement.

According to this your doctor doesn’t even understand the guidelines. Then there’s the study below which paints a different picture, cardiovascular disease <480 ng/dL in middle aged and elderly men showing the cutoff to be considered for a diagnosis of low testosterone to be too low.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

The locally weighted regression showed that total testosterone levels of 440 and 480 ng/dL were associated with increased Framingham CVD risk and an increased probability of increased hsCRP, respectively. Men with sexual dysfunction (poor sexual performance, decreased morning erection, and loss of libido) had significantly greater CVD risk.

All she said is that is was related to a liver enzyme? For give me if it sounds vauge, she was to me. I had to ask for the actual number as I was initially just told it was “fine.”

Ok, update time. I went to the urologist today and was diagnosed with hypogonadism. He put me on 200mg test cyp every other week. Now, my thinking was test has a half life of 7-8 days, so would I be better off dividing each bottle into 2- .5ml. Doses for a total of 100mg a week to avoid such a sharp crash? Just making sure my thinking was correct. Also, can 22 gauge syringes be bought over the counter as my insurance only gives me 2 for a month and if I split the does I’ll have a bit of a problem.

No way of knowing is weekly dosing is the correct move without knowing the other biomarkers, you’re basically shooting in the dark. Pre-TRT estrogen and SHBG is critical in selecting the appropriate protocol. This urologist is not going to be much help should you run into problems. You could be at this dialing in phase for a long time.

Did he leave the door open for revising the dose and injection schedule later if you get less than optimal results? Are you getting follow up labs, and if so, when?

If you have to work with this doctor, I’d follow the prescription. I’m sure many of his patients are doing 200mg twice monthly and are happy with it. No, I wouldn’t do it, I take 200mg every week. However, unless you have other options, I’d try to work with this guy. Better than nothing.

If other options are available, unless he’d be open to increasing your dose and injection frequency, I’d look to move on.

Yes, he was actually very easy to converse with. He said 200 every other week was a pretty standard way to go at the beginning. I am to run that for 3 months then come back with a new blood check and he said if I am still not feeling that great or my levels haven’t made a drastic change, then he will increase the dose and or frequency. Sounds like I should just go with his suggestion and go from there. Thanks.

50mg 2x week would save you a lot of time and trouble.


Imagine actually using that for IM injection. Yikes.

Make sure you get your blood drawn on the day of the injection, prior to it.

That’s what the prescription came with. 22gauge by 1inch for IM.

Yeah ,that’s what he told me .


18g, 2 inches, I didn’t use it, but we did use 20g 1.5 in.

Sounds good, who knows, maybe you’ll hold on to test and have decent levels at trough. If not, sounds like he’ll fix it.