T Nation

Bloodwork Check. Is this Low T?

T Replacement
#1

Hi guys,

Long time lurker. I was just told by my doctor that I may have low T.

A little info on me. I am 26 years old. Been lifting weights since I was 13 years old. I am also a martial artist. I still do both. I currently compete in grappling competitions like BJJ. In 2012 at 19 years old, I was having a terrible sex drive so I had my tests checked, came back at 266 as you can see in the doctors hand writing. I figured I might try to dial in my diet and nutrition to boost it. 7 years later, my nutrition and recovery and workouts have all been dialed in. However, I’ve been getting injured and haven’t been recovering as well. My sibling is 6 years older than me and does the exact routine as me but he recovers perfectly fine meanwhile i am taking about 2 weeks longer to recover. Went into doctors to get my bloodwork checked. Currently at 26 and at 185lbs, my tests are at 330.

Here are my bloodwork results. My doctor recommended me visit an Endo but he thinks that they will say it’s normal. Thoughts on my bloodwork? Am I considered low T?

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#2

Yes thats low. Obviously You know that you need to check free T also but you are still low regardless. TRT will make you feel better. Dont feed into any of the other nonsense you will read about restarts and optimized lifestyle and stuff. Your t will only drop more.

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#3

Endo’s are typically very ignorant and the least educated in sex hormones, your GP is even hinting your endo will say you are normal probably from experience. Your best bet is to pay out of pocket and see a TRT specialist instead of seeing a doctor that is known to be incompetent and not follow guidelines.

Most endo’s do not follow endocrine society guidelines.

Besides the variation in T assays, the cutoff value for low testosterone is different between studies and societies. 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 350 ng/dL; they widened the indication of TRT to TT <350 ng/dL in 2008 however in 2015 they suggested that TRT may be reasonably offered to symptomatic patients with TT concentration higher that 345 ng/dL based on clinical judgement.

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.

The studies are clear, you are at risk for the diseases of aging with levels this low. Big pharma has a huge influence of prescribing doctors and the sick care system isn’t making money if people don’t have disease. TRT treats and prevents disease and is why it’s so difficult to get prescribed. The cure for cancer, it will never see the light of day.

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#4

I fed into when I was 19 since I felt I was almost too young to be hopping onto TRT. I wanted to make sure I optimized everything I was doing before I even considered it anything like it.

#5

Thank you for the well formulated response! Do you suggest even giving the Endo’s a chance?

My GP made it very clear that he has no problem helping me so long as he is not the first one to write the script. He was good enough to say that he doesn’t have much experience but if I got a script from an Endo he had no problem helping me with follow ups and scripts. Ultra cool guy.

If I went the TRT clinic route and get a script, could I cancel that after a year and go through my GP? Or is there something more to the on-going follow ups in a TRT clinic?

#6

You’re welcome.

I believe it’s a complete waste of your time, even your GP is scared to be the first to prescribe TRT for fear of getting in trouble. No doctor is going to stick their neck out for a random guy with low testosterone, there is just too much stigmata in the medical community regarding TRT do to the fact doctors are taught TRT causes prostate cancer in medical school.

It was once believed TRT put you at risk for prostate cancer, the opposite is true and doctors are still operating on old outdated knowledge and are fearful of prescribing TRT to young men. If a man in his 50’s is prescribed TRT and develops prostate cancer, it cannot be blamed on TRT because older men commonly get prostate cancer.

It’s difficult for doctors to let go of old falsehoods and safer to do nothing because there is no risk involved to jeopardize their career.

Be careful of these TRT clinics, most are a shame and are staffed by people would have no clue how to read hormone labs or balance your hormones, they just care about “in range” levels and are just selling the same package deal to every unsuspecting man that walks in the door.

There are popular telemedicine options who are staffed excellent doctors, everything is done over the phone and mail.

If you provide a location, perhaps I can recommended a local TRT doctor.

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#7

Thank you so much for the in-depth answer. I am in NYC. I was recommended DefyMedical. What are your thoughts?

#8

The truth is, unless you can pony up for good private care, you’ll be figuring it out yourself most likely. I don’t see that as a bad thing. Get the doc to prescribe what yu need, insurance pays, he mostly stays out of the way, you win. If the doc is insistent on micro-managing and giving the shots and stuff, move on.

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#9

I’m signed on with Defy Medical, Dr. Saya and Dr. Calkins are top TRT specialists. You will not get the same lack of concern that you have received at Kaiser, it will be a world of difference.

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#10

Who do you recommend for initial consult?

#11

I went all out and forked over $628 for labs because I wanted to leave nothing undiscovered, at this point I had never had a thyroid panel in my life.

Defy likes to balance costs, the basic hormone panel covers a lot, but if you want to be thorough and not miss a thing, speak up.

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#12

That sounds rediculous. He is basically telling You he is afraid to write the script. However if he is willing to continue your scripts from a clinic then go to one and figure out what dose you need and get the hcg if you want it and then go back to him and ask him to continue your scripts. However there is a good chance he will want to keep you less than optimal so you will need to be up front with him and ask of he will continue the script exactly as it is or if he will get nervous and cut it back to a certain mg or try to keep you under a certain blood level. I find even my clinic Defy seems hesitant to get my dose and levels to real optimal levels. I think my issue is using the female P.A. they employ. Next consult I will probably have to spend the extra cash and get an appointment with one of the actual male Drs

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#13

Thank you! Which doctor do you trust?

#14

What do they dose you at?

#15

What do you pay monthly?

#16

Dr. Saya is the medical director, Dr. Calkins is the right hand man. I get my TRT prescription through Kaiser and everything else from Defy Medical.

I’m off TRT for now until I can figure out why my body is experiencing edema, head, mouth, abdomen, legs and arms.

#17

How did you get the initial prescription? Thinking of going through defy first and then try and see if my GP and take over afterwards.

And what happened to you?! Edema??

#18

Try Dr Michael Rotman urologist inNYC . Let me know how it goes

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#19

Is he your guy?

#20

Yes. Takes my insurance. He’s open minded.

And consults with other experts if needed.

Check his website
Bring your labs in. He may prescribe by just looking at your labs and symptoms. Am sure he will run more labs either way

@anthon92 also try to get baseline for dhea-s and prolactin, free t, dht

He may not want to check dhea but just tell him you want a base line. Cause once you start trt no more baseline.

He also has the ability to get medications from compound pharmacies. That’s a good sign in a trt dr

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