T Nation

Changing Doctors...Going to a Clinic


#1

Hello all - first post here at T-Nation, but I've been lurking for quite a while and have been lurking at other sites also.

Back in March, I mentioned to my Urologist that I've had a lack of libido for some time (thinking 15+ years). He had a Testim poster on his wall that had 10 symptoms listed and the only one I could point at that potentially could be caused by low T was the lack of libido. Anyway, the poster sparked me to ask the doc about it.

So, we drew blood that day. About 3 weeks later he calls me into his office. Total T = 250 (ref range of 250-1100) and Free T was at the bottom of the ref range also (don't recall the # or the ref range). No other tests were done other than Total T and Free T.

So, the doctor said I was a candidate for TRT. The protocol he prescribed was 400mg every 3 weeks injected in his office (yes, I had/have to go to his office to get the injection). No mention of E control, or hcg use. I feel like a million bucks for about 2 of the 3 weeks. The last week starts to get quite rough.

I started looking up what TRT was and it's benefits/potential downfalls were and found multiple web sites (including this one) with a lot of great information. Seeing that my doctor was severely lacking in the protocol, I started talking to him about a more frequent, smaller dose protocol and the use of some sort of E control. He has not necessarily said no, but in my conversations with him I can tell he's hesitant to do anything different. So, I've been exploring other options including hrt clinics.

I recently found one that seemed open and not overly priced. Their blood work requirements were much more substantial than my last set of labs. I had blood drawn 1 day post my normal injection (every 3 week protocol). I was trying to get blood done 1 day pre my next injection to see where my levels were, but scheduling didn't allow it to happen. So, you'll see that my total T and Free T are in the "high" range, and that's the reason (I'm assuming).

Here's the labs done and the numbers:
CMP14+LP+CBC/D/PLT+T4+TSH+P
Glucose, Serum 84mg/dl (65-99)
BUN 14mg/dl (5-26)
Creatinine, Serum 1.06mg/dl (0.76-1.27)
eGFR >59 (>59)
EGFR AfricanAmerican >59 (>59)
BUN Creatinine Ratio 13 (8-27)
Sodium, Serum 141 (135-145)
Potassium, Serum 3.9 (3.5-5.2)
Chloride, Serum 102 (97-108)
Carbon Dioxide, Total 24 (20-32)
Calcium, Serum 102 (97-108)
Protein, Total, Serum 7.3 (6.0-8.5)
Albumin, Serum 4.7 (3.5-5.5)
Globulin, Total 2.6 (1.5-4.5)
A/G Ratio 1.8 (1.1-2.5)
Bilirubin, Total 1.0 (0.0-1.2)
Alkaline Phosphatase, S 48 (25-150)
AST (SGOT) 25 (0-40)
ALT (SGPT) 22 (0-55)

Lipids
Cholesterol, Total 200 HIGH (100-199)
Triglycerides 57 (0-149)
HDL Cholesterol 63 (>39)
VLDL Cholesterol Cal 11 (5-40)
LDL Cholesterol Calc 126 HIGH (0-99)
LDL/HDL Ratio 2.0 (0.0-3.6)

Thyroid
TSH 1.42 (0.45-4.5)
Thyroxine (T4) 8.0 (4.5-12.0)
Triiodothyronine, Free, Serum 3.7 (2.0-4.4)
T4 Free (Direct) 1.44 (0.82-1.77)

Immunoassay
Protate Specific Ag, Serum 0.8 (0.0-4.0)
Insulin-Like Growth Factor I 192 (109-284)
Testosterone, Serum 1169 HIGH (280-800)
Free Testosterone (Direct) 36.9 HIGH (8.7-25.1)
LH 1.2 LOW (1.7-8.6)
Estradiol 46.2 HIGH (7.6-42.6)
Insulin 5.3 (0.0-24.9)
CBC, Platelet Ct, and Diff WBC 4.9 (4.0-10.5)
RBC 4.95 (4.10-5.60
Hemoglobin 15.2 (12.5-17.0)
Hematocrit 44.0 (36.0-50.0)
MCV 89 (80-98)
MCH 30.7 (27.0-34.0)
MCHC 34.5 (32.0-36.0)
RDW 13.4 (11.7-15.0)
Platelets 221 (140-415)
Neutrophils 62 (40-74)
Lymphs 30 (14-46)
Monocytes 8 (4-13)
Eos 0 (0-7)
Basos 0 (0-3)
Neutrophils (Absolute) 3.1 (1.8-7.8)
Lymphs (Absolute) 1.5 (0.7-4.5)
Monocytes (Absolute)0.4 (0.1-1.0)
Eos (Absolute) 0 (0-0.4)
Baso (Absolute) 0 (0-0.2)
Immature Granulocytes 0 (0-1)
Immature Grans (Abs) 0 (0-0.1)

Now, this clinic is VERY aggressive and suggested my same dose (400mg), only weekly (split into 2 injections) along with hcg (250iu twice (1 each day prior to injection)) and tamoxifin (20mg eod). The T dose seems like complete overkill to me and I mentioned that to them. Their response was, well we want you to feel good, that's our goal, but you could take a smaller dose if you would like, you just can't go over what the script is for.
So, I will be starting out with a much smaller dose and see how things go.

Do you see any other issues in either my lab work or protocol that could be improved?

Thanks for you help in advance.


#2

Forgot to mention:

Age: 37
Height: 6'2"
Weight: 195 (was 210 in March when I started TRT)
Waist: 34 (was 38)


#3

Your dose of T is 400mg/week? That would be insane.
Did you have a physical exam with the clinic?
They give you a script or provide consumables? More consumables means more profit.

Tamoxifen does not lower estrogen, it increases estrogens. Using that and hCG is insane [and stupid]. This all displays a deep lack of understanding.

You need Arimidex/anastrozole and the dose of that needs to be matched to your T dose then refined via E2 lab work. Your target is 22pg/ml.

Your cholesterol numbers are fine and might improve with a proper TRT.

When you do lab work, always have that done half way between injections. That also avoids getting level changes from lab timing.


#4

Thanks for the reply Ksman.

I have not started on this protocol yet, but the clinic's suggestion was 400mg/week. My current protocol that I'm trying to get away from is 400mg/3weeks.

And, yes, the clinic would be supplying everything.

Tamoxifin - shouldn't increase estrogen. It is an anti-estrogen as it binds to the estrogen receptor. At least, that's what I've been reading. Am I reading incorrectly?


#5

It is a SERM that actually is an estrogen-like compound that selectively binds to specific estrogen receptors, but will not reduce your total estrogel level, and may increase it like KSman said. An AI (arimidex) is an aromatase inhibitor that prevents the conversion of testosterone into estrogen in the first place.

Truthfully, your regimen sounds more like an AAS cycle than TRT.


#6

You see that a lot at these specialty anti-aging clinics I've noticed. This is absolutely insane. No surprise they are providing the gear. Greedy money grubbing assholes.

Agree you need an AI instead of a SERM.


#7

Thank you for the explanation.

I asked them "why tomaxifen and not adex?".

The response back was, "because your estrogen is high and your LH is low. Tomaxifen will help elevate your LH and lower your estrogen."

Starting to sound like this may not be the route to take...


#8

Please correct me if I'm wrong, but isn't LH always low on a properly administered TRT plan? Or is it still there but just "useless" at that point?


#9

If you are activating LH receptors with hCG, why cause the pituitary to produce LH? Still displays stupidity.

And you trust those hacks with your health and 400mg T per week? They are idiots and if your proceed as they suggest, you are also an idiot.

Watch your hematocrit and PSA. Do not let E2 get elevated. You cannot regulate E2 with a SERM. E2 is harmful to your prostate.