T Nation

Doctor Having Second Thoughts

I decided to start my own topic.

I just started HRT (November 21), 50mg injection per week (to start out). The doctor also wanted another blood workup prior to starting which I did. Now, 2 weeks into this I called the Dr to get my test results and he told me he’s concerned about my red blood cell count (it’s 16.3). He wants me to get a blood test tomorrow morning to see if the HRT has raised it any higher and if so possibly stop the HRT treatment. He also stated that my sleep apnea could be the culprit behind my low T levels (252).

So, here I am 2 weeks into it, I have low T and real low free T (6.9 out of 12-30) and facing the possibility of being pulled off the HRT. Comments?

I’m 52

Oh, by the way, I asked him what my estrogen level was, he said zero, it doesn’t show any level. Huh?

Joe

[quote]joeym wrote:
I decided to start my own topic.

I just started HRT (November 21), 50mg injection per week (to start out). The doctor also wanted another blood workup prior to starting which I did. Now, 2 weeks into this I called the Dr to get my test results and he told me he’s concerned about my red blood cell count (it’s 16.3). He wants me to get a blood test tomorrow morning to see if the HRT has raised it any higher and if so possibly stop the HRT treatment. He also stated that my sleep apnea could be the culprit behind my low T levels (252).

So, here I am 2 weeks into it, I have low T and real low free T (6.9 out of 12-30) and facing the possibility of being pulled off the HRT. Comments?

I’m 52

Oh, by the way, I asked him what my estrogen level was, he said zero, it doesn’t show any level. Huh?

Joe[/quote]

Your Dr obviously has no clue and does not know what he is doing.

You need at least 100mg per week. By doing 50, you are shutting down whatever production you used to have, and not getting enough to probably even equal that. So your going to end up even in worse shape.

When HRT raises blood cell count that can be countered by donating blood. You can go every 2 months at least I believe.

I would start looking for another Dr.

Just for the record, he’s an Endocrinologist, looks like he’s over 50 so he’s been around a while. I also checked out his credentials “American Board of Internal Medicine: Endocrinology, Metabolism” and the hospital he’s at is big, highly respected facility. I’m just trying to give you guys an idea of my dilemma; it seems like he’s well trained but damn, I’ve been going down this HRT journey since this time last year and FINALLY got it… and now I might lose it.

There are a lot of issues here.

First off, get a copy of your blood test results to keep. If he refuses to give you a copy, he’s either trying to hide his incompetence, or he’s treating you like a child. Either way, there is no reason for you to put up with it.

Secondly, you went to this guy because you had a problem. If his protocols don’t make you feel better, then they’re crap protocols and all the credentials in the world don’t change that.

I’d be willing to bet money that your estrogen levels are not zero. He’s just yanking your chain and that is bullshit.

Don’t forget that this guy works for you, you don’t work for him. It’s your life and your body and your health he’s fucking around with. Are you going to let him fuck you over just because he has a diploma?

Do the research so you’ll KNOW when he’s blowing smoke up your ass.

Happydog is my hero…Listen to him…

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I agree with these guys.

All I can add to this is it sounds like,(based on my limited experience)this guy gave you a very low dose,not because he wanted to help but because he wanted to shut you up about hrt.
Then when you come back with low levels still even with the treatment he can take you off the HRT cause its not working like he proabaly told you.

Any endo should know that 50mg a week will do nothing or next to it.
Anyone I have seen on TRT was closer to the 250mg/wk range

and there is no way you are at 0 e2 levels which again is why I think he just told you things and gave you this treatment to shut you up about it. I know its a bit harsh of me to say tha tabout the ma but I thats my opinion.

Look for a new doc please you will be better off.

Infact not to slam on age but I prefer the newer and younger docs, yes they lack the experience but they are fresh out of school meaning they are up to date on new treatments and protocols and also they have something to prove and may go out of their way to help because they still have that passion to help,and heal.
and older doc that has been in his own practice for 30 some odd years may be burnt out and not so caring and also he may or may not be in tune with newer treatments,which medical advancments happen so often its hard enough to keep up. It is very hard to find a decent “healer” its always easy to find someone that will mask your symptoms though.

I wish you the best of luck getting this issue taken care of.

[quote]Wise Guy wrote:
joeym wrote:
I decided to start my own topic.

I just started HRT (November 21), 50mg injection per week (to start out). The doctor also wanted another blood workup prior to starting which I did. Now, 2 weeks into this I called the Dr to get my test results and he told me he’s concerned about my red blood cell count (it’s 16.3). He wants me to get a blood test tomorrow morning to see if the HRT has raised it any higher and if so possibly stop the HRT treatment. He also stated that my sleep apnea could be the culprit behind my low T levels (252).

So, here I am 2 weeks into it, I have low T and real low free T (6.9 out of 12-30) and facing the possibility of being pulled off the HRT. Comments?

I’m 52

Oh, by the way, I asked him what my estrogen level was, he said zero, it doesn’t show any level. Huh?

Joe

Your Dr obviously has no clue and does not know what he is doing.

You need at least 100mg per week. By doing 50, you are shutting down whatever production you used to have, and not getting enough to probably even equal that. So your going to end up even in worse shape.

When HRT raises blood cell count that can be countered by donating blood. You can go every 2 months at least I believe.

I would start looking for another Dr.

[/quote]

Give blood before starting HRT. If your hematocrit/hemaglobin is too high, Red Cross won’t take it. Then, later, when they retest you, it’ll be too high and you’ll have to go to a hematologist to get a therapeutic phlebotomy.

HRT can be more than most people bargained for.

Thanks for the advice and support you folks have offered. Here’s an update.

As you know I’ve already done 2 shots, 50mg each over the past 2 weeks. Today I went to have blood drawn to test my T levels and my red blood cell count. Once the Dr gets the results I have no idea what will happen.

It’s amazing how foggy this field of medicine is. I would think that after 5 blood tests and 3 doctors over an 8 month period that they would be able to commit to a treatment and move forward. It almost makes me want to drop the whole thing and just fade away.

[quote]joeym wrote:
Thanks for the advice and support you folks have offered. Here’s an update.

As you know I’ve already done 2 shots, 50mg each over the past 2 weeks. Today I went to have blood drawn to test my T levels and my red blood cell count. Once the Dr gets the results I have no idea what will happen.

It’s amazing how foggy this field of medicine is. I would think that after 5 blood tests and 3 doctors over an 8 month period that they would be able to commit to a treatment and move forward. It almost makes me want to drop the whole thing and just fade away.[/quote]

It is frusterating,but stick with it no one will value your health and well being like you would, so do not give up on it.
keep going to docs untill you hear what you want to hear. and untill you feel better

Ok, I got the results of yesterdays blood test (Dr was testing me for RBC and T levels).

Original T level was .22 (range .18 -.78)
T level after 50mg/wk .53 (3 days after 50mg shot)

Red Blood Cell
HGB before 16.3 (range 14 - 18)
HGB Now 16.3

HCT before 46.3% (range 42 - 52)
HCT now 45.5

I have an appointment Monday with the Endo to discuss my TRT.

One thing that really confuses me are the T tests. I understand free T and bioavailable T and I THOUGHT I understood Total T but they seem to use 2 different systems for this. One is…

T 252 (range 240 - 950)
and other is
.22 (range .18 - .78)

In this most recent test they only had the numbers for that 2nd one I mentioned (which is now .53), what are these numbers?

Also as a side note I just remembered him saying at my last appointment that he doesn’t use free T numbers because the tests aren’t reliable (or something to that effect).

Thanks for all your replies,
Joe

I figured out the question I had about total testosterone and that other number, the number represented as a decimal (in my case .53). It is a measurement of the FAI (free androgen index). It has to do with bound and unbound T… nothings ever simple.

Quote from Dr John Dean, Specialist in Sexual Medicine, South Devon Healthcare NHS Trust

"Measurement of total testosterone is therefore a poor measure of active testosterone. Free testosterone levels are expensive to measure and are not widely available.

Free Androgen Index (FAI = total testosterone/SHBG x100) is an alternative measure of androgen state that is not as reliable as free testosterone, but is better than relying solely on total testosterone.

All this is confusing for doctors, too!"

Some endo’s believe no one should get more than 100mg x wk. They also believe if you need a rx to get your estradial down while on trt then your getting to much T. To much injected t the body can’t handle so it converts the excess to estradial. This really makes sense but I like my dose where it’s at so I treat estradial myself. Your endo will also get you into range and say your cured.

They don’t care or believe in optimal ranges or anything like that if your in range they have done what they needed to do. Oh the blood work it’s a valid concern, like was said previously go give blood but your going to have to do it consistently, you don’t want a high hemocrit and should be monitored by your physician if your already having problems.

Here is a link my old endo sent me
http://www.endo-society.org/guidelines/final/upload/AndrogensMenGuideline053006.pdf

I showed it to my Dr. and he said he would go ahead and take care of my tx. Anyways good luck and honestly talk to your dr about your options of being on trt with a high hemocrit.