I'm glad that I was referred to this forum (from a user on reddit) - unfortunately, I didn't find out about it before yesterday. I had my first TRT shot (200mg, plan is to do it every other week) yesterday, and now I'm wondering if I am even close to the point that I ought to be starting.
I've read most of the stickies and responses to them, but I apologize in advance if I ask a question that's already been answered - my short-term memory is... ridiculously bad, to put it lightly.
I'm a 23 year old male, about 5'10 315 lbs. I have been morbidly obese since I was ~15-16, and was at 350 lbs. from (at least) age 18 to 22 (lost 35 lbs. over the course of 2010 - not nearly what I wanted to, but depression's a bitch).
Notable medical history:
- Tonsils and adenoids removed at age 3 due to difficulty eating to the point of me refusing to.
- Orchiopexy at age 19 for cryptorchid right testicle; should have been dealt with at age 2, my mother - a nurse - believed that it was not an issue . Right testicle is extremely small as a result (approx. 1/3rd normal size).
- Multiple traumatic brain injuries: one injury that put me at a 9-10 on the Glasgow coma scale for about two hours @ age 4-5, one severe concussion @ age 9-10, a number of other hard hits that were near-traumatic.
- History of chronic migraines: 1-2 per week from age 13 to age 18, tapered off to about 3-4 per year now.
- 3 bone fractures: simple fracture, right femur, age 3; hairline fracture, right ring finger (metacarpal), age 11; simple fracture, right clavicle, age 15. All were trauma related.
Current meds: Cymbalta (30mg @ night), Welbutrin XR (450mg @ morning), daily multivitamin (Centrum, I think), 2000 I.U. Vitamin D3 (programmer plus living in Minnesnowta = very little exposure to direct sunlight), and 2400mg Fish Oil (1200mg @ morning, 1200mg @ night).
I wasn't even aware of hypogonadism until about four months ago, when my SO looked into possible effects or causes of cryptorchidism. After looking into some of the reported symptoms of hypogonadism, it seemed pretty obvious to me that it was likely - I have all of the major ones like brain fog, low motivation, low-grade depression (Dysthymia), social anxiety, manboobs, feminine fat distribution, etc.
I saw my PCP for some bloodwork (all he ordered was the TT test - 141 ng/dL at 10 AM), who then referred me to an endocrinologist.
My endo seemed to know what he was doing, so I trusted him to get the tests necessary. It seems that my trust may have been poorly put, at least according to the stickies here (which seem well-researched).
Many of the tests that are recommended here weren't mentioned, much less performed, and the cause of my low T hasn't been found yet - and my endo stopped ordering tests and said that it was okay to start treatment!
Actually, he wanted to delay treatment for four weeks of me being on the autopap because he is of the opinion that my low T is largely caused by sleep apnea... which seems absurd, since I have no symptoms (no headaches, I wake up feeling well-rested, I don't wake up at night except when I need to go to the restroom 1-2 times nightly, etc.) and since my apnea is relatively mild.
I advocated for starting treatment immediately unless he wanted to run more tests, and he said that he was done running tests and was okay with me starting. This guy did his residency and fellowship at the Mayo Clinic...
I also mentioned that I had heard that using an estrogen blocker was generally a good idea, and his response was to state that it wasn't and that no professional organization recommends it.
MRI -- normal, no mass, pituitary is good.
Sleep study -- mild asymptomatic sleep apnea (almost purely hypopnea). Will be getting an auto-pap this week or next.
Here are the results of the endo-ordered 8 AM blood test:
TEST = RESULT (LAB NORMAL)
ALKALINE PHOSPHATASE = 71 U/L (40-115 U/L)
BILIRUBIN, TOTAL = 0.7 mg/dL (0.2-1.2 mg/dL)
AST = 21 U/L (10-40 U/L)
ALT = 25 U/L (9-60 U/L)
TESTOSTERONE, TOTAL = 153 ng/dL (250-1100 ng/dL; low)
TESTOSTERONE, FREE = 36.9 pg/mL (46.0-224.0 pg/mL; low)
TESTOSTERONE,BIOAVAILABLE = 67.9 ng/dL (110.0-575.0 ng/dL; low)
SHBG = 13 nmol/L (7-49 nmol/L)
ALBUMIN,SERUM = 4.0 g/dL (3.6-5.1 g/dL)
CORTISOL, TOTAL = 12.9 mcg/dL (4.0-22.0 mcg/dL @ 8 AM)
FSH = 1.5 mIU/mL (1.6-8.0 mIU/mL; low)
LH = 3.1 mIU/mL (1.5-9.3 mIU/mL; low)
PROLACTIN = 9.0 ng/mL (2.0-18.0 ng/mL)
FREE T4 = 1.22 ng/dL (0.71-1.85 ng/dL)
TSH = 2.99 uIU/mL (0.30-5.00 uIU/mL)
After reading through the stickies, there seem to be some HUGE red flags. He didn't order an E2 test, free T3 test, digital rectal exam (fortunately, my PCP did do one when I mentioned low T issues - though my endo never asked about this), no vitamin labs, etc.
So here are my concerns so far - note: I'm looking for advice and information, not answers - I'm not here to ask people to tell me what to do
- Is an E2 test still reasonable despite having started TRT (I am one day out from my first injection of 200mg)?
- How do I advocate for an estrogen blocker with an endo that has a stick up his ass?
- I have a fairly reasonable PCP. He's shown a willingness in the past to prescribe medication that I felt would be useful (e.g. Xanax, Celexa). Would going through my PCP - for both the additional tests and a possible prescription for an estrogen blocker if needed - be a good idea?
- Edit: should I talk to my PCP about hCG as well? I would like to avoid testicular failure as there's a chance that I may want to have biological children in the future (though I will need to have a fertility test soon to figure out if that's even a possibility).
Edit 2: I live close to the Mayo clinic. Would it make sense to get a referral to an endocrinologist there, or would advocating for and picking my own treatment with my PCP be a better option in the long run?
Should I STOP treatment right away, or continue through with it?
My endo didn't mention any of the side effects of TRT (literally none). I'm now aware that it could likely render me permanently infertile (my understanding was that it was temporary). I am considering having a fertility test ASAP, and possibly freezing sperm if I'm even fertile to begin with. Any objections/suggestions on this subject?
Any other comments, information, or advice would be greatly appreciated!
Thanks a ton in advance! I'm going crazy trying to figure out what is the right thing to do at this point, and the posts in this forum have already been a great resource for helping me figure out what's best. I can't believe I didn't find this forum before when I was searching for resources, but I'm glad I was pointed to it today.