T Nation

Horrible TRT Predicament . . .

I’m in some trouble guys. I’m a Canadian that’s been on TRT (injections) for just under 5 months now, with mixed results, but confident I’ll get it worked out. When it works it’s great. But I’ve run into a problem. I went to see an anti-aging doc who knows a bit more about this stuff than my family doctor. I went with the hope that he’d help me with HCG, but he dropped a real bombshell.

He looked at my recent bloodwork, and said my Hematocrit at .51, my hemoglobin at 169 (135-170) and my Red Blood Cells at 5.81 (4.2-5.7) would prevent him from prescribing to me the test e that I need! Then he said, it’s no big problem, I can just go donate blood. So far, so good. BUT I had a heart bypass last year (went really well) and here in Canada you can never donate blood at the Canadian Blood Services if you’ve had a bypass. So, I said, “I’ll get a therapeutic phlebotomy, that works doesn’t it?” Then he said he can’t order that for me only a hemotologist can do so. And he said, in his experience, the hemotologists in Canada (and probably lots in the US too) will not prescribe a phlebotomy for TRT, they only prescribe a phlebotomy to combat a disease issue, not a “medicine induced issue”. They would send my doc a note saying that I shouldn’t be taking Testosterone! And he’ll be bound by that note and won’t be able to prescribe me anything, or risk his licence.

Is that a crock or what? My testosterone was legitimately low, yet a hemotologist would take away something that gives me renewed life, since HE thinks my quality of life would be better without testosterone? HE doesn’t care at all, he’s just following some outdated protocol that treats all test users like steroid abusers. Talk about discrimination . . .

So what options do I have? Well, I could stop the TRT altogether, hope my balls will come back, and get used to living like a monk. I could cut back on the dose, but I’m only taking about 80 mgs per week, and the Hematocrit seems to slowly creep up anyway. I could take a course in phlebotomy and do it myself (not kidding). Or maybe, I could cross the border, about 70 miles away, and donate blood in the US - I understand the American Red Cross will allow you to donate 6 months after a heart bypass, but I don’t know if they’ll allow a Canadian to do that, and I don’t know if they’ll allow the high RBC, Hematocrit and Hemoglobin mentioned above. What to do???

Why no donations from heart bypass patients?

This is your 3rd thread so I cannot see anything about you and will not cross-read your posts. Can only make comments about avoiding iron fortified prepared foods and breads.

Some would see your low T as a cause of your arterial disease and maybe insulin resistance.

Ksman, I now understand about the threads, and won’t create multiple threads again. I feared if I continued an old thread, that no one would look down the line. Won’t happen again.

I’m 57, otherwise in reasonably good health, have had low T for at least 5 years, ie November 2011 I had Total T of 6.3 (7.6-31.4 nmol/L) and Free Test 14.0 (25.0-80.o pmol/L). Yes, I was having most of the low T symptoms, but the heart issue was even greater, and I felt it unwise to start TRT when I was getting close to the bypass. Had a double bypass February 2012, very successful. Began taking Androgel Nov. 7, 2012; stayed on for a month, didn’t like the inconvenience, switched to Test enanthate, eventually settling in with 60 mgs/every 4 days. Total test results Feb. 22, 2013 were actually a little higher than the upper range (33.7 nmol/L) with bioavailable test also slightly above range. My PSA also jumped from .77 to 1.68, and that “velocity” of change was a little alarming to me, so I reduced my testosterone injection to 45 mgs every 4 days, or about 78-80 mgs/week. I also figured the lower test dose would help me with estradiol issues, but then obtained a script for Arimidex, took 1/8 mg. compounded for 21 days starting March 1, and ended up overshooting the mark; my elbows are just getting over the soreness.

I feel with all this experimenting, that I’ve at least dialed in a reasonble dose that works for me, namely 45 mgs test injected every 4 days, with, as Ksman wisely suggested, 1/8 mg Adex (I’m an overresponder).

But, as mentioned, a new more experienced doctor, says he can’t prescribe test to me if my hematocrit, hemoglobin and RBC’s are at or slightly over the limit. Canadian Blood services won’t act on someone whose had a bypass; the surgeon took an artery out of my arm, and the scar is clearly noticeable. It’s some kind of liability issue, maybe they think you’ll faint in their office if you’ve displayed heart issues? Who knows that’s their policy. I understand a hemotologist won’t prescribe a phlebotomy. Can somebody answer the following few questions for me?

  1. If I had to quit, would my testicles at least come back to produce the miserable pre TRT test level? Been on TRT for just under 5 months (including the 1 month on Androgel).

  2. If I get on HCG now, will my balls come back, and would it then be safer if I have to quit TRT in another 6 months?

  3. In the States the American Red Cross allows you to donate blood after a heart bypass provided 6 months has passed. Will the States allow me to donate blood if I’m a Canadian?

  4. Is there anyway to learn to safely do your own phlebotomy?

Man on man . . .

Yep they should come back with hcg or my friend uses clomid when he is done a cycle to bring them back. So does the doc prescribe Hgc or no? And what now you’ve paid him 300 just to screw u over? Does the guy use ai’s? Does he know his stuff? I think it depends on the person if it comes back or not but in most cases it should. Any info on this doc would be appreciated as I’m also an Ontarioguy. Thanks and good luck

Can’t you just donate and not tell the blood bank you’ve had a bypass? Ask them to use the arm that doesn’t have the scar…?

Hi, iw84aces - thanks for the reply. Thanks for the vote of confidence for my boys coming back. I’m becoming increasingly uncomfortable with the thought that I could be on TRT for any amount of time, maybe years, and then somebody deciding that I no longer qualify to get the drug . . . what happens then if your nuts don’t come back because too much time has passed? Like I said, they wouldn’t prescribe test for me IF my hematocrit is too high, AND they won’t give you a phlebotomy . . .

Everything I hear and read in advertising is “got low T? Talk to your doctor . . .” But when you talk to your doctor, they either don’t know, or they have a huge chip on their shoulder regarding what they see as “steroid abuse”. And then you’re dead in the water when it comes to their cooperation.

Regarding the Ontario doc; no, you shouldn’t get the wrong impression, he hasn’t screwed me over. He’s simply telling me that he can’t prescribe Test to me if my blood numbers are too high. I get that and don’t blame him. He seems to know his stuff, at least he knows a lot more than most docs, which isn’t really saying too much. He gave me a long list of blood tests he’d like done, and then I’m to come back and see him after he gets the results. So far I’m not unhappy with his service.

I really don’t want to go back to what I was; my reasons for getting on TRT were valid; legitimate low T resulting in poor sexual proweress, irritability, bad sleep, kind of sloppy body. All of those things have improved to a degree, and I had hoped for more improvement as it all gets dialed in. On the other hand, I really had no idea of what I was biting off when I started this, and the doc SURE DIDN’T TELL ME . . .

Dr. Pangloss - I’ve never donated blood before, but I’ve been told that they always check your arms (both of them) for tracks, fearing you might be an IV drug user. My bypass used one of the arteries in the forearm and I’ve got a one foot long scar where they took it out. I don’t really get why Canadian Blood Services is so hung up on it; basically if you had a bypass you can NEVER donate blood again. That’s not the case in the US from what I understand . . .

Ontarioguy,

Canadian Blood Services have been absolutely paranoid ever since the big tainted-blood scandal that broke out in the mid 1980s and early 1990s and caused the Red Cross in Canada to cease operations in blood donations and blood services , so maybe that’s why they’ve become unreasonably overcautious about taking blood from anyone who looks even slightly suspect.

I’m amazed to learn that haemotologists in Ontario cannot do phlebotomies as an adjunct to medically accepted treatments, and can force
your doctor to stop prescribing testosterone therapy. That strikes me as utter madness.

The more I learn about the state of TRT and other hormone replacement therapies in Ontario, the more discouraged I am that my own low-T can be effectively treated. It seems especially the case that if you live in Ontario, and have a rare disease or a poorly understood disease entity (in this case hypogonadism), the health care system will not cover it, or fund adequate resources to ensure it is looked after. After all, stories of patients in Ontario with rare cancers who need unusual or relatively untested drugs having to fight OHIP just to get treatment are legion.

Seems odd, blood donations use veins, not arteries. But sometimes policies are beyond reason.