T Nation

In Need of TRT Advice

Not quite 35 but I thought this was the best place to post about TRT options.

A little about myself. I’m 32, I rarely eat junk food. I do drink alcohol, might have a six pack with the boys on a biweekly basis. I get 7.5 - 9 hours of sleep a night and during my keto diet fats make up 50-55% of calories with 16 grams total of Omega 3 fish oil which includes 2 servings of Flameout. I’m 5’8, 170lbs, very lean and cut with a 30 inch waist. I think I put up pretty descent numbers in the gym, hit a 300lb front squat PR 3 weeks ago. I’ve been training for 12 years, certainly learned ALOT along the way on how to train properly. I don’t have any issues with depression and stress levels are low. The only medication I take is 1/4 proscar tab daily for hair loss. I have colitis but haven’t used the medication in the last 4 months as I’m thankfully not having symptoms.

I was reading up on test boosters and thinking about trying an Alpha Male and Rev-Z stack and wanted baseline levels so my family physician drew blood, we did this at 6:30pm on 4/10/08 the day after a hard workout, at this time I was following a carb cycling diet.
Quest Diagnostics did the blood work and results were:
Testesterone Total - 391 - Range 241-827
TSH 3rd Generation - 1.59 - Range .40 - 4.50

I was suprised my Total Test was so low.

On 5/31/08 I had an appointment with a Urologist for a different issue, while there I asked to them to draw blood. I used ZMA during these 6 weeks and had been on a keto diet for 4 weeks, blood was drawn 2 hours after waking on an empty stomach, no hard workouts for the 2 previous days.
Dianon Systems did the blood work and results were:
Testesterone Total - 343 - Range 241-827
Free Test - 5.40 - Range 8.7-25.1

I asked for more tests based on info I read on this board but they would only do 2, I can’t believe the uro wouldn’t test for E2. I had this test on 6/26/08 in the morning on an empty stomach, still on a keto diet, using ZMA and no hard workouts for 2 days.
Prolactin - 5.7 - Range 2.1 - 17.7
LH - 1.2 - Range 1.5 - 9.3

The URO (female) who treated me for another issue suggested I see another URO in the office (male) who deals with TRT. My appointment is this thursday at 1pm. I am going to ask him to redo the tests and see if he will test for more things like E2. I have been feeling run down and irrateable lately so I’ve taken the 10 days before the appointment off from training to rule out overtraining as an issue. She did mention the use of Androgel but that scares me.

What options should I be looking at? I’m not too keen on starting TRT, possibly for life at this age. I live outside of Philadelphia so if anyone knows a good doctor please let me know. Your help is greatly appreciated. I can provide additional information if needed. Thank you in advance. I plan on documenting my journey here that will hopefully help others in the future.

I think you have the right mind set for this journey. See why your low first then if it can’t be fixed go on HRT. I tested 3 times before thinking about HRT. I am on it now and it was the best thing I could of done for myself, but i wanted to be sure first. Life is a long time. At any age.

I know a guy in your area that might know of a good doctor. I’ll PM you.

[quote]JohnB001 wrote:
The only medication I take is 1/4 proscar tab daily for hair loss. [/quote]

…that could be part of the problem right there. Try doing a forum search on finasteride…hebs

Okay, so you’re 32, so what? So you don’t want to age as gracefully as possible and keep all your hard earned gains from the gym? Is that the problem? I know you’re not scared of a little needle in your butt once or twice a week, so what’s the real problem, really?

The hassle of a healthy heart? The integrity of strong bones? The reduced chances of ever developing Alzheimer’s? The greatly diminished possibility of ugly man boobs? The life long potential for reduced body fat? Come on man, what’s the real problem here? I am SO confused.
Any questions now? I’m all ears…

KNB,

Let me rephrase, I’m not saying I don’t want to ever be on TRT. I felt like on my last visit to the Uro she was saying, your test is low then take androgel. I would think there are other tests they should run on me and was hoping for users of the forum to give their input. If in the end the best option is TRT well then that is the route I will take.

I have read quite a few of your posts and you are a very smart guy. I appreciate you taking time to read my thread.

JohnB,
I’m glad you appreciated my point of view…
I have a suggestion; if you want to get more accurate numbers on your next blood test, stay off the ZMA for a couple of weeks and see what your “real” numbers are. In my past experience ZMA not increased my Total T numbers, but my Free T numbers as well.

I’ve been on HRT/TRT for two plus years and life is now GOOD!. Back when my TT was 135, I was fat, depressed, listless, thought women were still “pretty” but I wasn’t on the hunt, and didn’t know why until I was tested.

Now I’m always on the hunt, gaining muscle, got my self confidence back, and life doesn’t suck anymore.
You’re welcome, and thank you too.

My advice… from experience.

FIND A DOCTOR THAT KNOWS WHAT HE IS DOING.

Do not settle for a simple blood test panel, but demand the “Whole Picture”

Easier said than done. Also read everything KNB and KSman (and others as well) have researched and written about.

I think Dr Shippen is in PA ???

Ck this site out…
http://www.allthingsmale.com/index.htm

I agree find a good Dr. Also you aren’t a rare case at 32. I’m 35 and I’m probably 5 years overdue for TRT. The best thing to do is realize there are no easy solutions and go on TRT. Don’t accept anything less than T+HCG+AI either. T alone is useless after about a week.

Thanks everyone for the info. I certainly won’t settle for anything less than the best treatment. If I am not satisfied with what this doctor has to say I am ready to find a new doctor.

KNB I’ve been off ZMA for about a month now.

JohnB001,
There are some great doctors available, they are just really hard to find.

My insurance company is sending me to a new doctor. I hope he doesn’t suck. If he does, I’ll get what I can from him and pay out of pocket for the rest using my current doctor.
My insurance company wants to get me off the scripts that are expensive for the rest of my life like adex, and HCG as a start.
I’ll do it it legal, but I may not like it.

I’ll keep you guys posted and if you ever get near Reno and need a doctor that doesn’t suck. I know two…

EDIT: The insurance whore doctor they sent me to does SUCK. No adex, no HCG, back on T4 thyroid (which screws me up).
Even though my previous doctor sent copies of b/w showing I need adex, this idiot said no.
It’s back to paying cash again…

I forgot how bad doctors that suck really suck. He does!

UPDATE

Had my appointment with the Uro today, based on the research I’ve done he seemed like he had a good handle on how to procede.

He said he didn’t want to take any new blood work at this time and wanted to refer me to an endocrineologist. He said a Testosterone of 343 is low for me and with my LH and Free Test below normal I could be a case of Secondary Hypogonadism.

He told me the endocrineologist will most likely order more labs and a MRI of the pituitary and she also could do the TRT if it is deemed necessary.

The Uro told me as far as TRT goes he uses gel and injections, that the injections are better and he has his patients inject themselves once a week.

I asked about HCG and he said he doesn’t typically use it but for someone who may eventually want to have kids it can be used and he mentioned it also as a way to counter testicular shrinkage.

I called the endo multiple times today but couldn’t get thru to make an appointment so I will try again tomorrow. The good news is her office is across the street from my work so I can take the 1st available appointment. Hoping I won’t have to wait a month or more.

The Uro complemented me on researching the subject, I brought notes with me also. Overall I was pretty satisfied with the Uro although I don’t know why they made we wait a month for my appointment to then tell me I need to go see an Endo.

Any recommendations on what I should discuss with the endo when I meet her?

Any comments are welcome.

My advice would be ditch the endo and find a Dr that just does TRT. I can’t stress this enough. I got jerked around by an endo for months only to find out he wouldn’t treat and my TT was 379 and free T low.

If the endo treats you I doubt you’ll get HCG, you won’t get Arimidex, and she’ll shoot for mid range TT. You’ll be right where you are today.

[quote]brentf13 wrote:
My advice would be ditch the endo and find a Dr that just does TRT. I can’t stress this enough. I got jerked around by an endo for months only to find out he wouldn’t treat and my TT was 379 and free T low.

If the endo treats you I doubt you’ll get HCG, you won’t get Arimidex, and she’ll shoot for mid range TT. You’ll be right where you are today. [/quote]

I think it is worth seeing the Endo to rule out any pituitary issues. I wouldn’t do TRT with any doc who wasn’t open to using T+HCG+AI

Scheduled my appointment with the Endo but her first opening isn’t till Sept 25th. Going to do some research and see if I can find a good Endo with a sooner appointment available.

The same exact thing happened to me. I had to wait two months to see the endo, he ran his own labs (another two weeks), finally had my second appointment a month later and with T 379, Bio Avail T 44, Free T 1.3, and E2 42 he told me I was fine and have a nice day. I learned the hard way.

I met with the endo, he was a young guy I’d say in his mid 30s. He agreed my levels were low and I had symptons of low T and was open to TRT. However he said he doesn’t use HCG unless someone is trying to have a child and he doesn’t use anything to control estrogen. Not a doctor I would use for TRT.

Since I was already there I got new bloodwork done. The endo said he never tests E2 but would do it for me since I wanted it.

Here are my results. Blood was taken on a thursday 9/25 at 9:30 am, fasted, 2 hours after waking. Last workout was Monday evening. I have a followup appointment with the endo in 2 weeks to go over the bloodwork. Quest Diagnostics did the bloodwork.

Test Result Range

Total Testosterone 538 ng/dl 250-1100
Free Testosterone 61.3 pg/mL 35 - 155
Testosterone Free % 1.14% 1.5 - 2.2
LH 1.3 mIU/L 1.5 - 9.3
FSH 3.2 mIU/ml 1.6 - 8
Prolactain 3.3 ng/mL 2 - 18
TSH 1.2 mIU/L .4 - 4.5
T-4, Free 1.3 ng/dl .8 - 1.8
IGF1 151 ng/mL 106 - 225
Growth Hormone 7.5 ng/mL <=10 - Item Annotation 9/29/2008 10:28 AM
Estradiol 43 pg/ml 13 - 54
Cortisol Total 13.1 mcg/dl AM 4-22 PM 3-17 - Item Annotation 9/26/2008 1:15 PM
ACTH, Plasma 8 pg/ml 7 - 50

White Blood Cell Count 3.9 Thous/MCL 3.8-10.8
Red Blood Cell Count 4.7 Mill/MDL 4.2-5.8
Hemoglobin 14.6 G/DL 13.2-17.1
Hematocrit 42.2 % 38.5-50
MCV 89.8 FL 80-100
MCH 31 PG 27-33
MCHC 34.6 G/DL 32-36
RDW 13.9 % 11-15
Platelet Count 170 Thous/MCL 140-400
Absolute Neutrophils 2243 Cells/MCL 1500-7800
Absolute Lymphocytes 1123 Cells/MCL 850-3900
Absolute Monocytes 304 Cells/MCL 200-950
Absolute Eosinophils 183 Cells/MCL 50-550
Absolute Basophils 47 Cells/MCL 0-200
Neutrophils 57.5%
Lymphocytes 28.8%
Monocytes 7.8%
Eosinophils 4.7%
Basophils 1.2%

My Test shot up almost 200 points. I have increased calories and changed my training since the last bloodwork but I still feel symptons although some not as much as I used to.

All CBC values were in range.

My LH is still below the range and Free Test % is also below range. So I’d like to figure out what is causing that. I don’t know alot about the thyroid but the TSH is kinda low and I always have a low morning temperature @ 97 degrees. Maybe there is an issue there?

My E2 is high so I will need to get that under control.

Any thoughts or suggestions appreciated. Is there any followup bloodwork I should ask the doctor for?

[quote]hebsie wrote:
JohnB001 wrote:
The only medication I take is 1/4 proscar tab daily for hair loss.

…that could be part of the problem right there. Try doing a forum search on finasteride…hebs

[/quote]

I did some searching on T-Nation and google and what I found was finasteride could actually increase testosterone as it stops testosterone from converting to DHT. However the increased testosterone could then lead to an increase in estrogen.

Do you have a link to something that says otherwise? I am definatly curious about this issue.

[quote]JohnB001 wrote:
hebsie wrote:
JohnB001 wrote:
The only medication I take is 1/4 proscar tab daily for hair loss.

…that could be part of the problem right there. Try doing a forum search on finasteride…hebs

I did some searching on T-Nation and google and what I found was finasteride could actually increase testosterone as it stops testosterone from converting to DHT. However the increased testosterone could then lead to an increase in estrogen.

Do you have a link to something that says otherwise? I am definately curious about this issue.[/quote]

Well yes and no. Does T convert to DHT? Yes. Is it a problem for the vast majority? No. Your issue right now is E2, not DHT. If you want to get your T numbers up, get your E2 down.

If your DHT is too low, it may affect your sex drive and your performance. I used to take 1mg/day of finesteride and my DHT was so low my doctor said, “stop”, so I did.

You need DHT for your sex drive and maintenance of your sex organs. Some who use that crap end up with permanently damaged hormones levels and libido. That stuff is not harmless.

Use anastrozole to lower your E2. E2=43 can cause serious problems. If you reduce E2, your LH and T will increase. E2 also opposes the actions of that FT you have.

When you lower E2, your SHBG should reduce. That will increase your %FT.

LH is pulsatile. The time of the test determines the level. As long is there is a reasonable number, you are ok *. TT is a measure of your output. TT levels are quite steady. FT levels also change during the day. The exception for guys injecting TRT [who are HPTA shutdown] where their FT levels are very steady.

  • IF LH is near zero that is diagnostic for secondary hypogonadism. I really do not see a need to repeat LH and FST tests in your condition.

Your TSH level is good if your T3 and T4 levels are good. But it is a bit low. Your T4 is mid range, so that is ok. There can be a problem if you are not converting enough T4 to T3. You need FT4 and FT3 to complete the picture. Yes, your AM temps are a significant symptom of hypogonadism.

First make sure that you have not handicapped your thyroid. Are you getting enough iodine? Note that, counter to expectations, sea salt contains no useful amounts of iodine. Only sea salt that stated that it has been iodised can be assumed to contain iodine. Imported sea salts often are not.

KNB and KSman,

Thank you for your input. I have learned a great deal from reading your posting throughout the forum.

I think I should get my DHT checked and make sure those levels aren’t too low. I don’t think finesteride is harmless maybe a switch to EOD could be in order.

I will also ask the doc for Free T3 and Free T4 to complete the thyroid picture.

I know the sea salt I use doesn’t contain iodine. I will start using the table salt I have that does contain iodine, also will check into what other foods in my diet contain iodine. My Multi-Vit contains 50mcg Iodine (as potassium iodide). I’ve also read that Selenium and Coconut Oil are good for the thryroid. I have 1tbsp of Coconut Oil daily and eat Brazil Nuts for the Selenium.

I’ll look into getting anastrozole and probably use lef.org to check my E2 levels.

[quote]JohnB001 wrote:
I met with the endo, he was a young guy I’d say in his mid 30s. He agreed my levels were low and I had symptons of low T and was open to TRT. However he said he doesn’t use HCG unless someone is trying to have a child and he doesn’t use anything to control estrogen. Not a doctor I would use for TRT.

Test Result Range

Total Testosterone 538 ng/dl 250-1100
Free Testosterone 61.3 pg/mL 35 - 155
Testosterone Free % 1.14% 1.5 - 2.2
LH 1.3 mIU/L 1.5 - 9.3
FSH 3.2 mIU/ml 1.6 - 8
Prolactain 3.3 ng/mL 2 - 18
TSH 1.2 mIU/L .4 - 4.5
T-4, Free 1.3 ng/dl .8 - 1.8
IGF1 151 ng/mL 106 - 225
Growth Hormone 7.5 ng/mL <=10 - Item Annotation 9/29/2008 10:28 AM
Estradiol 43 pg/ml 13 - 54

My Test shot up almost 200 points. I have increased calories and changed my training since the last bloodwork but I still feel symptons although some not as much as I used to.

[/quote]

Here is your answer, from a July post:

If you were hypothyroid, nothing works quite right. This alone could account for the low-ish free T. Other issues–DHT, E2, propecia–are not primary movers here, if you were indeed hypothyroid.
Correction with T4 may be sufficient to restore normal levels of testosterone.
(So far, so good.)

So why, then, would a man be both hypogonadal and hypothyroid? In your first post you do not include your thyroid story or the original TSH. I suppose a man can have low TRH and low LH, and have normal cortisol, but I sure wish I had July’s TRH level.