T Nation

Introduction, Newbie to TRT

Hi All, I just joined the forum and this looks like a good place to learn about and discuss TRT related issues. I’m 56. I first had my T levels tested a few years ago. I didn’t have any symptoms at the time, I just wanted to see where they were at. Total T came back at 425 ng/dL. A little low but with no symptoms I didn’t pursue it at the time. Last year I think I was starting to notice systems and had my levels checked during my physical. Total T was 375 ng/dL with a standard range of 250 - 1,100 ng/dL and free T was 63 with a standard range of 35.0 - 155.0 pg/mL. I still didn’t pursue it.

But by this year I was definitely experiencing systems and the results came back at 303 ng/dL & 38 pg/mL. I decided to talk to my doc about it and he was happy to start TRT. After working through some issues with my insurance I started on 50 mg daily of Androgel in February. So far so good. My symptoms resolved quickly. The fatigue, difficulty concentrating, low sex-drive, mediocre erections, and difficulty achieving climax are all a thing of the past or at least significantly improved. I don’t know what my numbers look like now but I’m scheduled to be retested in a few weeks.

I notice a lot of folks here seem to prefer the injections and read that some people don’t absorb the gel well. It’s clear that there is not a 1:1 equivalence of the dosing as my 50mg a day is 350mg a week and that’s just the standard, lowest dose. I find the gel application pretty convenient and my insurance covers everything but an $8 a month co-pay so cost is not a factor. So far I’ve seen no negative side affects. I want to see what the numbers look like before making any changes. I’m also still researching the “ideal” levels. If I’m going to go through the trouble of doing this I might as well get optimal results rather than just acceptable. I’ll report back with my numbers once I test again.

Hello and welcome,

Typically androgel users at some point in the future start to develop absorption issues, not always but is common and therefore usually end up on injectable testosterone. If it works for you, do not change it just because what everyone else is doing.

If it’s one thing I have learned is what works for one guy will not work for another. You want levels in the high normal ranges (600-800), these are the ranges the clinic studies are showing to be more cardioprotective than mid normal ranges. Men with in high normal ranges live longer and have the least amount of cardiovascular and heart problems.

Levels at or below 440 ng/dL between 45 to 74 years old is associated with cardiovascular disease.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men:

These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction.

Here’s other interesting reading material. --> Testosterone and the Heart

SHBG binds sex hormones and affects the balance between Total T and Free T. Most men with SHBG midrange or higher need more Total T (800+) to equal high normal Free T levels, lower SHBG men like myself only need a Total T of 500 to have Free T in the high normal ranges.

I reckon your SHBG is about mid range based off your pre-TRT Total T and Free T levels. Free T is the hormone your body needs and where the rubber meets the road, Total T is useless to the bodies tissues because it is not bioavailable.

Do you by any chance have SHBG tested?

It sounds as though you are responding well to Androgel and the price is certainly right. The dosing seems higher than injections because it is not absorbed like injections are. The insurance plan may limit dosing in your case. See if you can have estradiol checked while you are at it. You free test percentage is 1.25% which is not terrible, but 2-3% is thought to be ideal.

The previous tests were only for total and free testosterone and one for estrone from Quest Diagnostics. I will ask for the full panel next month. These are the only tests that have been performed - you can see that it has been relatively low for quite a while:

June 2013
ESTRONE, LC/MS/MS 21 < OR = 68 pg/mL EZ
TESTOSTERONE,FREE/TOT,LC/MS/MS
TESTOSTERONE,TOTAL,LCMSMS 406 250-1100 ng/dL
TESTOSTERONE, FREE 47.4 35-155 pg/mL

November 2017
TESTOSTERONE,FR(DIALYSIS) AND TOTAL(LC/MS/MS)
Testosterone, Total 370 ng/dL 250 - 1,100 ng/dL
FREE TESTOSTERONE 63.3 pg/mL 35.0 - 155.0 pg/mL

November 2018
TESTOSTERONE,FR(DIALYSIS) AND TOTAL(LC/MS/MS)
Testosterone, Total 303 ng/dL 250 - 1,100 ng/dL
FREE TESTOSTERONE 38.3 pg/mL 35.0 - 155.0 pg/mL

Somewhere I saw a recommendation that a new TRT patient be tested at 3 months and 6 months but I don’t recall seeing anything about how often after that. I would assume at least annually? I need to read the article The Complete Guide to T Replacement - Testosterone Replacement Therapy 101 to get up to speed on some of this.

Some additional past lab results that I’ve found:

2013 - these seem kind of high but I live in Colorado Springs at 6660-ft altitude so that might be affecting these levels since this is with a relatively low T level and long before I started TRT)
HEMOGLOBIN 16.0 12.9-18.3 gm/dL
HEMATOCRIT 49.8 37.0-53.0 %

2016
PSA Total EXT 1.2 ng/mL < OR = 4.0 ng/mL

2018
PSA Total EXT 1.0 ng/mL < OR = 4.0 ng/mL

You’re definitely showing a steady decline in testosterone over those years. Nobody uses Estrone who is on TRT, any doctor ordering this test probably doesn’t specialize in TRT and is just inexperienced. Usually labs are required every 6 months and a visit by your doctor in person once yearly unless using a telemedicine clinic.

Consider JayCambell’s book TOT Bible or Testosterone for Life by Abraham Morgentaler, a treasure trove of information!

TRT cause exacerbate mild sleep apnea, sleep apnea can cause elevated hematocrit, have you had a sleep study done? Higher altitude can increase hematocrit as well.

TRT has my hematocrit hovering around 50% when Total T is 500 and Free T in the high normal ranges. When hematocrit gets to 54% blood donation or dosage reduction is usually recommended.

I’ve never had any sleep issues so I’ve never had a study done. I suspect it’s the altitude here causing that but I’ll look into it if it becomes an issue. I’ll pick up copies of those books too. I like to get as much information as possible. I don’t find the doctors know as much about this stuff as they should.

It’s by choice, TRT is low cost, low profit and most doctors just want nothing to do with TRT. You will find doctors only doing things that generate large amounts of income, if it’s profitable doctors will be doing it.

An example prescribing ED drugs, surgeries and expensive treatments. It’s common for doctors to say when scoring testosterone at the bottom of the ranges testosterone can’t be the problem, or thyroid hormones are low normal, “it can’t be that”, but here’s some Viagra for the ED and ADs for depression.

The Androgel is becoming less effective for you. You might want to consider scrotal cream or injections. Your doctor makes the same money from an every office visit, one thing doesn’t really make him more or less money than another, he should be open t changing a protocol that is becoming less effective. TRT is a highly profitable market, the money isn’t the reason that doctors in general don’t know much about it. They don’t need to. It’s perceived as largely a vanity problem and they are all scared of malpractice suits, so they play it safe and follow the accepted standards of practice. Doctor’s that are reasonable and not concerned about you suing them will be helpful, but you should know about the subject before you talk to them.

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This^.

Slight correction there - those test results are from before I started on TRT. I’ve only been on the Androgel for 2 months so I don’t know yet what my numbers look like now. I’m testing again in a few weeks. My doc has been pretty easy to work with so far though he has not really given me any reason to think he’s any sort of expert on TRT. He at least seems open to trying things. He suggested the gel if my insurance would cover it (which it does) due to the more consistent blood testosterone concentration that it produces vs the injections but also suggested that I might want to go with the injections as a cheaper alternative if I had trouble with insurance coverage.

I think you have a good doc to work with. Be friendly and he’ll take care of you.