T Nation

Low T & NHS Endo Won’t Help


#1

Hey guys,
I have suffered with all the symptoms of Low Testosterone for over 10 years now, tiredness, low libido, anxiety, depression, low confidence, low mood, bald patches on lower legs, fat around the waistline and chest (Gyno from puberty?) no other fat on my body, bad memory, no energy, sleeping all the time, etc etc.

My GP said it was Depression back then and prescribed antidepressants and looking back, i dont think i needed them. Why do they not do a full blood test before handing these out, i dont know?

I asked for a Testosterone blood test back in 2009 and the result was 10.9. The Doctor said ‘normal range’

I am now 44 and my symptoms have become worse. My recent Test came back at 11.2 and i had to basically beg the doctor to refer me to a Endo.

Second blood test at the Endo came back at 10.3 at a 9am blood draw.

Results
Testosterone 10.3nmol (10-38)
SHBG 22nmol (15-48)
Prostate Ag 0.41ugl (<2.50)
LH 5ul (2-9)
FSH 3ul (2-13)
Cortisol 302nmol
Ferritin 73ugl (30-400

Results from full blood count are in the normal range, but low end.

Two results were out of range

Creatinine 105umol (59-104)
Monos 0.9 (0.1-0.8)

The female Endo which i could hardly understand (Bad English) asked me to do a Short Synacthen test to assess the Cortisol level.

Before test 418 nmol
After Test 616nmol

She has also calculated my Free Testosterone based on her results and said it was 0.19nmol (0.092-0.5) although im not sure this is a correct free test calculation?

The Endo has now refered me back to my GP saying…

“Free Testosterone levels are normal and i cannot explain any Endocrine cause, causing the symptoms. The rest of your blood test including trophic hormones are normal. There is no need for TRT therapy”

I wonder if anyone could give me some advice on this, as it seems that i should have been given further tests to investigate.

Thanks.


#2

Typical of systems that use reference ranges to deny services and ignore symptoms. You may need to go private.

I do not see what triggered concern re cortisol. Cortisol best done at 8AM or 1 hour after waking up.

Many in UK are iodine deficient with low thyroid function that can contribute to your symptoms. See below re oral body temperatures. Problems are very common from not using iodize salt that is not stocked in all of the shops. https://www.ncbi.nlm.nih.gov/pubmed/23324480

Ferritin ample to support T4–>T3 conversion

Should also test estradiol [E2] as that can reduce LH/FSH if elevated.
SHBG looks good. With low T levels, even lower E2 levels can create some estrogen dominance.

Any other lab results to post?
hematocrit
RBC
TSH, T3, T4, fT3, fT4?

Please read the stickies found here: About the T Replacement Category

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.


#3

Hi there, you will struggle through th NHS as you are within the ‘normal’ values for t. As ksman has said look into these issues then if you can’t find a problem I’d go private. I know that the company I’m with will let you do a trial of trt if your test levels are on the low range and to see if it improves symptoms. That way you can work out if testosterone is the issue!


#4

Btw ksman where would you recommend getting iodised salt from? Any particular type?


#5

I believe giving someone a trial period of TRT is prefered to denying services to someone with no other possible medical explanation to what could be causing their low T symptoms. I don’t find it to be a coincidence that the UK has some of the lowest reference ranges and the highest denial of services even when most are below the ranges and still denied.


#6

I mean a trial period sounds daunting but if you feel better then you stay on and if you don’t you come off with some hcg and clomid. If it’s only been a month or two at trt doses then you will bounce back anyway.


#7

Thanks for the reply.

Heres a few more results

Erythrocyte 2mm/h (0.0-7.0)
Serum Urate 327umol (200-420)
Serum C Reactive Protein <10mgl (<10mgl)
Rheumatoid <10iuml (1.0-14.0)
B12 560pgml (197-771)
Folate 9.0ugl (>3.9)
ANTI CCP ABS <1iuml (<7.0)
Haemoglobin 139gl (130-180)
Haematocrit 0.437 (0.4-0.53)
Mean Cell Vol 83.1fl (80-100)
Mean Cell Haemoglobin 27.3pg (27-33)
Mean Cell Haemoglobin concentration 329gl (318-364)
Red Blood Cell Width 12.8 (11.5-15)
Lymphocyte 1.8 (1.4-4.8)
Monocyte 0.9 (0.1-0.8)

They didnt test for T3/T4 or E2


#8

Thanks oly,
I have managed to persuade my local GP to take an action plan on this, as i said im not happy with the Endo’s diagnosis.

Appointment on Tuesday to go in armed with paperwork and the wife as back up. (She is fed up with the constant sleep and low libido)


#9

I mentioned on the phone earlier to my GP that the Endo should have offered a trial of TRT, even gel or patches would be fine.

I am speaking to him on tuesday, although i doubt if he will offer a trial, just more bloods and waiting :frowning:


#10

Good luck!:crossed_fingers: There are some good sensible endos out there… apparently. If they fob you off give me a shout and I’ll put you in touch with the company I’m with ATM!


#11

Thanks!
If you could send me the info, that would be great.

I have been looking at services from the Leger Clinic, Balance My Hormones and Clear Chemist.


#12

Sure thing. I was with bmh but optimale are a bit cheaper and the service seems to be better. Not sure about leger clinic though. Optimale.co.uk is the link


#13

Hopefully you get it for free though :joy:


#14

Blood is a bit thin as expected with low T.

I have no knowledge about what brands of iodized salt are offered there. The amount of iodine is regulated. Do read related in the thyroid basics sticky.

Your oral body temperatures are very important.


#15

Thanks KSman,
Could i ask what important blood tests are missing from my results?

I know i need T3, T4 and E2. Is there anything else i should ask for on Tuesday?


#16

Just had a look…
I have two recent low T blood test results, so it looks like it would be £149 for the consultation, but it looks like TRT injections start from £90pm. :frowning:

Im sure i read BMH was about £52pm?

Even going through Clear Chemist would be £25 for the online doctors TRT consultation (They need to check two recent blood tests that have low T) and £12 for two months worth of Sustanon 250 (4 Amps) and £5.99 next day delivery.

Works out at about £21.50pm.


#17

I pay £80 quid per month for optimale.co.uk, bmh was slightly more if I remember - about £90 a month. I guess you are paying for the service, medical advice, all the extra needles and stuff and blood result checks. I’m pretty happy to pay a bit more per month for a legit service.


#18

Also I’m pretty sure you pay a monthly prescription fee on that one rather than just a one off… I may be wrong


#19

Id guess £25 prescription and £12 meds - £37pm


#20

Hi

I had a similar problem. Started with GP. I came to him explaining that, from my research, I thought my Testosterone levels were low. He did not believe me. So he tried to talk “anti depressants”. I said no way. I am like the happiest dude on the planet - laughing all day long. Very social and outgoing. No Way. So, reluctantly, he did some blood work. Guess what? I was totally dead on. My T levels were in the mid 200’s !!! Which is quite low.

But here comes the complex part. Acceptable T levels in the medical world are 300 to 800. Big difference. But as long as they get you above 300, they just don’t care. Whether or not you feel better at 300 does not matter. It’s just a number to them. The complex part is that some guys can be perfectly fine at 300. Others are perfectly fine at 800. So how can my GP decide that 300 is my sweet spot?

Anyway. . . My GP gave me some of that Testosterone Cream to rub on your shoulder. Told me I had to give it 6 months and then retest. Guess what? I went from 270 to 280. Wasted 6 months on stupid cream. So what happened next? I was told to use MORE cream and wait another 6 months. After a year … I was now from 270 to 282. A full year wasted.

Finally, I requested to try injections, because I felt the cream was not working. So my GP referred me to the endo. Endo was one of those “your just a number” type of doctor. Gave me a very small injection. Waited 6 more months and I was at 295.

Increased the injection by a small amount and waited 6 months. I was now at 315. And my Endo said - you’re good now. You are in the acceptable range. I told him that I had felt no better at all. He told me wait another 6 months.

So then, we are literally 2 years into this and I felt no better than day 1. I complained to my endo . . that I don’t feel any better and how can we know that 300 is where I need to be. . what if it IS 800 for me? I am telling you I don’t feel good . . stop treating me like a text book. He refused to budge. Fine.

I wrote a bad review about him on yelp. a week later, I got a letter in the mail stating that maybe we can increase it a bit more. And gave me a new script. 6 months later . I was around 400. And my endo was done. That’s where we stayed for another year and a half. And I felt no better at all. Wasting several years and having lost hope.

Suddenly, my endo retired and I somehow got referred to a urologist instead. Was the best thing that ever happened. He ran one blood work. Gave me an injection much higher. Took my peak and troph and was done. Had me on a much much much higher injection of Testosterone Cyponate. And my numbers were around 850, and I felt much better. Sometimes I climb over 1,000 but my urologist does not seem to concerned but tells me to let him know if I have any signs of problems.

I feel really good. My libido is back and I am working out now (I was fat and lazy before this . . almost 300 pounds and no energy. I am 215 now and work out 5 x a week).

Maybe try seeking a Urologist. My Uro told me that endo’s are FAMOUS for not understanding TRT. They often have you inject every two weeks, when you should inject every week or biweekly.

There are also T clinics around. Never been to one, but I heard there was a time that they were happy to get you jacked up . . as long as you could pay. Not sure what they are like anymore . . . but good luck