Low T, What Would You Do?

Pharma / TRT Testosterone Replacement
1

In October I decided to see my doctor due to fatigue and concentration issues. Thinking my cause was shiftwork and sleep disorder.

After initial blood work, it was apparent I had low Test. I had my blood checked at in the am, to see if there was an increase. Meantime I was prescribed Androgel 1.62%. 2 pumps for 1 month, did not help. Now 6 weeks at 3 pumps and I am due for a check up in 2 weeks.

Male
34
5-11
215
Body Fat 26%
BMI 29.98

Here are my results so far…

10/01/14 3:11pm
TEST 229

10/03/14 7:50am
Test 303
Test Free 7.54
%Free Test 2.49
HGB 42.9
HCT 15.2

11/10/14 7:50am
Test 281
Test Free 7.11
%Free Test 2.53
HGB 15.2
HCT 44.4

Personally, I do not feel that the androgel is working at all. I am going to wait and see what my next results are, and review them with my doctor. If the results are anything less than stellar, I will be asking in a change in treatment.

What would you do?

Is there anything I should ask my doctor?

What are my options?

What other prescriptions should I be open to for T Replacement/Supplementation?

Is an E blocker needed?

I read about Testicle shrinkage, what should I be taking if this occurs?

Is there any other blood work that I may be missing, or need to follow?

At what point should I seek help elsewhere?

From my research and understanding… I would like to think 700-900 on the T levels would ideal. I am open to all responses and treatments. Supplements, vitamins, herbal and mineral included. Even though I work out 3-4 times a week and eat a healthy diet, I feel like I am fighting a losing battle.

I know this may be a loaded Post, I feel that I can only get the best answers from the men and women that have tackled Test, Energy, Libido and Growth issues that we live with today.

2

All will be revealed if you read the advice for new guys sticky and protocol for injections.

Inability to absorb transdermal T is a symptom of hypothyroidism, can be subclinical. So you should test:
TSH
fT3
fT4 [not T3, T4]
CBC
E2
Prolactin

These confused:
HGB 42.9
HCT 15.2

Should have tested LH/FSH before attempting any TRT, sort of too late now unless you go 3-4 weeks with no T, not fun. You really should know why your T levels have crashed.

3

I indeed had those numbers swapped. I edited the original post.

I had been tested for thyroid issues on Oct 1.

TSH 1.28

Sorry, I should have mentioned that. There is another list of results, labeled CBC WITH DIFFERENTIAL, that did not look out of range. But I had not been test, I surely would have been questioning my doctors methods.

I am not sure, what caused the crash in T. I has been like this for a few years I suppose. I just never thought it was my T levels.

Currently, my doctor’s theory is that I am over stressed. Due to my personality type, I do not show stress or emotions as easily as most.

The Doc based this off of the fact, that I am up a 5am, on the road by 5:30, drive an hour, work 8-10 hour shift as a steel worker. Drive an hour home, and work out the normal duties of a husband and father. Then I get to the gym, 1-2 hours, 3-5 times a week.

Doc also directed me to get 8-9 hours of sleep, with the help of 10mg melatonin if needed.

4

I am reading, what you suggested, thanks. I Should have started there first.

5

melatonin: Most products are fast release. But if you look, you can find time release melatonin. If not time release, falling levels after 4-6 hours will wake you up as that is the waking mechanism. Start with 5-6mg time release, 30 minutes before you would like to be falling asleep.

Stress: If stress is affecting you as doc suggests, test also test rT3. See the thyroid basics sticky and check body temperatures and evaluate your long term use of iodized salt. In that sticky, note references to stress which can include med issues, diet and training.

6

My T level dropped to 273. My other levels seem slightly lower, but in line with the % of T level that had decreased.

I had requested my other levels to be checked, using the outline from the thread mentioned above. Somehow that request did not register in the medical system until after my blood was taken on Monday. I had that lab work today after my appointment and review of my T levels. From how much they had drawn, I am sure they will get it right this time around.

Due to my levels dropping 10-15 points every month since I have been being monitored, my physician referred to a specialist. I do believe injections are the next step. Unfortunately the next appoint I could get was on the 13th of Feb. I did ask to be put on the fill in list( Call Outs).

Though I am glad my main physician admits the lack of experience in TrT treatments, and was eager to refer me to someone who should be more specialized, I am very disappointed in the time that I will have to wait just to be seen. I will continue to read, here and elsewhere on the subject. I will no longer use the Androgel 1.62% as it is completely ineffective on me. Hopefully it did not have a negative effect.

Thank you for sharing your experiences, information, guidance and support.

It is invaluable to me.

7

Revised to add to top of thread. I will continue to update lab work, presciptions, ect…

-Sex- Male
-Age- 34
-Height- 5’-11
-Waist- 38
-Weight- 215-220
-Body Type- Endomorph
-Body and Facial hair - Forearms, thy and legs, average.
-Fat placement, and changes- Blessed with equal fat distribution. Gut and love handles increased in last 24 months.
-Health conditions, Symptoms [history]- Low Testosterone. Fatigue, Decreased libido, Concentration and Sleeplessness. Feel powerless, drained and hollow at gym, compared to what I know I can , should and have done. No depression initially, though I do feel a bit low or moody at times due to my inability to perform at the level I should be able to.
-Rx and OTC drugs, Other - Multivitamin, Vit D w/minerals, Glucosamine and Chondroitin and Provigil -Modafinal-
Prescribed Provigil to help Shift Work Disorder and Fatigue during long days and long drives.

Stopped all Protein, Creatine and Pre-Workout Supps to give tests a solid baseline. Reduced alcohol to 3 beers/week tops.

-Lab Results with ranges
Labs being updated

10/01/14 3:11pm
Testosterone
TESTOSTERONE 348-1197 ng/dL 229

Thyroid Cascade
TSH 0.27-4.20 mcU/mL 1.28

Comprehensive Metabolic Panel
POTASSIUM 3.5-5.5 mmol/L 4.0
SODIUM 133-145 mmol/L 140
CHLORIDE 98-110 mmol/L 103
Glucose 65-99 mg/dL 100
CALCIUM 8.4-10.4 mg/dL 9.4
ALBUMIN 3.5-5.0 g/dL 4.8
SGPT (ALT) 5-40 U/L 51
SGOT (AST) 10-37 U/L 30
BILIRUBIN TOTAL 0.2-1.2 mg/dL 0.3
Alkaline Phosphatase 25-115 U/L 105
BUN 6-22 mg/dL 19
CO2 20-32 mmol/L 22
CREATININE 0.5-1.2 mg/dL 1.1
eGFR African American >60.0 >60.0
GLOBULIN SERUM 2.0-4.0 g/dL 2.3
A/G RATIO 1.1-2.6 ratio 2.1
TOTAL PROTEIN 6.4-8.3 g/dL 7.1
ANION GAP 15.4

CBC W/Differential
WBC x 103 4.0-11.0 K/uL 6.2
RBC x 106 3.80-5.80 M/uL 5.35
HGB 13.2-17.3 g/dL 15.2
HCT 36.6-51.9 % 42.9
MCV 80-95 fL 80
MCH 26-34 pg 28
MCHC 32-36 g/dL 35
RDW 10.0-16.0 % 13.4
PLATELET 140-440 K/uL 220
MPV 6.0-10.8 fL 10.9
SEGMENTED NEUTROPHILS 40-75 % 60
LYMPHOCYTES 27-45 % 29
MONOCYTES 3-9 % 11
EOSINOPHIL 0-6 % 1
BASOPHILS 0-2 % 1
ABSOLUTE NEUTROPHILS 1.8-7.7 K/uL 3.7
ABSOLUTE LYMPHOCYTES 1.0-4.8 K/uL 1.8
ABSOLUTE MONOCYTE COUNT 0.1-0.9 K/uL 0.7
ABSOLUTE EOSINOPHIL 0.0-0.5 K/uL 0.0
ABSOLUTE BASOPHIL COUNT 0.0-0.2 K/uL 0.0

10/03/14 7:50am
TESTOSTERONE,FREE AND TOTAL
Testosterone 348 - 1197 ng/dL 303
Testosterone Free 5.00 - 21.00 ng/dL 7.54
%Free Testosterone 1.50 - 4.20 % 2.49

11/10/14 7:50am
TESTOSTERONE,FREE AND TOTAL
Testosterone 348 - 1197 ng/dL 281
Testosterone Free 5.00 - 21.00 ng/dL 7.11
%Free Testosterone 1.50 - 4.20 % 2.53

H&H
HGB 13.2-17.3 g/dL 15.2
HCT 36.6-51.9 % 44.4

PSA SCREEN
PSA SCREEN <=1.400 ng/mL 0.866

1/12/15 8:45am
TESTOSTERONE,FREE AND TOTAL

Testosterone 348 - 1197 ng/dL 277
Testosterone Free 5.00 - 21.00 ng/dL 4.68
%Free Testosterone 1.50 - 4.20 % 1.69

H&H
HGB 13.2-17.3 g/dL 14.8
HCT 36.6-51.9 % 43.4

Hepatic Function Panel
ALBUMIN 3.5-5.0 g/dL 4.1
TOTAL PROTEIN 6.4-8.3 g/dL 6.7
GLOBULIN SERUM 2.0-4.0 g/dL 2.6
A/G RATIO 1.1-2.6 ratio 1.6
BILIRUBIN TOTAL 0.2-1.2 mg/dL <0.1
BILIRUBIN DIRECT 0.0-0.3 mg/dL <0.2
SGOT (AST) 10-37 U/L 28
Alkaline Phosphatase 25-115 U/L 118
SGPT (ALT) 5-40 U/L 36

1/16/2015

ESTRADIOL 8-43 ng/L 15
CORTISOL 6.49
DHEA Sulfate 138.5 - 475.2 ug/dL 152.5

-Diet-
4-5 days a week.
Meal 1 - 4:30-5:30am
2-3 Eggs with Plain oats, Cream of Wheat or Grits.
1 pint of 2% Milk

Snack 1 - 10:00am While Working
Apple or Orange

Meal 3 - Noon Lunch Break
1 Bag of BBQ Baked Chips <-guilty
2-3 Hard boiled eggs

Snack 2 - 4:00pm In Car
Apple or Orange

Snack 3 - 5:00pm
1 can of Tuna fish or Fruit Smoothy -Frozen berrys and water-
or
1-2 Hard boiled eggs

Meal 3 - 7:00-8:00pm 50%

Home cooked meal, boneless meat and veggies
or
Mom and Pop Diner, Chain Restaurant, Take out Chinese or Pizza. ← Guilty

-Current Training- Gym 3-4 days/week. Med weight/Med Reps.
-Testes ache, ever, with a fever? - Only once have I had a noticeable pain in the left testicle. Recently.
-Morning/Night wood - Yes. Fully operational. No changes that I am aware of.

8

Inability to absorb transdermal T is a symptom of hypothyroidism, can be subclinical. So you should test:
TSH
fT3
fT4 [not T3, T4]
CBC
E2
Prolactin

Stress: If stress is affecting you as doc suggests, test also test rT3. See the thyroid basics sticky and check body temperatures and evaluate your long term use of iodized salt.

9

Just got back from the Urologist.

He is pushing Testopel. Said 14 Pellets for my weight/size should do. I am not opposed to this treatment if you and/or others have good reviews. I have never heard of this.

Before I agreed to anything, I asked for the cause of my low T. He said that is it is not likely to find the root cause, and even less likely to cure it.

I pressed it again, that I would like to know what I am up against. Is my thyroid not sending, are my testes not receipting, or are my testes not producing.

He went on to give me a brief rundown on how hormone biology works… I had to stop him and explain “I have read 4 hours every night on this subjuct and my condition, since oct 21. Not that it makes me a doctor, or any of the sort, but I get it. We are a dynamic biological machine. There is a cause, and before my testes stop producing altogether, there is hope to restore them, if its just the testes. But I want to know”

I mentioned HCG, Arimidex, Nolvadex, or Clomid , but was dismissed quickly. On not necessary until after I get treatment, and/or have negative side effects. But not used as preventive maintenance. He asked if I was planning on having more children. Even though the answer is no, I do wish everything to be fully functional.

So off to the lab I go. More lab work, to get to the bottom.

As always I take everything I read here in deep consideration and respect. Please comment honestly.

Also, please explain this a bit better for me…

“* 100mg test cypionate or ethanate injected per week with two or more injections per week. <—”

I get this part.

  • 250iu hCG SC EOD [every other day]
  • 1.0mg Arimidex/anastrozole per week in divided doses.

I would rather do injections my self. And I do plan on pushing for it, unless these pellets are fine.

What would you say is a healthy T/E level?

Me being 34 230 lbs 5-11, at 200-220/15-20 T/E atm… and feeling like road kill hit thrice…

10

And yes… the new labs are

TSH
fT3
fT4 [not T3, T4]
CBC
E2
Prolactin

Or should be… Its what I asked for.

11

Pellets create slowly dropping levels, so keeping anastrozole tuned against T levels is a problem. Pellets are a minor surgery with the costs reflecting that. Some here on pellets have pushed to switch to injections, never the other way around.

What are the insurance cost implications for you?
Ask what the costs will be to you.

12

Good point. I will call my insurance and see what it will run me.

13

25$ Co pay as always. But Up to $600 depending on how they bill it. After that I pay nothing. Not even Co Pay.

14

New Labs are in.

LH 2.9

Testosterone, Total , LC/MS 317.8 “hishest its been in 6 months”
Free Test 7.0

HGB 15.2

TSH 0.84

FSH 2.11

Prolactin 4.02

Odd how my T is higher when I am off Androgel. Either way I came to a fast conclusion on Testopel.

I am open about my issue to those that are truly concerned with health and fitness. That being said, I discuss my current issue with you here, and 2 other forums along with members of my gym.

Being open about my concerns with Testopel, a gym member I only speak to in passing, came forward and told me he has been on Testopel for over a year. I had no idea he was on TRT. He explained that he works in an office, sitting 5-6 hours day, so its not that bad on him. That bruise was 3 days old. Today was his first day back in the gym. He showed what Testopel’s can do to one’s ass cheek. I am not having that done. I am a steel worker. I work in confined spaces. There is no way that procedure will work for me. Even though he was happy with it, I was turned off. Large bruising and looked red around the edges.

After seeing that, I had to call my Urologists office. I just left a message with my doc’s secretary, and will discuss other treatments.

15

Get injectable T, use the tiny little insulin needles to inject your upper thigh twice weekly(painless). You will never regret that. Plus it is the cheapest form of testosterone and easiest to adjust dosage. No brainer for me.

Doctors push these gels mostly which are expensive and nobody knows how well the absorption is going to work.

16

I am running my labs by an Endo. I am sure I will be on TRT no matte what, but I want to rule out Thyroid.

Injections for sure.

17

Update

Good News

New Prescription
2x Test Cyp 200 /month Or 100/Week
Started 3/20/2015

I asked for 2 per week, and he just suggested me to do that my self since he didn’t want to write that as a prescription.
Came with a ton of over sized syringes. I did not feel a pinch or anything.
Today I feel a bit more pep in my step. More than I have in a while. I had very little caffeine through the day, and a small coffee at 3pm.

I ordered smaller gauge and CC in bulk, with wipes.

Bad News

Doc would not prescribe anything for E blocking, or HCG at all.
I tried to talk to him about looking into it. He shrugged off the information.

When I asked about followup blood work, he said that he would like to check my blood for allergic reaction. Hemoglobins I suspect.
I asked about T, LH, FSH, Prolactin, and E, he just looked about me funny and said… “Ok we can check those also”
Scheduled a appoinment with his nurses to show me how to inject… 4 weeks out…and a Lab Appointment 6 days after that.

So currently I am looking for another Urologist.

Other than calling pharmacies and asking who prescribes HCG and Anastrozole with Test…
I would like to see someone that my insurance will not have troubles with as they are very picky.

What would you suggest?

On another note, I have an appointment on a Endocrinologist April 2. I would like to see their opinion on my thyroid, and levels. I would like to know why my levels are low. And if I can just start my own T levels with HCG or other means.

18

Just got back from my first visit with the Endocrinologist.

The doctor felt that I was not tested correctly, not diagnosed correctly and not prescribed correctly. The Doc is calling for all medication/treatments to stop in order to provide clean labs.

I have a couple months to clear my system of Test Cyp and Provigil. And 1 month to let my body return to its normal state untreated.

1 multi vitamin a day is all I should be taking.

Ugghh… I should have started here!

It does suck that I have to start over to began right, but I do feel this is the best road. Only this way will I know what truly is the cause of my low T.

On a good note, this doctor was very informative and thorough. For the first time in a long time I felt I was at the right doctor.

Lab Orders Entail

ACTH Assay
Follicle Stimulating Hormone (FSH)
Free Thyroxine
Free Triiodothyronine
Luteinizing Hormone (LH)
Prolactin
Quantitative Immunoassay, - Alpha Pituitary Sub-Unit
Sex Hormone Binding Globulin
Somatomedin
Testosterone, Free
Testosterone, Total
Thyroid Stimulating Hormone (TSH)
Total Cortisol

Well, here goes 2-3 month of feeling crappy to get to the bottom of this.

KSman, thanks for the support and info. I will update as needed. I will be around.