T Nation

My Endo Was An Idiot - Advice?


#1

Hi,

I’m looking for some advice as my doctor isn’t that knowledgable about TRT. The real answer is to find a better doctor, but it looks like that’s going to take a while as I have no interest in paying for anti-aging clinics. In the mean time, I’m hoping someone here with more experience can provide some feedback.

I’m 41yo, 6ft tall, 215lbs, 38" waist, probably 20lbs overweight with extra fat around my gut but keep a fairly active lifestyle. My body is quite hairy with a full beard, balding. No Rx other than TRT (details below), VitD 3000IU, Calcium 600mg.

In a strange roundabout way (pneumonia->osteoporosis->hypogonadism), I discovered I have secondary hypogonadism. After a lot of back and forth, the endocrinologist reluctantly agreed to start me on TRT in Sept 2017 (100mg cypionate e2w IM). After talking with my family doctor, I’ve dropped the endocrinologist (many reasons) and have been working my family doctor instead. After a lot of reading, several blood tests and educating my doctor, I’m currently taking 100mg testosterone cypionate / week SQ.

About 6 weeks after first starting TRT I was thrilled to actually have a sex drive again. Now, it’s gone. :frowning: Still getting occasional morning wood (none before TRT). When I do get a hardon, it doesn’t seem to last.

I’m really confused by the most recent labs where the 7-day trough is higher than the peak levels. My general thoughts are that T levels should be higher (19-35 nmol/L?) and E2 levels could be lower. Doctor would probably be fine with me changing to two injections/week with 50mg e3.5d but is unlikely to increase the dosage. My doctor says my TT/FT levels are within ‘normal’ lab range, so just give it 4-6mn.

Any idea why my trough levels would be higher than the peak for the same injection?
How do my TT/FT/E2 levels look?
With libido/ED issues any suggestions for ‘optimal’ levels?

Labs:

100mg/wk peak (24h after SQ injection, 5weeks since dosage change)
TT 16.1 (ref 8.4-28.8) nmol/L
FT 481 (ref 196-636) pmol/L

100mg/week trough (7days after SQ injection, just before next injection)
TT 17.1 (ref 8.4-28.8) nmol/L
FT 509 (ref 196-636) pmol/L
E2 122 (ref <162) pmol/L

Other recent labs (not all taken at the same time):
SHBG 18.5 (ref 10-70) nmol/L
TSH 1.36 (ref 0.3-5) mIU/L
PTH (Intact) 3.3 (ref 1.2-8.5) pmol/L
25 Hydroxy Vit. D 67 (ref 75-250) nmol/L
PSA 0.6 (ref 0-4) ug/L
Albumin 45 (ref 35-50) g/L
Calcium 2.38 (ref 2.2-2.6) nmol/L
Ionized Calcium 1.25 (ref 1.15-1.35) nmol/L

CBC:
WBC 6.8 (ref 4.0-11.0) x E9/L
RBC 5.70 (ref 4.50-6.00) x E12/L
Hemoglobin 159 (ref 135-175) g/L
Hematocrit 0.480 (ref 0.400-0.500) L/L
MCV 84 (ref 80-100) fL
MCH 27.9 (ref 27.5-33.0) pg
MCHC 331 (ref 305-360) g/L
Platelets 339 (ref 150-400) x E9/L
RDW 14.1 (ref 11.5-14.5) %
Neutrophils 3.6 (ref 2.0-7.5) x E9/L
Lymphocytes 2.4 (ref 1.0-3.5) x E9/L
Monocytes 0.6 (ref 0.2-1.0) x E9/L
Eosinophils 0.1 (ref 0.0-0.5) x E9/L
Basophils 0.0 (ref 0.0-0.2) x E9/L

Pre-TRT baseline:
Cortisol - Random 332 (ref 120-620) nmol/L
Estradiol <92 L (ref 95-223) pmol/L
total testosterone 5.8 L (ref 10-42) nmol/L
TSH 1.131 (ref 0.3-5) mIU/L
PTH (Intact) 2.6 (ref 1.2-8.5) pmol/L
PSA 0.46 (ref 0-4)
25 Hydroxy Vit. D 75 (ref 75-250)
Albumin 43 (ref 35-50) g/L
Calcium 2.35 (ref 2.2-2.6) nmol/L
Ionized Calcium 1.24 (ref 1.15-1.35) nmol/L
HCT (hematocrit) 0.45 (ref 0.4-0.54) L/L


#2

First state healthcare and/or insurance doctors do not care or have the time to optimise you T levels, they only care that you’re within the ranges. Once you get there you’re done, that’s it they don’t want to see you anymore expect for your routine blood tests.

We have guys going on TRT a few points below your score, you need to get to 25-30 nmol/L to be optimal! There is no optimal at 17 nmol/L. Injecting more frequently with raise T levels even on same prior dosage.

You leave out a lot of details, your labs indicate UK location, but you’re talking in feet and pounds? Sustanon or Nebido or T-cypionate? Your new doctor is an idiot, he is measuring FT directly, this is wrong and inaccurate. FT is measured by calculating TT and SHBG = FT.

Your SHBG is low, if injecting cypionate twice weekly or EOD since your excrete most of your T into the urine. My SHBG is the same as yours, libido erections didn’t become consistent until I started injecting EOD. Only TSH tested, TSH is good but where are actual thyroid hormone levels? Your insurance is the problem, they restrict proper testing because they don’t want to pay for it.

Why are you running labs 24 hours after injection? It takes 48 hours to peak, doctors are truly morons! You want optimal you gonna have to start paying for TRT. Where is DHEA, DHT, pregnenolone levels? Is this E2 labs LC-MS/MS method? If not discard results.

Check out our thyroid sticky, check oral body temps as most are iodine deficient.


#3

Thanks for the info and confirming my suspicions SHBG is low.

I’m in Ontario, Canada. We’re supposed to be metric, but when you grow up where people work in construction imperial was the norm so I use both…

Sorry if I left out details. I’m taking T-cypionate from a pharmacy, currently 100mg once every week. FT is calculated, but I don’t know if they actually measure Albumin & SHBG or use a ‘standard’ placeholder value. There’s no Albumin/SHBG reported on my labs unless requested. The lab paperwork warns “Interpret free testosterone results with caution in presence of significant hypoalbuminemia.” SHBG is not covered by insurance so I’ve only tested it once.

E2 says it uses "Abbott Architect Immunoassay"
http://tests.lifelabs.com/test_information.aspx?id=26081&view=reporting

I thought splitting the dose to take it more frequently would reduce T levels, but even out peak/trough. Does this change with low SHBG?

Current GP said to run the peak test 24h after injection. Any of the reading I’ve done says it peaks within 24h eg:
https://www.sciencedirect.com/science/article/pii/S2050116116300058#f0015

The idiot endo said fT3, fT4 not needed. I can ask my current GP but if he doesn’t know what results he’s looking for he’s unlikely to test it.

I’ll check my oral temps.