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. 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?
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
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
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