T Nation

My Lab Results Are In. Going to Urologist Next Week - LOW T 165pmol/L


#1

@KSman

52 year old at 6’1 205lbs presenting these terrible (Free Test 165 pmol/L) results to my urologist. I would like to get to at least 700 on the Free Test. How much weekly cyp should I request he prescribe me, fellahs?

Anything else in these results I should enquire about? Thank you for your time. :)))

testlevels


#2

You have secondary hypogonadism. Any pains in your testes?

E2, estradiol not tested, but with low FT, E2 will be low.

Low SHBG is sometimes seen with diabetes. Fasting glucose and A1C OK? Are you overweight?

Many guys who come here also have low thyroid function, see below to self evaluate.

Self inject 50mg T eth/cyp twice a week
To preserve testes: 250iu hCG subq EOD
Most will need 0.5mg anastrozole at time of T injections.
Total 100mg T and 1.0mg anastrozole per week.

Routine labs:
TT
FT
E2
SHBG in your case
CBC
hematocrit
fasting glucose
fasting cholesterol
PSA !! - should have been done prior to TRT
AST/ALT
If body temperatures are low:
TSH
fT3
fT4 [please not indexes etc or T3, T4]

Do not test LH/FSH again as these -->zero


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

Here are some of the results you were asking for @KSman. Thank you. :)))

Not overweight, 6’1 205lbs and no pain in testes. Fasting glucose normal.

results


#4

TRT often will lower total cholesterol.

Your testes seem to be a weak link.

Other labs look good.

Please do not miss any points in my prior post. Do check your body temperatures.


#5

Yup, that’s what I’m going to tell him, my testes aren’t providing me enough testosterone and other labs are okay. Thank you KSman, really appreciate your knowledge and time. Will update with his answer to my getting TRT.


#6

3 months into TRT. I do 50mg of 1000mg/10ml Depo-Testosterone cypyonate, subQ every 3.5 days for a total of 100mg a week. Here are my results from this morning on trough day before my morning pin. Estradiol was on the list but not showing up yet, online, I’ll edit if it comes through.

Also, my SHBG really took a hit. It went from 30 to 16! Any ideas why and what I could do if I should?

Complete Blood Count C VIEW
WBC 7.7 x10^9/L 3.5-10.5 C VIEW
RBC 4.83 x10^12/L 4.00-5.50 C VIEW
HGB 157 g/L 125-170 C VIEW
HCT 0.462 L/L 0.380-0.500 C VIEW
MCV 95.7 fL 80.0-100.0 C VIEW
MCH 32.5 pg 27.0-34.0 C VIEW
MCHC 340 g/L 315-355 C VIEW
RDW 14.1 % 11.5-15.5 C VIEW
Plat 146 x10^9/L 130-380 C VIEW
MPV 12.0 fL 9.0-14.0 C VIEW
Automated Differential C VIEW
Neutrophil 5.2 x10^9/L 2.0-7.5 C VIEW
Immature Granulocyte 0.0 x10^9/L <=0.1 C VIEW
Lymphocyte 1.8 x10^9/L 0.8-3.5 C VIEW
Monocyte 0.6 x10^9/L 0.1-1.0 C VIEW
Eosinophil 0.2 x10^9/L 0.0-0.5 C VIEW
Basophil 0.0 x10^9/L 0.0-0.1 C VIEW
Prolactin 7 ug/L 3-13 C VIEW
Testosterone Total 15.8 nmol/L 6.1-27.1 C VIEW
Testosterone Free Calculated 459 pmol/L 110-660 C VIEW
Testosterone Bioavailable Calculated 10.8 nmol/L 2.8-15.5 C VIEW
SHBG 16 nmol/L 13-89 C VIEW

EDIT

Estardiol came in and it’s terrible.

Estradiol 192 pmol/L H 40-160

SAD!


3 Pins a Week for a Total of 100mg?
#7

You need to check your thyroid, hypothyroidism will cause your SHBG to drop. You’re shooting in the dark starting TRT without at least a thyroid panel. Those test numbers are underwhelming.

You need to check Free T3, Free T4, Reverse T3 and antibodies. You haven’t provided any body temps per thyroid sticky, most guy completely ignore it and wonder why TRT isn’t working. How about those body temperatures?


#8

Yeah, my appointment is next week to go over the bloodwork and re-script me. I’ll ask him for that since the only reference I have is that January TSH at 1.36 (0.35-5). Thank you systemlord.


#9

Your welcome,

TSH is very poor indicator of thyroid status, that’s why the free thyroid hormones are tested. It would be like relying on LH to diagnose a testosterone deficiency without actually testing testosterone levels. TSH can appear to look normal, but under the surface the free hormones (Free T3) can be quite low and the main symptoms is low SHBG.

If your doctor doesn’t understand the importance of testing free thyroid hormones I’m not sure he/she will even be in a position of knowledge to help you. Don’t expect you doctor to run these tests, it will be a fight to get him/her to even do it. This is what happens when clueless doctors believe in TSH only testing, it gives you no other direction to go in, no more options, you’re fine…


#10

@KSman

Holy crap @systemlord, my Estradiol result came in. I’m almost a woman. :(((

I guess I should pin at least 3 times a week, eh? Also, my urologist better agree to an AI or I’m screwed.

Estradiol 192 pmol/L H 40-160

:(((


#11

E2 is likely lower since you don’t even have the proper E2 labs, so E2 is lower than stated.


#12

@systemlord

So my urologist gave me a full thyroid panel for my next bloodwork in 3 months and said to pin 3 times a week. He does NOT want me to go on an AI, for now. His reasoning is that I don’t have any breast sensitivity or growth etc… and that we don’t know the long term results of using an AI. I’m on TRT for life. He says he has a few patients on an AI but they clearly show the symptoms. OOSH… we’ll see what my levels are at in 3 months after pinning 33.3mg, three times a week, and I’ll report back as my hormones settle in and that full thyroid panel comes back.


#13

Is it a Monday/Wednesday/Friday protocol?


#14

He told me to “do the math on 3x a week for a total of 100mg”. LOL I’m assuming a 7 day week so I’ll go 33mg every:

MON-THUR-SUN
WED-SAT-TUES
FRI-MON-THUR

etc…


#15

3x times a week, let me grab the calculator, lol. You might need to alternate morning injection, night time injection if math is your strong suit. To bad I can’t set an alarm on my phone every 2.5 days.


#16

LOL Exactly, will do the higher math for morning/night pins when I’m fresh and have a new calendar just for pinning, in my home office where I do it. haha


#17

Got new labs and urologist consult. Firstly, my Estradiol settled down to 83 from 192, happy to see my body naturally settled that down in 3 months. :slight_smile:

Complete Blood Count C VIEW
WBC 8.0 x10^9/L 3.5-10.5 C VIEW
RBC 5.03 x10^12/L 4.00-5.50 C VIEW
HGB 160 g/L 125-170 C VIEW
HCT 0.470 L/L 0.380-0.500 C VIEW
MCV 93.4 fL 80.0-100.0 C VIEW
MCH 31.8 pg 27.0-34.0 C VIEW
MCHC 340 g/L 315-355 C VIEW
RDW 14.4 % 11.5-15.5 C VIEW
Plat 139 x10^9/L 130-380 C VIEW
MPV 11.5 fL 9.0-14.0 C VIEW
Automated Differential C VIEW
Neutrophil 4.6 x10^9/L 2.0-7.5 C VIEW
Immature Granulocyte 0.0 x10^9/L <=0.1 C VIEW
Lymphocyte 2.2 x10^9/L 0.8-3.5 C VIEW
Monocyte 0.8 x10^9/L 0.1-1.0 C VIEW
Eosinophil 0.4 x10^9/L 0.0-0.5 C VIEW
Basophil 0.0 x10^9/L 0.0-0.1 C VIEW
Estradiol 83 pmol/L 40-160 G VIEW
Testosterone Total 12.8 nmol/L 6.1-27.1 C VIEW
Testosterone Free Calculated 372 pmol/L 110-660 C VIEW
Testosterone Bioavailable Calculated 8.7 nmol/L 2.8-15.5 C VIEW
SHBG 15 nmol/L 13-89 C VIEW
TSH 2.37 mIU/L 0.34-5.60 C VIEW
PSA 1.20 ug/L <=3.10 C

I mentioned to the Doc perhaps I should be pinning EOD because of my low SHGB of 15 but he disagreed. He says few of his patients do the 3x a week protocal and none do EOD. Sigh… so then I told him I’m not feeling what I know I can achieve, again, and the mediocre numbers prove exactly where I’m at, at about 60% of where I was before my testosterone naturally crashed.

I wanted to double my weekly dose and go 50mg EOD but he stood firm and reluctantly said he’d up my script to 120mg a week from 100mg and to continue with 3x a week (40mg per pin).

Any suggestions or comments on my bloods, guys, besides pinning 30mg EOD as opposed to his 40mg every 3 days?

EDIT He says my Testosterone Bioavailable Calculated 8.7 nmol/L 2.8-15.5
is where he likes it, “safe”. Real concern with new guidelines that just came out and the lowering of test levels. Sigh…that’s MID-RANGE!
:frowning:


#18

When I injected every 3.5 days I felt a dip 2.5 days out, if your levels are dropping in between your injections, these swings will get bigger as time goes on. Only a 20mg increase spread out over 3 injections is only 6.66mg of Test increase per injection, that’s a little too conservative and at this rate you’ll reach middle ranges in 2020.

Settling for middle ranges when normal healthy young men score 800+, that’s troubling.

Don’t settle for this level of care, get out from the care of this nincompoop.


#19

Yup. I’m not telling him I will go 30mg EOD and see what happens with bloods in 3 months. Perhaps after 2 years he’ll eventually allow me to go 200mg a week, pinning 28mg every day. LOL


#20

A lot of clueless doctor’s target middle ranges based on fear and inexperience. So your plan is to wear down your doctor in the hopes he will come around, if you want to accept this level of care than that’s up to you.

The second you go above 500 he’s going to cut your dosage, then what?