T Nation

Need Advice, Labs

Recently i started having some low T symptoms (low energy, weight gain, weakness, sex drive, no gym progress) so i had some labs done at a local mens clinic. The physician i saw seems eager to get me started on a protocol of 100mg test c weekly. He wants to charge me $900 for his 20 week protocol, which include 2 labs, 10ml vial, and all supplies. At this point I’m not sure if i should commit to a 20 week trail and see how i feel, or go see my PCP with these labs results.

Background: I’ve been lifting weights since i was 15 years old. I notice that i haven’t made any real progress in the last 5 years, but have stayed around the same strength wise. For example

Bench: 225x13 (315 1rpm)
Squat: 365
DL: 455

Age: 29
Height: 5’11"
Weight: 244
bf%: Roughly 20-25%

Labs
Comp. Metabolic Panel (14)

Glucose 91 mg/dL (65 - 99)
BUN 18 mg/dL (6 - 20)
Creatinine 1.45 Alert mg/dL (0.76 - 1.27)
BUN/Creatinine Ratio (12 9 - 20)
Sodium 141 mmol/L (134 - 144)
Potassium 4.3 mmol/L (3.5 - 5.2)
Chloride 101 mmol/L (96 - 106)
Carbon Dioxide, Total 22 mmol/L (20 - 29)
Calcium 9.2 mg/dL (8.7 - 10.2)
Protein, Total 7.5 g/dL (6.0 - 8.5)
Albumin 5.2 g/dL (4.1 - 5.2)
Globulin, Total 2.3 g/dL (1.5 - 4.5)
A/G Ratio 2.3 High (1.2 - 2.2)
Bilirubin, Total 0.8 mg/dL (0.0 - 1.2)
Alkaline Phosphatase 61 IU/L (39 - 117)
AST (SGOT) 37 IU/L (0 - 40)
ALT (SGPT) 58 Alert IU/L (0 - 44)

Prostate Specific Ag, Serum 1.1 ng/mL (0.0-4.0)
LH 11.7 High mIU/mL (1.7 - 8.6)
FSH 5.8 mIU/mL (1.5 - 12.4)
TSH 3.650 uIU/mL (.450 - 4.5)
Testosterone,Free and Total
Testosterone, Serum 473 ng/dL (264 - 916)
Free Testosterone(Direct) 8.3 Low pg/mL (9.3 - 26.5)
Estradiol 22.9 pg/mL 7.6 - 42.6 01
Sex Horm Binding Glob, Serum 45.3 nmol/L 16.5 - 55.9

According to the doctor my T levels are low, and i should get on TRT. Do these labs correspond with what he is saying. Any advice is appreciated.

Thank you


Update 2/24/19

Hello, I didn’t want to start another thread and wanted to keep my previously posted information. I saw my PCP and based on my labs and symptoms he started me on 200mg test c every 2 weeks protocol. He gave me a 10ml bottle with refills when needed. I told him that I didn’t agree with pinning on a bi weekly bases and that I would prefer to spread them out through the week. He said it’s up to me and how comfortable I feel with “poking” myself. He wants me to run labs in 3 months and see him in 5 months. He suggested we do the first dose in office, so I received a 200mg shot from the nurse.

Based on everything I’ve read receiving a single mega shot on a bi weekly bases will lead to me feeling terrible and unstable blood levels. I would prefer to start with a 100mg dose split into 33mg 3x weekly (Monday/Wednesday/Friday) for more stable blood levels and increase my dose based on how I feel/what my labs show.

How long should I wait before starting my 33mg 3x weekly protocol?

Any suggestions?

Thanks

Your free t is below range, so yes I agree with your doctor that TRT would be beneficial. There are a lot of us on here that are being treated while our numbers were still in range but had symptoms.

Seems pricy. And the dose is very low. I’d shop around for another doc.

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I’m no expert but this looks like testicular failure leaving you little choice to start TRT. If your doctor is a competent one, then the price is justified, but just know unless you are running into problems you can get TRT for far less for about $150 monthly from telemedicine.

TSH is a bit elevated, I would check Free T3, Free T4, Reverse T3, Thyroglobulin Antibodies (TgAb) and Peroxidase (TPO) antibodies before initiating TRT or at least 8 weeks after starting TRT because there is enough information pointing to a possible thyroid problem.

A high A/G ratio can be linked to low thyroid activity and this can lead to high ALT levels.

Have you had any ED too? I’d go this route before committing to the 20 week program. Present these numbers along with discussing corresponding physical symptoms. I’d leave out the gym gains, but your low FT with actual low T symptoms, you might be able to get all your testosterone prescribed and covered by insurance.

I went to a urologist for ED, I had below range TT on 3 separate tests and now I’m prescribed 200mg a week of test I pay $15 for the month (4 200mg/ml vials).

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I do have ED symptoms at times. The biggest thing I’ve noticed lately is staying hard during sex and having a good sex drive… It’s embarrassing going soft or only being half hard. I use to be able to have sex 2-3x per day, but now I notice after the first time I feel so drained for the rest of the day and I can’t stay hard for round 2…

I always assumed that low T would mean that I would lose all of the progressive I’ve made in the gym. I do realize that I haven’t made any strength progress in the last 5 year regardless of how much I eat/train, but I have hung onto it…even though it hasn’t been easy and requires a lot of work.

Do you guys think after I treat the symptoms that my strength gains would increase?

Thanks for the reply’s guys.

Your bf% is closer to 30% at that weight. That can cause low t. You need to lose some weight. Trt will definitely help.

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I was able to hold onto my gains with low t and gain a little strength but is was a slow hard fight. So no, if you keep putting in the work you won’t wither away with low T it just make it a lot harder.

As for strength yes it will increase on T. I have increased my weights quite a bit in the last year. Compared to before it was a hell of a lot faster in strength gains.

I’ve had this happen quite a bit … Mid sex, limp noodle for no reason… Wife crying, me questioning myself not understanding what happened… It’s vicious. After 2+ years on trt at different doses and protocols, I’m feeling pretty good now at 22mg daily and have had great success in the bedroom for 6+ months now.

It’s definitely a specific to oneself journey, but you have to start somewhere. This is a marathon, not a sprint.

I’d personally go to a doctor first. You might be required to have low t for 2-3 tests to get a diagnostic code for insurance, but once you get that, your T should be covered.

Keep is updated, rooting for you in your quest!

You should have prolactin checked.

Please see update in first post: started on TRT.

Thank you

Not necessarily, even unlikely, but I agree it is not ideal. Keep in mind GPs have put hundreds of thousands of men on this protocol, and they are happy with it.

Sounds good.

My doctor prescribed a 18g x 1” for drawing and 22g x 1.5” for injecting into the quad. My first injection has left my quad feeling very sore. Since I’ll be doing 3 shots per week I would like to change the size. From what I’ve read, a 27g x .5” insulin needle works well for IM or SQ. Also insulin needles don’t leave behind any oil.

I plan on sticking to IM quad injections for the first 3 months for consistency sake.

Any suggestions?

Thanks

A bit overkill on needle size. My doc prescribed 21g to draw and 25g to shoot. I would say 25-28g is a good size for self injections. I did quads for 4 months at first, but was hitting nerves and veins constantly. I switched to delts and haven’t had that issue. If you’re lean enough, a 0.5” needle will work. If you’re over 20-25% body fat a 0.5” needle might be too short for IM in the delt. A lot depends on where your body stores fat.

I’m experiencing swelling on my quad and right above and outer edge of my knee. My leg feels very tight when I try to squat down or bend it. Also it hurts to extend it. This is the same leg I got my injection on yesterday. I’m finding it painful to walk…is this normal for first time injection (200mg/1ml)…? Not sure if I should call my doctor and be concerned since I’ve seen other posts about swelling. How long will this last ? Should I expect this every time ?

Thanks

Injection soreness/pain has finally gone down after 5 days, its about 50% better!

I have a question about my injection protocol. Would my SHBG be considered normal since its within range or high ? Sex Horm Binding Glob, Serum 45.3 nmol/L 16.5 - 55.9

I’m coming across a lot of posts where guys have high SHBG and are recommended to do larger single doses vs guys who have low SHBG have a better experience with more frequent injections. Initially i wanted to do M/W/F at 33mg per week for stable levels, but now I’m not sure if due to my SHBG i should stick to one 100mg injection weekly. Also will my SHBG levels change after starting TRT?

Thanks

I feel really dumb about this. My plan was to do .33mg 3x weekly for a total of 100mg per week. I wanted to see how I felt and get labs done after 8 weeks. For some reason I was caught up with all of this new information that I didn’t realize that my bottle was 200mg/ml. For the last 5 weeks I’ve been taking .35cc 3x weekly. I now just realized that equates to 70mg 3x weekly for a total of 210mg per week…overall I feel normal with no side affects whatsoever. I have noticed a bit more energy, better sleep and sex drive. I’m not sure if I should change my dose to 100mg and start over, or continue 210mg for another 3 weeks and see what the labs say. Another issue is that my physician wanted me to take 200mg every other week, so now I’m about to run out twice as fast. Any suggestions ?

Thanks

You will be left with no T for a couple of weeks unless you adjust your dosage to where you don’t run out. You should calculate how much you have and ration out your dosage, it will be better than going with no T at all.

Do you think that my physician won’t refill my prescription because I ran out to quickly? I thought once I get low I can just request a refill.

Tell him you screwed up the math. Just be straight with him and it shouldn’t be a problem. He’ll probably want bloodwork right away which will probably make the case for a higher dose for you.