T Nation

New On TRT - Help with Bloodwork

To start, I am a 27 year old male. 5’10 200 lbs. I am overweight and I work night shift and I work 64 hours a week. Several days a week I only get 4-5 hours of sleep because of work. I started TRT a little less than 3 months ago.

I have read about all the different blood works I need, but when I brought up some of them to my DR he dismissed them as unneeded. I know, I know, I should get a new DR. But, this DR is an endocrinologist and he prescribed me 100mg Test C a week right off the bat and lets me inject myself at home. I requested E2 and other stuff tested but he kind of brushed it off. Maybe if I push harder he will do it next time. What else needs to be tested?

I will first post my bloodwork from before I started TRT, about 3 months ago.

Testosterone Total: 309ng/dl
Free Test: 65.9 pg/ml (from a range of 35-155)
Prolactin: 7.6 ng/ml
TSH: 2.5 mlu/l

Now, after 3 months on 100mg a week of Test C

LH: <0.2L (range 1.5-9.3 mlu/ml) - seems very low, but was not included in my initial blood work to compare before and after. (He did not retest Free T or TSH)

Prolactin: 12.1 ng/ml

Testosterone Total: 299 ng/dl

I have blood work/ urine work from before and after for: comprehensive metabolic panel and CBC. I just don’t know what is important and there are a lot of results, I can provide if needed.

On my comprehensive metabolic panel I noticed I was out of range on: Carbon Dioxide: 32. (on a range of 20-31)

Once again, I apologize for not having more blood work. Let me know what I really need to ask him to test for next time. And what is going on with that massively low LH level?

You obviously need a dosage increase and I’m surprised you doctor hasn’t done so. The fact that your doctor even bothered testing LH is an indication he not skilled enough to fix things should you start showing side effects of high E2, and since he refuses to even test for it I don’t see a resolution. LH production stops once you begin TRT, your HPTA is shutdown since your pituitary gland sees plenty of testosterone circulating in your blood. Once your dose is increased you will most likey need an AI do to high E2 sides. How are you’re testicals feeling about now? Pulled up tight or aching? Thats what HCG is for and will preserve fertility. I’m betting your endo would look at you funny for asking about HCG or an AI.I see no labs for SHBG, what is the foundation for regulating and activating sex hormones. Epic failure.

Let me guess, HMO endocrinologist right? Your Endo has no idea what he’s doing or how to deal with side effects since he doesn’t understand why he should test for E2. Problem is most endos are clueless, the only ones that know what they’re doing are cash pay only because to be good at it you must unshackle from these insurance companies who place roadblocks in the doctor’s path to save money. Let’s hope your endo is willing to learn because you could go through several of them before finding one that knows what they’re doing.these HMO endos can’t think for themselves, if they could they would start their own practice and be the best at what they do. TRT is like a side job to what these endos really do, it’s strays off the main course of what they really do all day, diabetes and thyroid because that’s where the money is, their training in the field of trt is severely limited because there is little money to be made in TRT.

I appreciate your feedback and response, brother.

Yeah he admitted himself that he is not knowledgeable on TRT. I was just happy to find a DR on my first try that was willing to prescribe test c injections on the first visit and also lets me inject at home. I think if I push harder for certain tests that he will agree.

My testicals feel fine, they do not feel to be very pulled up and do not ache at all. I’m honestly not too concerned with preserving fertility, I just want to focus on getting my test, E2 and everything else at an acceptable level. I’ve lived my entire life with low T, and really want to experience what it feels like to have normal, or even optimal levels. (I got my testosterone levels tested when I was 18 years old and in great shape; my TT was at ~300 when I was 18 and working out everyday in good shape! - The DR refused to consider TRT even though I was at ~300 at 18 years old and had bad symtoms of low T)

Yes, HMO unfortunately. Although I have plenty of money so that’s not really an issue. I would consider going out of pocket entirely, for the right doctor. I have tried to research who the best TRT doctors are in my area but am unable to find any reliable info. I have a very hectic work schedule and my time is limited as far as traveling to see a DR, ect.

Thanks again for the response. I will push him harder on my next visit for E2 to be tested, and to increase my dose.

So I need to get E2 and SHBG added to my next round of tests.

I need to ensure I am getting enough idodized salt, selenium and vit D.

and I need to take temperature in the morning and midday.

I wake up at around 7:30pm and go to sleep at either 9:00am or 3:30pm. Should I take my temp when I wake up at 7:30 PM or sometime in the actual “morning”?


Forgive my ignorance, I have read the stickies but am only getting more and more confused. A lot of info to absorb. What info do you need from me and what should I demand of my doctor?

Thank you for taking the time to help me and so many others. Your knowledge and insight it greatly appreciated

I would agree with SystemLord. I would look for a TRT specialist that can work with you and explain to you all the myriad of details in this process. The simple fact that your Endo didn’t check SHBG is a red flag. My two roomates all went with their Endo’s on TRT but I went with DefyMedical.com down in Florida. I will tell you now that my TRT program is WAY more detailed and dialed in than either of my roomies. Just putting you on testosterone is a huge mistake. Get with a competent TRT group that will look at the entire picture.