T Nation

New to HRT/TRT (Need Advice Please)


#1

Hi guys,
I am new to HRT/TRT and am seeking some sound advice on how to properly navigate this new terrain in my life.

I am 35 years old, 5'10", 180 lbs. About 15% BF. I get my health care through the VA (former Navy). I just did a T-test 2 weeks ago after pleading with my doc for 2 months and telling him that I have felt like crap in every way for the longest time...it came back very low. 141 ng. The doc ordered a second set of labs and they came back as follows: LH 2.8, FSH 2.6, ProLct 12.1, Cortisol (230pm) 5.0.

History: I have been on and off opiates since 2008 stemming from a service connected injury. I have finally quit the opiates and am now on a semi-opioid (Suboxone) for 2 months now. I did a 12 week cycle of BD Test-Cyp in the summer of 2006. From what I could remember my PCT was half ass. I did arimidex and HCG. In the summer of 2009 I did a 6 week cycle of Winnie only, 50mg a day. Got decent results. No pct. This past summer(2011) I did a 25 day cycle of prescription grade oxandrolone, I did a pyramid distribution over those days(June 20 to July 15th) with a max dosage of 30 mg. Got excellent results. No PCT.

Current status: I have Low-T and nipple sensitivity(mostly my left nipple). I have bad mood swings, low energy. I still get good erections and have a good sex drive though. The Doc has prescribed me either Testim or Andro-gel (he doesn't know yet, I find out tomorrow or early next week because of some VA process). I am just looking for some good advice on how and what to do to feel better and get right.

Any good input would be greatly appreciated. Thanks guys.


#2

Ask the dr to test you for estradiol, tsh, free t3, t4 before going on the trt...


#3

Ok, will do. Thanks. The last I talked with the Doc he said to use the cream or gel for 12 weeks and then he would run more tests. That seems like a long time to be on something I have no idea how I will react before retesting. I would think 1 month would be better.


#4

So, I just got off the phone with the VA. They have decided NOT to start TRT with the cream or Gel until I get 2 more series of labs done. Both labs have to be done between 7am-10am. I asked what was being tested and the nurse said Cortisol and Testosterone and a few others that she could not identify off hand. Hopefully both series of labs are complete and overseen by a competent doc. She did say that I have to have to sub 250ng T test results to get the approval for TRT. I'm assuming another doc interfered with my first docs orders to start TRT. I don't know. I hope this issues gets resolved asap.

I'm am open to any suggestions or advice on the labs or what I could do in the mean time to feel better. Thanks again to everyone. Peace.


#5

VA docs are notoriously bad, especially with hormones...worse than civilian doctors and civilian doctors are notoriously bad as well lol...You really need to get the estradiol tested BEFORE starting the cream/gel because it will rise with the gel. If you have high estradiol then you may just need an AI to reduce it and not even need to go on the T. I hate how doctors just prescribe TRT. At least he checked prolactin though...


#6

Yes...This whole process lately has felt like a huge "hack Job". When I asked the 2 docs in front of me about an AI and my overall options, they both looked a little puzzled and said "uh, we would have to send you to Endo for that". It felt like they didn't know proper protocol for a pretty basic "male" pathway. They just wanted to through some T at it and see what happens. I am thinking about just taking all of my lab results and seeking help elsewhere.

In the meantime I'm just gonna take some DHEA, fish oil, alot of protein and T boosting foods, and work out hard doing heavy compound exercises. I was thinking about herbals as well...


#7

If the doctors are not serious in helping you and you feel it, drop them and look elsewhere. No need to waste your time.

I have to ask, why on earth did you never run some pct post cycle? I know it is too late now, it's just mind boggling people would do that.


#8

Unfortunately, I didn't research it well enough until it was too late. Initially I found that Winny stints didn't require PCT, the same with Oxandrolone. I was told they didn't suppress the hypothalamus enough to bother with PCT. I regret not researching the topic enough. That is why I am trying my best to get this next phase right. I just want to get to a good T level and maintain it. 1000-ish I suppose. I am glad I haven't started the TRT yet. I am curious to see my next lab results. Thanks


#9

I got a referral to Endo today. I am very happy to say the least. My primary care doc was glad to wash his hands of dealing with my TRT. An Endo would be better at this anyway. I'll keep you all posted. Thanks again.


#10

One more thing,..The last lab that was ordered(primary doc)was T and PSA. That makes 2 T tests in 3 weeks and there is one more T test yet to be drawn....any thoughts?....why not E2?..What should I say or do?


#11

check out the stickies.. including the one on blood tests and the one on finding a good HRT doc.... It has some advice on how to talk with doctors.


#12

Got most recent labs back....

Total T.....165 250-1100
SHBG........37 10-50
LH..........1.7
FSH.........2.7
PSA.........0.17

I have my first appointment with ENDO this Friday. I guess I'll wait and see what they suggest. I am open to any advice on what route to go given my labs. They still haven't tested E2. I'll keep you posted. Thanks again.


#13

I have not come across a single story (that I can remember) where an Endo was of any help to anyone on HRT.

you also really need to ask for more tests (per Retinoid recommendations) thyroid, adrenals, and hormones are all interconnected.


#14

I did have my thyroid checked, it came out ok. As far as the other hormone panel stuff and AI, I will request it.


#15

"it came out OK" means what? does it mean that your TSH was below 1, your Free T3 was above 3.4, and your Reverse T3 was around 12? if not, then it really didn't come back "ok".

"they came back ok", and "within normal range" are like fingers down a chalk board...at least to me.... did you see the results or did your doctor just tell you that they were "ok"?


#16

I went in today and seems like I got nothing done and a bunch of smoke blown up my ass. The endo ordered more tests,..another cortisol, Total T, estriadol and a couple others he didn't mention because he was busy rushing out. I asked him about my Thyroid results, he said those where "OK", and didn't give me the values. Frustrated, I went to "Records" and I ordered a copy of all of my labs the last 2 years. Its 15 pages long with alot of ranges and definitions listed. I cant find any thyroid results that he spoke of. All I could find was free T and some of the labs I listed above. My "FR T-4" is 1.5. The endo also ordered an MRI of my brain to check the pituitary. To my surprise, He also mentioned that there was no good evidence that TRT will help with my condition. I am frustrated to say the least. I am caught up in a mess of VA red tape and getting different stories left and right and worst of all no treatment or direction 1 month later. One doc says I need only 2 test showing Free T values below 250 and normal "male panel" results to start TRT, another doc says 3 T test etc etc and that maybe I can start TRT in about 3 months. Mean while I'll just keep feeling the way I do. I guess its time to switch doctors and take it from there. What is funny is that when I first went to endo, before I had an official appointment, I spoke to 2 of the "injection nurses", they said they have never heard of such a delay or circumstances like mine from a "primary care doc". They said they give test injections all week to numerous patients. In fact, they showed me their TRT station(after I told them I was assured from my primary doc the VA doesn't do shots anymore, only gel), it was a little fridge cart with pins and a bunch of test inside the fridge ready to go. This is a total hack job. I'll just have to look into switching docs. At least I was given the name of a good TRT doc within the VA. We'll see how that goes....smh.


#17

I have a new primary care doc and new appointment Monday. I'll take that "sticky" on labs with me.


#18

Sorry about the "nails on a chalk board" feeling. I am trying my best to get my shit together in the midst of all I have going on. These docs are unbelievable, condescending, rude and generally unpleasant. The one that did most of the talking was a 3rd year medical student..(not quite a MD)..I have no idea why. One would think the MD in charge would come in and guide the patient with info and explanations. It was anything but that. Seemed odd. I'll keep you posted, thanks again for your input. If you or anyone else would like, I could scan my labs and post them.


#19

welcome to the club... you are experiencing what 99% of the people here have also faced. doctors basically suck when it comes down to quality of life issues that can't be solved by a quick antidepressant prescription.

I recommend putting your blood test results in a spreadsheet so that you can track them and make them easy to reference. there is no chance that any other doctor is going to read through 15 pages or be able to see any patterns given that format (not that spreadsheet have helped my docs either, but they have made it easier for me to manage my own health - to an extent).

you have to fight for your health and be your own champion and advocate. you have to push for treatment and risk damaging the oh so frail egos that doctors seem to carry around... heaven forbid a patient actually talks to their doctor and pushs for treatment.


#20

OK, I went in today and saw a new primary care doc. I explained the situation, he apologized and said he had no problem prescribing testosterone shots. The only hold up now is that the Endo I saw last week had not closed my file properly from his department. So yet again I am caught up in VA red tape. I also have to complete the MRI before I can start TRT. He said the dosage will be 2 shots a month at 200ml per shot....I am open to any good suggestions. Are there any sticky's that have exact TRT regiments?...The doc said he is open to my input.

Still waiting on the latest labs...

Found the sticky...