T Nation

Pinion - New Updated Labs

I come to you guys with hat in hand. After lurking here for a while, I decided to create an account and ask for help/advice.

I want to attack my issues the right way and not waste a lot of time with “try this and call us in a few months”. I want to find the underlying causes for my problems, not just treat the symptoms. I’ve read through countless postings and horror stories about how this doctor or that doctor was a complete waste of time. I guess what I really need help with is finding a doctor who is willing to do ALL the necessary tests to try and pinpoint what’s going on. I’m in the Triad NC area, but I’m willing to travel, if needed.

I am an avid bicycle racer/enthusiast and thought nothing of riding 250 miles per week while training. After a steady decline starting about 2 years ago, now it’s near impossible for me to train more than a few hours a week without severe fatigue problems. I thought I might be over training, so I took off this summer for about 2 months and stayed completely off the bike. It probably hurt me more than it helped. After restarting my training at a very slow pace, I realized that I just wasn’t recovering from it. I really enjoy riding/racing, so these issues have seriously dampened my enjoyment of a sport I love.

For a few years, I’ve had the usual suspects (fatigue issues, low libido, mild depression, long recovery after exercise, weight gain, no motivation).

After speculating that it may be a problem, I have been diagnosed with low T. I started researching the best course of action for TRT and discovered this forum. I’ve read through the stickies and fear I’m heading down the “dead end” path with my doctor.

My doctor prescribed Axiron 30mg (60mg total dose per day). I asked about injections as I have young daughters and do not want to expose them to a topical medication. Also, I’ve heard that you don’t really get the proper dose using topicals like you do with injections.

My doctor balked at the suggestion (no surprise). I can’t fault the guy too much as he told me after my low T diagnosis that he didn’t really know very much about TRT protocols. He told me that he would feel more comfortable with me going to an Endo. He’s a great Sports Medicine doctor, but TRT is just not his thing and he really seems like he is looking out for my best interests.

Needless to say, I’ve not started taking the Axiron. I wanted to wait until I found another doctor who would be more open to some of the things I’ve read here.

My doctor also referred me to have a sleep study to rule out any problems with apnea. I do
get very sleepy during the day and wake up many times at night. I did the study last night
(9-19-12) and I’m awaiting the results.

age - 42
height - 6’1"
waist - 38" (around the navel/love handles)
weight - 196 lbs (steadily increased from 165 in the past 5 years)
body and facial hair - arms/legs thin, lacking on torso, patchy beard
I tend to carry body fat on my chest and around my waist
Health - 10 years ago T level was tested by Uro (trying to have a kid) (353 total - no TRT for men back then, I was told), Kidney stones 1 time, different biking/sports injuries (hand, wrist, shoulder dislocation, and a lot of road rash)
No prescriptions, OTC vitamins only (D3 (2000iu/day), Fish Oil, Niacin, B complex)
Diet - For normal meals/non-training days (5-6 small ones per day), I follow a 60/20/20 plan. 60% Protein (chicken breast, fish, not a lot of red meat), 20% Carbs (mostly green vegetables, beans), 20% fats (olive oil, avocadoes, nuts). Training Days - Probably more like 40/40/20 (I need more carbs for fuel) - Probably 2200 cals per day.
Training - At my peak - 4-5 days/week - Mostly on the bike (cardio), lots of hill repeats
(strength), core, yoga (stretching). Now - 1-2 days/week - More than that kills me.
No testicle pain (they are small though), No fever.
Seldom have morning wood/spontaneous erections. Erections are not as firm.

Labs -

All labs were drawn on 8-17-2012:

T-Total - 197 ng/dl [348-1197]
T-Free - 7.7 pg/dl [6.8-21.5]

TSH - 1.95 uiU/ml [0.34-5.60]
T4 - 6.9 UG/dl [5.40-12.00]
T3 Uptake - 36.6 % [32-48]
FTI - 6.31 uiU/ml [5.20-12.90]

Vitamin D - 58 ng/ml [30-100]
Ferritin - 325 ng/ml [24-336]
Vitamin B12 - 439 pg/ml [180-914]
Nothing out of the ordinary in the Blood Panel or Urinalysis results.
PSA and DRE - normal

Unfortunately, the doctor did not run E2, LH, FSH, or SHBG. I asked, but as stated above, he is not a TRT guy and felt like I should see an Endo for that.

Should a go ahead and see the Endo? Or does anyone have another suggestion for a doctor in the area (Triad NC) who is “up” on the complete protocol? I just want to find someone willing to even consider the tests and possible medications needed to do this right. Also, someone that is OK with self injections if that’s what it comes to.

I’ve already called a few compounding pharmacies without much luck. The docs they recommended were either not willing to do what is needed or not taking new patients right now.

Yes! Find a Doctor that will treat you! Life is short to live it feeling like crap, when there is someting that can be done about it. Get E2 checked.

That’s what I’m trying to do. I just don’t want to waste my time and money with an Endo who probably won’t do anything. My sports med guy didn’t want to jump into this without the necessary background and I’m thankful that he didn’t want to use me as a lab rat for something he really doesn’t know about.

Getting tested for E2 is easier said than done when dealing with closed minded doctors. Most aren’t even willing to discuss it, much less order the test. I can pay out of pocket for the test on my own, but I have outstanding insurance and would like to use it if possible. I know there were people on this forum in the same boat who found doctors willing to do what’s needed. It would be great if someone could steer me the right way.

Try to look for a younger Dr with a open mind. Call around and see if you can find some compounding pharmacies that will give you names of Dr’s that prescribe Test Cyp, HCG, ect. Ask your GP for a referal. I got lucky and my first referal with a endo seems to be open minded. We will see for sure when I go back to revue my labs.

What cobra003 said: Get a young Dr. My doc was totally cool with it. He’s also younger than me :wink:
It’s just not a big deal.

Cobra, I’ve already tried several compounding pharmacies with no luck so far. They all seem to get uncomfortable when I mention the protocol I guess I’ll keep at it. I guess most medical people around here think “steroids!!!” when anyone mentions T.

Strangemeadow, thanks for the advice. The younger doctor thing was why I originally went to the sports doc. I guess I was thinking younger doctors would be more open to newer techniques in general. He is open to learning about the protocol, I think he is just trying to be careful because he hasn’t ever done it.

[quote]pinion wrote:
Strangemeadow, thanks for the advice. The younger doctor thing was why I originally went to the sports doc. I guess I was thinking younger doctors would be more open to newer techniques in general. He is open to learning about the protocol, I think he is just trying to be careful because he hasn’t ever done it.[/quote]
My doc is just a regular internist/gp kinda guy. It may take a couple of “interviews” with a few doc to find the right one, but it’s well worth it. Schedule appts with a few different DR’s. Check up on them online, see how old they are, where they went to school, ect. Be up front with them and tell them your concerns and what you’d like the outcome to be. If you are well informed and have a plan, I don’t think it’ll take long to find a doc that’s onboard with what you want to do. And in your area there are a lot of docs. I used to live in Winston-Salem, years ago. I know the area well.

Thanks for the replies so far.

I got tired of waiting for Endo referral (waiting 2 weeks so far for an appointment) so I had my own labs drawn. I thought it would help to already know my levels beforehand.

T-Total - 194 ng/dl [348-1197]
LH - 8.2 mIU/ml [1.7-8.6]
FSH - 28.2 mIU/ml [1.5-12.4]
E2 - 17.3 pg/ml [7.6-42.6]

Recommendations/referrals in the Triad NC area for helpful/well-versed docs? Anyone?

It looks like you are primary, as your FSH and LH are screaming for your body to make test but your nuts don’t seem to be cooperating. That would indicate you need test and a SERM challenge would likely fail. Hardasnails may have some contacts in your area.

Thanks, Ptownmike.

I doubt the serm restart will work for you. It sounds as if the boys called it quits sometime ago, your endocrine system is trying to wake them up, but they aren’t co-operating.
Push for test injections, forget about topicals.
With a total T of 192, I bet you are going to feel like a new man once you get some treatment, also you may not
need an AI right away with E2 @17
Good Luck!

Thanks, PKNY. I’m trying to find a doc who is open to injections and the full TRT protocol. The topicals just don’t sound like a good option for me.

Sleep study follow up appt with the neurologist is scheduled, so we’ll see what those results are. Hopefully, we’ll figure out some of the sleepiness issues. A little progress, I guess.

Now to find a TRT doc…

Finally got the Endo referral from my PC doc. Appt is on 10-4. I had to call both the Endo’s office and my PC doc several times over the past few weeks to get them to schedule. I wonder if all the trouble I had getting to see the Endo is a bad sign. Hopefully, I’ll get some good news.

Also, have the sleep study follow-up appt with a neurologist next week.

Met with the Endo this morning. Seems like a good dude. Talked about my TRT options and he took a look at my “outside” labs. More labs drawn today for Prolactin and a few others (I forgot to ask). He is “most likely” going to ask for an MRI also.

I think we’ve narrowed down my treatment to injections. He told me self-injection won’t be a problem and it would be way more convenient. He talked about HCG also and told me to decide whether I wanted it. The only problem with the injections is he said it would be every 2 weeks. I guess I get to ride the roller coaster unless I come up with another way.

What do you guys think? I don’t know my T dosage yet. I guess he’s waiting until after the labs and possible MRI. I suppose it could be broken up into smaller, more frequent doses? Is the HCG a good idea to go ahead with or not? I don’t want to rule it out from the beginning if he’s offering to prescribe it. He probably wouldn’t be willing later on.

If you’re self injecting than why are you going to be stuck on a roller coaster? Inject once a week using half the prescribed dose. Needles are cheap.

Get the HCG.

Thanks aj0538. That’s what I was thinking too. I’ll post the dosage once he prescribes everything.

I’ll tell him yes on the HCG.

Spoke to Endo yesterday. No MRI needed. He diagnosed me as primary. He said I needed to come in for “injection training” on Thursday. I’ll get my first shot and prescription then. I figure I’ll get the first one then start my SQ shots myself once I round up everything I need.

The only problem is the HCG. He said I would get HCG or T, but not both, and it was my choice. I completely don’t understand the reasoning behind this.

He proceeded to tell me that the HCG would only be good for fertility purposes (I understand) and that it would not help with my overall symptoms or with my “blood” T levels (I also understand that). He then said that if I wanted the HCG, I would need to start it first AND ONLY it first, No T yet. He also said once I start the T shots, HCG would not be an option. In other words: No HCG “support” during my TRT.

What I don’t get is that he told me I would be getting T regardless of which option I choose. Now he says that HCG without T, and then T ONLY later on are my only options.

How should I approach this? Anything else I can tell him to get what I need? Or should I just order the HCG on my own?

Took my first injection today. So far, so good. Got the script for Test Cyp 200mg/ml 0.8ml every 2 weeks.

I talked to Endo again before shot to clarify his HCG stance. Absolutely assinine conversation. Again he said no HCG with T. If I wanted HCG, I could not take the T. If I want the T, I can’t have the HCG. Both are not an option.

I need to find a source for the HCG (and possibly an AI later on, if needed). Preferably a doc that will prescribe the full protocol.