EDIT NOTE: As requested by responders, I’ve updated the test results below to include the reference ranges provided by LabCorp.
First post, but I’ve visited the site many times for research. I’m preparing to talk to my doctors at Kaiser Permanente (in Oakland, CA) about TRT. This won’t be the first time I’ve tried talking to them, and as you may know, Kaiser doctors are notoriously resistant to prescribing TRT. I’m hoping to get feedback on the results of independent blood work I’ve had done (see below), so I can go into the exam with a good idea of what questions to ask, what optimal treatment might look like, and what arguments to make if they refuse necessary treatment.
Some basic background:
- 45 year old male
- Have had all classic signs of Low-T for several years, especially complete lack of libido
- Complicating matters is that I am on long-term daily opiates for a chronic pain condition. But my Low-T symptoms were still present when I took a break from opiates for almost two years. And since I may be on the painkillers my whole life, even if some of the Low-T symptoms are caused by this, they have to be treated.
- In my mid-20’s I had some testicular trauma and chronic testicular pain for several years that was resistant to treatment. That pain mostly faded away, but I suspect it may have caused some long-term issues.
- So, between the opiates and past trauma, I may have both primary and secondary hypogonadism at the same time.
- Have never used any hormones for performance enhancement or bodybuilding.
- I have a vasectomy, so don’t care about sperm count, but want to avoid any testicular shrinkage/atrophy, which could cause recurrence of testicular pain.
A couple of years ago, I managed to get Kaiser to test my Testosterone levels. Even just getting the tests was like pulling teeth, and the doctors (Primary and Endocrinologist) looked at me like I was asking them to test for midichlorians or demonic possession. They really act like it’s a ridiculous request. Well, after several tests, my Total Testosterone then was around 177-225. A lot of places would consider that low enough to start TRT, but Kaiser shrugged it off and wouldn’t even consider it.
Since then, my symptoms have gotten worse, and frankly, are putting my marriage in jeopardy. So, in order to be prepared before going back to Kaiser about this again, I recently ordered a range of blood tests from DiscountedLabs.com, completed through LabCorp. The results are pretty dramatic, and I’m hoping that not even Kaiser can argue with me about them. The new relevant results are:
- Testosterone, Total, LC/MS: 66.9 ng/dL (LabCorp Range: 264-916)
- Free Testosterone (Direct), LC/MS: 3.0 pg/mL (LabCorp Range: 6.8-21.5)
- Prolactin: 29.2 ng/mL (LabCorp Range: 4.0-15.2)
- LH: 1.2 mIU/mL (LabCorp Range: 1.7-8.6)
- FSH: 2.8 mIU/mL (LabCorp Range: 1.5-12.4)
- TSH: 3.0 uIU/mL (LabCorp Range: 0.450-4.500)
- T3 (Triiodothyronine), Free, Serum: 4.2 pg/mL (LabCorp Range: 2.0-4.4)
- Estradiol, Sensitive: 7.1 pg/mL (LabCorp Range: 8.0-35.0)
- *SHGB, Serum: 12.1 nmol/L (LabCorp Range: 16.5-55.9)
So, obviously my T levels are now without question ridiculously low, and I’m hoping even Kaiser will recognize it. Even though finances are tight, I’m prepared to go through a clinic like Defy Medical and self-pay, but first I’d like to see if I can finally get what I need through my Kaiser coverage. I paid for these tests before going back to kaiser so that I can have something tangible and scientific to show them when they try to brush aside my symptoms again.
Based on these new results, are there specific treatment protocols or additional tests I should push for? What protocol would you want for yourselves for with these numbers? The super-high Prolactin and the low SHGB definitely stand out, and I’m not as sure how to interpret them. Is it strange that LH is low, while FSH is normal? Also, with low Estradiol, I wonder if it would actually be good to skip using an AI, at least in the beginning?
Also, do any of you currently receive TRT through Kaiser and have any advice? I’m afraid that even if they agree to TRT, all they’ll do is prescribe Androgel with no HCG or ability to carefully balance all my levels. Based on my research, I think I’d prefer frequent self-injection, but I don’t know if that’s even an option at Kaiser. (Another reason to avoid gels is that my wife is worried about transfer, as she is already dealing with her own hormonal issues and endometriosis.)
Thanks for any feedback or advice any of you can offer. I know this is a long post, but if you have tried getting TRT through Kaiser, you will understand that you need to be super prepared and educated first to have even a small chance of getting treated.