Start TRT or Not?

I’d suggest you don’t order any TRT medicine at all.

You need to do the thorough blood tests first to see what the problem is & what solutions will suit you.

Alright, i will go for these blood work tomorrow:

Total Testosterone
Free Testosterone
SHBG
Estradiol (E2)
LH-Luteneizing Hormone
FSH-Folicle stimulating hormone
Prolactin
Cortisol
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel

Will post the results here.

I was able to do a new blood test here in Netherlands last week, it was such a pain in the butt to find a clinic that is familiar with such tests, they done the test and somehow the result was missing the free and total testosterone level. they said that they somehow missed them. I however was lucky enough to get the blood test result that i had in US from the TRT clinic. they sent it to my email. so i am attaching both results, the new one without free/total testosterone and the older one with free/total testosterone.

Thanks.

US Test: Dropbox - US test.pdf - Simplify your life
New Test: Dropbox - New.pdf - Simplify your life

You’re still missing thyroid labs, you never ran a thyroid hormone panel. TSH is a poor indicator of thyroid status, it can appear normal when thyroid hormones are not. Anyhow TSH isn’t optimal. Test is very low and E2 labs are for females, you need the LC/MS/MS method which you must specify when ordering otherwise they will run the female E2 labs. No SHBG either.

Roche ECLIA methodology is for pre-menopausal women and children.

I gave them the list that you gave me:

Total Testosterone
Free Testosterone
SHBG
Estradiol (E2)
LH-Luteneizing Hormone
FSH-Folicle stimulating hormone
Prolactin
Cortisol
Thyroid Panel
CBC-complete blood count
Comprehensive Metabolic Panel
Lipid profile/panel

I see “thyroïd stimulerend hormoon” result on the results list that i sent here, but nothing else. Have you seen my first post test result? that one include a lot of thyroid tests, it is in my third reply in this post. do you see the thyroid results there?

I don’t know what else to do at this point man, doctors are retarded here.

HTC, hematocrit is quite high for low T.
You need to avoid high T doses as your HTC will be too high.
This is big problem.

TSH should be closer to 1.0
Forget “normal” as thyroid ranges are quite useless.
Get oral body temps, note that two sets are requested, see below.

When testing cortisol, get “AM Cortisol” done at 8AM or one hour after waking up. Results from later in day are mostly of no use.

Cholesterol and glucose need to be done ‘fasting’, in the morning with no food, just water.

DHEA Sulfate not shown, on a different page?

You need to test prolactin to see if that is the root cause of your problems. For a few days before the test you need to avoid things that cause prolactin release: orgasm, hugging {babies, puppies, kittens etc}


Please read the stickies found here: About the T Replacement Category - #2 by KSman

  • advice for new guys - need more info about you
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

Evaluate your overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid hormone fT3 is what gets the job done and it regulates mitochondrial activity, the source of ATP which is the universal currency of cellular energy. This is part of the body’s temperature control loop. This can get messed up if you are iodine deficient. In many countries, you need to be using iodized salt. Other countries add iodine to dairy or bread.

KSman is simply a regular member on this site. Nothing more other than highly active.

I can be a bit abrupt in my replies and recommendations. I have a lot of ground to cover as this forum has become much more active in the last two years. I can’t follow threads that go deep over time. You need to respond to all of my points and requests as soon as possible before you fall off of my radar. The worse problems are guys who ignore issues re thyroid, body temperatures, history of iodized salt. Please do not piss people off saying that lab results are normal, we need lab number and ranges.

The value that you get out of this process and forum depends on your effort and performance. The bulk of your learning is reading/studying the suggested stickies.

I admit I screwed the pooch on the the E2 recommendation, left out E2 “Sensitive”. If you had done the E2 Sensitive it would have showed even lower, so we know it’s low in your case because T is also low. You will have to donate blood on a regular basis while on TRT do to your hematocrit being high with low T.

It would be nice to know what SHBG sits at because if lower smaller injections EOD could help out with your high hematocrit versus larger doses less frequently. I don’t believe you have high SHBG, your Total T and E2 are both low so this might suggest SHBG is lower. I would inject 15-20mg EOD. We really prefer to use Total T and SHBG to get our free T percentages.

The half life is very short so free T measured directly has it’s problems. Sleep apnea could cause your hematocrit to be high, you should get a sleep study done.

Thanks for the info,

I think hematocrit is high because i am a smoker (about 10-15 cigarettes a day) probably i should stop if i start trt. most of the tests were done in morning and i don’t eat breakfast anyway.

Well, i can’t imagine myself donating blood. I was saying about that maybe hematocrit is high because i am a smoker?

What is the overall impression? would you start trt if you were in my situation? or you would live with some shitty symptoms? mainly lack of energy, a bit of overweight issues, ED problems.

I understand that i need to do these tests as well:

Prolactin
DHEA Sulfate
Checking oral body temperatures (not sure what is this exactly).
And preferably SHBG, LC/MS/MS

But is there any suggestion / impression that you guys can share with me right now based on the current results?

If you start TRT now hematocrit will shoot up and blood donation won’t become a choice, otherwise doctors will stop TRT. Your levels are low enough to cause heart problems, cardiovascular disease, dementia and alzheimer’s. You have some decisions to make regarding your health.

If I were you I would quit smoking, go on TRT and donate blood regularly. Checking oral body temps using a glass thermometer (not digital) upon waking an 2pm, you should get to 97.7 upon waking and 98.6 by 2pm.

I spent 10 months in 2015 withdrawing off Klonopin after 30 years so I know quitting smoking won’t be easy. My testosterone production never recovered and is why I’m need TRT.

Thanks man for sharing your thoughts. I think i need to make some decisions here.

Yeah i will find a glass thermometer, why is it useful? usually the body temperature is very warm at all time based on girlfriends comments.

Your body temps are directly connected to your free thyroid hormones, mainly Free T3. If body temps are off even a little, then Free T3 is not normal. Girlfriend could have hypothyroidism and lower body temps than you do making you feel warm to her when if in fact you’re low as well, just not as low as her.

What did affected your testosterone production in first place? smoking?

Withdrawing off of Klonopin damaged my pituitary gland.

Yeah i was wondering, because i remember i read that smoking actually increase the Testosterone in some people. not for me.

I used to smoke since age 17, now i am 30 almost, I quit smoking a few years ago for 2 full years, never easy, but started smoking again. should be easier this time i guess.

Been to a urologist specialist today, he seemed like a pretty good doctor and informative, he reviewed all of the blood work, examined testicles, bladder, kidneys etc. Said everything is fine, he was surprised that the testicles are pretty big. but the testosterone is very low. he did said that it could cause health issues, he prescribed the following:

testosterone injection fluid 250 mg/ml (undecanoate) fl 4 ml. No: 30 Milliliter.
1 injection per 10 week on 8:00, intramuscular.

I told him about my prescription from US is 2 injection per week and it is recommended to take no more than 100-150mg a week. but he recommended the above and said the above testosterone is different and i only need 1 injection per 10 weeks and it will work, any thoughts about this? or about what i should suggest him to adjust?

As for red-blood cells being high, he said its not high and he don’t think it will cause problems… but said he need to keep seeing me every 4 months. prostate check is also a must he said.

As for HCG and Estrogen Blocker, he said in Netherlands test is not used with HCG, it has to be either HCG or testosterone. he said there is exceptions and he can discuss this with his professor and get the permission, but he said he need to see my prescription from US showing that i was prescribed testosterone with HCG and estrogen blocker.

Right now he only prescribed me the testosterone above, No HCG, No Estrogen Blocker… pretty useless plan i guess?

and told me that in 6 months i might become infertile, said its best to freeze some now for future. But i kept telling him that HCG could help preventing that, and estrogen blocker will keep the estrogen low in case some testosterone got converted to estrogen.

Any thoughts? Thanks!

Nebido is problematic, your levels will start out high and will be low before your next injection. Nebido also gives a young man the hormone profile of an old man. It’s a one size fits all approach, ask for Ethanate or Sustanon.

Talked to the doctor today, he agrees with you :slight_smile:

He is going to switch the test to Sustanon.

He was saying that in Netherlands TRT protocol is without hcg and that’s the problem. he is going to discuss this with his professors to get a permission, he asked me to email him the dosage of the HCG.

500iu twice a week, does that sounds correct?

Don’t forget about an AI, HCG will increase estrogen production. Sounds like you found a good doctor. You could inject twice weekly, three times and even 250iu EOD as well. Whatever works best for you.

The retarded protocol here in europe doesn’t allow the use of both HCG and not even AI in TRT. My doctor did his best and couldn’t get authorization. finally i ended up getting them from the US. I also got my hands on some Clomid too for future use.

I had the option to choose between Nebido 1000, Sustanon 250. or Test Cyp grapeSeed Oil 200mg from US. i decided to give Nebido a try, i know the common problem with it, which is starting the high and then low before the next injection, the doctor assured that he can optimize that and play with the schedule of next injection, said generally it is taken each 10 weeks, but he can play with the time if i needed it sooner.

So i thought giving it a try, I had the first injection on Friday, i felt it right away, tons of energy and confidence on first day, but at night i could not sleep well. i woke up like 3 times during the sleep. the next day i was super sick with fever, chest pain, flu like symptoms, lack of energy. still feeling crappy today the third-day.

Not a good start. I don’t think i am looking forward for the second injection, probably it’s best to do Test Cyp which is the standard, most common test in the US, i don’t trust these european brands to be honest. generally they know nothing about testosterone here.

How long should i wait before I can switch to Test Cyp or Sustanon?