T Nation

Started TRT This Week. Tired and Dragging

46 yo male. New to TRT. Recently received bloodwork:

CBC With Differential/Platelet
WBC 11.1 High x10E3/uL 3.4 - 10.8 01
RBC 4.96 x10E6/uL 4.14 - 5.80 01
Hemoglobin 14.6 g/dL 13.0 - 17.7 01
Hematocrit 42.3 % 37.5 - 51.0 01
MCV 85 fL 79 - 97 01
MCH 29.4 pg 26.6 - 33.0 01
MCHC 34.5 g/dL 31.5 - 35.7 01
RDW 13.6 % 12.3 - 15.4 01
Platelets 229 x10E3/uL 150 - 450 01
Neutrophils 61 % Not Estab. 01
Lymphs 31 % Not Estab. 01
Monocytes 6 % Not Estab. 01
Eos 1 % Not Estab. 01
Basos 1 % Not Estab. 01
Neutrophils (Absolute) 6.7 x10E3/uL 1.4 - 7.0 01
Lymphs (Absolute) 3.4 High x10E3/uL 0.7 - 3.1 01
Monocytes(Absolute) 0.7 x10E3/uL 0.1 - 0.9 01
Eos (Absolute) 0.2 x10E3/uL 0.0 - 0.4 01
Baso (Absolute) 0.1 x10E3/uL 0.0 - 0.2 01
Immature Granulocytes 0 % Not Estab. 01
Immature Grans (Abs) 0.0 x10E3/uL 0.0 - 0.1 01
Comp. Metabolic Panel (14)
Glucose 163 High mg/dL 65 - 99 01
BUN 18 mg/dL 6 - 24 01
Creatinine 1.21 mg/dL 0.76 - 1.27 01
eGFR If NonAfricn Am 72 mL/min/1.73 >59
eGFR If Africn Am 83 mL/min/1.73 >59
BUN/Creatinine Ratio 15 9 - 20
Sodium 141 mmol/L 134 - 144 01
Potassium 4.2 mmol/L 3.5 - 5.2 01
Chloride 101 mmol/L 96 - 106 01
Carbon Dioxide, Total 27 mmol/L 20 - 29 01
Calcium 9.5 mg/dL 8.7 - 10.2 01
Protein, Total 7.1 g/dL 6.0 - 8.5 01
Albumin 4.6 g/dL 3.5 - 5.5 01
Globulin, Total 2.5 g/dL 1.5 - 4.5
A/G Ratio 1.8 1.2 - 2.2
Bilirubin, Total 0.4 mg/dL 0.0 - 1.2 01
Alkaline Phosphatase 109 IU/L 39 - 117 01
AST (SGOT) 24 IU/L 0 - 40 01
ALT (SGPT) 49 High IU/L 0 - 44 01
Testosterone, Serum 122 Low ng/dL 264 - 916 01
Estradiol 23.9 pg/mL 7.6 - 42.6 01
Roche ECLIA methodology
Prostate-Specific Ag, Serum
Prostate Specific Ag, Serum 0.9 ng/mL 0.0 - 4.0 01
TSH Rfx on Abnormal to Free T4
TSH 0.984 uIU/mL 0.450 - 4.500 01

My ass has been dragging for a LONG time. Very tired, totally unmotivated. Got on TRT with HCG. Any input? How long should this take to feel “normal” again?

Does anyone see any problem – other than the fact that I was on a lot of prednisone at the time (high glucose) + 4th of July celebrating. Is this sufficient for a baseline or does more testing need to be done?

TY!

MS

What’s your dose? How long have you been on? With a T that low, you should perk up almost immediately.

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200 mg / wk. Doing 100 mg 2x week (3.5d). Just started about 36 hours ago. Other than PIP not much happening. Is this normal or crazy? Or does it really take a long time to kick in…

It’s a high starter dose, but you should see a difference pretty soon. Cyp or Enanthate? By the third shot you’ll be starting to amp up a little and by week 6 you’ll forget how you used to be.

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Test Cip + AI + HcG.

So it does take a while eh?

Do you see anything weird in the labs? Anything I should demand my “normal” PCP recheck or expound on?

I have always been on the “low” end of the T range since teen, but always been brushed off. (Lose weight, your depressed, etc., you can’t possibly have low T your 6’ 2" and look like an ogre…) etc… very lame.

But I have an appointment with a PCP so figured I’d get some free labs out of it and see if anything else needed checking.

Thanks,

MS

Dosage is excessive!

You really do not have the proper labs for a guy about to undertake TRT, no Free T or SHBG. If SHBG is low you’re never going feel good on this protocol.

Your testosterone is very low and estrogen high in relation to testosterone, your estrogen should be in the stratosphere with 2 weeks. You need very frequent injections, AIs can be problematic and can cause horrible symptoms.

You can tell the skill of the doctor by the labs that are ordered, these labs indicate your doctor is of the clueless type. Your first mistake is expecting a managed healthcare to know how to manage a guy on TRT, do not expect your doctor to know what to do if you encounter symptoms.

Lymphocytes may be elevated do to disease or recent infection.

No doctor in sick care specializes in TRT, sex hormones are excluded in medical school.

You asked how long it’s going to take for you to start feeling good, working with this doctor it’s gonna be a long miserable time.

I would not be in a hurry to use the AI or the HCG. Better to see how you go with just the test first.

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HI @mistershadow if you are giving yourself the shots you need to cut that in half.
Start low and work your way up. This is a marathon, not a sprint.
Whether you take 100 or 200mg/wk the TRT honeymoon is coming. Trust me it won’t last so that is the first hurdle to get over. You stay on the high TRT dose and you will be setting yourself up for HCT issues, although you are dam anemic now, and big-time E2 issues. Got a wife? Know how she is on her period? That will be you. Best of luck hope my suggestions help.

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@Systemlord: I think you misunderstood my question-- so I clarified it below. The Dr. prescribing seems to be a fairly competent doctor. Albeit, I don’t have the ability to get “perfection.” (Edited comment) I’m using private medicine for TRT. I just happen to have gotten a new PCP (co-incidentally)

Thanks for your input. I appreciate it. I’m not really interested in having some PCP “manage” or even discuss TRT.

I have a standard “physical” scheduled and at my age, I need one… however, might as well take advantage of the typical “we need labs” routine and demand a full panel… just want to make sure I hit all the bases. I will simply instruct him I’d like a full male metabolic etc. Usually not that hard to do. I don’t expect a PCP to be out on the bleeding edge.

Looking for suggestions on what I should request.

Thanks,

MS

Was that bloodwork fasted?

How high was your prednisone dose? Are you still on it?

I ask because your glucose is high. 4- 8 mg/day of pred is a cortisol replacement dose. If you were on much higher for long, then you should check a few things for insulin sensitivity. Minimum a1c and fasting insulin. If you just want to buy some otc insulin sensitizers, then you can try some chromium and lipoic acid with each meal with carbs. These are safe and not a bad idea anyways.

Any cortisol supplementation will lower dhea when you lose the acth stimulus. So you should be adding in 25 mg/dhea/day, if you haven’t. Trt will likely lower it some but trt + cortisol absolutely will.

Your dose is too high and your labs aren’t very thorough.

  1. Was that bloodwork fasted? - No. It was not fasted.

  2. How high was your prednisone dose? Are you still on it? i took 40 mg for 3 days for severe swelling causing acute pain due to a minor but painful injury. I am not on it anymore. (Just those three days and it worked like a charm btw)

  3. I am usually around 80-90 historically on a fasting panel. I’m porky but not morbidly obese-- definitely will benefit from some weight loss-- if i can get off my ass and stop dragging… ugh this sucks.

  4. Your dose is too high and your labs aren’t very thorough. – Can you suggest exactly what I should request for labs since I get this done for free anyhow (for this visit – this visit has nothing to do with TRT its my free yearly physical)?

Thanks,

MS

Below is a list of what is needed for a diagnosis and for those about to go on TRT, you probably already have some of them so scratch those off the list.

  • Total T
  • Free T
  • SHBG
  • Estradiol Sensitive (E2)
  • LH-Luteinizing Hormone
  • FSH-Follicle stimulating hormone
  • Prolactin
  • Cortisol
  • Ferritin
  • Thyroid Panel
  • CBC-complete blood count
  • Comprehensive Metabolic Panel
  • Lipid profile/panel

Thank you very much. I’ll look into it. I will have them repeat the Total T and Free T if possible, together with the rest. The list seems pretty reasonable. The first time I found out that I was low several years ago (before I really did anything about it) I had some of these tests done.

Thanks again,

MS

Well, I had a fun day today at the new PCP. He informed me that Testosterone Replacement Therapy doesn’t really work and it’s mainly a “money making scheme” and that if I just lost weight and went to the gym more often it would be the same effects without the “side effects.” Needless to say, he was educated and I requested as many of the tests as I could get him to write. I’m not holding breath, he actually wanted to fight about it. It was really embarrassing to the medical profession. As a licensed professional myself, it was a bit shameful, maybe even borderline malpractice… but you can’t make it up. So I’ll see what comes back and I’ll get em up here.

As a note, psychological is improved. I’m not anywhere near as grouchy as I was before I started.

Thanks!

MS

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How could TRT has the same effects as naturally raising testosterone if it doesn’t really work?

Your doctor is an official idiot, are you sure your doctor is real? I think your doctor is attempting to save face for a complete lack of knowledge on the subject of TRT and has taken the position of ignorance in an attempt to not appear ignorant.

So when you start TRT and you labs come in, ask him how a money making scheme is able to elevate testosterone, hematocrit and red blood cells if TRT doesn’t really do anything. I’m not sure I would want someone so incompetent incharge of my health and would have said so and walked out on him.

The clinical studies on TRT are irrefutable.

Testosterone lost its patented decades ago, I don’t see how TRT is a money making machine

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The guy really said that. I was flabbergasted. I basically told him he was committing medical malpractice. I just demanded he do his job… and it is a necessary test battery at my age… and he sorta agreed to half my demands in that regard… And yes, I believe he is officially a dimwit.

This is one for the “you can’t make this sh*t up” category.

As an aside… I needed a PCP (not that I have to but works easier for HMO insurance plan) and they randomly assigned me to this guy for my yearly free physical… I didn’t choose him and he wasn’t recommended to me by friends or something… so… I told him I was being treated elsewhere in private medicine and that he didn’t need to worry about it… i’d copy him on “relevant” data… that’s about it. told him what I take for the record and that was it.

But as I said, I’ll keep ya’ll posted.

MS

The last time I changed insurance I was randomly assigned a PCP. He wasn’t actually at the practice anymore and hadn’t been for 2 years. He was at the far end of the State and I don’t think he was even actually covered anymore at the practice that he had moved to. And yet, I had to fight with the insurance to get it changed. I really hate Blue Cross/Blue Shield, and have told them so on multiple occasions in no uncertain terms. I miss the Canadian system.

Oh great, guess who I just switched to? Gah.

ROFL… can you guess who my ins. co is??? Hint: Anthem BCBS.

I have “private” insurance (which is a much much better and robust version than the exchange junk policies) through them, but they still suck. We only have 2 choices in my market. You either have them or a worse company (way worse).

People on welfare here have better coverage. But I needed to get a PCP for the “referal” game and for the free physical and I have some things i need referals to get checked out.

I was really kinda flabbergasted by this clown.

MS

In the past 4 years I’ve had Cigna, United, BCBS and Atena.

I actually had the best experience on BCBS worst was Aetna but this was largley circumstantial. So I am not advocating for one over the other.

I will say though, the best thing for me is to get off the plans where you need a referral and a dedicated PCP. Those are the worst. Unfortunately choice in health care in this country sucks and the only good options are through an employer. I’m lucky that my employer provides good options.