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Starting TRT Next Week, Agreeable Doctor, Need Help with Bloods

Hi all, I’ve been symptomatic with fatigue and depression for a while, not much sexual dysfunction just low libido. Got some bloodwork done. My doc seems like he will pretty much give me whatever I ask for, which is great but hes ready to prescibe with just these bloods, what other bloods should I take? what should I look out for if they are low or high?

Also of note, 32 year old caucasian Male, been taking finasteride 1mg daily for a year, (wondering if this may have exacerbated symptoms, will switch to topical solution soon) overweight,nonobese

Preliminary list to get checked:
LH.
FSH.
Estradiol.

Test panel:

  • |TotalT|282ng/dL| 264-916ng/dL|
  • |FreeT|6.1pg/mL| 8.7-25.1pg/mL|

I’ve also had this bloodwork done.

Thyroid panel:

  • TSH: 2.18 uIU/mL .45-4.5 uIU/mL.
  • Free T4: 1.22 ng/dL .82-1.77mg/dL.

Lipids panel:

  • |Cholesterol, Total|201 mg/dL*|100 - 199 mg/dL|
  • |Triglycerides|123 mg/dL|0 - 149 mg/dL|
  • |HDL|51 mg/dL|>39 mg/dL|
  • |VLDL Cholesterol Cal|25 mg/dL|5 - 40 mg/dL|
  • |LDL|125 mg/dL|0 - 99 mg/dL|
  • |NON-HDL CHOLESTEROL|150 mg/dL|0 - 129 mg/dL|

CBC Panel:

  • |WBC|7.2 x10E3/uL|3.4 - 10.8 x10E3/uL|
  • |RBC|4.83 x10E6/uL|4.14 - 5.80 x10E6/uL|
  • |Hemoglobin|14.7 g/dL|13.0 - 17.7 g/dL|
  • |Hematocrit|43.2 %|37.5 - 51.0 %|
  • |MCV|89 fL|79 - 97 fL|
  • |MCH|30.4 pg|26.6 - 33.0 pg|
  • |MCHC|34.0 g/dL|31.5 - 35.7 g/dL|
  • |RDW|13.5 %|12.3 - 15.4 %|
  • |Platelet Count|306 x10E3/uL|150 - 450 x10E3/uL|
  • |Neutrophils|39 %|Not Estab. %|
  • |Lymphs Relative|45 %|Not Estab. %|
  • |Monocytes|11 %|Not Estab. %|
  • |Eos Relative|4 %|Not Estab. %|
  • |Basos Relative|1 %|Not Estab. %|
  • |Neutrophils Absolute|2.8 x10E3/uL|1.4 - 7.0 x10E3/uL|
  • |Lymphocytes Absolute|3.3 x10E3/uL|0.7 - 3.1 x10E3/uL|
  • |Monocytes Absolute|0.8 x10E3/uL|0.1 - 0.9 x10E3/uL|
  • |Eosinophils Absolute|0.3 x10E3/uL|0.0 - 0.4 x10E3/uL|
  • |Basophils Absolute|0.0 x10E3/uL|0.0 - 0.2 x10E3/uL|
  • |Immature Granulocytes|0 %|Not Estab. %|
  • |Immature Grans (Abs)|0.0 x10E3/uL|0.0 - 0.1 x10E3/uL|

Metabolic panel:

  • |Glucose|90 mg/dL|65 - 99 mg/dL|
  • |BUN|13 mg/dL|6 - 20 mg/dL|
  • |Creatinine, Serum|1.11 mg/dL|0.76 - 1.27 mg/dL|
  • |eGFR If NonAfrican American|87 mL/min/1.73|>59 mL/min/1.73|
  • |eGFR If African American|101 mL/min/1.73|>59 mL/min/1.73|
  • |BUN/Creatinine Ratio|12|9 - 20|
  • |Sodium|142 mmol/L|134 - 144 mmol/L|
  • |Potassium|4.4 mmol/L|3.5 - 5.2 mmol/L|
  • |Chloride|102 mmol/L|96 - 106 mmol/L|
  • |CO2|25 mmol/L|20 - 29 mmol/L|
  • |CALCIUM|9.6 mg/dL|8.7 - 10.2 mg/dL|

I’d get FSH, LH, prolactin, E2, DHEA, VitD, PSA and SHBG checked prior to starting. I’d recheck TSH and free T4 plus get free T3 while I was at it.

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The finasteride very well may have in fact lowered your testosterone, finasteride is also known to double and even triple testosterone. Your hair isn’t worth the damage that finasteride can cause to your HPTA which is sometimes irreversible. It’s possible your levels could increase after stopping finasteride.

TSH is a stimulating hormone, Free T4 is not the active thyroid hormone responsible for increasing metabolism, if you want to see how much thyroid hormone is making it into your cells you must test Free T3 and Reverse T3.

Your SHBG is probably mid-range so two 50-60mg injections per week should work just fine, this will get most men to the high normal ranges.

re:finasteride
Thanks, I dont think finasteride caused the low T as i’ve felt this way for years, but i think it may have made my symptoms worse by blocking the serum dht. Also what is HPTA? (nm, looked it up)

also, I do want to father children in the future and want to avoid testes atrophy, do I need to get started with HCG? Or can I see how test only affects my system first before hopping on hcg? I’d rather not have a laundry list of chemicals i need to take for the rest of my life if i can avoid it

Hypothalamus-Pituitary-Testicular-Axis, the hypothalamus stimulates the pituitary gland, the pituitary gland stimulates the testicles to make testosterone. Finasteride can cause infertility as well and a host of other problems, you are basically rolling the dice on your health by blocking a hormone that only provides benefits to multiple other functions, wellbeing, libido etc…

You may want to prevent testicular atrophy, but choose your poison wisely because HCG while it can help with testicular atrophy, it can also cause other issues like poor mood, low libido and excess water retention.

You may not be one of those with testicular atrophy on TRT. Starting TRT on a bunch of other compounds will make dialing in TRT more difficult, you won’t even know which is causing symptoms. HCG may require the use of an AI do to the fact it increases estrogen, AI’s can cause hair loss even to those on finasteride.

In fact there was a guy in here not 2 weeks ago who was taking finasteride and added anastrozole to his TRT protocol and began losing hair.

so, start TRT test only, get blood/ reasses after a few months if i need to add HCG, if i add HCG reasses after a few months to see if i need to add AI?

also, switching to topical fin will greatly reduce its systemic effects so it should help me out there

No one should contemplate using an AI if there is a way around it, nobody should ever want to be on an AI. There are AI over-responders who can’t touch it without crashing estrogen, these are the big guns reserved for those in hopeless situations where all other methods to control estrogen fail.

Topical finasteride is expensive.

This should be a banner on the top of every page here.

actually pretty cheap if you get morr-f from ebay (indian product 3% or 5% minox with .1% finasteride, runs about $15 a month)

so is there any other way to maintain testicular function while on TRT?

We do not value blood testing LH and FSH. This is because they go up and down a lot, so getting a 24 hour urine sample to get an understanding of the total amount per day is a better idea.

So you’re not going to diagnose primary or secondary based on bloods. It is just not an accurate assessment. Even the urine test is not fool proof.

The only way to really know if your primary is to test the testes with HCG and find out. Most people are secondary, I can only remember a handful of people in 10 years that were really primary hypogonadal and most of them were due to injury of the actual testicle, or military members that were injured in a IED. Lots of those guys running around and they really need T, I think this is partially why so many suicides are taking place in the military.

So for us, LH and FSH is not important on a blood lab.

Hope this helps.

ive taken a few blows there in my teens doing martial arts and already they seem a bit small/ hiked up

Testicular function on TRT isnt necessary, you’re injecting testosterone, you’re replacing testosterone because you natural level is no longer getting the job done.

Some have used micro dose clomid while on TRT, something like 12.5mg or less every couple of days.

adding some more data, preliminary calculated SHBG: 27.7 nmol/L
(calculated using default albumin of 4.3 here http://www.issam.ch/freetesto.htm, obviously not as accurate as a blood test but barring any crazy albumin levels should be close to accurate, possible range if albumin 3.5 = 32.75, if albumin 5.4 = 20.65)

don’t forget Progesterone…

Do not use that calculator, is was created before current testing methods were created and is not accurate, use the TruT calculator.

https://tru-t.org/ The ranges are 16-31.

Current methods for measuring free testosterone (fT) are technically challenging and not accurate. The widely used direct immunoassay and tracer analog techniques for measuring fT have been shown to be inaccurate. Equilibrium dialysis, the reference method against which other methods are compared, is labor-intensive and cumbersome, and therefore has had limited clinical adoption.

Recently, Endocrine Society’s Expert Panel acknowledged the experimental problems in fT measurements and concluded that “…the calculation of free testosterone is the most useful estimate of free testosterone in plasma…” For this reason they advocate for indirect “calculator” based methods, where free testosterone can be computed from the total testosterone, SHBG, and albumin concentrations.

However, we have demonstrated that even the calculated fT values derived from the prevailing equations, based on linear law-of-mass action models or empiric equations, differ systematically from free testosterone measured by equilibrium dialysis by as much as 40%.

I didn’t forget it. It was omitted.

welp, all of a sudden my doc now wants to refer me to a urologist when i asked for something besides every 14 day injections or gel/patches

I doubt the urologist will be much better than your doctor you have now, not when the standard of care is basically non-existent.

At least your current doctor knows when he’s in over his head, unable to think outside the box.

There is a price to pay for using insurance which is often more trouble than it’s worth.

do you know if i can use my hsa to pay for defy medical?