T Nation

Switching to New Doc Out of VA System--Levels Safe?


#1

Hi all,

Posted several months back about advice for TRT.

Due to a back injury I was prescribed opioids by the VA for years, and it shut off my testosterone production TOTALLY.

Long story short, started off with basically nonexistent test levels (I think 42 on a range of 72-800 total test) Went from lowest to highest dose of Androgel. Total test Level crawled up to only 120, free wasn’t much better.
Went from lowest possible injectable dose of T, to .5 ml twice per week now.
Total Testosterone now up to 900.
On a range of 46-224, free testosterone is 400.
(I also take 10,000 IU of D3 per day since that is supposed to help with depression and available test)
Using Anastrazole with my highest T dose, my Estradiol went from 49 down to 24.
Shgb was at 7 on lowest injectable T dose, now its 5.
Hemoglobin is 17, just donated blood to lower it a few days ago; I plan to do that regularly from now on.
Hematocrit is 51.
LH and FSH are both low; I think about .3 and .7 (don’t have the labs in front of me)
PSA has gone from 2.1 to 2.2, about the same.

Prior to TRT at this higher dose, I couldn’t achieve an erection at all, I had a huge belly, no energy, brain fog, etc.
Now I feel great.

VA docs say they will only treat me if my total test stays at 400.

I’m thinking of going to DefyMedical, or an outside doc.

I want to stay on my T and Anastrazole protocol, in conjunction with donating blood regularly.

Given what I’ve shared, are my levels ok, and is it SAFE to remain where my levels are at? (Minus the high hemoglobin and hematocrit levels)

Thanks!


#2

So, is my free test level UNSAFE?
Is it UNSAFE to have FSH and LH in the .3 and .7 amounts ?

I’d appreciate opinions, cause I cannot find anything on the internet saying these levels are unsafe.

?


#3

TT FT levels vary by lab.

TT 900 - 1000 is good place to be if near E2=22pg/ml

Did I provide these in one of your earlier threads?

TT=900
FT=400, [46-224]
E2=24
SHBG=5 [what range] probably ensures “available test”.
But really low SHBG can be a sign of [pre]diabetes.
Often guys with really low SHBG have a problem getting balanced.

"VA docs say they will only treat me if my total test stays at 400."
Are you confusing TT and FT?
at 400?
less than 400?

Please read the stickies found here: About the T Replacement Category

  • advice for new guys
  • things that damage your hormones
  • protocol for injections
  • finding a TRT doc

#4

Thank you for your response; I did read the stickies.

:slight_smile:

Yes, the VA docs will only treat me if my total test is at 400, on their range scale which is 72-800.
Surprisingly, they don’t care about free test or bioavailable test…they actually told me they ONLY care if my total test is 400… perfectly midrange on their scale of 72-800.

My free test really IS 400 on a range of 46-224. (Guessing perhaps because I take 10,000iu of D3 per day).
My total test is 900 on their range of 72-800.

I would say I AM pre-diabetic, as I was told by another doc i trust, that I have metabolic syndrome.

I have recently changed my diet to include only the following: chicken breasts, tilapia, broccoli, olive oil, carrots, walnuts, a low carb/low cal protein drink after exercise, and one serving of rice per day. Total calories at 2,000, but I weigh 230, and have about %25 body fat.

Another factor: I have a condition called bile acid malabsorption, so I have problems digesting fats and other nutrients.

I started weightlifting again after a several year layoff due to back injury.

I think my new eating plan will help me control blood sugar, and I’ll keep the calories low until I have significant weight loss to justify increasing them.

I read that lowered FSH and LH is a typical result of TRT, but didn’t know if my extremely low amounts, .3 and .7 on a range of 1.6-9, was somehow “dangerous”.

My SHBG has always been somewhat low; before treatment, it was 10 on a range of 10-50.

During treatment, it dropped from 10, to 7, now at 5.
So I have always been at the bottom of the range.


#5

HPTA shuts down on TRT and LH/FSH–>zero
Testing LH/FSH is now pointless and a waste of blood and money.

Vit-D3 is not increasing FT, low SHBG is doing that.

Your metabolic syndrome can easily have a thyroid component. Thyroid hormone fT3 is part of body temperature regulation loop. fT3 controls mitochondrial activity which creates ATP the universal currency of cellular energy. If fT3 is low, or blocked by elevated rT3, every cell in your body slows down and sugars are not burned, you get fat as metabolism of cholesterol is reduced and cholesterol increases. You can eval overall thyroid function by checking oral body temperatures as per the thyroid basics sticky. Thyroid function can be low if you have not been using iodized salt.

Linked VA document seems to assume, but I did not see stated, that injections would be every 14 days and levels should be evaluated at 7 days. At that point, levels would be down a lot from peak. Please read and see what you want to do in terms of holding your doc to the criteria in the document.http://www.pbm.va.gov/clinicalguidance/criteriaforuse/Testosterone_Replacement_in_Adult_Males_Criteria_for_Use.pdf