T Nation

Testosterone Replacement - Low Dosage


#1

Hi all,

Just back from seeing an endocrinologist in London for a second opinion. Been experiencing a range of symptoms linked to Low T including loss of libido, fatigue, low mood, loss of muscle mass and issues with concentration. I was referred to a NHS endocrinologist last year who concluded that my t levels of 14 and 13.1 n/mol in my two tests did not warrant any further action (I believe the acceptable range in the UK is from 8n/mol upwards). I am 34 and therefore wanted a second opinion which resulted in my appointment today with a private endocrinologist.

Anyway he was quite attentive and sympathetic and has ordered blood tests which I will undertake next week. He suggested I may have a testosterone insufficiency, which once the bloods came back could be addressed by taking a small dosage of testosterone gel twice weekly which could bring up my t levels to a more acceptable level and not cause my body to stop producing T.

This was the first time I have heard of supplementing T like this. I was under the impression testosterone gel had to be applied everyday as a replacement therapy and once such treatment commenced it would result in your body stopping the natural production of T. He is a highly qualified endocrinologist so didn’t feel able to question his initial suggestion, but has anyone else heard of supplementing T levels like this?

Thank you for reading and any advice would be welcome


#2

That does seem wrong and E2 may be your only increase.

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

  • 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.


#3

Gel base testosterone are useless for most guys and even if it does work it most likely will become less effective over time. I’ve seen a lot of guys come here and seem baffled as to why the T levels are continuing to decline while their doctor increase the dosage to no avail, the fact that your endo has suggested gels twice a week tells me he’s wholeheartedly inexperienced in TRT. Most experienced endos will prescribe injections once or twice weekly as they know anything else will not work, seems like he’s afraid of injections and never heard of gels twice weekly! You’re dealing with mentally challenged doctors (who live under a rock) over in the UK who couldn’t pin a tail on a donkey let alone understand that all these lab ranges were taken from sick, fat out of shape people.

Please post all labs including ranges.


#4

Thanks, my blood test is on Tuesday so will post when they come back. The more I read the more astounded I am that he could claim low amounts of T gel would not stop my body producing testosterone.


#5

Hello sorry for the delay, just got my blood test results. The doctor did not consider the results warranted an MRI or ultrasound and had prescribed 2 months worth of Testogel to be taken twice a week (50mg). Would appreciate any insight of the following results…sorry about the formatting.

FSH 2.3 iu/l Range 1.5 - 12.4
LH 5.3 iu/l 1.7 to 8.6
Testosterone 12.8 nmol. 7.6-31.4
SHBG 23nmol. 16-55
Prolactin 224 miu/l 86-324
Cortisol 316 nmol.
Free Test 7.29pg/ml. 4-30

A.C.T.H 28.7ng/l up to 46

Haemoglobin 139g/l. 130-170
HCT 0.446. 0.37-0.50
Red Cell Count 5.38. 4.40-5.80
White cell count 4.39. 3.0 - 10.0

DHEA sulphate 12.5umol. 0.44 - 13.4
TSH 1.66miu/l 0.27 - 4.2
Free T3 4.6pmol/l. 3.1 - 6.8

PSA total 0.65 ugl. 0.00 - 1.40
PSA free 0.32 ugl. 0 - 1.40


#6

Requested body temperatures?

TSH should be closer to 1.0
Are you iodine deficient from not using iodized salt?

"Testogel to be taken twice a week (50mg)"
You need ~ 10mg T absorbed per day, 70mg/week.
Typical absorption is 10%, so 50mg --> 5mg absorbed.
Your protocol as described can be expected to make your situation and symptoms worse.
Lab results on described dose will unfortunately be highly determined by lab timing.

You did not get E2 tested, need to do that when on TRT.


#7

Thanks KSman. I should have been clearer each dose is 50mg so 100mg each week, but I guess from what you say above it is still not enough.

He maintains that the levels at which I would be taking would not have negative effects on my body’s production or fertility levels, despite what I was saying.

Unfortunately he didn’t test E2 and said it wasn’t needed at this stage.

I will get a thermometer today and look into iodised salt. A men’s multivitamin I take does include iodine, but I guess natural is always better.

He also claimed my results did not indicate any issues with my testes or pituitary gland. Is this right? Because for me there must be a root cause as to why the levels are where they are.


#8

Temps: Yesterday 3pm 98.06

Today 7am 97.52

Today 3pm 98.06

I take a multivitamin which has 100% of the recommended daily allowance of Iodine and 274% of selenium. It does not contain iron. I also eat brazil nuts each day.

I had a varicocelectomy 2 years ago on a left side Grade 3 varicocele and though the pain has subsided, some residual veins remain. I don’t know if it’s worth going back the urologist again. If the varicocele was causing problems would I have a high FSH?

I feel like I’m chasing my tail for the past few years and just wish I could meet a doctor who could help me get to the bottom of things. Strangely over last few weeks libido is there but have difficulties getting hard enough. I get nocturnal erections but don’t wake with one.

Any input would be greatly appreciated.


#9

Iodine is a element and the concept of natural is meaningless.

Your doctor is half-baked.
FSH is low and is the problem. Testes might perform OK if LH/FSH were better. E2 not tested to see if that is a negative feedback factor.

Have you read all of the things that damage your hormones sticky?

Time of day for cortisol lab work?
No ranges provided.
Better to test “AM cortisol” at 8AM or 1 hour after waking.

High FSH, way higher than LH is a sign of testicular cancer and then if TRT is started, LH–>zero and FSH stays elevated. FSH and LH sometimes with low T when the pituitary is trying hard to compensate. Not your case.


#10

Bloods were taken at 8.28am.

Sorry range for cortisol is 133 to 537n/mol - mine was at 316

I did read the things that damage hormones sticky. Three large veins were ligated during the varicocelectomy and I can’t say that things have improved since that op.

So what could be causing the low FSH? Am I right that is usually associated with damage to the pituitary gland?


#11

A post was split to a new topic: Started TRT a Month Ago, Low Sex Drive


#12

Any further input please? Can FSH be increased naturally? Or is TRT the only answer?

Yesterday AM temp: 97.16
Yesterday PM: 98.06

Today AM: 96.98


#13

Can anyone provide any further input please? @KSman?


#14

@KSman

Had an ultrasound the other day. Said I no longer have a grade 3 varicocele and that my testes were of normal size and no issues with epididymis.

Can anyone please give me some input into what can cause low FSH? What can I do to increase it naturally?