T Nation

The Long Journey

Hi Guys, This is a great thing you guys have done.

I was diagnosed in June of 2011 with low T, I’ll give the numbers in a minute, but the GP I go to just gave me some gel and said see you in 3 months for blood work. I figured this would be an easy thing to control. After minimal results from the Androgel after 3 months, we checked 6 months later.

He only checked TT and PSA. TT came back lower than when I was first diagnosed in June! Told him I wasn’t wasting my money anymore and wanted injections. He said logistically it wasnt a good option. Started me on Androderm patch. Started getting Severe welts after a month and he finally agreed to send me to an Endo for shots.

I found this sight 2 nights before my first appointment (thank God!) and printed some things off to bring with me to the appointment. Without even running labs the Dr. took my most recent blood work of some minimal panels from 2 months ago and said he was starting me on 200mg T IM twice a month. I asked about doing 100mg once a week, divided into smaller doses every couple of days.

He said no there is a bell curve after the shots as you feel worse, then it is time for another shot. I said I dont want to feel worse, just steady. He disagreed and I could see where this was going. I asked about using HCG as part of the protocol and he asked why. I explained because I didnt want my testes to shrivel up. He said that is a fertility drug and doesn’t use it on any of the 400 men he is treating for low T, especially if I’ve had a vasectomy already.

Then I asked him about monitoring my E2. He said your not growing breasts are you? I said no, and he said Im not going to treat you for a problem that isnt there. I went over with him that I was new to this, but with all the research I’ve done, as the FT goes higher, the E2 will as well. This offsets the benefits of the T. He said no way. At this point I just wanted to get the script and get out and look for another doc.

He gave me a bunch of labs to do after a month and a half of the treatments, (no E2 or DHT) but did not want a new lab run to get a base line of numbers before starting the injections. I went home and searched for another Dr. that had better reviews and just made another appointment for 2 weeks from now. Anyway, I can see this is certainly going to be more difficult than I thought, at least in the begining. I am going in for first shot and lesson on how to inject myself on Monday.

My question, after this long winded story, is after I start the injections, do you think it would be better to stick with the twice a month IM protocol to start, or switch right away to the twice a week SC option? There’s no way I’m going back to the guy who prescribed me the first vial since he fits right into the typical egomaniac, closed minded, know-it-all Dr. Hopefully this second opinion Doc will be more helpful since the office visits are only covered 80% each time. I could go broke just trying to find the correct Dr. Also, without the HCG and Amiridex, do you see a big negative to starting the treatment with just the T and not the others? Should I wait to start until I find someone willing to work with me all the way?

41 years old
6 foot 1
35 inch waist
208 pounds
Male pattern baldness. Mostly just hairaround the side of my head with Peach fuzz in the middle. No back hair, but average amount of hair on the rest of my body. Facial hair has always been light and slow growing. I could go 3 days without shaving and it would just be noticeable.
Fat is mostly carried around my waist and face and chest.
Usual Low T symptoms, low libido, no joy, but not depressed, completely unmotivated, hard time losing the fat around my waist, no morning wood, restless sleep. Had Melanoma on back 6 years ago. It did not spread and condition is cured.
No meds (stopped the Androderm 2 weeks ago)or supplements. When I get motivated to start exercising again, I use Protein powder once a day after my workouts.

These are the only labs the GP ordered. All Fasting
NA 138.5 (136-145)
K 4.53 (3.5-5.10)
CL 107.9 (98-107)
CO2_LC 24.6 (23-29)
ASTNEW 17(5-34)
TBILI 1.1 (0-1.1)
ALTNEW 17 (10-40)
ALPNEW 44 (35-123)
GLU 101 (70-105)
TP 6.9 (6.4-8.3)
CA 9.1 (8.5-10.5)
CREAT 1.3 (0.7-1.3)
BUNNEW 14 (7-18)
ALBNEW 4.8 (3.5-5)
CHOL 153 (0-200)
TRIG 93 (0-250)
LDL_CL 84 (0-130)
HDLNEW 50 (30-70)
TESTOSTERONE, SERUM 251 (348-1197)
FREE T 5.7 (6.8-21.5)
PSA .34 (less than .4)

Roughly 2500 calorie per day. Been really lazy lately and have been eating a lot of sweets, so it has been more than that and bad calories. But usually fruits, veges, eggs, nuts, chicken, beef everyday. Not much fish at all.

Training is in fits and spurts. Not motivated at all right now, but when I am, I’ll do total body weight workouts with minimal rest 3X a week. Cardio another once or twice. Usually will go for several months and then slack off.

Testes ache more and more. Usually when aroused. I thought it was a side effect from a Vasectomy in December. No fevers.

Morning/nocturnal wood was gone until about 3 months on Androgel. Since I stopped the patch 2 weeks ago they are diminishing again.

Sad to say but everyone has been down the road you’re on. You basically have two choices. 1) Self administered TRT and run labs through LEF.org 2) Go to an anti-aging clinic and pay a fortune for them to do nothing. At least there you’ll get proper TRT. I can tell you this. Urologist = waste of time. Endo = TOTAL WASTE OF TIME #$%^ing MORONS!!!

Do not know any one in florida I can refer you to who knows anything about that type of stuff. Most of those places are TRT chop shops.

I know I’m setting my self up for disappointment, but I’ll see this new Doc on Tuesday and hope he is a little more open minded. I’m bringing a bunch of stuff with me to back up my arguements in case he is willing to read them and see the new studies and protocols and give them a try.

In the mean time I found a study that showed if both your Total and Free T are both low, you probably don’t need Test at all, but more than likely you would need HCG and Arimidex only. Can anyone comment on that?

not true…I dont know why the study would conclude that–it makes no sense. If Total Test is low, Free T can’t be HIGH, but it is usually low as well. This can be caused due to either Primary Hypgonadism (testicles dont work making hcg/arimidex therapy useless) or secondary (you’ve got a shot with the ancillaries)

not true…I dont know why the study would conclude that–it makes no sense. If Total Test is low, Free T can’t be HIGH, but it is usually low as well. This can be caused due to either Primary Hypgonadism (testicles dont work making hcg/arimidex therapy useless) or secondary (you’ve got a shot with the ancillaries)

VTBalla, thanks for the response. It wan’t that the Free test was HIGH, it was if Total Test was low and Free test was mid range. I don’t know if that’s possible either, but that was the suggestion. What do you think… still BS?

Too much generalization to give a proper answer…lets just focus on actual blood tests for individuals…this shit is too complicated to give blanket answers for mental masturbation exercises.

Got the lab work and they are as follows:
TT 194 ng/dL [160-726 is the range]
FT 0.159 NMOL/L [Median 0.361, 5th percentile is 0.204 and 95th percentile is 0.637]
DHEA-S 106 ug/dl [80-560]
FSH 6.5 mIU/mL
LH 2.0 mIU/mL [0.8-7.6]
SHBG 18.10 nmol/L [10.0-57.0]
E2 <20 pg/mL [no range given]
Estrone, Serum 37 pg/mL [12-72]
FreeT4(Free Thyroxine) 1.17 ng/dL [0.89-1.76]
TSH 1.98 mIU/mL [0.4-4.0]
Vitamin D 25-Hydroxy 32.29 ng/mL [>=30]
IGF-1 181 ng/mL [101-267]
Prolactin 8.36 ng/mL [2.50-17.00]
PTH Intact 41.80 pg/mL [12.00-65.00]

Complete Blood Count:
WBC 6.4 x10^3/UL [4.4-10.3
RBC 4.91 x10^6/UL [4.70-6.10]
HGB 15.4 g/dL [14.0-18.0]
HCT 43.2% [42.0-52.0]
MCV 88 fL [80.0-94.0]
MCH 31.4 PG [25.0-35.0]
MCHC 35.7 g/dL [31.0-38.0
RDW 13.4% [11.0-16.0
PLT 212 x10^3/UL [130-400]
MPV 8.6 FL [8.0-11.0]
GRAN # 4.7 x10^3/UL [1.2-8.0]
LYMPH # 1.3 x10^3/UL [0.5-5.0]
MID # 0.4 x10^3/UL [0.1-1.5]
GRAN% 73.1% [35-80]
MID% 5.7% [2.0-15.0]
LYMPH% 21.2% [15.0-50.0]

Metabolic Panel:
All was fine but HIGH Glucose (114) and HIGH TOTAL BILIRUBIN (1.3 mg/dL range 0.0-1.2)
CHOL 153 mg/dL [0.0-200]
TRIG 93 mg/dL [0-250]
LDL CL 84 mg/dL [0-130]
HDLNEW 50 mg/dl [30-70]
PSA 0.38

Even though he knew I didn’t have good results from the gel and patch, and even though I told him all I wanted was the shots, he still kept pushing the damn Androgel. I finally told him the gel cost me $120 a month and the shots cost me $10. He backed off and started me on 120mg Test Cyp IM once a week. I had the conversation with him about HCG and he said he would work with me on it but thinks the ache in my nuts might go away after I get my T levels up. If not he said he will want me to go to a urologist just to cover his ass to make sure there is nothing wrong with my testicles. Not what I wanted to hear, but better than telling me no way. I brought some different things from this forum to him and he was thankful. I can tell I know more about this than he does, but as long as I don’t rub his face in it, I think he will work out to be open to listening to my requests. We’ll see…
I have to go back in Oct. for follow up blood work, but if anyone can comment on the results above that would be cool. Thanks.

Got the lab work and they are as follows:
TT 194 ng/dL [160-726 is the range]
FT 0.159 NMOL/L [Median 0.361, 5th percentile is 0.204 and 95th percentile is 0.637]
DHEA-S 106 ug/dl [80-560]
FSH 6.5 mIU/mL
LH 2.0 mIU/mL [0.8-7.6]
SHBG 18.10 nmol/L [10.0-57.0]
E2 <20 pg/mL [no range given]
Estrone, Serum 37 pg/mL [12-72]
FreeT4(Free Thyroxine) 1.17 ng/dL [0.89-1.76]
TSH 1.98 mIU/mL [0.4-4.0]
Vitamin D 25-Hydroxy 32.29 ng/mL [>=30]
IGF-1 181 ng/mL [101-267]
Prolactin 8.36 ng/mL [2.50-17.00]
PTH Intact 41.80 pg/mL [12.00-65.00]

Complete Blood Count:
WBC 6.4 x10^3/UL [4.4-10.3
RBC 4.91 x10^6/UL [4.70-6.10]
HGB 15.4 g/dL [14.0-18.0]
HCT 43.2% [42.0-52.0]
MCV 88 fL [80.0-94.0]
MCH 31.4 PG [25.0-35.0]
MCHC 35.7 g/dL [31.0-38.0
RDW 13.4% [11.0-16.0
PLT 212 x10^3/UL [130-400]
MPV 8.6 FL [8.0-11.0]
GRAN # 4.7 x10^3/UL [1.2-8.0]
LYMPH # 1.3 x10^3/UL [0.5-5.0]
MID # 0.4 x10^3/UL [0.1-1.5]
GRAN% 73.1% [35-80]
MID% 5.7% [2.0-15.0]
LYMPH% 21.2% [15.0-50.0]

Metabolic Panel:
All was fine but HIGH Glucose (114) and HIGH TOTAL BILIRUBIN (1.3 mg/dL range 0.0-1.2)
CHOL 153 mg/dL [0.0-200]
TRIG 93 mg/dL [0-250]
LDL CL 84 mg/dL [0-130]
HDLNEW 50 mg/dl [30-70]
PSA 0.38

Even though he knew I didn’t have good results from the gel and patch, and even though I told him all I wanted was the shots, he still kept pushing the damn Androgel. I finally told him the gel cost me $120 a month and the shots cost me $10. He backed off and started me on 120mg Test Cyp IM once a week. I had the conversation with him about HCG and he said he would work with me on it but thinks the ache in my nuts might go away after I get my T levels up. If not he said he will want me to go to a urologist just to cover his ass to make sure there is nothing wrong with my testicles. Not what I wanted to hear, but better than telling me no way. I brought some different things from this forum to him and he was thankful. I can tell I know more about this than he does, but as long as I don’t rub his face in it, I think he will work out to be open to listening to my requests. We’ll see…
I have to go back in Oct. for follow up blood work, but if anyone can comment on the results above that would be cool. Thanks.

These labs were while on androgel, correct? Or had you discontinued it? Or am I out to lunch here?

Regardless, T is still low and 120 mg/week is a good starting point. You should divide that up and inject it twice per week. E2 is good for now, but keep an eye on it. Same for need for hcg.

You are on the right path it appears.

No, I stopped the Andro in May and then did just one shot of T Cyp with the first D Bag Endo. Went to this new Endo after only one visit to the last one and he said no more treatment for a few weeks and then we’ll get a base line blood work up. That’s what this is. The Andro wasn’t working at all. My levels in March were lower than when I started the previous June. Hopefully this will get me back to where I need to be.

Updated blood work. This was actually from October and I never posted it. I go back Friday to get results from last weeks blood draw. Can anyone comment on this one though even though they are from a few months ago? I know the FT and TT are high. He lowered me down from 120/ week to 100/ week. Also looks like the E2 is high. He said it’s OK for now. Any thoughts? Thanks.

Test Result Range

Estrone, Serum 50 pg/mL 12-72
TSH 1.71 mIU/mL .400-4.00
FT4 .88 ng/dL .89-1.76
IGF-1 239 ng/mL 101-267
C-Peptide 1.29 ng/mL .90-4.60
FSH <0.1 miu/mL No range reported
LH <0.1 miu/mL No range reported
Estradiol 46 pg/ml ND - 56
DHEA-Sulfate 86.4 ug/dL 80- 560
SHBG 18.8 nmol/L 10 -57
Calc Free Test 1.020 NMOL/L Median .361 5th perc. .204 95th perc. .637
Testosterone 994 ng/dl 160 - 726
Prolactin 6.95 ng/mL 2.50 - 17.00
PTH Intact 60.20 pg/mL 12.00 - 65.00
Vit D-25 Hydroxy 26.75 ng/mL >= 30.00
Com Blood Count:
WBC 5.6 x10^3/UL 4.4-10.3
RBC 5.15 x10^6/UL 4.70-6.10
HGB 16 g/dL 14-18
HCT 46.8 % 42-52
MCV 90.8 fL 80-94
MCH 31.2 PG 25-35
MCHC 34.3 g/dL 31-38
RDW 12.4 % 11-16
PLT 231 x10^3/UL 130-400
MPV 9 FL 8-11
GRAN # 3.7 x10^3/UL 1.2-8.0
LYMPH # 1.5 x10^3/UL 0.5-5.0
MID# 0.4 x10^3/UL 0.1-1.5
GRAN% 65.8 % 35-80
MID % 7.3 % 2.0-15
LYMPH% 26.9 % 15-50

HBA1C 4.40 g/dL 3.5-6.2
Metabolic profile Nothing out of range except Glucose was 105 and range is 65-99

Cholesterol 127 mg/dL 0-200
Triglycerides 76 mg/dL 40-160
HDL 44 mg/dL 30-70
LDL Direct 76 mg/dL 0-100