T Nation

The Need for Regular Bloodwork


#1

Hi All,

I have a question relating to upkeep for those of us making use of a T Cyp protocol:

I started on TRT as a 22 y/o, and I just turned 29. I started on TRT in grad school and had regular bloodwork done up until the time I graduated, which ended up being age 26. I was in grad school at Yale at the time and had very good doctors. I started then and have since continued since doing the typical .5mL/week Test Cyp protocol, with my T levels staying roughly in the 700s.

My first year post-school, I was working so much that I never had the chance to make an appointment to continue comprehensive bloodwork, much less get an endo in my new city (I have been in a professional field working 80+ hour weeks fairly regularly for long stretches). And getting a good endo in my city is very difficult. I received a prescription for Test Cyp from my general practitioner after presenting various bloodwork history from grad school and have maintained that prescription since.

My second year, I ended up suffering something of a serious medical event that resulted in most of my colon being removed, a three week hospital stay, and subsequent surgeries resulting from a very large abscess. During this time I was doing continual general bloodwork that included limited hormone panels but, again, not of the comprehensive fasting/etc. variety that were the norm for me during the earlier years. But again, combining this life change with work obligations, have not set up getting an endo or doing the type of comprehensive bloodwork I did in my first few years of use.

My question is this: I am looking to transition employers in the near future to a situation that will afford me more time. I've been continuously taking the Test Cyp for these years without any noticeable changes or events that correspond to needing anything in particular relating to it.

Should I now, with more time available to me, go back to the endocrinology protocol of my grad school years, being seen a couple of times a year with the comprehensive labs and such, or do those more comprehensive labs serve a primarily diagnostic purpose as opposed to a maintenance one? It's not that I'm averse necessarily to getting the tests, but they (at least in the past) are very time consuming (and expensive depending on insurance) so I want to see whether they are something that are more appropriate for someone in the earlier years of their use of the medicine versus someone who is just "trucking along" as I am.

Thank you for your time.


#2

Doctors are the big problem. Endo’s and urologists seem to be the worse overall.

Please read these stickies then come back:

  • advice for new guys — and note the first paragraph — need more info about you
  • protocol for injections
  • finding a TRT doc

Also see the ‘hormones and health’ sticky as it connects some of the dots re vitality and metabolism.

Best docs seem to be GP’s who have moved into the age management circle. Not cheap but you do get a lot of face time.

Sorry to hear about your GI surgeries and complications. The stress of this on your body can create thyroid functions by increasing rT3. More info in the thyroid basics, see adrenal fatigue, stress, rT3.

levels that the block fT3. Your overwork can do this too. Check your overall thyroid function by taking oral body temperatures:

  • when you first wake up should be 97.7-97.8F, higher is OK, 97.3 is a problem
  • also check for 98.6 mid-afternoon
  • iodine deficiency from not using [long term] iodized salt can lower body temperature
  • more info in thyroid basics sticky

Lab work that you order your self and pay out-of-pocket is a viable alternative and you will get better analysis of the numbers here.

Keep this thread for your case. Multiple threads will become detached from whatever facts you provide.

After reading the stickies, you can decide if your old endo might get things done right.

Post labs with ranges:
TT
FT
E2
LH/FSH from before TRT if available
prolactin at any time
CBC
hematocrit
TSH
fT3
fT4
Vit-D25
CRP
fasting glucose
fasting cholesterol [could be too low]
AM cortisol [at 8AM please]

Please do not miss any of the above points. And body temperatures are important and you can get that data quickly.


#3

Thank you for your reply, KSMan. I think, though, that my question was less about future steps as it relates to whether I need a particular type of treatment and more about whether, after having gone through the protocol you discuss above over the course of the initial several years, there is a need to continually do that type of bloodwork and testing several times a year throughout the course of one’s life or whether becoming in some manner symptomatic is when the medical protocol should be revisited.

Thanks.


#4

Docs want to test every 6 months because they feel that they legally need to do that. If something goes wrong that can be tied to TRT and doc has not been doing tests that would have flagged a problem earlier, that can easily be construed as negligence.

Also need to watch for dangers of increasing PSA, liver markers and hematocrit. An age management doc has a perspective of looking at overall health and vitality. Other docs have a disease management perspective and focus only on what they think is wrong. And when we need a doc to do diagnostics that consider low-T the symptom and the disease we have docs that will put young men on T without checking LH/FSH, prolactin etc. Many need their fasting cholesterol and glucose levels tracked.

Any seeing a patient every 6 months is good bu$ine$$.

If the doses are been refined, you need labs.

TRT is a subset of managing hormones. Some docs are looking at many hormones, including thyroid, cortisol and GH. Note that Vit-D25 is also a hormone.

Doing labs several times a year is excessive if everything is good and steady.


#5

I get what you are saying, but regular blood work is necessary with TRT, even if you are not feeling symptomatic. You might have an abnormal lab values, say hematocrit, and not even know it. My doctor will not renew T prescriptions if too much time has lapsed between visits as it is considered unsound practice to provide medicine or care for someone with no monitoring of lab values or face-to-face conversation regarding symptoms.

As for the time taken to go get blood work done, I can’t relate. How much time does it take to simply drive to a nearby Quest or Labcorp location, sign in, wait five to 30 minutes, provide blood, and leave? Some locations are open on weekends. And are you serious in that some employer who whom you are giving 80 hours of work per week, will not let you come in or leave an hour (or maybe a few hours) late or early to work two to four times per YEAR because of time for your healthcare?

I am going for blood work next week. What do I do? Go to the lab as early as possible, and arrive at work an hour late. That’s all.


#6

[quote]BrickHead wrote:
As for the time taken to go get blood work done, I can’t relate. How much time does it take to simply drive to a nearby Quest or Labcorp location, sign in, wait five to 30 minutes, provide blood, and leave? Some locations are open on weekends. And are you serious in that some employer who whom you are giving 80 hours of work per week, will not let you come in or leave an hour (or maybe a few hours) late or early to work two to four times per YEAR because of time for your healthcare? [/quote]

Just to respond to that question, the issue is less having a period of free time than it is a scheduled period of free time. I’m able to type right now because I’m not particularly busy at this instant. But one of the unfortunate things about the nature of my work is that scheduled time away is much more difficult due to the fact that at most given times, something can come up that needs to be addressed. It’s just the nature of this particular level of corporate work that I do: especially on the ground level the first few years, you’re really expected to grind in a way that makes scheduled leaves feel like a material difficulty within the culture of the firm. And that’s setting aside the fact that I would be having to interrupt/suspend getting a lift in or other things that are part of my routine (which can obviously be dealt with a couple times a year).

This will be less of an issue at my next job and is less of an issue even now that I’m experienced enough with the culture and have relationships to know that things will play out fine. So while I appreciate the thrust of the “You really can’t take an hour? An hour???”–the answer is that unless I were very ill or something of that nature, the answer at least for those first couple years becomes “Yes, taking that time for something like blood tests is a difficulty.” But that becoming less of an issue now is what led to the question in my OP.

Thank you for your thoughts though, and I take your points. Once I have the new job and information relating to insurers and such, I will probably try to get it moving.


#7

Man I’m sorry to derail a bit but dang, you are scaring the spit out of me. I’m having a fistulectomy this Monday. Abcsess and all. Did they know it was that bad upfront or did you wake up too a “surprise”?


#8

[quote]sweet-t wrote:
Man I’m sorry to derail a bit but dang, you are scaring the spit out of me. I’m having a fistulectomy this Monday. Abcsess and all. Did they know it was that bad upfront or did you wake up too a “surprise”?[/quote]

Look, let me be straight up with you. I had two things that you need to be concerned about:

The first, and probably the worst in terms of pain: I had most of my colon removed and my stomach was a complete disaster. I contracted C-Diff, which is a very powerful infection that exists in hospitals (I was at a top-5 research university hospital for this, so this is not just an issue of good facilities). C-Diff causes serious diarrhea. I cannot tell you the hell that several nights were in that hospital. If you had put a gun at my bedside, I would have ended it then and there. Thinking back on it, I would not endure it again if I had another out. I thought I knew what physical suffering was from things like training and other various accidents along the way (football, etc.), but let me tell you that I had no idea what suffering was until I was in the hospital with C-Diff in my condition. I don’t use the term “pain,” because pain doesn’t really capture it.

  1. The Abscess: this was something that completely developed randomly. I was out of the hospital. On the mend for a few weeks. Feeling like shit all the time, but at least I was recovering somewhat and not in the hospital anymore.

I got to the point where I could do what for me at that point was exercise. Let me preface this with the following: two days before I was admitted, I was squatting 430 for sets of 6. By the time I got out of the hospital, I’d lost 40-50 pounds or so in three and a half weeks and could barely walk up stairs.

So after a few weeks, I start going to our apt gym. Doing really minimal things, but things that for me were exercise: very light elliptical for ten minutes, curling on the machine with the lighter weights, etc. My stomach area was always sensitive after leaving, as hell–I’d been cut open from the bottom of my sternum to near my crotch, so it wasn’t going to feel great. And I looked distended anyway because …well…my entire GI system had just sustained the equivalent of running into a wall at 70mph–it was wrecked. Anyway, I notice that the pain I’m experiencing is more localized. I’m sitting on a machine and look down, and I note that part of the scar looks yellow-ish.

So I decide I need to do something about it. I go to the doctor, see a nurse. She says “Oh yeah, no big deal that happens sometimes, we lance it and it tends to resolve with proper medicine.” Great, I think: time to nip this in the bud. I go in, a doctor images it and thinks the image looks a bit off. He lances it and realizes that stuff just keeps coming out. If you could imagine, my abdominal area had become something of a bottom-heavy hourglass of puss: I’d identified the top area that had puss/infection in it, but it had pierced down into my abdomen and developed into a massive (to use the term in their report “a very large”) abscess, to the point where they could push down on my abdomen and incredible amounts of puss would come out. I ended up needing a tube and multiple surgeries over the subsequent months relating to it. It sucked and was very depressing, but nowhere near the level of acute suffering caused by C-Diff.


#9

I don’t say any of that to scare you, just so that you know what’s out there.