T Nation

Tired of My Doctor Guessing. Any Advice? Update 4/18/15


#1

So after much searching of the internet I have ended up here because there seems to be a lot of very informed people in here so I thought I would try here to see if I could get some answers because I am tired of my doctor guessing.

The back story, I was having the following symptoms: Have very low energy/drive anymore, get very tired half way through workout, have a harder time recovering, little depression, get irritated a lot more lately, trouble sleeping, sex drive has been much lower, getting up in the middle of the night to pee.

So around 18 months ago I decided to go see my doctor. He said though that all my symptoms were because I was not sleeping, so he put me on some sleeping pills. Well I sleep better but none of my other symptoms improved. I started reading a book by Rob Wolf and he recommended some blood test to do.

I went back to the doc August telling him none of my symptoms improved and I would like to do the blood test listed in Rob�¢??s book. So we did the blood test listed below (8/12/14). It came back that my TSH was high (5.51 mU/L). So he put me on thyroid medication Levothyroxine (50 mcg). I had smaller blood panel done on 3/12/14.

This came back that my TSH was now in the normal range (2.19 mU/L). The issue is that none of my other symptoms have seemed to improve. Things that have changed since I have been on Levothroxine. I used to get really hunger at times, that has now gone away. I used to have trouble falling asleep but now I fall right a sleep. I still don�¢??t sleep well and often get up. Also my cholesterol numbers have gone up but I have not changed my diet.

I mentioned to my doctor that my testosterone is in the low end of the range. So he suggested we try Androgel. I am getting tired of him guessing so I am going to a TRT clinic/doctor on Wednesday to get his advice.

I read the stickies especially the one on thyroid. I don�¢??t think I am getting enough iodine, since I rarely eat salt and have lower body temps (morning 96.8 afternoon 97.8). If I supplement with Potassium Iodide is that the same thing? I can get that at my local vitamin store in 32 mg tablets. I am also looking into TRT therapy. Is there anything else I should be looking into?

-age: 38
-height: 6"-01"
-waist: 38"
-weight: 250 lbs
-describe body and facial hair: Lots of body hair and facial hair/head hair grows fast.
-describe where you carry fat and how changed: Around my waist seems to be increasing but otherwise no change.
-health conditions, symptoms [history]: Have very low energy/drive anymore, get very tired half way through workout, have a harder time recovering, little depression, get irritated a lot more lately, trouble sleeping, sex drive has been much lower,
-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Rx Levothyroxine (50 mcg) OTC Zytec occasionally when allergies are bad, mitivitamin, Fish Oil, Vitamin D.
-describe diet [some create substantial damage with starvation diets]: Nothing special Breakfast: three egg omlet with ham and bacon, Lunch 10oz chicken with mix veggies, dinner 10oz pork chop with salad (mix greens, shrimp, cucumber, rash, avocado, balsamic vinagretee), snack orange, string cheese, pre-workout: milk with Whey
-describe training [some ruin there hormones by over training]: When I have enough energy/drive I work out 1-5 times a week. 3 days lifting (Wendlers 5/3/1) 2 days sled push/tire flip
-testes ache, ever, with a fever? No
-how have morning wood and nocturnal erections changed: Seem to be less often.
-Morning and evening body temps: 96.8 and 97.8
-lab results with ranges: I have two set one from 8/12/2014 and one from 3/12/14 then ranges
WBC: 7.6 : Not taken : 4.0-11 k/mm3
RBC: 5.57 : NT : 4.30-6.00 m/mm3
Hemoglobin: 16.2 : NT : 13.0-18.0 g/dl
Hemotocrit: 46.0 : NT : 40.0-53.0 %
MCV: 80 : NT : 78-100 fL
MCH: 28.2 : NT : 27.0-34.0 pg
MCHC: 35.2 : NT : 31.0-37.0 g/dL
Platelet Count: 149 : NT : 130-450 K/mm3
RDW(sd): 38.5 : NT : 36.0-55.0 fL
RDW(cv): 13.2 : NT : 12.1-18.2 %
MPV: 11.1 : NT : 7.5-14.0 fL
Segmented Neutrophils: 46 : NT : 40-85 %
Lymphocytes: 38 : NT : 10-45 %
Monocytes: 13 : NT : 3-15 %
Eosinophils: 2 : NT : 0-7 %
Basophils: 1 : NT : 0-2 %
Absolute Neutrophil: 3.5 : NT : 1.6-9.3 k/uL
Absolute Lymphocyte: 2.9 : NT : 0.6-5.5 k/uL
Absolute Monocyte: 1.0 : NT : 0.1-1.6 k/uL
Absolute Eosinophil: 0.2 : NT : 0.0-0.7 k/uL
Absolute Basophil: 0.1 : NT : 0.0-0.2 k/uL
Immature Granulocytes: 0 : NT : 0.0-1 %
Absolute Immature Granulocytes: 0.0 : NT : 0.0-0.1 k/uL
CRP, High Sensitivity: 1.4 : NT : <=0.9 mg/L
Homocysteine: 10.8 : NT : 6.0-15.0 umol/L
TSH, High Sensitivity: 5.51 : 2.19 : 0.45-4.50 mU/L
T3 Free Non-Dialysis: 3.1 : NT : 2.0-4.8 pg/mL
T4 Free Non-Dialysis: 1.2 : NT : 0.8-1.7 mg/dL
Prostate Specific Ag: 0.4 : NT : <=4.0 mg/mL
Estradoil: 20 : NT : 8-43 pg/mL
DHEA Sulfate: 339 : NT : 120-520 ug/dL
Human Growth Hormone: <0.1 : NT : <=2.9 mg/mL
Cortisol, Serum: 14.7 : NT : 4.0-22 ug/dL
Vitamin D, 25 Hydroxy: 38.8 : NT : 30.1-100.0 ng/mL
Magnesium, RBC: 4.8 : NT : 4.0-6.4 mg/dL
Glucose: 109 : 102 : 65-99 mg/dL
Urea Nitrogen (BUN): 23 : 20 : 8-25 mg/dL
Creatinine: 1.47 : 1.29 : 0.60-1.5 mg/dL
GFR Estimated: 60 : 70 : >=61 mL/min/1.73m2
BUN/Creatine Ratio: 15.6 : 15.5 : 10.0-28.0
Sodium: 140 : 135 : 135-145 mmol/L
Potassium: 4.5 : 4.3 : 3.5-5.2 mmol/L
Chloride: 104 : 98 : 96-110 mmol/L
Carbon Dioxide: 24 : 26 : 19-31 mmol/L
Anion Gap: 12 : 11 : 4-18
Protein, Total: 7.5 : 7.6 : 6.0-8.0 g/dL
Albumin: 4.6 : 4.6 : 3.3-4.9 g/dL
Globulin: 2.9 : 3.0 : 2.0-3.7 g/dL
Albumin/Globulin Ratio: 1.6 : 1.5 : 1.0-2.0
Calcium: 9.0 : 9.5 : 8.710.5 mg/dL
Alkaline Phosphatase: 51 : 50 : 40-129 IU/L
Alanine Aminotransferase: 29 : 27 : 5-60 IU/L
Bilirubin, Total: 0.6 : 1.4 : 0.2-1.3 mg/dL
Cholesterol: 191 : 213 : <=199 mg/dL
Triglyceride: 89 : 117 : <=149 mg/dL
Cholesterol/HDL Ratio: 4.2 : 4.2 : <=4.9
HDL Cholesterol: 46 : 49 : >=40 mg/dL
Non-HDL Cholesterol: 145 : 164 : <=159 mg/dL
LDL Cholesterol, Calculated: 127 : 141 : <=129 mg/dL
VLDL Cholesterol: 18 : 23 : <=29 mg/dL
Testosterone, Free: 70.6 : 70.0 : 35.0-155.0 pg/mL
Testosterone Total, LC/MS/MS: 343 : 336 : 250-1100 mg/dL
Zinc: 87 : NT : 60-130 mcg/dL


KSman is Here
#2

There are some hormonal imbalance issues popping out. I’ve had all the same issues you have minus the man issues :stuck_out_tongue:

Your glucose is not in the normal range, kind of confused why your doctor put you on thyroid medicine and not on any pre-diabetic med. Did your Dr. mention anything about being insulin resistant? Abdominal fat is a tell-tale sign. If so this can relate to your high cholesterol & high triglycerides, its all interconnected. It kind of pisses me off because I know that full spectrum blood test costs a lot and the Dr. is not even using the results to its fullest.

Your diet looks fairly low carb/ high fat are you specifically on a Keto type Diet and is it specifically for the purpose of weight loss (cutting)? Just glancing at your diet listed sounds around 2100-2200 calories and that seems low for your height, weight and activity level. Starvation dieting is a contributing factor in hypothyroidism along with iodine deficiency.

When your Dr. mentions that he/she believes it may be a sleep issue, I think he/she is really trying to explain that cortisol levels may be part of the issue, maybe stress and inflammatory responses. Which is also interconnected. The problem is its a feedback communication problem. The hypothalamus controls body temperature, thirst, fatigue, sleep, and circadian cycles. The hypothalamus uptakes, thyroid hormone T4 (thyroxine), which regulates metabolism. This uptake mediated by the enzyme D2 (Deiodinase) which is involved in the activation and deactivation of thyroid hormones. This is also the enzyme that inhibits the basal metabolic rate during starvation. T4 hormones are converted to the more active T3. These two hormones are responsible for the stimulation of the metabolism of every tissue in the body. They are produced by the thyroid gland through the stimulation of the hormone TSH (thyrotropin) which is produced and secreted from cells of the anterior pituitary gland.

You mentioned Allergies and that makes me think that you may have some autoimmune issues, which could also be a contributing factor and in some ways can be related to hypothyroidism. My doctor put me on Naltroxene off the label, low dose starting at 1.2mg built up to 4.5mg each night. You’ll find that there are conflicting opinions in the medical community about its off label use (this is because of a lack of large scale blind studies). Its use as low dose is to trick the body into healing itself and promote restful sleep.


#3

In a sense high TSH is a problem in itself, and correcting it is good in itself, but two things:

  1. Improving to 2.19 mU/L is still leaving TSH high.

  2. 50 mcg T4 per day is a very low dose, which in and of itself is good if resulting free T3 level is good, but probably is not enough dosage when TSH was as high as it was in the first place, or as high as it is now. (TSH is staying that high because of the thyroid still sensing somewhat low biological activity of thyroid hormone.)

  3. Not sure if the free T3 and free T4 levels are reflective of your current condition with the 50 mcg/day? Not impossible that they are but they could be prior to developing the problem?

  4. I recommend using either iodized salt on your food with a reasonably free hand, such as 1/2 teaspoon to 1/2 tablespoon per day if you have not been doing so, or taking kelp tablets. Yes, there are advocates of dosages such as 32 mg a time, but all sorts of things have been advocated. Actual research finds ongoing doses of more than about 1 mg/day to risk hypothyroidism rather than be beneficial, and there’s no evidence that the entire human body contains more than about 20 mg total iodine. 32 mg at a time is total megadosing.

Good ongoing dosing is about 300-800 mcg/day, from the standpoint of a few weeks of use recovering from low intake, about 1 mg/day is good with 2 being high but still reasonable.

It seems likely your levothyroxine dose is inadequate for full improvement, and/or it might be unneeded and the real solution could be adequate iodine intake (if you have not been having that.) A current blood test would certainly be good.


#4

sportyrose25

My doctor discussed my glucose with me. He said that he normally does not prescribe any meds for it unless you are consistently over 110. My highest reading over the past 5 yrs or so has been the 109. But it has always been above 95. My cholesterol has never been outside of “normal” range until I went on thyroid medication. As for the diet, I am not specifically on a Keto diet I just really don’t like many carbs (bread, pasta etc.). So it is really more of a taste thing. For the allergies it is only a couple of months out of the year that I have issues. I don’t take it regularly during that time either, maybe 3-4 times a week. You said you had the same issues. Did they ever get it fixed?

Bill Roberts

  1. My doctor mentioned upping my thyroid meds but wanted me to try Androgel to see if that improved any of my symptoms.
  2. I should look into upping the dose? or will more iodine help with that?
  3. I am going to a TRT clinic on Wednesday I could have them test T3 and T4. My Dr. just did not test them last time to cut back on cost
    4)I don’t use hardly any salt currently, don’t really like it. BUT I will start adding it in. That is a reason I was looking at the tablets. The dosage level was because in the Thyroid Basic sticky it says from IR use 50 mg. Will Potassium Iodide work the same as Iodine?

You mention a current blood test. I had one on 3/18/15 should I take a more currently then that or should I wait for a few week until I have upped my iodine levels? Is TRT something I should look into?


#5

Potassium Iodide is a salt that will provide a good source of Iodine. High dosages are for emergency situations, radiation protection, and prior to removal of the thyroid gland.

Potassium Iodide:
Comes in tablets, with servings ranging from 0.23 to 130 mg. This closely-bound inorganic form of iodine has been shown to only offer 20% assimilation to bodily tissues. Studies show that potassium iodide blocks the uptake of radio-iodine in the thyroid gland, thus lowering the chances of developing thyroid cancer [2]. Moreover, potassium iodide has been used in emergency treatments for hyperthyroidism (PDF) [3].

â?? Dr. Edward F. Group III, DC, ND, DACBN, DCBCN, DABFM

Web MD also has a decent write-up on it: http://www.webmd.com/drugs/2/drug-1823/potassium-iodide-oral/details

And:
To treat iodine deficiency:
Adults and teenagersâ??0.3 to 1 mL three to four times a day. (drugs.com)


#6

[quote]tcataz wrote:

Bill Roberts

  1. My doctor mentioned upping my thyroid meds but wanted me to try Androgel to see if that improved any of my symptoms.
  2. I should look into upping the dose? or will more iodine help with that?
  3. I am going to a TRT clinic on Wednesday I could have them test T3 and T4. My Dr. just did not test them last time to cut back on cost
    4)I don’t use hardly any salt currently, don’t really like it. BUT I will start adding it in. That is a reason I was looking at the tablets. The dosage level was because in the Thyroid Basic sticky it says from IR use 50 mg. Will Potassium Iodide work the same as Iodine?

You mention a current blood test. I had one on 3/18/15 should I take a more currently then that or should I wait for a few week until I have upped my iodine levels? Is TRT something I should look into?[/quote]
I was thinking your posted, older blood test was the latest but indeed you said you had one recently. That’s recent enough to be meaningful, if it’s at least a few weeks after your most recent dosage change.

On iodine, if eggs, saltwater fish, potatoes including skin, turkey, and dairy don’t make up a pretty big part of your diet and you don’t use iodized salt or take a supplement, almost certainly you’ll be iodine deficient and that alone could explain your thyroid problem.

If you increase your levothyroxine dose much, then your thyroid is unlikely to regain natural production as it will be suppressed by the added levothyroxine.

At your present dose, recovery of natural production could occur once correcting your iodine intake. So, because it sounds very likely that you were deficient, I’d want to correct that first and then see if the direction could be discontinuing the levothyroxine, or at least not increasing it.

It is worth testing for free T3; necessary really for a good picture of what’s going on (the closest single measurement you can get to the biological activity.)

Potassium iodide is fine as a supplemental source of iodine. Just be careful on the dosage as there are some extreme high-dose products out there, as with some iodine products also.


#7

[quote]Bill Roberts wrote:

I was thinking your posted, older blood test was the latest but indeed you said you had one recently. That’s recent enough to be meaningful, if it’s at least a few weeks after your most recent dosage change.

On iodine, if eggs, saltwater fish, potatoes including skin, turkey, and dairy don’t make up a pretty big part of your diet and you don’t use iodized salt or take a supplement, almost certainly you’ll be iodine deficient and that alone could explain your thyroid problem.

If you increase your levothyroxine dose much, then your thyroid is unlikely to regain natural production as it will be suppressed by the added levothyroxine.

At your present dose, recovery of natural production could occur once correcting your iodine intake. So, because it sounds very likely that you were deficient, I’d want to correct that first and then see if the direction could be discontinuing the levothyroxine, or at least not increasing it.

It is worth testing for free T3; necessary really for a good picture of what’s going on (the closest single measurement you can get to the biological activity.)

Potassium iodide is fine as a supplemental source of iodine. Just be careful on the dosage as there are some extreme high-dose products out there, as with some iodine products also.
[/quote]

Thank you for you assist sir. I will get my T3 tested on Wednesday. What is your opinion on TRT in my case. My last Testosterone test was Free=70.0 and total=336. I know free is more important than total but my total seems low for my age for everything I have read/researched. My free is kind of middle of the road. Or would it be wise to get my thyroid/iodine issues fixed first then see what my numbers end up at?


#8

Everything seems to be in range. Your T is pretty low… And your diet isn’t too bad either, I may just add in some carbs .

In regards to TRT:

It would be more beneficial in the decision-making process if you would get FSH and LH tested. This would indicate whether you are secondary or primary hypogonadism. If your LH and FSH are in a good range, then that means that you are primary and the testicles are not working properly and you will need TRT. If the FSH and LH are low, then you have secondary and the pituitary isn’t working properly and a SERM/ can be used to stimulate it to start working again and that should fix your low T problem. The main concern here is fertility. TRT will shut down fertility unless you incorporate HCG into your protocol.

In this case, it’s your decision. If you care about fertility and testicular size, you can either test FSH and LH and do a SERM/HCG restart (if the FSH/LH are low), or just hop on TRT and add HCG to maintain testicular size and fertility.


#9

[quote]Slasher917 wrote:
Everything seems to be in range. Your T is pretty low… And your diet isn’t too bad either, I may just add in some carbs .

In regards to TRT:

It would be more beneficial in the decision-making process if you would get FSH and LH tested. This would indicate whether you are secondary or primary hypogonadism. If your LH and FSH are in a good range, then that means that you are primary and the testicles are not working properly and you will need TRT. If the FSH and LH are low, then you have secondary and the pituitary isn’t working properly and a SERM/ can be used to stimulate it to start working again and that should fix your low T problem. The main concern here is fertility. TRT will shut down fertility unless you incorporate HCG into your protocol.

In this case, it’s your decision. If you care about fertility and testicular size, you can either test FSH and LH and do a SERM/HCG restart (if the FSH/LH are low), or just hop on TRT and add HCG to maintain testicular size and fertility. [/quote]

fertility is not really an issue. Two kids is all we want so that part of are life is set. I am just trying to feel better/get healthier. The last 3 or so years I have not felt right and it is getting worse. Thank you for you insight and I will do some research this weekend over the things you mentioned.


#10

Simple answer, Yes. It took a concerted three prong process (diet, medication, stress-relief/rest/re-evaluated training) and it was a good 1- 2 year process.

I would have to say, perhaps I was a little over enthuse about my assessment of your situation. Its just a topic I’m passionate about it. So I apologize for that, if it came across any other way, then I had intended.

If indeed it is just a thyroid issue, all the advice above me, seems fairly solid.

Best Regards.


#11

Human Growth Hormone: <0.1 : NT : <=2.9 mg/mL
You should test IGF-1 to eval GH status and not test GH itself.

Were you fasting for those labs?

You can use body temperatures as a thyroid medication dosing guide. Getting TSH “normal” is misguided.

TSH, High Sensitivity: 5.51 : 2.19 : 0.45-4.50 mU/L
T3 Free Non-Dialysis: 3.1 : NT : 2.0-4.8 pg/mL
T4 Free Non-Dialysis: 1.2 : NT : 0.8-1.7 mg/dL

TSH is very high, suggest that you also check for thyroid antibodies
Serum fT3 is not bad. When serum fT3 is good and body temps are low, rT3 needs to be checked.
Read thyroid basics sticky and note references to rT3, adrenal fatigue and stress

Then or now: Is your thyroid enlarged, asymmetrical or lumpy? Can you see your thyroid in the mirror? Are your outer eyebrows sparse? Dry skin? Feel cold easily.

You need LH/FSH before attempting TRT. !!!

Guys with thyroid functions typically cannot absorb transdermal T and you would be better off with self injecting.

If you go to a T shop, thats what you will get. What you really need is some diagnostic effort to find out why you have the symptom of low T instead of just covering it up.

Need these labs, you have some now:
FT
TT
E2
LH/FSH
AST/ALT
IGF-1
AM cortisol
Vit-D25


#12

[quote]KSman wrote:
Human Growth Hormone: <0.1 : NT : <=2.9 mg/mL
You should test IGF-1 to eval GH status and not test GH itself. [/quote]
I will get the IGF-1 test. My Dr listed the HGH.

[quote]KSman wrote:
Were you fasting for those labs? [/quote]
Fasting and in the AM.

[quote]KSman wrote:
You can use body temperatures as a thyroid medication dosing guide. Getting TSH “normal” is misguided.

TSH, High Sensitivity: 5.51 : 2.19 : 0.45-4.50 mU/L
T3 Free Non-Dialysis: 3.1 : NT : 2.0-4.8 pg/mL
T4 Free Non-Dialysis: 1.2 : NT : 0.8-1.7 mg/dL

TSH is very high, suggest that you also check for thyroid antibodies
Serum fT3 is not bad. When serum fT3 is good and body temps are low, rT3 needs to be checked.
Read thyroid basics sticky and note references to rT3, adrenal fatigue and stress[/quote]
I will have the rT3 tested. I really don’t think I have adrenal fatigue. I really don’t have that much stress in my life other than traffic.

[quote]KSman wrote:
Then or now: Is your thyroid enlarged, asymmetrical or lumpy? Can you see your thyroid in the mirror? Are your outer eyebrows sparse? Dry skin? Feel cold easily. [/quote]
No enlarged or asymmetrical thyroid that I can see. No thinning of outer eyebrow. Yes on dry skin. Don’t get cold actually the opposite.

[quote]KSman wrote:
You need LH/FSH before attempting TRT. !!!

Guys with thyroid functions typically cannot absorb transdermal T and you would be better off with self injecting.

If you go to a T shop, thats what you will get. What you really need is some diagnostic effort to find out why you have the symptom of low T instead of just covering it up. [/quote]
The only reason I looked at TRT is that my Dr put me on Angrol gel. With the wife and kids I did not want to deal with it so I thought injection would be easier. Will get LH/FSH tested before starting and do more research. I would rather not be on Androgel or injects if I can get things fixed and raise my testosterone without them.

[quote]KSman wrote:
Need these labs, you have some now:
FT
TT
E2
LH/FSH
AST/ALT
IGF-1
AM cortisol
Vit-D25
[/quote]
Will get those that I don’t have during my appointment Wednesday.

From the reading/research I have been doing over the last several days about iodine I think that I am low on iodine. I use hardly any salt and most of it is sea salt or seasoning salt.

Thanks for your help.

EDIT: In your opinion would it be better to cancel the TRT clinic appointment and look for someone to do my eveluation. I am sure the TRT clinic will recommend TRT.


#13

[quote]tcataz wrote:

Thank you for you assist sir. I will get my T3 tested on Wednesday. What is your opinion on TRT in my case. My last Testosterone test was Free=70.0 and total=336. I know free is more important than total but my total seems low for my age for everything I have read/researched. My free is kind of middle of the road. Or would it be wise to get my thyroid/iodine issues fixed first then see what my numbers end up at?[/quote]
I agree with the excellent answers you’ve gotten above.

I’d see where you are and where you can be with the thyroid first. It could be that that is your entire issue.

Also agreed on needing LH/FSH next time.


#14

I have been talking Kelp tablets and iodine for a little of a week now. Started taking 800-1000 mcg/day have dropped it down to 400-600 mcg/day. I have also been using the Adrogel for 2 weeks.

After 2-3 days I feel much, much better. The last couple of mornings my temps have been 97.4 and afternoon at 98.5. My sleep has been better. I feel like I have more energy and I can make it through my workouts without crashing. I have also noticed that my muscles feel “harder”. I did not go the TRT clinic since I wanted to try and get things with the Thyroid workout.

How long after starting the iodine should I wait to have everything tested agian?


#15

So have not posted in a while but several things have changed. I switched doctors and he took me off Androgel and put me on Test Cyp injections. I feel so much better since switching from Androgel to shots. I have lost around 35lbs, gained some muscle and feel much better. I have been on the shots for around 1 year. Below is my currently injection schedule.

-Test Cyp 160 mg on Thursday @ 4:00 pm
-HCG 500 iu on Thursday @ 4:00 pm
-Amridex 0.25mg on Saturday morning (after my latest blood test he switched to 0.25mg on Friday afternoon and 0.25mg on Saturday afternoon)
-Levothyroxine 75 mcg every morning

OTC:
Fish oil, kelp, multivitamin, Vit D and ZMA.

I had blood tests done on 4/21/16 exactly 7 days post injection. Here are the results:

TSH, High Sensitivity: 2.19, range: 0.45-4.50 mU/L
Total Testosterone: 868, range: 336 : 250-1100 mg/dL
Prostate Specific Ag: 0.5, range : <=4.0 mg/mL
Hemoglobin: 15.6, range: 13.0-18.0 g/dl
Estradiol: 39.7, range: 8-43 pg/mL
Blood pressure: 112/61 (this has really dropped since being on TRT)
Pulse: 60 bpm.

When the test was taken I was on Amridex 0.25mg on Saturday morning. He switched me to 0.25mg on Friday afternoon and 0.25mg on Saturday afternoon. He would like to get my Estradiol down to around 30 pg/ml.

I did a consultation with another doctor today. She seemed very knowledgeable and nice to work with. She said that my last blood test the Test level look good but my Estradiol should be between 20-25 pg/ml and my TSH should be around 1 mu/l. She did not like my injection schedule and thought the HCG was way too low. She said that twice a week is a much better schedule. Below is what she would do for an injection schedule (it is close to what KSman recommends):

-Test Cyp 50 mg twice a week (adjust to stay in the 800-900 mg/dl)
-HCG 600 iu twice a week
-Amridex 0.25mg twice a week (adjust to get to 20-25 pg/ml)
-Levothyroxine 75 mcg every morning or switch another pill that is T4 and T3.

Currently it cost me $80 a month for shots and blood tests, but I have to go to his office once a week for the shots (about 15 minutes out of the way for me). The rest is covered by my insurance. The new doctor will let me do at home shots twice a week after the first shot. All the supplies will be shipped to me. BUT they don’t take insurance and it will cost around $300 a month. They will give me an itemized receipt and I can submit to my insurance to see if they will cover it.

Some questions, is it worth the extra $220 a month to switch to shots twice a week? Or should a maybe look at doing TRT on my own without a doctor and do shots twice a week? If I decide to do it without the doctor about how much does it cost per month to do TRT (including blood test)?


#16

$300/month seems expensive. My meds cost $130 for 10 weeks worth. That includes 2000mg of T cyp, ten 1mg anastrozole tabs and 5,000iu of hcg and all the syringes.


#17

Do you go through a doctor?


#18

I get the prescriptions from a doctor but I get the meds from a pharmacy.


#19

I need to find a doctor like that. This lady seems to recommend everything that I have read on this forum and others like it. The HCG is a little higher than what I have seen recommended 1200iu a week. The convienence of doing everything at home would be nice but $300 is steep compared to $80 I am paying now.

EDIT: Another option would be to stay on my current protocal for $80 and buy HCG online. The armidex he give me a bottle of pill every couple of months so I could up the dose to lower the E2.


#20

Just so you know. Blood work for me is only covered once per year. Any other testing is out of pocket. So I spend about $400/yr on labs. So that adds another $33/month and that’s if I only do labs two other times in a year.