T Nation

Total T 386, Doc Says No TRT?


#1

Hi, looking for some advice. I'm 40 and have some pretty bad symtoms of low T so my Dr ordered a blood test. He says T is fine at 386 and gave me a script for Zoloft instead. Yeah I'm depressed but so would anyone who's sex drive is, ummm, on a scale of 1 to 10 about 0.5 on a good day. It's been like this and getting worse over the past 4 years or so but now I have to do something about because my marriage is falling apart.

And I'll do anything to keep my family together. Enough whining like a little b*tch.

I've been working out for 25 years. Lately it's 3 months on / 3 months off because eventually my knees and elbows hurt too much. I'm just wondering if it's possible 386 is too low and if I should see another Doctor? Or is a lifetime of TRT too extreme for someone above 220ng/dl (or whatever, this is the level he says I'd have to be at) He says the risk of prostate cancer and bone problems are too bad to consider it. From what I've read this is B.S.

Maybe someone can recommend a good Doctor in the Seattle area?


#2

Can't help with locating a Dr. in your area but I went through alot of what you're going through now. Any doc that's gonna tell you you're "fine" or "normal", get rid of him. I looked for a Dr. who was a D.O. (doctor of osteopathic medicine). Basically they listen first and foremost to YOUR problems and then compare them to the bloodwork. Even if your within ranges, they won't dismiss your symptoms. Also start doing your homework here and learn up on TRT, andropause, serms, aromatase inhibitors, thyroid issues, and bloodwork results, etc.

It's daunting but it will only benefit you. There are stickies here and in the steroid forums you'll need to check out. If your thyroid is an issue, Google "Mary Shomon" and look up her website. Look for any threads by Happydog48 and KSman. Actually, KSman will most likely drop by this thread any minute now.....

Edit: aromatase inhibitor = AI


#3

ry3, were there any other hormone tests done? Tested PSA, CRP?

What are your cholesterol numbers? Blood sugar level [glucose]?

Drugs, Rx or OTC can cause hormone problems. So can a blow to the head. Any changes to range of peripheral vision or other visual field disturbances.

SSRIs will further erode your libido, not a good direction to go.

Liver problems can reduce E2 clearance, allowing E2 levels to increase.

Some docs only look at free T [FT] and do not care about TT as most of TT is SHBG bound T that cannot activate T receptors.

You might also have elevated or high estradiol [E2] levels that block the action of what T you have. E2 can also reduce your T output - an estrogen trap. E2 also causes prostate problems.

If you need to loose fat, that fat can be increasing E2 and thus also lowering T. Then you can't loose the fat - estrogen trap.


#4

Your T levels are roughly the same as mine were just over a year ago, I was suffering the same symptoms as you.
After just a few weeks of my TRT I was a new man.. My wife, who previously would want sex way more than the libido could keep up with, can be often heard saying "Can we at least skip one day now and then? I'm sore as hell."

As far as finding a Dr who won't blow you off, try the great advice that was recently given to me in the following thread:

http://tnation.tmuscle.com/free_online_forum/sports_body_training_performance_bodybuilding_senior/looking_for_a_good_trt_doc_california_socal_andor_nocal


#5

Wow that's awesome informal68 - I would be willing to fly down to San Diego avery 3 months if that's what it took. As a last option, I'll contact your Dr. I had to show my wife your post... maybe there's hope for us yet despite the hell we've been though over this. She is a total nymphomaniac so you can just imagine. It's a miracle we haven't split up sooner - I think only because we were so close before this.

Today I went back to same Dr and my wife was with me this time. I get a feeling he thinks I'm putting him on because I have a little muscle. He still said he won't give me T because the "side effects are too severe and life-threatening", but I did get at least get referral to an endocrinologist this time.

I was also armed with some more intelligent questions. No, he didn't even test me for free T. He didn't really know what a normal range would be for someone my age. The averages he has covers ALL men and he admits he could be comparing my number to what might be normal for a 70 year old. I probably wouldn't want a doctor so uneducated in this field running a TRT program anyway.

It makes me angry that I'm a peice of paper away from something that could potentially keep my family together and I can't get it. I have kids 5 and 9 yrs old. I've never juiced (no offense to anyone who does, I was always just chicken) so I don't take the decision to take medication the rest of my life lightly.

I don't think bodyfat is bad enough to be an issue - the AccuMeasure has me at 15.3% I know those things aren't exact but it should be ballpark. I'm 6' and 225 lbs. I still am working on dropping another 15-20 lbs though, anything that could help. It has been getting a little tougher keeping muscle and losing fat, I was 235 at estimated 12% bodyfat 3 years ago when libido problems were just starting to get bad.

KSMan, this time I only had the T test, but 3 months back when I first went in reporting a problem I had more typical bloodwork. The only thing I had that you mentioned is Glucose. But they did do a thyroid test. I don't even know what a lot of the things on the list are (Lymphocytes, Basophils, etc). Some are just mineral levels and blood cell count. I definitly have some research do to, as poophead mentioned.

Glucose Random (normal 75-139) 92mg/dL
Thyroid Stimulating hormone 1.39 milli intl-units/L

Everything is normal range, comments at the bottom are "labs are normal". I ended up with a Wellbutrin perscription. Which turned out to be a useless waste of another 3 months.


#6

Definitely try the compounding pharmacies for referrals, Unless you live in the middle of nowhere, I'd be willing to bet you'll have good luck, The first one I called tossed me 3 names and numbers that are within 10 miles of me.

If you have any questions feel free to send me a PM.


#7

Thanks man, I tried that and found 2 places that look like they would help anyone who's hormone levels are below average. They don't take insurance but I'm willing to go that route if I have to. Just compared to the lawyers-alimoney-child support of a divorce it's a small price to pay. Not to mention the long lasting emotional damage to my kids (and myself) that I would avoid at any cost.

In the meantime, the endo I'm referred to by my doctor now has me booked for a 7/23 appointment. 3 weeks of waiting but hopefully it's worth it. I looked up the Dr and it's looks like this is his first job after fellowship which has me a little worried! What would a brand-new Dr be likely to think? More progressive, or still blindly following lessons from their teachers?


#8

A new doc might have learned something new in med school that may have be more useful to you than an old doc who is experienced at doing things incorrectly for 20 years.


#9

I hope so. Just in case I am also going to see another Dr who specializes in TRT - that way I'm not back to square one 2 months from now if this one turns out to be as useless as the first. TRT Doc talks about the same stuff as you and also recommends I read "The Testosterone Syndrome", which I saw you do on another thread (ordered a copy today). It gives me confidence in him to think he's on the same page as you.

Only problem is he doesn't take insurance, which should be fine unless I'm looking at 10k a year or more for treatment? I really have no idea, if one needs to pay out of pocket what should I expect between Dr visits, labs, and perscriptions combined? I would almost rather pay to get this done right than stumble along with someone with little/no experience. From what I've read here it seems like a lot of doctors are just as likely to screw you up more.


#10

I'm going to guess my first year of TRT ran me about 3-4k(Dr's visits/testing/medication) If the Dr I found in my area is someone I want to work with, It will reduce my costs by about 90 percent (insurance)

Good luck man.


#11

I pay for everything out of pocket. My age management specialist dropped BCBS after they started blackballing him for writing so much T and GH. Dropping insurance is not always something that docs want to do. I now do my labs as he specifies via LEF.org/LabCorp and get my T cyp and hCG at Sam's club, very cheap with a Business Membership. I have a high detectability HSA plan and put all of the cost on that via it's HSA debit card. Once dialed in, you should only be doing labs and seeing the doctor every 6 months. Labs in doctor's offices can be costly.


#12

Just a small update, just had a visit with Endo on Thursday. He knows a lot more about this than last doc and has other patients on TRT which is promising. I went in the next AM for another blood draw, this time testing for Free T, SHBG, LH, FSH, iron and Vit D. I asked why no E2 and he said because I have no signs of testicular cancer, and that's the only time he's seen high estrogen in males. Makes me wonder what his idea of high E2 is, I should have asked but it sounded like he wouldn't have said anything over 22.

Doesn't look like I have any enlargement with thyroid, pituitary, liver. So he's a little unsure about why the symptons despite appearing to be in perfect health. I asked about possible high E because of what I've read so much about, he pretty much wrote it off immediately (but I'm not convinced). I lost another inch on my waist and am now in the 14% bodyfat range, yet I can pinch a fold of fat about 1.5" thick under my pecs. That's about triple what I can pinch on my waist!! While I'm getting some definition, even seeing faint abs and veins in my delts, lower chest and thighs are completely smooth. Doc checked for gyno and says I don't have any breast tissue development, but this bodyfat distribution should be a big warning sign of high E2?

Anyway, since the blood is drawn and I have nothing to lose I decided to take a small dose of liquid Anastrozole last night. My plan was 1/3mg 3x/wk for the first week, then drop the dose to 1/6mg. Wow, I thought this stuff was supposed to take 14 days to start working? Took my dose around 10pm, fell asleep, and was up at 3am after having some pretty vivid sex dreams. I don't remember dreaming about sex for at least the last several years, so for me this is huge! Woke the somewhat shocked wife up, had sex, ate, back asleep around 5am. What do you know, more sex dreams!

I know this isn't placebo effect because I've taken lots of other herbs and supps with high hopes before. I'm wondering if this sounds like maybe I'm an over-reponder, or maybe my E2 was just way too high? I may drop the dose to 1/6mg next time instead of doing the 1-week front load I was planning. Seems like I don't need to load.

Many thanks to KSman and the others on this forum for pointing out things most specialists aren't even aware of. And to the "One" Research, I placed my anastrozole order on a Friday and it arrived Tuesday! I actually ordered from 3 different places thinking most would be scams but all came through fine.


#13

Sorry to bring up an old thread again but I got my lab results back and am wondering if I could get some feedback... This is kind of puzzling because my T number came out mid-range this time. I have no idea if the other results are good or not, there is no range listed.

T Free 75.0 pg/mL (normal 35-155)
T Total 640 ng/mL (normal 250-1100)
FSH 1.7 milli intl-units/mL
LH 1.5 milli intl-units/mL
Prolactin 7.7 ng/mL

Also had some liver tests, iron, vit D which all came out normal (mid-range)

Like I mentioned, I've been taking a little anastrozole on a hunch my E2 was high. It gave me a serious kick in the pants the first day but not much since. Blood was drawn before I started so that wouldn't have caused the T increase. I know, its just a shot in the dark until I get E2 tested, I'll have to go through LEF/Labcorp as soon as possible for that.

So, I'm relieved my T is closer to "normal" than I thought but disapointed that I'm back to square one with no solution to my problems... Maybe some HCG would help? Does the fact that the Ldex worked so well for about the first 18 hrs indicate this the path I should be looking down, or is that a typical reaction?


#14

while i cant really help you out on your blood work i do know that if you can grab 1.5 inches of fat on your upper pec and this is significantly more fat than you carry on your waist then you have a serious aromatization problem (converting T to E)

your pecs fat deposits are a direct indicator of your efficiency of converting T to E. ie the higher the pecs measure compared to other fat sites the more T you convert to E which as you would know is a shit situation where you end up with low T and high E.

also remember your libido isn't just totally dependent on your test levels you need the correct balance between test, estrogen, DHT prolactin and whole lot of other stuff which is beyond me.

what im getting at is even if your Testosterone levels are normal like they are in your latest lab, high estrogen will still kill your libido. which you havnt got tested for yet (but is very likely to be very high considering the fat on your pecs)

and if you cant get a doc to prescribe you some T you could consider artificially lowering your T by not sleeping, drinking alcohol, eating no fat. ect before you get some blood work done, doing this will get your levels so low they will definitely prescribe you T

theres even an article on here on how to do it!

http://www.tmuscle.com/free_online_article/sex_news_sports_funny_grok/your_doctor_your_dealer
http://www.tmuscle.com/free_online_article/sex_news_sports_funny_grok/your_doctor_your_dealer_2

edit:
oh yeh i forgot to mention high fat on the quads and hammies in relation to triceps (triceps indicate test levels) also indicate high estrogen and i think you mentioned earlier you had smooth legs as well.
this says to me without a doubt you have a big estrogen/aromatization problem that needs to be sorted.


#15

Yes exactly - and now that I'm losing some fat it's getting a lot easier to see where the heavier deposits are. I think the Ldex is helping here, I've settled in a 2 drops/day which seems to be working. I've had to diet very hard to lose any fat, like 1000 cal on 3 no-carb days per week and 2000-3500 on 2 each medium/high days. This would typically get me to lose about a pound per week which still making some muscle gains. But over the past week I dropped 7 lbs! And my high-carb days weren't as clean as usual. Another libido spike last night too, though nowhere near as strong as that first day on the Ldex.

I saw that article and thought about trying it... That actually sounds like how I used to live my life! Heavy drinking almost everyday, rarely more than 3-4 hours sleep each night, etc. I probably did a lot more damage to myself than I thought. I wasn't aware the alcohol-estrogen relationship until recently. Wasn't beer supposed to make you macho, not girly? I don't want to go back, even if it's just for a week!!

I'd still like to know how it feels to be high-normal (and don't want to fall back to low-normal) with T and am going to start on HCG. Prior to this latest test I was talking options with my Endo he said he uses this for HRT patients who still want to have kids and that the major drawback is high cost... not sure what he means, 5000iu is less than 20 bucks? Maybe he's using very high doses, I was thinking maybe 750iu twice a week? I understand 250iu 3 times/wk is recommended for those on T but from what I've read doses need to be higher to work when HCG is taken by itself.


#16

Testosterone is always highest in the morning. Levels fluctuate through out the day and can drop to almost 0 at times. Think morning wood. This is the reason you are or should always be tested in the morning, unless your on T and then it doesn't make a difference. Might be lucky and be good with just anastozle since it seems to be working for you.


#17

I hope it's that simple, crazy to think I've been miserable for years because I just needed 10 cents per day's worth of anastrozole! And how the 3 doctors I've seen were so useless, other than helping me rule out what wasn't wrong. Morning wood has returned, libido is coming back. Had sex twice yesterday and tried for a third time but my wife was too worn out, LOL. I feel so different I can't even recognize the sorry sack of sh*t I was just a few weeks ago.

The only puzzling thing is why I've been prone to joint pain in the past, with likely high E. Seems like it should be the opposite. For now, I'll attribute it to overtraining.

I also started on HCG this morning. Hopefully to get a little extra boost to the high-normal T range.


#18

Ry3...

Thank you for the thread...

I had tests today, awaiting results... Fat deposits and symptoms are very similar... except I do have joint pain, mostly tendons...

Please keep posting!


#19

Null, where are you getting the joint pain? For me it was mostly elbows and shoulders. But this time around I've been lifting since April with nothing so bad it keeps me out of the gym. The main difference is I'm very careful to keep elbows forward a little on pressing movements and do external rotater excercises at least once a week. But the biggest change is dropping direct arm work completely. Oddly enough my arms seem to be growing better than ever! My guess is the screwed up hormones play havoc on recovery and this is showing up in the joints/tendons long before overtraining has a chance to set in.

And the HCG, wow. Looking back at my blood work, I had LH of 1.5 - Medline has the normal range for men at 7-24. Not sure why the Endo didn't think this was a problem, but the Leydig cells are definitely awake now :slightly_smiling: I wouldn't be surprised if T is 1000 range now, this feels almost too good! When I started I also upped anastozole dose to 4 drops per day. I'm pretty curious to see how this works out over the next few weeks.


#20

ry3: How are you dosing your hCG? How did you convince your endo to write for it? Are you also taking testosterone? Sounds like you are having good results.