T Nation

TRT Journey and Dr. Advice needed


A little background first: 40 year old with typical symptoms of fatigue, foggy head and low sex drive-Around Nov 2009 at physical exam mentioned symptoms to doctor #1 and he tested for total T and came up to 331 ng/dl (range 249-836). Doc says gotta be below 175 before he's worried and here's a script for viagra.

Early March 2010 had to see doctor #2 at same practice for bronchitis as doctor #1 had full schedule. Mentioned to doctor #2 about my other symptoms and T lab results. He says lets test again because it can fluctuate. Results were 171 ng/dl (range 249-836) and tells me to choose gel or injections. Chose the injections which would be 200 mg test cyp every other week administered in office during certain hours on two days of the week.

Retested three months later (June) with result of 424 ng/dl (range 249-836). I at that time convinced doctor #2 to prescribe weekly 100 mg injections. Continued with injections throughout summer of 2010 despite the hassle of having to be in their office weekly as i work out of town.

In the fall, i asked to switch to androgel then back to shots for personal convenience reasons. Was to be retested in December but never was. In December i missed the last three straight weeks of injections due to work schedule and felt horrible.

2011-I wised up and saw doctor #3 in the town i work in. Said he liked his patients to be over 500 ng/dl. Did convince him to check E2 as well.
Results from 01/06:
T = 68 ng/dl (249-836)
E2 = 17.0 pg/ml (7.6-42.6)

Starting from this low point with weekly injections 0f 100 mg test cyp i could literally feel everything that i have read in the stickies and posts taking place in regards to T and E2. Felt the sweet spots come (energetic and morning wood, etc.) then go away only to have the same old symptoms just not to the same degree. Then retested:

Results from 02/18:
T = 474 ng/dl (249-686)
E2 = 46.6 pg/ml (7.6-42.6)
Free T = 10.7 (6.8-21.5) convinced the lab nurse to add this

Doctor #3 then wanted to cut me back (despite being below his 500 preferred level) to biweekly injections of 100 mg (yes 100 mg biweekly). Said hes afraid of overshooting the range. I wanted something to work on the E2 rising. Seemed to avoid that. Agreed to continue weekly 100 mg injections for a month and retest.

Results from 04/01:
T = 502 ng/dl (249-686)
E2 = 50.0 pg/ml (7.6-42.6)
Free T = 14.9 (6.8-21.5)

If anyone can give me your thoughts on these latest results and advice in how to approach the E2 issue with the doctor it would be appreciated. I see him tomorrow and would really like to get the E2 issue resolved. Then i will approach the self injection method-just dont want to ask for too much out of his norm all at once.

thanks in advance


Read the advice for new guys stick and the protocol for injections.

You need to self inject and use anastrozole to manage E2 levels. E2=50pg/ml is killing you.

Post rest of lab work results.

Test TSH, inability to absorb transdermal T is a symptom of hypothyroidism. Check waking body temps and a few times during the day, record for a few days and report back. Using iodized salt, iodine in vitamins, eating sea food?

T lab results depend on timing. A big issue with weekly injections. Suggest 100mg/week with two 50mg doses.

Three idiot doctors. You need to manage your own health care and stop been passive. You can learn all that you need to know here.

Post location and perhaps there will be some suggestions for doctors. There is a sticky for that too.


Thanks KSMAN-I have read the stickies and advice sections and understand from them and posts in this forum that the E2 is wrecking my condition. Doctor #3 never tested TSH but was normal when tested in March 2010. I just dont remember the exact reading. I switched from shots to gel because of the difficulty making it to the clinic during the "shot" times of the week. I then switched back to shots because i didnt want to apply it before bed (wife) and was always rushing to get ready for work at 4AM. I switched back not because of absorption issues but rather the inconvenience of the shot times was the lesser of two evils.

I have listed below the other results from 01/06 which were not fasted results as i called for an appointment and went that afternoon. The results from 02/18 and 04/01 in my original post were the only tests ordered. What i had planned for tomorrows consult with doctor is lay out the protocol you suggest - i have it printed out and will carry it with me. I was really needing advice on convincing an "idiot" to prescribe the arimidex. I do plan to question him directly on why he wanted to reduce my injections and not address the e2.

Results from 01/06/11
Testosterone=68 ng/dl (249-836)
Estradiol=17.0 pg/dl (7.6-42.6)
LH=0.8 mIU/mL (1.7-8.6)
FSH=2.1 mIU/mL (1.5-12.4)
Cholesterol, total =196 mg/dl (100-199)
Triglycerides=211 mg/dl (0-149)
HDL Cholesterol =48 mg/dl (>39)
VLDL Cholesterol Cal=42 mg/dl (5-40)
LDL Cholesterol Cal=106 mg/dl (0-99)
LDL/HDL Ratio=2.2 (0.0-3.6)
Glucose=90 mg/dl (65-99)
BUN=14mg/dl (5-26)
Creatinine=1.2 mg/dl (0.76-1.27)
BUN/Creatinine Raio=12 (8-27)
Sodium=138 mmol/L (135-145)
Potassium=4.0 mmol/L (3.5-5.2)
Chloride=100 mmol/L (97-108)
Carbon Dioxide=21 mmol/L (20-32)
Calcium=9.8 mg/dl (8.6-10.2)
Protein=6.9 g/dl (6.0-8.5)
Albumin=4.6 g/dl (3.5-5.5)
Globulin=2.3 g/dl (1.5-2.5)
A/G Ratio=2.0 (101-2.5)
Billrubin=0.1 mg/dl (0.1-1.2)
Alkaline Phospatase=71 IU/L (25-160)
AST (SGOT)=29 IU/L (0-40)
AST (SGPT)=43 IU/L (0-55)


"Normal ranges" for TSH include varying degrees of hypo and hyper thyroidism.

Best if you don't repeat what your doc says about normal lab results. You need numbers, get old lab reports.


And the root cause of all this was ?


you also really really really need to check your cortisol levels.
please post your TSH result. 1.0 or less is ideal. > 1 is not ideal.


Thanks to all for the responses. Following my friday visit i decided this doctor may have been the most clueless of them all. Sidestepped me, talked in circles, refused my requests to lower e2 under KSMAN's protocol saying it wasnt necessary and under 60 is fine. I reminded him that at my last visit with him he said under 50 was fine. He wanted to lower T dose-i refused that and got a refill for current dose.

Called and got a referral from compounding pharmacist yesterday for dr he says is best one in my area and will prescribe what i need. Stopped by his office and signed to have all my charts transferred to him and should be able to get in and see him in the next week. Will try to get the TSH results from previous labs but i know that hasnt been tested in about a year and cortisol-never have seen that tested at all. Will request all labs in stickies if this new doctor doesnt already check. Thanks again.



This may or mat not help? I always like to produce as much medical information when going to any doctor, I feel Your pain as I'm struggling with the same issue, I've seen endros, hematologist and urologist with little results My primary has listened but yet has to taken my advice as he does openly admit he's not well versed in complete hormone therapy.

One question I have asked my 8 pound water head endro after he told me there's No need to check estrodiol/estrogen levels in men!!!!?

So my response back was..... If a pre menopause/ menopausal women was to be evaluated by you, do You not check their testosterone levels along with their estrogen levels? And treat appropriately?

So the difference is?

Good luck on your quest, I finally found a hormone doctor close by and have done a phone consultation and meet with him May 6th.
I'm hoping my insurance covers some.


Saw doctor #4 today and it was a positive experience. He already had results from first two doctors as i had them transferred from a sister office. Took all my results from doctor 3 with me to share. Informed him i had been self injecting 50mg test cyp twice weekly for the past two weeks. He did not like my elevated e2 and was not satisfied with my total T level from my april 1st blood draw. He was much more in tune to male hormone issues than the others as he just shook his head knowing I had not been getting proper treatment. He prescribed 1mg anastrazole per week and actually felt that a guy my size (5'11" 245lbs)needed a little more T and put it at 150mg test cyp per week. He left injection frequency up to me and suggested dividing the anastrozole up to match injection frequency.

He said "OUR GOALS" are levels where I feel the best, typically he said between 600-800 T and <30 e2. He said he would have no problem prescribing hcg in the future if it were needed. He instructed me to schedule lab work in two weeks on the day of an injection but prior to actually injecting. I did not think to get the makeup of all the labs he would test as i was just so glad to be talking to a dr who understood what i was going through. At that time we would tweek any dosing that may be needed. I think injecting EOD would be much simpler since it is up to me. Any other advice on this EOD frequency is appreciated.


any chance you discussed testing TSH and 8am Cortisol?


We didnt but i will request it.