T Nation

Upcoming Endocrinologist Visit

In less than one month I will be seeing an endocrinologist to talk about the possibility of myself start TRT.
Background: I have tested my testosterone levels 2X and both times it came back as low. Since I am 48 yo my doctor suggested either start TRT or meet and Endocrinologist to have a second opinion. I chose the second option because my doctor didn’t ask/checked any other hormone or cross referenced that information with anything else.
Stats:
48 yo 185 lbs 12%bf lifting/exercising since I was 12
Symptoms:
Low energy, no libido, excessive caffeine consumption, terrible sleep, difficulty loosing body fat, ease to add body fat
Lifestyle:
7-8 h sleep lift 4-6X a week no cardio yoga/hot yoga 1-3X a week Pilates 1X a week
Eat very close to Paleo (a lot of night shades if that matters)
Alcohol on weekends only
Sugar addict (I indulge very often but never more than 1X a week)

Questions:
1 - what shoudl I ask the doctor
2 - what information should I have ready for him?

Thank you for your time

If you’re in the US the next step, which should have been through your primary doc, would be a sleep study. Sleep apnea will crush hormones.

Doc will want to know all of your supplements and medications.

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You want a complete workup I’m including in the list below, but your endo may or may not know how to prescribe TRT, the every two week protocols are to be avoided at all costs. If your doc attempts to prescribe an every two week protocol, you can make a good guess he doesn’t have much experience prescribing testosterone.

You should inject T at least once weekly or more to optimize treatment.

You should ask what Total T values doesn’t he target for treatment. You could arm yourself with studies showing where poor health outcomes are commonly seen.

Testosterone Threshold for Increased Cardiovascular Risk in Middle-Aged and Elderly Men: A Locally Weighted Regression Analysis.

  • Total T
  • Free T
  • SHBG
  • Estradiol Sensitive (E2)
  • LH-Luteinizing Hormone
  • FSH-Follicle stimulating hormone
  • Prolactin
  • Cortisol
  • Ferritin
  • Thyroid Panel -> TSH/Free T4/Free T3/Reverse T3/antibodies
  • CBC-complete blood count
  • Comprehensive Metabolic Panel
  • Lipid profile/panel
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I live in Canada, have had 2 studies done, yes apnea is an issue but isn’t major.

Thank you for the, response I will make sure that I bring the studies to the specialist.
With the list of supplements

TRT can be challenge in Canada, but there are very good docs in Canada, they are just few and far between. There are a few members here who live in Canada, @dbossa is one and he could recommend his doc, but they are private if I’m not mistaken.

Dr. Lawrence D. Komer Burlington in Ontario runs a men’s and women’s hormone clinic and only hear great things about him.

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With sleep apnea ruled out, I’d find a TRT practice.

I would start with these labs:

Lipids
CMP
CBC
total testosterone
free testosterone
estradiol (the IA test is fine but you can get either that or LC/MS/MS
FSH
LH
prolactin
IGF-1
TSH
free T3
free T4
DHEA-S
SHBG
VitD
PSA

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