T Nation

VA Patient Seeking TRT Consult

T Replacement
#1

I get all my healthcare treatment through the VA. My understanding is that VA docs are very reluctant to prescribe TRT, and even more so to do it correctly. I have an appointment with my primary care doc at the end of Feb and I would like to go in armed with labs and knowledge to start a dialogue with her.

My question: What is the most inclusive lab I can order online and get done at my local quest diagnostic? Any other advice is much appreciated. Thanks!

Only labs taken so far: (12/11/2017)
TESTOSTERONE,FR(DIALYSIS) AND TOTAL(LC/MS/MS)
TESTOSTERONE, TOTAL, LC/MS/MS 273 250-1100 ng/dL 01
FREE TESTOSTERONE 74.9 35.0-155.0 pg/mL 01

#2

https://www.discountedlabs.com/pre-trt-male-hormone-wellness-panel

Just an example… not sure about quest imparticular

#3

The problem with the VA doctors is they are mostly robotic, they will look at you TT score and those ranges and say well you’re within range without realizing your age or that most diseases occur below a threshold of 440 ng/dL. If you were to compare your levels to that of an 80 year old man you would lose, in fact our president has you beat at 446 ng/dL at 71 years old.

Also whenever you have a guy at the bottom of these ranges most fail to understand that these blood tests have a large deviation (error + or -) meaning there only so accurate. No one feels good even in the 300 range. Whenever a doctor is reluctant to prescribe TRT it’s a sign their scared because the lack confidence because they have no clue what their doing, it’s easier for them to tuck their tail between their legs.

You should also run a full thyroid panel as we get guys in here all the time that go on TRT and feel worse or no better because their thyroids are also lagging behind and TRT will only work if your thyroid is optimal.

#4

Good news brother. More than likely with that number the VA is obligated to treat you. I know the reference ranges and the bottom is somewhere around 360.

If all goes well, sounds like you have your testosterone covered.

For the most part, VA docs will want you to do gels first, don’t go that route. First they will try and get you to do 200mg either once a month, once every 3 weeks or once every 2 weeks. I’m not joking.

However, the VA does allow you to self inject at home, so you can technically do it however you want.

Be advised though, the standard protocol that is called for on here is 50mg twice a week total of 100 once a week. Which is what the VA will probably give you… (200mg per 2 weeks, or 100 a week.) If you do the twice weekly injections, you can easily get your test into the upper limit (1000 or higher), and the top of VA reference range is 827 (confirmed).

Good to do outside labs before you go into the VA and test high and get it yanked. You will probably have to go to Endo and have an MRI to rule out pituitary tumor.

#5

I appreciate all of the information gentlemen.

Allday, it looks like there isn’t a lab for that particular company in my area.
I did find: https://www.directlabs.com/TestDetail.aspx?testid=1398

Thoughts on that test? I’ll also be adding a full thyroid panel. Any other recommendation?

#6

Its decent, has some basics covered with FT, TT and e2. The VA will recheck your LH and FSH no doubt. I wouldn’t worry so much about buying your own thyroid labs, the VA will check those. But having the low T info is valuable.

#7

@bbackus, it’s my understanding that you pay and schedule through discountlabs.com and choose the lab where they draw the blood. They should provide you with a list of labs in your area where you can have the blood drawn. Let me know if it works out as I’m going to be using them in the near future for labs. Thanks and good luck boss.

#8

I pulled my TSH levels from my last VA apt (07/2017) and I was at 1.52 (0.47-5). In October I started minding a very strict diet and added in a multi + selenium & iodine so I feel pretty confident about my TSH levels. Thoughts @KSman ?