T Nation

Young Man in Military Starting TRT


#1

-Age: 36
-Height: 5'7"
-Waist: about 33" tape measure at the naval, size 30 pants
-Weight: 165 - lost around 10 this year so far.
-Describe body and facial hair: Plenty of hair on legs, forearms, little on chest, grow facial hair fine but a few spots that do not grow, pubic and armpits thick. I have a light frame.

-Describe where you carry fat and how changed: My arms and legs are very lean. Carry almost all of my fat in abodomen and neck
-Health conditions, symptoms [history]: Gallbladder removed earlier this year, vasectomy 3 1/2 years ago, severe GERD, depression, anxiety, chronic cough from GERD when not on double dose of Nexium, asthma ruled-out, varicocele near both testicles.

-Rx and OTC drugs, any hair loss drugs or prostate drugs ever: Nexium (stopped taking, side effects huge) Allegra (just stopped, allergy shots are amazing) Zoloft & Wellbutrin... Want to quit these I hate them - a week after my first TRT shot depression and anxiety were GONE. Now a week later they are back.

-Describe diet [some create substantial damage with starvation diets]: Cleaned up diet quite a bit... still do fast food a couple of times a week. Focusing on more protein and vegetables. I do drink two times a week or so - 1 or 2 drinks.

-Describe training [some ruin there hormones by over training]: I haven't been training for a year... it's disgusting. I keep having false starts on running and strength training.

-Testes ache, ever, with a fever?: Yes - thought pain and "tubes" were normal for a dude ever since a doc said it was since puberty. As soon as I exposed my genitals the uro, without even walking across the room said I had a large varicocele. Ultrasound indicated varicocele on the right side as well. It's ridiculous that I've put us with this pain I am scheduled for a varicocele embolization at the end of the month. No fever. Been putting up with this for a quarter century! The urologist was surprised I was able to get my wife pregnant... don't worry, they both look just like me!

-How have morning wood and nocturnal erections changed: Five years ago - anytime I woke up in the night or in the morning I would have an erection. Last couple of years it has been not as often to now it is just plain rare in the morning. Two days after my first (only so far) TRT shot it was back with a vengence! Not just that, but also random erections during the day too. Erections just as... awesome... as they were five years ago. Now, another week after the shot - things are almost back to pathetic again.

I used to be a stallion. Five years ago my libido went from very high to tapering down to the low/none that it is now. Until my first TRT shot we had not had sex this year - we did five days in a row after it! We used to have sex almost every night. My wife has a lot of 'energy' and is always ready and willing unless she's having trouble with neropothy (cancer survivor). At great effort and little joy, I would masturbate every couple of weeks to remind myself that I still could finish. I've also gone from a shooter to a dribbler.

I have large issues now with strength (never been that strong anyway), sleep (sleep studies confirm insomnia, no apnea), endurance (I used to run marathons), depression (had no problems with this ever until about five years ago), anxiety (always had a little - now though it is destroying my work), concentration, motivation, even my intelligence (I'm in one of those smart-guy military jobs and score in 5th percentile or better on every standardized test I would take, including GRE & ACT, I was accepted to MENSA, but quit because I didn't like how elitist they acted).

Labs prior to HRT:

I took one lab from the urologist.

The only result I was told was

total test 313 ref 280-800

I've had two other testosterone tests:

May 2014:

Testosterone, Serum or Plasma Quantitative
391 ng/dL 193-836

Albumin, Serum or Plasma Quantitative
4.8 g/dL 3.5-5.2

Sex Hormone Binding Globulin, Serum or Plasma Quantitative
36 nmol/L 11-76

Testosterone.Free, Serum or Plasma Quantitative
71 pg/mL 33-138

Testosterone.Bioavailable, Serum or Plasma Quantitative
185 ng/dL 77-346

May 2013:

Testosterone, Serum or Plasma Quantitative
340.5 ng/dL 280-800

Hemolysis Index, Serum or Plasma Quantitative

NORMAL

Lipemia Index, Other Specimen Quantitative

TRACE

Icteric Index, Other Specimen Quantitative

NORMAL

Ive had three low Vitamin D labs. I get much more sun nowadays though and the ache joints that the doc blamed on Vit D have improved greatly and rarely are an issue - they used to be terrible.

Cholesterol was high two years ago - has been normal for a year.

As mentioned above -

I just started treatment with a urologist. 400 mg once every three weeks. His typical is 400mg once every four weeks. From my understanding this is not a super regimen - some pretty serious troughs. I am at two weeks now and I am back to feeling AWFUL.

At the end of the month I am having a varicocele embolization. Maybe that alone can get me going.

I am seeing an endo in KC middle of next month. If my uro isn't flexible on the concerns of dosage, frequency, discussing HCG and AI, and self-administration, maybe the endo will be.

I've read a TON of infomation and the stickies. My questions specific to me:

I've seen there are a few Kansans on here. I would like to somehow, not on a public forum (seriously, there's no PMs on this forum?!), to find out what MODERN TRT docs you have found in the Atchison, Leavenworth, Lawrence, KC, St. Joe area. I'm looking for one that is willing to discuss HCG and AI and such. Also am looking for one that is willing to allow me to self-inject (which would really be my wife injecting me!)

I would also really like to have a chance to meet a few fellow Kansans that have these same type of issues. I really could use a sympathetic MALE buddy to talk with on this - maybe over a beer. My wife is more than willing to talk - and is as understanding as can be - but she lacks, well, balls, I mean a perspective to truly relate.

Thanks!


#2

My Urologist was a complete tool. His focus was simply prostate issues for the elderly and didn't have any interest in learning new treatment methods since his retirement is fast approaching. If I had listened to him I would have had a life of celibacy and no drive in life.

I got a referral from my gp to see an endo and it was a completely different experience. The guy was up to date, puts the patient in a position to make choices, and showed that he could adjust to practical things like medication pricing and personal preference.

Hopefully your experience with the Endo is similar to mine.


#3

See the finding a TRT doc sticky.

Self injections with insulin needles is easy to do, you will end up doing that yourself at some point.

With your infrequent injections, your labs are quite meaningless.

Can you get the details of your labs and post. There must be more than that.

Did they ever test LH/FSH? After your varicocele embolization your T levels might improve. But if LH/FSH were low, that may not be sufficient. I expect that you will be off of the T to see if you can fly on your own. A SERM restart might be useful.

Prior to TRT, if LH/FSH were low, E2 and prolactin levels would have been useful for diagnosis. When you are flying on your own, if T levels are not good, those labs will be useful.

I would like to see AM Cortisol results. If cortisol is high, one can get skinny limbs and an apple shaped body.

Self screen for functional hypothyroidism: check body temperatures [AM, PM] as per the thyroid basics sticky. If thyroid levels are low, you will have low energy and difficultly loosing fat.

GERD: You may have http://en.wikipedia.org/wiki/Hiatus_hernia
Weight loss can be very useful.

Get hard copies of your prior labs.

66047


#4

That was fast! Thanks for getting back. I'm working with a GI doc. I do not have a hiatal hernia. We are doing additional testing to see if I am a candidate for a surgical solution to my GERD.

I'm in the Army - I've already learned the lesson to keep hard copies of EVERYTHING.

I just did a google search for compounding pharmacies at a zip code other than mine but close to my place...! Sent them an email.

Below are all of my labs from the last two years EXCEPT for the testosterone test the uro pulled. I see them on next monday I will get it then. Since rnages are included I won't type the units.

JUL14 CHEM 14
Albumin 4.2 3.4-5
Billirubin .3 .1-1
Calcium 8.9 8.5-10.1
Chloride 103 98-107
Creatinine .73 .8-1.3
Glucose 99 74-106
Alkaline Phos 110 50-136
Potassium 4 3.5-5.1
Protein 7.2 6.2-8.5
Sodium 140 136-145
Alanine Amino 36 30-65
Aspartate Amino 23 15-37
Urea Nitrogen 10 7-18
GFR Non-Black 119.3333 90>
GFR Black 137.95 90>

MAY13 CBC
WBC 6.7 3-10.7
RBC 4.97 4.08-5.76
Hemoglobin 14.8 12.8-17.2
Hematocrit 44 37.2-48.5
MCV 88.5 78.8-95.7
MCH 29.8 25.8-35.5
MCHC 33.6 33.2-36.8
RDW CV 13.8 9.4-15.6
MPV 10.9 8.1-11.5
Platelets 169 147-376
Neutrophils 58.7 40.9-69.7
Lymphocytes 31.5 18.6-45.6
Monocytes 8.5 5.2-12.9
Eosinophils 1 0-6
Basophils .3 0-1.5
ABS Neutrophils 3.9
ABS Monocytes 2.1
ABS Basophils 0
ABS Esoinophils .1

Liver function
Albumin 4.3 3.4-5
Bilirunin .4 .1-1.0
Alkaline Phosphatase 108 50-136
Protein 7.4 6.2-8.5
Alanine Aminotranferase 63 12-78
Aspartate Aminotransferase 32 15-37

IgE 44.8 kU/L (Gallbladder removed at this time)

Vit D 25 30-100 LOW

APR14 Lipid
Cholesterol 152 0-200
Triglyceride 109 15-200
LDL 98 0-130
HDL Risk 4.8 4.4-5.0
HDL 32 35-60 LOW
Cholesterol non-HDL 120 <130

Alanine Aminotransferase 87 12-78 HIGH

Liver Function -
Similar results

JAN14Lipids
Cholesterol 256 0-200 HIGH
Triglyceride 151 15-200
LDL 194 0-130
HDL Risk 8 4.4-5 HIGH
HDL 32 35-60 LOW
Cholesterol non HDL 224 <130

SEP13 Vit D 28 30-100 LOW

SEP13 Glucose 94 74-106

SEP13 Lipids Similar to next test (listed above

MAY13 Vit D 15 5-60

MAY13 CHEM 14
Albumin 4.1 3.4-5
Billirubin .4 .1-1
Calcium 8.9 8.5-10.1
Chloride 103 98-107
Creatinine .8 .8-1.3
Glucose 94 74-106
Alkaline Phos 109 50-136
Potassium 3.9 3.5-5.1
Protein 7.3 6.2-8.5
Sodium 138 136-145
Alanine Amino 49 30-65
Aspartate Amino 28 15-37
Urea Nitrogen 12 7-18

MAY13 CBC
WBC 6 3-10.7
RBC 4.93 4.08-5.76
Hemoglobin 14.7 12.8-17.2
Hematocrit 42.4 37.2-48.5
MCV 86 78.8-95.7
MCH 29.8 25.8-35.5
MCHC 34.7 33.2-36.8
RDW CV 12.7 9.4-15.6
MPV 11.1 8.1-11.5
Platelets 174 147-376
Neutrophils 51 40.9-69.7
Lymphocytes 39.9 18.6-45.6
Monocytes 7.3 5.2-12.9
Eosinophils 1 0-6
ABS Neutrophils 3.1 1.3-5.9
ABS Monocytes .4 .2-.9
ABS Basophils 0 0-.1
ABS Esoinophils .1 0-.4


#5

Also - I should add - the 391 total test was when I was trying to raise mine naturally. Was taking ZMA, GNC's Mega Man testosterone, increased protein and strength training.


#6

Odd that total cholesterol would be changing so much.

Everything looks good. Stay on top of the LH related issues that I outlined.

Whats going on with your energy levels through the day? Initiative to get things done OK?
How do you react to major stress events? These can knock you down for a while?


#7

I was on lipitor for a few months.

Energy is very low. Motivation is awful. Very unproductive. I have learned to avoid stress... because I just can't shake the inner pessimist! This is all opposite how I used to be.


#8

I called the uro. They want me to get my t drawn again today to see where my levels have gone. I asked to have a thyroid panel added.


#9

Based on your response re stress, you need to get 'AM cortisol' done, at 8AM, or 1 hour after you wake up if an early riser.
Concern is adrenal fatigue. If so, rT3 can be elevated, blocking fT3.

TSH, fT3,fT4 [not T4, T3]
AM cortisol
rT3

Self screen for functional hypothyroidism: check body temperatures [AM, PM] as per the thyroid basics sticky.
Self screen for functional hypothyroidism: check body temperatures [AM, PM] as per the thyroid basics sticky.
Self screen for functional hypothyroidism: check body temperatures [AM, PM] as per the thyroid basics sticky.
Self screen for functional hypothyroidism: check body temperatures [AM, PM] as per the thyroid basics sticky.
Self screen for functional hypothyroidism: check body temperatures [AM, PM] as per the thyroid basics sticky.


#10

Silliness continues.

Turns out my wife threw out our thermometer a week ago because it was no longer working. I will pick one up today and check my temperatures in the morning.

I received results from my "thyroid panel"

They only put me in for TSH. Typical. 1.1 I forget the ref range - it was very similar to the one I read several places on this forum and if I remember right 1.0 was a great place to be.

I will wait until I get the T results to see if they will give me another injection. If they do I will go with a list of labs I want - I saw the before list in the stickies and also from KSMan post above - since I have already received an injection and am hopefully getting a second today - should any modifications be made to this list? If they give me any pushback on putting me in for labs (why the hell would they do that?!) I'm sure that my PCM would do it.

I will also be asking him specifically about his views on HGC and an aromatose inhibitor. I'm was worse now than before I received my first injection. My concern is estrogen - since I am sooo down and almost, embarrasingly, feel like I am on the edge of breaking down in tears... and I haven't cried since I was a child!

One thing that seems odd. All of my symptoms came back EXCEPT for the erectile issues. I am still waking up with morning wood every day - and have surprises out of nowhere throughout the day. However it feels almost numb and I wasn't able to finish the deed with my wife on two attempts. I didn't lose erection - but just couldn't climax. Last night was able to with a LOT of masturbation - I NEEDED to know that I still could... I could barely at that - I'm concerned that everything is shutting down. Does any of this make sense?


#11

We have seen many cases with weekly injections where the results are poor.


#12

I am stuck waiting until I see an endo on the 20th of August. Good news is that I have heard great things about him as being progressive and thorough... not specifically to TRT though.

I just talked with a nurse at the urologist.

She said that my numbers were normal at 597. I asked about any other metrics including free and she said they only checked total. I also asked her if they tested anything else last time around - only total. When I asked if they could test anything else, such as estrogen numbers she said that the doctor "does not do that" - they only check the testosterone. She said that I should wait until my monday appointment and that with my 597 I could wait even longer.

So hell. I don't know if I should go in on monday at all. I'm tempted to say screw it and wait until the 20th of next month. Would my endo have a much clearer view of where I truly am if I did that?

Should I rise back to where I was prior to the injection?

They are going to give a huge 400mg shot on Monday if I go in and I'll feel almost euphoric for a few days or a week or so (if it goes the same way) and then I will have a massive crash again. At that point it is a matter of getting another shot right before the endo or go in w/o.

I really need some good advice on this.

I've never met the doctor that refused to put in for tests.


#13

I've made the decision to stop playing the roulette wheel of referrals to doctors that have no appointments for two-three months just to see if they practise modern and progressive medicine rather than outdated regimes from back in the day when they were ambitious to learn or blindly following the first article to come up on a google search.

Add to my list of symptoms that I am bitter and angry and square my insomnia.

I called a national group... one of those membership fee places. Going out for labs today - will schedule an appt. with a doc when the results come in. I will have to drive to Tulsa to see him. Horray for driving across Kansas. Then they will send the appropriate medication in the mail with all supplies. The fee includes all follow-up lab testing, the initial testing, all supplies, medication, initial doc appnt. and yearly follow-up appointments. They said it vaires by client - but typically they send test, HGC and an AI. I believe they might send B12 also.

I will be paying out of pocket. But I don't care. And the prices are pretty reasonable.

In the meantime: I will still go to my monday appt. for the 400mg injection. And I will still see the endo next month to look for contributing issues. I am still getting my varicocele embolization next week.

Fortunately I already have a massage booked tonight. Normally it's focused on some exciting military injuries - this might be the first time when I ask him to just focus on relaxation. I have never felt to wrong in my head. I'm sure KSman can speculate as to what's happening in there.


#14

Rock Creek Welless Center. Dr Mark.
5401 College Blvd
Suite 203
Leawood, KS 66211


#15

Thanks! I've already send funding down another route though. Hopefully someone in the area in need will find this. If the route I am going doesn't work out then this will be my fallback.


#16

I received a second shot of 400mg test. cyp this morning.

The doc didn't like that I had crashed so badly despite my numbers being "excelent" mid last week with a 593 total.

I requested a full copy of my records with them.

I did see the initial bloodwork they conducted.

They only tested total and free. 313 (240-950 and 9.4 (9-30).

He thought maybe I just needed to run higher - and is increasing my dosage to 400 every other week. I went ahead and made an appointment - even though I plan on cancelling when other treatment begins.

They did draw again today - this time for t, free-t and est. Will serve as a good trough-level to show to the new doc.


#17

As I have stated before. Lab work is rather pointless when injecting infrequently.

So they never checked LH/FSH and don't know if you are primary or secondary.

Have you checked your body temperatures?


#18

What group? And how much is it costing you? Curious as I am in a similar situation with nowhere to turn.


#19

jdub, are you looking for a doc in the KCKS area? I reference one above.


#20

The numbers I just posted - 313/9.4 were from a draw BEFORE I started TRT. Those were the numbers when the uro decided "I guess you are pretty low, we can try it and see how it works."

I have copies of ALL of my labs from the last two years - LH and FSH have never been checked. The uro has proven to be right-on with many stereotypes I've read on his field on this and other forums. He only sees the numbers - not the syptoms, not the patient - and has no concern for primary vs. secondary. I would even go as far as to say that he has very little concern for me as a patient at all - except he has mentioned how good my insurance is and "they'll pay for whatever I ask them to."

I ended up out of town over the weekend for a typical surprise military duty. I am picking up a thermometer on the way home today and will start checking in the morning.

jdub: lowtestosterone.com