2 Months on Androgel - Total T Decreased?

Pharma TRT
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Thanks for all the feedback. I have an appointment to see the doc tomorrow afternoon. Based on what I have read, I plan on asking him:

Why free or bioavailable Testosterone is unavailable (how do their specialists diagnose problems?)

For cortisol test (for adrenals). I have stopped working out (2 weeks now - which sucks) and caffeine in hopes of correcting the beat up feeling I was experiencing–especially after workouts. I really hadnt thought about adrenal fatigue much until this came up.

increasing dosage of androgel vs test cyp IM twice a week

hCG augmentation - any suggestions on handling this? I am not sure if the doc will know much about this.

referal to someone up to speed on TRT/Andrology - Have no idea how successful I will be in finding someone.

DHEA-S

Prolactin

Questions:

Does the above sound right?

Did my estradiol lab provide any value (result: <12)? KSman asked for e2 and I thought e2 and estradiol were the same, but maybe I am misunderstanding things. It sounds like the estradiol I had was the wrong test. IF this is the case, what exactly should I ask for? I dont want to go in and ask for e2 and the doc tell me that is what I had.

Both me and my girlfriend have noticed a noticeable decrease in the amount of ejaculate I am producing. Is this related and if so, what do I need to know/do to correct it?

I seem to be “aware” of my testes more than ever. By this, in the past, they were there and outside of an occasional ache here and there, I was never really “aware” of them. Now, I am aware and they seem to be hanging lower. This may be due to stressing about my results.

Am I missing anything?

Thanks again for all the help and support!

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Update: Doc said he was out of his area of expertise and did not feel comfortable increasing dosage or changing to injections. He encouraged me to stop altogether.

He did refer me to an endo. I asked for one versed in andrology and was informed that the first visit is a consult. I will be seen by the correct specialist after the consult. Interesting the way HMOs work.

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I would look to other factors or injections to over ride the problem along with a good HRT dr that knows what the hell he is doing… HMOS suck and we will not take them because it does not pay a pot to piss in for Dr’s. When dealing with these complex cases getting 15 bucks a visit is an insult. I would suggest biting the bullet and getting to a good dr that you may have to pay cash to see, but will increase your qualitry of life dramatically. I work with Dr. Overbeck which a alot of guys that have come on here to see and have been incredible pleased with the results. People travel some times travel from cali to east coast to get proper help or they could end up wasting months feeling like crap.

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Thanks.

Are there any recommendations for good TRT Drs in So. California? How much (ballpark) does it cost out of pocket for TRT per month and for visits?

I found out how bad HMOs suck during my visit with the endo yesterday.

First, he asks me a series of questions regarding symptoms, medical history, and thoughts about having kids.

Then, he tells me that my total t was 382 just prior to starting A-gel which was normal and the test before that was in the 360s–again normal. He said with these results, he would never have started me on TRT and told me to stop immediately. He confirmed that he believes the exogenous T has shut down my natural T production which is why my levels dropped and I feel worse.

He actually said my TT was probably higher than his. I am not sure what that has to do with anything, but apparently, it was some sort of justification for not pursuing TRT.

When I asked about having a free t or bio-t test since total-t is a less than ideal indicator, he said that that there are problems with the free-t test and as a result Kaiser does not test for Free-T (their labs are not set up for it). They use total-t and sometimes review it within the context of SHBG, then go from there. I have never read of any issues with the free-t test–has anyone else?

When I asked him to explain why I felt better and many of my symptoms disapeared when I first started A-gel (2 pumps daily), he said it was probably the rush body builders and athletes get when the body has excess T circulating. I mentioned that those people are using T in quantities which is a great deal higher than my 35g per week–like 15x-20x higher . During this line of discussion, he seemed to imply I was after steriods since my numbers were “normal”.

It then devolved into him telling me that TRT is for life and that it can cause infertility, prostate cancer, elevate red blood cell counts, gyno, etc. I told him that I understand that it was for life and that many of the risks he mentioned can be mitigated with proper protocol including hCG and an AI. He then said that the endocrine society recommends TRT only for those people with total t in 280 range. As for my symptoms, he suggested I use other meds that may help with mood, fatigue, sex drive/ED issues, etc. to which I countered that that too is for life and carries just as many unwanted side effects. No dice.

The only concession I got was to stop TRT and wait 4 months at which time Total T and SHBG will be tested again and if the numbers dont improve, then he will consider starting TRT. He didnt want to make a firm judgement because I had not had a SHBG test prior to starting (I had asked for it and many others and was told it was unnecessary–TT was the only one I needed). Meanwhile, I feel like crap.

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it can be costly ($200+/-) to see a good HRT doctor. The big problem is going to be getting your labs covered.

You can pick up T-Cyp at Costco or Sams for pretty cheap (per other threads), and maybe research adex (not my thing).

what you really need to ask is how much is your health and quality of life worth to you and how much can you afford to spend? and then go do it. Life is too short.

Pay $200 go see a doctor referred by a local compounding pharmacy maybe get a couple of tests run if possible. Get a couple of prescriptions, get them filled and self inject. Is it ideal? no, but it a heck of alot better than wasting four months suffering with no promise of help from your HMO.

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Thanks PureChance…I appreciate your advice (and everyone else’s for that matter).

I am going to check out my options locally first, including maybe seeing another doc with my HMO (it cant hurt to try a second opinion). I’ll pay for the necessary labs.

While I agree with your sentiment regarding cost vs quality of life, cost is important nonetheless as I had not previoulsy budgeted for this out of pocket expense

My question now is do I wait it out and get a true and accurate baseline first? I had asked for all the recommended labs in the begining and as I mentioned, my PCP said it was unnecessary. I am thinking now maybe it may be worthwhile to attempt to determine if I am primary or secondary.

Lastly, does Dr. Overbeck have a website?

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[quote]Ghosttrider wrote:

Lastly, does Dr. Overbeck have a website?[/quote]

He does not, but I can vouch that Dr Overbeck and his assistant Shawn are very good at what they do. They will run all the necessary tests (blood, nutrtion, saliva, everything you need) and spend the time to adequately investigate it and address their concerns with you. May be an issue accepting your HMO plan though, but you will have to investigate that yourself.

If you can get with them, I highly recommend it.

I hate to hear your problems with your endo and supporting cast. It is scary common though. Relief is available, you just gotta spend the time to do it right. Will be worth it in the end.

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Thanks VT.

Where is Dr. OVerbeck located? How do I contact him?

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He is in Consohocken, Pennsylvania. Google search his name and city and you will find him. You can also contact HardAsNails on this site via PM for a direct number.

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I’m not sure if I should resurect this thread or start a new one. Going to try resurecting.

For various life reasons, I put this issue on the back burner. When I last posted, I was advised by my HMO endo to stop androgel and get retested in 4 months.

This was due to my Total T levels going from 362 on 4/6/2010 to 286 on 6/25/2010.

I recently had my follow up Total T (5 months later rather than 4) on 11/27/2010. It came back at 205.
He also ordered SHBG which was drawn at the same time and came back at 15.3.

I contacted the doctor and he indicated I took the labs too late in the day (2:45 PM) and to retest at 8:00 AM. I get this message and I am thinking: I know T levels peak in the AM, but 205 is still 205 - Should it ever be 205 for a 39 yr old male?. Anway, I was retested at 8:02 AM Friday and the results came back:

Test Date: 12/3/2010 8:02 AM
Total T: 253 ng/dL
SHBG: 13.6 nmol/L
LH: 3.1 mIU/mL
FSH: 2.0 mIU/mL

Below is up to a year history of labs (HMO will not do free or bio T)

Total Testosterone
Ref Range: 280-800 ng/dL
9/28/2009 388
4/6/2010 362 (started androgel due to symptoms)
6/25/2010 286 (stopped androgel due to T levels crashing)
11/27/2010 205 (first follow up test done at 2:45 PM)
12/3/2010 253 (second follow up test done at 8:00 AM)
**symptoms have only gotten worse

SHBG
Ref Range: 14.5 - 48.4 nmol/L
11/27/2010 15.3
12/3/2010 13.6

LH
Ref Range: N/A mIU/mL
6/25/2010 1.4
12/3/2010 3.1

FSH
Ref Range: N/A mIU/mL
12/3/2010 2.0

I am waiting to see what he comes back with at this point, but I would like some thoughts on my results so I can be better to prepared when I talk to doc.

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