33 yo Hypogonadic Looking for Good TRT Dr

Pharma TRT
21

[quote]HouKN98 wrote:
Still waiting for results of Friday’s labs.

In the meantime, I’ve dug up my old liver function tests, one from 3 years ago pre-TRT and one from last year while on TRT (Testim).

One thing jumped out at me was the change in ALT values between those tests, and all the other values changed very little.

3 YEARS AGO - BEFORE TRT:
ALT 44 - Range: 9 - 60 u/l
Now:
ALT 17 - Range: 9 - 60 u/l

Everything else stayed about the same, EXCEPT that ALT dropped from 44 pre-TRT to 17 on TRT. BIG change! What does that mean??

EDIT: I did take antifungal medication for my toe, twice in the past 3 years - maybe it affected my liver somehow.
[/quote]

Hey - Very interested to follow this thread.
Do you see the decrease in ALT as a problem? I usually see people looking for elevated levels as problems. I wouldn’t stress some toe medication or these levels.

22

[quote]nomadic wrote:
Hey - Very interested to follow this thread.
Do you see the decrease in ALT as a problem? I usually see people looking for elevated levels as problems. I wouldn’t stress some toe medication or these levels.[/quote]

Yeah, I don’t know what it means. Maybe it’s a change for the better, and not for the worse.

Recent labs will tell the real story, should come to me any day now. I called the nurse, and she said “everything looks normal”, which I’m sure is a load of BS.

I’m done with this doctor and his staff. Totally DONE. My next appointment will be with a different doctor.

Will post labs when I get them.

By the way, still having weak or lack of morning wood. I was hoping L-Arginine and Pycnogenol would at least help a little with that, but aside from a couple of days, it didn’t really do all that much. Disappointing.

23

Here are my new labs:

PSA 0.4 (<4.0)
FT: 70.7 (35-155 pg/ml)
TT: 377 (300-1000 ng/dl)
Prolactin: 8.2 (2-18 ng/ml)
Total Estrogen: 63 (40-115 pg/ml)***

*** Yes I know this isn’t E2/Estradiol, and I know total estrogen is useless, but Dr. Uro-Idiot ordered the wrong test even after I specifically requested E2. See my perfect addition to the stupid doc thread:

http://tnation.T-Nation.com/free_online_forum/sports_training_performance_bodybuilding_trt/stupid_things_that_docs_do_and_say?id=4047387&pageNo=2 - scroll down to my name

Liver function:
Total Protein 7.6 (6.1-8.1 g/dl)
Albumin 5.0 (3.6-5.1 g/dl) <— does this seem a little high?
Globulin 2.6 (1.9-3.7 g/dl)
Albumin/Globulin ratio 1.9 (1.0-2.5)
Total Bilirubin 0.7 (0.2-1.2 mg/dl)
Direct Bilirubin 0.1 (<0.2)
Indirect Bilirubin 0.6 (0.2-1.2 mg/dl)
Alkaline Phosphatase 63 (40-115 u/l)
AST 18 (10-40 u/l)
ALT 14 (9-60 u/l)

Thyroid Panel
T3 UPTAKE: 31 (22-35%)
T4: 7.4 (4.5-12.0 mcg/dl)
Free T4 INDEX T7: 2.4 (1.4-3.8)

No free T3, or reverse T3, like I said my urologist is an idiot… don’t worry, I fired him already. Made an appointment with a new doctor that a few pharmacies referred me to when I did some legwork.

Anyway, what do you make of these results?

Obviously the Androgel is not as effective as it should be. Prolactin looks OK, right?

I have no idea how to interpret these thyroid labs.

24

I’d just add your IGF1 is low.

GH is expensive, but if you can afford and get it it’s worth a try.

25

How many hours a week are you training/riding. I am older than you, 44 but have been fighting low t . I was in the low 200’s and after quitting riding for two months, my level was up to 500. After starting to ride again and ramping training back up to 14 hrs/week, iam back down to 250. In my case , i think cortisol levels from heavy training are to blame. You may be in same boat.
As endurance athletes, i think we may go too clean with our diets and cut fat intake too low. I am going to experiment with more eggs, cheese etc.

My doc wants me on T shots, but as i race , its not an option for me. Hopefully i may find something across the counter that may help.
Anyhow dont count out the training as a cause

26

Added more labs to my latest post (3 posts above).

Tuna: GH probably won’t be an option, insurance won’t cover, and can’t afford it. Any way to raise IGF1 naturally?

Slalom: Hey, good to see a fellow cyclist on here! I don’t ride as much as you do, and I don’t race either, but I ride probably ~6 hours a week. My training is going great, actually… I’m feeling very strong on the bike and just knocked out a 5 hour century recently. I don’t avoid cheeses, fats, or even egg yolks. I try to keep my sugar intake low, because I have a family history of diabetes.

27

antifungal medication can increase E2 by loading up the enzyme pathways that clear liver

as you know from your careful reading of the stickies: inability to absorb transdermal T is a symptom of thyroid problems, report your iodine intake and body temperatures as per the advice for new guys sticky and thyroid basics sticky

28

i was having issues with low testosterone and low libido. i remedied it by changing various things such as
1 - first thing in the morning I drink warm water with a whole lemon
2 - take cold showers
3 - set up a diet where I eat twice as much carbs as protein 2-3:1 ratio whereas before i was eating a lot of protein. also 30% fat with most of the fats coming from monounsaturated, following saturated fats. my polyunsaturated fats came mainly from pine nuts and walnuts
4 - supplement with ginseng panax, gingko biloba, horny goat weed, and maca
4b - obviously caution should be taken as to how you stack these supps, might be ideal or necessary to cycle between since maca and ginseng are both adaptogens (if im correct)
5 - supplement with zma before bed
6 - i would definitely check my mineral and vitamin for deficiencies
7 - avoid all stimulants including green tea and coffee
8 - i also added biotin
9 - I read somewhere that chronic cardio reduces testosterone
9b - I changed my work outs from more of a bodybuilding routine which usually lasted from 1-2 hours to no more than 45 minutes with compound movements including olympic lifts

it took me a 1-2 months to notice differences and im still treating although I do feel 100% better. if you dont have everything in place then I wouldnt expect anything to have much of an effect especially when it comes to supplements.

29

KSman, thanks for responding. I knew antifungals had a dark side… how long does it take to normalize from that? I have not taken antifungal meds for over a year, maybe 1.5 yrs. I’ll make sure to mention it to my new doc.

Body temps & current iodine intake:
I have been measuring morning temps almost every day, and I always seem to wake up at 97.9 F, with little or no variance. I never seem to make it to 98.6 in the afternoons, though (and I know the thermometer works fine). I already eat iodized salt and take 150 mcg with multivitamin, so maybe I need a real boost in iodine.

David, thanks for your post… few questions:

  • how do cold showers help?
  • have you tried L-Arginine as well?
  • what do you mean by “chronic cardio”? too much cardio exercise, or some kind of heart problem?
30

1 - 7 Health Benefits of a Cold Shower | The Art of Manliness
2 - i have tried arginine but perhaps because im eating plenty of food with arginine its not my best option
3 - chronic cardio = excessive cardio exercise - it appears cycling is terrible on testosterone especially if the seat is the wrong type - look it up.
4 - while the macros could help with testosterone, the food sources also greatly help. check out foods that increase libido.

31

David,

  1. I’m sold on the cold showers!

  2. Overtraining is always a possibility when long duration and/or intense cardio is involved. But when many other cyclists (or runners, or tri-athletes) do way more training than I do, I have a hard time believing that I am overtraining. They’re putting in 8-12 hours a week of training, while I only do 4-6 hours a week, and if I AM overtraining, then I gotta be scratching my head on this. Maybe I’m not eating enough or not taking appropriate steps to recover maximally from intense training.

Also on cycling - I know about the right and wrong types of seats, and I have a V-shaped saddle with a groove down the middle to keep blood flowing through the perineum in a way it protects the sensitive nerves down there. A novice cyclist can easily choose the wrong type of saddle if he doesn’t know what he’s doing. I think I’m fine in that regard, and that overtraining may be more of an issue than the type of my saddle.

32

Took a closer look at my test results, and turns out my ex-urologist was an even bigger idiot than I thought.

The T3 was not really T3, it was T3 UPTAKE.

The Free T4 was not really FT4, it was FT4 INDEX T7, which has totally different ranges.

Shit. I’m going to have to redo the whole thyroid panel to get the real story. Hopefully my new doc is willing to do it. I’m hesitant to start IR when I don’t really know what’s going on with my thyroid.

33

7 pm temp: 98.7 F

First time I’ve seen it that high. I’ll see if I can hit that again the next few days before ruling out hypothyroid issues.

34

NEW DOCTOR UPDATE:

He, a GP, seemed open minded and enthusiastic, if not a wee bit conservative, but he is willing to work with me. I’ll break it down by area of interest (T delivery, aromatase, fertility).

T DELIVERY:

I gave him my TRT history and all of my labs, and after a lot of interactive discussion, he gave me a prescription for compounded testosterone cream. The new GP likes compounding creams, but is not totally closed to injections if the creams don’t work. I figured, let’s try it, what’s the harm… it just might work.

The strength is 100 mg/ml, 100 mg to be applied in the morning, and 25 mg to be applied in the evening. Total daily dose is 125 mg. Assuming 10% absorption through the skin, that would be 87.5 mg per week… pretty close to 70 mg per week that the injections protocol gives.

He told me to apply it to the sides of my trunk / rib cage, shoulders, my interior thigh areas, or onto the calves. He said it’s important to apply it wherever the skin is thinner, and to never apply it to the stomach or scrotum (due to aromatase).

Only downside is the cream costs $55 per month. If it doesn’t work, I’ll push for injections (cheaper).

AROMATASE:

I asked about T → E2, and he knows about that. He said I should take Chrysin to manage E2, and he is willing to track E2 along with TT and FT. I don’t know how effective Chrysin is, but he seems to think it’ll work fine for me. He said I have no gynocomastia so I shouldn’t have much to worry about. (This is why I think this GP is a bit conservative rather than going aggressive by prescribing an AI like anastrozole). I think if the cream causes gyno issues or raises my E2 and Chrysin proves ineffective, then I will push for anastrozole. I think he MAY be open to that route if it comes to that.

FERTILITY:

I raised fertility concerns by asking about testicular atrophy, and he said he does NOT want testicular atrophy to occur while I’m on TRT. He seemed surprised when I told him I had some shrinkage when I was on Testim. He said he wants to manage my T levels so that my low T symptoms go away, but that I shouldn’t become infertile. When infertility or testicular atrophy occurs, he thinks it’s because the T dose is too high and he’d lower it. I don’t think HCG is going to happen with this guy. HOWEVER, he said he is willing to do a fertility test with sperm count 3 months from now.

SUPPLEMENTS:

He asked why I was taking L-Arginine and Pycnogenol, and I told him it’s to help with the erections. He seemed very interested in what I told him, and said he’d like to do some research on that. Wrote down the supplements for his own reference.

SUMMARY:

In summary, I thought it was promising… this doctor he was quite open-minded and would not close doors on alternatives if his initial plan didn’t work. Told me that he’ll work with me to fine tune things based on lab work and how I’m feeling. He probably just wants to be conservative on the AI, but if I gave him studies and references from good sources, he’ll be malleable and open to what I ask for.

I didn’t bring up the thyroid topic because I have been taking my body temps, and they hover between 97.8 in the morning and 98.6 in the afternoon. Before I went to the doctor today, my temp was 98.3 at 1 pm. I honestly don’t think I have any thyroid issues, based on my body temps, and based on what other guys WITH thyroid problems have written in their threads (their symptoms like weight control problems don’t match mine).

Opinions?

35

The more I read about Chrysin, the more disappointed I get. I really don’t want to have to look for YET another doctor, I feel like I’ve been playing the doctor roulette for years and I’m tired of it.

I don’t really want to try Chrysin. I want to try anastrozole. So, I’m thinking about doing either:

A) Calling my new GP and ask for an Arimidex Rx instead, OR
B) Order Liquidex online.

But I’m a little afraid of taking anastrozole right now, especially when my T is still in the 300s. Don’t want to wipe my E out. Should I wait until my labs actually prove that I DO need an AI before I start taking it?

36

Chrysin is expensive, hard to absorb and not very effective. OK in in-vitro, not so effective in in-vivo.

You are needed to educate this doc. He does not know much. HPTA shutdown is fundamental. TRT that does not cause HPTA shutdown is a contradiction of terms.

With the iodine in the vitamins, your iodine status might be OK. Would not be harmful to build up iodine stores with a 1mg kelp product for a while.

Get the thyroid labs soon.

Tell doc that injected T esters are a time release bio-identical testosterone delivery system. After the ester group is removed, testosterone is testosterone. The bio-identical “believers” are confused and ignorant about this. Transdermal T is simply more expensive.

T cream, you can apply to one wrist, then wipe your arms together to spread along inner arms. That absorbs well. But does increase transfer potential to wife or kids. Some small amount of T to your wife might spark things up a bit. T where there are hair follicles will increase DHT vs areas without hair. If you have male pattern baldness, that will increase hair loss and injections will have a lesser effect. DHT is mission critical for libido and maintenance of sex organs.

37

Ok, I drafted an email / letter to my new doc, and I’m going to give him Dr. Chrisler’s papers on TRT/HCG. I’m also looking for credible med sources to convince him to Rx me hCG and AI.

Here’s my draft:

Dear Dr. xxxx

Thank you for taking the time to see me, and I enjoyed our conversation. As you may have noticed, I’ve done quite a bit of due diligence on TRT because it is likely I will need it for life.

I understand you were short on time, but I wanted to further discuss my TRT protocol. You prescribed me a compounded cream, which costs $55 / month.

I feel that testosterone cypionate (or enanthate) injections would be cheaper, and also safer due to zero chance of transference to my wife and stepson. Injected testosterone esters are a time release bio-identical testosterone delivery system, which I would prefer to use over gels because I sweat and shower a lot, especially in the summer.

I also feel that I must be on hCG to maintain fertility. As I said, I have experienced testicular atrophy while on Testim. You’ve said that it shouldn’t happen, but I do not want to take any chances because I want to have kids soon. Attached is Dr. Chrisler’s protocol for TRT administration along with HCG, and I hope this helps. Dr. Chrisler is one of the top TRT experts in the country. After having kids, I will agree to stop using hCG.

We also talked about preventing aromatization, and I researched Chrysin, and it seems to be effective only in-vitro, but not in-vivo. It also is not easily absorbed. I believe a prescription for low-dose anastrozole would work better, starting with 1 mg / week and testing Estradiol periodically. I want to keep my Estradiol levels between 20 and 25 pg/ml for optimal health.

I would like to have a protocol such as 100 mg / week via testosterone injections, 250 IU hCG every other day, and 1 mg / week anastrozole. This protocol is similar to what Dr. Chrisler prescribes.

I hope we will work together to administer a similar protocol. If you still feel that I should use compounding creams, I will do so. However, I think it is very important that hCG and anastrozole be included in my TRT protocol for my fertility and general health needs.

Anything I should add or leave out??

38

I went ahead and sent the email with a few changes in wording, and also sent some sources including Crisler’s papers on TRT and HCG.

I just hope it’s well received!

I’m thinking about adding ZMA to my supplement regimen, as I haven’t been sleeping well lately. Toss in some kelp and I should safely rule out thyroid issues (I think).

39

Got a reply from the Dr’s office… it was from his assistant. The doc wants me to schedule a follow-up appointment with him to discuss the questions I brought up in my email.

At least they didn’t say no, or else brush me off! That has to be a promising sign.

40

Started compounded creams yesterday and man, does it work fast! Got morning wood and spontaneous erection on my way to work.

I like it better than Androgel already. Testim also worked for me, so there is something about Androgel that just doesn’t work for me, period.

Now I’m going to watch my testicles for any size of shrinkage and my E2 as well, as well as collect ammo for the new doc in our follow-up. Hopefully it won’t be a lecture about how patients shouldn’t read medical advice over the internet, lol.