Blood Tests When You Know Cause - Another ?

Hi again - I had posted about treatment for primary hypogonadism. In preperation for my test tomorrow - I’ve printed out the tests that Dr. John recommends on All Things Male.

My question is: I know why my testosterone levels are low already (I had one removed due to torsion and the other was undescended until age 13) - I’m now 24 and am experiencing a non-existent libido and an emotional blankness and am seeking Test Cyp self injections from my endo. tomorrow.

I’m just wondering if the full gamut of tests is really necessary since my levels haven’t just randomly dropped - there is an obvious and undeniable cause to it.

Thanks for any insights or similar experiences you may be willing to share. Below are the tests that I will be seeking:

�?� Total Testosterone
�?� Bioavailable Testosterone
�?� Free Testosterone
�?� SHBG
�?� DHT
�?� Estradiol
�?� LH
�?� FSH
�?� Prolactin
�?� Cortisol
�?� Thyroid Panel
�?� CBC
�?� Comprehensive Metabolic Panel
�?� Lipid Profile

First Off soiry to hear you need this at your age
IMO yes get them all. I would not say anything to the Endo about Dr. john they seems to not like there patients having a brain. Good luck and play it by ear. Let the doctor be the snart 1 and you be armed with the knowledge you have now.

[quote]jakeman124 wrote:
First Off soiry to hear you need this at your age IMO yes get them all. I would not say anything to the Endo about Dr. john they seems to not like there patients having a brain. Good luck and play it by ear. Let the doctor be the snart 1 and you be armed with the knowledge you have now. [/quote]

Thanks Jake - that’s exactly my plan - just let her dictate the flow of the appointment, but if she gets off track…non-combatively offer my opinion.

I am surprised that they didn’t ask me to fast (I called and asked) considering I did ask for a Lipid Profile - should I fast anyway?

[quote]jakeman124 wrote:
First Off soiry to hear you need this at your age
IMO yes get them all. I would not say anything to the Endo about Dr. john they seems to not like there patients having a brain. Good luck and play it by ear. Let the doctor be the snart 1 and you be armed with the knowledge you have now. [/quote]

Strange, I usually get really good results when I bring up that I’m almost done with a biology degree. Maybe it’s the doctor being nostalgic, but they usually spend more time with me and actually explain the thought processes behind their treatment plans.

It may also be because I always defer to their knowledge - not because they are an authority figure, but because they really do know a lot more on the topic than I do. After establishing a rapport, they’ve actually listened to me about symptoms that turned out to be important after their initial dismissal.

I just think docs don’t like patients who read one article on WebMD and think they know everything about a particular condition.

[quote]HoratioSandoval wrote:
jakeman124 wrote:
First Off soiry to hear you need this at your age
IMO yes get them all. I would not say anything to the Endo about Dr. john they seems to not like there patients having a brain. Good luck and play it by ear. Let the doctor be the snart 1 and you be armed with the knowledge you have now.

Strange, I usually get really good results when I bring up that I’m almost done with a biology degree. Maybe it’s the doctor being nostalgic, but they usually spend more time with me and actually explain the thought processes behind their treatment plans.

It may also be because I always defer to their knowledge - not because they are an authority figure, but because they really do know a lot more on the topic than I do. After establishing a rapport, they’ve actually listened to me about symptoms that turned out to be important after their initial dismissal.

I just think docs don’t like patients who read one article on WebMD and think they know everything about a particular condition.[/quote]

Yeah - I think that it’s really an open and shut case anyhow because my insurance only covers injections and it’s not like I’m just saying I have low levels - there’s an obvious cause and the numbers are low so I can’t imagine what she’d debate me on considering I will need this over the rest of my life - I can’t imagine her wanting to go the gel route knowing it’s going to cost me out of pocket for life whereas injections would be just the co-pay.

As a biology student - any advice on fasting (I called and asked and they said I didn’t have to) but I plan on getting a Lipid Profile? I def. don’t want to fast, but also don’t want to skew my results at all.

For the basic blood work, you have to be on a least a 12 hour fast, water only, for the cholesterol and the serum glucose. You will not be eating, but do not get dehydrated. That can shift all of the lab numbers.

There is no need to test for LH or FSH to diagnose type 1 hypogonadism. Ask what tests do not need to be done when there are no testicles.

Your DHT will be low and any amount of TRT will increase this. Testing for TT and FT when there are no testes is probably not needed, but may be required so the insurance coverage can see a lab supported diagnosis.

TRT will change all of the numbers. Doctors like to see things change, even when there is nothing useful they can do with the information of how it increased. If DHT gets too high, then they get concerned. But that does not need a baseline.

TRT: You may see a drop in cholesterol and some improvement in serum glucose if elevated now. Blood pressure should go down if it is higher than it should be.

You need the freedom to self inject. You cannot be tied down to a doctors office all of your life. You will not need hCG if the undescended teste is non functional.

HRT is not a single hormone. You also need to balance your T:E ratio. E2 in the lower 20’s would provide the optimal results.

You can inject T with an insulin syringe EDO to get a more natural and steady level of T. This will also avoid T spikes which lead to higher SHBG and lower FT.

If your maturation/virilization was cut short, you will need higher T levels to deal with that. TT=900-1000 should be your goal.

What is the condition of your skin? Less elastic or thinner? If not, then you have been spared some of the decline from low T.

Let the doctor know that you are interested, learning and not passive. She will then have a sense that you will be appreciating what she does.

Testing. Your pregnenolone is probably quite low. That should be tested. When that is low, DHEA levels may then be low. Test for DHEAs not DHEA.

Your PSA should be tested. Never get tested after recent sex or masturbation, as that will cause PSA levels to surge and create lab numbers that do no represent anything. Ditto for a DRE. Pressure on the prostate also releases PSA. If the doc does the DRE and sends you for labs on the way out, that is obviously a problem. Otherwise, ejaculation is vital to men’s health.

At your age and low hormone levels, you prostate has no reason to be enlarged and there may not be a prostate exam unless a rigid protocol calls it up.

Wow KsMan - thank you so much for such a great and informative post. It has been super helpful since I figured there was a difference between common tests and what I’d need based on the fact that my symptoms have a reasonable cause so something like a thyroid panel to ensure it’s not hypothyroidsm is probably not AS important.

I saw you had recommended a once a day shot to keep levels steady. Is there a huge drawback to once a week? I am sure injecting daily becomes a routine and after a while injected yourself isn’t a big deal anymore, but once a week seems convenient. Obviously I want to feel better so am willing to do what I have to do.

I go today for my tests - will post numbers once I have em’ and anything the doctor might’ve said to seek more advice. I really REALLY appreciate the help.

I just got back from my consult - she sent me to a lab tomorrow morning for the actual blood test and ordered:

Lipid Panel
TSH, 3rd Gen
HCG, Total
DIHYDROTESTOSTERONE
Estradoil, Free
FSH and LH
Test, FR/TOT
Estrone, LC/MS

Then, 2 weeks from now I have a follow-up to discuss treatment. She said she knows they will be low and definitely wants to put me on something, but once we see the levels we can discuss treatment. She said she’d prefer gel and I just said okay for now, but during the follow-up I’m going to tell her the cost. She was very cordial and it went well. I was disappointed that the blood couldn’t be drawn today and surprised at how little testing she signed off on - e.g. no SHBG. We will see how these numbers come back.

I was speaking of EOD, every other day injections. You can inject once a week if you want to. Try that for a while and see if things seem ok for you. You can choose between #29 .5" needles and #23 1.5" needles too. If you get onto hCG injections EOD, doing T at the same time is a decent routine.

Free E, I don’t think that there are many who can suggest what levels are harmful and what are optimal. Serum E is what is typically done.

Natural hCG is mostly foreign to a man’s body, except for certain testicular cancers. Testing for hCG is a cancer screening technique.

[quote]KSman wrote:
I was speaking of EOD, every other day injections. You can inject once a week if you want to. Try that for a while and see if things seem ok for you. You can choose between #29 .5" needles and #23 1.5" needles too. If you get onto hCG injections EOD, doing T at the same time is a decent routine.

Free E, I don’t think that there are many who can suggest what levels are harmful and what are optimal. Serum E is what is typically done.

Natural hCG is mostly foreign to a man’s body, except for certain testicular cancers. Testing for hCG is a cancer screening technique.[/quote]

I’ve picked that up now - I had thought EOD meant “End of Day” - so my game plan is to go in when discussing treatment and let her know my goal TT and E2 levels and tell her that I’d like to discuss how to acheive these. My skins is quite elastic as I have a lot of extra skin since I used to weigh 275 lbs - now weigh about 185. I have two questions - for EOD injections - what type of dosage would each injection typically be if I want to achieve a total test of 900-1100. I realize it’d be helpful to have my TT now to figure this out, but is there a formula or a typical dosage you could refer me to? Also, to ensure E2 doesn’t get out of control - I understand Armindex is the way to go - is this a pill or another injection? What type of dosage is the standard?

I think it should be easy to get her to get me on injections since my insurance does not cover gels. Thanks for your continued help/support KsMan.

100mgwk test cyp is a basic starter dose to use until lab work shows how you respond to that. I am still on that and that puts me in the 900-1000 range [with hCG].

For 200mg/ml, you need .5ml/wk. If you inject .14ml [28mg] EOD [3.5 times per week] that will add up to 96mg/wk.

A typical start on adex is 1mg/wk. If you R2 is not high now, she may not script this until lab work shows a need. You may have to become symptomatic of E problems.

If your TT is not low enough, you may not get T. In any case, if you start on TRT, whatever your prior TT was is not an influence on your dose, as the TRT will shutdown your own production and the injected T keeps you above zero.

Hi - quick update for anyone following my story.

I got the numbers back today from my doctor.

Cholesterol, Total 194
HDL 66
HDL Ratio 2.9
LDL 117
Triglycerides 55
TSH, 3rd gen. 3.63
LH 5.1
FSH 28.7*
HCG, Total, QN <2.0
Estrone 46
Dihydrotesterone 21*
Estradiol, % Free 2.56*
Estradiol <2
Test, Total 224*
Test, % Free 2.21*
Test, Free 49.5

I’ve starred out of range values.

She gave me a perscription for 5g Androgel daily (surprise, surprise) - I asked her “Are HCG and Androgel ever used as complimentary treatments?” Her response was “No, Never…” At that time, I knew I was going to have to find another doctor. So anyhow - I will start researching a more specialized doctor. I live in the Manhattan area so if anyone has any recommendations - please feel free. Also, any comments on my bloodwork would be helpful.

Thanks for all the continued help and support - I really appreciate it.

PS - I used the search on Dr. Johns site and only found doctors who don’t accept insurance or don’t seem to be what I’m looking for. I work in Midtown if I can get really picky for recommendations :-p

PSS - I plan on using 5g Androgel tomorrow just to get this started - should I be concerned that my left testicle may shrink more than it already is? Would it be beneficial to wait to get a second opinion to start so maybe I can go with HCG alongside of tgel…to counteract the possibility that there may be a decrease is testicle size.

Forgot the ranges!

TSH 3rd Gen 3.63 .40-4.50 miu/l
LH 5.1 1.5-9.3 miu/l
fsh 28.7 1.6-8.0 miu/ml
hcg total <2.0 <5.0miu/ml
estrone, lc/ms/ms 46 <OR=68 pg/ml
dihydrotestosterone 21 L 25-75 ng/dl
estradiol free lc/ms/ms <0.05 pg/ml adults <OR=.45 pg/ml
estradiol, % free 2.56 1.25-1.85 %
estradiol <2 < OR = 29 pg/ml
test, total 224 250-1100 ng/d;
test, % free 2.21 1.5-2.2%
test, free 49.5 35.0 - 155 pg/ml

My mom has hyperthyroidism so it wouldn’t be a huge surprise to me if that is an issue - esp with my high tsh as someone pointed out, but the doc didnt want to pursue more tests. I am kind of alarmed that the follow up bloodwork she scheduled for July 12 only includes CBC, Hepatic Function Panel, Test (Free/total, lcmshs) and a PSA. Seems like it’d be incredibly important to monitor E2 levels at this point since I’m introducing Testosterone. Sigh like i said - im seeking a second opinion from a more specialized doc in NYC that takes insurance…just need to find that person. used the search on dr johns site unsuccessfully so far…

So I’ve been on Androgel for 6 months now - here are the results

Start with 5g Androgel
Tested twice @ 1700 T levels
Dropped to 2.5g Androgel
Tested at 863 levels

New doctor had me do a scrotal sonogram and dexa and put me back on the 5g a day. the last time i saw him even though my test is 1700 - i am just not feeling the effects as much as i should so he upped me to 7.5g and prescribed me 1 mg of adex a day as well - which seems super aggressive. im to have blood tests after 6 weeks on the new regimen . he also prescribed me 5g of cialis a day as the sonogram showed i have underdeveloped something and the blood flow to my penis is suffering.

he and his rn are really shocked that on 5g on androgel my levels went from 200 to 1700- they think i have the most absorbent skin known to man. from the way things have been going, i expect that eventually ill be put onto shots because i just dont seem to be responding to the gel in terms other than what the bloodwork shows.

i appreciate the help this board has given me through this thread and others stories…just wanted to throw an update out there.

You are the 3rd guy that I am aware of that is on 7mg/adex per week. You should expect single digit E2, mood/mental disturbances and no libido.

1mg/day is to remove all E2 from women who have estrogen positive breast cancer. 1mg/day is the standard dose for that. With men, one is looking for an optimal level like E2=22pg/ml.

For T levels that high, suggest 1.75 mg adex/week. That would be .25 ED, but .5 EOD will also work well. You can get an E2 only test in 2-3 weeks to help dial in adex dose.

You need to know the effects of E2 too low and be able to eval if you are an adex over responder.

Do not apply agel the day of your labs before the lab. Transdermals create spikes of T.

Ask for the hCG.

You can edit your posts. Please list DHT and range.