Low Testosterone (Seeking Advice)

Pharma TRT
1

I recently received the bad news that I have low testosterone. I’ve been lifting on and off for the past 2-3 years but got really serious about it around 6-7 months ago. I started out at around 225 lbs (high body fat) in around October and have dieted down to around 190 lbs (15-16% body fat) now. I noticed a drop in my libido around 2 months ago and decided to get some bloodwork done to check my test levels, and just found out that they were quite low.

Age: 26
Height: 6’-0"
Weight: 190 lbs

Body/Facial Hair: I’ve always been extremely hairy, thick hair pretty much all over my body, except for my back

Where I carry fat: Fat seems to evenly distribute throughout my body, but is most noticeable in my legs, butt, midsection, and upper back.

Health Conditions: I use to have high blood pressure but as I lost the weight it decreased.

Lab Results: Testosterone, Serum: 91 / Free Testosterone (Direct) 1.9 [Refer to attached images]

Diet: For the past 5-6 months I have tracked my intake religiously. I know fat intake plays a crucial role in testosterone production so I made sure to get around 50g per day (while dieting) and now that I am trying to gain some lean muscle mass I’m getting around 90-100g a day. I dieted from around October 2012 to January 2013, took a break, then dieted again from February to May, now I am slow bulking (250 calorie surplus @ 3,250 calories/day).

Training: I lift 6 days a week with one rest day. Typically lifting sessions last around 1-1.5 hours.

Testes never ache. However my libido is definitely not there anymore; however I am still capable of getting and maintaining an erection, it’s just not something I desire anymore.

My doctors recommendation:
My doctor wanted to give an injection (of what I am unsure but I believe it to be 200 mg of cypionate) every month. From what I’ve read this is a bad treatment method and will cause huge peaks and valleys in my testosterone levels. I have an appointment soon and plan to discuss my concerns with my doctor but I would love to have some evidence or some good information that I can present to him so that he doesn’t scoff at the concerns I express.

I really appreciate all the advice and help you guys will have to offer; I have been pretty distraught over this news considering how passionate I have become about lifting and bodybuilding and this is a huge let down and discouragement. I just hope that I can convince my doctor to go with weekly or even bi-weekly injections instead of the asinine once a monthly injection.

2

All you need to know what to explain is how half-lives (test cyp is 7 days) work to your doctor. If they plan on injecting you with 200mg of testosterone cypionate once a month, then with 21 days left you’ll only have 100mg left, with 14 days left you’ll have 50mg left, 7 days left and you’ll be at a very low 25mg. If he is stubborn and you can handle it for a month, ask for a blood test that last week and the numbers will speak for themselves.

The typical (and archaic) standard is at least 200mg/every two weeks. Once a month is ridiculous. Read over the protocol for injections sticky post at the top of the forum and see if you can get him on board with that. The injections are done 2-3 times a week sub-q to alleviate long-term muscle damage and avoid the troughs and peaks associated with high-dose bi-weekly injections, or worse, once a month injections.

Repost bloodwork. The images didn’t show.

3

Sheet 1: http://i.imgur.com/lGRo9WT.jpg
Sheet 2: http://i.imgur.com/F1TLZ5u.jpg

4

They didn’t test for LH and FSH?

Can’t test LH and FSH after you’ve started TRT as they will be virtually at zero. Those values will tell you if you have primary or secondary hypogonadism. If secondary, it’s possible that your HPTA can be salvaged. At 26, you would be much better off finding the root cause than just throwing testosterone at the symptoms. TRT is not a fix-all, and those underlying issues will still haunt you even if your total testosterone is at 1,000,000.

Need more labs done first. Be patient. It will pay off in the end.

5

Hah; it’s funny you mention patience because I definitely have none, although I definitely understand it’s importance. I am just really worried that he will not be receptive to changing his routine treatment method for TRT (which is apparently the 1 injection per month).

I suppose I should really ask for a referral to an endocrinologist and get a more comprehensive blood panel done. The only thing I could think of as to a cause would be either overtraining or stress (coritsol levels) or quite possibly too low of a fat intake.

I was just wrapping up that diet about 2-3 weeks before the blood work I linked was done. I am guessing calorie deficits and intense exercise can lower you testosterone production?

EDIT: I am just in panic mode I suppose, considering how damned passionate I’ve become about bodybuilding in the past few months. I’ve dedicated my whole being to it and this news is just earth shaking to me.

6

Diet and exercise can play a role in testosterone, but with a TT of 91 at 26 years old, I highly doubt it played that much of a role.

The waiting game with doctors can be a PITA. If he is closed-minded and unresponsive to requests, it may be time to find another doctor. Most simply don’t know much about HRT. Most of us on here haven’t had much luck with endocrinologists either.

It can be tough to wait when you know something is wrong and you have an avenue to seemingly fix it (TRT), but the satisfaction WILL be short lived. I can promise you this.

Read the “advice for new guys” sticky at the top of the forum. You can edit your original post at the bottom right and add in all additional information.

7

Bumping thread for potentially more input. Thank you for your advice Kaynon311.

EDIT: I have an appointment with my doctor today. I spent the past few days educating myself and prepared a report with source documents referencing the AACE and the Endocrine Society so I will be prepared to discuss my concerns with the doctor.

I plan on requesting more blood work to determine if it’s primary or secondary hypogonadism and going from there. I am thinking it’s secondary though based upon the causes for primary that I’ve read. If it comes back as secondary I will try to get an MRI because of how astronomically low it is (the endocrine society recommends and MRI if it’s less than 150).

8

Good luck to you, mad kow. If you can get all these labs you should be on the right track.

Labs to be done before you start TRT
-LH and FSH [LH/FSH] -->determine primary or secondary
-TT
-FT or bio-T
-E2
-Prolactin **to rule out prolactinoma (most common tumor)
-IGF-1 **somatotrophic adenomas (second most common)
-DHT
-PSA

Thyroid labs
-TSH
-fT3
-fT4
-rT3

Adrenal labs
-Cortisol four sample saliva testing [the gold standard]
-Pregnenolone [the foundation of the adrenal hormones and all steroid hormones *]
-DHEA-S [DHEA Sulphate]

9

Alright, I have some more lab results to add:

6/4/13:
Cortisol: 18.4
LH: 1.5
FSH: 2.5
Prolactin: 4.9
Estradiol: 14.4

For reference the 5/9/13 results:
Total Test: 91
Free Test: 1.9