My Results and Some Backround (Updated with Doc response and Treatment Regiment)

Pharma / TRT Testosterone Replacement
1

Hey there, so Ive got actually three tests over last year I want input on as well as a little (ok pretty long) anecdote to go along with it an put it into context.

I am a 25 year old guy, and for about the last 5 years I have had most of the symptoms of low t to varying extents. I have had allot of the symtoms that are listed on this forum foggybrain/difficulty concentrating, depression, Low Labido (I can still get erections), dry skin, often brittle nails, low desire to socialize, chronic sleep problems, low self esteem, and I did feel as though I had a hard time building muscle (although I will readily admit that until more recently I did not work out for more than about 3 months at a time).

10 months ago, after I had begun to phase into adult hood and begin to pursue a career in the health professions, I decided it was time to deal with the depression (I think its relveant to say that I bit the bottle and the cancer sticks hard up until about a year and a half ago, and had always assumed that fact that a felt like shit were due to those vices). This pursuit caused me to look up some mental health youtube channels, and I stumbled upon concept of low testosterone as a cause of depression, so I had my PCP run my total testosterone. And low and behold it came back very low.

The First Results: 9/16/2015 (TAKEN AT 5 PM)
(all relevant data)
TT 184 ng/dL (241-827)
fT4 1.14 ng/dL (0.76-1.80)
AST 30 U/L (0-37)
ALT 21 U/L (12-78)
TSH 3.20 (0.34-4.82)
Hemocrit 46.1% (40.0-52.0)

I then looked up on where to do next (my PCP had no idea, he actually didn’t even know the test was supposed to be taken in the morning) and so I came here and actually made another post looking for help (which you guys gave great advice for). I then went back to my PCP and got another more thorough round of blood work done. These were also incomplete but in different ways (oops). I also had LH/FSH done, but I can’t find them, they were pretty average from what I remember.

The Second Results: 10/23/2015 (0938)
Test/Serum 428 ng/mL (348-1197)
FT 11.9 pg/mL (9.3-26.5)
E2 24.3 pg/mL (7.6-42.6)
Chol, Total 156 mg/dL (100-189)
Triglycerides 83 mg/dL (0-114)

I ended up hitting a wall with finding an endo, and with a pretty high test (relatiely), and TRT being such a commitment, I decided to try to see explore less drastic solutions. In the time since the second test I started taking Welbutrin along with a root called Rhodiola Rosea (both on recommendation with a doctor) and I really did notice a relative positive shift in things, although only relative. I still feel like I am still experiencing significant low T symptoms. Also in that time I worked to eliminate any and all things that could be holding my Testosterone back, I lost 15 pounds and am at bout 15% body fat. I drink less than 1/mo, and when I do its often 1-2 drinks. I quit smoking as well. I exercise 5/6 times a week, either free weights/body weight, cardio, and 2 days at a local bootcamp. While my endurance had imporved, I have found it very hard to gain strength (I have made almost no progress with free weights, and the couple of times I’ve gone without lifting for a week or so (just cardio) I feel as though I am back to square 1 with the reps/weights I can do. I completely changed my diet, which is honestly almost perfect (all home cooked, leafy greens, only complex carbs, good proteins, portion moderation). I also try to meditate to reduce stress.

I won’t say that I don’t feel better than I did a year ago, but I still feel far off from where I wan’t to be, and I still have what I consider to be distinctive Low T symtoms (I do want mention that I still “ski with one pole” however when I do I do it more as a release or distraction than much else, and the conclusion has been dull for as long as I can remember). I decided to test my T again to see if all the changes I made had had much of an effect. That day I made sure I was fully rested, well fed the day before, and got it within 45 min getting up. I had also had a week off, as I usually lead a very stressful lifestyle, working 30+ hours a week along with taking a full load at school, so stress was at an all time low. My T had to have gotten higher…

The Third Results: 6/11/2016 9:34
TT 374 ng/dl (348-1197)
FT 9.3 ng/dl (9.3-26.5)

I’ve made the decision that I am going to follow through with this and get a definitive answer. I have made an appointment with a Bioidentical doctor, with a free consultation. Do you guys have an opinion about those kinds of more alternative doctors? Any one have any advice for someone with my situation of being low normal (I’m not in the dumpster like some of the posts I see). Ultimately, I have a strong gut feeling that some form of hormone therapy will help me. I would be remise though If I didn’t ask if any one who reads this thinks it’s a bad idea, given my age and the numbers themselves. Other than making sure I get all the recommended things checked for this next test, are there any tips on how I should approach this type of doctor. I also intend to explore the more traditional route with a PCP and see if I can go see an Endo/Urologist through insurance, if nothing else than to get a conservative opinion.

Also, and this is a more general question, but I live in the Bay Area/ Northern California Area, so If any one has any doctor recommendations I would be greatly appreciative!

Thanks for reading! I really think this is an amazing community!

Best,
Minutsrbroke

2

You ARE low in regards to T. Your thyroid is also not good. If you want some person without any ounce of care for you to come and say you’re too young or anything out of the people who will give you genuine opinions, you’re free to do whatever you want. How you want to treat these low numbers is dependent on the cause of your low numbers. If overtraining/ lack of any training is the cause among other lifestyle issues you need to sort that out first. The number on the test means nothing without symptoms. The symptoms dictate and numbers support. If you’re hypogonadal your total T being 200 or 350 has no consequence at all! You should know this first, do not compare numbers.

Depending on your cause, you can fix the cause and if you cannot , go on t replacement.

Age is an argument I can’t make sense of. If anything the argument should be the other way, considering T falls as we age. If one is low enough to be having symptoms , it’s only going to go down hill from there, if cause is not known or untreatable. So please make your own decision. I’m 25 and on TRT. I am not a gym rat, I’m a business grad and I go to the gym as a normal person so it’s not a choice, I had a condition and I and my doctor do whatever’s needed to control the condition.

3

Hey thanks for your response!

I totally get where your coming from about making my own decision, and I will. I suppose I just recognized that I am really kinda set on getting TRT (if it’s indicated), and wanted to make sure that if there were good reasons not too that I havn’t seen yet, that I should hear them, and not just from pro TRT people. Im like that with most things I do.

I do not think at this point that it is either under training, nor over training. I am consistent with about 40-50 minutes of exercise a day with 1-2 (occasionally 3) days off a week. I totally agree that since It’s only likely to go down hill, I might as well enjoy the benefits of it sooner rather than later. It’s good to hear from someone in my age bracket that seems to have had success. I suppose I was looking to consider reasons that it might be worth postponing TRT (as in are there and long term side effects of TRT that can be avoided if you postpone it until later in life.) I am wondering if you can tell me what sort of doctor did you get treatment from?

Thanks again for taking the time to respond.

4

Hey there everyone!

So these are my extremely thorough results. I made sure I was as nourished/rested as possible and went to get my blood taken the second that I got out of bed. I would say that I was certainly having a (relatively) good morning (Some days I feel the low T symptoms more than other) compared to most.

There seems to be a general improvement in the Free Testosterone from the last test. This is the panel that a Bio-Identical Doctor I went to see ordered. He indicated that treatment was likely called for. He then ordered all of these tests (I actually left some stuff out…) and I was very impressed since it seemed to coincide with what I’ve read here and was VERY thorough.

Although I regularly take vitamins, what did stand out to me is that my Vitamin D is a smidgen low. Also my free testosterone also seems to be a healthy margin into the normal compared to last time.

I go to see this doctor again on Tuesday. He seems legit, not like some careless doc that will give me whatever I ask for.

Ultimately I think I am in good hands with him, however I wanted to see if anyone here could tell me if they seeing anything glaring here that might contraindicate treatment, that can be solved. This forum has been a great resource for me over the last year and I really hold the opinions of the the major contributors here in high esteem.

Thanks you guys!

(Forgive the Copy and Paste I tried to organize it!)

LIPID PANEL
CHOLESTEROL, TOTAL 156 (125-200 mg/dL UL)
HDL CHOLESTEROL 57 (> OR = 40 mg/dL UL)
TRIGLYCERIDES 61 (<150 mg/dL UL)
LDL-CHOLESTEROL 87 (<130 mg/dL (calc) UL(
Desirable range <100 mg/dL for patients with CHD or
diabetes and <70 mg/dL for diabetic patients with known heart disease.
CHOL/HDLC RATIO 2.7 (< OR = 5.0 (calc) UL)
NON HDL CHOLESTEROL 99 mg/dL (calc) UL

COMPREHENSIVE METABOLIC UL

PANEL
GLUCOSE 81 (65-99 mg/dL)
UREA NITROGEN (BUN) (17 7-25 mg/dL)
CREATININE 1.09 (0.60-1.35 mg/dL)
eGFR NON-AFR. AMERICAN 94 (> OR = 60 mL/min/1.73m2)
eGFR AFRICAN AMERICAN 110 (> OR = 60 mL/min/1.73m2)
BUN/CREATININE RATIO NOT APPLICABLE 6-22 (calc)
SODIUM 140 (135-146 mmol/L)
POTASSIUM 4.2 (3.5-5.3 mmol/L)
CHLORIDE 104 (98-110 mmol/L)
CARBON DIOXIDE 26 (19-30 mmol/L)
CALCIUM 9.7 (8.6-10.3 mg/dL)
PROTEIN, TOTAL 7.4 (6.1-8.1 g/dL)
ALBUMIN 5.1 (3.6-5.1 g/dL)
GLOBULIN 2.3 (1.9-3.7 g/dL)
ALBUMIN/GLOBULIN RATIO 2.2 (1.0-2.5 (calc))
BILIRUBIN, TOTAL 0.9 (0.2-1.2 mg/dL)
ALKALINE PHOSPHATASE 92 (40-115 U/L)
AST 18 (10-40 U/L)
ALT 13 (9-46 U/L)
TSH 2.06 (0.40-4.50 mIU/L) UL
T4, FREE 1.5 (0.8-1.8 ng/dL) UL
T3, FREE 3.4 (2.3-4.2 pg/mL) UL

THYROID PEROXIDASE EN
ANTIBODIES 4 <9 IU/mL
IGF I, LC/MS 260 83-456 ng/mL EZ
Z SCORE (MALE) 0.7 -2.0 - +2.0 SD
Fasting reference interval
DHEA SULFATE 242 85-690 mcg/dL EN
SEX HORMONE BINDING GLOBULIN 26 10-50 nmol/L
FSH 2.7 1.6-8.0 mIU/mL UL

PROGESTERONE <0.5 (<1.4 ng/mL)
PROLACTIN 8.6 ( 2.0-18.0 ng/mL)
CORTISOL, A.M. 11.4 mcg/dL UL

PSA, TOTAL WITH REFLEX TO EN
PSA, FREE
PSA, TOTAL 0.9 < OR = 4.0 ng/mL

ESTRADIOL, ULTRASENSITIVE LC/MS/MS 20 pg/mL < OR = 29 pg/mL
TESTOSTERONE, TOTAL, 391 250-1100 ng/dL
FREE TESTOSTERONE 70.2 35.0-155.0 pg/mL

APOLIPOPROTEIN B mg/dL 64 <80 80-119 >=120

Metabolic Markers Lab: EZ
HEMOGLOBIN A1c % of total Hgb 4.9 --------- (Optimal) <=5.6 (Moderate) 5.7-6.4 (Low) >=6.5
INSULIN uIU/mL 3.2 ------------- (Optimal) <23 (Moderate) N/A (Low) >=23

Metabolic Markers Lab: SLI
VITAMIN D, 25-OH, TOTAL 29 ng/mL ---------- (Optimal) >=30 (Moderate) 20-29 (Low)<20

5

I’m Glad to hear that you found a good doctor. Did you get his response from the blood work back?

6

No I see him tomorrow. Ill post an update, if for nothing else, than as a point of reference…

7

Hey there,

So this is the result of seeing the doc today:

As I was already expecting, he believed treatment was indicated in my case.

He noted that my FSH levels were quite low considering that I had low T levels, indicating that at least part of this problem is coming from signaling.

He is a very conservative Doc (which I personally like) and likes to start off low and work up at a reasonable pace. I am starting of at 25mg Testosterone injected twice a week IM. He usually recommends sub-q, but was totally cool with me doing IM if that was my preference.

Along with that I am also doing HCG at 500 units (.5ml) twice a week, sub-q.

He also prescribed Vitamin D pills.

He noted that my progesterone was also very low, but I told him I wanted to focus on just this medication until the next meeting in about 6 weeks. He indicated he really wanted to address the progesterone again in our next appointment. He indicated that I could replace it with an oral supplement.

This update if for nothing else can maybe serve as a reference for someone that might be in a similar situation, with comparable lab results/age, and see what the course a treatment looked like.

Im always interested in any poignant feedback from the knowledgable contributors here on this forum, so let me know if you guys have any thoughts.

I am very (but also somewhat cautiously) optimistic about the treatment. If there is interest I can give updates on my progress, as it seemed (for me at least) particularly hard to find a thorough account of younger guys experience with this treatment journey.

Thanks!

8

That’s a very low dose of T. Very. I wouldn’t call that conservative, more like lack of knowledge. Most people pin 100mg/week some go as low as 80mg. At 50mg/week you are going to suppress what you have and not likely improve on it. Hopefully you get follow up blood work sooner than later (4-6 weeks) so he can increase your dose.

9

Thanks for the input.

Well he did make it clear that it was a minimum dose, and that it very likely will increase. Given than I am also starting on HCG, would you really call it lack of knowledge. Should I not also expect the HCG to accrue some benefits, especially given that I have a weak pituitary response given the low T blood levels?

He mentioned he has seen clinical efficacy at that low dosage, is there evidence that a low dosage will really further suppress my T levels? If there is could you let me know where to find it? I’d like to bring it up with him sooner rather than later. He is very amenable to questions, so perhaps I can get his ok to increase the dose over the phone.

10

hCG does not raise T that much in most cases, but when young like you it might work well.

Check your oral body temperatures to eval overall thyroid function as per the thyroid basics sticky.

See these stickies found here: About the T Replacement Category - #2 by KSman
advice for new guys
things that damage your hormones
protocol for injections
thyroid basics
finding a TRT doc

TSH should be closer to 1.0
Are you iodine deficient from not using iodized salt?
fT3 and fT4 are above mid-range. If body temps are low, suspect stress induced elevated rT3 and get that tested. See the thyroid basics sticky for references to rT3, stress, adrenal fatigue, iodine.

You can get 2% non-Rx progesterone cream, KAL brand, see amazon. Please not other brands - absorption issues. Oral progesterone is quite hard to absorb.

Half life of hCG makes 250-300iu hCG SC EOD a better bet.