Totally New Here, Need Help

Pharma / TRT Testosterone Replacement
1

First off, I want to say how grateful I am for the support in this forum.
I read as much as I could on the stickies but I got some heavy brain fog going on.
I just started TRT last December and have experienced some great changes, but a few things have got me really plagued. I’ll post my blood work in a second.
I had a previous T-test done 3 years ago but didn’t really qualify. My doc left his practice 7 months ago and isn’t accessible now, so I’m stuck with a Nurse Practitioner (NP) who approved me for TRT but knows very little about TRT…and I’m a Cash Pay in a very unaffordable situation at this time.
She didn’t test for SHBG, Cortisol levels, Estradiol (E2), Progesterone levels, LH, FSH, PSA, DHT, T-4, T-3, FT-4, FT-3, RT-3, Ferritin, etc…and I didn’t ask her because I thought maybe she new protocol and I didn’t really know better (wish I read the stickies in December)
It’s too late to check LH, FSH, and Cortisol for baseline bloodwork since starting my injections over a month ago.
Yesterday I asked her to check SHBG (she didn’t know what that was and looked at me like I made it up), and my E2 levels. She said she usually only checked Estrogen for women but she would do it anyway. She won’t check Pregnenolone, Progesterone, DHT, or DHEA, but she gave in to testing SHBG and Estradiol. She tested me yesterday and I’ll know soon what my second set of labs look like.

Any ideas on how to work with this women? I brought up AI’s if E2 was suprahigh and she said she only prescribes the Testosterone and I’d have to find an endocrinologist. I’m almost flat broke right now and can’t cash pay a specialist.

Anyway my first labs are below. Everything with an “:arrow_backward:” next to it is concerning in regards to one another. What do you guys think?

AGE: 40
●Testosterone
Testosterone, Serum 587 (264-916 ng/dL)
Free Testosterone(Direct) 8.1 (8.7-25.1 pg/mL)
●TSH to T-4 Teflex
TSH 3.890 (0.450-4.500 uIU/mL)
●Lipid Reflex to Direct LDL
Cholesterol, Total 127 (100-199 mg/dL)
Triglycerides 57 (0-149 mg/dL)
HDL Cholesterol 46 (>39 mg/dL)
LDL Cholesterol Calc 70 (0-99 mg/dL)
●CBC With Differential/Platelet
WBC 6.6 (3.4-10.8 x10E3/uL)
RBC 5.26 (4.14-5.80 x10E6/uL):arrow_backward:
Hemoglobin 10.8 (13.0-17.7 g/dL) :arrow_backward:
Hematocrit 34.8 (37.5-51.0 %) :arrow_backward:
Platelets 292 (150-379 x10E3/uL)
●Comp. Metabolic Panel
Glucose 86 (65-99 mg/dL)
Albumin 4.9 (3.5-5.5 g/dL)
Globulin, Total 2.5 (1.5-4.5 g/dL)

MY OLD TESTOSTERONE TEST LEVELS 9/24/2015 (prior to being qualified for TRT)
AGE: 37
TT: 711
FT: 10.9

My NP started me out at 100mgs Test-c every 2 weeks (that didn’t go well), changed it to 50mgs weekly (meh…), then eventually 100mgs weekly…good times for a while. Now at 100mgs weekly my heart is racing, my BP is like 194/82 resting, and my libido, ED and energy levels have crashed this last week and a half. What the hell is up? I was feeling terrific for 3 weeks, then BOOM, problems!
To make matters worse, I injected 100mgs 2 days ago and she’s checking a peak T bloodwork level from yesterday rather than a trough bloodwork reading. I can only imagine how she’ll react to the numbers.
I’m switching my injection regimen to 50mgs twice weekly in hopes that my symptoms might clear up.
In the meantime
-What do I do about my situation with my NP? She doesn’t seem open to suggestions or patient provided information.
-Why on earth would my T be working miracles at 100mgs for 3 weeks and implode for the last week and a half?
-How do I manage with the unfinished initial labs and what do I do if my labs come back with high E2 or something? She looked at me crazy when I asked her what she thought about Anastrozole.
Hiz-elp pliz-ease if you have any suggestions, experience, or expertise in dealing with this crap. I liked my new life (so did my girlfriend)…where…did…it…go and what do I do? Anyone?

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Total test could be up more. You could try an increase 120-150mg per week

This points towards high SHBG binding up your free test

Suggest getting a complete thyroid panel

Numbers are low, are you eating much iron in your diet ? (eggs, spinach, artichokes, beans, lean meats, and seafood) and foods rich in cofactors (such as vitamin B6, folic acid, vitamin B12, and vitamin C) important for maintaining normal hemoglobin levels. I would suggest getting this looked into.

That is a lot of changes going on over a short period. It can take up to 6 weeks for a protocol to stabilise. The TT is a bit low, I find around 500 I get problems and it seems you have high SHBG = free test is very low. Its possible a higher dose would benefit, like 120-150mg per week. They normally say with high SHBG bigger shots once weekly is better. Something like 120-150mg once per week for 6 weeks, then retest everything. I’m sure other more knowledgeable members will chime in, I’m just a member not a doctor.

I would push for these tests, without them you only paint a part of the picture

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This is a fairly common situation believe it it not. I started with a PA, and my story is very similar to yours. If she’s letting you self inject, then that’s a plus because you can at least have a say in your injection frequency. You imploded at 3 weeks in because A, you weren’t stabilized yet (takes 6-8 weeks), and B, weekly injections may not be your best protocol. We can’t say that for sure until you get your SHGB back and you stabilize in a protocol to determine how your body metabolizes Test.

Stick with the 50mg twice a week protocol for at least six weeks. Put your mind in a different place concerning the AI. You shouldn’t need it on 100mg per week, especially if you’re splitting the injections. Stay away from them if at all possible.

Lastly, your TSH is elevated so you’ll want to get a full Thyroid work up ASAP. Thyroid issues can make TRT ineffective.

Financially speaking, this shit costs a lot of money to get right. If you don’t have insurance to help with labs, you should look hard into some sort of HSA to help you out. You can order your own labs through online sources like discounted labs. That could probably save you a little as well.

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Are you a vegetarian?

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Your Free T is pathetic and is likely do to high SHBG which binds testosterone, so the more SHBG you have, the lower your Free T will be. I would recommend you inject 50-60mg twice weekly to keep levels stable, testosterone peaks in 24-48 hours and starts declining and you may be inducing highs and lows which we call a hormonal roller coaster.

Injecting large infrequent doses of T can cause estrogen to spike high causing high blood pressure and higher heart rates via water retention which puts pressure on blood vessels. Your thyroid is terrible, TSH >2.5 is indicating a problem, don’t believe the bull about being in the normal ranges, the ranges are invalid according to as study.

A thyroid panel consisting of Free T3, Free T4, Reverse T3 and antibodies is recommended.

The evidence for a narrower thyrotropin reference range

It has become clear that previously accepted reference ranges are no longer valid as a result of both the development of more highly sensitive TSH assays and the appreciation that reference populations previously considered normal were contaminated with individuals with various degrees of thyroid dysfunction that served to increase mean TSH levels for the group. Recent laboratory guidelines from the National Academy of Clinical Biochemistry indicate that more than 95% of normal individuals have TSH levels below 2.5 mU/liter. The remainder with higher values are outliers, most of whom are likely to have underlying Hashimoto thyroiditis or other causes of elevated TSH.

Doctors are still going by the older invalidated ranges because that’s what the insurance companies want so they can save on healthcare costs and invest in their future and not yours.

This is bad news, it means she’s unwilling to learn and listen to patient feedback. It’s her way or the highway. I suggest you hit the road then and find a doctor that will work with you.

Cash pay and this is the kind of treatment one can expect paying out of pocket…

Solution, Defy medical is a telemedicine clinic with experienced TRT and thyroid doctors and is more affordable than you think. I pay $100 monthly which includes consults, labs and medicine.

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No, not a Vegetarian at all. I don’t eat enough cruciferous vegetables though which might merit my hemocrit levels being low.
On the other hand, my mother has Thalassemia and her blood doesn’t carry much iron naturally. 2 doctors have told me I don’t have thalassemia, however, every blood test I’ve ever taken shows I’m slightly or very Anemic…could be a B12 issue, we’ll see when my Ferritin test comes back what I can do next. What’s Ironic is that my grandmother on my moms side had Haemochromatosis and carried massive excess’s of Iron in her blood requiring frequent blood transfusions.

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You really should fix this first.
I would be flipping out with your RBC, Hemo and Hema. Those are the worse numbers I have seen on any of the mens health forums I am a member. I would be asking for IV’s of Iron and B12 shots you can give yourself.
What is wrong with your doctors? No wonder you feel like crap. You might not even need TRT however it will help you heal and recover from this anemia.

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The Labs are all pre-T treatment. The lab shown above is what persuaded my NP to prescribe Test-C but I don’t think she understands TT vs FT. Total-T isn’t awful in that lab but it’s been dropping significantly over the last 3 years for every lab test I’ve had. My Free-T has been lower and lower since my first Labs were done 3 years ago. I’m hoping SHBG is the culprit since it shouldn’t be binding at more than 55% with Albumin binding at a lower level…we’ll see when my new labs come in.

I eat plenty of meat, eggs, beans, and seafood (canned salmon mostly), but I need to up my intake of greens. Taking supplemental vitamins since I train in the gym but it’s not the same as vitamins in foods of course.

My new labs should have all the above in them except Thyroid tests which my NP thinks are redundant because I fall into medically “Normal” in my labs…l think she’s a bit in over her head with the Endocrinology aspect of things being swung at her and the last thing she wants is to feel uneducated about the matter. The last thing I want is to do all this again as a cash pay with another doctor.

Thanks for the suggestions and honesty. I need as much personal experience and information as possible to get this dialed in. I’ll post my next lab results soon.
@bmbrady77 @Rizla81

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No, not a Vegetarian at all. I don’t eat enough cruciferous vegetables though which might merit my hemocrit levels being low.
On the other hand, my mother has Thalassemia and can’t carry much iron in her blood naturally. Ironically, my grandmother has Haemochromatosis and need to have blood transfusions frequently due to the high Iron she couldn’t get rid of. I’ll find out more when my Ferritin levels come back soon. Could be an inability to absorb B12…who knows, I always test Anemic but 2 doctors have said I don’t have a blood disorder.

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Doctors who don’t specialize in a particular field are, in particular, laymen regarding that field. Once Ferritin levels come back, we’ll know what to do next. If I can roll on without TRT and get everything optimized, then that’ll be my course.

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I’ll check out Defy medical. Appreciate the suggestion and article information. My Nurse Practitioner won’t listen to me but she will look at and act on PubMed articles, university studies, and other non anti aging clinic data. This is, of course, problematic but if I can get a link to that article, I can send it to her for observation.

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@thehokiefloyd you are correct. if them numbers are pre TRT then that’s not bad at all for TT. I’m a believer that if one is on TRT it’s better being optimal right at the top end. It would be clearer with the new labs ‘on’ TRT.

I myself had high SHBG and bottomed out Free T. Starting TRT brought mine down from 57 to 35 and free test shot up. It sounds like you are clued on about it all, it’s just finding a doctor who will run the proper testing you need. My own doctor sits there looking puzzled when I talk about blood tests. I pay privately for tests. I would normally get the TRT check plus which covers most things thyroid included. It costs around £120 in UK.

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Thanks brother. Yup, I’m going to need to find a new doc and/or source my own labs. I think you and some of the others who commented are spot on about the SHBG. Systemlord had some interesting things to say about why my blood pressure’s been through the roof as well. I think one of the biggest things I’m picking up here is the importance of Thyroid function. I’ve got to find some literature from a medically credible source without an obvious monetary interest to support the science behind actual normal THS values and where they differ from what labs are considering to be “Normal”. Regardless of what comes back on my other labs, I’m sure it’ll help with figuring out what to do regarding a few of the issues with my blood work. I’m excited to see where Ferritin, SHBG, and E2 are at. My NP took my labs 38 hours after my Test-C injection so I’m sure she’ll look at my TT and FT and think that’s the typical amount of Testosterone I have floating around my blood at all times :rofl:. Can’t wait to see what she says when she posts them. Anyway…appreciate your help and feed back. Still learning as much as I can.

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Here are some studies on normal thyroid levels and not what sick care believes is normal, the majority of doctors don’t read these studies, between seeing 20 patients in a single day and personal life, they don’t have the time to read studies.

I didn’t mention it before, but TSH isn’t a thyroid hormone, it merely stimulates the thyroid gland. You wish to know how your thyroid is performing, you must test those thyroid hormones listed in my earlier post.

Reference ranges for TSH and thyroid hormones

Google “Optimal VS Normal Thyroid Levels for all Lab Tests & Ages”

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Yeah, modern medicine isn’t all that modern in terms of patient care. My Doctor left his practice to move to the VA in July of last year, he was an incredible doctor who really cared about his patients. Now I’m stuck with this Nurse Practitioner and doesn’t take nearly as much interest in her patients as my doc did. These are my Thyroid results 3 years ago:

TSH 1.350 (0.450-4.500 uIU/mL)
Thyroxine (T4) 5.2 (4.5-12.0 ug/dL)
Triiodothyronine, Free, Serum 3.0 (2.0-4.4 pg/mL)
Numbers looked a hell of a lot better back then.

My nurse Practitioner doesn’t want to test for T4 or FT3 because my doc already did 3 years ago and the numbers were good…WTF!?

My NP will only learn if she doesn’t think she is being taught by her patient. So I have to reference a specific article that’s got heavy credibility behind it I.E. .gov, PubMed, institutions like Harvard, etc…or she doesn’t really care. I don’t exactly blame her either, snake oil salesmen and miracle workers are everywhere…for the right $$$.

Patient self diagnosing is at an all time high as well which really shuts down people in the medical field from taking the time to listen to their patients. This misfortune has cost many of us an opportunity to work “with” our doctors and many medicine practitioners are now skeptical about what we as patients say. It’s unfortunate for those of us that are taking our health into our own hands.

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My SHBG is high also (65) and free t in the gutter. I’m 2 weeks into my first TRT protocol, 80mg 2x a week. Looking forward to seeing results and my next labs in 4 weeks.

Good luck to you brother

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80mgs twice a week to start? Wow, what does your current bloodwork look like if you’re alright with me asking? I’m curious for my own sake. My Labs should be back by Monday or Tuesday and it’ll be interesting to see where they sit. My NP took my labs early because I was already in the office for a separate issue. She doesn’t really understand Endocrinology well and got weird on me when I asked for SHBG and E2 levels to be tested. She agreed reluctantly to test for these but said I might need to see an Endocrinologist. More money out of pocket for me as a cash pay if I got to find a new doc and I’ll have to go through this all over again. What’s your free T looking like? @Brando52

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At the risk of generalizing, you need a doctor. Nurse Practitioners are a useless waste of your time, and only exist to save someone else money when treating you. You don’t have to put up with it, it is YOUR health at stake, and that is more important than the bottom line, at least outside of the US. You can demand a doctor and refuse lesser qualified people. You will have enough trouble when it’s a qualified doctor, you don’t need to play with a pretend medical professional.

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Yeah, I wish it was that easy brother. I had a great doctor of 10 years who left the practice to go to the VA. I got stuck with this NP because he left in July. I’m in the U.S. and unfortunately don’t have health insurance so I’m paying a cash rate for everything. I had Insurance but now I’m staying at home as a single parent taking care of my son who has some really heavy mental health issues. Not playing the sob-story card here, but that’s the position I’m in.

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I guess a better way to put it is, I pay $75 every 2 months for a visit with my NP, $35 for a 10ml/1000mg vial of Testosterone Cypionate, and $15 for 25gauge syringes and 18gauge drawing tips.