I’m 43. Began TRT from a urologist a year ago. T levels are now 935, but now I’m plagued with erectile dysfunction that I didn’t even have when T was ~200. Urologist refuses to do any bloodwork other than total test and PSA. He also refuses to do aromatase inhibitors. Bottom line, I need a Dr who will properly manage TRT with comprehensive lab work. Will graciously welcome recommendations for Dr’s in my area.
Please follow these links in the 2nd post of the 1st forum topic:
- advice for new guys
- things that damage your hormones
- finding a TRT doc
Post all of your labs with lab ranges. Post pre TRT labs with LH/FSH
Urologists as a group seem to be the worst and endo’s are a close second.
Suggest:
TT
FT
E2
prolactin
PSA
CBC with hematocrit
TSH
fT3
fT4
AM cortisol
You can do your own labs via lef.com and they have docs that will consult with results [free for members] and they can supply TRT referrals.
I’m 43, 6’00" 195 lbs.
Here’s the worst part. He did not initial labs except for total testosterone and PSA, so I apologize for not having all the info you requested, which is why I’m seeking out a Dr that is known to treat TRT properly. Even when my Testosterone level was up to 935, I began having erectile dysfunction that I had never experienced before. Dr refuses aromatase inhibitors despite my argument.
This began in April 2015
Testosteron, Serum 245 Low ng/dL Range 348- 1197
Testosterone%,Free+Weakly Bound 15.6 % Range 9.0 - 46.0
Testost., F+W Bound 38.2 Low ng/dL Range 40.0 - 250.0
Prostate Specific Ag, Serum 1.5 ng/mL Range 0.0 - 4.0
With these results, the Dr started me on 200mg Test Cyp every 2 weeks, which I divided into
100mg weekly.
August 2015 this is what I got:
Lab Test Results
testosterone, serum
Reference Range Units
testosterone, serum 935 348-1197 ng/dL
prostate-specific ag, serum
Reference Range Units
prostate specific ag, serum 1.6 0.0-4.0 ng/mL
lipid panel
Reference Range Units
ldl cholesterol calc 131 0-99 mg/dL
vldl cholesterol cal 15 5-40 mg/dL
hdl cholesterol 39 >39 mg/dL
triglycerides 74 0-149 mg/dL
cholesterol, total 185 100-199 mg/dL
comp. metabolic panel (14)
Reference Range Units
glucose, serum 95 65-99 mg/dL
bun 13 6-24 mg/dL
creatinine, serum 1.26 0.76-1.27 mg/dL
egfr if nonafricn am 69 >59 mL/min/1.73
egfr if africn am 80 >59 mL/min/1.73
bun/creatinine ratio 10 9-20 1
sodium, serum 142 134-144 mmol/L
potassium, serum 4.4 3.5-5.2 mmol/L
chloride, serum 103 97-108 mmol/L
carbon dioxide, total 23 18-29 mmol/L
calcium, serum 9.3 8.7-10.2 mg/dL
protein, total, serum 6.8 6.0-8.5 g/dL
albumin, serum 4.6 3.5-5.5 g/dL
globulin, total 2.2 1.5-4.5 g/dL
a/g ratio 2.1 1.1-2.5 1
bilirubin, total 0.5 0.0-1.2 mg/dL
alkaline phosphatase, s 72 39-117 IU/L
ast (sgot) 28 0-40 IU/L
alt (sgpt) 24 0-44 IU/L
cbc/diff ambiguous default
Reference Range Units
wbc 4.9 3.4-10.8 x10E3/uL
rbc 5.38 4.14-5.80 x10E6/uL
hemoglobin 17.4 12.6-17.7 g/dL
hematocrit 50.4 37.5-51.0 %
mcv 94 79-97 fL
mch 32.3 26.6-33.0 pg
mchc 34.5 31.5-35.7 g/dL
rdw 13.7 12.3-15.4 %
platelets 258 150-379 x10E3/uL
neutrophils 53 %
lymphs 38 %
monocytes 6 %
eos 3 %
basos 0 %
neutrophils (absolute) 2.6 1.4-7.0 x10E3/uL
lymphs (absolute) 1.8 0.7-3.1 x10E3/uL
monocytes(absolute) 0.3 0.1-0.9 x10E3/uL
eos (absolute) 0.1 0.0-0.4 x10E3/uL
baso (absolute) 0.0 0.0-0.2 x10E3/uL
immature granulocytes 0 %
immature grans (abs) 0.0 0.0-0.1 x10E3/uL
And the new labs done January 2016 are mind boggling.
testosterone, serum
Reference Range Units
testosterone, serum 133 348-1197 ng/dL
prostate-specific ag, serum
Reference Range Units
prostate specific ag, serum 1.1 0.0-4.0 ng/mL
How did my level drop so drastically while on TRT. No diet changes. No activity changes. No alcohol consumption. The Dr’s only recourse was to up my TRT to 200mg weekly, with STILL no aromatase inhibitors. I told him I want to find the cause of the erectile dysfunction but he just upped my TRT dose and prescribed Cialis, which, by the way isn’t effective. Someone please help!
Your HTC is getting to be a concern. Doubling your T to 200mg/week will cause problems with HTC.
HTC is partly forced by peak T levels and injecting ever two weeks was part of that.
When injecting every two weeks, T levels spike then drop. Your lab results are mostly then determined by lab timing and then they do not represent anything meaningful.
You need to be self injecting 50mg twice a week and taking anastrozole at time of injections as needed.
Please see the link to protocol for injections.
Increase in PSA may be driven by higher E2 levels and E2 peaks that labs are not showing.
Most guys here have some problems with:
- iodine
- body temperatures
- thyroid
If I’m doing multiple injections weekly when would I have labs drawn? Currently I’m being told to have labs drawn the day prior to injections. Also, I appreciate all the knowledge you’re sharing especially about the potential for polycythemia. My problem is I can’t find a doctor who will fully evaluate me, order all the labs that should be ordered, and manage my TRT properly. Can you point me in the direction of finding one? Thanks again
You are going to need to do some leg work to find a Dr. Call all compounding pharmacies in your area and ask them if they can suggest a Dr who prescribes trt, arimidex and hcg. Do the same with regular pharmacies minus the hcg. Your hematocrit is getting dangerous. High hematocrit will make your blood thick and muddy. I would also bet your e2 may be high. When you inject more frequently the timing of your labs matters much less because levels are more stable. I now inject every other day and prefer this to twice per week personally. Good luck.
I suggest injecting twice a week or EOD and doing labs half way between and always doing the same so lab changes are not timing artifacts.
Well now that you gentlemen have effectively scared the shit outta me, I have one more question. I live in Florida, which seems to be the land of “anti-aging” clinics. I spoke with one today who says they have a dr on staff, perform full physical evaluations with comprehensive labs, and that they prescribe hcg, adex, TRT, and even HGH if that’s what you’re after. When I expressed my concern over the potential for polycythemia, he ordered a full set of labs even before my first visit. Are these types of “anti-aging” clinics safe and appropriate for what I need?