29 year old TRT Kaiser Permanente

[UserUnknown]

First time poster long time lurker. ANY advice is greatly appreciated.

Stats: 29 year old male 5'7 140lbs 14% BF 22.5 BMI Kaiser Permanente Member

At 21 years old my levels were:

Total Testosterone = 37 ng/dL (280 - 800 ng/dL) @ 12/15/2010 3:53 PM Retested Total Testosterone = 440 ng/dL (280 - 800 ng/dL) @ 01/10/2011 8:18 AM

At 29 years old my levels are:

LAB RESULTS 2/2/18 @ 9AM

SHBG = 23 (11 - 78) Free Testosterone = 8.9 (7.0 - 36.7) Total Testosterone = 366 (240 - 871) TSH = 0.56 (0.35 - 4.00)

I specifically asked for LH, FSH, and estradiol to also be tested but my GP messed up the order. He has cleared me to get tested again, but I've already been referred to an endocrinologist by another GP from the same facility because my GP is to busy and self admittedly out of his element when it comes to testosterone.

Symptoms: No libido Fatigue/Lethargy Naps once a day (after breakfast or dinner) Depression Mood swings More noticeable joint pain in wrists, ankles, and elbows. Lost the "enjoyment of life" Erections are weaker but I can still get them Lost 5lbs over the past month or so due to symptoms worsening

I'm fairly fit. Thin fit. I workout 3-4 times a week. Heavy lifting no cardio. Compound workouts. I've tried both 3 larges meals and a protein shake, and 6 small meals and a protein shake. Yadda yadda yadda I've tried it all over the past 7-8 years. I've done a ton of research on testosterone. I am aware the biggest risks would be Polycythemia and Permanent Infertility (15-20% chance).

This is very personal and private to me, I have not spoken to anyone about this. I will be seeing an endocrinologist soon, and I'm curious to see what you guys have to say.

 

[Systemlord]

Where are all your labs? What about SHBG?

Kaiser is still quite a bit behind the times when it comes to TRT, I'm with Kaiser. The thing my endo understood was even injecting weekly has its problems with most guys, but my endo stated if I had trouble getting wife pregnant I would have to stop TRT which isn't even true, an endo that doesn't know anything about HCG can't be good. Forget about being prescribe HCG or an AI to control high estrogen. Your estrogen must be low if you have joint pain, bet there popping and clicking. Your levels are close to my own pre-TRT, request injection twice weekly. Trust me you'll thank me later!

Don't get your hopes up because most insurance doctors are almost always automatically mentally challenged when it comes to TRT, they simply don't have time to reeducate as their to busy triaging people. Once you hit the normal ranges they don't want to hear from you anymore until your scheduled labs tests, my endo was perfectly happy with me having a trough of 442 ng/dL which is still in low T land. They don't care if you're at 450 or 750, they don't have time to balance your hormones because they have to see 30 people in an 8 hour shift.

Be prepared to pay out of pocket for proper care!

 

[Mycelium]

I spent 5 years arguing with various doctors from my general doc, endo, neurology, urology and another endo. I was bringing on published articles from the Journal of Endocrinology, Journal of Neurology, clinical trials and articles from the Epilespy Foundations written by Neurologist.

I finally got sick of the feeling sitting on the couch breathing was more work than I had motivation. I was drinking 3 pots in coffee before noon easily. No erections or sexual desire. I would be looking in the background of porn and checking out the house or what I could see out the windows.

Ask for self injection. Test cypionate is usual. Try for at least 100-120mg week. There is not truly 100mg of testosterone in 100mg of test cyp. Part of the weight is the ester attached to it.

Asking for an aromatase inhibitor to control estrogen or else you will need labs constantly to figure out yoir dose that won't cause elevated estrogen.

Human Chronic Gonadotropin/hCG helps keep our testicles from shrinking and all the problems attached to that.


My pack a day smoking habit pays for my TRT for a financial comparison. It seems like a lot when you see pharmacy grade and prescription TRT but I'll sell body in a dark alley before I go back to Low T.

 

[UserUnknown]

UPDATE 2/13/18:
Saw my endocrinologist today. We talked for over an hour about my symptoms and previous labs. He says I am in the ***8220;gray area***8221; of low-normal testosterone levels, which may or may not be the problem. He concluded that if my levels were not below the clinically low range (240), he would most likely not prescribe testosterone. But he also stated that he was possibly open to a trial run, due to my low-normal range and being symptomatic. He wants more lab results to determine the next move.
He has ordered following labs: ALBUMIN, DHEA-S, ESTRADIOL (ULTRA SENSITIVE, PEDIATRIC), ESTRADIOL, FSH, LH, PROLACTIN, SHBG, TESTOSTERONE, VITAMIN D.
Now***8230; I feel like shit. What would you guys do? Should I tank my T levels intentionally? I would feel silly if I did that but at the same time, if this doesn***8217;t go through, I may end up at a Men***8217;s Health Clinic paying an arm and a leg. On top of that this endocrinologist was actually really chill and semi open-minded. I mentioned the Estradiol ***8220;sensitive***8221; test, he didn***8217;t even know what it was but was willing to test it anyway. He also through vitamin D in there per my request.

Any comments are appreciated.

 

[Systemlord]

It sounds like this doctor is going to ignore symptoms and play it on the numbers which means this doctor is clueless when it comes to diagnosing a testosterone deficiency. These normal ranges doesn't mean anything about whether you are low T or not, there purely statistical. Your symptoms indicate a testosterone deficiency and doctors that lack critical thinking and deductive reasoning will always play the numbers games with patients for the simply fact they're lazy minded, insurance doctors employ these tactics because all they do all day is stare at labs ranges, they don't base their decisions on labs AND symptoms, that's to challenging from them.

A trial run is an easy tool for those doctors who are clueless one way or the other about whether someone will benefit from TRT, these doctors do not stay ahead of the curve on the lastest TRT related studies. Their heads will forever remain in the clouds.


https://www.ncbi.nlm.nih.gov/pubmed/27843074

CONCLUSION:
These data showed that a testosterone threshold of 440 ng/dL was associated with increased Framingham 10-year CVD risk in middle-aged and elderly men. Poor sexual performance, decreased morning erection, and loss of libido had an impact on the testosterone threshold for CVD risk. The threshold level was higher in men with sexual dysfunction. Further study is required to evaluate the validity of these testosterone thresholds for CVD risk.

 

[UserUnknown]

Interesting article. I may bring that up with him.

He was actually much more open-minded than I expected, but really my latest lab results will determine the next move. I feel if my levels are anything below 366, associated with symptoms, I am going to seek treatment. I will push for a trial run with him, hopefully "dial in" and be on with my life.

I will keep you guys updated.

 

[UserUnknown]

UPDATE: Latest labs are in fellas

Collected @ 02/14/2018 8:47 AM

FSH = 2.7 (1.0 - 12.0 mIU/mL)
Albumin = 5.1 (3.3 - 4.8 g/dL)
Estradiol = 18 (11 - 44 pg/mL)
SHBG = 26 (11 78 nmol/L)
LH = 2.4 (<=12.1)
Total Testosterone = 460 (240 - 871 ng/dL)
DHEA-S = 242 (160-449 mcg/dL)

Thoughts?

 

[Systemlord]

While those level might be perfectly fine for one guy, it might cause symptoms in another guy. This is why TRT is tricky, you might have to go out of pocket as I believe the doctor is going to cling to the one higher 460 number. The moment you start paying for everything doors seem to swing open, insurance doctors are only going to provide treatment based on your insurance companies rules and coverages. Doctors don't always have the final say so, the insurance companies have the final say so and doctors must wiggle with those parameters.

 

[UserUnknown]

Right on. Makes sense.

Just to keep everyone updated if interested:

Spoke with Doc again today. He says my Prolactin and Albumin levels are just above limit. He wants to retest to make sure I don't have any pituitary issues. I agreed.

I told him that while my 460 level is within normal range, it is the average for a 70 year old and I am in tip top shape. He understood and is most likely willing to begin a trial test (even though his colleagues would look down on it).

I've never tested above 500 and it's fucking with my head lol.

 

[Mycelium]

Even with impotence, gyno and being 397-400 I was refused over and over. My TT dropped like 28% in 24 months when the average is supposed to be around 1% per year . . . Still refused.

I said screw it I'll pay out of pocket to get my life back. Faq da institutionalized system!!! ***55357;***56833;

 

[UserUnknown]

Update 2/21/18:

Spoke with Endo today. Says all my pituitary labs are good. Now for the real thing...

He is willing to put me on a trial run at 40mg of testosterone injections once a week. Since my last level was 460, he says 40mg will bump me up 100-200 more and may make me feel better.

I agreed because I don't want to throw away the opportunity, but at the same time I'm a bit worried that its too low of a dosage. Also, I don't think he intends to keep me on for life.

Thoughts?

 

[Systemlord]

Update 2/21/18:

Spoke with Endo today. Says all my pituitary labs are good. Now for the real thing...

He is willing to put me on a trial run at 40mg of testosterone injections once a week. Since my last level was 460, he says 40mg will bump me up 100-200 more and may make me feel better.

I agreed because I don't want to throw away the opportunity, but at the same time I'm a bit worried that its too low of a dosage. Also, I don't think he intends to keep me on for life.

Thoughts?

Oh Jesus your endo is clueless, your endo doesn't understand that injectable T will shut your pituitary gland down ending your natural production! This is not a standard TRT protocol, guidelines suggest 75-100mg total weekly.

When you respond poorly to the 40mg he will believe you didn't need TRT and he will stop treatment.

You think you feel bad now, you just wait as you'll find a new level of hell!

He believes adding 40mg of testosterone will add to your natural production, truly ridiculous!!!

An opportunity, I think you should pass and find a doctor who is competent.

 

[freqfly23]

Oh Jesus your endo is clueless, your endo doesn't understand that injectable T will shut your pituitary gland down ending your natural production! This is not a standard TRT protocol, guidelines suggest 75-100mg total weekly.

When you respond poorly to the 40mg he will believe you didn't need TRT and he will stop treatment.

You think you feel bad now, you just wait as you'll find a new level of hell!

He believes adding 40mg of testosterone will add to your natural production, truly ridiculous!!!

An opportunity, I think you should pass and find a doctor who is competent.

Agree 100% with Systemlord. Your Dr is either clueless or ignorant. There are plenty of docs out there who will steer you in the right direction; so seem like you have your head on straight and want the best for your health, find a dr in alignment broski; all the best~

 

[Mycelium]

Playing along will cost you in quality of life. If you can stand it and show the doctor it actually drops your levels with labs you could educate a doctor.

It's just like everyone said above, you can't add testosterone to the system like that.

 

[UserUnknown]

Update 4/9/18:

Latest blood test 4/6/18:

TESTOSTERONE, TOTAL 392 ng/dL (240 - 871 ng/dL)
ESTRADIOL 13 pg/mL (11 - 44 pg/mL)
WBC'S AUTO 6.3 x1000/mcL (4.0 - 11.0 x1000/mcL)
RBC, AUTO 5.25 Mill/mcL (4.70 - 6.10 Mill/mcL)
HGB 15.9 g/dL (14.0 - 18.0 g/dL)
HCT, AUTO 47.8 % (42.0 - 52.0 %)
MCV 91.0 fL (80.0 - 94.0 fL)
MCH 30.2 pg/cell (27.0 - 35.0 pg/cell)
MCHC 33.2 g/dL (32.0 - 37.0 g/dL)
RDW, BLOOD 12.2 % (11.5 - 14.5 %)
PLATELETS, AUTOMATED COUNT 242 (x1000/mcL 130 - 400 x1000/mcL)


You guys were right. Thanks

 

[Systemlord]

Update 4/9/18:

Latest blood test 4/6/18:

TESTOSTERONE, TOTAL 392 ng/dL (240 - 871 ng/dL)
ESTRADIOL 13 pg/mL (11 - 44 pg/mL)
WBC'S AUTO 6.3 x1000/mcL (4.0 - 11.0 x1000/mcL)
RBC, AUTO 5.25 Mill/mcL (4.70 - 6.10 Mill/mcL)
HGB 15.9 g/dL (14.0 - 18.0 g/dL)
HCT, AUTO 47.8 % (42.0 - 52.0 %)
MCV 91.0 fL (80.0 - 94.0 fL)
MCH 30.2 pg/cell (27.0 - 35.0 pg/cell)
MCHC 33.2 g/dL (32.0 - 37.0 g/dL)
RDW, BLOOD 12.2 % (11.5 - 14.5 %)
PLATELETS, AUTOMATED COUNT 242 (x1000/mcL 130 - 400 x1000/mcL)


You guys were right. Thanks

You're worst off than before you started and now your HPTA is shutdown. So what's the plan now?

 

[scorob777]

Low total test and low estrogen, moderately high HCT. What does your doc say about this?

Any chance you could get him to give you 100 mg/wk? That should fix you right up.

 

[Dreaded Pirate Roberts]

Id pay out of pocket too. I know When my levels are high and my estrogen is in check I feel like a million bucks