Advice wanted for first follow-up after starting TRT

[barnowl]

Been lurking here a while and have learned a lot but wanted to ask for some advice on my specific situation.

48 years old, have a long-time endo who treats me for Graves' disease, asked her in January about possible low-T. Test results were:

Testosterone 240 ng/dl (range 292-867)
SHBG 26 nmol/l (range 16-94)
Calc. free Test 5.3 ng/dl (range 4.8-25.0)
Prolactin 9.9 ng/ml (range 3.0-30.0)
LH 3.0 miu/ml (range 1.2-7.8)

My thyroid levels are under constant supervision for the Graves' and have been stable and normal for years.

Based on this I started TRT, with Testim for a month which did nothing and cost a fortune, so I was able to convince her to switch me to self-injections. She started me on 160mg E14D (yes, I know, crazy low and infrequent dosage) which I took the liberty of 'interpreting' as 80mg E7D. Even at this low dose, I am feeling a lot better and combined with 10mg/day or so of RUI Cia I can only describe the results as "life-changing".

First follow-up is on the 22nd, she wanted me to take blood at the mid-point between injections so I did the calculations and taking it at the low point (just before injection) on an E7D cycle is pretty close to the mid-point of an E14D cycle so that's what I did. I suspect I can talk her into officially approving E7D but E3.5D would be a stretch at this point. In any case, I'm not noticing too much of an up-and-down on E7D so I'm not going to rock the boat too hard yet.

She did not order E2 for the follow-up blood work, WTF? Although at this tiny dose it may not be too much of a worry. Not on HCG or anything else like that but also definitely not having any more kids.

I won't get my lab results until I'm at the doc's office but I wanted to see if any of you super-knowledgeable guys here could offer me any advice on what to look for in my labs and what to ask for from the doc. She's been very reasonable and understanding of my concerns and since I have another endocrine issue to cope with I won't be switching doctors (she actually let me go against conventional treatment for the Graves' and keep my thyroid, I'm just on anti-thyroid medication). If I come armed with knowledge specifically applicable to my situation, I'm sure she'll meet me halfway at least. Planning to at least ask her about monitoring E2 and expecting my T will come in at the low end of normal so hoping I can get a bigger dose and official sanction for E7D.

Thanks in advance!

 

[barnowl]

So here's what the results were:

Labs taken May 9th (on dose day, before injection):
Testosterone 330 ng/dl (range 292-867)
SHBG 33 nmol/l (range 16-94)
Calc. free Test 6.6 ng/dl (range 4.8-25.0)

Based on this I talked the doc into 100mg E7D (up from prescribed 160mg E14D, actual 80mg E7D). Just got follow-up results from a few weeks on that protocol, labs taken June 17th (3.5 days post-injection):

Testosterone 693 ng/dl (range 292-867)
SHBG 27 nmol/l (range 16-94)
Calc. free Test 17.2 ng/dl (range 4.8-25.0)

"Labs look great. No change." was the doc's comment. The numbers back up what I'm feeling... a big improvement.

 

[MBB]

Did he test E2?

 

[barnowl]

Nope, hasn't checked E2 in any of my labs. Might ask about it on my next visit in September, since the T number is no longer hanging out at the bottom end of the range. Had so many questions on my last visit I didn't get around to asking about E2. Luckily I'm not really having any symptoms of high E2.

 

[Megatron28]

Nope, hasn't checked E2 in any of my labs. Might ask about it on my next visit in September, since the T number is no longer hanging out at the bottom end of the range. Had so many questions on my last visit I didn't get around to asking about E2. Luckily I'm not really having any symptoms of high E2.

E2 is about the most important thing that needs to be checked. Dont wait to check it. Go back to your doc and have him run it or see below in my signature below for how to get cheap, fast blood work on your own. Whatever you choose, make sure you get it checked sooner rather than later.

 

[barnowl]

Thanks, Megatron28, wasn't too worried on the original low dose but now that I'm well into normal territory your advice is well-taken. Now that I think about it, I did manage to ask the doc about E2 on my last visit and she said she was more "symptoms oriented" or something like that and wasn't concerned about it unless I had symptoms. Luckily I know how to talk up symptoms to get what I want (which is how I got her to order the original testosterone check) so it shouldn't be a problem to get 'er done.

 

[Megatron28]

Thanks, Megatron28, wasn't too worried on the original low dose but now that I'm well into normal territory your advice is well-taken. Now that I think about it, I did manage to ask the doc about E2 on my last visit and she said she was more "symptoms oriented" or something like that and wasn't concerned about it unless I had symptoms. Luckily I know how to talk up symptoms to get what I want (which is how I got her to order the original testosterone check) so it shouldn't be a problem to get 'er done.

Symptoms are useful for identifying problems, but not everyone experiences them the same way. Some ill effects of high E2 may not even be felt. Better to check E2 and evaluate symptoms.

Let give you analogy. They call High Blood Pressure the Silent Killer because it is bad for you but most people never even notice they suffer from it. So ask your doc if she checks your blood pressure or just waits for you to complain when it is too high.

 

[barnowl]

Excellent analogy, Megatron, thanks for the tips. Gonna order some private labs soon so I can go in armed in September if necessary.

 

[Needtogetaas]

Are you or have you had any problems with Gynaecomastia? Almost 40% of men with Graves end up With Gyno. I have found over time that low dose nolvadex was the only thing I used on people that would help. I have been very interested in this subject as of late. So I will deff be watching your thread my friend. Awesome when some one can get test, has a doctor that will work with them, and can share with the rest of us. Thank you so much

 

[MBB]

E2 is about the most important thing that needs to be checked. Dont wait to check it. Go back to your doc and have him run it or see below in my signature below for how to get cheap, fast blood work on your own. Whatever you choose, make sure you get it checked sooner rather than later.

^This^^^. I don't get test checked all the time, but I always get my E2 checked - at the moment that seems to be once a month trying to get things dialed.

 

[barnowl]

Thankfully I've never had any problems with gynecomastia... hadn't even heard of that as a problem for men with Graves' but a quick search seems to indicate it as more of a 'presenting' feature. I had lots of those (including the rare pretibial myxedema), but not gynecomastia, and they're mostly gone since the Graves' has been under control for over 5 years now. I did have a pretty long discussion with my endo about recent research indicating that low sex hormone levels may be a contributing factor in auto-immune diseases. She was unaware of this research (naturally) but unsurprised, noting that (for example) pregnancy often causes remissions while menopause causes flares. It's encouraging to me that perhaps bringing my testosterone up will help with the Graves' somehow.

Now to get a handle on my E2 and educate my endo...

 

[Alpin]

Looks good. Get Estradiol checked. ..
Peak and trough....
You are at a reasonable T level.
I advise to stay there and not get caught up in the numbers.
Higher T levels will raise HCT faster, more DHT aggravating prostate etc, more Estradiol conversion.
Keep it simple. Barn owl eh? Lol nice handle name.

 

[barnowl]

Agreed, APOLLON... all looking good, not sweating anything right now, we'll see how it looks in a few months, hoping it all stays stable. A little surprised the T jumped so much (330 to 697) going from 80 to 100mg/week but the doc said that it can do that when she raised the dose. And, heh, barnowl was by CB handle back in the day...

 

[Alpin]

Ya higher level guys ususlly have a hell of a time dialing in.
Most could probably get dialed in without estradiol issues if they stay at 600-700 ng dl

 

[barnowl]

I'm just glad I convinced her to up the dose a little. She was planning to leave me where I was, just over the lower bound of the normal range. I suspect I've been a "lower level" guy all my life so being up in 600-700 ought to be paradise by comparison. I really do feel about 20 years younger now!

 

[Alpin]

Yup.

 

[Needtogetaas]

I'm just glad I convinced her to up the dose a little. She was planning to leave me where I was, just over the lower bound of the normal range. I suspect I've been a "lower level" guy all my life so being up in 600-700 ought to be paradise by comparison. I really do feel about 20 years younger now!

Its hard finding docs that are willing to work with people. You are lucky bro

 

[Westshore]

Dude....Private labs (the one under Megatron's signature) is really awesome. I have ZERO relationship to this service and Lab Corp....but am 100% satisfied. I ordered my labs, paid about $58. (Google coupon code) and had my results back to me in about 21 hours. Awesome experience for me.

Order up your own labs and you'll get a huge rush from the autonomy of the whole process.

 

[juced_porkchop]

E2 is about the most important thing that needs to be checked. Dont wait to check it. Go back to your doc and have him run it or see below in my signature below for how to get cheap, fast blood work on your own. Whatever you choose, make sure you get it checked sooner rather than later.

^^ I agree, get it checked not, not later on. call them back and say you want to know your E2.

 

[anzel]

In my state I WAS able to do private labs up until recently...... Now its not allowed anymore. I consider it a major blow to everyhting I do. It was great while I had it.