Concerns with recent blood work.

[NimbusTim]

So I've been on testosterone replacement therapy (TRT) for a little while now and I have some concerns.

Blood Work: 07/30/2012
CBC - All numbers looked good with the exception absolute eosinophils.
Absolute Eosinophils - 520 (Range - 15-500 cells/ul)
Testosterone Total - 402 (Range - 241-827 ng/ml)
PSA - 1.5 (Range - < or 4.0 ng/ml)

I was feeling pretty good a week or two before the visit, then I started getting all my old symptoms back.
Instead of rock hard erections, they became weak & far between. Morning wood completely dissapeared,
as well as the majority of my desire. I developed horrible sweating, trouble sleeping, and a sensitive right nipple.

Upon talking with the Nurse, I asked for new blood work soon after the one above. I specifically asked for E2
levels, but the Dr. refused saying there is NO need to check Estrogen. He ordered another Total Testosterone
and Free Testosterone draw.

Those results are as follows.

Blood Work:08/14/2012
Testosterone, Free and Total, LC/MS/MS Testosterone, Total, LC/MS/MS - 890 (Range - 250-1100 ng/dl
Free Testosterone - 201.1 (Range - 35.0-155.0 pg/ml)


So I'm left confused as to why the two totals vary so much, as the dosage stayed the same....and they were both
drawn in the morning BEFORE my next injection.

I still feel horrible, and I'm pretty sure my E2 levels are up. I have another Dr. Appointment with a new Dr. on Friday...
and I hope he can figure it out. I know he prescribes AI's, but I will be forced to pay him $20 a week to inject me. No
sefl inject.

My previous Dr. that did the latest blood work actual had the nerve to call me and say, "I'm not sure why you're
feeling bad, but I hope you get to feeling better. I cancelled your appointment this week, and I will see you again
in 3-4 months. Make sure you get your Total, Free, and PA blood work done the week before your appointment."

What crap.

 

[zgx]

So I've been on testosterone replacement therapy (TRT) for a little while now and I have some concerns.

Blood Work: 07/30/2012
CBC - All numbers looked good with the exception absolute eosinophils.
Absolute Eosinophils - 520 (Range - 15-500 cells/ul)
Testosterone Total - 402 (Range - 241-827 ng/ml)
PSA - 1.5 (Range - < or 4.0 ng/ml)

I was feeling pretty good a week or two before the visit, then I started getting all my old symptoms back.
Instead of rock hard erections, they became weak & far between. Morning wood completely dissapeared,
as well as the majority of my desire. I developed horrible sweating, trouble sleeping, and a sensitive right nipple.

Upon talking with the Nurse, I asked for new blood work soon after the one above. I specifically asked for E2
levels, but the Dr. refused saying there is NO need to check Estrogen. He ordered another Total Testosterone
and Free Testosterone draw.

Those results are as follows.

Blood Work:08/14/2012
Testosterone, Free and Total, LC/MS/MS Testosterone, Total, LC/MS/MS - 890 (Range - 250-1100 ng/dl
Free Testosterone - 201.1 (Range - 35.0-155.0 pg/ml)


So I'm left confused as to why the two totals vary so much, as the dosage stayed the same....and they were both
drawn in the morning BEFORE my next injection.

I still feel horrible, and I'm pretty sure my E2 levels are up. I have another Dr. Appointment with a new Dr. on Friday...
and I hope he can figure it out. I know he prescribes AI's, but I will be forced to pay him $20 a week to inject me. No
sefl inject.

My previous Dr. that did the latest blood work actual had the nerve to call me and say, "I'm not sure why you're
feeling bad, but I hope you get to feeling better. I cancelled your appointment this week, and I will see you again
in 3-4 months. Make sure you get your Total, Free, and PA blood work done the week before your appointment."

What crap.

I agree with you, I think your E2 is high as well. What's your BF% like?

Don't wait for another Dr appointment to get your labs done, use private md labs for 50 bux with the online coupon code and get your E2 levels checked. You want the female hormone panel from Private MD - Buy Lab Tests Online that is about 59 dollars but you get 9/10 dollars off with the coupon. Good luck.

 

[clsmth700]

Do u get SHBG /sex binding hormone checked?

can mess with free test

 

[NimbusTim]

25% +- a couple. I've experienced some stomach bloat, and an increase of weight in the amount of about 10lbs.
I know higher body fat % tends to create higher E2 levels. I think once the levels get ironed out, I will be feeling great.

The new Dr. I will be seeing is going to order my E2 levels. Blood will be drawn Monday morning. My results comeback the next day from our
local Quest Diagnostics. I will make sure the correct E2 draw/test is performed.

 

[NimbusTim]

Do u get SHBG /sex binding hormone checked?

can mess with free test

No. He seems to think the only values that need checking are CBC, PSA, Total & Free. The new Dr. I will be seeing on Monday
is supposed to run more test to accurately see what's going on. I've found some good feedback concerning him.

 

[NimbusTim]

No. He seems to think the only values that need checking are CBC, PSA, Total & Free. The new Dr. I will be seeing on Monday
is supposed to run more test to accurately see what's going on. I've found some good feedback concerning him.

A couple questions.

Since the two testosterone draws were performed with different ranges, can I convert it as follows?

890/1100 = .809% (Range 250-1100)
669/827 = .809% (Range 241-827)

Is that correct?

Also, even though my Free Testosterone level is 201.1 (Range 35.0-155.0), can a high E2 value keep it from being used properly? If I'm not mistaken, something
with Androgen Receptors?

Any questions I should be asking my Dr. tommorow?

Like I said, my numbers don't look horrible, but I feel horribel.

Symptoms:
- Very little libido
- No morning wood
- When I do get erections, their pretty weak
- Trouble sleeping
- Worsened body odor (might be in my head)
- Sensitive nipple
- Decreased blood flow (when soft)

 

[zgx]

A couple questions.

Since the two testosterone draws were performed with different ranges, can I convert it as follows?

890/1100 = .809% (Range 250-1100)
669/827 = .809% (Range 241-827)

Is that correct?

Also, even though my Free Testosterone level is 201.1 (Range 35.0-155.0), can a high E2 value keep it from being used properly? If I'm not mistaken, something
with Androgen Receptors?

Any questions I should be asking my Dr. tommorow?

Like I said, my numbers don't look horrible, but I feel horribel.

Symptoms:
- Very little libido
- No morning wood
- When I do get erections, their pretty weak
- Trouble sleeping
- Worsened body odor (might be in my head)
- Sensitive nipple
- Decreased blood flow (when soft)

You have all the symptoms of high E2. For me high E2 means weak erections, lack of morning wood, strong sweat/bo and I get moody.

 

[NimbusTim]

You have all the symptoms of high E2. For me high E2 means weak erections, lack of morning wood, strong sweat/bo and I get moody.

Well it looks like I may have found the right Dr.
I had fasted blood work performed Friday to test my E2 levels, LH, FSH, SHBG. He also increased my testosterone dose to 200mg per week. He said based on my sides, he fully expects my E2 numbers too be high. He said once my blood work comes back Monday/Tuesday he will go from there....more than likely prescribing me an Aromatase inhibitor (AI).
He wants my Total Testosterone numbers in the 1200 range, with high levels of Free as well. Estrogen will be monitored and controlled as well. HCG is a possible addition if wanted. (However I'm snipped, so more than likely nothing I will partake in).

 

[NimbusTim]

You have all the symptoms of high E2. For me high E2 means weak erections, lack of morning wood, strong sweat/bo and I get moody.

Definitely what I've been experiencing. I've had to catch myself with my kids (3 year old), because I've been on edge lately.

 

[zgx]

Well it looks like I may have found the right Dr.
I had fasted blood work performed Friday to test my E2 levels, LH, FSH, SHBG. He also increased my testosterone dose to 200mg per week. He said based on my sides, he fully expects my E2 numbers too be high. He said once my blood work comes back Monday/Tuesday he will go from there....more than likely prescribing me an Aromatase inhibitor (AI).
He wants my Total Testosterone numbers in the 1200 range, with high levels of Free as well. Estrogen will be monitored and controlled as well. HCG is a possible addition if wanted. (However I'm snipped, so more than likely nothing I will partake in).

You're quite lucky! Is your doctor in Florida? lol. Anyhow there are some posts in this forum that talk about the good effects of HCG outside of stimulating the testes to make sperm. You may want to look into it if interested although I've read that people who don't care about shrinkage or fertility are quite happy without HCG as well.

 

[NimbusTim]

So the nurse called me yesterday and told me that my E2 levels were over 130 and that they wanted me under 30. I was called in a script for Letro. She also mentioned that my blood was "thick" and my red blood count was high. She said I had to give blood before my next shot on Friday. Does this sound normal?

 

[lucius11]

...my blood was "thick" and my red blood count was high. She said I had to give blood before my next shot on Friday. Does this sound normal?

Yep, sounds correct to me. You need to lower your estrogen level (hence the Letro) as everyone suspected and discussed above. Testosterone will increase red blood cell production and raise hemoglobin levels - your blood gets thick. Donating blood will lower the hemogolbin level. Sounds like your doc is doing the right things. I have to donate blood every two months to keep the hemo in check ... we lowered my test does to see of this will give me some relief from the high hemoglobin levels.

 

[Megatron28]

Taking testosterone can increase you hematocrit -- thicker blood. Giving blood will help but be careful of anemia, etc if you have to do it too frequently. Do a search on the boards here and you should be able to find a lot of info on the topic.

Good luck getting your estrogen down.

 

[Rich_B]

What is the likely starting dose of Aromatase inhibitor (AI) for the OP? How will the Doc decide how much to prescribe?

 

[lucius11]

What is the likely starting dose of Aromatase inhibitor (AI) for the OP? How will the Doc decide how much to prescribe?

I don't know the answer to this. Perhaps the OP can tell us. In this case it seems they opened the door to estrogen problems from the get go (no Aromatase inhibitor (AI) and no blood levels taken for Estrogen). So now his E levels are at 130 and the doc prescribes Letro. From what I read, Letro is one of the strongest AI's ... more than 95% effective. So hopefully they get the dose right and don't overshoot and crash his E levels. Seems like the doc has all the data to get the dosage right. At least he reversed course on the whole "no need to check Estrogen" position. If the doc is not testing frequently enough for your liking you can always go to privatemdlabs once or twice and make sure the E level settles into a reasonable range. No sense suffering anymore.

 

[lucius11]

I have read quite a few threads like this one in this forum. The local doctor prescibes testosterone replacement therapy (TRT) but won't check Estrogen or prescribe an Aromatase inhibitor (AI). Then, as expected, Estrogen problems develop. It's nice to have a local doctor but ... our board sponsor IMT would not let this scenario happen. After my local doc would not check Estrogen or prescribe an Aromatase inhibitor (AI) - I switched to IMT. My E levels never went out of range.

 

[zgx]

Regarding letro just like was already said be cautious of dosage. Ask your doctor about other alternatives, i.e. aromasin, arimidex.

 

[NimbusTim]

Thanks for all the responses.

The letro dosage he started me on is 1.25mg per week. I know letro is really strong so I'll be watching closely for sides.

I also gave blood today, so we'll see how it goes. Overall I feel good about the track I'm on now.

 

[Rich_B]

Thanks for all the responses.

The letro dosage he started me on is 1.25mg per week. I know letro is really strong so I'll be watching closely for sides.

I also gave blood today, so we'll see how it goes. Overall I feel good about the track I'm on now.

That does seem quite high for Letro, I suffered significant joint pain at that dose.

 

[NimbusTim]

I just recieved a copy of my actual blood work performed a couple weeks back and I have a question about my LH values.

My LH value came back < 0.2 on a range of 1.5-9.3 mIU/mL

I noticed he did not check my FSH or SHBG like I thought he was. With that said, what do you make of my LH #'s?