Help me help my Dr. to help me - Literature

[fasteddy333]

I am 43 yr old Male 5'10" 200lbs 25%BF (?) Not lifting with any serious intent just dropping fat for now (80lbs in 2 years so far)
I was 220lbs at 12% (Hardcore BB and dedicated but natty only) 20 yrs ago but let it all go in my successfull quest for a big gut , big career, big house and flabby arms.

I started Dr prescribed "TRT" about 2 months ago here in Canada with my regular family Dr. He has generally been brilliant with anything my entire family has ever presented to him but does not have deep experience with the testosterone replacement therapy (TRT) and is not really too comfortable with it so we have a very "slow and carefull" approach.

Treatment so far was one shot 100mg then 5 weeks of 50mg Test E 1x week (on Friday), then blood work which tested a bit lower for free and total Test. So now have had 2 weekly shots at 100mg with blood work planned for Wednesday this week.

I've asked him for some additional blood tests to what has already given me but I think I need to backup my requests with some solid documentation to get him up to speed as he is hesitant. I have done so much "research" on this forum and other internet sources in the last 6 months that my head is spinning. I have saved some info but apparently not specifically what I am looking for.

I have had a panel of tests which included:
FreeTest Calc. (method of Vermeulen) =
230 pmol/L (range 200-800)
Test (total?)= 14.8 nmol/L (range 8.4-28.7)
(Roche-Electrochemiluminescence) and
SHBG = 22 nmol/L (range 13-71) (Roche-Electrochemiluminescence).

What I think I need is tests for :
Estradiol, Progesterone, DHEA and Luteinizing hormone (LH). (Please correct me if I have come to the wrong conclusion)

I am sure I found some studies or Drs notes or some other professional looking documents that summed it all up nicely at some point but I either did not save it or have lost it. Been looking all weekend but no luck. Can anyone point me in the right direction?

 

[RJ]

what exactly are you asking?

 

[cashout]

As RJ asked, if you can tell me what you want your doc to do for you, I'll gladly provide you .pdfs and links to all kinds of studies on the subject of Hormone Replacement Therapy (HRT) and the sort. I am the source for useless academic studies

But I need to know what you want to accomplish so I can provide the right type of documentation.

Regards.

 

[fasteddy333]

what exactly are you asking?

LOL - it all seemed so clear late last night while I was writing it! My shifts are a bit screwy right now, I will blame my unclearness on mild sleep deprivation........

I think that my Drs only experience with "TRT" has been dispensing small doses of Test. He has said that is all that his other patients have needed to "feel better", "regain libido" etc. I would like to know the reason I have low test to begin with and treat the root cause, not just keep adding more Test until my blood level is "high enough". For example am I still producing enough Test naturally but have an estrogen conversion issue? I would also like to keep fertility options open, avoid any other side effects etc. So I want to monitor and manage all the other affected stuff.

To that end I believe he will order what bloodwork is needed if I can demonstrate intelligently why it is needed. So l am looking for something scientific/professional on paper to help guide him - more than I can verbalize.

So to finally answer your question I am asking for two things please:

1 -for input on what tests I would need that I have not had yet:

"What I think I need is tests for :
Estradiol, Progesterone, DHEA and Luteinizing hormone (LH). (Please correct me if I have come to the wrong conclusion)"

2 - Documents in the form of studies or a Drs notes or (?) that will give my Dr some scientific validation to order and interpret and treat based on these tests

I'll gladly provide you .pdfs and links to all kinds of studies on the subject of Hormone Replacement Therapy (HRT) and the sort. I am the source for useless academic studies

Thats the ticket, I was sure that I had some perfect stuff saved on my comp, but when I went to print it before my last visit I could not find it. It was some kind of "TRT How to" guide for Physicians or something, I would have thought it was on this forum as this is where I lurk the most but no can find.

Thank you both for replying, hope that is a little clearer, my inability to get the point across is a large reason I don't do much posting!

 

[cjw2021]

Good luck with convincing your doc bro. Pubmed.com - check it out.

 

[fasteddy333]

Thanks, it would be a shame if he is only willing continue the Test only, I want to stay with the same Dr as he knows my history well but I am very aware of how important it is to look at the whole package.

 

[fasteddy333]

So No then? LOL, I thought i was gonna be hit with tons of answers!

I seem to have most of it covered now except for estrogen. I still have not found that one single document I once read that covered it all.
Anyone have an article or study saying why it is important to test for estrogen levels (and treat if needed)? Dr still seems resistant to this one, I am not clear why exactly, expensive test maybe?

Cashout?

 

[cashout]

So No then? LOL, I thought i was gonna be hit with tons of answers!

I seem to have most of it covered now except for estrogen. I still have not found that one single document I once read that covered it all.
Anyone have an article or study saying why it is important to test for estrogen levels (and treat if needed)? Dr still seems resistant to this one, I am not clear why exactly, expensive test maybe?

Cashout?

Both of these detail the benefits of managing estrogen in males.

Kowska EA, Rozentryt P, Ponikowska B. Circulating estradiol and mortality in men with systolic chronic heart failure. JAMA. 2009 May 13;301(18):1892-901.

Tivesten A, Vandenput L, Labrie F, et al. Low serum testosterone and estradiol predict mortality in elderly men. J Clin Endocrinol Metab. 2009 Jul;94(7):2482-8.

 

[fasteddy333]

Thanks Cashout,
hopefully these along with a couple of the specific references from them will do the trick.