Help with testosterone replacement therapy (TRT) please

[si123456]

Help with TRT please

Hi any help/advice would be greatly appreciated. I have been on a journey to get the right diagnosis and treatment and am trying not to rush in despite the negative aspects the condition is having.


Initially i went to the docs with ED problems and he did some blood test. It came back that I had borederline thyroid results and low testosterone.

He gave me testogel and told me to come back after 4 weeks and some more blood tests.

initial visit before testogel

GFR calculated abbreviated MDRD =>=90
serum gamma-glutamyl transferase level = 20 u/l Original result 20 U/L (0-50)
serum alkaline phosphatase = 54 U/L Original result 54u/L (0-125)
serum alanine aminotransferase = 21 U/L Original result 21 u?L(0-41)
serum bilirubin = 8 umol
serum albumin 47g/l
serum creatinine = 81 umol/l
serum urea level = 5.7 mmol/l
serum pottassium 4.7mmol/l
serum sodium = 141mmol/l
serul ldl cholesterol =4.67 mmol/l
erum hdl cholesterol = 1.25 mmol/l
seum triglycerides = 1.71 mmol/l
serum cholesterol = 6.7 mmol/l High
serum TSH =5.33mU/L High original result 5.33mu/L (0.0-5.0)
serum testosterone 11.1 nmol /l
serum t4 level = 13.9 pmol/l
Score 0.6 Method:QRISK2 for :Cardiovascular diseases

After 4 weeks of Testogel , 1 sachet per day a negative effect on testosterone happened.

serum testosterone = 8.6nmol/l

My profile
-age: 31
-height: 6ft
-waist: 36 in
-weight: 210lbs
-describe body and facial hair: slender body, fat on stomach . receding hair facial hair grows patchy.

-describe where you carry fat and how changed: I carry most of my fat at the stomach

-health conditions, symptoms [history]: Ed problems. Inability to develop muscle since aged 21 despite powerlifting regularly. Strength gains are lost very quickly.speech problems. Socially quite. Growung more and more depressed with teenage pathetic outbursts and over reactions.
Any thoughts much appreciated ]
- I am generally very fit , i do not smoke, drink excessively, regularly exercise and lift and eat healthly and naturally
- morning body temp 36.6

I was then sent to a specialist who conducted more blood test

testosterone 9.3 nmol/l 10.0-28
Serum SHBG 33 nmol/l 14-71
free testosterone 0.18 nmol/l 0.25 - 0.79
Luteinising Hormone 2.3 IU/L 1.7-8.6
Prolactin 107 mU/L 86-324
Serum FSH level 2.0 IU/L 1.5-12.4

He diagnosed me with Primary Hypogonadism due to testicular failure. I have a normal sperm count and am going to freeze my sperm as my wife and I want children. He has mentioned Clomiphene treatment at the point we are ready but until then basic testosterone replacement therapy (TRT) probably Nebido. He has not taken any E2 reading, I will insisit at the point before I go on TRT. Are their any other tests that I should insist on?

Whats your opinion please , how should i progress?

I don't think the specialist is much cop as I belive my condition is secondary hypogonadism as lh and fsh are normal.

(taken from page 18 ncbi.nlm.nih.gov/...les/PMC1472884/ )


Many thanks for all your help & advice in advance.

 

[Megatron28]

Hi any help/advice would be greatly appreciated. I have been on a journey to get the right diagnosis and treatment and am trying not to rush in despite the negative aspects the condition is having.


Initially i went to the docs with ED problems and he did some blood test. It came back that I had borederline thyroid results and low testosterone.

He gave me testogel and told me to come back after 4 weeks and some more blood tests.

initial visit before testogel

GFR calculated abbreviated MDRD =>=90
serum gamma-glutamyl transferase level = 20 u/l Original result 20 U/L (0-50)
serum alkaline phosphatase = 54 U/L Original result 54u/L (0-125)
serum alanine aminotransferase = 21 U/L Original result 21 u?L(0-41)
serum bilirubin = 8 umol
serum albumin 47g/l
serum creatinine = 81 umol/l
serum urea level = 5.7 mmol/l
serum pottassium 4.7mmol/l
serum sodium = 141mmol/l
serul ldl cholesterol =4.67 mmol/l
erum hdl cholesterol = 1.25 mmol/l
seum triglycerides = 1.71 mmol/l
serum cholesterol = 6.7 mmol/l High
serum TSH =5.33mU/L High original result 5.33mu/L (0.0-5.0)
serum testosterone 11.1 nmol /l
serum t4 level = 13.9 pmol/l
Score 0.6 Method:QRISK2 for :Cardiovascular diseases

After 4 weeks of Testogel , 1 sachet per day a negative effect on testosterone happened.

serum testosterone = 8.6nmol/l

My profile
-age: 31
-height: 6ft
-waist: 36 in
-weight: 210lbs
-describe body and facial hair: slender body, fat on stomach . receding hair facial hair grows patchy.

-describe where you carry fat and how changed: I carry most of my fat at the stomach

-health conditions, symptoms [history]: Ed problems. Inability to develop muscle since aged 21 despite powerlifting regularly. Strength gains are lost very quickly.speech problems. Socially quite. Growung more and more depressed with teenage pathetic outbursts and over reactions.
Any thoughts much appreciated ]
- I am generally very fit , i do not smoke, drink excessively, regularly exercise and lift and eat healthly and naturally
- morning body temp 36.6

I was then sent to a specialist who conducted more blood test

testosterone 9.3 nmol/l 10.0-28
Serum SHBG 33 nmol/l 14-71
free testosterone 0.18 nmol/l 0.25 - 0.79
Luteinising Hormone 2.3 IU/L 1.7-8.6
Prolactin 107 mU/L 86-324
Serum FSH level 2.0 IU/L 1.5-12.4

He diagnosed me with Primary Hypogonadism due to testicular failure. I have a normal sperm count and am going to freeze my sperm as my wife and I want children. He has mentioned Clomiphene treatment at the point we are ready but until then basic testosterone replacement therapy (TRT) probably Nebido. He has not taken any E2 reading, I will insisit at the point before I go on TRT. Are their any other tests that I should insist on?

Whats your opinion please , how should i progress?

I don't think the specialist is much cop as I belive my condition is secondary hypogonadism as lh and fsh are normal.

(taken from page 18 ncbi.nlm.nih.gov/...les/PMC1472884/ )


Many thanks for all your help & advice in advance.

You aren't primary. You are secondary. If he thinks you are primary ask him why he wants to put you on clomid! That wouldn't do anything if you are primary.

I would be getting your thyroid checked out. Get a full thyroid panel.

Gels/creams suck. Nebido is supposed to suck too. Ask for Test E or Test C. Make sure you can self-inject too. We can help you with a good protocol if you end up doing injections.

I would check out the thyroid out first though. Try to figure out what is going on there.

How about sleep? Have you had a sleep study performed?

 

[si123456]

I find it quite difficult to fall asleep but onc e i'm asleep there is no waking me! Whats a sleep study and what is it for?

Thanks for the help

 

[Megatron28]

I find it quite difficult to fall asleep but onc e i'm asleep there is no waking me! Whats a sleep study and what is it for?

Thanks for the help

You are monitored with sensors while you sleep. It is used, among other things, to determine if you have sleep apnea or hypopnea. Anyone can have this, but there is a correlation with snoring.

 

[si123456]

So I'm off to my docs this week , I'm gonna explain that I don't understand the urologists diagnosis as research would suggest as my lh and fsh are normal I have secondary hypogonadism. I will also explain I have frozen my sperm and am ready to start testosterone replacement therapy (TRT) if that is my only option , but would prefer to investigate my hypothyroid issues to try to fix my low testosterone without risking infertility and my chances of a family .

Does that seem like the right approach ?????

Thanks again

 

[Megatron28]

So I'm off to my docs this week , I'm gonna explain that I don't understand the urologists diagnosis as research would suggest as my lh and fsh are normal I have secondary hypogonadism. I will also explain I have frozen my sperm and am ready to start testosterone replacement therapy (TRT) if that is my only option , but would prefer to investigate my hypothyroid issues to try to fix my low testosterone without risking infertility and my chances of a family .

Does that seem like the right approach ?????

Thanks again

Sounds like a decent approach. I would add in a couple of things. Ask to do a sleep study. And before starting testosterone replacement therapy (TRT) you could try a "restart". This is also known as post cycle therapy (pct) or Dynamic Therapy. Basically though you would take clomid for a little while which would stimulate your body to make testosterone again IF you have secondary hypogonadism. It isn't something you can stay on forever, but it is fine to run for several weeks while you you try to get you body to make its own testosterone again. If it doesn't work you could then go on TRT. Good luck!