Hindsight is always 20/20

[swilk]

Kinda wished I had done some due diligence and read, read and read some more before the first needle punctured my skin .... but alas I did not.

Anyway ... my history.

39 years old and feeling like a whipped dog for the last several months. I head into my GP and tell them my symptoms and ask to have some blood work done. Never having it done before, ever, they ran what is likely a standard scan that included TT, Comprehensive Metabolic Panel, Complete Blood Count, Lipid, Thyroxine and TSH.

RBC was flagged as high at 5.83 (4.14-5.80)
Sodium was flagged as high 146 (134-144)
Calcium was flagged as high 10.4 (8.7-10.2)
LDL was flagged as high 137 (0-99)
Total Cholesterol was flagged as high 204 (100-199)

Testosterone was flagged as low 287 (348-1197)
TSH 2.650 (.450-4.500)
T4, Free 1.27 (.82-1.77)

I go over the results with the doc and she is concerned a bit about the high calcium and the obviously low T .... orders more blood work. She ordered a PTH test for the calcium level and somehow the lab screwed it up and came back with PTT results so exactly how my parathyroid is doing remains a mystery at this time. My calcium did come back down to 10.2 and is on the very upper end of acceptable so I will wait a bit for the PTH test.

TT came back at 332 and free was 8.3 (8.7-25.1) on the second test.

Go see doc this past Monday ....

We discuss results and how the lab screwed up the PTH test but because the calcium came in lower we will wait and have it checked in a few months. We talk about the low T and the options. I rule out the gels and the implants and tell her even though I am not crazy about needles lets do the injections.

So .... doc walks in with a syringe filled with 1cc and sticks me. Tells me that I can stop in next week and see the nurse and discuss how I am feeling and they will likely hit me again with the same or higher dosage depending on how I "feel".

I talked to her about self injecting and that is not a problem .... after next week we can make that happen.

She gave me a slip to have more blood work done in 6 months.

Fast forward to this morning and a few hours of reading on these fine forums and I have some questions/concerns.

It looks like obviously I should ask for more "stuff" when I have my next blood test done .... I dont think that will be a problem .... should I go ahead and wait the 6 months or go have it done sooner? Will the single injection I have already gotten effect any of what would have been my baseline results? Except testosterone of course.

Thoughts?

edit: decent libido but I admit it has fallen off lately. Minor ED symptoms of rarely a spontaneous erection but never failed to perform when needed. Quality of the erection is a bit .... off.

 

[methos0123]

Your RBC is high. You need to find out why because TRT is going to exacerbate it.

 

[Megatron28]

Where are your LH and FSH values?

Waiting six months to check blood work again is too long. Do it in 3 months. And make sure you get an Estradiol Sensitive lab.

Donate some blood to lower your RBC's and keep doing it every 56 days while on exogenous testosterone.

 

[Mprtz]

Sounds like you likely got 200mg T (1cc) and will get the same next week (or more?). That's a lot. Without an aromatase inhibitor you could be sprouting acne and have other issues at 6 months or earlier. You can also expect some testicular shrinkage unless you add human chorionic gonadotropin (hcg). Has your doctor discussed either?

 

[JOWS7]

Read this. https://www.aace.com/files/hypo-gonadism.pdf

It will be a great start as it will give you some information and it will be a reputable source to show your doctor if something doesn't jive with you.

 

[swilk]

LH and FSH must not have been taken.

Here is what I think I know ....

I am going to make an appointment next week or early the week after to talk to my Doc again. I am going to bring her a list of the blood work I want done and ask that we schedule it for sooner rather than later.

I am also going to make sure that I get no more than 1cc (200 mg) of test per 7 days until I get TT tested again 3 months out.

I am going to talk to her about sub-q injections and that I would like to get on a schedule of every 3.5 days with 1/2 of my weekly dose.

The RBC thing .... I am going to have that as part of this sooner test and if it comes back in that high range again I guess I will bite the bullet and go give blood. not a big fan of the procedure but if I need to do it I will.

edit: I will also talk to her about HCG ... I am 39, 3 kids and had a vasectomy so other than the "well being" part Im not sure what HCG will do for me.

edit 2: I have been taking a multi vitamin and after looking at the packaging it has Zinc 73%, Iron 44% and Calcium 22%. I will stop taking it immediately.

 

[Mprtz]

LH and FSH must not have been taken.

Here is what I think I know ....

I am going to make an appointment next week or early the week after to talk to my Doc again. I am going to bring her a list of the blood work done and ask that we schedule it for sooner rather than later.

I am also going to make sure that I get no more than 1cc (200 mg) of test per 7 days until I get TT tested again 3 months out.

I am going to talk to her about sub-q injections and that I would like to get on a schedule of every 3.5 days with 1/2 of my weekly dose.

The RBC thing .... I am going to have that as part of this sooner test and if it comes back in that high range again I guess I will bite the bullet and go give blood. not a big fan of the procedure but if I need to do it I will.

edit: I will also talk to her about HCG ... I am 39, 3 kids and had a vasectomy so other than the "well being" part Im not sure what HCG will do for me.

edit 2: I have been taking a multi vitamin and after looking at the packaging it has Zinc 73%, Iron 44% and Calcium 22%. I will stop taking it immediately.

Sounds like a good plan. Some suggestions:

I would drop the idea of sub-q for now. No need to confront your doctor with another change which may well not work for you and whose benefits are uncertain. You can still split your dose biweekly intramuscular, though it will mean higher trough levels.

I would not wait to donate blood - just go do it. You didn't list HCT, but at about 55% you may be turned away from your blood center. On 200mg per week my HCT went from 45% to 48% in about 4 weeks. If your RBC is high your HCT is probably already over 50%.
I wasn't a fan either but I got used to it quickly (just like injections). Unless you change your approach (to way less than 200mg per week) it's a near certainty that you will have to donate blood to manage your hematocrit. You also want to know sooner rather than later if you are not eligible to donate for some reason (finasteride, travel, tattoos, etc.)

HCG will keep your testicles from shrinking and will make it somewhat more likely that you can restart natural production (should you change your mind about TRT) by keeping your Leydig cells active.

 

[swilk]

The sub-q was more for my mental state than anything else .... using that tiny little needle just makes me feel better about the entire process. The doc seems very open to my input and suggestions so I will likely run it by her and see what she says. If she is set against it for now I will do what she wants in the short term.

HCT threw me off ... it is listed as Hematocrit on my sheet. 50%.

 

[Mprtz]

The sub-q was more for my mental state than anything else .... using that tiny little needle just makes me feel better about the entire process. The doc seems very open to my input and suggestions so I will likely run it by her and see what she says. If she is set against it for now I will do what she wants in the short term.

HCT threw me off ... it is listed as Hematocrit on my sheet. 50%.

That's fine. If it's just about the size of the needle, you should know that depending on your body fat you can do intramuscular injections with a tiny needle too. I use a 29gauge 1/2" insulin syringe about 90% of the time to inject quads, delts an ventro-glutes. You've probably had glute injections at the doctors office - that probably requires a longer needle. I don't do that because I can't easily reach.

 

[swilk]

The injection that I got was at about the belt-line above my right rear jean pocket ... it was about as painless as could be but I doubt I could get turned around and duplicate what they did.

Im 5-10 and about 177. Just this week started working out again but I am blessed with pretty decent genes and have kept a somewhat muscular frame despite bad eating habits and not working out like I should. Not much fat at all on the the quads.

 

[swilk]

A question for those who know way more than me ... which is not hard to do ... will that first shot of T mess up future short term tests?

I have no problem waiting until the results of this future blood test are known before taking a second injection but I wonder if the one already in my system will skew the results any?

Tests i am going to ask for:

CBC, Metabolic Panel, Estradiol Sensitive, SHBG, PTH, Comprehensive Thyroid and FSH+LH

I see no reason to get another T count at this time. Anything I am missing?

 

[Mprtz]

A question for those who know way more than me ... which is not hard to do ... will that first shot of T mess up future short term tests?

I have no problem waiting until the results of this future blood test are known before taking a second injection but I wonder if the one already in my system will skew the results any?

Tests i am going to ask for:

CBC, Metabolic Panel, Estradiol Sensitive, SHBG, PTH, Comprehensive Thyroid and FSH+LH

I see no reason to get another T count at this time. Anything I am missing?

Are you asking which results will be affected by having had one T shot, so that you don't get a true baseline?

Of the ones you listed, Estradiol and FSH+LH are most likely to be skewed.

 

[swilk]

I was asking that .... and if there are any additional tests I should ask for at this time to get my baseline.

I have read numerous posts about the half-life of T .... would waiting a couple of weeks without a second injection and then having the tests done help?

 

[Mprtz]

I was asking that .... and if there are any additional tests I should ask for at this time to get my baseline.

I have read numerous posts about the half-life of T .... would waiting a couple of weeks without a second injection and then having the tests done help?

Yes, if you want an accurate baseline waiting about a month without another shot should do it.

As far as other tests: Lipid profile and PSA (probably obvious), I'd throw in DHT and a urinalysis if it wasn't costing me. I wouldn't skip TT and free T for a baseline taken after your shot has worn off. Also glucose if it's not already included in the metabolic panel. Maybe iron and ferritin.

 

[swilk]

I have a lipid profile from 3 weeks ago and the TT and free test from last week prior to the first shot.

 

[Mprtz]

I have a lipid profile from 3 weeks ago and the TT and free test from last week prior to the first shot.

You can skip the lipid profile, but no sense in skimping on retesting TT and free T or your baseline for E2 and SHBG (and DHT if you do it) won't be very meaningful. You need to verify that you normalized after your single 200mg dose.

 

[Megatron28]

Sorry OP. If you already had an injection of test, the ship has sailed on getting good baseline natty numbers. Your LH, FSH, TT, Estradiol and others have already been impacted. You will never know if you are primary or secondary hypogonadal.

You could try coming off and doing a restart. But you will never be certain if you return to your true baseline numbers.

 

[Mprtz]

Sorry OP. If you already had an injection of test, the ship has sailed on getting good baseline natty numbers. Your LH, FSH, TT, Estradiol and others have already been impacted. You will never know if you are primary or secondary hypogonadal.

You could try coming off and doing a restart. But you will never be certain if you return to your true baseline numbers.

Isn't that a little pessimistic? The OP only had a single injection of 200mg. Seems like a pretty good chance of bouncing back and the pre and post TT numbers should give a good indication whether or not that happened. Do you think a complete restart protocol is necessary after a single dose?

 

[swilk]

I would tend to agree with Mega ... there is no way of knowing for sure if a true pre injection baseline would be possible.

If the ship has indeed sailed is there any reason to jump off now? Or just move forward, see my doc, continue my injections and get more blood work done in 90 days that includes everything needed?

I appreciate the input fellas .... just wanting to do as much as I can to ensure my quality of life going forward and make sure the pathway to that quality is the best possible.

 

[Megatron28]

I think he already had a suppressed HPTA. An injection of 200mg is only going to make it worse. Problem is, we don't know if he was secondary to say whether or not PCT would even work. His doc really screwed him over by not getting pre-TRT labs.