Intro and a few questions

[Tired]

I am 48 years old and have had symptoms of low T for years. Recently I had some other problems and decided to I needed to get checked out by a urologist last week. I was diagnosed with hypogonadism, mild BPH, and chronic prostatitis. Doc put me on cypro for the prostatitis which seems to be working well and told me I probably need TRT but he doesn't start TRT without two low am readings a month apart. So I go back to get my T checked again next month. So far the only labs I have are:

Total T 268 ng/dl (8 am)
PSA .21 ng/dl
DHT 30 ng/dl (reference range 30 - 85)
He also ran a prolactin test to rule out a pituitary tumor. I haven't heard back from him so I assume that was ok.

I assume he will run more tests once he confirms that I need TRT next month.

So I have been reading up on TRT in preparation for next month. I'm pretty confident in this Dr since he is published on TRT but I want to have a game plan just in case he is old school on TRT. Originally I told him I wanted to use gel and he recommended I go with a gel from local compounding pharmacy but I got the sense that he preferred injections. Now that I've done some reading on TRT I think weekly injections would be the best starting point for me.

So my questions are:

Testosterone Cypionate - 100mg/weekly seems to be the standard starting point but I've read a few opinions that say start with 75 mg/weekly. Is there any reason I should ask to start with 75mg instead of 100mg? Or do you think that would just be wasting time?

HCG - I don't want to start off using it since I've had a vasectomy and don't care about maintaining fertility and it's expensive but I am wondering what symptoms I should be on the look out for to tell me that I should start using HCG. Also what is a good starting dosage if I do decide to start hcg? I've read 100 iu/day is a good starting point but I've also read some that say 250 iu/bi weekly works just fine. I do want to bring the topic up with the Doc just to hear his thoughts on using HCG.

DHEA/Pregnenolone - what is a good dosage for these supplements if not using HCG?


Thanks in advance
Richard

 

[tbonexl]

Your doc will determine a good starting dose of test for you. As far as hcg goes,I really don't see a need since you got a vasectomy. If anything ask about the possibility of using an aromatize inhibitor such as Arimidex or Aromasin...

 

[Tired]

I thought I had read that not all men have a problem with E2 from TRT and that if E2 does increase then going to biweekly injections might avoid the need for an AI. Is that correct?

 

[halfwit]

A PSA of 0.2 and he's worried? I'd definitely see if you can get cialis covered as it's honestly one of the best BPH drugs there are, and it has many other positive benefits outside prostate health. Speaking of prostate health, hopefully he is aware that ESTRADIOL is the enemy here, and it needs to be monitored/controlled to prevent issues. The Mayo clinic has several studies proving this, just in case he hasn't been caught up to speed just yet.

While screening your pituitary is good, I don't see any mention of LH or FSH. These are the pituitary hormones responsible for testosterone generation, and what determine if you're primary/secondary hypogonadal. If you have low LH /FSH, then you're secondary hypogonadal, which potentially can be treated by finding the root cause for pituitary distress. Sometimes, SERM treatment can even restore pituitary function if there isn't an existing issue driving it's production down, like sleep apnea for instance.

I would try to get those checked first, as it can take some time to get in a sleep study. (if necessary) HCG might also be covered if needed, and the reason I supplement with it is to backfill the hormonal pathways like pregnenolone and DHEA as you mentioned. I'd also get your vitamin D checked while you're at it.

I used to take micronized DHEA/Pregnenolone, but I don't recall the doses off the top of my head. I found those to be less effective and more costly than HCG myself, but your mileage may vary.

There isn't a set value for TRT dosing, but 100mg/wk is a common starting dose, and how you feel will determine whether any adjustments are needed. The numbers are good to provide a reference, but don't become focused on them. Some guys feel AMAZING at 500ng/dL, some just need more. Keep in mind however, that some issues from having low T do take awhile to completely go away, so be patient for the first couple months.

I think that answers your questions, and please feel free to ask more if any should arise. I strongly recommend that you also read the TRT FAQ that's stickied at the top of this forum. It has plenty of great information that will better prepare you for the days to come.

Welcome to ology!

My .02c

 

[halfwit]

I thought I had read that not all men have a problem with E2 from TRT and that if E2 does increase then going to biweekly injections might avoid the need for an AI. Is that correct?

Yes, that is correct. Less peaks will stimulate less aromatase action.

 

[Tired]

Thanks halfwit

A PSA of 0.2 and he's worried?

No he didn't seem worried about the PSA/BPH, he said it's very mild and the PSA is way below what he normally see's in guys my age. I don't have any significant symptoms of BPH. He really just told me I'm too old to be drinking the amount of coffee I was and if I didn't cut back I would probably have more rounds of prostatitis/cypro in my future.

My wife is a pcp that refers a fair amount of business to him so I think he's being extra cautious.

While screening your pituitary is good, I don't see any mention of LH or FSH. These are the pituitary hormones responsible for testosterone generation, and what determine if you're primary/secondary hypogonadal. If you have low LH /FSH, then you're secondary hypogonadal, which potentially can be treated by finding the root cause for pituitary distress. Sometimes, SERM treatment can even restore pituitary function if there isn't an existing issue driving it's production down, like sleep apnea for instance.

I'm assuming he will do those tests on my next visit if my T is still low, which I'm sure it will be. If not I will request LH/FSH and a baseline E2.

I guess the only question I still have is if HCG needs to be daily or if bi weekly is ok. I don't have a problem with injecting but daily sounds like a pita. Although the same would go for daily supplements I guess.

Oh and on some of the posts people mention what they do on their "cycle". Is that part of TRT or for performance gains? Same for the term "gear".

 

[Megatron28]

Thanks halfwit



No he didn't seem worried about the PSA/BPH, he said it's very mild and the PSA is way below what he normally see's in guys my age. I don't have any significant symptoms of BPH. He really just told me I'm too old to be drinking the amount of coffee I was and if I didn't cut back I would probably have more rounds of prostatitis/cypro in my future.

My wife is a pcp that refers a fair amount of business to him so I think he's being extra cautious.




I'm assuming he will do those tests on my next visit if my T is still low, which I'm sure it will be. If not I will request LH/FSH and a baseline E2.

I guess the only question I still have is if HCG needs to be daily or if bi weekly is ok. I don't have a problem with injecting but daily sounds like a pita. Although the same would go for daily supplements I guess.

Oh and on some of the posts people mention what they do on their "cycle". Is that part of TRT or for performance gains? Same for the term "gear".

hCG is usually injected twice a week. Show your wife this study.

Self-priming effect of luteinizing hormone-human chorionic gonadotropin (hCG) upon the biphasic testicular response to exogenous hCG. I. Serum test... - PubMed - NCBI

There are guys who are not here for TRT. They are running cycles of steroids (aka Blasts). They are not doing this for therapeutic reasons. They are trying to get " huge". So Arnold Schwarzenegger for example.

Gear is a slang term for Anabolic Androgenic Steroids (AAS).

 

[Tired]

Thanks Megatron.

I'm reading Crisler's book and just got to the part where he recommends HCG starting at 250iu on the two days before weekly T injections.

My wife doesn't do TRT as 95% of her practice is female. She wants to read Crisler's book when I'm done with it just to get an idea of how it should be done now that I'm about to start TRT.

 

[Megatron28]

Thanks Megatron.

I'm reading Crisler's book and just got to the part where he recommends HCG starting at 250iu on the two days before weekly T injections.

My wife doesn't do TRT as 95% of her practice is female. She wants to read Crisler's book when I'm done with it just to get an idea of how it should be done now that I'm about to start TRT.

She can still apply the concepts she learned in medical school and her rotations. It basically just comes down to understanding the HPTA feedback loop (LH, FSH, Testosterone, Estrogen) and how medications work (i.e. half life's). And researching medical studies. Finally, there are parts of TRT that come down to shared knowledge as the realm of documented medical knowledge isn't as vast as it should be. For example, many of us pin twice a week or more often to help keep estradiol under control and not be on a rollercoaster ride but I haven't seen that documented in studies or drug literature. The directions on the bottle say to pin once every 14 days! But enough of us here have experimented and run blood work to know that it is helpful for many guys. TRT is a learning process to see what works best for you.

 

[IMT staff]

For those that just have the mental symptoms of TRT such as low libido, trouble sleeping and mental fog 100mg will usually alleviate those symptoms.

If you have excess android fat due to low testosterone your definitely going to need more than 100mg to bring down your BMI and make body composition changes.

This has also been proven in research.

 

[Tired]

She can still apply the concepts she learned in medical school and her rotations. It basically just comes down to understanding the HPTA feedback loop (LH, FSH, Testosterone, Estrogen) and how medications work (i.e. half life's). And researching medical studies. Finally, there are parts of TRT that come down to shared knowledge as the realm of documented medical knowledge isn't as vast as it should be. For example, many of us pin twice a week or more often to help keep estradiol under control and not be on a rollercoaster ride but I haven't seen that documented in studies or drug literature. The directions on the bottle say to pin once every 14 days! But enough of us here have experimented and run blood work to know that it is helpful for many guys. TRT is a learning process to see what works best for you.

She told me she thought about BHRT certification years ago but she was working on getting certified in lipidology and didn't have time. I expect she will get up to speed pretty quickly now that her interest has been peaked again.

I'm hoping I can use her for leverage to direct my urologist if I don't like his approach.

 

[Tired]

For those that just have the mental symptoms of TRT such as low libido, trouble sleeping and mental fog 100mg will usually alleviate those symptoms.

If you have excess android fat due to low testosterone your definitely going to need more than 100mg to bring down your BMI and make body composition changes.

This has also been proven in research.

I'm 6' 200-205lbs. Up until my early 40's I was always 185-190lbs. I exercise regularly and generally eat healthy but can't make a dent in these extra 10-15 lbs. It would be nice if TRT helped me drop a few lbs.

 

[halfwit]

She told me she thought about BHRT certification years ago but she was working on getting certified in lipidology and didn't have time. I expect she will get up to speed pretty quickly now that her interest has been peaked again.

I promise you that if she soaks up the knowledge on how to do it right, she'll never stop getting referrals from satisfied patients. There are simply too many doctors out there that haven't got a clue - and a great deal of them are freaking endocrinologists!

 

[Tired]

I'm impatient and didn't want to wait until next month to see what my Doc was going to test before starting TRT so I ordered a few labs for myself that I was curious about.

Test Name_________________Result_____Reference Range Lab

LH________________________4.1_______1.7-8.6 mIU/mL 01
FSH_______________________3.4_______1.5-12.4 mIU/mL 01
DHEA-Sulfate_______________237.7_____71.6-375.4 ug/dL 01
Sex Horm Binding Glob, Serum_43.8______16.5-55.9 nmol/L 0

These are 8am labs. I guess I should have also ordered T at the same time. I thought my LH was going to be higher. Do LH levels vary throughout the day in the opposite way T does? That is lowest in the morning and highest at night. I'd try to look it up in my Crisler book but my wife stole it and took it to work lol.

 

[Megatron28]

I'm impatient and didn't want to wait until next month to see what my Doc was going to test before starting TRT so I ordered a few labs for myself that I was curious about.

Test Name_________________Result_____Reference Range Lab

LH________________________4.1_______1.7-8.6 mIU/mL 01
FSH_______________________3.4_______1.5-12.4 mIU/mL 01
DHEA-Sulfate_______________237.7_____71.6-375.4 ug/dL 01
Sex Horm Binding Glob, Serum_43.8______16.5-55.9 nmol/L 0

These are 8am labs. I guess I should have also ordered T at the same time. I thought my LH was going to be higher. Do LH levels vary throughout the day in the opposite way T does? That is lowest in the morning and highest at night. I'd try to look it up in my Crisler book but my wife stole it and took it to work lol.

I wouldn't over-analyze your LH and FSH. Just take it on the surface that your normal LH and FSH along with low T indicate that you have Secondary Hypogonadism. That will help guide what to look for when trying to identify the cause and/or determine treatment.

SHBG is on the higher side of the normal range. This indicates that your Free T may be on the lower side.

And yes, you should have checked TT and Estradiol as well. Vitamin D, CBC, lipids and Meta-bolic profile are good too. TSH if you have not checked it recently. Let us know when your prolactin results come back in.

 

[Tired]

Prolactin was normal...7.0

I could go get TT, Estradiol, TSH tomorrow to fill in the picture. Hopefully my urologist will run these tests (paid by insurance) prior to starting TRT but I don't mind spending a little $ for my own piece of mind. I've wasted far more money on far more frivolous things.

Just going off of the TRT overview sticky, my impression is that at my age the treatment for Secondary Hypogonadism is still going to be TRT (assuming I don't have a serious pituitary problem). Is that correct?

I have an appointment to get established with a pcp the week after I go back to urologist. I already know he will be doing advanced lipid panels and all the other general bloodwork.

My plan was that even if decide I don't want to stay with my urologist for TRT that I'd take the script and get the party started. I'm tired of being Tired.

 

[juced_porkchop]

Welcome and good luck!

 

[Tired]

Thanks porkchop


On PrivateMDLabs they have...

Testosterone, Free (Direct), Serum With Total Testosterone
and
Testosterone, Free (Direct) With Total Testosterone, LC/MS-MS

Both the same price. Which one do I want?

 

[Megatron28]

Thanks porkchop


On PrivateMDLabs they have...

Testosterone, Free (Direct), Serum With Total Testosterone
and
Testosterone, Free (Direct) With Total Testosterone, LC/MS-MS

Both the same price. Which one do I want?

Order panels at privatemd. They are cheaper. Many of us get either the Hormone Panel for Females or the Hormone Panel for Males. Despite names, both are for males. Just depends on what you want to see for which one you should order. Since you want TSH, I would recommend the Hormone Panel for Males.

 

[Megatron28]

Prolactin was normal...7.0

I could go get TT, Estradiol, TSH tomorrow to fill in the picture. Hopefully my urologist will run these tests (paid by insurance) prior to starting TRT but I don't mind spending a little $ for my own piece of mind. I've wasted far more money on far more frivolous things.

Just going off of the TRT overview sticky, my impression is that at my age the treatment for Secondary Hypogonadism is still going to be TRT (assuming I don't have a serious pituitary problem). Is that correct?

I have an appointment to get established with a pcp the week after I go back to urologist. I already know he will be doing advanced lipid panels and all the other general bloodwork.

My plan was that even if decide I don't want to stay with my urologist for TRT that I'd take the script and get the party started. I'm tired of being Tired.

Since you appear to be Secondary, an HPTA Restart is an option (likely using Clomid). If that doesn't work then TRT would be the likely course of action.