Newb potentially starting TRT in the next few months. Advice?

[halfwit]

Thanks for the info Megatron. I read through the TRT overview. I guess my questions boil down to: if my hormone panel next month shows that I'm low-normal Test (~400), would your recommendation as someone who has experience with TRT be to avoid therapy and wait until my levels inevitably drop in X number of years? Or should I get started now if I'm already comfortable doing that?

I'm aware this isn't a black or white issue. Just looking for some perspective and guidance as I deal with this in the next few months.

Thanks again.

Please keep us updated on your results from the surgery with regards to your testosterone output. It will be interesting to see what the impact is.

I'm not Tron, but as another guy with primary hypogonadism, my personal experience is that the pituitary does eventually tire out (I haven't done extensive research on the time frame or if there's a means of prolonging/preventing this) and testosterone values won't improve - just decline further.

If you feel like you're experiencing the symptoms of hypogonadism (some guys manage fine at lower levels), then the choice will obviously be more difficult. I had a total testosterone of 120ng/dL done first thing in the morning and felt like death incarnate, so my decision was quite easy.

My .02c

 

[Megatron28]

I agree with Halfwit. If you feel fine and Hypogonadism isn't adversely affecting your health, stay off TRT. Just keep monitoring things on a regular basis.

My feeling is that there is a tipping point. Maybe you feel fine at 420. But slide down into the 300's and things change. Maybe it is the 200's for you. When you get to that tipping point I think TRT becomes a necessity. But like I said also get regular check ups. Is your thyroid moving towards Hypo? Cholesterol getting worse? Sleep getting worse? Body fat % increasing? Etc.

 

[ChronosOceanus]

Thanks fellas. I'll update the thread after my next blood test and let you know what happens. Appreciate the advice.

 

[ChronosOceanus]

Just wanted to follow up on the comment made by IMT Staff above. If my e2 is low is there any other way to treat that other than TRT? From what I'm finding by searching around it sounds like that is the only way to boost low e2.

Both of my hormone panels showed low e2 levels for the reference ranges. With regards to SHBG I only have the results from my first test (done in the afternoon). It looks low, but within range. I wanted to post my results from both tests here so I don't have to keep referring to multiple earlier posts, or documents saved in different places:

Test 1 (07/28/2015 @ 3:45 PM)
SHBG: 27 nmol/l (Ref Rng: 13-89)
Testosterone Free: 5.1 ng/dl (Ref Rng: 4.0-29.0)
Testosterone: 213.38 ng/dl (Ref Rng: 170.00-780.00)
Testosterone Bioav.: 96 ng/dl (Ref Rng: 77-357)
LH-Serum: 8.12
FSH-Serum: 35.9
Estradiol: <20

Test 2 (08/18/2015 @ approx. 8:30 AM)
Estradiol: 10.7 pg/mL (Male Ref Rng.: 27.1-52.2 pg/mL; 3rd generation E2 assay)
Testosterone Level Total: 425 ng/dL
Luteinizing Hormone: 13.9 mIU/mL (Male Post-Pubertal Ref Rng.: <10 mIU/mL)
Follicle Stimulating Hormone: 27.4 mIU/mL (Male Post-Pubertal Ref Rng.: <10 mIU/mL)


The results from the second test were posted to my online account with the hospital, but I'm going to see if there is a full report that shows additional tests. If so, I'll update above.

 

[Megatron28]

Just wanted to follow up on the comment made by IMT Staff above. If my e2 is low is there any other way to treat that other than TRT? From what I'm finding by searching around it sounds like that is the only way to boost low e2.

Both of my hormone panels showed low e2 levels for the reference ranges. With regards to SHBG I only have the results from my first test (done in the afternoon). It looks low, but within range. I wanted to post my results from both tests here so I don't have to keep referring to multiple earlier posts, or documents saved in different places:

Test 1 (07/28/2015 @ 3:45 PM)
SHBG: 27 nmol/l (Ref Rng: 13-89)
Testosterone Free: 5.1 ng/dl (Ref Rng: 4.0-29.0)
Testosterone: 213.38 ng/dl (Ref Rng: 170.00-780.00)
Testosterone Bioav.: 96 ng/dl (Ref Rng: 77-357)
LH-Serum: 8.12
FSH-Serum: 35.9
Estradiol: <20

Test 2 (08/18/2015 @ approx. 8:30 AM)
Estradiol: 10.7 pg/mL (Male Ref Rng.: 27.1-52.2 pg/mL; 3rd generation E2 assay)
Testosterone Level Total: 425 ng/dL
Luteinizing Hormone: 13.9 mIU/mL (Male Post-Pubertal Ref Rng.: <10 mIU/mL)
Follicle Stimulating Hormone: 27.4 mIU/mL (Male Post-Pubertal Ref Rng.: <10 mIU/mL)


The results from the second test were posted to my online account with the hospital, but I'm going to see if there is a full report that shows additional tests. If so, I'll update above.

In men, it takes testosterone to make estrogen via the aromatization process.

 

[IMT staff]

^^^ correct. Looks like the only thing you can do is jump on TRT.

 

[ChronosOceanus]

Been reviewing some my last blood workup while I'm waiting for my next panel (on Jan. 11 - follow up on the 20th). My hemoglobin count is 13.1 g/dL, which shows up as "Low" in the reference range (no range given, just shows Low next to the count).

Does anyone have info to shed light on what this could mean? I've Googled, but I'm still confused. Could mean I'm anemic, but I definitely don't have any dietary issues (eat meat/veggies/good fats, etc.). Other causes don't sound like they would apply (no prior chemo, no sickle-cell issues, no big losses of blood, no kidney issues). Any info is appreciated, as usual.

 

[Megatron28]

Been reviewing some my last blood workup while I'm waiting for my next panel (on Jan. 11 - follow up on the 20th). My hemoglobin count is 13.1 g/dL, which shows up as "Low" in the reference range (no range given, just shows Low next to the count).

Does anyone have info to shed light on what this could mean? I've Googled, but I'm still confused. Could mean I'm anemic, but I definitely don't have any dietary issues (eat meat/veggies/good fats, etc.). Other causes don't sound like they would apply (no prior chemo, no sickle-cell issues, no big losses of blood, no kidney issues). Any info is appreciated, as usual.

Check your iron and ferritin levels.

Do you donate blood regularly? Donations lower hemoglobin.

 

[ChronosOceanus]

Check your iron and ferritin levels.

Do you donate blood regularly? Donations lower hemoglobin.

Thanks, I'll ask my doc about it next time. I live in NJ so I can't use private med labs for blood tests on my own, unfortunately.

No, I haven't donated blood in 10+ years. The only blood taken has been for several blood tests leading up to my surgery and hormone level testing.

 

[ChronosOceanus]

I took my first bloods post ball surgery this past Monday, 1/11 @ 8:45 AM, after about 2.5 months. My results are as follows:

Testosterone Total: 274 ng/dL (Range: 249 - 836 ng/dL)
Estradiol: 19.6 pg/mL (Range showed <=42.5 on this and then a bunch of ranges for pregnant women. This is different from the range for the last test I took at the same lab...weird)
FSH: 40.3 mIU/mL (HIGH)(Range: <=12.3)...like scary high...
LH: 18.3 mIU/mL (HIGH)(Range: 1.7-8.6 mIU/mL)
Albumin: 4.8 g/dL (Range: 3.9-5.2)

Again, I'm not sure if this is the complete results because I just got them off of my profile on the hospital's website when they were posted today. I have an appointment with my urologist on Wednesday, 1/20, of next week to discuss these results, and I'll ask if there were any other tests on there that weren't included.

After the surgery my brain fog and motivation (especially at work) has definitely dropped off, but I've always been low energy. Basically, I wake up tired (which I know is common), pound 2-3 cups of coffee and run on that until lunch. After lunch I'm basically half brain-dead until I go to bed. My stamina in jiu jitsu has definitely suffered, and I just don't feel as strong as I did even 6 months ago. I used to be really excited to go to each class, but now it's a battle to walk 2 blocks to the gym after work. I feel like I have reached a tipping point in the last couple of months.

I am going to see what my doc says at the appointment next week, and hopefully we can put together a treatment plan that gets me back on track. I'm going to listen what he has to say. Hopefully, it's injections 2x per week at home. If he tries to push gel or pellets on me I'm going to push back, and if he won't be convinced I'll take my health and business to IMT.

If it comes to me pushing back I was thinking of telling him that one of my buddies is on TRT and that he "told me" to ask my doc certain questions (e.g. can I do 2 injections per week at home, what does he think of an AI or hCG if needed, etc). Does that sound like a good strategy, or should I just not mention where I got info from?

 

[THE-DET-OAK]

Surgery always lowers testosterone for some reason. Your definitely low and would benefit from testosterone replacement therapy.

 

[Megatron28]

I took my first bloods post ball surgery this past Monday, 1/11 @ 8:45 AM, after about 2.5 months. My results are as follows:

Testosterone Total: 274 ng/dL (Range: 249 - 836 ng/dL)
Estradiol: 19.6 pg/mL (Range showed <=42.5 on this and then a bunch of ranges for pregnant women. This is different from the range for the last test I took at the same lab...weird)
FSH: 40.3 mIU/mL (HIGH)(Range: <=12.3)...like scary high...
LH: 18.3 mIU/mL (HIGH)(Range: 1.7-8.6 mIU/mL)
Albumin: 4.8 g/dL (Range: 3.9-5.2)

Again, I'm not sure if this is the complete results because I just got them off of my profile on the hospital's website when they were posted today. I have an appointment with my urologist on Wednesday, 1/20, of next week to discuss these results, and I'll ask if there were any other tests on there that weren't included.

After the surgery my brain fog and motivation (especially at work) has definitely dropped off, but I've always been low energy. Basically, I wake up tired (which I know is common), pound 2-3 cups of coffee and run on that until lunch. After lunch I'm basically half brain-dead until I go to bed. My stamina in jiu jitsu has definitely suffered, and I just don't feel as strong as I did even 6 months ago. I used to be really excited to go to each class, but now it's a battle to walk 2 blocks to the gym after work. I feel like I have reached a tipping point in the last couple of months.

I am going to see what my doc says at the appointment next week, and hopefully we can put together a treatment plan that gets me back on track. I'm going to listen what he has to say. Hopefully, it's injections 2x per week at home. If he tries to push gel or pellets on me I'm going to push back, and if he won't be convinced I'll take my health and business to IMT.

If it comes to me pushing back I was thinking of telling him that one of my buddies is on TRT and that he "told me" to ask my doc certain questions (e.g. can I do 2 injections per week at home, what does he think of an AI or hCG if needed, etc). Does that sound like a good strategy, or should I just not mention where I got info from?

Still an extreme case of Primary Hypogonadism. Your pituitary is calling for testosterone but your testicles just don't want to make enough.

 

[ChronosOceanus]

Still an extreme case of Primary Hypogonadism. Your pituitary is calling for testosterone but your testicles just don't want to make enough.

I know, I've read a ton of posts both on this board and the AAS board and haven't seen anyone's numbers come in that high for LH and FSH. Seems like most guys here are secondary, too, from the posts I've read.

Are the causes for primary hypogonadism known? Obviously some damage was done from the surgery, but what's the mechanism that causes my pituitary to SCREAM at my testes, and then just not get a response?

Is there any evidence of really high LH/FSH causing symptoms on their own (separate from low T)?

 

[Megatron28]

I know, I've read a ton of posts both on this board and the AAS board and haven't seen anyone's numbers come in that high for LH and FSH. Seems like most guys here are secondary, too, from the posts I've read.

Are the causes for primary hypogonadism known? Obviously some damage was done from the surgery, but what's the mechanism that causes my pituitary to SCREAM at my testes, and then just not get a response?

Is there any evidence of really high LH/FSH causing symptoms on their own (separate from low T)?

Here are some causes. It simply comes down to your pituitary knows you don't have enough test in you so it tells your testicles to make more. But for whatever reason, your testicles aren't capable to producing enough.

Possible causes of Primary Hypogonadism include: physical trauma to the testicles, aging, toxins (e.g. alcohol or heavy metals), Klinefelter***8217;s Syndrome, XYY Syndrome, anorchia, orhitis, varicocele, hemochromatosis, mumps, certain prescription drugs and radiation treatment or chemotherapy. There are other possibilities as well that you can discuss with your doctor. If you are Primary you should consult with an urologist to see if you can determine what is wrong with your testicles.

Possible causes of Secondary Hypogonadism include: physical trauma to the head, aging, pituitary and/or hypothalamus tumor (usually benign), Hyperprolactinemia, Kallman***8217;s Syndrome, HIV, obesity. Again, there are other possibilities as well that you can discuss with your doctor. If you are secondary you should consult with an endocrinologist and probably have an MRI done. Sometimes it is possible to get your pituitary gland working again by attempting a ***8220;restart***8221;. This option should be considered especially if you are in your 20***8217;s or early 30***8217;s. I won***8217;t go into details here, but it often involves using Clomid or other similar medications. I would strongly encourage you to work with a doctor that is very knowledgeable in restart protocols.

Unfortunately, the truth is that many guys never determine what is causing their Hypogonadism. The good news is that means one of the serious illnesses listed above is not causing it. It likely comes down to getting old, being over-weight or being unlucky.

I am not aware of any concerns over having high LH and FSH when your testicles aren't working.

 

[ChronosOceanus]

Thanks again, Mega. I'll update the thread again after my appointment next week.

-CO

 

[Graeme]

It'd be worth asking your doctor for a Karyotype, which tests your chromosomes for abnormalities.

Normally a man has a pair of XY sex chromosomes, whereas a woman has XX. In Klinefelter's Syndrome, a male will have typically have three as XXY. It's possible to have a mixture of XY and XXY (mosaicism), or even more Xs, such as XXXY or XXXXY, but these forms are rarer and have worse outcomes.

Symptoms include being taller than average, less body and facial hair, long limbs, wide hips, infertility and gynecomastia. Depression is common, and there have been links to autism.

XYY is similar, but involves acquiring extra Y chromosomes, as the name might suggest. There's also XX male syndrome, which is also self explanatory.

I'm awaiting Karyotype results myself to check for Klinefelter's Syndrome. It normally takes three or four weeks to complete, and so far mine has taken six. Should be back in a fortnight.

 

[ChronosOceanus]

It'd be worth asking your doctor for a Karyotype, which tests your chromosomes for abnormalities.

Normally a man has a pair of XY sex chromosomes, whereas a woman has XX. In Klinefelter's Syndrome, a male will have typically have three as XXY. It's possible to have a mixture of XY and XXY (mosaicism), or even more Xs, such as XXXY or XXXXY, but these forms are rarer and have worse outcomes.

Symptoms include being taller than average, less body and facial hair, long limbs, wide hips, infertility and gynecomastia. Depression is common, and there have been links to autism.

XYY is similar, but involves acquiring extra Y chromosomes, as the name might suggest. There's also XX male syndrome, which is also self explanatory.

I'm awaiting Karyotype results myself to check for Klinefelter's Syndrome. It normally takes three or four weeks to complete, and so far mine has taken six. Should be back in a fortnight.

I did karotype testing when I was going through fertility issues last year. There were not any abnormalities so it's not Klinefelters. Just unknown congenital and/or idiopathic causes I guess.

 

[Graeme]

I figured that you might have been tested. Thanks for letting me know.

 

[Cap'n]

I am going to see what my doc says at the appointment next week, and hopefully we can put together a treatment plan that gets me back on track. I'm going to listen what he has to say. Hopefully, it's injections 2x per week at home. If he tries to push gel or pellets on me I'm going to push back, and if he won't be convinced I'll take my health and business to IMT.

If it comes to me pushing back I was thinking of telling him that one of my buddies is on TRT and that he "told me" to ask my doc certain questions (e.g. can I do 2 injections per week at home, what does he think of an AI or hCG if needed, etc). Does that sound like a good strategy, or should I just not mention where I got info from?

You may end up being surprised. I live in a small lakeside village in Central NY and our family doctor is very receptive to working with his patients. He'd told me about several very successful TRT patients of his and how he'd treated them prior to my blood tests with him, I brought in my past 2 years of tests to start the conversation. I'd mentioned HCG and using an AI, he wasn't very familiar with using an AI and hadn't heard of HCG, and my next appt. to discuss blood work and he walked in the door rattling off everything positive he'd been researching.

I asked him about what protocol he recommended and he told me ultimately it would be up to me to decide. He described several ones starting out with offering free samples of gels, to starting at 75mg once per week, and then starting with a massive dose and then tapering down, etc. I brought up the aromatization factor, the roller coaster ride of from spacing out injections, and that I'd like to start out on 100mg per week at 2 - 50mg doses every 3.5 days. I then asked him to prescribe 29g needles which he had no issue with either. He's all for it and prescribed it as such.

I'll be starting my injections on the 1st, my own choice, and move forward with getting my testosterone levels dialed in to optimum levels. My intent is to try to avoid using an AI if possible and I'm contemplating trying to add in HCG at a later date, I'm still debating this. Due to test cyp being a "controlled substance" my local pharmacy wouldn't give me more than a 30 day supply, actually 45 but who's counting So, for a 6 week supply, 3 - 1ml (200mg/ml) vials, it cost me a whopping $35 and nothing for the syringes or needles.

The point of my story is you hear so many horror stories about guys talking to their doctors and it doesn't always turn out that way. You are a patient, and a customer, and are free to take your business elsewhere if you feel your needs are not being met. A conversation about your health and wellbeing should be a 2 way street and not some omnipotent demigod dictating how you should feel. Break a leg off his pedestal if you need to.

 

[Megatron28]

You may end up being surprised. I live in a small lakeside village in Central NY and our family doctor is very receptive to working with his patients. He'd told me about several very successful TRT patients of his and how he'd treated them prior to my blood tests with him, I brought in my past 2 years of tests to start the conversation. I'd mentioned HCG and using an AI, he wasn't very familiar with using an AI and hadn't heard of HCG, and my next appt. to discuss blood work and he walked in the door rattling off everything positive he'd been researching.

I asked him about what protocol he recommended and he told me ultimately it would be up to me to decide. He described several ones starting out with offering free samples of gels, to starting at 75mg once per week, and then starting with a massive dose and then tapering down, etc. I brought up the aromatization factor, the roller coaster ride of from spacing out injections, and that I'd like to start out on 100mg per week at 2 - 50mg doses every 3.5 days. I then asked him to prescribe 29g needles which he had no issue with either. He's all for it and prescribed it as such.

I'll be starting my injections on the 1st, my own choice, and move forward with getting my testosterone levels dialed in to optimum levels. My intent is to try to avoid using an AI if possible and I'm contemplating trying to add in HCG at a later date, I'm still debating this. Due to test cyp being a "controlled substance" my local pharmacy wouldn't give me more than a 30 day supply, actually 45 but who's counting So, for a 6 week supply, 3 - 1ml (200mg/ml) vials, it cost me a whopping $35 and nothing for the syringes or needles.

The point of my story is you hear so many horror stories about guys talking to their doctors and it doesn't always turn out that way. You are a patient, and a customer, and are free to take your business elsewhere if you feel your needs are not being met. A conversation about your health and wellbeing should be a 2 way street and not some omnipotent demigod dictating how you should feel. Break a leg off his pedestal if you need to.

Have your doc prescribe 10ml multi-use vials. They are MUCH cheaper and more convenient. If your pharmacy gives you issues take your script elsewhere. There are plenty of pharmacies.

Also, check out Prices, Coupons and Information - GoodRx. I use their coupon for test cyp to get my 10ml vial at Walgreen's for about $45.