No change with TRT, doc wants to reduce due to RBC count

[deathwagon]

Hi all. For over a decade I've been suffering from extreme fatigue, brain fog, memory loss and general apathy. I was unable to get a diagnosis from the dozen or so doctors I consulted. Thanks to the info on this forum, I finally diagnosed myself with low T and convinced my doctor to confirm with a blood test, which showed my ttl at 200. I was referred to an endocrinologist in the same hospital and began treatment 3 months ago.

Age: 46
Dosage: 100mg of test cypionate once per week[/B]

After 90 days of treatment, I feel no different than before. I just got my first labs back since starting therapy and my current ttl is at 340. My doc's assistant called me to tell me to stop treatment immediately, because my red blood cell count is extremely high at 18.6. She recommended waiting a week to see if my rbc count comes down, and if it does, they'll resume, but at a lower dose.

Now I knew the higher red blood cell count was possible while on TRT and even before starting therapy, I asked if I should start donating blood to keep it under control. My doc said to wait for 90 days for the first scheduled labs before donating any blood.

I really have no desire to stay on TRT at the current dosage, and certainly not at a lower dosage, since I'm experiencing the usual side effects of hair loss, testicular atrophy and acne, but seeing no benefits. So I have a few questions I'm hoping you guys can help with.

Is a red blood cell count of 18.6 unusual after being on TRT for 3 months? Pre-treatment levels were normal.

Should I expect to feel better with T levels at 340, up from 200?

I haven't taken any testosterone for 11 days and don't feel any different than when I was on it. Is that normal after stopping, and should I expect a crash soon?

If I stop therapy permanently, should I expect my ttl to level to return to pre therapy levels, or would a further drop be in my future due to my body shutting down production for 3 months?

*Edit- Oh, and what would you think a normal prescribed dosage would be with a starting ttl of 200?
Thanks in advance for any feedback.

 

[IMT staff]

its as simple as your dose is inadequate.

 

[deathwagon]

Thanks for the response IMT. My doc just called and says she wants me to drop it to 75 mg going forward.

If anyone has any feedback on my other questions I'd really appreciate it.

 

[halfwit]

That shit REALLY pisses me off. A patient shouldn't have to learn more than the professional EVER, but that's so the case with TRT all too often.

Look OP, your dose is WAY too small, and they're likely going to try to keep you barely in "normal range" because they don't care how you feel and are frankly too damn lazy to actually read up on how this actually works. I'm pretty sure that you're not going to be happy until you're at 200mg/wk (1ml) as your results look pretty dismal so far.

Yes, a hemoglobin of 18.6 is awfully high as that's 55.8% hematocrit. Again, your doctor is giving you HORRIBLE advice by telling you to wait. Once you approach 60% hematocrit, you will no longer be able to donate blood, and guess who makes more money draining a couple pints from you instead? You guessed it, that very same doctor. The worst part is, once you've been flagged as requiring therapeutic phlebotomies, you are deferred for LIFE from donating.

Go donate now, have a serious conversation with your doctor and DEMAND that your quality of life be improved by actually increasing your dose and none of this silly 90 day horseshit. FYI: It takes 28 days for testosterone cypionate to reach steady state blood serum levels, which just further shows me how ignorant your doctor is.

Remember this; YOU are in charge of your health, and YOU are the boss here. If your doctor can't take the time to actually do his job and provide a level of care that is expected, he can be fired and a replacement found the next day.

My .02c

 

[deathwagon]

Thanks, Halfwit. Rather than battle with my current doc, I think I'll consult someone else. In addition to the seemingly odd recommendations I've received from her thus far, I also got an unexpected response to my questions about estrogen levels. When I went in for my 90 day follow up, I asked about estrogen levels. She said she doesn't test males for estrogen, because she doesn't know what normal levels should be. I had to ask her twice to add that to my blood tests before she agreed to include it.

So I think I'll seek out a specialty clinic. If anyone has recommendations for a specialist in Austin, TX, I 'd really appreciate it.

 

[FormerFatty]

Go donate now, have a serious conversation with your doctor and DEMAND that your quality of life be improved by actually increasing your dose and none of this silly 90 day horseshit. FYI: It takes 28 days for testosterone cypionate to reach steady state blood serum levels, which just further shows me how ignorant your doctor is.

This ^^ donate now, your DR may not even know that is the easiest way to lower the number.

 

[deathwagon]

Oh yes, I already donated blood. Didn't want to have a heart attack or thrombosis due to having blood as thick as Aunt Jemima syrup.

 

[Milton]

Oh yes, I already donated blood. Didn't want to have a heart attack or thrombosis due to having blood as thick as Aunt Jemima syrup.

Aunt Jemima Syrup... mmmmmmmmmmmmmmmmmmmmm

 

[halfwit]

Thanks, Halfwit. Rather than battle with my current doc, I think I'll consult someone else. In addition to the seemingly odd recommendations I've received from her thus far, I also got an unexpected response to my questions about estrogen levels. When I went in for my 90 day follow up, I asked about estrogen levels. She said she doesn't test males for estrogen, because she doesn't know what normal levels should be. I had to ask her twice to add that to my blood tests before she agreed to include it.

So I think I'll seek out a specialty clinic. If anyone has recommendations for a specialist in Austin, TX, I 'd really appreciate it.

If you're going to go that route, take note of the guy above. IMT is where I'd go if insurance didn't cover my TRT or if I had the money to do it right. I'd at least see what they can do for you.

 

[Megatron28]

What was your hematocrit at before and after your blood donation? Did you do a whole blood donation? There are other possible options for lowering hematocrit.

 

[deathwagon]

If you're going to go that route, take note of the guy above. IMT is where I'd go if insurance didn't cover my TRT or if I had the money to do it right. I'd at least see what they can do for you.

Yep, just contacted them. Cost is a consideration though, so depending on that factor, I may have to try to find a local specialist. That search is not looking promising.

What was your hematocrit at before and after your blood donation? Did you do a whole blood donation? There are other possible options for lowering hematocrit.

My red blood cell count was 5.06 before starting TRT. I haven't received the post donation labs yet. I just did a regular donation at a blood drive, I'm not sure if that 's considered whole blood. They just stuck a harpoon the size of a drinking straw in my arm and let it flow.

 

[Megatron28]

Yep, just contacted them. Cost is a consideration though, so depending on that factor, I may have to try to find a local specialist. That search is not looking promising.




My red blood cell count was 5.06 before starting TRT. I haven't received the post donation labs yet. I just did a regular donation at a blood drive, I'm not sure if that 's considered whole blood. They just stuck a harpoon the size of a drinking straw in my arm and let it flow.

What are the reference ranges? I don't have them all memorized.

 

[Gbrad]

Yep, just contacted them. Cost is a consideration though, so depending on that factor, I may have to try to find a local specialist. That search is not looking promising.




My red blood cell count was 5.06 before starting TRT. I haven't received the post donation labs yet. I just did a regular donation at a blood drive. Not sure if that 's considered whole blood. They just stuck a harpoon the size of a drinking straw in my arm and let it flow.

Yeah sounds like a whole blood donation. When I began TRT I had spikes in HCT and Hb but over time they smoothed out. In fact, I went from 140mg per week to 120mg per week after the initial 6 months due to climbing HCT. After a few regular donations, I noticed my Hb hadn't climbed when I went to donate on the next appt after 2 months. So, now I donate once or twice a year and stay in range on 140mg week. That plus HCG 750 iu keeps me at 860 TT trough and feeling great.

So maybe your body is hyper responsive right now like mine was and you will be able to get a reasonable dose going to get those levels up!

 

[deathwagon]

What are the reference ranges? I don't have them all memorized.

The normal red blood cell count range is 4.70 to 6.10, so my 18.6 was crazy high.

 

[deathwagon]

Yeah sounds like a whole blood donation. When I began TRT I had spikes in HCT and Hb but over time they smoothed out. In fact, I went from 140mg per week to 120mg per week after the initial 6 months due to climbing HCT. After a few regular donations, I noticed my Hb hadn't climbed when I went to donate on the next appt after 2 months. So, now I donate once or twice a year and stay in range on 140mg week. That plus HCG 750 iu keeps me at 860 TT trough and feeling great.

So maybe your body is hyper responsive right now like mine was and you will be able to get a reasonable dose going to get those levels up!

That's what I'm hoping. I really don't want to live the rest of my days feeling like i have one foot in the grave.

 

[Megatron28]

The normal red blood cell count range is 4.70 to 6.10, so my 18.6 was crazy high.

The 18.6 was for hemoglobin, not RBC. Hemoglobin is correlated to RBC's, but not the same. Totally different reference ranges.

In the future, when you list blood work results it always helps to include the units and reference ranges. Each lab is different.

 

[deathwagon]

The 18.6 was for hemoglobin, not RBC. Hemoglobin is correlated to RBC's, but not the same. Totally different reference ranges.

In the future, when you list blood work results it always helps to include the units and reference ranges. Each lab is different.

Thanks Megatron. According to my labs:


Pre-treatment RBC- 5.06 million/mcL (normal range 4.70 - 6.10)

90 days into TRT treatment, RBC- 18.60 million/mcL (normal range 4.70 - 6.10)

Maybe my lab does something wonky with their reports. I'll ask my endo.

 

[halfwit]

Thanks Megatron. According to my labs:


Pre-treatment RBC- 5.06 million/mcL (normal range 4.70 - 6.10)

90 days into TRT treatment, RBC- 18.60 million/mcL (normal range 4.70 - 6.10)

Maybe my lab does something wonky with their reports. I'll ask my endo.

Uhhhhhhhhh, I would get a retest ASAP. I too assumed you were referring to hemoglobin, but if that truly is your RBC count, there may be some issues here.

50 bucks and privatemdlabs.com will solve that mystery as I'd be VERY surprised if you have such a crazy production so quickly. I am one of those that does platelet apheresis as I do make a lot of RBC's myself, but the highest I've ever had was 700M/mcL.

 

[deathwagon]

I'll take your advice and test elsewhere. I have zero faith in my current endo and staff. Her physicians assistant has made numerous errors, including sending the wrong original test cyp dosage to my pharmacy, which resulted in an insurance investigation that delayed the start of my treatment by a month, and gave me incorrect injection site instruction that resulted in frequent nerve strikes. The latest lab info was relayed by phone, so it wouldn't surprise me if she provided the wrong info altogether. So frustrating.

I just got a quote from one of the online TRT services advertised here and the cost is just out of my league. Wish me luck on finding a local endo or specialist who is better informed about male hormone treatment. So far the local specialists I've contacted only do creams or don't allow self-injections. Grrrr.

 

[halfwit]

I'll take your advice and test elsewhere. I have zero faith in my current endo and staff. Her physicians assistant has made numerous errors, including sending the wrong original test cyp dosage to my pharmacy, which resulted in an insurance investigation that delayed the start of my treatment by a month, and gave me incorrect injection site instruction that resulted in frequent nerve strikes. The latest lab info was relayed by phone, so it wouldn't surprise me if she provided the wrong info altogether. So frustrating.

I just got a quote from one of the online TRT services advertised here and the cost is just out of my league. Wish me luck on finding a local endo or specialist who is better informed about male hormone treatment. So far the local specialists I've contacted only do creams or don't allow self-injections. Grrrr.

Do not give up. I have interviewed many doctors and continue to do so while I retain the services of my current script monkey that only knows to test total testosterone.

Worst case scenario, you find a guy like I have (he really is nice!) and learn as much as you can while continuing the search for someone better. Perhaps some day we'll both find a doctor that can even list the three kinds of estrogen.