Questions I should ask my Dr. abot my trt

[cave62]

Hi all, I had my testosterone checked 3 month ago and my results were as follows:

Testosterone, Free SEE NOTES
SEE NOTE
(NOTE)
Test Result Flag Unit RefValue
------------------------------------------------------------------
Testosterone, Total and Free, S
Testosterone, Free, S 3.4 L ng/dL 9-30
Testing performed by Equilibrium Dialysis.
Testosterone, Total, S 172 L ng/dL 240-950
Testing performed by Liquid Chromatography-Tandem Mass
Spectrometry (LC-MS/MS).
Test Performed by:
Mayo Clinic Laboratories - Rochester Main Campus
200 First Street SW, Rochester, MN 55905
Laboratory Director: Franklin R. Cockerill, III, M.D.


My Dr. put me on test cyp. 200mg once a month, this was about 3 months ago and it really hasn't done anything for me, I still feel pretty crumby and lazy.

Well I just got a second test done last week and my testosterone hasn't gone up much at all: From Testosterone, Free, S 3.4 L ng/dL 9-30 to 3.7 and from Testosterone, Total, S 172 L ng/dL 240-950 to 214.

My Dr. nurse called me last week and said he wants to put me on 150mg of cyp. every other week. That's only upping 100mg a month which seems pretty low.

What could I or should I say to convince him to up my dose? I'm sick of feeling lethargic all the time and it's really starting to drive me nuts!!

 

[jomamma007]

Show your doctor the half life of test cypionate, 5-6 days.
Tell him you can feel the injection fade after a week.
You need to inject AT least once a week, ideally two.
Have him split that 150mg into once a week injection of 75 at least.

Ideally you'd want 100mgs a week to start split into two 50mgs injections per week.

 

[halfwit]

Wow. So your doctor put you at the upper end for female testosterone replacement. Nice.

Agree with joemomma; self-injects are superior in every way and allows you to take control over your protocol. Injecting 2x a week is usually superior as it will provide for more stable levels. I also do not see any testing for what KIND of hypogonadism you have. He should have checked your LH/FSH/Prolactin/estradiol/TSH/DHEA-S/Cortisol at the very least.

Estradiol (E2) is just as important if not more so than your testosterone levels as this hormone can wreck havoc on you and make you feel really crappy. If he doesn't listen to your concerns ASAP, I'd start looking elsewhere for treatment. TRT isn't something docs should just get their feet wet with; they should do their homework and understand how this stuff works and what the REAL consequences/protocols require. Otherwise, you become a human lab-rat that they get to learn on - and being the rat in an experiment is not what we want to be.

Check the TRT sticky by Megatron at the top of the forum. It has TONS of great information that will help you better prepare yourself with some knowledge for your next consult.

My .02c

 

[cave62]

Prolactin 4.0 - 15.2 NG/ML 13.2

TSH 0.27 - 4.20 uIU/ML 2.58

He did these two other tests, sorry I forgot to post them. I haven't talked to my Dr. since my original tests were done, I was suppose to see him yesterday but his office was closed due to the weather.

I guess I'll have to decide if I want to switch to a different doc after my next appt. on the 17th. How does one go about finding a good doctor for trt specifically?

 

[riprockwell]

Prolactin 4.0 - 15.2 NG/ML 13.2

TSH 0.27 - 4.20 uIU/ML 2.58

He did these two other tests, sorry I forgot to post them. I haven't talked to my Dr. since my original tests were done, I was suppose to see him yesterday but his office was closed due to the weather.

I guess I'll have to decide if I want to switch to a different doc after my next appt. on the 17th. How does one go about finding a good doctor for trt specifically?

Are you in the US?? If so, why don't you work with IMT (IncreaseMyT.com) and they will get you on a good TRT protocol and you will feel a million times better.

 

[Alpin]

The TRT protocol you are on is garbage!!!!
Get this doc to prescribe you 100 mg/week.
Stay on it for 3-4 weeks then do labs 48 hours after shot to see peak levels.
Do you have an AI on hand ?
I've met docs that say E2 does not mean anything in a TRT protocol.
I really don't want to re-live any of this.
I spend less time now on the forums and enjoy my life more being on the right TRT.
I'm out the house more, more social....
didn't feel like doing anything and my T levels were 290 ng/dl....no one cared or wanted to listen to me.
I can imagine what you feel like at 172 ng/dl
Have you done a sleep study ?

 

[cave62]

Thank for the reply Apollon, we never discussed AI, my new script is for 2-1ml vials of test cyp. per month. I am suppose to throw out the remaining 1/2ml, yeah right.

I will be doing my own injections so I will be doing 100mg a week. My next appt. is Friday,I'll ask about AI and E2. What if he says don't worry about an AI? And no I haven't done a sleep study.

 

[cave62]

Is Arimidex or something like it easily obtainable? Probably wrong section for that question.

I'd like to here more about your treatment Apollon and how long it took for you to feel like yourself again.

 

[cave62]

Does 100mg weekly seem like enough to get me back to normal? I know everyone is different just looking for opinions.

 

[Brunodk]

Does 100mg weekly seem like enough to get me back to normal? I know everyone is different just looking for opinions.

It's very hard to say. At 200mg per week my trough was at 600. For others that dose could put them in supra physiological range.

 

[Alpin]

Thank for the reply Apollon, we never discussed AI, my new script is for 2-1ml vials of test cyp. per month. I am suppose to throw out the remaining 1/2ml, yeah right.

I will be doing my own injections so I will be doing 100mg a week. My next appt. is Friday,I'll ask about AI and E2. What if he says don't worry about an AI? And no I haven't done a sleep study.

Well bro....
You can't really bring up stuff like that with a doc cause it is technically "off label"....
if you do it will raise red flags for him and in my experience a lot of Endo's don't like the patient directing the treatment protocol.
Now, if you want my advice it would be to play dumb, act like you know nothing about this stuff and go about getting COMPLETE blood work done on yourself. You don't have an E2 result here posted I see...
You might not even need it. You need to exercise caution with use of AI's....
too much and you can crash your E2...
you do not want to crash your E2, you will feel terrible!!!!
Never heard you say anything about getting a sleep study done....

 

[Alpin]

It's very hard to say. At 200mg per week my trough was at 600. For others that dose could put them in supra physiological range.

2 shots of 100 mg per or 1 dose every 7 days ?
What's your BMI, weight ?

 

[Alpin]

Does 100mg weekly seem like enough to get me back to normal? I know everyone is different just looking for opinions.

How much do you weigh ?
BMI ?
you relatively lean, low body fat ?

 

[Megatron28]

Thank for the reply Apollon, we never discussed AI, my new script is for 2-1ml vials of test cyp. per month. I am suppose to throw out the remaining 1/2ml, yeah right.

I will be doing my own injections so I will be doing 100mg a week. My next appt. is Friday,I'll ask about AI and E2. What if he says don't worry about an AI? And no I haven't done a sleep study.

What you need to discuss with your doctor is how to monitor and manage the side effects one can get from exogenous testosterone. 1) Increased Hematocrit and 2) Elevated estradiol levels due to aromatization of the testosterone into estradiol.

#1 is managed by donating blood on a regular schedule. You can give whole blood every 56 days. It is monitored by getting a CBC via blood work.

#2 is managed by using an Aromatase Inhibitor if your estradiol gets too high or lowering your testosterone dose. Common AI used with TRT are Arimidex and Aromasin. Arimidex is cheaper generally and very effective. A common starting dose is .25mg every 3.5 days. Estradiol is monitored via blood work as well. You would want to get the Sensitive Estradiol Assay rather than the Regular Estradiol Assay as it is more accurate at the lower levels found in men. Anecdotally, the "sweet spot" for estradiol seems to be between 20-40pg/ml.

While true that it is off label for men, it is commonly used with TRT. I would not let this worry you in bringing it up with your doctor. Estradiol management is essential to an effective TRT protocol. You don't want it to be too low or too high.

 

[methos0123]

Most docs will not give you an AI, unless they are a "anti aging doc." I would ask them to test your E2 though, and go from there.

 

[Alpin]

Most docs will not give you an AI, unless they are a "anti aging doc." I would ask them to test your E2 though, and go from there.

All the mainstream Endo's I saw never even tested for E2 let alone prescribe an AI...
very sad and unfortunate.

 

[Brunodk]

2 shots of 100 mg per or 1 dose every 7 days ?
What's your BMI, weight ?

2 shots of 100mg and 2 shots of 500iu HCG weekly. I'm 6'7" and fluctuate around 250.

 

[Alpin]

2 shots of 100mg and 2 shots of 500iu HCG weekly. I'm 6'7" and fluctuate around 250.

That's a lot of body....
Your dose is totally justified...imo
I also do E3D shots of 500 i.u. for HCG....
haven't noticed any shrinkage or pain....
anything less and it feels like they lose size...

 

[Spunkey71]

OP the truth is based on what you have told us your doctor has no clue what they are doing in relation to TRT. You would be far better off starting over with a knowledgeable doctor, someone has already mentioned IMT and that is a great place to start if you can. If you continue to stay with a doctor that doesn't really know what they are doing you will only be wasting your time and money.

From my experience body weight doesn't really have anything to do with dosing, I have gotten to know several guys at the doctor I see and some of them are half my size and take more Test than I do and we have similar TT numbers.


Best of luck to you!

 

[THE-DET-OAK]

these gentleman have steered you in the proper direction!