Question for Dante, Homon,J. Meadows and other knowledgeable guys regarding TRT

[cac3071]

I don’t post here much (mostly because I don’t have much to add from a BB POV) but I do read allot and enjoy the maturity of the guys here. I am a 33 year old corporate manager with a wife and kids and recently started to feel “off”. I had little energy to train, play with the kids and just didn’t seem to enjoy life like I usually do. I also noticed I was shaving less and results in the gym were non-existent.

So I went to my PCP and told him I wanted blood work done including testosterone. He calls me the next morning and says everything is normal but my test is low (110 total/41 free) and he wants to get me into an endocrinologist ASAP. I have never used gear due to the fact that my wife is a physician and I would never want questions raised about how they were obtained so past AAS use is not the cause.

I will probably have an MRI done to rule out a pituitary tumor but what questions should I be asking and what are the next steps for a guy in my situation? Should I push for injections over the patches? Do I need an anti-E? Just not real knowledgeable about this area and any advice in terms of questions to ask and what to expect would be greatly appreciated.

Lastly, thank you to DC, Homon, JM and the other vets here for open and mature discussion. Allot of guys here are 30+ years old and as you know life looks much different at 30 with a career and family then it does at 21 when getting to class at noon and training are you first priorities. I never would have known to have this checked had I not spent time reading some great posts here at PM.

Thanks guys

 

[terryd5150]

cac: I know I don't have the status of some of the guys you mentioned, but I am on prescribed HRT.

I found it easier to regulate my test levels using injections over the patches. Increased moodiness/irritability, mood swings, and disturbed sleep patterns are signs that your test levels are unstable (at least they are in me).

I don't have these issues with injections.

Once I was able to prove, in the doctor's office, that I was capable of administering my own injections in a safe, sanitary manner I was given a prescription and didn't have to return to the doctor every week for an injection.

You seem to have some hesitation regarding this, and I can tell you that true HRT is NOT like being "ON". Also, you won't need any estrogen control.

My quality of life is much better. I wish I had gotten on it sooner.

Good luck!

 

[aussiebulldog]

I think you should hear what your endocrinologist has to say.

 

[Stewie]

There are several factors that can lead to low T symptoms, one is that You pointed out thats a primary cause, a tumor of the pituitary gland, Prolactinoma and Adenoma, as you stated an MRI is used to determine this.

Then there are secondary cause that lead up to low T levels, Vitamin and mineral deficiencies.
Thyroid either hypo or hyperthyriodism will cause low T symptoms.

Certain chemicals lower hormonal levels leading up to low T symptoms.
Stress the list goes on.

A Good endro and you arming your self with medical literature to take with you showing your doctor that if its not a tumor, rule out deficiencies and correct before starting TRT.

IMO stay away from gels they work, but You may experience absorbtion issues if and has a higher aromatase occurrence.

Most endros don't recognize the use of an AI. Or HCG while on TRT.


Rule out deficiencies first IMO

 

[cac3071]

I think you should hear what your endocrinologist has to say.

100% agree. My wife is an MD so i don't buy into the whole doctors don't know what they are talking about stuff. My wife could talk circles around 99%of the guys you see posting on message boards who feel they are experts because they know some medical jargon.

 

[cac3071]

cac: I know I don't have the status of some of the guys you mentioned, but I am on prescribed HRT.

I found it easier to regulate my test levels using injections over the patches. Increased moodiness/irritability, mood swings, and disturbed sleep patterns are signs that your test levels are unstable (at least they are in me).

I don't have these issues with injections.

Once I was able to prove, in the doctor's office, that I was capable of administering my own injections in a safe, sanitary manner I was given a prescription and didn't have to return to the doctor every week for an injection.

You seem to have some hesitation regarding this, and I can tell you that true HRT is NOT like being "ON". Also, you won't need any estrogen control.

My quality of life is much better. I wish I had gotten on it sooner.

Good luck!

Thanks for the info. I am not hessitant at all about HRT (although I was hoping it was something I would explore at 53 and non 33 LOL)

 

[cac3071]

Rule out deficiencies first IMO

Thanks for you input.

 

[Kaladryn]

100% agree. My wife is an MD so i don't buy into the whole doctors don't know what they are talking about stuff. My wife could talk circles around 99%of the guys you see posting on message boards who feel they are experts because they know some medical jargon.

While I do have a great respect for the full spectrum of knowledge an MD has, and the extensive experience, I have to caution you about docs when it comes to TRT. In your case, you do have to first find out what is causing the issue, make sure TRT is the right choice, etc. Your endo will be great for this, but if you do go on actual TRT, you may be surprised how many different methods doctors employ, and how differ in opinion about how it should be done. Some will be open to using an AI, others won't even consider it. Some will want to only use gel, some will even want to use HCG instead of test. I know someone who was getting MONTHLY 400mg cyp injects. Educate yourself, and make sure your doctor is doing it the way that is best for you.

 

[cac3071]

While I do have a great respect for the full spectrum of knowledge an MD has, and the extensive experience, I have to caution you about docs when it comes to TRT. In your case, you do have to first find out what is causing the issue, make sure TRT is the right choice, etc. Your endo will be great for this, but if you do go on actual TRT, you may be surprised how many different methods doctors employ, and how differ in opinion about how it should be done. Some will be open to using an AI, others won't even consider it. Some will want to only use gel, some will even want to use HCG instead of test. I know someone who was getting MONTHLY 400mg cyp injects. Educate yourself, and make sure your doctor is doing it the way that is best for you.

Thanks for the info Kaladryn. I am married to an MD and have lots of MD freinds and yes I can tell you that how knowledgable they are about a specific issue 100% depends on their motivation and willingness to learn post residency. Its not like they learn about HRT in medical school in terms of application.

I am trying to educate myself prior to meeting with the Endo to make sure I ask relevant questions. First priority is finding out what is causing this. I have a family and top of mind for me is could this be a tumor? A very distant second is how do I ensure that I understand the course of treatment and the options available.

Do you know what a typical sequence of events would be in terms of treatment? Is it try a certain dose and then retest? Is this something that most people stay on for life?

Thanks again to everyone who has provided comments.

 

[aphextwin]

It's for the rest of your life once you start TRT.

 

[maldorf]

100 mg/wk injectable test cyp and youre as good as gold. That puts me at about 650 total test and I feel good there. the only problem I am having, and it can be common, is too high a hemoglobin/hematocrit. I go in monthly for a phelbotomy to keep that down. Be sure the doc keeps track with a CBC at least once every 3 months Id say. SOme people have more touble than others with this side.
Most docs want to prescribe it as 200mg every 2 weeks, but youre much better off doing it weekly at 100mg. Injections are really easy, and since your wife is an MD I'm sure you could even have her inject. 23 gauge 1 inch needles, what I use.

 

[dragonfire101]

Lower dosages more frequently are better. This is why test gel/creams are usually used. Like maldorf already said high hemoglobin/hematocrit can be an issue with any injectables and even any synthetic type test transdermal products.

Bioidentica hormones that are identical, on a molecular level, with what your body produces are usually best because they suppose to work better with the body and are better in regards on hemoglobin/hematocrit. These are test dreams that are special compounded at a pharmacy.

I agree MD may know 99% more than most don this board angeneral population,but when it comes to HRT they are in the dark ages from what they have been taught. I have experienced this with several doctors who followed the basic protocol of 200mg test cyp inj every 2 weeks, didn't check, vit D levels, and other key nutrients and or hormones like DHEA, etc. Find a doctor who incorporates the above in his treatment and testing and you found someone that knows what they are doing.

I like the way test cyp makes me feel...so i use that 75mg IM twice week. My HRT doc preferred me to inject subq daily 20mg, but i did not want to the daily inj. so we compromised.

 

[maldorf]

Lower dosages more frequently are better. This is why test gel/creams are usually used. Like maldorf already said high hemoglobin/hematocrit can be an issue with any injectables and even any synthetic type test transdermal products.

Bioidentica hormones that are identical, on a molecular level, with what your body produces are usually best because they suppose to work better with the body and are better in regards on hemoglobin/hematocrit. These are test dreams that are special compounded at a pharmacy.

I agree MD may know 99% more than most don this board angeneral population,but when it comes to HRT they are in the dark ages from what they have been taught. I have experienced this with several doctors who followed the basic protocol of 200mg test cyp inj every 2 weeks, didn't check, vit D levels, and other key nutrients and or hormones like DHEA, etc. Find a doctor who incorporates the above in his treatment and testing and you found someone that knows what they are doing.

Can you elaborate on why you would want to test vitamin D and DHEA? I would like to know more about this so maybe I could approach my endo about it. My endo is a bit of an ass though when it comes to listening to anytihng I have to say, so my chances are slim that he might acutally change his regime but I would still like to know more. I know DHEA is a precursor to many hormones, including test, but if youre taking exogenous test then thats not a worry.

 

[BigDaddyBone]

Bioidentica hormones that are identical, on a molecular level, with what your body produces are usually best because they suppose to work better with the body and are better in regards on hemoglobin/hematocrit. These are test dreams that are special compounded at a pharmacy.

Could you expound on this some more? I thought testosterone was testosterone, and that the "bioidentical" part referred to individualized dosing protocols for testosterone, DHEA, etc.

I had no idea that the testosterone itself would vary.

 

[morepain]

probably the best male hormone replacemnet discussions and real world reference material you will find is aover at t-nation in the TRT forum. Read the stickied threads there...tons of information about real world results including how to find a COMPETENT physician. GPs have absolutley no business handling hormone replacement (or damn near anything else for the most part).

 

[S2N]

100% agree. My wife is an MD so i don't buy into the whole doctors don't know what they are talking about stuff. My wife could talk circles around 99%of the guys you see posting on message boards who feel they are experts because they know some medical jargon.

If I want to ruin my body with a statin drug id talk to your md wife. If im looking to learn about hrt, id listen to the guys on this board

 

[cac3071]

probably the best male hormone replacemnet discussions and real world reference material you will find is aover at t-nation in the TRT forum. Read the stickied threads there...tons of information about real world results including how to find a COMPETENT physician. GPs have absolutley no business handling hormone replacement (or damn near anything else for the most part).

thanks man. I wil check that out. I don't see my Endo for a month so plenty of time to get educated on the various options and more importantly what others experiences have been. Again, I don't subscribe to the docs have no idea what they are talking about POV. They just don't have 20 in arms and 6 pack abs at the top of their concerns which gets translated into they don't know anything.

 

[cac3071]

Lower dosages more frequently are better.
I like the way test cyp makes me feel...so i use that 75mg IM twice week. My HRT doc preferred me to inject subq daily 20mg, but i did not want to the daily inj. so we compromised.

Exactly the kind of info I was hoping to gather. Thank you very much for sharing. Do you know if dosing is difficult with the gels? How would you know how much to apply?

 

[cac3071]

If I want to ruin my body with a statin drug id talk to your md wife. If im looking to learn about hrt, id listen to the guys on this board

My wife is an OB/GYN so unless you need a C-section you probably wouldn't need to discuss anything with her LOL! Agreed that many of the big dogs here have real world experience and I think that info coupled with "medical" info puts me in a good spot to be as informed as possible. The vets here have been around the block and do their own investigation which is why I love PM.

And I agree that unless an MD specifically learns about HRT they will not be an expert in it. For example my wife has no idea what the Endo will want to do. How would she? That isn't her expertise. However, she knows a hell of allot more detail about the endocrine system then Hyopthalamus stimulates pituitary to release LH and FSH. That is great but what other downstream issues does this create? That to me is where the Endo is invaluable. Most guys only see it as my test is low I need testosterone ASAP. Yes that it is true but if you father and brother had prostate cancer at 40 or you uncles all dies at 40 from heart attacks then we make slow down and think this through.

 

[Stewie]

probably the best male hormone replacemnet discussions and real world reference material you will find is aover at t-nation in the TRT forum. Read the stickied threads there...tons of information about real world results including how to find a COMPETENT physician. GPs have absolutley no business handling hormone replacement (or damn near anything else for the most part).

^^^^
This agreed in the T replacement forum, I've picked up quite a bit there and I have also posted several medical literatures for others to print off and take with them to their doctors, and posted my experiences with some to be honest very inexperienced doctors that have the authority to prescribe TRT, but Don't understand the whole physiology behind TRT. It's major learning curve.

Maldorf heres one of many links of Vitamin D,

High vitamin D level = high testosterone level