TRT no effects

[rapt]

So I was put on trt 100mg weekly injection and then tested at 6 weeks.
initial test was total t: 286 280-800 ng/dL
six weeks TESTOSTERONE, TOTAL 554 280-800 ng/dL
SEXHORMONE BINDING GLOBULIN 19.5 14.5-48.4 nmol/L
Test done a little over a year ago when I went to another dr with the same symptoms
testosterone test: 2 Feb 2007
411 range 241 - 827

Ok at this point I'm still not really feeling anything and my Dr. has the lab send out for a free t test
This is what he sent me,
Your total testosterone actually came back lower at 473; however your % free testosterone was 2.73 percent, which is high, and your free testosterone is 129 (normal is 35 - 155). You are now running at the high end of normal. Based on these, there would be no adjustments and you would want to continue on the same dosing, especially because I believe these were drawn just before you had your testosterone injection. This indicates you are running high normal right before your shot comes due, so you are probably above normal for a good period of time after injection. I won't decrease yourt dose, but It would be inappropriate for me to increase it.

So I'm kinda at a loss of what to do if anything. Obviously I'm not feeling better although I did notice a bit of a change the first couple weeks of injections and if anything I feel worse now. My total t was falling as can be seen from T lvls in feb 07 and the next test on 5/27/08 which initiated the tx. My Dr. seems to feel that since all my numbers are within normal range (except free T which he thinks is high) that I'm fine and doesn't seem concerned with pursuing it.
Thanks for any advice.

[hardasnails1973]

Your profile represents that of a person with insulin resistance or type 2 diabetes. They usually have normal testosterone and high free T levels which are usually a red flag. i would examine your cell membrane structure to probably cause of your issue. I would examine lifestyle, nutrient imbalances, eating habits, adrenal, and thyroid functions. DR need to look further just into numbers and think out side the box in a naturopathic matter in order to treat the preson as a whole not just on testosterone. YOu have no idea have many people we have found with adrenal imbalances which if addressed may allow there natural bodies to return to homeostasis. If you are in your early to mid 20's TRT would not be the route in majoirty of cases because majority of them have metabolic road blocks from other causes that are at the root of things.

Where are you located?

[rapt]

San Diego.
Just some stats
age 38
weight 225 A month ago it was 210 and had been that weight since I started working out 6 months before.
I eat
.5 pnds of lean hamburger
.5 pnds of flank steak
2 cups of cottage cheese
half gallon while milk
1 cup oatmeal
some protein supplement
fishoil
olive oil
post workout drink
4 eggs
This is in reference to my diet and 14 pnd weight gain in a month, not sure of it matters but I'm thowing it out there anyways. Before the weight gain I had more protien and fats alot less carbs lol but my weights really went up with this new diet.
Oh lifestyle, I'm a stay at home father

Ok I only have energy in the morning if I don't do what needs to be done by 10-11 am it's not getting done. Been like that for like 3-4 years. Seems like after that whatever energy I have is gone. Irritable, lack of sleep basicaly all the symptoms of low T except they haven't got better.

[hardasnails1973]

Another fish oil person LOL
You have no clue how many people have stopped fish oils and feel a million bucks better
I just tell them to eat fish 2 times a week and no problems.
Your dr has the "fill the tank" approach with hormones instead of finding out what other things are out of balance, probablly because they are lazy finding easy way out. How many people have come to use wanting TRT and we find out that its just a symptom of a bigger cause ...

[JanSz]

Originally Posted by rapt

So I was put on trt 100mg weekly injection and then tested at 6 weeks.
initial test was total t: 286 280-800 ng/dL
six weeks TESTOSTERONE, TOTAL 554 280-800 ng/dL
SEXHORMONE BINDING GLOBULIN 19.5 14.5-48.4 nmol/L
Test done a little over a year ago when I went to another dr with the same symptoms
testosterone test: 2 Feb 2007
411 range 241 - 827

Ok at this point I'm still not really feeling anything and my Dr. has the lab send out for a free t test
This is what he sent me,
Your total testosterone actually came back lower at 473; however your % free testosterone was 2.73 percent, which is high, and your free testosterone is 129 (normal is 35 - 155). You are now running at the high end of normal. Based on these, there would be no adjustments and you would want to continue on the same dosing, especially because I believe these were drawn just before you had your testosterone injection. This indicates you are running high normal right before your shot comes due, so you are probably above normal for a good period of time after injection. I won't decrease yourt dose, but It would be inappropriate for me to increase it.

So I'm kinda at a loss of what to do if anything. Obviously I'm not feeling better although I did notice a bit of a change the first couple weeks of injections and if anything I feel worse now. My total t was falling as can be seen from T lvls in feb 07 and the next test on 5/27/08 which initiated the tx. My Dr. seems to feel that since all my numbers are within normal range (except free T which he thinks is high) that I'm fine and doesn't seem concerned with pursuing it.
Thanks for any advice.

Newer do FreeT testing (do not do assay for a FreeT).
It gives wrong results.
Doctor do not have a clue about FreeT uselesness, looks at the number, gives you bs.

FreeT must be calculated using TotalT and SHBG as an input.
There are three (correct) ways to get FreeT.

Do Quest Diagnostic Test
Testosterone, Free, Bio/Total (LC/MS/MS)

use chart or internet calculator.

If you use Quest and their above test, they calculate the FreeT for you, use it.
But with that test you will ge better indicator, BAT, BioAvailableTestosterone.

Goal BAT~575
Goal FreeT (160-300) closer to 300 better
================================================== ======================

You list:
TT=411
SHBG=19.5

You have FreeT=110(160-300)

it is so low that it is not even funny.
=======================================

Normally one does not look at just T levels, you need to do overall testing.
I posted a list of tests that I do, you may want to look at it, it is in my sticky,
or on my thread on AM board.
.
.
.
.
.

[rapt]

My test was sent out to quest labs, so that means it's accurate right? I heard using the calc with shb total t and your assuming for the albumin to get the free t number? If so thats what we used before then he decided to get the free t done by quest labs. If not I'd like to get the calc your using to give to my doc.
thanks

[hardasnails1973]

use rhiens urine test takes all the guesing games out of it ..

[JanSz]

Originally Posted by rapt

San Diego.
Just some stats
age 38
weight 225 A month ago it was 210 and had been that weight since I started working out 6 months before.
I eat
.5 pnds of lean hamburger
.5 pnds of flank steak
2 cups of cottage cheese
half gallon while milk
1 cup oatmeal
some protein supplement
fishoil
olive oil
post workout drink
4 eggs
This is in reference to my diet and 14 pnd weight gain in a month, not sure of it matters but I'm thowing it out there anyways. Before the weight gain I had more protien and fats alot less carbs lol but my weights really went up with this new diet.
Oh lifestyle, I'm a stay at home father

Ok I only have energy in the morning if I don't do what needs to be done by 10-11 am it's not getting done. Been like that for like 3-4 years. Seems like after that whatever energy I have is gone. Irritable, lack of sleep basicaly all the symptoms of low T except they haven't got better.

Get TT & SHBG, then figure out your FreeT, get it to 300
Control E2 & DHT
DHT in upper top range
E2 use blood test and nighthly wood, nipples, etc, to figure out sweet spot.

I was in need of afternoon nap year ago (low energy and a fog afternoons).
Checked my thyroid, low, (1.5+ 0.75)mg Armour Thyroid put my FreeT3 close to the top range.
Big improvement but still missing something.
Added (10+5+5)mg Cortef
No down period in afternoon, I am sharp from the time I get up till 9-10PM.
I tried Cortef a year ago and missed its effects, had to wait for few days for it to kick in.
.
.

[rapt]

Again what are you using to figure out free t ? What is the calc? I only know using the online calc that uses albumin, shbg and total T and that from what I heard in inaccurate.

[JanSz]

Originally Posted by rapt

Again what are you using to figure out free t ? What is the calc? I only know using the online calc that uses albumin, shbg and total T and that from what I heard in inaccurate.

Why do not you use a chart that dr Shippen is using.
Much less confusing.
I posted that chart on post #41

Jan's BloodTest April13/2007 - Page 2
================================================== =================

About that internet calculator.
If you input numbers righ, watching units
you will get:

correct value for FreeT (but it is 10x smaller than chart would show, because of units)

incorrect value for BAT, no mater how you slice it
.================================================= =================

You can also use chart for sanity check and calculator for decimal values.
But we are really not chasing decimal values, it is not that critical.
.
.

[rapt]

ok here is the type of test quest did to get free t
liquid chromatography tantem
lc/ms/ms

[BBC3]

Originally Posted by rapt

So I was put on trt 100mg weekly injection and then tested at 6 weeks.
initial test was total t: 286 280-800 ng/dL
six weeks TESTOSTERONE, TOTAL 554 280-800 ng/dL
SEXHORMONE BINDING GLOBULIN 19.5 14.5-48.4 nmol/L
Test done a little over a year ago when I went to another dr with the same symptoms
testosterone test: 2 Feb 2007
411 range 241 - 827

Ok at this point I'm still not really feeling anything and my Dr. has the lab send out for a free t test
This is what he sent me,
Your total testosterone actually came back lower at 473; however your % free testosterone was 2.73 percent, which is high, and your free testosterone is 129 (normal is 35 - 155). You are now running at the high end of normal. Based on these, there would be no adjustments and you would want to continue on the same dosing, especially because I believe these were drawn just before you had your testosterone injection. This indicates you are running high normal right before your shot comes due, so you are probably above normal for a good period of time after injection. I won't decrease yourt dose, but It would be inappropriate for me to increase it.

So I'm kinda at a loss of what to do if anything. Obviously I'm not feeling better although I did notice a bit of a change the first couple weeks of injections and if anything I feel worse now. My total t was falling as can be seen from T lvls in feb 07 and the next test on 5/27/08 which initiated the tx. My Dr. seems to feel that since all my numbers are within normal range (except free T which he thinks is high) that I'm fine and doesn't seem concerned with pursuing it.
Thanks for any advice.

Keep in mind that most teen men, say age 15, can get as high as 1500. Your numbers are still incredibly low. I am just now learning about TRT and how the percentages and relations of different hormones relate. I have found that MANY TRT docs will prescribe 200mgs/wk. I see a lot of people around here calling that an excessive amount. However, they do this for a reason. I personally feel that the 200mg/wk dose that I was recently prescribed, will be about right. It will definitely not be excessive as I only feel "pretty good". Of course there must be some threshold for all, a point a diminishing returns, when considering a long term approach. My thoughts would be to go on the heavier side (200mg/wk) and simple take a week off every 12 weeks to control the half life build up. I think it would be better to live feeling great for 11 weeks, back of, and keep moving forward with same.

[rapt]

Well according to the range the lab gave for my test I'm in the higher range for free t and the dr. doesn't want me going above that range so won't increase in my test shots to raise my total t. Quest labs actually has to different sites that give different ranges one with a wider range in age has my total t being low, the other more age specific has me at the high end. I'm actually asking my Dr. at this point to at least get me in the top 1/4 range and see how I do and if I'm not feeling any different then drop my to my current dose if I do feel better then test free t and go from there, We'll see what he says. Most likely that is going to be a no go so then I have the option to retest or see if it's something else. My arguement is to do the above to at least make sure this is or isn't the problem. I may just have to end up seeing different Dr. in my insurance plan till I find one who will at least do that.

[BBC3]

Look in the phonebook under "wellness" doctors. They will have no problem going 200/wk. Probably out of network. The right one should not charge more than 150 initial consult and about 85 per follow up. Your insurance will still cover labs in network hospitals and meds in network pharmacies tegardless.....

[rapt]

I'm going to have to stick to Dr.s in Kaiser at this point. Wife is a nursing student and I stay home with the kids. Who knew when my wife and I said that our kids would not be put in daycare that it would be me having to stay with them!! One problem is that I really like my doc and he could very well be right, I might have somthing going on with my thyroid. I just feel at this point we should try to raise tt before we start playing around with other things and make sure that this isn't the problem.
On that note if anyone is getting treatment from a good Dr. with kaiser in the san diego area feel free to pm me.
thx

[JimRat]

Just don't get hung up on the T issue. It may not be your primary problem. If your energy is dead low, it may be adrenal and/or thyroid as the others have stated. Creating a balance will sometimes lift sagging numbers up to normal. At least rule out other issues before resigning yourself to T regimens that may just make you dependent on longterm replacement.