Starting HRT program

[NoMojo]

Would first like to say thanks for a great site full of good information. Just started the begining stages of getting on a HRT program.

Background:
   I'm 34 years old. Began noticing symptoms around 28 years. About a year after my vasectomy. Not sure if that had an effect.
I have always enjoyed working out, consuming large amounts of milk, meat and whey protein (the de-natured crap). Also everything
i ate and drank out of was plastic. At one point was having problems with penis sensitivity, there was none. I could get erections but there was no sensation, freaked me out.
Thats when i started looking into possible solutions. First thing i did was get rid of all plastic products. Also had to change my diet because i was gaining to
much fat and no longer had the raging appetite like before. Very rarely do i eat meat and if i do its chicken or fish. No more cow milk, rice milk now. After about a year the sensitivty improved
still not as intense as it use to be.

Today:
   I have no sex drive. Back before this happened the biggest arguments with the wife were about getting more sex. Now im turning her down because it doesnt intrest me at all. No more morning erections. Takes way longer to recover from a workout. I dont have near the strength i use too. in fact smaller guys are lifting more than me now. I dont sleep as long as i use too.

Current diet:

fresh organic foods. Monday thru friday i eat: 1 apple, 1 banana, a container of fresh organic baby spinach, Raw organic trail mix, 2 eggs,
fresh juiced vegetables( 1 head of kale, 1lb of carrots, 2 apples all organic) About 25ounces of juice, 1 protein bar an hour before workout, Protein shake(non-denatured whey) after and finally a fresh, made from scratch, meal made by my wife for dinner. We have gotten rid of all proccessed foods. Weekends vary depending on whats available to make. I have lost most of the fat i was gaining, still have some stubborn fat around the midsection. I'm eating about a quarter of the calories i use too when my hormones were normal.

First visit to doctor i had a full physical and disscused the issues i was having so he scheduled some blood work.
Sodium 138   134-144
Potassium 3.8   3.5-5.2
chloride 103   97-108
glucose 82 65-99
BUN 13   6-20
creatinine   1.0 .76-1.27
BUN/creat ratio 13   8-19
calcium 9   8.7-10.2
phosphorus 3   2.5-4.5
bili total .9   0-1.2
alk phos 56   25-150
ast/sgot 51   0-40
ALT/SGPT 43   0-55
ggt 17   0-65
LDH 211   0-225
protein total 6.5   6-8.5
albumin 4.2   3.5-5.5
globulin 2.3   1.5-4.5
A?G Ratio 1.8   1.1-2.5
uric acid 5.2   3.7-8.6
cholesterol 150   100-199
HDL 50   >39
chol/HDL ratio 3   0-5
LDL calc 86   0-99
VLDL 14   5-40
triglyceride 72   0-149
est CHD Risk <.5   0-1
T4 thyroxine 8.8   4.5-12
T3 free 3   2-4.4
TSH 2.150   .450-4.5
Iron 96   40-155
PSA .8    0-4
Testosterone Total 391   348-1197
testosterone Free direct 8.5   8.7-25.1
Vitamin D 25-OH 33.2    30-100
Estradiol   12.5    7.6-42.6
IGF-1  208    115-307
SHBG  37.3    16.6-55.9
WBC 7.8   4-10.5
RBC 5.44   4.10-5.6
Hgb 16.1   12.5-17
hct% 46.8  36- 50
MCV 86   80-98
MCH 29.6   27-34
MCHC 34.4   32-36
RDW 12.9  11.7 - 15

Not sure why he didn't test for estrogen or the sex hormone binding gobulin. I called to set up additional blood tests for SHBG, Estradiol, IGF-1, vitamin D. Currently waiting on those test results. Then i will schedule a follow up, on what to do next. Im thinking shots because the gels seem to be messy and afraid it might get on my wife or kids. What type of testosterone do u recommend for shots?

[PeakT]

That's very low total and free of course, esp. for your age.  Did you get the blood draw in the early a.m.?  We've got another young guy with T around your level who is really having strong low T symptoms, so I'm not surprised to read what you wrote.

By the way, I know you're feeling terrible, but I want to say congrats as some of your #s are very good and should serve you well:  pretty good HDL and a good cholesterol number for example.

Quick q that I always ask you younger guys:  are you sure you don't want any more kids?

Also, have you gone through the site and looked for all the obvious lifestyle issues that can impact T (lack sleep, sleep disorders, depression, drinking/medications, etc.) to see if any apply? 

[FightLowT]

I get the feeling I'm the guy Lee is referencing.
Here is my story...See my other posts as I feel they are highly relevant and attest to the fact that you can be very healthy and still be stricken with this affliction.

https://www.peaktestosterone.com/forum/index.php?topic=139.msg783#msg783

Look at the physique I had when I was 22 ( never touched a steroid)  I'm almost 33 ; I still lift weights and can still bench press 315 for reps and max out at 405. I don't look bad now but not like that guy in the picture ..I got plenty of attention from girls back then and believe me I had plenty of interest in them as well. I have stubborn belly fat that won't go away for anything no matter what my weights drops to ( currently 228 lbs) and my muscles are not near as full as they used to be. Nowdays My strength one would think could not be possible with my testosterone levels, but as Lee has stated it seems your physical strength becomes less compromised vs. your libido, mood, energy levels, and erection abilities. I too no longer have raging appetites like I used to and after I work out I no longer get that sexual boost or endorphin high I used to get. It's really depressing in all honesty. I trully believe that my T levels (of course they were  ) played a role in the break up with my girlfriend a month ago whom I dated for a year. She says it was for different life circumstances that we grew further apart or were not right for each other and while some of that may be valid, the Low T did not help matters at all and thats a fact. Most the time I feel like a totally diluded version of what I used to be. I rarely laugh and I don't get excited much about anything. Most days I at least tear up and mildy cry a couple of times a day, very much like a menopausal woman. This disease is so insidious you often lose the cognitive ability to asess how differently you react to the world at the present compared to when you used to not have testosterone deficiency and everything in life had more allure and color. I used to be totally enthralled with music, flying RC helicopters, wood working, going out in public (very reclusive now), lifting weights ( now it's just a chore to not become a flabby slob) . The smell of summer night air while driving with the windows down listening to music would put me in an almost euphoric mood and I would romanticize about women, friends, laughter, and life in general. I'm not going to live this way much longer and life will be forced to give back what it has undeservingly robbed from me for the past few years. 

So your doc is sympathetic to your situation. That's rare...Good for him and more importantly you. The gels and creams convert more to DHT which is very key for libido. Because of this gels and creams allow for the improvements to be seen with less serum total counts than the injections. You may feel great on the gels and creams in the 500-600 range but may need to be in the 700-900 range on the injections to see the same benefits. What type of testosterone? More than likely he is going to use cypionate (although enanthate is almost the same). Don't let him talk you into biweekly shots or God forbid one every 3 weeks. You might as well be shooting olive oil into your butt. Go for at least one injection a week to provide stable levels or more preferably two injections a week in a divided dose every three days. Sustanon is a different story. It contains short , medium, and long acting esters that supposedly can be used once every two weeks. In some circles it is regarded as the rolls royce of  testosterone replacement therapy. As one ester goes through it's half life and metabolizes in the body the next ester begins to take effect and so on..

[FightLowT]

As a side post it would be of great interest to me to see some additional labs of which include:


LH
FSH
SHBG
Cortisol
ACTH
DHEA
DHT
Estradiol
Vit D3
Iron

All of these I feel are very important and need to be considered by any doctor who wants to learn this craft and improve the research which will be necessary in order to establish some possible reversals of the condition or substantiate a preventative measure to fight against it. It is in my opinion our levels (mid to high 300's ) while still very symptomatic of low testosterone could possibly be improved through diet, sleep, lowered stress, etc. to try and make it to the lower 500's or maybe higher still..

Remember your levels are going to drop possibly up to 35% from where they peaked in the AM. At 392 ng/dl this is going to put you in a very low range by the end of the day ( possibly 255 ng/dl) . I believe AM readings are important as they provide a base starting point, however one should not ignore that this will be the only amount of T your body has to work with for the remainder of the day. "ahem" DOCTORS VISITING SITE TAKE NOTE PLEASE
Just because a guy is over the starting point by 50 ng/dl does not make him less immune from the tortures of low T. 
I've had labs taken at 6pm come to 199ng/dl ( holy shit batman  ) So one can easily see how weeks, months, and years of exposure to these suboptimal T levels as they fall lower and lower through the day can begin to do the damage most if not all of us on this site have come to experience and live with. Doctors ( or better yet witchdoctors) like to believe or blame it's a lack of imagination, passion, or performace anxiety ( well no duh)  as to why a man with these levels starts to experience sexual dysfunction. Like the old saying goes, wish in one hand and shit in the other and see which one fills up faster. You can wish for sex all you want in the evening but if you don't have the necessary fuel for combustion  , it's likely to not happen or be very short lived ( no pun intended) in any regard. Biology is biology..Some of these doctors should retire and become tarot card readers...

[NoMojo]

That's very low total and free of course, esp. for your age.  Did you get the blood draw in the early a.m.?  We've got another young guy with T around your level who is really having strong low T symptoms, so I'm not surprised to read what you wrote.

By the way, I know you're feeling terrible, but I want to say congrats as some of your #s are very good and should serve you well:  pretty good HDL and a good cholesterol number for example.

Quick q that I always ask you younger guys:  are you sure you don't want any more kids?

Also, have you gone through the site and looked for all the obvious lifestyle issues that can impact T (lack sleep, sleep disorders, depression, drinking/medications, etc.) to see if any apply?

Yeah i was pretty stoked with the cholesterol numbers. The only bad number was AST/SGOT, they said could be Fatty liver.
I did a 12hour fast before the blood work. Blood was taken at 8:00am. I have 4 great kids. I got fixed when i was 27 after my 4th kid. So yes im done having kids. My lifestyle can't get any cleaner. I fall asleep no problem around 9:00pm-10:00pm , but usually wake up around 3am, then fall back asleep till 5:00am(weekdays). I haven't had any depressions for a couple years. Did have a period of depression when i was 29. I don't drink and hate taking medications, so that area is not an issue. My diet can't get any cleaner. So i think i have done everything i can. I still browse the web for any new information that i can try.

[NoMojo]

I get the feeling I'm the guy Lee is referencing.
Here is my story...See my other posts as I feel they are highly relevant and attest to the fact that you can be very healthy and still be stricken with this affliction.

https://www.peaktestosterone.com/forum/index.php?topic=139.msg783#msg783

Look at the physique I had when I was 22 ( never touched a steroid)  I'm almost 33 ; I still lift weights and can still bench press 315 for reps and max out at 405. I don't look bad now but not like that guy in the picture ..I got plenty of attention from girls back then and believe me I had plenty of interest in them as well. I have stubborn belly fat that won't go away for anything no matter what my weights drops to ( currently 228 lbs) and my muscles are not near as full as they used to be. Nowdays My strength one would think could not be possible with my testosterone levels, but as Lee has stated it seems your physical strength becomes less compromised vs. your libido, mood, energy levels, and erection abilities. I too no longer have raging appetites like I used to and after I work out I no longer get that sexual boost or endorphin high I used to get. It's really depressing in all honesty. I trully believe that my T levels (of course they were  ) played a role in the break up with my girlfriend a month ago whom I dated for a year. She says it was for different life circumstances that we grew further apart or were not right for each other and while some of that may be valid, the Low T did not help matters at all and thats a fact. Most the time I feel like a totally diluded version of what I used to be. I rarely laugh and I don't get excited much about anything. Most days I at least tear up and mildy cry a couple of times a day, very much like a menopausal woman. This disease is so insidious you often lose the cognitive ability to asess how differently you react to the world at the present compared to when you used to not have testosterone deficiency and everything in life had more allure and color. I used to be totally enthralled with music, flying RC helicopters, wood working, going out in public (very reclusive now), lifting weights ( now it's just a chore to not become a flabby slob) . The smell of summer night air while driving with the windows down listening to music would put me in an almost euphoric mood and I would romanticize about women, friends, laughter, and life in general. I'm not going to live this way much longer and life will be forced to give back what it has undeservingly robbed from me for the past few years. 

So your doc is sympathetic to your situation. That's rare...Good for him and more importantly you. The gels and creams convert more to DHT which is very key for libido. Because of this gels and creams allow for the improvements to be seen with less serum total counts than the injections. You may feel great on the gels and creams in the 500-600 range but may need to be in the 700-900 range on the injections to see the same benefits. What type of testosterone? More than likely he is going to use cypionate (although enanthate is almost the same). Don't let him talk you into biweekly shots or God forbid one every 3 weeks. You might as well be shooting olive oil into your butt. Go for at least one injection a week to provide stable levels or more preferably two injections a week in a divided dose every three days. Sustanon is a different story. It contains short , medium, and long acting esters that supposedly can be used once every two weeks. In some circles it is regarded as the rolls royce of  testosterone replacement therapy. As one ester goes through it's half life and metabolizes in the body the next ester begins to take effect and so on..

Yeah i had read your post before i posted mine, a lot of good info thnx for posting it. I feel for you and hope you can get your levels back up soon. The only reason i go to the gym now is the same as you. If i don't i get fat, tired and depressed. We definitely have a lot of symptoms in common. I remember when it was real bad,  my wife would tell me i was worst than a girl. Always clingy, insecure and emotional. I think my levels were way lower back then, before i changed my diet and got rid of anything that could be affecting my hormones. But now the no libido and zero drive to do anything is to much and i need to get it fixed. Not fair when you try to do everything you can to fix it and it doesn't help

Thanks for the info on the testosterone types. That will be very helpful when i talk to him about treatment. 

[NoMojo]

As a side post it would be of great interest to me to see some additional labs of which include:


LH
FSH
SHBG
Cortisol
ACTH
DHEA
DHT
Estradiol
Vit D3
Iron

All of these I feel are very important and need to be considered by any doctor who wants to learn this craft and improve the research which will be necessary in order to establish some possible reversals of the condition or substantiate a preventative measure to fight against it. It is in my opinion our levels (mid to high 300's ) while still very symptomatic of low testosterone could possibly be improved through diet, sleep, lowered stress, etc. to try and make it to the lower 500's or maybe higher still..

Remember your levels are going to drop possibly up to 35% from where they peaked in the AM. At 392 ng/dl this is going to put you in a very low range by the end of the day ( possibly 255 ng/dl) . I believe AM readings are important as they provide a base starting point, however one should not ignore that this will be the only amount of T your body has to work with for the remainder of the day. "ahem" DOCTORS VISITING SITE TAKE NOTE PLEASE
Just because a guy is over the starting point by 50 ng/dl does not make him less immune from the tortures of low T. 
I've had labs taken at 6pm come to 199ng/dl ( holy shit batman  ) So one can easily see how weeks, months, and years of exposure to these suboptimal T levels as they fall lower and lower through the day can begin to do the damage most if not all of us on this site have come to experience and live with. Doctors ( or better yet witchdoctors) like to believe or blame it's a lack of imagination, passion, or performace anxiety ( well no duh)  as to why a man with these levels starts to experience sexual dysfunction. Like the old saying goes, wish in one hand and shit in the other and see which one fills up faster. You can wish for sex all you want in the evening but if you don't have the necessary fuel for combustion  , it's likely to not happen or be very short lived ( no pun intended) in any regard. Biology is biology..Some of these doctors should retire and become tarot card readers...

Im still waiting on the results for SHBG, Estradiol, Vit D3, IGF-1. My iron level was 96, normal is 40 - 155. I will ask him to run LH, FSH, Cortisol, ACTH, DHEA, DHT next wednsday when i see him.
Yeah im pretty happy so far with this doctor. He listen's and wants to help. He also wrote a book about the benefits of Vitamin D, which is how i found him. Back when i was reading everything on nutrition and vitamins. So hopefully he continues to work with me.

[PeakT]

That's very low total and free of course, esp. for your age.  Did you get the blood draw in the early a.m.?  We've got another young guy with T around your level who is really having strong low T symptoms, so I'm not surprised to read what you wrote.

By the way, I know you're feeling terrible, but I want to say congrats as some of your #s are very good and should serve you well:  pretty good HDL and a good cholesterol number for example.

Quick q that I always ask you younger guys:  are you sure you don't want any more kids?

Also, have you gone through the site and looked for all the obvious lifestyle issues that can impact T (lack sleep, sleep disorders, depression, drinking/medications, etc.) to see if any apply?

Yeah i was pretty stoked with the cholesterol numbers, must be all the veggies The only bad number was AST/SGOT, they said could be Fatty liver.
I did a 12hour fast before the blood work. Blood was taken at 8:00am. I have 3 great kids. I got fixed when i was 27 after my 3rd kid. So yes im done having kids. My lifestyle can't get any cleaner. I fall asleep no problem around 9:00pm-10:00pm , but usually wake up around 3am, then fall back asleep till 5:00am(weekdays). I haven't had any depressions for a couple years. Did have a period of depression when i was 29. I don't drink and hate taking medications, so that area is not an issue. My diet can't get any cleaner. So i think i have done everything i can. I still browse the web for any new information that i can try.

Okay, well I don't see any red flags.  I believe you said you're not overweight or dropping weight, so that is good.  Sounds like classic low T symptoms obviously.  I think you know what you want to do and you've got a doctor who is willing to help and really check it out. 

There's a lot to be thankful for there - over half the guys on this board probably do not have that situation.

[NoMojo]

got results on the new blood work

Vitamin D 25-OH 33.2    30-100
Estradiol             12.5    7.6-42.6
IGF-1                   208    115-307
SHBG                   37.3    16.6-55.9

Vitamin d is low, going to start taking Vitamin d drops
Estradiol is low.

Went over the labs with the doctor. He said injections would be fine. Since its early for me to be having these issues, he wants me to see a endocrinologist first.
He sent me for some more blood work cortisol, dhea dhea-s, lh/fsh, Total Test, Free Test. This way i have all the blood work for the endocrinologist to look over.

[PeakT]

Estradiol is low.

That's concerning.  You want to get on top of that. 

For example:

https://www.peaktestosterone.com/forum/index.php?topic=107.30

[NoMojo]

Estradiol is low.

That's concerning.  You want to get on top of that. 

For example:

https://www.peaktestosterone.com/forum/index.php?topic=107.30

Going to bring that up with the Endo. Hopefully he can get me a bone density check to see how much damage has been done.

[feelgood]

i was pretty shocked when he did my bone density last month...."osteopenia in the spinal column" it read. I'm not in my 20's but I'm not old either! work out hard, exercize, eat right, etc, and here i am with essentially pre-osteoporosis. Yikes.

Just another reminder of the insidious things low T (my counts in lower 200s) can do.

He made sure to tell me to immediately start on at least 500 milligrams of calcium a day.

Really anticipating my T level and estrogen/estrodiol results next week after 5 months on Clomid.

[PeakT]

Be sure to get plenty of Vit D3 and magnesium as well. 

[FightLowT]

Estradiol is low.

That's concerning.  You want to get on top of that. 

For example:

https://www.peaktestosterone.com/forum/index.php?topic=107.30

Going to bring that up with the Endo. Hopefully he can get me a bone density check to see how much damage has been done.

Your Free T isn't very high so this makes sense that your estrogen is a bit low because there isn't adequate free T to effectively aromatize into E2 and DHT. Estrogen is much more important than many doctors give it credit for in men. In fact Dr. Eugene Shippen considers estrogen in men to be of the utmost importance. When I first had my Free T taken a year ago it was around 11 and it was taken 8:30AM. A little higher than yours but not much. I then had estradiol checked about 3 weeks later and it was also on the low side at 17 pg/ml. I equate this again to just having sub-optimal Free T.

BTW don't let that endo tell you that you are normal. They often like to do that because they don't know what they are doing and are afraid to admit it (after all they are specialists..lol). Most bad doctors are not able to swallow their pride and tell you they don't know what they are doing and instead just blow you off. Hey if you were that full of shit wouldnt you? Good doctors on the other hand are more likely to try and refer you to someone who is supposed to know what they are doing and are not afraid or ashamed to say they don't know or are willing to learn.  If the endo tries to tell you that then you tell the little "over-schooled and under-educated qwak" that you want your damn $50 co-pay back. It's been my experience along with many others here that endo's know about as much regrading HRT and the importance of male vitality for quality of life as much as Richard Simmons knows what a woman's lower anatomy looks like.

Qwaks beware!!!
FightLowT is coming to get ya!!!

[PeakT]

Go get 'em FightLowT. 

I have to say, though, that it's not so much ignorance (in the case of an endo) as not taking into account the individuality of testosterone symptoms.  There's a huge block of men that are symptomless in the hypogonadal range.  That seems bizarre to you and me.  I don't know how they walk around with T of 300 and survive - I was just miserable myself and I know you were too.  But a big percentage of guys aren't.  Trust me - they'll take T readings all the time and tell a guy, "You're low in T" and the guy will say "I didn't know..."

But to that I can say, "You shouldn't ignore symptoms!"  Isn't that what medicine is all about?!?

And they should not ignore all the studies that show long term health issues with low testosterone.  At the very least, they should advise their patients of the potential risks if they're not going to treat them!