- 01-30-2009, 12:23 PM
I've been lurking around for a while I was waiting for a second set of results - fantastic forum by the way - absolutely tons of information and advice!
Anyway - I'm 39 and a keen runner averaging 35-45 miles per week. Over the last couple of years I started noticing symptoms with ED, a reduction in lack of morning wood, mood swings, grumpiness, night time urination etc.
So the doc did a blood test (at around 10am) that returned 15 nmole/L (432 ng/dL). After a bit of persuasion I got him to do another test at around 5:30pm. The results were:
LH: 1.4 U/L (1.0.-9.0)
FSH: 2.8 U/L (1.0-10.0)
Prolactin: 118 mU/L (60-500)
Testosterone: 9.0 nmol/L (10-30) (259 ng/dL)
SHBG: 22 nmol/L (6-45)
Calc Free Testosterone: 206 pmol/L (245-785) (5.93ng/dL)
Albumin: 47 g/L (35-50)
After this he recommended another am (9:45am this time) Calc Free Test. It came back with:
Testosterone: 11.7 nmol/L (337 ng/dL)
SHBG: 28 nmol/L
Calc Free Testosterone: 249 pmol/L (7.18 ng/dL)
Albumin: 45 g/L
So - according to the NHS ranges I'm borderline low (if you count 5 pmol/L in the calc free test result!). I'm back to see the docs on Monday to discuss what's next. I reckon I'll get referred to an endo. What do you guys think of the results? From reading tons of posts on the forum it appears that my gonads are working to a certain degree. Do you think that the clomid/HCG route is the way to go?
- 01-30-2009, 12:41 PM
I would definetly ask about clomid therapy and see what's comes of it. If that doesn't work I'm not sure hCG will work and keep u working. Keep us posted
- 01-30-2009, 07:17 PM
My post #44, between blue lines, here:
Jan's BloodTest April13/2007
You may have few other things wrong, not only low testosterone.
Speaking only of testosterone and just the closest tests that you should do:
Quest Diagnostics, blood drawn at Quest, best make appointment for 7AM.
21 • Folate, RBC & Hematocrit - (1768N)
42 DHEA sulfate
43 Prolactin - (746X)
46 Progesterone, LC/MS/MS - (17183X)
47 Pregnenolone, LC/MS/MS (31493X)
48 Estradiol, Ultrasensitive, LC/MS/MS (30289X)
49 Estrone, LC/MS/MS (23244X)
50 Testosterone, Free, Bio/Total (LC/MS/MS) Code: 14966X
51 Dihydrotestosterone (204X)
Do not use clomid or nolva.
If you decide to go for TRT it is for life, steady state, no cycling.
Consider other health aspects first, they may improve your testosterone situation.
Going for TRT,
first have DHEAs(500-640)
start with HCG first, get most out of HCG.
While on HCG you are getting natural testosterone production plus other products that testis made.
After you are optimized on HCG, if BAT is still low, add external testsoterone.
There ate two ways of adding testosterone
Transdermal and/or injectable.
Your situation with DHT decides which test you will use.
Low DHT---> use transdermal
High DHT---> use T-shots
Transdermal testosterone raises DHT but it does not affect E2 (much).
Reason is high frequency (daily or 2x/day) applications of transdermals.
Keep that in mind when using T-injections.
Many men have hard time controling their E2, they would have much less problems if they injected more frequently, (even daily if need be).
No ane can stand daily shots with large needles, that is why we have 31Ga 5/16" long needles insuline syringes 3/10cc.
Use them for all shots, T & HCG.
Try hard using (pointers above) to be in position so you do not have excessive E2.
If you cant help it, use Arimidex, newer more than 1.5mg/week, always divide into small doses so you use it frequently.
Liquid not only cost less than pills, but most important, it is easy to dispense accurately in very small doses (using 3/10cc syringe).
runner averaging 35-45 miles per week
you may have adrenal/thyroid problem
specially adrenals may have set you back, that may be all that you need to look at, at least at first.
01-31-2009, 03:34 AM
Thank you for all that information! I'll make sure that they cover all those areas when I get further tests done. I remember my Hct being normal (~43) from the first test. Being a runner that one's of interest!
I guess if it does come down to TRT then I'm sure I'll cope with jabbing myself. A 5/16" needle can't be that bad!
I notice that most people on here go for frequent does (i.e. every week). What do you think of longer interval approaches such as Nebido (test undecanoate) which apparently lasts for 12 weeks?
01-31-2009, 10:13 AM
Weekly testosterone injections are in-frequent.
Weekly testosterone injections are relatively tolerable for quite a few men.
The payment comes when they are not able to find permanent way of dealing with E2, estradiol.
Jump from weekly injections to transdermal delivery is dangerous for most people because most suffer high DHT when on transdermals.
For men suffering overt symptoms of low testosterone,
any delivery of testosterone is better than none.
I say that because some of us are stuck with a bad doctors who insist on huge doses once a month.
If you suffer depression, suicidal mind, have no other choice, take it.
It is only survival mode, until you figure better deal.
Nebido at first is very expensive.
It will be used at too long intervals.
It have to be researched when it becomes available at resonable price.
Look for steady TT levels that are in turn minimizing E2 problems.
Most headway will be made when folks accept 31Ga 5/16" long neddle as a standard for testosterone injections.
Old habits are hard to breake.
All kind of theories and explanations are being devised to keep folks sticking with needles that are 40x larger.
Another break thru I see is when folks accept that when starting on TRT start with HCG, and get the most out of HCG as you possibly can.
Then, if required, top it off with external test
I have no use for Clomid or Nolva
01-31-2009, 02:15 PM
Thanks again. The reason I mention Nebido is that I think that's the typical injectable available on the NHS here in the UK. I think it's a 12 week interval. I guess other forms of test on a weekly basis are always going to be more likely to provide a stable set of levels.
Is the 5/16" needle for sub-cutaneous injections or shallow IM?
I think HCG may be a route for me as my testicles are obviously producing something. What happens if you start to take HCG and then stop? Are there any adverse effects?
01-31-2009, 06:27 PM
I do not think there should be much of a problem with Nebido.
Harder to figure out proper dose and next shot.
I highly doubt that it is going to be a close to 12 weeks.
More like 4-6 week, still much better than daily or weekly T shots.
One still would have to do HCG shots.
Say someone is currently using 140mg/week Depo-T and it works for him.
Rather than using Nebido and do 12*140=1680mg every 12 weeks
I think is better to try 4*140=560 every 4 weeks
I see Nebido being sold:
Nebido (Testosterone Undecanoate) Injections
1000mg / 4ml N1
Schering AG, Germany
Not sure how this shots can be divided, if they can be divided.
So for someone currently on 140mg/week
it may be a jump to Nebido
500mg every 3.5 weeks
1000mg every 7 weeks
Ok, I am using now Depo-T 200mg/mL
each shot 22 units
that is 44mg EOD or 22mg/day on average
500mg will last me 500/22=22.7~28 days
1000mg will last me 1000/22=45.45~45 days
I think I would try first the 28 days system
I use original Depo-T and pay cash out of my pocket, at Walgreens, $150
If I really want I could get compounded T for $50
The 10ml vial lasts me 10/0.22=91 days
so it is $150 (or $50) agains for 91 days (frequent shots)
$350 for 45 days (2 shots)
$700 for 90 days
From $50 (or $150) to $700 jump
big jump for me, I am retired and count $$, someone else may not mind.
But, if I could not get anything else but Nebido, I would have to take it.
For me life without test was real tough.
Remember, first get HCG, and get as much as you can out of your testis.
That is priority #1.
02-01-2009, 08:35 AM
Yeah - the 12 week interval will cause potential difficulties in adjustment of dose. I found a presentation (click on "view presentation" in this page - agingmale2006.com/abstracts/abs_sag_long-acting_vs_standard_testosteron e.asp (sorry can't post links yet - not enough posts!)) that implies that it is quite stable. Note though that the presentation is sponsored by Schering!
It is a very expensive form of test. Luckily in the UK the Health Service will bear the brunt of this otherwise it would be pretty hard to afford!
I guess my life's not too bad at the moment. The ED comes and goes and I'm liable to mood swings and short episodes of depression. Libido's not great either. I think I need to think long and hard about going on test. The thing is with my levels being borderline they're not going to be getting better. I'll probably find that my symptoms get gradually worse over the next few years unless I treat it. I'm hoping that they might find some way of increasing my test without supplementing. My running's also important to me and I'm a bit worried it may be detrimentally affected by mucking about with my endocrine system! I guess some may say that the running would only get better with higher levels of test and the associated increase in hematocrit!
02-01-2009, 11:57 AM
But instead, (fishing around your info) I found this:
Clinical experience with a new long-acting injectable testosterone undecanoate (Nebido)
I looked only at:
Comparison of kinetics, efficacy and safety of the long-acting testosterone undecanoate formulation with standard testosterone enanthate
Found that Nebido comes in 4mL ampoules.
So it may be difficult to divide doses, but I am sure it can be done if one really want.
Second, I have found a chart showing kinetics of both
types of testosterone.
I am not commenting on them assuming once every 3 weeks T-enanthate shots (stupid).
But I noted two items:
#1, Nebido's TT drops after 2.5-3 weeks
#2, study aims to achieve TT~12nmol/L=350ng/dL (or there about, vey low levels)
We here aim at BAT(BioAvailableTestosterone)
that (on average, depending on SHBG) ends with TT~(900-1100)ng/dL
350ng/dL is better than nothing, is something ment for 69yo men (like me),
but I am not buying it.
So possibly my previous assumptions was too optimistic,
better start would be to suck the Nebido from the 4mL ampoule into 3 equal syringes, 4/3=1 1/3 cc
and inject every
With Nebido, slow acting, I would not test my BAT levels sooner than after 3 months.
But if you can afford it, the more tests the better.
Hematocrit, DHEAs, E2 & DHT tests you may want to do more often.
Dependind on ones starting point, assuming it is you with current low TT,
it may be a good idea to start with 2 doses at the first shot and then follow normal routine.
You being in UK, do not have access to BAT
and use chart to figure out FreeT
do not make FreeT direct tests, useless, worst-confusing.
02-01-2009, 12:22 PM
i still dont understand this theory of "no cycling"? As commonly recognized, using low to mod doses of test is safe practice, so why is coming off after 20 weeks for a couple months, harmful to your health? especially if you are using pharm grade test from a doc, and not some homebrew **** with lead or mecury in it.
02-01-2009, 02:10 PM
That was indeed the presentation I was talking about. You're right about the drop in TT to quite low levels after 3 weeks. Probably a very good idea to split the ampoule. Mind you - wouldn't it just be the same as doing Sustanon on those timescales? Is it safe to split an ampoule into separate syringes?
I've never seen a BAT test over here. Maybe it'll get done when I go to the Endo. My calculated Free T has been done twice and came out as 206 & 249 pmol/L -is that really too low on a 250-300 range basis? The lab range was 245->785.
02-01-2009, 03:39 PM
Jan's BloodTest April13/2007
Post your TT, SHBG (and Albumin)
That chart is made on assumption that Albumin=4.3
the farther off your Albumin is the larger the error.
Albumin>4.3 chart underestimates
Albumin<4.3 chart overestimates
02-01-2009, 03:54 PM
Read more, hopefully you will come around.
Unfortunately many of "anti-aging" clinics and doctors are not helping much.
It is really very simple, and it should be inexpensive and easily available.
Should cost few $$ a month not 1000's.
02-01-2009, 04:24 PM
i dont understand what u mean. i read alot of non biased info, so im not sure where u come up with that. also, it may not make sense to you becaue your levels are in the tank, but mine are 350 total test naturally, before ever hitting a drug. i opt to treat it in spurts. to me this seems perfectly reasonable. of course i dont feel amazing when im off, but at 350, i dont think i NEED to be on right now for life, especially since im 26.
02-01-2009, 04:28 PM
My calc free T as shown in post 1 is based on TT, SHBG and Albumin. I think it's on the same basis as used in the calculator here - w ww.issam.ch/freetesto.htm
02-01-2009, 04:31 PM
02-01-2009, 04:44 PM
Some more info from the calculator:
Test where TT = 9.0 nmol/L - Free T = 0.206 nmol/L (2.29%) - Bioavailable T = 5.26 nmol/L (58.5%) - 151 ng/dL
Test where TT = 11.7 nmol/L - Free T = 0.249 nmol/L (2.14%) - Bioavailable T = 6.13 nmol/L (52.4%) - 176 ng/dL
These BATs look very low compared to your target range of 460-575...
02-01-2009, 05:09 PM
If you will need injectable T, consider what I do, I use same size, 31Ga 5/16" long needles for both my shots, T & HCG. Very minimal injury using those tiny needles. The "normal" needles are 30-40x larger.
Testosterone: 9.0 nmol/L
from chart FreeT=58
this is very very low
you want to be (250-300)
being "natural" with or without HCG FreeT>160 may be acceptable.
If you are supplementing external T, there is no sense of going for anything less than 250 (unless hematocrit would go up too much).
02-02-2009, 12:57 PM
What I think you're saying is that my 58 pmol/L (5.8nmol/L) from the graph is way below a 250-300 ng/dL range. 58pmol/L comes in at 167 ng/dL.
Using a BAT of 275 ng/dl and based on my bioavailable ration being roughly 54% then my total T should be around 509 ng/dL (17.67 nmol/L). Still seems a bit low mind you...
I was at the docs today and he has referred me - hopefully won't be too long a wait to see the Endo...
02-02-2009, 09:43 PM
02-03-2009, 12:37 AM
Jansz is one of the best posters I ever saw Just thought Id post this..he really goes all out to help others plus he is very knowledgeable.
02-03-2009, 01:39 PM
Thanks again JanSz - that means I would have to have total T of 800-1000 ng/dL (28-35 nmol/L). I wonder if I'll be able to swing those sorts of levels over here on the NHS. They're at the top of their TT range and they might think that one you're up around 600ng/dL that you're sorted!
02-03-2009, 03:22 PM
It is a one number out of many variables.
If possible try to convince your doctor that the real goal is to have proper level of
secondary reason is FreeTestosterone
With FreeTestosterone right away one have a problem, there is about of a half a dozen ways to get FreeT.
That one that you want to get is as figured out by Vermulen, (chart).
You are right, looking at the chart, you need to have (800-1000)
As you TT gets higher your other values may change, SHBG, Albumin, E2
It is a process, even if you get into evrerything right, today, with passing time you may see some changes.
After you get everything that you monitor into about where you want, you still need periodic re-evaluations, blood tests.
02-04-2009, 12:59 PM
I'll take that chart in with me when I get my appt. I agree re the BAT testosterone - the loose binding to Albumin is apparently easily broken so it's reasonably available...
P.S. I wish I could give you more rep points but it the forum won't let me yet!
02-04-2009, 01:55 PM
Before you go to your doc, make a copy of my blood test list, post #44 between blue lines, here:
Jan's BloodTest April13/2007
The more of that list you can get, the more basis you will have for any possible dicussion with you doc or any other doc that you may see in the future.
02-04-2009, 02:51 PM
I will do - I intend to print quite a few things off you take in with me. I have no idea what their attitude will be to T deficiency so I best be prepared!
02-14-2009, 12:26 PM
Got my Endo date through but it's towards the end of March. I thought I would bump up Zinc and Magnesium by using ZMA in the meantime. Been doing it for a few days so far with no effect!
02-14-2009, 09:07 PM
to figure out if you are getting enough zinc.
Zinc Tally is a simple screening method for evaluating zinc status. By placing two teaspoons of Zinc Tally in the mouth, a lack of taste or a delayed taste perception suggests a possible zinc insufficiency. An immediate taste perception suggests zinc status may be adequate. Zinc Tally may also be taken as a supplement.
Read this: (by Charles Poliquin)
02-15-2009, 09:55 AM
It appears you can get something called Zincatest over here that's the equivalent to the Metagenics solution. I'll get some this week and give it a go! I suspect I may be deficient even though I take a multivit each day with 15mg Zinc Oxide.
In the meantime I've been doing a bit more reading on TRT. I was beginning to think that as my LH was low (and my testes do seem to work now and again) I should probably ask for Clomid to start with to see if it would kick start things. If that didn't work then I would try for HCG (subq). The last resort would be test itself. However, I had a look at the documents on AllThingsMale and their line seems not to focus on SERMS (Clomid) or HCG. The internet is wonderful in one way for finding stuff out but it's a double edged sword when there's conflicting advice around! I'm reasonably sure that what I think my plan of attack is correct (I know you would recommend going straight to HCG but I think it may be worth an attempt at getting my LH up).
02-23-2009, 12:48 PM
My Zincatest arrived and I gave it a go. I believe I'm a two on the scale - slight furry dry feeling in the mouth! I'm currently taking 15mg Zinc Oxide in the morning and 30mg of Zinc in ZMA so I'm hoping that will be enough to up the levels!
BTW - one aspect of low test is joint pain. I get stiff knees if I sit down too long (i.e. like at a theatre) and when I'm running up hills I also dull aches. Fine apart from that though. Do these sound like symptoms?
Still over 4 weeks to go to my endo appt unfortunately!
02-23-2009, 03:38 PM
02-25-2009, 05:03 PM
03-17-2009, 12:29 PM
A few further developments prior to my Endo meeting next week. After reading a few of the thyroid posts on here I thought I'd check my basal body temps. I do feel cold/hot quite a lot so there was a point to it. Anyway - I've done three days so far:
15/3 4:58am - 36.03
16/3 5:30am - 36.19
17/3 5:10am - 36.27
This is done with a basal digital thermometer under the tongue for around 5 mins. Hopefully that's reasonably accurate or should I do armpit instead?
Anyway even if the measurements were 0.3 degrees down they would still appear to be low. The last time the doc measured my TSH it was "normal". I have no idea what that figure was though.
03-17-2009, 01:10 PM
Without that is hard to do anything that would make sense.
7 • Iodine, iodide Panel
9 Copper, serum
17 • Iron and Iron Binding Capacity
18 • Iron, Total (571X)
19 • Ferritin
20 • Transferrin
21 • Folate, RBC & Hematocrit
22 • Hemoglobin A1c
23 • Hemoglobin, Plasma
27 T3, Total
28 T4, Total (Thyroxine)
29 T3, Free
31 T3, Reverse
32 Ultrasensitive TSH
33 Thyroid Peroxidase and Thyroglobulin Antibodies
37 IGF Binding protein-3
40 Cortisol Binding Globulin (Transcortin)
41 Cortisol AM/PM
42 DHEA sulfate
03-26-2009, 02:37 PM
I had my appt today. As I expected, nothing much happened! I was seen by a registrar as the Endo wasn't around. She asked loads of questions but made it pretty clear that unless my results were consistently < 10nmol/L on TT then they were unlikely to treat (they weren't too bothered about Calc Free Test either). SHe also couldn't do anything without seeing the Endo.
They've got me coming back in 3 months for another TT test at 9am and to see the Endo (yeah right) two weeks after. Today they decided to do a Short Synacthen Test and measure my ferritin. They also did some vision tests which I suspect have nothing to do with my condition but probably as a control for some study.
So - at least another 3 months of feeling crap. It's no wonder that loads of people in the UK self medicate.
03-26-2009, 03:22 PM
I just remembered something else. I asked her if there was a chance of a short term treatment to see if matters improved. She said they wouldn't normally do that as taking "steroids" (her words) tends to make people feel better whatever their levels are! Eh - OK then - gimme some!
03-26-2009, 05:40 PM
03-27-2009, 03:39 AM
Unfortunately this is what our health service is like. If you fall into a prescribed range of numbers you will not be treated! They're also hard to persuade otherwise as it means spending cash outwith their normal budget. Don't get me wrong, we're very lucky to have a health service in the UK but it doesn't always behave as you'd like! There's also an issue with postcode treatment (i.e zipcode for you guys). This means that someone staying in one region in the UK may be treated differently from another as they have different budget allocations!
03-28-2009, 08:22 AM
One thing I hadn't mentioned before is that I have Gilberts Syndrome. I assumed that this had no bearing on my well being but I'm beginning to change my mind. Apparently I have "normal" TSH and T4 (I'll have to ask the doc for the figures at some point) but I do have a hypothyroid symptoms. I read somewhere that T4 to T3 conversion is done in the liver and it could be that my T3 is low. Now, the NHS won't test my T3 (yet anyway) as my T4 is normal! Unreal. I'm really going to push for them to test T3.
It'll be interesting to see what the results are form my Cortisol test. The one thing that concerns me with the test though is that I read that you're meant to lie down for the test. Not me though - they had me walking about. I hope that doesn't skew the results!
04-25-2009, 04:43 PM
I got my results from my Cortisol ATCH test. They were 221 nmol/L (8 ng/dL) increasing to 640 (23.17) after 30 mins. Apparently normal. They also tested Ferritin which was also normal (I have no figure though), Total Testosterone 9.8 nmol/L (low again) and Oestradiol 59 pmol/L (16.08 ng/dl).
So, I'm left waiting for another Testosterone test in June. I had a shockingly bad bout of depression last week but thankfully it calmed (the doc wanted to put me on Prozac!). I feel OK but quite lethargic. My running's quite poor and I've gained weight around my middle. I'm off to Vegas with work in a couple of weeks so that'll be another few pounds on as well!
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