Is My Testosterone Count Too Low?

[kinggg]

Kinggg, I am on TRT. Yes. My dose is 1cc every 2 weeks. It started at 2cc 1 time a month.

I must say it has helped me.

Hi cajun,

Appreciate the reply. Just wanted to be clear on a few things.

1) I assume youre on the cheaper short term T injections. Have you tried the expensive long term T injections? If so which do you prefer for increased libido?

2) Do your T injections elevate libido to a great satisfying extent?

3) How much do you pay are your injections?

.

[Simbarn]

I inject twice weekly, I do it myself and have done this for years. This maintains a much better peak and trough, which also helps stop testosterone being converted into excessive amounts of estrogen.

Are you saying that short term T injections are better than the more expensive long term T injections? What i mean by 'better' is does it produce more libido than the long term T injections? Does it also achieve libido faster?

Yes, short term always better. No longer than a week. The long term injections are to be avoided for many reasons. I explained this in another thread recently. Do a search.

[Cajun Jeff]

Kinggg: my bottle of T last 5 months. The price has jumped recently. It was $55. Now it’s $85. Still not bad fir 5 months. My insurance does not cover it.

[Simbarn]

Kinggg: my bottle of T last 5 months. The price has jumped recently. It was $55. Now it’s $85. Still not bad fir 5 months. My insurance does not cover it.

You are doing very well at those prices. Out of interest how many mgs per 1cc is it in your preparation? Enanthate or Cypionate?

[Cajun Jeff]

The vile is 2000 mg/10ml

I inject 1ml evert 2 weeks.

It is Testosterone Cypionate

Hope that helps. This time insurance covered it. I paid $25

[kinggg]

The vile is 2000 mg/10ml

I inject 1ml evert 2 weeks.

It is Testosterone Cypionate

Hope that helps. This time insurance covered it. I paid $25

Hi cajun,

So the injections are $85 and you only copay $25 is very good! Will ask my uro about this. Only concern is my T count of 337 which I'm hoping is low enough for him to consider scripting me short term T. Other than low libido, I'm not feeling myself, feel weakness all over my body especially leg muscles, have sleep issues, depression and very low confidence to do things in life.

[Cajun Jeff]

Do let us know what the Dr says. Mine was a bit lower.

[stephen54]

Hi guys.. My libido is at an all time low. I'm presently 50 and need your help. My testosterone count is 337. Do you think this is considered too low and if so is it low enough to get on TRT?

Understand that 337 is literally just a number, and that the "normal" ranges you see on lab reports are just reference ranges. Labs and physicians need something to point to at least directionally, and something, even if mostly anecdotal, to reference to say this guy is borderline low, or about normal vs the population overall, or he's high. None of any of that speaks to your individual particular situation or experience or health. It's just a guideline, and with testosterone it's an extremely wide, messy and variable guideline.

My lab's reference range states that a "normal" testosterone level is 255 - 1083. What the hell sense does that even make? 1083, their stated high end of "normal", is more than 400% higher than their stated "low" end of normal. That's not how cholesterol works, or blood sugars, or insulin levels, or hematocrit/hemoglobin, etc etc. That sloppy wide range is of virtually no help in a practical sense.

All of this speaks to the variability in individuals. If you're having some deep conversation with your physician about the nuances and differences of a 337 testosterone vs a 289 testosterone vs a 550 testosterone...respectfully, I think you're having the wrong discussion and your physician is entirely missing the bigger picture. The issue really should be - are you symptomatic for low testosterone? Or are you not? Are you experiencing very low sex drive/libido, erectile changes, hair loss, fatigue, loss of muscle mass, mental acuity/sharpness, anemias...? Multiples of those?

Physicians should be treating testosterone to address demonstrated symptoms - not to congratulate themselves for staying within a sort of comically broad reference range if the symptoms are not improved. That doesn't mean that there isn't importance to being wary of dosing too high to where blood levels put you at demonstrable risk for cardiovascular problems (clots etc).

My testosterone was 280 something when I was in my early 40s. It kept steadily falling (on average we lost 1% of our native testosterone production per year after we turn 30). My libido never suffered in the least, it's always been ferocious. My libido was still on overload when I turned 50 and my testosterone was only 88. So on the issue of libido alone, no right-thinking physician would or should have prescribed testosterone for me. Even on just the issue of libido, they should be digging in and evaluating the psycho-social contributors to libido, too.

My doc dug down, asked questions about energy levels, fatigue, mental acuity, and he also measured body fat/muscle mass etc. Put me on Testopel (the sub-dermal testosterone pellets they put under your butt cheek). I never got much of an increase, only up into the 200s, even with 12 pellets in me. Moved to self-injecting 200mg of testosterone cypionate every 14 days. Bam. Issues of fatigue and body/mass started to change quite quickly, over just a couple months, very measurable. So I was fortunate to identify an obvious causal relationship between increased T levels and symptoms. We tweaked my dosing after watching how my body was reacting. Now I'm on 200mg every 10 days. My blood levels on day 0, my inject day, are typically in the low 100s. On day 5 after injecting (at "peak plasma") my levels are around 1,000-1,100.

Injecting definitely isn't the ideal mimic to how your body naturally produces and distributes testosterone (at predictable, mostly fairly constant levels of production and distribution). Upon injecting, you will get a very rapid rise in circulating testosterone levels over the first couple days, and then a flattening and a quite quick fall off of levels out at days 7-10. There's a fairly wild rollercoaster effect to your blood levels when you dose intramuscularly. For that reason, I'd much rather be on pellets or another modality which releases the testosterone in a more controlled, more physiologically-mimicking way, but my body just doesn't seem to want to absorb the testosterone from those other routes, so I stuck with injections.

Way more of an answer than I think you were seeking...sorry for the long note...but hopefully something in there is of help.

[kinggg]

Understand that 337 is literally just a number, and that the "normal" ranges you see on lab reports are just reference ranges. Labs and physicians need something to point to at least directionally, and something, even if mostly anecdotal, to reference to say this guy is borderline low, or about normal vs the population overall, or he's high. None of any of that speaks to your individual particular situation or experience or health. It's just a guideline, and with testosterone it's an extremely wide, messy and variable guideline.

If you're having some deep conversation with your physician about the nuances and differences of a 337 testosterone vs a 289 testosterone vs a 550 testosterone...respectfully, I think you're having the wrong discussion and your physician is entirely missing the bigger picture. The issue really should be - are you symptomatic for low testosterone? Or are you not? Are you experiencing very low sex drive/libido, erectile changes, hair loss, fatigue, loss of muscle mass, mental acuity/sharpness, anemias...?

Hi stephen,

You know, I couldnt agree with you more on that point. Interestingly enough, the new uro (who's an asshole btw) told me on day 1 of seeing him at the clinic that he "knows everything about ED." When I mentioned PT141, he drew a blank stare and uttered, "whats that?" Lol. What an idiot.

All the classic symptoms of low T I'm experiencing currently despite my T count of 337. Btw my Folicle Stimulatin Hormone count is 2.6. I dont know what that is exactly, maybe you can tell me what thats for? Do you think its too low?

My doc dug down, asked questions about energy levels, fatigue, mental acuity, and he also measured body fat/muscle mass etc. Put me on Testopel (the sub-dermal testosterone pellets they put under your butt cheek). I never got much of an increase, only up into the 200s, even with 12 pellets in me. Moved to self-injecting 200mg of testosterone cypionate every 14 days. Bam. Issues of fatigue and body/mass started to change quite quickly, over just a couple months, very measurable.

This is the type of convo my uro should be having with me.

A past uro of mine scripted me androgel which takes many weeks before it taking any effect. But I became scared to take it because I read about its nasty side effect of hair loss. This is why I'm thinking of taking short term injections. Do you think those cause hair loss? Have you yourself experienced any hair loss?

.

[stephen54]

All the classic symptoms of low T I'm experiencing currently despite my T count of 337. Btw my Folicle Stimulatin Hormone count is 2.6. I don't know what that is exactly, maybe you can tell me what thats for? Do you think its too low?

Believe it or not, before I got into the medical device industry I worked in clinical marketing in pharma for a company which sold a testosterone replacement. So a lot of this is stuck still in my brain. If you're frankly symptomatic at 337 then you just need to find someone to listen to you, forge on and supplement your testosterone, but do it in a step-wise, controlled manner...the goal being, get you to the lowest dose of testosterone supplementation necessary which sufficiently alleviates your demonstrated symptoms. If you're not being taken seriously about your symptoms, then move on to another doc.

Maybe your symptom-free peak TRT # will be 500 and maybe it will be 900 or 1,000. You just need to identify a doc who is not blowing smoke about their knowledge and capabilities on such things. It might not be your urologist who should be managing this, you might in fact want to seek out a competent endocrinologist who you find you have a good rapport with, one who is curious, one who listens, and one who is patient in seeing this through with you. I've had physicians who didn't even have a basic understanding of the inevitable natural declines in native T production as men age:

testosterone2.jpg (27.8 KiB) Viewed 1522 times

So I've decided to juggle my TRT puzzle and my historic ED with two different docs, one from each specialty. They talk to one another and we've found a good rhythm. My uro got a little uncomfortable with the testosterone peak levels I was showing in the early part toward middle of my 10 day injection cycle (upwards of 1,100) but my endo was able to be part of that discussion and things are working out well now.

Part of their comfort level revolved around my submitting to some other recurring lab testing to monitor, chiefly, the TRT impact on my blood; ie, higher levels of testosterone are associated with increased hematocrit/hemoglobin (higher red blood cell production/counts) and higher blood viscosity ("thicker" blood, for lack of a better way to say it, ie blood demonstrating less resistance to flow, never, ever a good thing) and higher platelet adhesion (you don't want highly adhesive platelets or platelet aggregation...that's how you end up with thromboembolic events ie clots). So the responsible physician is going to want to closely monitor such things as your max T #'s edge higher. Don't fight that.

As relates to FSH...ok,remember, I'm not a clinician/physician here, just a guy who's spent his life working in the drug/device side of human medicine, so please don't take the following as gospel...it's just my accumulated knowledge of the basics...please validate with an engaged, competent clinician...

But at 2.6 you're probably within a "normal" reference range there, too, but on the low end. FSH helps regulate reproduction in both genders and it's relationships with other hormones and tissues is complex. It acts on the testes, it spurs sperm production, it affects and influences general growth processes, puberty, maturation. Chronically low levels of FSH in men can be linked with pituitary and hypothalamic disorders. Insufficient testosterone may then be produced resulting in underdeveloped testicles, lowered sperm count, and of course all the other symptoms of low T already mentioned here. Either the pituitary or hypothalamus may be the culprit.

So with very low FSH, big big picture, worst case, and unlikely, but certainly possible scenario...there may be a tumor present in either the pituitary or hypothalamic gland which can be identified with a radiological examination. If FSH is trending very low over time a competent clinician will seek to rule out the bad stuff. A combination of CT scan and evaluation of prolactin serum levels would help with tumor diagnosis. If there is no tumor present, hypogonadism can then be treated with testosterone replacement therapy.

A past uro of mine scripted me androgel which takes many weeks before it taking any effect. But I became scared to take it because I read about its nasty side effect of hair loss. This is why I'm thinking of taking short term injections. Do you think those cause hair loss? Have you yourself experienced any hair loss?

Any TRT can potentially impact hair loss. I don't know. I've been on TRT a long time and at pretty high levels to alleviate my symptoms and my hair after 10 years or so is utterly unchanged. I'm blessed with a full head of thick hair at 55 years old. Good hair DNA I guess.

You mention Androgel and time-to-effect. You're talking about "pharmacokinetics", the process by which a drug is absorbed, distributed, metabolized, and eliminated by the body. All those dynamics vary by 1) specific drug taken, 2) route of administration ie oral, transdermal, intramuscular, IV, and 3) your specific body make up, age, base metabolism, gender, other conditions, and on and on. Pharmacokinetics can be visually depicted with graphs pretty effectively to paint a picture of how a drug, generally, will behave after administration. For sure, the transdermal testosterone gels are slower to absorb into your system...they tend to have lower peak levels but more prolonged/elongated effects, and at typically lower total levels in your body over time. In a sense, if you are administering gels daily, you are more closely mimicking your body's natural process of testosterone production. A more even, flatter level over time with less up and down variability.

Intramuscular/injecting is a really different graph:

Testosterone.jpg (47.23 KiB) Viewed 1522 times

Here you can see the relative absorption and distribution rates of testosterone in your body, over time, gel vs injection. That big bolus spike of levels over the first 1-3 days is, with injecting, unavoidable. The drug is more directly systemically available more quickly. Just how it is. It's beyond my knowledge to say which is "better" or preferred etc etc. They're just different. It makes sense to me logically that if you can mimic a natural bodily function closely, then you should. I tried with gels. I just couldn't get the levels I needed to alleviate symptoms unless I was rubbing gel on my shoulder in massive amounts and at short intervals. For me I just find the needle easier.

Sorry to ramble on here. Again, hope something in here was of some benefit.