new from chicago illinois

Good morning,

had my annual physical examination last week, and during the physical examination my doctor discovered that my left testicle is much smaller and much softer than the right one, in fact he had a very difficult time locating it. he then said he wanted to do blood tests to check for the amount of testosterone. the results came back that my total testosterone was 237 at 9:40 am. he had me come back, he explained the lab tests and the total testosterone was the only result that was abnormal. he reexamined my testicles with the same findings and then said he wants to start me with androgel. also did a prostate exam and said my prostate is very small and dosnt find any problems with it. picking up my prescription this afternoon. he suggested applying it at night before bed. wondering how long it will take to raise the total testosterone levels back to normal since I am only 40

How long it will take is hard to say, everyone responds a little differently. Here are a few factors to keep in mind:

1. Your testosterone levels will go up quickly but that does not mean you're symptoms will go away at the same time.

2. For most men, it takes 8-12wks of treatment for the benefits of TRT to really show, and that's assuming they are on the right protocol. It can take up to a full year for the full benefits of TRT to be reached. At that point it's simply about maintaining the benefits. If you truly have low testosterone, remedy the problem and then stop treatment, you will just go back to having low testosterone.

3. Androgel - approximately 20% of all men will not respond to transdermal testosterones, meaning levels will not go up. Of those that it does work, what is often referred to as transdermal fatigue is not uncommon. What this means is the gel or cream doesn't work as well any more and requires larger and larger doses. Does this happen every time? No, but it's something to keep an eye on. This is not a problem that can exist with injectable testosterone.

4. Make sure your blood work is including both Total and Free testosterone. Some physicians only check the total, but the Free is what is actually usable. As low as your total is your free is probably low too since free is a portion of the total, but when you check your followup blood work you need to know where your free is.

5. Make sure all followup blood work includes a CBC panel (hematocrit, RBC's, etc.) - if these numbers get too high you will either have to discontinue treatment or consider periodic therapeutic phlebotomy.

6. Make sure all followup blood work includes an estradiol panel, preferably Estradiol Sensitive. Testosterone can raise E2, which can lead to side effects. Equally, E2 that is too low can lead to problems. One of the key factors many people miss with TRT is the importance of balancing testosterone and estradiol.

I hope this information helps. Feel free to ask any other questions you might have.

really never gave too much thought to having any symptoms...outside of having an annoying ache in my testicles. usually quite tired at the end of a 12-15 hour day but thought that was kinda normal. so 237 is quite low I take it then? what should it be for someone my age?

Optimal testosterone is going to be over 500 ng/dl for Total Testosterone and over 15 pg/ml for Free Testosterone on the LabCorp scale for any adult male regardless of age. Most men will find they feel best in the 700-1100 & 20-30 ranges. That's not to say that's where you need to be. Where a man needs to be is the point in which he has no symptoms of low testosterone and has no health issues related to treatment. Where this is can vary greatly from one man to the next.

It doesn't sound like you have a lot of symptoms, which is an important factor if you are to receive treatment. You must have symptoms and low levels. Being tired after a 12-15hr day, well I think anyone would be tired even if on treatment. One of the more curious questions I hear almost daily from TRT patients is asking why they still feel tired at the end of the day. The answer to that is you're still a human being - testosterone isn't something that changes this. But yes, 237 is low and prolonged low levels can lead to more symptoms and even health complications long term but again, to receive any form of treatment you'd need to have symptoms.

had a evaluation with a urologist toay, he feels the same as my primary doctor, that the let testicle is considerably atrophied and is not functioning or functioning extremely slightly. said that he thinks my primary doctor is on the right path with starting androgel at first.