Michigan Phlebotomist and TRT Clinic?

[Tom76]

Hi, I'm in the metro Detroit, MI area and am in need of a phlebotomist. My physician recommended one but from my past experiences I'm uncomfortable having to deal with anyone who isn't familiar with TRT. Does anyone know of a phlebotomist you'd recommend in Michigan? Any other local resources you'd recommend would be great too. I work with Defy and it's been good but have no local contacts for anything.

(Also I know how to find blood donation but my hemoglobin is too high and my blood pressure goes up when I go. So far I haven't been able to be approved for it for one reason or another.)

Thanks, Tom

 

[Tom76]

I did go to the phlebotomist my doctor recommended and it was quite horrible. He specialized in patients with blood cancer and both the nurse that interviewed me as a new patient and the doctor were extremely bothered by the idea I needed a phlebotomy because of my TRT. They treated me with a great deal of attitude and questioned me like I was a criminal. I just had to stay calm and repeatedly tell them I do in fact need TRT and I can't just go off TRT over and over until they gave up and I was just like you gonna prescribe a phlebotomy or what?

They ended up prescribing the phlebotomy which I had to come back for. But they ended up no longer having a phlebotomist on staff when I was due again and continued to be just not too cool with me so I didn't go back. Unfortunately I haven't found another place to go as I've been dealing with other issues too. It's overwhelming the amount of appointments and doctors I need to find for every little thing for all of my conditions.

I looked into Testosterone doctors in the Metro Detroit area again recently but they all seem to be virtual appointments only as I guess they are focused on only TRT diagnosis and selling the medicine subscriptions they offer.

If anyone knows a good all around TRT doctor near Metro Detroit that sees you in person and provides a more complete service, please let me know.

Thank you

 

[t_spacemonkey]

i know red cross doesn't take blood over 20 hemoglobin, but i know places, like in AZ, vitalant which have no upper limit.
you can call around, find somebody who goes higher then 20 and then go back to red cross and do a double donation that way.

 

[Cataceous]

Have you tried any dose adjustments? A lot of guys can improve HCT/HGB by lowering testosterone to be closer to what's normal for their physiology. Are you still on 50 mg TC twice a week? That represents more testosterone than the vast majority of guys make naturally. A combination of additional splitting and lowering of the dose may be helpful. A step beyond that is to reduce testosterone intake even further while preserving the daily peak level. This can be accomplished by switching to daily injections of a cypionate/propionate blend.

In addition, you'd mentioned having primary hypogonadism. If so then you have the means to see where your body wants your testosterone to be. The idea is to tune your testosterone dose until LH and FSH rise to normal levels. Bear in mind that lowering the dose frequently causes symptoms of low testosterone, but these usually recede over a few weeks. Patience is important.

 

[Tom76]

Have you tried any dose adjustments? A lot of guys can improve HCT/HBG by lowering testosterone to be closer to what's normal for their physiology. Are you still on 50 mg TC twice a week? That represents more testosterone than the vast majority of guys make naturally. A combination of additional splitting and lowering of the dose may be helpful. A step beyond that is to reduce testosterone intake even further while preserving the daily peak level. This can be accomplished by switching to daily injections of a cypionate/propionate blend.

In addition, you'd mentioned having primary hypogonadism. If so then you have the means to see where your body wants your testosterone to be. The idea is to tune your testosterone dose until LH and FSH rise to normal levels. Bear in mind that lowering the dose frequently causes symptoms of low testosterone, but these usually recede over a few weeks. Patience is important.

Thank you, that's some interesting food for thought. I've never heard of the tuning to normal LH and FSH levels I wouldn't of thought that possible. I'm on 56mg eod subq shots. But in the past when I tried to go lower it didn't go well.

I also found when my dose was raised my hemacrit and hemoglobin levels didn't go up. They initially went up when I switched from gels to shots. But didn't get worse as my dose was raised. They just hang out a little high whatever dose I take. But I haven't changed my dose or experimented in a long time.

Maybe I'll experiment with a lower dose or daily shots.

 

[Cataceous]

You're injecting 196 mg of TC a week. That's approaching double the top end of normal testosterone production, and is about triple the production of average healthy young men. It's not remotely physiological. I assume HCT and HGB didn't rise with higher dosing because you'd already passed the saturation point with respect to effects on hepcidin.

What part of lower dosing didn't go well? When your body is accustomed to excess it can be uncomfortable to return to the physiological, but it's worth the effort.

If your absorption rate is typical then there's probably not going to be much benefit in increasing the dose frequency from EOD to daily, at least with a long-acting ester such as cypionate. On the other hand, a propionate blend should be injected daily, because it then creates a diurnal rhythm, somewhat mimicking natural variation in serum testosterone. The hypothesis is that some of the benefits of testosterone come from peak levels, whereas the side effects may be more correlated with trough or average levels.

You may not view it as realistic, but ideally you should spend a few months at 20 mg TC EOD to see what normal levels are really like. You can get there either via a slow taper or by going cold turkey. A sudden drop may be more traumatic, but a slow taper may also play with your mind, leaving you tempted to blame every problem on the slowly falling levels.

I've come across at least two guys with primary hypogonadism who successfully tuned their TRT doses to normalize their LH and FSH. There may be some independent benefits in having in-range LH.

For encouragement, here's my list of anecdotes from guys who found that lower is better:

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