Testosterone and Pain and Liver issues

[Julian Jude]

Hi, I have been on low dose testosterone cream for about a month and a half. A week and a couple days ago I upped the dose, still relatively low, and immediately got a lot of fatigue and then two days later got a bad pain in my left side, which moved to a mild pain in my right side after twenty four hours, and has since moved to my lung, and my legs. I went to the doctor and she did a urine test, an oxygen test, and a comprehensive blood test. The blood test showed that my liver was slightly elevated, my third elevated liver test, the first two were two to one month before I started testosterone.
Should I be worried? I went but to the very low dose but I don't feel like it is doing much. I have seen no changes except a slight increase in libido. I wonder if I should just go off all together, I am in m forties and don't want to mess with my health.
Other than that I eat really healthy and exercise a lot.

[Tysilio]

Has your doctor checked your testosterone level since you started?  I started on the standard half dose, and mine checked it after a couple of months and found that it was too high, so she actually lowered the dosage. I'm older than you, but I do think we react a bit differently as we age, depending on what our ovaries are up to and such; there's also just a lot of individual variation.

If your level is within the normal range, there's probably no need to change the dosage; there may be other causes for the symptoms you're having. That said, liver function is something to be careful with, so your doc should keep monitoring that.

I wouldn't worry about not seeing changes yet. For most people, they really don't get going until around two or three months. (A lot of the anecdotal reports along the lines of "My voice dropped and I started growing a beard after 3 days!" are based on placebo effects and wishful thinking, I suspect -- there really isn't much support for such immediate changes in the medical literature. )

If you take a look at the table on page 24 in the WPATH Standards of Care, that will give you a better idea of what to expect by way of a timeline.

[Julian Jude]

Thank you. That is good advice, and I actually decided to stay on the same dose for a little while longer while I wait for my testosterone results, which I haven't gotten labs back for yet. I wondered that actually, if there is any way my dose could be too high.

[Felix]

We don't have a whole lot of data for what is normal or good for hormone therapy for transguys. You should go with how you feel and what you need and what works for you and what your doctor wants. It sounds like you are already doing that, and Tysilio's advice is good.

I know people have their own feelings about it but I'm also a fan of WPATH standards and I agree they're good for getting a feel for how to proceed.

[Julian Jude]

Thank you Felix.

[JLT1]

Hi,

Specifically,  what was elevated in your liver test? 

Jen

[Julian Jude]

I don't have it on me because it is online on my patient portal, but elevated liver enzymes on my general blood tests. Like I said, slightly elevated, and have been so since before testosterone. The fatigue has gotten a bit better and the muscle pain as well. I'm still waiting for my testosterone test results.

[Julian Jude]

The doctor wrote me so it was the elevated enzymes but now my biliruben is also elevated. If it doesn't get better soon I will probably go off. Sigh.

[Julian Jude]

I got my testosterone test back and it seems to be in the middle of the male range which is higher than I would expect on low dose cream.

[JLT1]

HI,

Sorry I'm late getting back to you.

There are a number of causes of elevated enzymes and elevated bilirubin.  In general, something is gumming up the liver - pharmaceuticals, alcohol (or other such things, alone or in combination) as well as a few diseases.  A rather odd cause is diet (gluten). Testosterone won't cause these problems although hypothyroidism can be a problem that could be exasperated by T.  Your doctor is probably keeping things slow, waiting for your system to correct itself - which can happen.  However, as time goes on, he needs to start moving faster. 

The good news is that the liver can fix itself far better that any other organ.  If you can get a diagnosis or a cause, you stand a good chance or recovery.

Watch what you eat, drink or take.  Lower the gluten for a while.  Keep on your doctor.

And keep us posted.

Hugs,

Jen